NURS3020 – Health Assessment

Question 1 The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear?

Answers: a. Dullness

b. Tympany

c. Resonance

d. Hyperresonance

• Question 2 Which structure is located in the left lower quadrant of the abdomen?

Answers: a. Liver

b. Duodenum

c. Gallbladder

d. Sigmoid colon

Question 3 A patient is having difficulty swallowing medications and food. The nurse would document that this patient has:

Answers: a. Aphasia.

b. Dysphasia.

c. Dysphagia.

d. Anorexia.

Question 4 The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?

Answers: a. Percuss and palpate in the lumbar region.

b. Inspect and palpate in the epigastric region.

c. Auscultate and percuss in the inguinal region.

d. Percuss and palpate the midline area above the suprapubic bone.

Question 5 The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is:

Answers: a. Increased salivation.

b. Increased liver size.

c. Increased esophageal emptying.

d. Decreased gastric acid secretion.

Question 6 A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handle bars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of the spleen in this situation?

Answers: a. The spleen can be enlarged as a result of trauma.

b. The spleen is normally felt on routine palpation.

c. If an enlarged spleen is noted, then the nurse should thoroughly palpate to determine its size.

d. An enlarged spleen should not be palpated because it can easily rupture.

Question 7 A patient’s abdomen is bulging and stretched in appearance. The nurse should describe this finding as:

Answers: a. Obese.

b. Herniated.

c. Scaphoid.

d. Protuberant.

Question 8 The nurse is describing a scaphoid abdomen. To the horizontal plane, a scaphoid contour of the abdomen depicts a ______ profile.

Answers: a. Flat

b. Convex

c. Bulging

d. Concave

Question 9 While examining a patient, the nurse observes abdominal pulsations between the xiphoid process and umbilicus. The nurse would suspect that these are:

Answers: a. Pulsations of the renal arteries.

b. Pulsations of the inferior vena cava.

c. Normal abdominal aortic pulsations.

d. Increased peristalsis from a bowel obstruction.

Question 10 A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is:

Answers: a. Diarrhea.

b. Peritonitis.

c. Laxative use.

d. Gastroenteritis.

• Question 11 The nurse is watching a new graduate nurse perform auscultation of a patient’s abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?

Answers: a. “We need to determine the areas of tenderness before using percussion and palpation.”

b. “Auscultation prevents distortion of bowel sounds that might occur after percussion and palpation.”

c. “Auscultation allows the patient more time to relax and therefore be more comfortable with the physical examination.”

d. “Auscultation prevents distortion of vascular sounds, such as bruits and hums, that might occur after percussion and palpation.”

Question 12 The nurse is listening to bowel sounds. Which of these statements is true of bowel sounds? Bowel sounds:

Answers: a. Are usually loud, high-pitched, rushing, and tinkling sounds.

b. Are usually high-pitched, gurgling, and irregular sounds.

c. Sound like two pieces of leather being rubbed together.

d. Originate from the movement of air and fluid through the large intestine.

Question 13 The physician comments that a patient has abdominal borborygmi. The nurse knows that this term refers to:

Answers: a. Loud continual hum.

b. Peritoneal friction rub.

c. Hypoactive bowel sounds.

d. Hyperactive bowel sounds.

Question 14 During an abdominal assessment, the nurse would consider which of these findings as normal?

Answers: a. Presence of a bruit in the femoral area

b. Tympanic percussion note in the umbilical region

c. Palpable spleen between the ninth and eleventh ribs in the left midaxillary line

d. Dull percussion note in the left upper quadrant at the midclavicular line

Question 15 The nurse is assessing the abdomen of a pregnant woman who is complaining of having “acid indigestion” all the time. The nurse knows that esophageal reflux during pregnancy can cause:

Answers: a. Diarrhea.

b. Pyrosis.

c. Dysphagia.

d. Constipation.

Question 16 The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:

Answers: a. Flatness, resonance, and dullness.

b. Resonance, dullness, and tympany.

c. Tympany, hyperresonance, and dullness.

d. Resonance, hyperresonance, and flatness.

Question 17 An older patient has been diagnosed with pernicious anemia. The nurse knows that this condition could be related to:

Answers: a. Increased gastric acid secretion.

b. Decreased gastric acid secretion.

c. Delayed gastrointestinal emptying time.

d. Increased gastrointestinal emptying time.

Question 18 A patient is complaining of a sharp pain along the costovertebral angles. The nurse is aware that this symptom is most often indicative of:

Answers: a. Ovary infection.

b. Liver enlargement.

c. Kidney inflammation.

d. Spleen enlargement.

Question 19 When assessing a patient’s nutritional status, the nurse recalls that the best definition of optimal nutritional status is sufficient nutrients that:

Answers: a. Are in excess of daily body requirements.

b. Provide for the minimum body needs.

c. Provide for daily body requirements but do not support increased metabolic demands.

d. Provide for daily body requirements and support increased metabolic demands.

Question 20 The nurse is providing nutrition information to the mother of a 1-year-old child. Which of these statements represents accurate information for this age group?

Answers: a. Maintaining adequate fat and caloric intake is important for a child in this age group.

b. The recommended dietary allowances for an infant are the same as for an adolescent.

c. The baby’s growth is minimal at this age; therefore, caloric requirements are decreased.

d. The baby should be placed on skim milk to decrease the risk of coronary artery disease when he or she grows older.

Question 21 A patient tells the nurse that his food simply does not have any taste anymore. The nurse’s best response would be:

Answers: a. “That must be really frustrating.”

b. “When did you first notice this change?”

c. “My food doesn’t always have a lot of taste either.”

d. “Sometimes that happens, but your taste will come back.”

Question 22 The nurse is performing a nutritional assessment on a 15-year-old girl who tells the nurse that she is “so fat.” Assessment reveals that she is 5 feet 4 inches and weighs 110 pounds. The nurse’s appropriate response would be:

Answers: a. “How much do you think you should weigh?”

b. “Don’t worry about it; you’re not that overweight.”

c. “The best thing for you would be to go on a diet.”

d. “I used to always think I was fat when I was your age.”

Question 23 The nurse is discussing appropriate foods with the mother of a 3-year-old child. Which of these foods are recommended?

Answers: a. Foods that the child will eat, no matter what they are

b. Foods easy to hold such as hot dogs, nuts, and grapes

c. Any foods, as long as the rest of the family is also eating them

d. Finger foods and nutritious snacks that cannot cause choking

Question 24 The nurse is reviewing the nutritional assessment of an 82-year-old patient. Which of these factors will most likely affect the nutritional status of an older adult?

Answers: a. Increase in taste and smell

b. Living alone on a fixed income

c. Change in cardiovascular status

d. Increase in gastrointestinal motility and absorption

Question 25 When considering a nutritional assessment, the nurse is aware that the most common anthropometric measurements include:

Answers: a. Height and weight.

b. Leg circumference.

c. Skinfold thickness of the biceps.

d. Hip and waist measurements.

Advanced Health Assessment and Diagnostic Reasoning NURS 6512

Main Post Week 1
Scenario: 16-year-old white pregnant teenager living in an inner-city neighborhood
The client interview is a crucial professional skill contributing to quality care by establishing trust. Ball, Dains, Flynn, Solomon, and Stewart (2015) support interviewing a client to develop a therapeutic relationship and understand the client’s unique perspective, which enables the provider to disregard assumptions that could negatively impact care. Fortin, Dwamena, Frankel, and Smith (2013) suggest commencing the interview with a “non-focusing” method (p. 40), in which the provider asks a general open-ended question and allows the client to speak freely while observing nonverbal signals before additional dialogue. In the case of the 16-year-old, this information could help determine how she feels about the pregnancy. As an experienced labor and delivery nurse and obstetrics and gynecologist nurse, I believe the pregnancy was unintended. However, this inner-city youngster may regard her pregnancy as a ticket out of a harsh or even abusive home environment, and she welcomes the pregnancy. Permitting the client to express her emotions will help me deliver caring, nonjudgmental care. Regardless of the client’s age or disease, it is crucial to implement the communication approaches Ball et al. (2015) suggested to establish rapport and ensure the client’s comfort. There are other, more specialized requirements based on the client’s age. In Illinois, unmarried pregnant adolescents must get parental consent for treatment (Illinois Department of Health, 2018). Because adolescents may be reluctant to speak openly in the presence of a parent, the NP should advocate for the client by requesting permission to conduct some interviews without the parent’s presence. Seeing the client alone for at least a portion of the intake interview will enable the screening of abuse in confidence. Ball et al. (2015) describe the vast amount of data obtained from pregnant clients. For a young mother, it may be easier to complete an intake if it is divided up across numerous office visits or if it can be done at home and returned to the office. Risk Assessment Instrument Postpartum depression (PPD) is a serious condition that affects one in five mothers and is more prevalent among adolescents than adults (Illinois Department of Health, 2018).
Therefore, screening for this risk is crucial. The Edinburgh Postnatal Depression Scale is a valid and accurate risk assessment instrument. Intriguingly, the equipment is recommended for usage beginning in the second trimester to provide early detection of PPD (Lydsdottir, Howard, Olafsdottir, Thome, Tyr-fingsson, & Sigurdsson, 2014). The screening instrument consists of ten questions that focus on the client’s emotions throughout the past week. The customer completes the instrument. Question areas include disposition, affect, activity interest, and self-harm. Targeted Inquiries There are numerous questions designed to aid in gaining an understanding of this client and identifying her risks during pregnancy and after.
Five crucial questions to ask include

1. “How has your life changed since you became pregnant?”

2. “What are your hopes and dreams for your child?”

3. “How do you feel about “Have you ever contemplated self-harm?” Who do you confide in while feeling down or overwhelmed?

4. How do the father, your family, and your friends feel about the pregnancy?

5. “Describe the people and animals in your household.” The questions mentioned above were selected because they correspond with The American College of Obstetricians and Gynecologists (ACOG) (2018) and the Edinburg Depression scale, which suggest that maternal anxiety, life stress, unintended pregnancy, and poor relationship quality increase the risk of perinatal depression and allow the practitioner to quickly and efficiently identify at-risk individuals.

References
American College of Obstetricians and Gynecologists (ACOG). (2018). Screening for Perinatal Depression. Retrieved from /orders/www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination. St. Louis, MO: Elsevier.
Illinois Department of Health (2018). Trends in teen birth rates: Illinois. Retrieved from: http://dph.illinois.gov/topics-services/life-stages-populations/maternal-child-family-health-services
Lydsdottir, L. B., Howard, L. M., Olafsdottir, H., Thome, M., Tyr-fingsson, P., & Sigurdsson, J. F. (2014). The mental health characteristics of pregnant women with depressive symptoms identified by the Edinburgh Postnatal Depression Scale. Journal of Clinical Psychiatry, 75(4), 393-398. doi: 10.4088/JCP.13m08646.
Smith, R. C., Fortin, A. H., Dwamena, F., & Frankel, R. M. (2013). An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Education and Counseling, 91(3), 265-270. doi: 10.1016/j.pec.2012.12.010

(NURS 3020 ) – discussion peer response

Response 1
Hi Stacia, Your discussion thread and the case you chose were enjoyable to read. After analyzing the circumstance, the available information, and the necessary diagnostics, I would also consider Radiculopathy/Sciatica as a differential diagnosis. Patients with radiculopathy or sciatica typically exhibit numbness, weakness in the lower extremities, discomfort radiating to the buttocks and leg (particularly if the pain spreads past the knees), and a unilateral presentation. SPINE-health.com (2018) identifies lumbar disc herniation, degenerative disc disease, spondylolisthesis, and spinal stenosis as common causes of back discomfort. I concur with your primary diagnosis of a herniated disc because it corresponds with the patient’s reported pain location and the occupational risk of heavy lifting!
References
Huether, S. E., & McCance, K. L. (2017). Disorder of the joints. In alterations of musculoskeletal function (6th ed., pp. 991-1038).SPINE-health (2018). What You Need to Know About Sciatica. Retrieved October 14, 2018from: /orders/www.spine-health.com

Advanced Health Assessment and Diagnostic Reasoning NURS 6512 – Main Post Week 3

Health Issues and Risks of Children’s Weight

For a 5-year-old girl of normal weight with obese parents, BMIParental obesity is a risk factor for childhood obesity (Fuemmeler, Lovelady, Zucker, & stbye, 2013); hence, it is vital to evaluate familial features regarding weight issues. According to Sahoo et al. (2015), body mass index (BMI) is inheritable to 25 to 40 percent. It is one of the leading causes of obesity, placing a 5-year-old girl of normal weight at a greater risk for obesity than a kid whose parents have a normal BMI. Childhood obesity is associated with poor physical health, including an increased risk of developing sleep apnea, Type II diabetes, asthma, cardiovascular disease, high cholesterol, insulin resistance, and menstrual abnormalities, as well as social and emotional issues associated with low self-esteem and the stigmatization of bullying (Sahoo et al., 2015). This increased social isolation might increase sedentary behavior and weight gain (Sahoo et al., 2015).

Additionally, excessive school absences can severely impact academic achievement, particularly when a chronic disease occurs (Sahoo et al., 2015). Information Required for Weight Evaluation To determine the possible dangers linked with childhood obesity, a complete medical history of the parents is required. If parental obesity is associated with a disease process, the child may be at risk of having the disease. In addition, information regarding the mother’s health during pregnancy, particularly a history of gestational diabetes, would be relevant because it might cause metabolic abnormalities in kids (Lehnen, Zechner, & Haas, 2013).

The following questions would be good for this patient:

• Was there a history of pregnancy-related problems, such as Gestational Diabetes?
• Does she (the youngster) engage in at least one hour of daily physical activity?
• What types of foods and beverages does she consume and have access to at home?
• How many hours of television (TV) does she watch each day? 5. How does the child engage with their peers?
• Does she love playing with other children, or is she aware that she’s alone?

Strategies for Healthier Conduct Family has a crucial influence in developing and maintaining good kid behaviors (Faith et al., 2018). Weight-related conversations can be delicate; therefore, shifting this patient’s/discourse family towards improving general health rather than focusing simply on weight loss or maintenance could be beneficial. It is good to discuss a healthy diet with the parents, focusing on foods that boost health and are nutritionally sound and adequate hydration that excludes sugary and caffeinated beverages. A debate on restricting television viewing and embracing other activities, such as unstructured and social play, enhances critical thinking abilities (Hill et al., 2016). A healthy lifestyle for the mind and body can be promoted by promoting physical exercise over television.
References
Anderson PM, Butcher KE. (2018) Childhood obesity: Trends and potential causes. Future Child, 16(1). Retrieved from http://files.eric.ed.gov/fulltext/EJ795889.pdf
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Faith, M. S., Van Horn, L., Appel, L. J., Burke, L. E., Carson, J. A., Franch, H. A., & Kral, T. (2018). Physical activity and metabolism; Council on clinical cardiology, cardiovascular disease. Retrieved from /orders/professional.heart.org/professional/ScienceNews/UCM_455052_Severe-Obesity-in-Children-and-Adolescents.jsp
Fuemmeler, B. F., Lovelady, C. A., Zucker, N. L., & Østbye, T. (2013). Parental obesity moderates the relationship between childhood appetitive traits and weight. Obesity (Silver Spring, Md.), 21(4), 815–823. http://doi.org/10.1002/oby.20144
Hill, D., Ameenuddin, N., Chassiakos, Y. L. R., Cross, C., Hutchinson, J., Levine, A., … & Swanson, W. S. (2016). Media and Young Minds. Pediatrics, e20162591. Retrieved from http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2591
Lehnen, H., Zechner, U., & Haaf, T. (2013). Epigenetics of gestational diabetes mellitus and offspring health: the time for action is in early stages of life. Molecular human reproduction, 19(7). doi: 10.1093/molehr/gat020
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187–192. http://doi.org/10.4103/2249-4863.154628

Djohnsonfolmar Financial Analysis methods – Health Assessment

The horizontal analysis enables investors and analysts to determine what has been driving a company’s financial performance over several years and identify trends and growth patterns, such as seasonality. It allows analysts to evaluate and project relative changes in line items across time. By simultaneously examining the income statement, balance sheet, and cash flow statement, one may generate a comprehensive picture of operational outcomes and determine what has been driving a company’s success and whether it is functioning profitably and efficiently. Vertical analysis is a method for analyzing financial statements in which each line is listed as a percentage of the statement’s base figure. Thus, income statement line items can be expressed as a percentage of total revenue.

In contrast, balance sheet line items can be expressed as a proportion of total assets or liabilities. A cash flow statement’s vertical analysis depicts each cash inflow or outflow as a percentage of the total cash inflows. The vertical analysis makes it considerably simpler to compare the financial statements of different companies and industries. This is because the balanced proportions of account balances are visible. It also makes it easy to compare past periods for time series analysis, which compares quarterly and annual numbers over several years to evaluate if performance indicators are improving or degrading.

In contrast to horizontal analysis, which examines how the dollar amounts in a company’s financial statements have changed over time, the vertical analysis examines each line item as a percentage of the statement’s base figure. My opinion is that one cannot exist without the other. Unlike horizontal, which is used to calculate throughout a time, vertical is used to calculate each item. Whether annual or monthly, all financial ratios are quite crucial for a financial organization. The horizontal dimension represents an extended period, and the vertical dimension represents a single object.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. NURS3020 – Health Assessment

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. NURS3020 – Health Assessment

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS3020 – Health Assessment

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For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. NURS3020 – Health Assessment

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS3020 – Health Assessment

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