NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 9 Forum
Diagnosing Neurological Disorders
As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.
For this Discussion, consider the following three case studies of patients presenting with neurological disorders.
Case Study 1
80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.
PMH: HTN, controlled
Prostate cancer 20 years ago
Dyslipidemia
SH: no alcohol or tobacco use; needs assistance with medications
PE: VS stable, physical exam unremarkable
Case Study 2
A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.
Case Study 3
A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia
PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.
To Prepare:
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 7 Forum
Urinary Frequency
Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Discussion, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Case Study 1
A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.
Case Study 2
This is a 40 year old Hindu married male complaining of sudden high grade fever for the last 2 days. He is complaining of right flank pain with some burning on urination.  PMH: diabetes, HTN. Current meds: metformin 500mg bid, Lisinopril 10mg QD
Case Study 3
A 52 year old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s loss at least “10 pounds”. For the past week and a half she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20 year history of Crohn’s disease. She also tells you that she is a practicing vegan.
To prepare:
Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Discussion.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient.
Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
Think about potential treatment options for the patient.

NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 2 Forum
Diagnosing Integumentary Disorders
When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Forum, consider the following three case studies of patients presenting with integumentary disorders.
Case Study 1
A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.
Picture of a hand that is covered in a pruritic skin rash between the fingers, which covers the wrist. The rash does not uniformly cover the hand and is scaly in some areas.
Case Study 2
K.B., a 52 year old Irish American patient who present today complaining of “a mole” on the skin that is changing colors. He said he has had this ‘mole’ for almost two years. K.B. is a construction worker currently residing in Hawaii. As a teen he worked outside and visited the tanning bed several times a month. He is a worried that this “mole” doesn’t look like the others on his body.
On your examination, you note, the lesion as round, dark colored in appearance, and scaly. You also note the mole has an irregular border and about 0.2cm in size.
Depicted on the skin are four moles. In the center is a large mole that is dark colored in appearance, with an uneven colored tone, appears scaly, and has an irregular border. The other three moles depicted appear normal in appearance.
Case Study 3
J.V. 50 year old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%.
She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions.
Patient presents with lesions on the right side of her face and neck. The lesions are red in appearance and vary in size. They appear scaly and do not uniformly cover the entire region of her face or neck.
To prepare:
Review Part 5 of the Buttaro et al. text and the case studies provided
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.
Note: For this Forum, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Forum Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 3 Forum
Diagnosing HEENT Disorders
In clinical settings, advanced practice nurses may initiate a physical examination of a patient by examining the components of the HEENT system. Assessing primary diagnoses and differential diagnoses as they concern the HEENT system are important in informing your practice in providing optimal care.
For this Discussion, consider the following three case studies of patients presenting with head, eyes, ears, nose, and throat disorders.
Case Study 1
An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily. The physical examination reveals a frail older female with some facial dryness and slight scaling. Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation.
Case Study 2
A middle-aged male presents to the office complaining of a two-day history of a left earache. The onset was gradual, but has steadily been increasing. It has been constantly aching since last night, and his hearing seems diminished to him. Today he thinks the left side of his face may even be swollen. He denies upper respiratory infection, known fever, or chills. His patient medical history is positive for Type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient has a known allergy to Amoxicillin that results in pruritus. Medications currently prescribed include Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81 milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam reveals a middle aged male at a weight of 160 pounds, height of 5’8”, temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of 18, and blood pressure of 138/76. Further examination reveals the following:
Face: Faint asymmetry with left periauricular area slightly edematous
Eyes: sclera clear, conj wnl
L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible
R ear: no tenderness, R external auditory canal clear without edema, erythema, exudates
+ tenderness L preauricular node, otherwise no lymphadenopathy
Cardiac: S1 S2 regular. No S3 S4 or murmur.
Lungs: CTA w/o rales, wheezes, or rhonchi.
Case Study 3
A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.
To prepare:
Review the case studies provided in this week’s Resources.
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 10 Forum
Examining Endocrine, Metabolic, and Hematologic Disorders
In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.
For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.
Case Study 1
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Case Study 3
V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.
To prepare:
Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Discussion.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient.
Think about potential treatment options for the patient.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 2 Forum
Diagnosing Integumentary Disorders
When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Forum, consider the following three case studies of patients presenting with integumentary disorders.
Case Study 1
A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.
Picture of a hand that is covered in a pruritic skin rash between the fingers, which covers the wrist. The rash does not uniformly cover the hand and is scaly in some areas.
Case Study 2
K.B., a 52 year old Irish American patient who present today complaining of “a mole” on the skin that is changing colors. He said he has had this ‘mole’ for almost two years. K.B. is a construction worker currently residing in Hawaii. As a teen he worked outside and visited the tanning bed several times a month. He is a worried that this “mole” doesn’t look like the others on his body.
On your examination, you note, the lesion as round, dark colored in appearance, and scaly. You also note the mole has an irregular border and about 0.2cm in size.
Depicted on the skin are four moles. In the center is a large mole that is dark colored in appearance, with an uneven colored tone, appears scaly, and has an irregular border. The other three moles depicted appear normal in appearance.
Case Study 3
J.V. 50 year old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%.
She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions.
Patient presents with lesions on the right side of her face and neck. The lesions are red in appearance and vary in size. They appear scaly and do not uniformly cover the entire region of her face or neck.
To prepare:
Review Part 5 of the Buttaro et al. text and the case studies provided
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.
Note: For this Forum, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Forum Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life Span
Week 3 Forum
Diagnosing HEENT Disorders
In clinical settings, advanced practice nurses may initiate a physical examination of a patient by examining the components of the HEENT system. Assessing primary diagnoses and differential diagnoses as they concern the HEENT system are important in informing your practice in providing optimal care.
For this Forum, consider the following three case studies of patients presenting with head, eyes, ears, nose, and throat disorders.
Case Study 1
An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily. The physical examination reveals a frail older female with some facial dryness and slight scaling. Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation.
Case Study 2
A middle-aged male presents to the office complaining of a two-day history of a left earache. The onset was gradual, but has steadily been increasing. It has been constantly aching since last night, and his hearing seems diminished to him. Today he thinks the left side of his face may even be swollen. He denies upper respiratory infection, known fever, or chills. His patient medical history is positive for Type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient has a known allergy to Amoxicillin that results in pruritus. Medications currently prescribed include Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81 milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam reveals a middle aged male at a weight of 160 pounds, height of 5’8”, temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of 18, and blood pressure of 138/76. Further examination reveals the following:
Face: Faint asymmetry with left periauricular area slightly edematous
Eyes: sclera clear, conj wnl
L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible
R ear: no tenderness, R external auditory canal clear without edema, erythema, exudates
+ tenderness L preauricular node, otherwise no lymphadenopathy
Cardiac: S1 S2 regular. No S3 S4 or murmur.
Lungs: CTA w/o rales, wheezes, or rhonchi.
Case Study 3
A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.
To prepare:
Review the case studies provided in this week’s Resources.
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life Span
Week 5 Forum
Examining Chest X-Rays
Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Forum, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.
Consider the three patient case studies and x-rays
Note: By Day 1 of this week, your Instructor will assign you to post on one of these patient case studies and x-rays:
Case Study 1
35-year-old Asian male presents to your clinic complaining of productive cough for two weeks. Stated he has had mild intermittent fever with myalgia, malaise and occasional nausea.
SH: works as a law clerk
PE: NP noted low grade fever (99 degrees), with very mild wheezing and scattered rhonchi.
An x-ray film is presented which shows a cloudy lung that appears slightly distended.
Case Study 2
This is a 44-year-old Caucasian male being seen at your clinics with complaints of complaints of cough for 4 days and worsening. Stated he has had high grade fever. States he feels weak and has been in bed most of the last two days. Complains of exertional dyspnea, followed by dyspnea at rest, non-productive cough and pleuritic chest pain
MEDS: Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, filgrastin
PMH: HTN, Hep C, HIV/AIDS, thrush
SH: Past IV Drug abuse; lives in a group home;
PE: VS: Ht: 5’7, Wt: 150#, BMI 23,
Anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi. You note decreased in breath sounds, dullness, and egophony
An x-ray film is presented which shows petechial markings on the lungs and which are cloudy in appearance.
Case Study 3
A 50 year old Caucasian female presents to the clinic with complaints of cough for almost 2 weeks. Positive productive green sputum with associated chills, sweating, and fever up to 101.5. She manages a daycare and states that many of the children have had upper respiratory symptoms in the last two weeks. PMH: DM diagnosed 7 years ago, controlled on medications.
MEDS: Glyburide 10mg qd
PE: She looks ill with continuous coughing and chills.
BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.
Lungs: +Crackles, increased fremitus
Labs: CBC 17,000 cells/mm3 , blood sugar is 120
An x-ray film is presented which shows cloudiness on the lungs and which also shows some scarring on the lungs.
To prepare:
Review Part 10 of the Buttaro et al. text in this week’s Resources, as well as the provided x-rays.
Reflect on what you see in the x-ray assigned to you by the Course Instructor.
Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.

NURS6531 Advanced Practice Care of Adults Across the Life Span
Week 7 Forum
Urinary Frequency
Urinary frequency is a genitourinary disorder that presents problems for adults across the lifespan. It can be the result of various systemic disorders such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these disorders have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks. In this Forum, you examine a case study of a patient presenting with urinary frequency. Based on the provided patient information, how would you diagnose and treat the patient?
Case Study 1
A 52-year-old African American male presents to an urgent care center complaining of urinary frequency and nocturia. The symptoms have been present for several months and have increased in frequency over the past week. He has been unable to sleep because of the need to urinate at least hourly all day and night. He does not have a primary care provider and has not seen a doctor in more than 10 years. His father died when he was a child in an automobile accident, and his mother is 79 years old and has hypertension. The patient has no siblings. His social history includes the following: banker by profession, divorced father of two grown children, non-smoker, and occasionally consumes alcohol on weekends only.
Case Study 2
This is a 40 year old Hindu married male complaining of sudden high grade fever for the last 2 days. He is complaining of right flank pain with some burning on urination.  PMH: diabetes, HTN. Current meds: metformin 500mg bid, Lisinopril 10mg QD
Case Study 3
A 52 year old woman presented to the clinic for ongoing fatigue and weight loss during the last 6 weeks. She thinks she’s loss at least “10 pounds”. For the past week and a half she’s noted some progressing ‘muscle cramping’ tetany, as well as ‘tingling’ sensation around her mouth and lower extremities. She’s also noted some intermittent colicky abdominal pain. On your exam, you noted a positive Chvostek’s sign. PMH: 20 year history of Crohn’s disease. She also tells you that she is a practicing vegan.
To prepare:
Review Part 13 and 17 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Forum.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient.
Review the Marroquin article in this week’s Resources. If you suspect prostate cancer, consider whether or not you would recommend a biopsy.
Think about potential treatment options for the patient.

NURS6531 Advanced Practice Care of Adults Across the Life Span
Week 9 Forum
Diagnosing Neurological Disorders
As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.
For this Forum, consider the following three case studies of patients presenting with neurological disorders.
Case Study 1
80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.
PMH: HTN, controlled
Prostate cancer 20 years ago
Dyslipidemia
SH: no alcohol or tobacco use; needs assistance with medications
PE: VS stable, physical exam unremarkable
Case Study 2
A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.
Case Study 3
A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia
PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.
To Prepare:
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.

NURS6531 Advanced Practice Care of Adults Across the Life Span
Week 10 Forum  
Examining Endocrine, Metabolic, and Hematologic Disorders
In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Forum, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.
For this Forum, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders.
Case Study 1
An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:
Eyes: + pallor conjunctiva
Cardiac: irregular rhythm. No S3 S4 or M. NO JVD
Lungs: CTA w/o rales, wheezes, or rhonchi
Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding
Rectal: no stool in rectal vault
Case Study 2
A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal.
Case Study 3
V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.
To prepare:
Review Part 17 and 21 of the Buttaro et al. text in this week’s Resources.
You will either select or be assigned to a patient case study for this Forum.
Review the patient case study and reflect on the information provided about the patient.
Think about the personal, medical, and family history you need to obtain from the patient in the case study. Reflect on what questions you might ask during an evaluation.
Consider types of physical exams and diagnostics that might be appropriate for evaluation of the patient in the study.
Reflect on a possible diagnosis for the patient.
Think about potential treatment options for the patient.

NURS6501 Advanced Pathophysiology
Week 4 Quiz 
Question 1When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
Question 2A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the:
Question 3A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by:
Question 4Which of the following patients is at highest risk for developing pulmonary embolism (PE)?
Question 5A 60-year-old male undergoes surgery for a bone fracture. Which of the following nursing measures would be most effective for preventing pulmonary embolism (PE) in this patient?
Question 6A 65-year-old male is transported to the ER for chest pain. An electrocardiogram reveals a prolonged QRS interval. What is the nurse monitoring when the nurse observes the QRS complex on the electrocardiogram? The QRS complex reflects:
Question 7Which organ should the nurse monitor closely since it is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)?
Question 8While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head.
Question 9A 50-year-old male is diagnosed with pulmonary embolism (PE). Which of the following symptoms most likely occurred before treatment?
Question 10Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension.
Question 11A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause:
Question 12A 50-year-old female received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage?
Question 13A 60-year-old male is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located?
Question 14A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid?
Question 15A 56-year-old male is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change?
Question 16A 70-year-old female is in the hospital for pelvic fracture. She develops pulmonary thromboembolism. The nurse realizes this embolus is composed of:
Question 17When a patient has a massive pulmonary embolism (PE), what complications will the nurse monitor for?
Question 18An 80-year-old female is in the hospital for a bone fracture. While there she develops a large, nonlethal pulmonary embolus. Which of the following is a direct result of the obstruction to pulmonary blood flow?
Question 19A 62-year-old male presents to his primary care provider reporting chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina?
Question 20What term should the nurse document for a detached blood clot?
Question 21A 5-year-old female is found to have hypertension during three separate visits to her primary care provider. The nurse would expect tests to suggest that the hypertension is secondary to:
Question 22Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses:
Question 23A 65-year-old female presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the:
Question 24A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis?
Question 25A 54-year-old male is diagnosed with left bundle branch block. Which of the following structures would not receive an electrical impulse?
Question 26A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient?
Question 27A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is:
Question 28Which of the following findings in the patient with Raynaud disease would indicate a need for further teaching?
Question 29A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation?
Question 30A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by:
Question 31Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunction?

NURS6501 Advanced Pathophysiology
Week 2 Quiz 
Question 1When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?
Question 2A 35-year-old male is diagnosed with lobar pneumonia (lung infection). Which of the following exudates would be present in highest concentration at the site of this advanced inflammatory response?
Question 3A 5-month-old child is admitted to the hospital with recurring respiratory infections. A possible cause of this condition is:
Question 4A 10-year-old male is stung by a bee while playing in the yard. He begins itching and develops pain, swelling, redness, and respiratory difficulties. He is suffering from:
Question 5Which of the following patients would be at greatest risk for basal cell carcinoma?
Question 6A child fell off the swing and scraped the right knee. The injured area becomes painful. What else will the nurse observe upon assessment?
Question 7Exhaustion occurs if stress continues and _____ is not successful.
Question 8A 30-year-old female is diagnosed with cancer. Testing reveals that the cancer cells have spread to local lymph nodes. A nurse realizes this cancer would be documented as stage:
Question 9A 65-year-old female is diagnosed with metastatic breast cancer. She has developed muscle wasting. Which of the following substances would be produced in large quantities to eliminate the tumor cells and cause muscle wasting?
Question 10A 30-year-old female presents to her primary care provider reporting fatigue, excessive sweating, and increased appetite. Physical examination reveals protruding eyes, and laboratory testing reveals hyperthyroidism secondary to autoantibody production. This disorder falls into the category of type _____ hypersensitivity.
Question 11During inflammation, the liver is stimulated to release plasma proteins, collectively known as:
Question 12When a patient asks the nurse what hypersensitivity is, how should the nurse respond? Hypersensitivity is best defined as:
Question 13An infant develops a fever secondary to a bacterial infection. Which of the following most likely triggered the fever?
Question 14A 20-year-old male shoots his hand with a nail gun while replacing roofing shingles. Which of the following cell types would be the first to aid in killing bacteria to prevent infection in his hand?
Question 15A 30-year-old male is having difficulty breathing and has been spitting blood. He reports that he began experiencing this reaction after cleaning his pigeons’ cages. Testing reveals he is suffering from allergic alveolitis. Which of the following is he experiencing?
Question 16When a patient presents at the emergency department for an allergic reaction, the nurse recognizes the most severe consequence of a type I hypersensitivity reaction is:
Question 17A patient has a tissue growth that was diagnosed as cancer. Which of the following terms best describes this growth?
Question 18A 3-year-old is making play cakes in a sandbox and is eating the play cakes. The sand was also being used by cats as a litter box and was contaminated with toxoplasmosis. Which of the following would most likely also be present?
Question 19When histamine is released in the body, which of the following responses would the nurse expect?
Question 20While planning care, a nurse recalls seasonal allergic rhinitis is expressed through:
Question 21A 10-year-old male presents to his primary care provider reporting wheezing and difficulty breathing. History reveals that both of the child’s parents suffer from allergies. Which of the following terms would be used to classify the child?
Question 22A nurse recalls an example of an immune-complex-mediated disease is:
Question 23A 45-year-old male presents with persistent, severe stomach pain. Testing reveals a peptic ulcer. Further laboratory tests reveal the presence of Helicobacter pylori. Which of the following is of concern for this patient?
Question 24While planning care for children with cancer, which information should the nurse remember? Most childhood cancers originate from the:
Question 25Which of the following individuals would be at greatest risk for an opportunistic infection?
Question 26Which of the following hormones activates adrenergic receptors?
Question 27A 70-year-old female with osteoporosis fractures her leg at a location of preexisting abnormality. She reports that the fracture occurred following a minor fall. Which of the following best describes the fracture?
Question 28A 30-year-old female complains of fatigue, arthritis, rash, and changes in urine color. Laboratory testing reveals anemia, lymphopenia, and kidney inflammation. Assuming a diagnosis of SLE, which of the following is also likely to be present?
Question 29A 20-year-old female presents with vaginal itch and thin-walled pustular lesions. She is diagnosed with candidiasis. This condition is caused by a:
Question 30A 54-year-old male was recently diagnosed with rheumatoid arthritis (RA). Which of the following is the expected treatment of choice?
Question 31The nurse would expect the occurrence of scabies to occur more commonly among children who:
Question 32A 40-year-old female is diagnosed with SLE. Which of the following findings would be considered a symptom of this disease?
Question 33A 46-year-old male presents with severe pain, redness, and tenderness in the right big toe. He was diagnosed with gouty arthritis. He is at risk for developing:
Question 34A 5-year-old male is diagnosed with tineacorporis following development of lesions on the non-hairy parts of his face, trunk, and limbs. A common source of this condition is a:
Question 35A 3-year-old male develops tineacapitis after playing with the family dog. This infection is caused by a:
Question 36The pathophysiology student would correctly identify the etiologic agent of smallpox as:
Question 37Which cells are involved in initiating immune responses in the skin?
Question 38A 5-year-old female develops chickenpox after exposure at her day care center. This disease is caused by:
Question 39A 2-month-old female develops diaper dermatitis. A nurse will monitor this patient for which secondary infection that frequently accompanies diaper dermatitis?
Question 40What common symptom should be assessed in individuals with immunodeficiency?
Question 41The nurse would be correct in identifying the duration of rubella.