Cardiac disease is the number one cause of death in the United States. Patient and family education to prevent coronary disease is an important role of the primary care provider. It is also important that APRNs recognize the signs and symptoms of a myocardial infarction when the patient is presenting in the primary care setting, and to immediately call 911. Which of the following in NOT a common sign or symptom of a myocardial infarction?

Your next patient is a 62 year-old man with intermittent right upper quadrant abdominal pain. His past medical history includes hypertension and GERD. He is afebrile and hemodynamically stable. An abdominal exam reveals a positive Murphy’s sign, the rest of his PE is unremarkable.  What is the best next step to confirm a diagnosis?

Pancreatitis has many precipitating factors that can be easily identified using the ABCs of Causes for Acute Pancreatitis. What is the most common cause of pancreatitis in the United States?

You are seeing a 42 year old female patient with a past medical history that includes hypertension, elevated body mass index and gastric bypass surgery 5 years ago. She stopped taking all of her medications 3 years ago due to a combination of the cost of the medications and her financial situation.  Physical exam findings include BP 100/50 mmHg, HR 88 beats per minute, HEENT exam:  conjunctival pallor (paleness of conjuntiva), cheilosis (inflammatory lesion at the corner of her mouth) and glossitis (inflammation of the tongue).  Her neuro exam revealed loss of proprioception.  What is most likely the cause of this patient’s symptoms?

Your next patient is a 19-year-old female with abdominal pain. She states the pain has been bothering her for the last week, and has progressively become worse. She denies nausea, vomiting, any episodes of diarrhea, or chest pain. She is sexually active with her boyfriend, and admits to having some pain during sex. She states she does not feel comfortable telling her boyfriend that she does not want to have sex. Her last menstrual period was two weeks ago. She reports no history of sexually transmitted infections, but says that she has not questioned her significant other because “he would be upset.” VS 37.1 C (98.7 F), BP 120/70 mmHg, HR 82 beats/minute, RR 18 breaths/minute.  PE:  The patient is visibly uncomfortable during the physical exam, which reveals a few bruises on her abdomen and lower back that are at different stages of healing. What is an appropriate technique for screening for intimate partner violence in this patient?

Your next patient is a 34-year-old female with a “twisted ankle.” She stepped off a curb 3 days ago and came down “wrong”. She has had moderate pain, moderate swelling and it has been difficult to bear weight. She has slightly limited ROM and stability.  After reviewing the clinical guidelines, you know that:

Diagnosing a patient with a fever is based on many factors. Which of the following statements is incorrect regarding facts about body temperature?

Your next patient is a 52-year-old female patient with a BMI of 31.5. She drinks 1-2 alcoholic beverages/day, 2-4 cups of coffee/day and eats fatty foods 3x/week. She smokes ½ pack of cigarettes/day. Her medication list includes asa 325 mg PO every day and Advil PRN as needed for pain. She states that she has had frequent recurrent epigastric pain and burning sensation for the past few months.  She describes the pain as occurring mostly after meals and sometimes it wakes her up during the middle of the night.  She occasionally experiences regurgitation of a sour-tasting fluid. She denies dysphagia, weight loss, or blood in her stool.  PE findings were unremarkable. What is the most appropriate initial management for this patient?

You prescribed ferrous sulfate, PO, 325 mg TID X 90 days for the diagnosis of iron deficiency anemia. Which of the following statements would NOT be included in patient and family education?

A patient has a gradually enlarging nodule on one lower eyelid and reports that the lesion is painful. On examination, the lesion appears warm, erythematous, edematous and painful to touch.  The APRN knows that this is likely to be which type of lesion?