CDC is the abbreviation for which of the following?

Simulated Patient Case Scenario: Respiratory and Abdominal Assessment Read the following case scenario, as documented in a “SO”AP format. Then follow the directions. Patient Information Name: David ReynoldsAge: 54 yearsSex: MaleRace/Ethnicity: African American Chief Complaint “I’ve had this cough for over a week, and now my stomach hurts every time I cough.” History of Present Illness David Reynolds is a 54-year-old African American male presenting to an urgent care clinic with an 8-day history of a productive cough. He reports coughing up thick yellow sputum and states that his symptoms have gradually worsened over the past several days. He also reports increasing fatigue and mild shortness of breath with activity. Mr. Reynolds reports that his cough and shortness of breath have progressively worsened over the past two days despite using an over-the-counter cough suppressant. This morning, he noticed he became more winded while walking from the parking lot to work and decided to seek evaluation at an urgent care clinic.  Mr. Reynolds states that his lower abdomen has become sore from frequent coughing. He describes the discomfort as a dull ache that worsens when he coughs and improves with rest. He rates the discomfort as 3/10 and denies sharp abdominal pain. He reports a decreased appetite but has been able to maintain adequate fluid intake. He has been taking an over-the-counter cough suppressant with minimal relief. He denies nausea, vomiting, diarrhea, constipation, hematemesis, melena, urinary symptoms, chest pain unrelated to coughing, recent travel, or known exposure to individuals with similar symptoms. Past Medical History Hypertension Hyperlipidemia Surgical History Cholecystectomy at age 42 Medications Amlodipine 10 mg orally once daily Atorvastatin 20 mg orally once daily Over-the-counter cough suppressant as needed Allergies No known drug allergies Family History Father deceased at age 72 from myocardial infarction; history of hypertension and hyperlipidemia Mother alive, age 79, with type 2 diabetes mellitus Brother alive with chronic obstructive pulmonary disease (COPD); current smoker No known family history of lung cancer, asthma, or cystic fibrosis Social History Married; lives with spouse Works as a warehouse supervisor Smokes approximately one pack of cigarettes daily for 30 years (30 pack-year history) Drinks 1–2 alcoholic beverages on weekends Denies vaping or illicit drug use No recent travel No known occupational exposure to asbestos, silica, or other respiratory hazards Review of Systems General Reports fatigue and decreased appetite over the past week. Denies chills, night sweats, or unintended weight loss. Skin Denies rashes, lesions, cyanosis, or diaphoresis. HEENT Denies headache, dizziness, visual changes, ear pain, hearing changes, nasal congestion, rhinorrhea, sinus pressure, sore throat, dysphagia, or hoarseness. Respiratory Reports an 8-day history of productive cough with thick yellow sputum, mild shortness of breath with exertion, and occasional pleuritic discomfort when coughing. Denies hemoptysis or wheezing. Cardiovascular Denies chest pain unrelated to coughing, palpitations, orthopnea, paroxysmal nocturnal dyspnea, syncope, or lower extremity edema. Gastrointestinal Reports soreness across the lower abdomen that worsens with coughing. Reports decreased appetite. Denies nausea, vomiting, diarrhea, constipation, abdominal distention, hematemesis, melena, hematochezia, or changes in bowel habits. Genitourinary Denies dysuria, urinary frequency, urgency, hematuria, or flank pain. Musculoskeletal Reports soreness of the lower abdominal muscles associated with frequent coughing. Denies joint pain, muscle weakness, back pain, or recent trauma. Neurological Denies headache, dizziness, weakness, numbness, tingling, or changes in coordination. Psychiatric Denies anxiety, depression, or changes in mood. Reports sleep has been interrupted due to frequent coughing. Endocrine Denies heat or cold intolerance, excessive thirst, excessive hunger, or polyuria. Hematologic/Lymphatic Denies easy bruising, bleeding, or swollen lymph nodes. Allergic/Immunologic Denies seasonal allergy symptoms, recent allergen exposure, or immunocompromised state. Objective Assessment Findings Vital Signs Blood Pressure: 148/88 mmHg Heart Rate: 96 bpm Respiratory Rate: 22 breaths/min Temperature: 100.9°F (38.3°C) Oxygen Saturation: 93% on room air Height: 5 ft 11 in Weight: 215 lb BMI: 30.0 kg/m² Physical Examination General Alert and oriented ×4. Appears mildly ill and fatigued. Mild respiratory distress noted with exertion. Productive cough observed throughout the examination. Skin Warm and dry. No cyanosis or diaphoresis. HEENT Head normocephalic and atraumatic. Oral mucosa pink and moist. No pharyngeal erythema or exudate. Neck Supple without cervical lymphadenopathy. Trachea midline. Respiratory Respiratory rate mildly increased. Mild use of accessory muscles with exertion. Chest expansion mildly decreased over the right lower posterior thorax. Increased tactile fremitus over the right lower lobe. Percussion reveals dullness over the right lower posterior lung field. Crackles auscultated over the right lower lobe. Remaining lung fields clear to auscultation bilaterally. No wheezes or rhonchi. Cardiovascular Regular rate and rhythm. S1 and S2 present. No murmurs, rubs, or gallops. Peripheral pulses 2+ bilaterally. Abdomen Abdomen soft and nondistended. Bowel sounds normoactive in all four quadrants. Mild tenderness of the lower abdominal musculature with coughing. No tenderness to light or deep palpation at rest. No rebound tenderness or guarding. No palpable masses. No hepatosplenomegaly. No costovertebral angle tenderness. Musculoskeletal Full range of motion of all extremities. Lower abdominal discomfort reproduced only during coughing. Neurological Alert and oriented ×4. Speech clear. No focal neurologic deficits. Diagnostics No laboratory studies or imaging have been obtained prior to today’s evaluation in the urgent care clinic. ——————————————————– Written Response Question Based on David Reynolds’ history and physical examination findings obtained throughout this case, identify your top three differential diagnoses in order of priority. In your response: Identify three appropriate differential diagnoses and rank them in order of priority. Explain the subjective and objective assessment findings that support each differential diagnosis. Describe how the patient’s history, risk factors, and physical examination findings contribute to your clinical reasoning and prioritization of the differential diagnoses. Directions Respond in 3–4 well-developed paragraphs using evidence-based clinical reasoning and appropriate medical terminology. Support your rationale with in-text citations when appropriate. Course textbook(s), course lecture notes, and course content are the only resources permitted. A reference page is not required. Please see the attached rubric.

/content/enforced2/8034374-APSU_202014_NURS2020_NURS_NURS2020_SEC01_NURS2020/Sound4.m4a Sound _______ David Reynolds presents to the urgent care clinic with complaints of a productive cough and shortness of breath. During your respiratory assessment, you auscultate the following breath sound over the right lower posterior lung field. Listen to the audio recording and identify the breath sound. The breath sound is: ____________________________ Identify the lung sound above.  (Normal, Crackles, Wheezes, Pleural Rub, Stridor)

Reflect on your current professional transition from RN to Advanced Practice Nurse (APN). What do you see is the biggest challenge going from RN to Advanced Practice Nurse?  How are you approaching the assessment process differently (if at all)? *Respond in well-developed paragraph format. Your response should be 2–3 well-developed paragraphs. Do not use bullet points or numbered lists.  *Please refer to the attached rubric for this test question.

Michael Turner presents with an intensely pruritic rash after clearing brush on his property. Which additional subjective history questions should the APRN ask to further evaluate the patient’s skin condition?

           Michael Turner is a 42-year-old White male presenting to an urgent care clinic with complaints of an itchy rash on his arms and legs. Chief Complaint “My rash keeps spreading and itching like crazy.” History of Present Illness Michael reports developing an itchy rash approximately five days ago. The rash first appeared on his right forearm and has since spread to both forearms and his lower legs. He describes the itching as severe, rating it 8/10, and states that it is worse at night and after sweating. Scratching provides temporary relief but seems to make the rash more irritated. The patient reports spending the previous weekend clearing brush and removing vines from the wooded area behind his home. He wore short sleeves and shorts while working outdoors for several hours. He recalls brushing against several plants but did not notice any immediate skin irritation. Approximately 24 to 48 hours later, he noticed redness and itching on his right forearm. Over the next several days, the rash became more widespread and developed small fluid-filled blisters. He denies pain but reports occasional burning sensations when sweating. He has applied over-the-counter hydrocortisone cream with minimal relief. He denies using any new soaps, detergents, lotions, perfumes, medications, or personal care products. He denies recent travel, insect bites, tick exposure, or contact with individuals who have similar symptoms. The patient denies fever, chills, fatigue, weight loss, shortness of breath, wheezing, facial swelling, lip swelling, tongue swelling, difficulty swallowing, nausea, vomiting, diarrhea, joint pain, or muscle aches. Past Medical History Seasonal allergic rhinitis Hyperlipidemia Childhood asthma, resolved No history of eczema, psoriasis, or chronic skin conditions Surgical History Appendectomy at age 18 Medications Atorvastatin 20 mg daily Cetirizine 10 mg daily during allergy season Hydrocortisone 1% cream applied to affected areas for the past two days Allergies Penicillin – develops rash No known food allergies Family History Father alive with hypertension and type 2 diabetes Mother alive with rheumatoid arthritis Sister alive with asthma Patient unsure whether any family members have psoriasis, eczema, melanoma, or other skin disorders Social History Married; lives with spouse and two children Works as a middle school science teacher Denies tobacco use Consumes alcohol socially, approximately 1–2 beers on weekends Denies illicit drug use Enjoys gardening, hiking, and outdoor activities Recently spent several hours clearing brush and vegetation on his property Review of Systems General Denies fever, chills, night sweats, fatigue, or unintended weight loss. Skin Reports intensely pruritic rash on bilateral forearms and lower legs. Reports redness and blister formation. Denies pain, drainage, bleeding, or previous similar episodes. HEENT Denies facial swelling, lip swelling, tongue swelling, visual changes, or oral lesions. Respiratory Denies cough, wheezing, chest tightness, or shortness of breath. Cardiovascular Denies chest pain, palpitations, or edema. Gastrointestinal Denies nausea, vomiting, abdominal pain, or diarrhea. Musculoskeletal Denies joint pain, swelling, or muscle aches. Neurological Denies headaches, dizziness, weakness, or sensory changes. Vital Signs: BP 126/78 mmHg HR 76 bpm RR 16/min Temperature 98.2°F (36.8°C) SpO2 99% on room air Height: 5’11” Weight: 210 lbs BMI: 29.3 kg/m² Physical Examination Findings: The patient is alert, oriented, cooperative, and appears mildly uncomfortable due to itching. Frequently scratches affected areas during the examination. Multiple erythematous linear plaques, papules, and vesicles are noted on the bilateral forearms and anterior lower legs. The largest affected area on the right forearm measures approximately 12 cm × 4 cm. Additional linear lesions range from 2 cm to 8 cm in length. Vesicles measure approximately 1–3 mm in diameter and contain clear serous fluid. Affected skin is erythematous with well-demarcated borders and mild surrounding edema. Several excoriations are present from scratching. A small amount of dried serous crusting is noted on two lesions of the left forearm. No purulent drainage, fluctuance, induration, warmth, abscess formation, or foul odor is present. No facial involvement is noted. No lesions are present on the scalp, palms, soles, oral mucosa, or genital region. Hair distribution and texture are normal throughout. No areas of alopecia, scaling, or infestation are observed. Nail plates are pink, smooth, and intact bilaterally. No clubbing, cyanosis, pitting, Beau’s lines, splinter hemorrhages, or fungal changes are present. Head is normocephalic and atraumatic. Conjunctivae are pink. Sclerae are white. Oral mucosa is pink and moist without lesions or edema. Respirations are even and unlabored. Breath sounds are clear throughout all lung fields. No wheezing, rales, or rhonchi are appreciated. Heart rate is regular without murmurs, rubs, or gallops. No cervical, supraclavicular, axillary, or epitrochlear lymphadenopathy is noted. No laboratory testing obtained during today’s visit. No skin biopsy performed. No imaging studies ordered. ——————————————————————– Directions: Write the Objective (“O”) section ONLY of a SOAP note for this patient. Follow the guidelines discussed in the “SO”AP Note TIPS and “SOAP Note Example located in Module 1. Your documentation should be complete, focused, and written as if you were the provider completing a clinical physical examination. Be sure to include all required components of the Objective section, including vital signs, general appearance, and a focused physical examination of the skin, hair, nails, and any additional body systems relevant to the patient’s presenting concern. Organize your documentation using appropriate body system headings and include pertinent positive and pertinent negative physical examination findings. Ensure that objective findings are factual, measurable, and observable. Do not include patient-reported information, interpretations, or subjective statements in this section. A focused physical examination is appropriate for this case; however, all relevant dermatologic findings must be clearly documented with appropriate clinical descriptors (e.g., location, distribution, color, size, lesion type, and associated findings). *Submit only the Objective (“O”) portion of the SOAP note. *Please refer to the attached rubric for this question.

Please read the following the case scenario and then follow the directions: Linda Martinez is a 52-year-old Hispanic female presenting to establish care and obtain a routine wellness examination. She recently relocated to the area and has not seen a primary care provider in approximately three years. When asked what brings her in today, she states, “I know I’m overdue for a checkup. I’ve also been feeling more tired than usual over the last few months.” Linda reports that the fatigue began gradually approximately four months ago. She feels tired most days and notices that her symptoms are worse in the evenings after work. Rest improves her symptoms somewhat, but she often wakes feeling unrefreshed despite sleeping six to seven hours each night. She rates the fatigue as a 5 on a 10-point scale. She reports gaining approximately 12 pounds during the past year and admits that she exercises less than she used to because she is often tired after work. She denies fever, chills, night sweats, chest pain, palpitations, shortness of breath, cough, wheezing, abdominal pain, nausea, vomiting, diarrhea, constipation, urinary symptoms, dizziness, syncope, numbness, tingling, or lower extremity swelling. She reports occasional headaches that occur once or twice per month and are relieved with over-the-counter acetaminophen. Linda states, “My mom developed diabetes around my age, and I’m worried the same thing may be happening to me.” Her medical history includes hypertension diagnosed five years ago and seasonal allergic rhinitis. She takes lisinopril 20 mg by mouth daily, loratadine 10 mg as needed for allergies, and a daily multivitamin. She reports an allergy to sulfa medications that causes a rash. She is married and lives with her husband. Their two adult children live independently. She works full-time as an administrative assistant at an elementary school and describes her job as busy and stressful. She smoked cigarettes for several years while in college but quit more than 25 years ago. She drinks one to two glasses of wine on most weekends and denies recreational drug use. She reports walking for exercise once or twice weekly when her schedule allows. Her mother has hypertension and type 2 diabetes. Her father died from heart disease. Her brother has hypertension. She is unsure of the age at which her father died and does not know whether any additional family members have cardiovascular disease or cancer. Linda reports receiving annual influenza vaccinations and completed the COVID-19 vaccine series. She recalls having a mammogram several years ago and completed a home colon cancer screening test “a long time ago.” She cannot remember when her last Pap smear was performed. Additional information obtained during the interview reveals that she has experienced increased stress at work over the past year. She denies depression, anxiety, suicidal thoughts, heat intolerance, cold intolerance, vision changes, hearing loss, difficulty swallowing, skin changes, or changes in appetite. Blood Pressure: 148/88 mmHg Heart Rate: 78 beats/minute Respiratory Rate: 16 breaths/minute Temperature: 98.4°F (36.9°C) Oxygen Saturation: 98% on room air Height: 5 feet 4 inches Weight: 186 pounds BMI: 31.9 kg/m² Patient is alert, cooperative female appearing stated age. Appropriately dressed and groomed. Maintains eye contact and answers questions appropriately. No acute distress noted. Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Conjunctiva pink without pallor. Tympanic membranes intact bilaterally. Nasal mucosa pink without drainage. Oral mucosa moist. Dentition in good repair. No oral lesions noted. Neck supple without cervical lymphadenopathy. A small, firm, non-tender nodule is palpated in the left thyroid lobe. No thyromegaly noted. Trachea midline. No carotid bruits. Heart regular rate and rhythm. Normal S1 and S2. No murmurs, rubs, or gallops. Peripheral pulses 2+ and equal bilaterally. No peripheral edema. Chest symmetrical. Respirations unlabored. Breath sounds clear to auscultation bilaterally without wheezes, crackles, or rhonchi. Breasts symmetric bilaterally. No skin dimpling, erythema, nipple retraction, or nipple discharge. No palpable masses or tenderness. No axillary lymphadenopathy. Soft abdomen, non-tender, non-distended. Bowel sounds present in all quadrants. No hepatosplenomegaly or masses palpated. Full range of motion in all extremities. No joint swelling, erythema, or deformities. Skin warm and dry. No rashes, lesions, or suspicious lesions noted. External genitalia without lesions or masses. Mild vaginal atrophy noted. Vaginal mucosa pale pink without discharge or lesions. Cervix visualized without lesions, masses, or discharge. No cervical motion tenderness. Uterus midline, smooth, and non-tender. Adnexa non-tender without palpable masses bilaterally. Pap smear specimen obtained during today’s visit. Alert and oriented to person, place, time, and situation. Cranial nerves II-XII grossly intact. Strength 5/5 throughout. Sensation intact. Gait steady. Screenings today: PHQ-9: Score 9 (mild depression symptoms) GAD-7: Score 5 (mild anxiety symptoms) The following labs are ordered today: Thyroid Stimulating Hormone (TSH) Free Thyroxine (Free T4) Comprehensive Metabolic Panel (CMP) Lipid Panel Hemoglobin A1C Pap smear (performed during today’s visit) ————————————————————————————— Please answer the following question: Which of the following physical examination techniques are appropriate to perform during Linda Martinez’s routine wellness examination? Select all that apply:

Read the following case scenario and then follow the directions: Linda Martinez is a 52-year-old Hispanic female presenting to establish care and obtain a routine wellness examination. She recently relocated to the area and has not seen a primary care provider in approximately three years. When asked what brings her in today, she states, “I know I’m overdue for a checkup. I’ve also been feeling more tired than usual over the last few months.” Linda reports that the fatigue began gradually approximately four months ago. She feels tired most days and notices that her symptoms are worse in the evenings after work. Rest improves her symptoms somewhat, but she often wakes feeling unrefreshed despite sleeping six to seven hours each night. She rates the fatigue as a 5 on a 10-point scale. She reports gaining approximately 12 pounds during the past year and admits that she exercises less than she used to because she is often tired after work. She denies fever, chills, night sweats, chest pain, palpitations, shortness of breath, cough, wheezing, abdominal pain, nausea, vomiting, diarrhea, constipation, urinary symptoms, dizziness, syncope, numbness, tingling, or lower extremity swelling. She reports occasional headaches that occur once or twice per month and are relieved with over-the-counter acetaminophen. Linda states, “My mom developed diabetes around my age, and I’m worried the same thing may be happening to me.” Her medical history includes hypertension diagnosed five years ago and seasonal allergic rhinitis. She takes lisinopril 20 mg by mouth daily, loratadine 10 mg as needed for allergies, and a daily multivitamin. She reports an allergy to sulfa medications that causes a rash. She is married and lives with her husband. Their two adult children live independently. She works full-time as an administrative assistant at an elementary school and describes her job as busy and stressful. She smoked cigarettes for several years while in college but quit more than 25 years ago. She drinks one to two glasses of wine on most weekends and denies recreational drug use. She reports walking for exercise once or twice weekly when her schedule allows. Her mother has hypertension and type 2 diabetes. Her father died from heart disease. Her brother has hypertension. She is unsure of the age at which her father died and does not know whether any additional family members have cardiovascular disease or cancer. Linda reports receiving annual influenza vaccinations and completed the COVID-19 vaccine series. She recalls having a mammogram several years ago and completed a home colon cancer screening test “a long time ago.” She cannot remember when her last Pap smear was performed. Additional information obtained during the interview reveals that she has experienced increased stress at work over the past year. She denies depression, anxiety, suicidal thoughts, heat intolerance, cold intolerance, vision changes, hearing loss, difficulty swallowing, skin changes, or changes in appetite. Blood Pressure: 148/88 mmHg Heart Rate: 78 beats/minute Respiratory Rate: 16 breaths/minute Temperature: 98.4°F (36.9°C) Oxygen Saturation: 98% on room air Height: 5 feet 4 inches Weight: 186 pounds BMI: 31.9 kg/m² Patient is alert, cooperative female appearing stated age. Appropriately dressed and groomed. Maintains eye contact and answers questions appropriately. No acute distress noted. Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Conjunctiva pink without pallor. Tympanic membranes intact bilaterally. Nasal mucosa pink without drainage. Oral mucosa moist. Dentition in good repair. No oral lesions noted. Neck supple without cervical lymphadenopathy. A small, firm, non-tender nodule is palpated in the left thyroid lobe. No thyromegaly noted. Trachea midline. No carotid bruits. Heart regular rate and rhythm. Normal S1 and S2. No murmurs, rubs, or gallops. Peripheral pulses 2+ and equal bilaterally. No peripheral edema. Chest symmetrical. Respirations unlabored. Breath sounds clear to auscultation bilaterally without wheezes, crackles, or rhonchi. Breasts symmetric bilaterally. No skin dimpling, erythema, nipple retraction, or nipple discharge. No palpable masses or tenderness. No axillary lymphadenopathy. Soft abdomen, non-tender, non-distended. Bowel sounds present in all quadrants. No hepatosplenomegaly or masses palpated. Full range of motion in all extremities. No joint swelling, erythema, or deformities. Skin warm and dry. No rashes, lesions, or suspicious lesions noted. External genitalia without lesions or masses. Mild vaginal atrophy noted. Vaginal mucosa pale pink without discharge or lesions. Cervix visualized without lesions, masses, or discharge. No cervical motion tenderness. Uterus midline, smooth, and non-tender. Adnexa non-tender without palpable masses bilaterally. Pap smear specimen obtained during today’s visit. Alert and oriented to person, place, time, and situation. Cranial nerves II-XII grossly intact. Strength 5/5 throughout. Sensation intact. Gait steady. Screenings today: PHQ-9: Score 9 (mild depression symptoms) GAD-7: Score 5 (mild anxiety symptoms) The following labs are ordered today: Thyroid Stimulating Hormone (TSH) Free Thyroxine (Free T4) Comprehensive Metabolic Panel (CMP) Lipid Panel Hemoglobin A1C Pap smear (performed during today’s visit) ————————————————————————— Directions: Reflect on the role of therapeutic communication and interviewing techniques in obtaining accurate patient information. Provide at least three (3) examples of specific interview strategies you would use with this patient and explain how they contribute to diagnostic accuracy and patient-centered care.  *Respond in well-developed paragraph format. Do not use bullet points or numbered lists. Your response should be 3 well-developed paragraphs. Include in-text citations to support your rationale.  *Please refer to the attached rubric for this test question.

Read the following case scenario and then follow the directions: Linda Martinez is a 52-year-old Hispanic female presenting to establish care and obtain a routine wellness examination. She recently relocated to the area and has not seen a primary care provider in approximately three years. When asked what brings her in today, she states, “I know I’m overdue for a checkup. I’ve also been feeling more tired than usual over the last few months.” Linda reports that the fatigue began gradually approximately four months ago. She feels tired most days and notices that her symptoms are worse in the evenings after work. Rest improves her symptoms somewhat, but she often wakes feeling unrefreshed despite sleeping six to seven hours each night. She rates the fatigue as a 5 on a 10-point scale. She reports gaining approximately 12 pounds during the past year and admits that she exercises less than she used to because she is often tired after work. She denies fever, chills, night sweats, chest pain, palpitations, shortness of breath, cough, wheezing, abdominal pain, nausea, vomiting, diarrhea, constipation, urinary symptoms, dizziness, syncope, numbness, tingling, or lower extremity swelling. She reports occasional headaches that occur once or twice per month and are relieved with over-the-counter acetaminophen. Linda states, “My mom developed diabetes around my age, and I’m worried the same thing may be happening to me.” Her medical history includes hypertension diagnosed five years ago and seasonal allergic rhinitis. She takes lisinopril 20 mg by mouth daily, loratadine 10 mg as needed for allergies, and a daily multivitamin. She reports an allergy to sulfa medications that causes a rash. She is married and lives with her husband. Their two adult children live independently. She works full-time as an administrative assistant at an elementary school and describes her job as busy and stressful. She smoked cigarettes for several years while in college but quit more than 25 years ago. She drinks one to two glasses of wine on most weekends and denies recreational drug use. She reports walking for exercise once or twice weekly when her schedule allows. Her mother has hypertension and type 2 diabetes. Her father died from heart disease. Her brother has hypertension. She is unsure of the age at which her father died and does not know whether any additional family members have cardiovascular disease or cancer. Linda reports receiving annual influenza vaccinations and completed the COVID-19 vaccine series. She recalls having a mammogram several years ago and completed a home colon cancer screening test “a long time ago.” She cannot remember when her last Pap smear was performed. Additional information obtained during the interview reveals that she has experienced increased stress at work over the past year. She denies depression, anxiety, suicidal thoughts, heat intolerance, cold intolerance, vision changes, hearing loss, difficulty swallowing, skin changes, or changes in appetite. Blood Pressure: 148/88 mmHg Heart Rate: 78 beats/minute Respiratory Rate: 16 breaths/minute Temperature: 98.4°F (36.9°C) Oxygen Saturation: 98% on room air Height: 5 feet 4 inches Weight: 186 pounds BMI: 31.9 kg/m² Patient is alert, cooperative female appearing stated age. Appropriately dressed and groomed. Maintains eye contact and answers questions appropriately. No acute distress noted. Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Conjunctiva pink without pallor. Tympanic membranes intact bilaterally. Nasal mucosa pink without drainage. Oral mucosa moist. Dentition in good repair. No oral lesions noted. Neck supple without cervical lymphadenopathy. A small, firm, non-tender nodule is palpated in the left thyroid lobe. No thyromegaly noted. Trachea midline. No carotid bruits. Heart regular rate and rhythm. Normal S1 and S2. No murmurs, rubs, or gallops. Peripheral pulses 2+ and equal bilaterally. No peripheral edema. Chest symmetrical. Respirations unlabored. Breath sounds clear to auscultation bilaterally without wheezes, crackles, or rhonchi. Breasts symmetric bilaterally. No skin dimpling, erythema, nipple retraction, or nipple discharge. No palpable masses or tenderness. No axillary lymphadenopathy. Soft abdomen, non-tender, non-distended. Bowel sounds present in all quadrants. No hepatosplenomegaly or masses palpated. Full range of motion in all extremities. No joint swelling, erythema, or deformities. Skin warm and dry. No rashes, lesions, or suspicious lesions noted. External genitalia without lesions or masses. Mild vaginal atrophy noted. Vaginal mucosa pale pink without discharge or lesions. Cervix visualized without lesions, masses, or discharge. No cervical motion tenderness. Uterus midline, smooth, and non-tender. Adnexa non-tender without palpable masses bilaterally. Pap smear specimen obtained during today’s visit. Alert and oriented to person, place, time, and situation. Cranial nerves II-XII grossly intact. Strength 5/5 throughout. Sensation intact. Gait steady. Screenings today: PHQ-9: Score 9 (mild depression symptoms) GAD-7: Score 5 (mild anxiety symptoms) The following labs are ordered today: Thyroid Stimulating Hormone (TSH) Free Thyroxine (Free T4) Comprehensive Metabolic Panel (CMP) Lipid Panel Hemoglobin A1C Pap smear (performed during today’s visit) ———————————————————————————– Directions: After reviewing this patient scenario, describe and discuss how an Advanced Practice Registered Nurse’s (APRN’s) approach to assessment differs from that of an RN. Provide an example(s) from this case that demonstrate the APRN’s role in at least three (3) of the following areas: gathering data identifying potential diagnoses ordering appropriate screening tests addressing preventive health needs/recommended screenings/health promotion *Respond in paragraph format and if needed, support your rationale with in-text citations. A minimum of three (3) well-developed paragraphs are required for this assignment. *Please see the attached rubric before answering this discussion question.

The lipid that stabilizes cell membrane at extreme temperatures and is found in the hydrophobic regions of the bilayer is _____.