A 60-year-old patient receiving chemotherapy develops fever and cough. WBC is 1,900/mm³ (normal 5,000–10,000/mm³), with marked neutropenia. The chest examination is initially unimpressive. The NP bases the plan of care on

A 70-year-old patient with severe hypothyroidism becomes progressively lethargic during a respiratory infection. The patient is hypothermic, bradycardic, and minimally responsive. Family members state that increasing fatigue and slowed cognition had been attributed to depression for several months. The NP bases the plan of care on

A 32-year-old woman has dysuria, urinary frequency, suprapubic discomfort, and cloudy urine without fever or flank pain. Urinalysis supports bacterial infection. The NP bases the plan of care on the understanding that…

A 35-year-old patient with microcytic anemia has a lifelong history of anemia, a strong family history, and no evidence of chronic blood loss. Iron studies are not consistent with iron depletion. The NP bases the plan of care on

A 47-year-old patient with autoimmune thyroid disease presents with progressive weakness, weight loss, nausea, abdominal discomfort, dizziness, and increasingly darkened skin. Blood pressure is 86/54 mm Hg. Serum sodium is 128 mEq/L (normal 135–145 mEq/L), potassium is 5.8 mEq/L (normal 3.5–5.0 mEq/L), and glucose is 61 mg/dL (fasting normal 70–99 mg/dL). The patient has not taken exogenous glucocorticoids. The NP bases the plan of care on

A 43-year-old patient has progressively heavy menstrual bleeding, pelvic pressure, and an enlarged irregular uterus. Transvaginal ultrasound shows several well-circumscribed masses arising from the myometrium. The NP bases the plan of care on the understanding that…

A 14-year-old has never menstruated and is being evaluated for delayed pubertal development. The NP is reviewing genetic, endocrine, and anatomic possibilities rather than assigning a diagnosis from age alone. The NP bases the plan of care on the understanding that…

A 41-year-old has recurrent abdominal pain associated with alternating constipation and diarrhea. Extensive evaluation shows no structural, inflammatory, or biochemical abnormality, and symptoms worsen during stress. The NP bases the plan of care on the understanding that…

A 66-year-old patient with chronic lymphocytic leukemia is evaluated because of increasing fatigue and recurrent respiratory infections. The WBC count is markedly elevated, yet the patient has experienced three bacterial infections in four months. The NP bases the plan of care on

A 25-year-old reports pelvic pain, dyspareunia, abnormal vaginal discharge, and postcoital bleeding. Temperature is 38.3°C, and pelvic examination demonstrates significant lower abdominal tenderness. The NP bases the plan of care on the understanding that…