NURSING EXAM WITH QUESTIONS VERIFIED 100% CORRECT ANSWERS 2023 Grade A+, Exams of Nursing

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NURSING EXAM WITH QUESTIONS VERIFIED 100% CORRECT ANSWERS 2023 Grade A+ Ms. Campbell is a 25-year-old female patient that presented to the facility c/o of burning and pain with urination for 3 days. • After interview and assessment, it was discovered she has unprotected sex, reported and observed mucopurulent vaginal discharge, cervix had a friable appearance, and she was positive for gonorrhea on culture. • She is diagnosed with cervicitis. • Her treatment plan is for dual antibiotics given as a one-time dose, education on safe sex practices, importance of informing all recent partners so they may be tested and treated, and recommendations for further screening, exams, and vaccinations. • Chronic Illness/Major Traumas: None • Hospitalizations: None Family History • Mother: Diabetes mellitus • Father: CAD, HTN, hyperlipidemia • Sister: no medical issues Social History • Nancy Campbell is a 25-year-old female patient that works as a consultant. • She is a former smoker with a history of two packs a year of cigarettes. • She admits to drinking alcohol approximately twice a week, consuming approximately four to five beverages. • She denies using recreational or illegal drugs. • She engages in unprotected sexual activity and has had multiple partners. ROS • General: Denies fever, chills, fatigue, or weakness. • Skin: Denies rash, bruising, discoloration, or changes in moles. • Eyes: Denies visual changes or disturbances. • Neuro: Denies numbness or tingling. • Psych: Denies depression, SI or HI. Exam • Ht: 5’5” Wt: 135 lbs BMI: 22.5 HR: 66 BP: 116/64 R: 12 SPO2: 99% Temp: 98.7 F (oral) • General Appearance: Pt is A&O x 4, answering question appropriately, appears well groomed and without distress • Skin: Intact warm, pink, dry. • HEENT: Head normocephalic, a traumatic, without lesions. PERRLA at 4mm. Sclera white, conjunctiva pink. TM pearlescent bilaterally. Nasal mucosa pink, no sinus drainage noted. Airway patent. Pharynx clear without erythema, edema or exudate noted. Good dentation. • Breast: Non-tender. • Cardio: Heart sounds normal with normal rate and rhythm. Exam - Continued • Respiratory: BBS equal coarse all fields. No retractions crepitus, flail segment or paradoxical notion noted. • GI: Abd soft, non-tender without guarding, distortion. rigidity, pulsating masses. • Amine/whiff test Diagnosis and Differentials • Diagnosis: • Cervicitis – ICD 10: O86.11 • Bases for diagnosis: Reported discharge, sexually active without condom use, urinary symptoms, mucopurulent discharge from cervical os, cervix friable appearance, and positive culture for gonorrhea. • Differentials by rank: 1. Trichomoniasis – ICD 10: A59.9 2. Bacterial Vaginosis – ICD 10: N76.0 3. Urinary Tract Infection – ICD 10: N39.0 (CDC, 2017) Management Plan • Medications: 250 mg IM ceftriaxone and 1 g PO azithromycin; both given as a one-time dose • Education: • Ms. Campbell will need to contact all recent sexual partners, at least those she has had in the last 60 days, to inform them of her STD status and recommend that they get tested and treated. (Gorgos et al., 2016; Kidd & Workowski, 2015; Polk, Mattson & Nyirjesy, 2015) Evidence-Based Article I •Title, author(s), and year of article: Chronic cervicitis: Presenting features and response to therapy. Polk J, Mattson, S., and Nyirjesy, P. 2015. •Brief summary/purpose of the study: This study was conducted to review the symptoms present with a diagnosis of cervicitis and the effectiveness of various treatment options. This study was a retrospective review of a small pool of patients based of their ICD 10 code for cervicitis and requires two of three criteria to be included in the review. This inclusion criteria was mucopurulent discharge noted by either the patient or the provider and cervical bleeding with probing via cotton swab. The symptoms that were reviewed included abnormal discharge, irritation, itching, odor, burning, inter-menstrual bleeding, bleeding with coitus, and urinary symptoms. Treatment options included azithromycin, doxycycline, moxifloxacin, additional antibiotic treatments with clindamycin, flagyl, and the afore mentioned antibiotics, hormonal treatments, vaginal hydrocortisone, cryotherapy, LEEP, and silver nitrate. The success rates for each treatment vary with the LEEP and silver nitrate having a 100% success rate and cryotherapy and vaginal hydrocortisone completely failing. Antibiotic treatment had a 43% success rate and hormone therapy had a 50% success rate. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides symptoms of Evidenced-Based Article III identify a correlation between bacterial vaginosis and cervicitis. There were two cohort groups for this study, one in Seattle and one in Kenya. The study utilized PCR and 16S rRNA gene PCR to identify what bacteria was present on the cervical swabs. The presence of bacterial vaginosis was present in many of the cases reviewed. However, 4:14 cases of cervicitis found the cause to be a common STD infection, such as gonorrhea, chlamydia, or trichomoniasis. Using the Evidenced-Based Article IV PCR and 16S rRNA gene PCR, a link was found between cervicitis and M. indolicus in the Seattle cohort while the Kenyan cohort had a lower incidence of bacterial vaginosis but a higher incidence of HIV. Ultimately, the study linked a specific bacterial vaginosis-associated species to cervicitis. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides another possible Evidenced-Based Article V cause to cervicitis if the condition persists after treatment for gonorrhea. •Title, author(s), and year of article: Cervicitis: A prospective observational study of empiric azithromycin treatment in women with cervicitis and non-specific cervicitis. Josephine Lusk, Frances L Garden, Robert G Cumming, William D Rawlinson, Zin W Naing, Pam Konecny. 2016. Evidenced-Based Article VIII •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it shows that azithromycin should can be used in her treatment. While the study notes it is primarily effective against chlamydia and mycoplasma, chlamydia is known to have gonorrhea as a coinfection. Ms. Campbell has gonorrhea as evidenced by culture. Evidenced-Based Article IX •Title, author(s), and year of article: Management of Gonorrhea in Adolescents and Adults in the United States. Sarah Kidd and Kimberly A. Workowski. 2015. •Brief summary/purpose of the study: This study discusses the reported cases of gonorrhea in the US in adolescences and adults. The study utilized a STD Treatment and Guidelines Expert Consultation meeting, which was hosted by the CDC, to discuss recent developments in prevention Evidenced-Based Article X and treatment of gonorrhea, and other STDs. Nine key questions were presented to the experts ranging from first line antibiotic changes to medication regimens with allergies to first line antibiotics to current recommendations of testing and treatment. It was determined there should be no changes to the first line antibiotic regimen of 250 mg IM ceftriaxone and 1 g PO azithromycin for the treatment of gonorrhea. The study does list all antibiotics that can be Evidenced-Based Article XIII up-to-date treatment options are presented to the community and providers. •Title, author(s), and year of article: Treatment of cervicitis; LEEP versus cryotherapy. Mustafa Ozturk, Mustafa Ulubay. 2016. •Brief summary/purpose of the study: This study was conducted to determine whether the LEEP or cyrotherapy was more effective in the treatment of cervicitis. This study Evidenced-Based Article XIV was a retrospective analysis of individuals that had a diagnosis of cervicitis and had either a loop electrosurgical excision procedure (LEEP) or cryotherapy as their course of treatment. There was a small pool of individuals, 52 patients, that were reviewed. It was found that cryotherapy failed in 18% of those reviewed and 36% experienced dizziness or near syncope. Those that had the LEEP performed had no treatment failures and approximately 27% Evidenced-Based Article XV experienced three days of postoperative bleeding or spotting. This study concluded that a LEEP was more effective than cryotherapy but had more incidence of postoperative bleeding. •How did the study support Ms. Campbell’s case?: This study supports Ms. Campbell’s case as it provides an effective treatment option for cervicitis. It also allows for the provider to have an alternative procedure to present to Ms. Campbell.