NURS6512Week6Mi dter
m Exam /NURS6512Week6Mi dt
erm Exam
(Lat
est)
:
AdvancedHeal
thAssessment:Wal
denUniversi
ty(
Alr
eadygradedA)
NURS6512Week6Mid
ter
mExam/NURS6
512We
ek6Mi
dte
rmE
xam(
Lat
est
):Ad
van
ced
Heal
thAs
sess
me n
t:Wal
denUn
ive
rsi
ty
Be
for
epe
rfor
min
gana
bdomi
nal
exa
min
ati
on,
thee
xami
ners
hou
ld:
Hav
eth
epa
tie
nte
mpt
yth
eirb
lad
der
Du
rin
gani
nte
rvi
ew,
tea
rsa
ppe
ari
nth
epa
tie
nt’
sey
esa
ndh
isv
oic
ebe
come
ssh
aky
.In
iti
al
ly
,yous
hou
ld:
Kee
p
t
hei
nte
rvi
ewmov
ingt
odi
st
rac
tth
epa
tie
nt
Wh
ichoft
hef
oll
owi
ngi
sth
emos
tac
cur
ater
efl
ect
ionofa
nin
div
idu
al’
sfoodi
nta
ke?F
oodd
iar
y
Pe
rcu
ssi
nga
tth
eri
ghtmi
dcl
avi
cul
arl
i
ne,
bel
owt
heu
mbi
l
icu
s,a
ndc
ont
inu
ingu
pwa
rdi
sth
ecor
rec
tte
chn
iqu
e
f
orl
oca
tin
gth
e:L
owe
rli
verb
ord
er
Af
ix
edi
mag
eofa
nyg
rou
pth
atr
ej
ect
sit
spot
ent
ial
foror
igi
nal
i
tyori
ndi
vi
dua
li
tyi
skn
owna
sa:
Ste
reot
ype
Pe
rit
oni
ti
spr
odu
cesb
owe
lsou
ndst
hata
reDe
cre
ase
d/Hy
poa
cti
ve
Br
it
tl
ena
il
sar
ety
pic
alf
indi
ngsi
n:
Old
era
dul
ts
Wh
ichoft
hef
oll
owi
ngi
sane
xpe
cte
dch
ang
eint
hea
sse
ssme
ntoft
het
hyr
oidd
uri
ngp
reg
nan
cy?Ab
rui
ti
s
a
usc
ult
ate
dd/
tin
cre
ase
dva
scu
lar
it
y
Youa
rep
lan
nin
gtop
alp
atet
hea
bdome
nofy
ourp
ati
ent
.Wh
ichp
artoft
hee
xami
ner
'
sha
ndi
sbe
stf
orp
alp
ati
ng
v
ibr
ati
on?Ul
nars
urf
ace
A5
-ye
ar-
ol
dch
il
dpr
ese
ntswi
thn
asa
lcon
ges
ti
ona
ndah
ead
ach
etoa
sse
ssf
ors
inu
ste
nde
rne
ssy
ous
hou
ld
p
alp
ateov
ert
he:
Max
il
la
rys
inu
seson
ly
Du
rin
gph
ysi
cal
exa
min
ati
onofa3
0-y
ear
-ol
dCh
ine
sema
nyoun
oti
ceas
li
ghta
symme
tryofh
isf
ace
.th
e
c
ran
ial
ner
vee
xami
nat
ioni
snor
mal
.You
rbe
sta
cti
oni
sto–As
kth
epa
tie
nti
fth
isc
har
act
eri
st
icr
unsi
nth
e
f
ami
l
y
Un
usu
alwh
itea
rea
sont
hes
kinma
ybedu
eto-
Vit
il
i
go
Youa
reu
sin
ganop
hth
almos
cop
etoe
xami
neap
ati
ent
’
sin
nere
ye.
Your
ota
tet
hel
enss
ele
ctorc
loc
kwi
se,
t
henc
oun
ter
cl
ock
wis
etoc
omp
ens
atef
or:
Myop
ia
Mr
s.We
bbi
sa3
8-y
earol
dpa
tie
ntwh
oha
sbe
enc
han
gin
ghe
rli
fes
tyl
etoe
ati
nah
eal
thywa
yan
dlos
ewe
igh
t:
du
rin
gyou
rhe
alt
hpr
omot
ione
duc
ati
onr
ega
rdi
ngh
ern
utr
it
ion
als
tat
us,
youe
xpl
ai
nth
efu
nct
ionofd
iet
aryp
rot
ei
n
a
s:Bu
il
di
nga
ndma
int
ain
ingt
is
sue
s
Mr
.Ak
insi
sa7
8-y
/op
ati
entwh
opr
ese
ntst
oth
ecl
i
nicwi
thc
omp
lai
ntsofh
ear
ingl
oss
.Wh
ichoft
hef
oll
owi
nga
re
c
han
gesi
nhe
ari
ngt
hatoc
curi
nth
eel
der
ly
?Se
lec
tal
lt
hata
ppl
y.L
ossofh
ighf
requ
enc
y-s
oun
dsma
ybeg
arb
led
,
di
ff
icu
ltt
oloc
ali
ze–u
nab
let
ohe
ari
nac
rowd
edr
oom
Th
emos
tsu
per
iorp
artoft
hes
toma
chi
sth
e-F
und
us
,Mr
s.Gr
acei
sa5
8-y
ear
-ol
dpa
tie
ntwh
oha
sad
iag
nos
isofp
ern
ici
ousa
nemi
a.Wh
ichBv
it
ami
nisde
fic
ien
tin
p
ati
ent
swi
thp
ern
ici
ousa
nemi
a?B1
2
A5
1-y
/owoma
nca
ll
swi
thc
omp
lai
ntsofwe
igh
tlos
san
dcon
sti
pat
ion
.Sh
ere
por
tse
nla
rge
dhe
mor
rhoi
dsa
nd
r
ect
alb
lee
din
g.Youa
dvi
seh
ert
o:Comet
oth
ela
bor
ator
yforas
tool
gua
iac
,Pl
aci
ngt
heb
aseofav
ibr
ati
ngt
uni
ngf
orkont
hemi
dl
in
eve
rte
xoft
hep
ati
ent
’
she
adi
sat
estf
or:
Lat
era
li
zat
ion
ofs
oun
d
Wh
icht
ech
niqu
eismos
tli
kel
ytor
esu
lti
nth
epa
tie
ntsu
nde
rst
and
ingofqu
est
ion
s?Us
eth
epa
tie
nt’
sown
t
ermsi
fpos
sib
le
Mr
.Wi
l
li
ams
,ag
e25
,ha
sre
cov
ere
dre
cen
tlyf
roma
nup
pera
ndl
owe
rre
spi
rat
oryi
nfe
cti
on.
Hede
scr
ibe
sal
ong
-
s
tan
din
gna
sal
dri
ppi
ng.
Hei
sse
eki
ngt
rea
tme
ntf
orami
l
dhe
ari
ngl
osst
hath
asn
otg
onea
way
.In
for
mat
ion
c
onc
ern
ingh
isc
hron
icp
ost
nas
ald
rips
hou
ldb
edoc
ume
nte
dwi
thi
nwh
ichs
ect
ionoft
heh
ist
ory
?Pa
stme
dic
al
d
ata
Na
sal
symp
tomst
hati
mpl
yana
ll
erg
icr
esp
ons
ein
clu
de:
Blu
ishg
rayt
urb
ina
tes(
Tur
bin
ate
sth
ata
ppe
ar
b
lui
shg
rayorp
alep
inkwi
thas
wol
l
enb
odyc
ons
ist
enc
yma
yin
dic
atea
ll
erg
ies
.Se
ide
l24
3
Mr
.Fr
ank
li
niss
pea
kin
gwi
thy
out
heh
eal
thc
arep
rov
ide
r,a
bou
thi
sre
spi
rat
oryp
rob
lem.
Mr.
Fra
nkl
i
nsa
ys,
“I’
ve
h
adt
hisc
oug
hfor3d
aysa
ndi
t’
sge
tti
ngwor
se.
”Your
epl
y,“
Tel
lmemor
eab
outy
ourc
oug
h.”Mr
.Fr
ank
li
nst
ate
s,
“
Iwi
shI
cou
ldt
el
lyoumor
e,t
hat
’
swh
yIa
mhe
re!
Yout
el
lmewh
at’
swr
ong
.”Wh
ichc
are
giv
err
esp
ons
ewou
ldb
e
t
hemos
tap
prop
ria
tef
ore
nha
nci
ngc
ommu
nic
ati
on?Af
ter3d
ays
,you
’r
eti
redofc
oug
hin
g.Ha
vey
ouh
adaf
eve
r?
Wh
ent
aki
ngah
ist
ory
,yous
hou
ld:
Useac
hron
olog
ica
nds
equ
ent
ial
fra
mewor
k
Wh
ichoft
hef
oll
owi
ngf
orma
tswou
ldb
eus
edf
orv
isi
tst
hata
ddr
essp
rob
lemsn
oty
eti
den
tif
iedi
nth
epr
obl
em-
or
ien
tedme
dic
alr
ecor
d(POMR)
?Br
iefSOAPn
ote
Mr
.an
dMr
s.J
ohn
sonh
avep
res
ent
edt
oth
eof
fi
cewi
tht
hei
ri
nfa
nts
onwi
thc
omp
lai
ntsofe
ard
rai
nag
e.Wh
en
e
xami
ni
nga
nin
fan
t’
smi
ddl
eea
r,t
hen
urs
esh
oul
dus
eon
eha
ndt
ost
abi
l
izet
heot
osc
opea
gai
nstt
heh
eadwh
il
e
u
sin
gth
eot
herh
andt
o:Pu
llt
hea
uri
cl
edowna
ndb
acki
nane
ffor
ttos
tra
igh
tent
heu
pwa
rdc
urv
atu
reoft
hec
ana
l
Wh
ichqu
est
ionwou
ldb
econ
sid
ere
dal
eadi
ngqu
est
ion
?Youd
on’
tge
the
ada
che
sof
ten
,doy
ou?
Mr
.Bl
acki
sa4
4y/
opa
tie
ntwh
opr
ese
ntst
oth
ecl
i
nicwi
thc
omp
lai
ntsofn
eckp
aint
hath
eth
ink
sisf
romh
is
j
obi
nvol
vi
ngc
omp
ute
rda
tae
ntr
y.Ast
hee
xami
ner
,youa
rec
hec
kin
gth
era
ngeofmot
ioni
nhi
sne
cka
ndn
ote
t
heg
rea
tes
tde
gre
eofc
erv
ica
lmob
il
it
yisa
t?C4t
oC5
;C4a
ndC5a
ndC6p
rov
idet
heg
rea
tes
thor
iz
ont
al
mob
il
it
yina
dul
ts
Th
ete
rmd
enot
ingt
hec
are
giv
er’
sne
edt
odon
oha
rmt
oth
epa
tie
nti
s:De
ont
olog
ici
mpe
rat
iv
es
At
ool
use
dtos
cre
ena
dol
esc
ent
sfora
lcoh
oli
smi
sth
e:CRAF
FT
Un
dern
orma
lci
rc
ums
tan
ces
,howmu
chwa
teri
slos
tda
il
ybyt
heb
ody
?Ap
prox
.2t
o2.
5li
te
rsofwa
teri
slos
t
da
il
y
Youh
avej
ustc
omp
let
edas
kina
sse
ssme
ntonMr
.Ba
ker
.Du
rin
gyou
ras
ses
sme
nt,
youh
avet
ran
sil
l
umi
nat
eda
s
kinl
esi
on.
Dur
ingt
hep
hys
ica
lex
ami
nat
ion
,youk
nowt
hats
kinl
esi
onsa
ret
ran
sil
l
umi
nat
edt
odi
st
ing
uis
h:
Tr
ans
il
lu
min
ati
oni
sus
edt
ode
ter
min
eth
epr
ese
nceoff
lui
dinc
yst
san
dma
sse
s.F
lui
dfi
l
ledl
esi
onswi
l
l
t
ran
sil
l
umi
nat
ewi
thar
edg
low,
ands
oli
dma
sse
swi
l
lnott
ran
sil
l
umi
nat
e.
Mr
.Mi
l
lsi
sa5
5/y
/op
ati
entwh
opr
ese
ntst
oth
eof
fi
cef
ora
nin
iti
alv
isi
tforh
eal
thp
romot
ion
.As
urv
eyof
mob
il
it
yan
dac
ti
vi
ti
esofa
cti
vi
ti
esofd
ail
yli
vi
ngi
spa
rtofa
(n)
:Fu
nct
ion
ala
sse
ssme
nt
Swe
atg
lan
ds,
hai
r,
andn
ail
sar
eal
lfor
medf
rom?I
nva
gin
ati
onofe
pid
ermi
sin
tod
ermi
s
, Ab
rie
fst
ate
men
toft
her
eas
ont
hep
ati
enti
sse
eki
ngh
eal
thc
arei
sca
ll
edt
he?Ch
iefc
onc
ern
Wh
ichp
artoft
hei
nfor
mat
ionc
ont
ain
edi
nth
epa
tie
nt’
sre
cor
dma
ybeu
sedi
ncou
rt?An
yth
ingt
hati
sen
ter
edi
nto
ap
ati
ent
’
sre
cor
dinp
ape
rore
lec
tron
icf
ormi
sal
ega
ldoc
ume
ntt
hatc
anb
eus
ed
Wh
ichc
ran
ial
ner
vesi
nne
rva
tet
hef
ace
?5a
nd7
I
ncou
nse
li
ngac
li
entr
ega
rdi
ngn
utr
it
ione
duc
ati
on,
youe
xpl
ai
nth
atl
i
nol
ei
cac
id,
ama
jorf
att
yac
id,
ist
hou
ghtt
o
b
ees
sen
tia
lfor
?Li
nol
ei
cac
id,
fou
nda
bun
dan
tlyi
nmi
l
kan
dda
iryf
ati
sre
qui
redf
orn
orma
lgr
owt
han
d
d
eve
lop
men
t,i
tha
sbe
ens
ugg
est
edt
hati
tca
nre
duc
ebod
yfa
tinov
erwe
igh
tpa
tie
nt
Wh
ena
reop
en-
end
edqu
est
ion
sge
ner
all
ymos
tus
efu
l?Du
rin
gth
ein
iti
alp
artoft
hei
nte
rvi
ew
Kn
owl
edg
eoft
hec
ult
ureorc
ult
ure
sre
pre
sen
tedb
yth
epa
tie
nts
hou
ldb
eus
edt
o?He
lpma
kei
nte
rvi
ew
qu
est
ion
smo
rep
ert
ine
nt
Mr
s.Be
rge
risa3
9-y
ear
-ol
dwoma
nwh
opr
ese
ntswi
thac
omp
lai
ntofe
pig
ast
ri
cab
domi
nal
pai
n.Youh
ave
c
omp
let
edt
hei
nsp
ect
ionoft
hea
bdome
n.Wh
ati
syou
rne
xts
tepi
nth
eas
ses
sme
ntp
roc
ess
?Au
scu
lta
tion
Ag
uid
eforh
ist
oryt
aki
ngi
sforc
are
giv
erst
o-Ma
ken
ote
ssp
ari
ngl
ysot
hatp
ati
ent
sca
nbeob
ser
vedd
uri
ngt
he
h
ist
oryt
aki
ng
Wh
icht
ypeofs
pec
ulu
msh
oul
dbeu
sedt
oex
ami
neap
ati
ent
’
sty
mpa
nicme
mbr
ane
?
Youa
rep
alp
ati
ngap
ati
ent
’
sth
yroi
dan
dfi
ndt
hati
tsb
roa
des
tdi
men
sionme
asu
res4
cm.
ther
igh
tlob
eis2
5%
l
arg
ert
hant
hel
eft
.Th
esed
atawou
ldi
ndi
cat
e?
Mr
.L.
pre
sen
tst
oth
ecl
i
nicwi
ths
eve
reg
roi
npa
ina
ndah
ist
oryofk
idn
eys
ton
es.
Mr.
L.’
ssont
el
lsy
out
hat
,for
r
eli
gi
ousr
eas
ons
,hi
sfa
the
rwi
she
stok
eepa
nys
ton
eth
ati
spa
sse
din
tot
heu
rin
efi
l
tert
hath
eha
sbe
enu
sin
g.
Wh
ati
syou
rmos
tap
prop
ria
ter
esp
ons
e?
Be
for
epe
rfor
min
gana
bdomi
nal
exa
min
ati
on,
thee
xami
ners
hou
ld?
Youa
ree
xami
ni
ngap
reg
nan
tpa
tie
nta
ndh
aven
ote
dav
asc
ula
rle
sion
.Wh
eny
oub
lan
cheov
ert
hev
asc
ula
r
l
esi
on,
thes
it
ebl
anc
hesa
ndr
efi
l
lse
ven
lyf
romt
hec
ent
erou
twa
rd.
Then
urs
edoc
ume
ntst
hisl
esi
ona
sa?
Asy
oue
xpl
ai
nyou
rpa
tie
nt’
scon
dit
iont
ohe
rhu
sba
nd,y
oun
oti
cet
hath
eisl
ean
ingt
owa
rdy
oua
ndp
oin
ted
ly
b
li
nki
ngh
ise
yes
.Kn
owi
ngt
hath
eisf
romE
ngl
and
,you
rmos
tap
prop
ria
ter
esp
ons
etot
hisb
eha
viori
sto?
Wh
enp
alp
ati
ngt
hea
bdome
n,y
ous
hou
ldn
otewh
eth
ert
hel
i
veri
sen
lar
gedi
nth
e?
E
xpe
cte
dnor
mal
per
cus
siont
one
sin
clu
de?
Mr
.Ab
dul
isa4
0-y
ear
-ol
dMi
ddl
eEa
ste
rnma
nwh
opr
ese
ntst
oth
eof
fi
cef
oraf
ir
stv
isi
twi
tht
hec
omp
lai
ntof
n
ewa
bdomi
nal
pai
n.Youa
tec
onc
ern
eda
bou
tvi
ol
ati
ngac
ult
ura
lpr
ohi
bi
ti
onwh
eny
oup
rep
aret
odoh
isr
ect
al
e
xami
nat
ion
.Th
ebe
stt
act
icwou
ldb
eto?
F
luor
esc
ingl
esi
onsa
reb
estdi
st
ing
uis
hedu
sin
ga(
n)?
Mr
s.Ha
rtz
ell
isa3
4-y
ear
-ol
dpa
tie
ntwh
oha
spr
ese
nte
dforn
utr
it
ion
alc
oun
sel
i
ngb
eca
uses
hei
sa
v
ege
tar
ian
.De
fic
ien
cyofwh
ichoft
hef
oll
owi
ngi
sac
onc
erni
nth
eve
get
ari
and
iet
?
m Exam /NURS6512Week6Mi dt
erm Exam
(Lat
est)
:
AdvancedHeal
thAssessment:Wal
denUniversi
ty(
Alr
eadygradedA)
NURS6512Week6Mid
ter
mExam/NURS6
512We
ek6Mi
dte
rmE
xam(
Lat
est
):Ad
van
ced
Heal
thAs
sess
me n
t:Wal
denUn
ive
rsi
ty
Be
for
epe
rfor
min
gana
bdomi
nal
exa
min
ati
on,
thee
xami
ners
hou
ld:
Hav
eth
epa
tie
nte
mpt
yth
eirb
lad
der
Du
rin
gani
nte
rvi
ew,
tea
rsa
ppe
ari
nth
epa
tie
nt’
sey
esa
ndh
isv
oic
ebe
come
ssh
aky
.In
iti
al
ly
,yous
hou
ld:
Kee
p
t
hei
nte
rvi
ewmov
ingt
odi
st
rac
tth
epa
tie
nt
Wh
ichoft
hef
oll
owi
ngi
sth
emos
tac
cur
ater
efl
ect
ionofa
nin
div
idu
al’
sfoodi
nta
ke?F
oodd
iar
y
Pe
rcu
ssi
nga
tth
eri
ghtmi
dcl
avi
cul
arl
i
ne,
bel
owt
heu
mbi
l
icu
s,a
ndc
ont
inu
ingu
pwa
rdi
sth
ecor
rec
tte
chn
iqu
e
f
orl
oca
tin
gth
e:L
owe
rli
verb
ord
er
Af
ix
edi
mag
eofa
nyg
rou
pth
atr
ej
ect
sit
spot
ent
ial
foror
igi
nal
i
tyori
ndi
vi
dua
li
tyi
skn
owna
sa:
Ste
reot
ype
Pe
rit
oni
ti
spr
odu
cesb
owe
lsou
ndst
hata
reDe
cre
ase
d/Hy
poa
cti
ve
Br
it
tl
ena
il
sar
ety
pic
alf
indi
ngsi
n:
Old
era
dul
ts
Wh
ichoft
hef
oll
owi
ngi
sane
xpe
cte
dch
ang
eint
hea
sse
ssme
ntoft
het
hyr
oidd
uri
ngp
reg
nan
cy?Ab
rui
ti
s
a
usc
ult
ate
dd/
tin
cre
ase
dva
scu
lar
it
y
Youa
rep
lan
nin
gtop
alp
atet
hea
bdome
nofy
ourp
ati
ent
.Wh
ichp
artoft
hee
xami
ner
'
sha
ndi
sbe
stf
orp
alp
ati
ng
v
ibr
ati
on?Ul
nars
urf
ace
A5
-ye
ar-
ol
dch
il
dpr
ese
ntswi
thn
asa
lcon
ges
ti
ona
ndah
ead
ach
etoa
sse
ssf
ors
inu
ste
nde
rne
ssy
ous
hou
ld
p
alp
ateov
ert
he:
Max
il
la
rys
inu
seson
ly
Du
rin
gph
ysi
cal
exa
min
ati
onofa3
0-y
ear
-ol
dCh
ine
sema
nyoun
oti
ceas
li
ghta
symme
tryofh
isf
ace
.th
e
c
ran
ial
ner
vee
xami
nat
ioni
snor
mal
.You
rbe
sta
cti
oni
sto–As
kth
epa
tie
nti
fth
isc
har
act
eri
st
icr
unsi
nth
e
f
ami
l
y
Un
usu
alwh
itea
rea
sont
hes
kinma
ybedu
eto-
Vit
il
i
go
Youa
reu
sin
ganop
hth
almos
cop
etoe
xami
neap
ati
ent
’
sin
nere
ye.
Your
ota
tet
hel
enss
ele
ctorc
loc
kwi
se,
t
henc
oun
ter
cl
ock
wis
etoc
omp
ens
atef
or:
Myop
ia
Mr
s.We
bbi
sa3
8-y
earol
dpa
tie
ntwh
oha
sbe
enc
han
gin
ghe
rli
fes
tyl
etoe
ati
nah
eal
thywa
yan
dlos
ewe
igh
t:
du
rin
gyou
rhe
alt
hpr
omot
ione
duc
ati
onr
ega
rdi
ngh
ern
utr
it
ion
als
tat
us,
youe
xpl
ai
nth
efu
nct
ionofd
iet
aryp
rot
ei
n
a
s:Bu
il
di
nga
ndma
int
ain
ingt
is
sue
s
Mr
.Ak
insi
sa7
8-y
/op
ati
entwh
opr
ese
ntst
oth
ecl
i
nicwi
thc
omp
lai
ntsofh
ear
ingl
oss
.Wh
ichoft
hef
oll
owi
nga
re
c
han
gesi
nhe
ari
ngt
hatoc
curi
nth
eel
der
ly
?Se
lec
tal
lt
hata
ppl
y.L
ossofh
ighf
requ
enc
y-s
oun
dsma
ybeg
arb
led
,
di
ff
icu
ltt
oloc
ali
ze–u
nab
let
ohe
ari
nac
rowd
edr
oom
Th
emos
tsu
per
iorp
artoft
hes
toma
chi
sth
e-F
und
us
,Mr
s.Gr
acei
sa5
8-y
ear
-ol
dpa
tie
ntwh
oha
sad
iag
nos
isofp
ern
ici
ousa
nemi
a.Wh
ichBv
it
ami
nisde
fic
ien
tin
p
ati
ent
swi
thp
ern
ici
ousa
nemi
a?B1
2
A5
1-y
/owoma
nca
ll
swi
thc
omp
lai
ntsofwe
igh
tlos
san
dcon
sti
pat
ion
.Sh
ere
por
tse
nla
rge
dhe
mor
rhoi
dsa
nd
r
ect
alb
lee
din
g.Youa
dvi
seh
ert
o:Comet
oth
ela
bor
ator
yforas
tool
gua
iac
,Pl
aci
ngt
heb
aseofav
ibr
ati
ngt
uni
ngf
orkont
hemi
dl
in
eve
rte
xoft
hep
ati
ent
’
she
adi
sat
estf
or:
Lat
era
li
zat
ion
ofs
oun
d
Wh
icht
ech
niqu
eismos
tli
kel
ytor
esu
lti
nth
epa
tie
ntsu
nde
rst
and
ingofqu
est
ion
s?Us
eth
epa
tie
nt’
sown
t
ermsi
fpos
sib
le
Mr
.Wi
l
li
ams
,ag
e25
,ha
sre
cov
ere
dre
cen
tlyf
roma
nup
pera
ndl
owe
rre
spi
rat
oryi
nfe
cti
on.
Hede
scr
ibe
sal
ong
-
s
tan
din
gna
sal
dri
ppi
ng.
Hei
sse
eki
ngt
rea
tme
ntf
orami
l
dhe
ari
ngl
osst
hath
asn
otg
onea
way
.In
for
mat
ion
c
onc
ern
ingh
isc
hron
icp
ost
nas
ald
rips
hou
ldb
edoc
ume
nte
dwi
thi
nwh
ichs
ect
ionoft
heh
ist
ory
?Pa
stme
dic
al
d
ata
Na
sal
symp
tomst
hati
mpl
yana
ll
erg
icr
esp
ons
ein
clu
de:
Blu
ishg
rayt
urb
ina
tes(
Tur
bin
ate
sth
ata
ppe
ar
b
lui
shg
rayorp
alep
inkwi
thas
wol
l
enb
odyc
ons
ist
enc
yma
yin
dic
atea
ll
erg
ies
.Se
ide
l24
3
Mr
.Fr
ank
li
niss
pea
kin
gwi
thy
out
heh
eal
thc
arep
rov
ide
r,a
bou
thi
sre
spi
rat
oryp
rob
lem.
Mr.
Fra
nkl
i
nsa
ys,
“I’
ve
h
adt
hisc
oug
hfor3d
aysa
ndi
t’
sge
tti
ngwor
se.
”Your
epl
y,“
Tel
lmemor
eab
outy
ourc
oug
h.”Mr
.Fr
ank
li
nst
ate
s,
“
Iwi
shI
cou
ldt
el
lyoumor
e,t
hat
’
swh
yIa
mhe
re!
Yout
el
lmewh
at’
swr
ong
.”Wh
ichc
are
giv
err
esp
ons
ewou
ldb
e
t
hemos
tap
prop
ria
tef
ore
nha
nci
ngc
ommu
nic
ati
on?Af
ter3d
ays
,you
’r
eti
redofc
oug
hin
g.Ha
vey
ouh
adaf
eve
r?
Wh
ent
aki
ngah
ist
ory
,yous
hou
ld:
Useac
hron
olog
ica
nds
equ
ent
ial
fra
mewor
k
Wh
ichoft
hef
oll
owi
ngf
orma
tswou
ldb
eus
edf
orv
isi
tst
hata
ddr
essp
rob
lemsn
oty
eti
den
tif
iedi
nth
epr
obl
em-
or
ien
tedme
dic
alr
ecor
d(POMR)
?Br
iefSOAPn
ote
Mr
.an
dMr
s.J
ohn
sonh
avep
res
ent
edt
oth
eof
fi
cewi
tht
hei
ri
nfa
nts
onwi
thc
omp
lai
ntsofe
ard
rai
nag
e.Wh
en
e
xami
ni
nga
nin
fan
t’
smi
ddl
eea
r,t
hen
urs
esh
oul
dus
eon
eha
ndt
ost
abi
l
izet
heot
osc
opea
gai
nstt
heh
eadwh
il
e
u
sin
gth
eot
herh
andt
o:Pu
llt
hea
uri
cl
edowna
ndb
acki
nane
ffor
ttos
tra
igh
tent
heu
pwa
rdc
urv
atu
reoft
hec
ana
l
Wh
ichqu
est
ionwou
ldb
econ
sid
ere
dal
eadi
ngqu
est
ion
?Youd
on’
tge
the
ada
che
sof
ten
,doy
ou?
Mr
.Bl
acki
sa4
4y/
opa
tie
ntwh
opr
ese
ntst
oth
ecl
i
nicwi
thc
omp
lai
ntsofn
eckp
aint
hath
eth
ink
sisf
romh
is
j
obi
nvol
vi
ngc
omp
ute
rda
tae
ntr
y.Ast
hee
xami
ner
,youa
rec
hec
kin
gth
era
ngeofmot
ioni
nhi
sne
cka
ndn
ote
t
heg
rea
tes
tde
gre
eofc
erv
ica
lmob
il
it
yisa
t?C4t
oC5
;C4a
ndC5a
ndC6p
rov
idet
heg
rea
tes
thor
iz
ont
al
mob
il
it
yina
dul
ts
Th
ete
rmd
enot
ingt
hec
are
giv
er’
sne
edt
odon
oha
rmt
oth
epa
tie
nti
s:De
ont
olog
ici
mpe
rat
iv
es
At
ool
use
dtos
cre
ena
dol
esc
ent
sfora
lcoh
oli
smi
sth
e:CRAF
FT
Un
dern
orma
lci
rc
ums
tan
ces
,howmu
chwa
teri
slos
tda
il
ybyt
heb
ody
?Ap
prox
.2t
o2.
5li
te
rsofwa
teri
slos
t
da
il
y
Youh
avej
ustc
omp
let
edas
kina
sse
ssme
ntonMr
.Ba
ker
.Du
rin
gyou
ras
ses
sme
nt,
youh
avet
ran
sil
l
umi
nat
eda
s
kinl
esi
on.
Dur
ingt
hep
hys
ica
lex
ami
nat
ion
,youk
nowt
hats
kinl
esi
onsa
ret
ran
sil
l
umi
nat
edt
odi
st
ing
uis
h:
Tr
ans
il
lu
min
ati
oni
sus
edt
ode
ter
min
eth
epr
ese
nceoff
lui
dinc
yst
san
dma
sse
s.F
lui
dfi
l
ledl
esi
onswi
l
l
t
ran
sil
l
umi
nat
ewi
thar
edg
low,
ands
oli
dma
sse
swi
l
lnott
ran
sil
l
umi
nat
e.
Mr
.Mi
l
lsi
sa5
5/y
/op
ati
entwh
opr
ese
ntst
oth
eof
fi
cef
ora
nin
iti
alv
isi
tforh
eal
thp
romot
ion
.As
urv
eyof
mob
il
it
yan
dac
ti
vi
ti
esofa
cti
vi
ti
esofd
ail
yli
vi
ngi
spa
rtofa
(n)
:Fu
nct
ion
ala
sse
ssme
nt
Swe
atg
lan
ds,
hai
r,
andn
ail
sar
eal
lfor
medf
rom?I
nva
gin
ati
onofe
pid
ermi
sin
tod
ermi
s
, Ab
rie
fst
ate
men
toft
her
eas
ont
hep
ati
enti
sse
eki
ngh
eal
thc
arei
sca
ll
edt
he?Ch
iefc
onc
ern
Wh
ichp
artoft
hei
nfor
mat
ionc
ont
ain
edi
nth
epa
tie
nt’
sre
cor
dma
ybeu
sedi
ncou
rt?An
yth
ingt
hati
sen
ter
edi
nto
ap
ati
ent
’
sre
cor
dinp
ape
rore
lec
tron
icf
ormi
sal
ega
ldoc
ume
ntt
hatc
anb
eus
ed
Wh
ichc
ran
ial
ner
vesi
nne
rva
tet
hef
ace
?5a
nd7
I
ncou
nse
li
ngac
li
entr
ega
rdi
ngn
utr
it
ione
duc
ati
on,
youe
xpl
ai
nth
atl
i
nol
ei
cac
id,
ama
jorf
att
yac
id,
ist
hou
ghtt
o
b
ees
sen
tia
lfor
?Li
nol
ei
cac
id,
fou
nda
bun
dan
tlyi
nmi
l
kan
dda
iryf
ati
sre
qui
redf
orn
orma
lgr
owt
han
d
d
eve
lop
men
t,i
tha
sbe
ens
ugg
est
edt
hati
tca
nre
duc
ebod
yfa
tinov
erwe
igh
tpa
tie
nt
Wh
ena
reop
en-
end
edqu
est
ion
sge
ner
all
ymos
tus
efu
l?Du
rin
gth
ein
iti
alp
artoft
hei
nte
rvi
ew
Kn
owl
edg
eoft
hec
ult
ureorc
ult
ure
sre
pre
sen
tedb
yth
epa
tie
nts
hou
ldb
eus
edt
o?He
lpma
kei
nte
rvi
ew
qu
est
ion
smo
rep
ert
ine
nt
Mr
s.Be
rge
risa3
9-y
ear
-ol
dwoma
nwh
opr
ese
ntswi
thac
omp
lai
ntofe
pig
ast
ri
cab
domi
nal
pai
n.Youh
ave
c
omp
let
edt
hei
nsp
ect
ionoft
hea
bdome
n.Wh
ati
syou
rne
xts
tepi
nth
eas
ses
sme
ntp
roc
ess
?Au
scu
lta
tion
Ag
uid
eforh
ist
oryt
aki
ngi
sforc
are
giv
erst
o-Ma
ken
ote
ssp
ari
ngl
ysot
hatp
ati
ent
sca
nbeob
ser
vedd
uri
ngt
he
h
ist
oryt
aki
ng
Wh
icht
ypeofs
pec
ulu
msh
oul
dbeu
sedt
oex
ami
neap
ati
ent
’
sty
mpa
nicme
mbr
ane
?
Youa
rep
alp
ati
ngap
ati
ent
’
sth
yroi
dan
dfi
ndt
hati
tsb
roa
des
tdi
men
sionme
asu
res4
cm.
ther
igh
tlob
eis2
5%
l
arg
ert
hant
hel
eft
.Th
esed
atawou
ldi
ndi
cat
e?
Mr
.L.
pre
sen
tst
oth
ecl
i
nicwi
ths
eve
reg
roi
npa
ina
ndah
ist
oryofk
idn
eys
ton
es.
Mr.
L.’
ssont
el
lsy
out
hat
,for
r
eli
gi
ousr
eas
ons
,hi
sfa
the
rwi
she
stok
eepa
nys
ton
eth
ati
spa
sse
din
tot
heu
rin
efi
l
tert
hath
eha
sbe
enu
sin
g.
Wh
ati
syou
rmos
tap
prop
ria
ter
esp
ons
e?
Be
for
epe
rfor
min
gana
bdomi
nal
exa
min
ati
on,
thee
xami
ners
hou
ld?
Youa
ree
xami
ni
ngap
reg
nan
tpa
tie
nta
ndh
aven
ote
dav
asc
ula
rle
sion
.Wh
eny
oub
lan
cheov
ert
hev
asc
ula
r
l
esi
on,
thes
it
ebl
anc
hesa
ndr
efi
l
lse
ven
lyf
romt
hec
ent
erou
twa
rd.
Then
urs
edoc
ume
ntst
hisl
esi
ona
sa?
Asy
oue
xpl
ai
nyou
rpa
tie
nt’
scon
dit
iont
ohe
rhu
sba
nd,y
oun
oti
cet
hath
eisl
ean
ingt
owa
rdy
oua
ndp
oin
ted
ly
b
li
nki
ngh
ise
yes
.Kn
owi
ngt
hath
eisf
romE
ngl
and
,you
rmos
tap
prop
ria
ter
esp
ons
etot
hisb
eha
viori
sto?
Wh
enp
alp
ati
ngt
hea
bdome
n,y
ous
hou
ldn
otewh
eth
ert
hel
i
veri
sen
lar
gedi
nth
e?
E
xpe
cte
dnor
mal
per
cus
siont
one
sin
clu
de?
Mr
.Ab
dul
isa4
0-y
ear
-ol
dMi
ddl
eEa
ste
rnma
nwh
opr
ese
ntst
oth
eof
fi
cef
oraf
ir
stv
isi
twi
tht
hec
omp
lai
ntof
n
ewa
bdomi
nal
pai
n.Youa
tec
onc
ern
eda
bou
tvi
ol
ati
ngac
ult
ura
lpr
ohi
bi
ti
onwh
eny
oup
rep
aret
odoh
isr
ect
al
e
xami
nat
ion
.Th
ebe
stt
act
icwou
ldb
eto?
F
luor
esc
ingl
esi
onsa
reb
estdi
st
ing
uis
hedu
sin
ga(
n)?
Mr
s.Ha
rtz
ell
isa3
4-y
ear
-ol
dpa
tie
ntwh
oha
spr
ese
nte
dforn
utr
it
ion
alc
oun
sel
i
ngb
eca
uses
hei
sa
v
ege
tar
ian
.De
fic
ien
cyofwh
ichoft
hef
oll
owi
ngi
sac
onc
erni
nth
eve
get
ari
and
iet
?
