The nurse is providing client education on dental care.  How often should the nurse instruct the client to receive a dental exam?

Insertions or deletions of nucleotides that are not multiples of three cause:

The nurse is assessing the clients extraocular muscle function (EOM).  How should the nurse conduct this assessment?

An individual who uses a wheelchair is being discharged from an inpatient rehabilitation facility to their home. In determining accessibility of the interior home environment, the patient’s family have transitioned the patient’s bedroom to the first level.  The COTA’s primary concern is:

An older adult recovering from right total hip replacement surgery and is unable to reach their feet to put on socks. The client wants to regain independence with lower body dressing.   What specific assistive technology could the COTA recommend to increase client occupational performance and safety & Provide a Rationale for AT: (2 points) When the COTA issues AT to the client, which frame of reference or treatment approach is the COTA following? (1 Point)

Mendel’s Law of Segregation is best described as which of the following statements?

Review the patient information below and submit complete and thorough Admission Orders in the following essay question. Patient Name: Mia Johnson Age: 59 years old Gender: F Chief Complaint:  “I slipped and fell in my bathroom and now my left hip really hurts”   HPI:  The pt is a 59 y/o F who presents s/p slip and fall at home. The pt reports she slipped on a wet floor, landing on her left side. She states she immediately felt pain in the upper left leg and could not stand up after the fall despite assistance from her husband due to pain with attempted weight bearing. She did report some potential crepitus upon attempting to stand. The fall occurred approximately 1 hour prior to arrival. The pain is better with sitting still. The pain radiates down the affected leg at times. The pain is currently rated 8/10. She denies any symptoms preceding the fall such as dizziness or presyncope.    Pt states that her head landed on the bathroom carpet and denies HA, neck pain, or loss of consciousness. She states that she can remember the whole event and recalls yelling for help from her husband after the fall. She has not been able to remove her pants to see if she has any bruising, but did not see any blood on her clothing.   Associated symptoms include nausea without vomiting. Pt denies chest pain, dizziness, numbness/tingling anywhere, confusion, or memory loss. Pt denies hx of a bleeding disorder, the use of any blood thinners, or use of any alcohol / drugs recently.  Past Medical History (PMHx):  Illnesses/Injuries:  Stage 2 CKD due to IgA Nephropathy Hypertension Papillary thyroid cancer (now resolved) Hypothyroidism (due to thyroidectomy) Osteoporosis Hypercholesterolemia Hospitalizations:  Pneumonia (3 years ago) Hyponatremia (2 years ago) Surgical History:  Right total knee replacement (2 years ago) Thyroidectomy (5 years ago) Screening/Preventive History: Pt is up-to-date on all vaccinations and preventative screenings, including Tdap/Tetanus, pneumonia, COVID, and influenza. Medications (Prescription, Over the Counter, Supplements):  -LIsinopril 20mg PO daily -Risedronate (Atеlvia) 35mg once weekly -Vitamin D3 20mcg (1000 I/U) PO daily -Levothyroxine 50 mcg PO daily -Rosuvastatin 10mg PO daily Allergies (e.g. environmental, food, medication and reaction): NKDA Family Medical History:  Mother (deceased, age 90) has history of Dementia, Osteoporosis, lupus Father (decreased, age 88) has history of Hypercholesterolemia, HTN, DM2 Sister 1 (alive, 55) has history of depression and alcohol abuse Daughter 1 (alive, 27) – healthy Son 1 (alive, 29) – healthy Family history of osteoporosis on pt’s mother’s side   Social History: Substance Use / Alcohol Use: Remote hx of tobacco use (1 pack daily for 10 years before quitting at age 40).  No substance abuse/use reported. Pt quit drinking alcohol 20 years ago. Previously, pt would drink on special occasions only. Diet: No special diet reported Home Environment:  Lives with husband in their single-story home. No stairs inside, but there is a single step to get inside the home. Occupation: Retired 5th grade teacher Leisure Activities: Pt likes to garden, take the family dog or a walk, or walk with her friends at the beach or local park. Pt also is an avid photographer. Exercise: Active 3-4x per week, near-daily walking Sleep: 6-7 hours per night Religion: Atheist Sexual: Sexually active only with his husband. No hx of STD/STD.   ROS (Review of Systems): General: No weight loss, fever/chills, or night sweats. Skin: See HPI. No eczema, dry skin, or skin changes reported.  HEENT: No headache, neck pain/stiffness, no sore throat. No vision changes or double vision. No congestion/runny nose. Respiratory: No cough, shortness of breath or wheezing. Cardiovascular: No chest pain or palpitations. Gastrointestinal: No n/v, diarrhea or constipation. No reported abdominal pain, flank pain, or change in bowel consistency. Genitourinary: No change in urination, dysuria, hematuria, or increased urinary frequency. Musculoskeletal: See HPI. No back pain or neck pain reported. Psychiatric: No depression, anxiety, or thoughts of self harm. Hematologic: Pt does report that she occasionally bruises easily but this has been a long-standing issue for her. She denies easy gum bleeding or bleeding problems otherwise.. Endocrine: No hot or cold intolerance or new hair/skin changes recently. Neurologic: No dizziness, headache, confusion, or disorientation. No numbness or weakness reported. Physical Exam:   Vital Signs:  Temperature: 97.8*F / 36.6 *C Heart Rate: 90 beats per minute Blood Pressure: 140/82 mmHg Respiratory Rate: 20 breaths per minute Pulse Oximetry: 98% on RA Weight: 105 lbs / 47.6 kg Height: 62 inches / 157.5 cm   Physical Exam (continued): General: Pt appears uncomfortable, in acute pain at times during the exam. She is wearing street clothes upon arrival. Pt is alert and cooperative, answering questions appropriately.  Skin: Upon inspection of the skin, there is ecchymosis and a focal hematoma visible over the lateral upper thigh area without laceration or abrasion.  No lacerations or active bleeding visualized on the remainder of the skin exam. The skin is warm, without rashes, has normal turgor, and no pallor or cyanosis noted throughout, including distal B/L LEs.  Head: Normocephalic, atraumatic. No obvious signs of head trauma on exam such as contusion, abrasion, bruising, or laceration. Eyes: PEERLA B/L, EOMI B/L, sclera anicteric, conjunctiva clear. Ears, Nose, Throat: Normal ear, nose, and throat inspection. No pharyngeal erythema or lymphadenopathy noted. Ear canals patent B/L. Hearing grossly intact B/L. No hemotympanum, raccoon eyes, Battle sign, or otorrhea noted.  Neck: Non-tender, c-spine ROM intact, no midline TTP, step-offs, or deformity. No visible skin changes, contusion, or abrasion. Pulmonary: Lungs clear to auscultation B/L, no crackles, wheezes, or rhonchi. Cardiac: Tachycardia noted, with normal rhythm, no murmurs, gallops, or rubs. Normal S1 and S2 otherwise. Peripheral Vascular: Capillary refill less than 2 seconds throughout distal extremities bilaterally. Peripheral pulses full and equal bilaterally, most notably 2+ radial pulses B/L with normal capillary refill of L hand (as well as R hand) Abdomen: Soft, non-distended, non-tender. Normoactive BS presents in all 4 quadrants. No signs of abdominal trauma such as contusion, abrasion, or bruising. Rectal: Deferred GU: Normal external genitalia without evidence of trauma or injury. MSK: Cervical, thoracic and lumbar spine are without midline tenderness, step-off or deformity. Pelvis stable and without TTP. No crepitus, or depression appreciated. The left leg appears shortened on general exam when compared to the right and is sitting internally rotated on the initial exam. No gross deformity immediately appreciated. Crepitus was felt when attempting to externally rotate the hip or flex it toward the pt’s trunk, therefore the remaining of the upper hip area exam was withheld. The L knee also was difficult to assess due to proximal pain, but appeared to have normal ROM, and landmarks. L ankle and foot appears normal, with ROM intact. There is TTP along the upper thigh and at the greater trochanter landmark.  R lower extremity appears without evidence of contusion, deformity, or swelling. ROM intact at R hip, knee, ankle, and foot    B/L upper extremities WNL at all major joints, without limitation of ROM, deformity, or crepitus.  Neuro: Pt is AAOX4. Memory and recall intact of the fall and recent events. Sensation noted to be intact and present throughout all extremities. No obvious gross motor or sensation deficits of areas assessed. Strength 5/5 all extremities at major joints with exception of L hip and knee, which could not be accurately assessed due to pain and concern for fracture.  CN 2-12 exam is otherwise grossly intact, but pt’s gait could not be assessed. Reflexes 2+ RLE, B/L upper extremities, and distal L achilles, but L patellar reflex was not assessed due to pt’s pain. No tremor noted. Psychiatric: Appropriate mood and affect for situation  

Diagnostic Results: CBC WBC 8.8 RBC 5 Hgb: 15 Hct 46% MCV 95 MCHC 34 Platelets 290 Neutrophils 59% Lymphocytes 34% Monocytes 3% Eosinophils 2% Basophils 1% 4.0-11.0 3.9-5.1 12-16 35-45% 80-100 27-34 150-450 40-60% 20-40% 2-8% 1-4% 0.5-1% CMP Sodium 144 mmol/L Potassium 3.9 mmol/L Chloride 98 mmol/L CO2 27 mmol/L BUN 20 mg/dL Creatinine 1.1 mg/dL Glucose 124 mg/dL Calcium 9.0 mg/dL Alk phos 85 U/L ALT 35 U/L AST 32 U/L Albumin 3.8 g/dL Total Protein 7.0 g/dL Total bilirubin 0.9 mg/dL 135-145 mmol/L 3.5-5 mmol/L 96-106 mmol/L 20-30 mmol/L 6-20 mg/dL 0.6-1.3 mg/dL 60-126 mg/dL 8.5-10.2 mg/dL 20-130 U/L 4-36 U/L 8-33 U/L 3.4-5.4 g/dL 6.0-8.3 g/dL 0.1-1.2 mg/dL HBg A1C 5.7%

Intro and Chief Complaint (PLO 2)  Patient Info and Chief Complaint: Patient name: Barney Jackson Patient age: 65 years old Patient self-reported gender: Male Chief complaint: “Possible left foot infection” Care setting: Internal medicine office, scheduled appointment Section Task 1: (A.) List ten (10) differential diagnoses for this patient scenario, based solely on the information provided above. (B.) For each diagnosis, list two (2) symptoms, risk factors, or historical findings that would help you differentiate that specific diagnosis from the others. Each symptom, risk factor, or historical finding may only be used once in total when answering this question.

Physical Exam Findings:  VITAL SIGNS:  Temperature: 37.2°C (98.9°F) Pulse rate: 80 bpm Respiration Rate: 18/min Blood pressure: 126/80 mmHg. Oxygen saturation: 99% on room air Weight: 79.5 kg (175 lb) Height: 182 cm (72 in) GEN: Well-developed, well-nourished female. Appears in no acute or general distress. Alert and oriented x 4, answering questions appropriately.  HEENT Atraumatic, normocephalic. Ear canals clear bilaterally, TMs pearly gray with no bulging or defect noted. Nares patent, septum intact. Lips and gingiva normal in appearance, posterior pharynx without erythema or exudates. PERRLA, EOMI B/L. NECK: Neck is supple, no masses, trachea midline, no thyroid nodules, masses. No lymph node tenderness or enlargement.  SKIN: No bruising, cyanosis, or pigment changes appreciated, without obvious lesions or rashes. Normal hair pattern. HEART: Regular rate, regular rhythm with normal S1, S2, without rubs, murmurs or gallops auscultated. No peripheral edema noted. No JVD. LUNGS: Clear to auscultation B/L. No adventitious breath sounds. No increased respiratory effort appreciated. No wheezing, rales, rhonchi, or stridor. PERIPHERAL VASCULAR: Capillary refill WNL throughout extremities, < 2s. No peripheral edema. Pulses 2+ and intact at DP, PT, brachial and radial B/L. No digital clubbing noted. ABD: Normoactive bowel sounds heard throughout all quadrants. Soft, non-distended abdomen without tenderness to light or deep palpation. No rebound or guarding noted. No hepatosplenomegaly noted. No abdominal bruits or pulsatile masses. No CVA tenderness elicited B/L. The bladder does not feel distended on palpation. No masses appreciated on deep palpation. GU/Rectal:  Pelvic exam reveals pink, multiparous, non-friable cervix. No discharge, CMT, or bleeding from closed cervical os. No appreciable mass or deformity. Vaginal canal without blood present throughout. No inguinal LAD appreciated.  Rectal exam reveals normal sphincter tone. No hemorrhoid, mass, or lesions noted externally. Hemoccult testing negative. NEURO: Pt alert and oriented x 4, following commands appropriately. Speech clear and without slurring. No facial asymmetry. Gait steady and without limp or need for assistance. Strength 5/5 in all extremities and major muscle groups, equally throughout B/L sides. No sensory deficit appreciated throughout extremities.  PSYCH: Affect and mood normal. Judgment and insight intact; no confusion. No homicidal or suicidal ideation. No pressured or tangential speech. No evidence of hallucinations. Diagnostic Results: CBC WBC 8.2  RBC 4.5  Hgb: 13.2  Hct 36.9%  MCV 85  MCHC 29  Platelets 300  Neutrophils 56%  Lymphocytes 30%  Monocytes 6%  Eosinophils 3%  Basophils 1% 4.0-11.0  3.9-5.1  12-16  35-45%  80-100  27-34  150-450  40-60%  20-40%  2-8%  1-4%  0.5-1% CMP Sodium 138 mmol/L  Potassium 4.1 mmol/L  Chloride 100 mmol/L  CO2 24 mmol/L  BUN 18 mg/dL  Creatinine 0.9 mg/dL  Glucose 114 mg/dL  Calcium 9.1 mg/dL  Alk phos 48 U/L  ALT 20 U/L  AST 19 U/L  Albumin 4.4 g/dL  Total Protein 7.1 g/dL  Total bilirubin 0.9 mg/dL 135-145 mmol/L  3.5-5 mmol/L  96-106 mmol/L  20-30 mmol/L  6-20 mg/dL  0.6-1.3 mg/dL  60-126 mg/dL  8.5-10.2 mg/dL  20-130 U/L  4-36 U/L  8-33 U/L  3.4-5.4 g/dL  6.0-8.3 g/dL  0.1-1.2 mg/dL PT/INR PT: 11.2  INR: 1.0 PT: 11-13.5 seconds INR: 1-1.2 aPTT 25 seconds 22–39 seconds Urinalysis and microscopy  Color: Yellow  Appearance: Clear  Leukocyte esterase: 0  Nitrites (mg/dL): 0   Urobilinogen (mg/dL) 0.9  Protein (mg/dL): 40   pH: 6.8  Blood (mg/dL): 0.250  Specific gravity: 1.01  Ketones (mg/dL): 0   Bilirubin (mg/dL): 0  Glucose  (mg/dL): 0  RBC: 50/hpf  WBC: None/hpf  Squamous epi cells: 3/hpf  Bacteria: None seen  Mucus: Trace Clear to yellow  Clear  0 (Negative)  0 mg/dL (Negative)  0.2-1 mg/d/L  0-20 mg/dL  4.6-8.0  0-0.02 mg/dL   1.005-1.030  0 mg/dl (Negative)  0 mg/dl (Negative)  0 mg/dl (Negative)  0-4 / hpf  0-4 / hpf  0-3 / hpf  None  None to trace Urine Gram Stain and Culture Preliminary gram stain reveals no bacterial growth; Final (full) culture and sensitivity results are pending   No bacteria seen (gram stain);  No bacterial growth (culture) Urine NAAT  STI Panel(gonorrhea, chlamydia, trichomoniasis) Negative;  Negative;  Negative Negative;  Negative;  Negative 24-hour urine protein 140 mg/dL per 24 hours