K.W. is an 18-year-old woman who comes to Planned Parenthood for a pregnancy test because a condom broke during intercourse the night before. Her last menstrual period (LMP) was 13 days ago and was normal. She always has a monthly menstrual cycle. She is extremely nervous about pregnancy because she is beginning college on a scholarship soon. She states there have been no other acts of unprotected intercourse since her LMP and declines a gynecologic examination.
K.W. says, "Are you talking about having an abortion?" Formulate a response.

P.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient clinic with his girlfriend, he seems alert but acutely ill, with an average build and a deep tan over the exposed areas of skin. He reports headaches, joint pain, a low-grade fever, cough, anorexia, and nausea and vomiting (NN), especial ly after eating any fatty food. P.M. describes vague abdominal pain that started about the same time as the other problems. He states that he has been using "a lot ofTylenol" for his pain. His past medical history reveals he has no health problems, is a nonsmoker, and drinks "a few" beers each evening to relax. Vital signs are 128/84, 88, 26,100.6 degree F (38.1 degree C); awake, alert, and oriented x 3; moves all extremities well with complaints of aching pain in his muscles; very slight scleral jaundice present; heart and breath sounds clear and without adventitious sounds; bowel sounds clear throughout abdomen and pelvis; and abdomen soft and palpable without distinct masses. You note moderate hepatomegaly measured at the midclavicular line; liver edge is easily palpated and tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days.
Your institution uses electronic charting. Based on the health history and assessment described in the scenario, which of the following systems would you mark as "abnormal" as you document your findings? Mark abnormal findings with an X and provide a brief narrative. X Abnormal Neurologic:
Respiratory:
Cardiovascular:
Gastrointestinal:
Genitourinary:
Musculoskeletal:
Skin:
Pain:

M.E. is a $62$ -year-old woman who has a $5$ -year history of progressive forgetfulness. She is no longer able to care for herself, has become increasingly depressed and paranoid, and recently started a fire in the kitchen. After extensive neurologic evaluation, M.E. is diagnosed as having Alzheimer's disease. Her husband and children have come to the Alzheimer's unit at your extended care facility for information about this disease and to discuss the possibility of placement for M.E. You reassure the family that you have experience dealing with the questions and concerns of most people in their situation.

How would you explain Alzheimer's disease to the family?

For each characteristic below, identify whether it describes hepatitis A (A) or hepatitis B (B).
___ a. Fecal-oral transmission.
___ b. Transmitted by sharing needles.
___ c. Transmitted by blood transfusions.
___ d. Vaccination is a three-shot series.
___ e. Illness is usually mild, similar to a flulike infection.
___ f. Symptoms include anorexia, nausea, vomiting, fever, fatigue, and jaundice.

M.S. has never had an osteoporosis screening. She confides that her mother and grandmother were diagnosed with osteoporosis when they were in their early $50$s.

M.S. is also instructed to take a calcium plus vitamin D supplement. She asks, “If I am taking the osteoporosis pill, won't that be enough?” How do you answer her?

The physician has the option of treating A.P. by one of two different methods. First, the physician could prescribe treatment over a period of 1 week. A.P. would be given the first dose of doxycycline (Monodox) 100 mg PO, and then she would be prescribed the same dose to be taken PO bid for 7 days. Second, the physician could prescribe a one-time dose of azithromycin (Zithromax) 1 g PO, which could be administered in the clinic.
Which choice is best for A.P.? Explain your reasoning.

You are working in a busy OB/GYN office, and the last patient of the day is P.B., a $36$-year-old who is planning to get married soon. She wants to use birth control but is not sure what to choose. Her fiancé is in law school, and they do not have health insurance, so she is anxious not to get pregnant right away. She asks you to review the various methods and help her explore what is best for her.

What lifestyle information will help you assist P.B. in choosing an appropriate method for her?

You are working in a busy obstetrics/gynecology (OB/GYN) office, and t he last patient of the day is P.B., a 3S-year-old who is planning to get married soon. She wants to use birth control but is not sure what to choose. Her fiance is in law school, and they do not have health insurance, so she is anxious not to get pregnant right away. She asks you to review the various methods and help her explore what is best for her.
P.B. asks you about the effectiveness rating of available birth control methods. Describe the term efficacy and categorize the available methods according to the following efficacy ratings: most effective (more than 99%), highly effective (97% to 99%), and moderately effective (less than 90%)

L.W. wants to know about adoption. What will you tell her?

The unit is busy, and you are concerned about monitoring T.C. carefully enough. Your present patient load is six; of these, two patients are newly postoperative and one is getting ready for discharge. You have one experienced unlicensed assistive personnel (UAP) to help you. You are concerned that T.C:s respiratory status may further decline.
Formulate a plan for the UAP and you to care for T.C. during your shift

T.C. is a $30$ -year-old woman who $3$ weeks ago underwent a vaginal hysterectomy and right salpingo-oophorectomy for abdominal pain and endometriosis. Postoperatively, she experienced an intraabdominal hemorrhage, and her hematocrit (Hct) dropped from ( $40.5\%$) to ( $21\%$). She was transfused with $3$ units of packed RBCs. After discharge, she continued to have abdominal pain, chills, and fever and was subsequently readmitted twice: once for treatment of postoperative infection and the second time for evacuation of a pelvic hematoma. Despite treatment, T.C. continued to have abdominal pain, chills, fever, and nausea and vomiting.

T.C. has now been admitted to your unit from the post-anesthesia care unit (PACU) after an exploratory laparotomy. Vital signs (VS) are $130/70, 94$, $16$, $99.7^{\circ} \mathrm{F}\left(37.6^{\circ} \mathrm{C}\right)$ (tympanic). She is easily aroused and oriented to place and person. She dozes between verbal requests. She has a low-midline abdominal dressing that is dry and intact and a Jackson-Pratt (JP) drain that is fully compressed and contains a scant amount of bright red blood. Her Foley to down drain has clear yellow urine. She has an IV of $1000$ mL D$5.45$NS infusing at $100$mL/hr in her left forearm, with no swelling or redness. T.C. is receiving IV morphine sulfate for pain control through a patient-controlled analgesia (PCA) pump. The settings are dose $2$mg, lock-out interval $15$ minutes, $4$-hour maximum dose of $30$mg. When aroused, she states that her pain is an $8$ on a scale of $1$ to $10$. She also has $2$ L oxygen by nasal cannula (O$_2$/NC); her Sao$_2$ by pulse oximeter is $93\%$.

Which of T.C.'s vital sign values would be most important for the NAP to report to you immediately?

• a. Temperature of $100^{\circ} \mathrm{F}\left(37.8^{\circ} \mathrm{C}\right)$
• b. Blood pressure of $160/80$mm Hg
• c. Heart rate of $100$ beats/min
• d. Respiratory rate of $8$ breaths/min

You are the nurse in a walk-in clinic. A.P. is being seen this morning for a 2-day history of diffuse, severe abdominal pain. She has complaints of nausea without vomiting; she denies vaginal bleeding or discharge. A.P. reports having unprotected sex with several partners recently, two of whom had penile discharge. Her last menstrual period ended 3 days ago. She has no known drug allergies and denies previous medical or psychiatric problems. Vital signs are 108/60, 110, 20, $100.6^{\circ}F$ ($38.1^{\circ}C$). Physical examination reveals that her abdomen is very tender. The slightest touch of her abdomen causes her to wince with pain. Bowel sounds are normal. Pelvic examination reveals purulent material pooled in t he vaginal vault, which appears to be coming from the cervix. A sample of the vaginal drainage is obtained and sent for culture. The result of a pregnancy test is negative; a rapid diagnostic test for chlamydia! infection has a positive result.
How would you provide emotional support to A.P. at this time?

Describe the assessment you would need to perform to differentiate what might be occurring with S.K.

S.K. is obviously relieved about not being pregnant, but she expresses fear that this could be cancer. What should you tell her to reassure her?