NRNP 6540 Advanced Practice Care of Frail Elders
NRNP 6540 WEEK 7 Knowledge Check
1. June is a 69-year-old being seen for her GYN exam. She still has her uterus and ovaries.
What do you expect to find on bimanual examination?
Examining the female genito-reproductive system would be the same...
nrnp 6540 advanced practice care of frail elders 2022
june is a 69 year old being seen for her gyn exam she still has her uterus and ovaries
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NRNP 6540 Advanced Practice Care of Frail Elders
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NRNP 6540 WEEK 7 Knowledge Check
June is a 69-year-old being seen for her GYN exam. She
1.
still has her uterus and ovaries.
What do you expect to find on bimanual examination?
Examining the female genito-reproductive system would be the same in younger and older
patients. On a bimanual examination, the ovaries should not be palpable and the uterus should
be small and firm.
2. Your 82-year-old patient comes to the clinic with complaints of cramping abdominal
pain, nausea, vomiting, and obstipation for the past 4 days. His PMH includes hernia
repair, HTN, and atrial fibrillation. Your examination leads you to suspect a small bowel
obstruction. What is your diagnostic test of choice to determine the diagnosis?
The initial diagnostic test for small bowel obstruction is the plain abdominal x-ray with flat and
upright views. This radiologic test identifies multiple air-fluids, distention of small bowel loops
and absence of gas in the areas of the colon. If no obstructions are seen in the x-rays but the
provider has a high suspicion of the diagnosis, a CT scan is recommended. CT scan is found to
be as high as 90% sensitive in identifying the presence of bowel strangulation and can determine
the etiology and site of the obstruction. Ultrasonography is often utilized to evaluate acute
abdominal pain and can also be used to identify obstruction and what caused it.
3. Sarah is a 68-year-old patient who had a mammogram and biopsy positive for breast
cancer. Her breast cancer is staged at T1N0M0. Sarah asks you what this means. Please
describe what TNM indicates.
TNM Classification of Malignant Tumors by the The American Joint Committee on Cancer
(AJCC) and the Union for International Cancer Control (UICC)
is a staging system to classify malignant tumors. For breast cancer, it tells about the tumor size
and how far it has spread within the breast and to adjacent tissues (T), the extent of spread to
nearby lymph nodes (N), presence or absence of distant metastases (spread to distant organs)
(M). Upon determining T, N, and M, stages are assigned as 0, I, II, II, or IV, with stage 0 being in
situ stage, stage I as early stage invasive cancer, and stage IV as the most advanced disease with
organ metastases.
Sarah’s T1N0M0 means: TI means that the cancer cells are only growing in the layer of cells
where they started, without growing into deeper layers. This may also be called in situ cancer
or pre-cancer. N0 means nearby lymph nodes do not contain cancer. M0 means that no distant
cancer spread has been found.
4. Harry is an 81-year-old male who complains of increasing urinary frequency, nocturia,
weak or intermittent urine stream, and a sensation of incomplete voiding, what would
your differential diagnoses consist of? Name at least three.
Based on the symptoms presented, Harry's differential diagnoses consist of the following:
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