L.P., age 23, is a white woman who graduated from college last year. She began working as an accountant 1 month after graduating. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L.P. reports that she has a good relationship with her boyfriend, but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects.Diagnosis: Generalized Anxiety Disorder Questions:1. List specific treatment goals for L.P.2. What drug therapy would you prescribe? Why?3. What are the parameters for monitoring the success of the therapy?4. Describe specific patient monitoring based on the prescribed therapy.5. List one or two adverse reactions for the selected agent that would cause you to change therapy.6. What would be the choice for second-line therapy?7. What dietary and lifestyle changes should be recommended for this patient?Provide 3 Postings (Initial Posting and Respond to 2 Peer Based on APA Guidelines). Respond in complete sentences, 2-3 paragraphs. Work must be supported by peer-reviewed article published within 5 years.

ScenarioAs a nurse on a general medical floor, the RN has received a new admit. Review the client data provided.Richard Henderson58 years oldMaleAdmit diagnosis: GI bleedHistory: no surgical historyMedical history: Gastritis & GERDMedications: Prilosec 40 mg PO daily, Atenolol 25 mg PO BID, Fiber daily, Alka Seltzer PO – states he takes this at least daily.Report from physician’s office: Mr. Henderson arrived to the physician’s office today for a complaint of increasing abdominal pain. He states that he is now throwing up coffee-ground emesis. He states that he didn’t take his BP medication this morning because he was dizzy. The physician is admitting him with a diagnosis of GI bleed with an EGD scheduled for tomorrow. He is NPO, and has a 22G IV lock in the left forearm. Last set of vital signs BP 106/60 mm Hg, HR 98 beats/min, RR 20 breaths/min, Temp. 98.8 degrees F, P.O. 90% on room air. He last vomited about 45 minutes ago with a small amount of dark coffee-ground emesis. His pain is 4/10 at present. No pain medication is ordered at this time.Lab assessments ordered: CBC and chemistry panelCT of the abdomen shows no signs of free air (no perforation)When he arrives to the floor, he is pale, nauseous, and his skin is cool and clammy. When he is transferred to the bed from the stretcher, he vomits a large amount of coffee-ground emesis and loses consciousness.InstructionsIn the discussion post, address the following:While receiving report, what concerns do you have regarding the client report?What type of shock is occurring?What stage of shock is the client experiencing?What is your next intervention and why?What additional lab assessments would you anticipate?Provide additional thoughts and insights.In the initial posting provide one additional resource other than the required reading.When responding to the initial posting, provide an evidence-based article in support of your response.POST TO REPLY TO1. While receiving report, what concerns do you have regarding the client report?Hypovolemic shock occurs when low blood volume causes an arterial pressure decrease. This prevents body perfusion and adequate gas exchange for vital organs (Shagana, 2018). Hypovolemic shock can happen from hemorrhage after trauma, surgery, or GI ulcers (Workman, 2021). This client is presenting with multiple concerns from a nursing standpoint. I would be concerned about the possibility of a GI bleed as well as his fluid and electrolyte balance.2. What type of shock is occurring?The patient was admitted with a medical history of gastritis and GERD. He is showing signs of hypovolemic shock due to a possible GI bleed.3. What stage of shock is the client experiencing?The client appears to be in the progressive stage with signs of the refractory stage. In the progressive stage the client exhibits confusion, rapid pulse, low blood pressure, pallor, cyanosis, cool or moist skin, anuria, and a 5-20% drop in oxygen saturation (Workman, 2021). During the refractory stage, clients exhibit a rapid loss of consciousness; nonpalpable pulse, cold and dusky extremities, slow and shallow respirations, and an unmeasurable oxygen saturation (Workman, 2021).4. What is your next intervention and why?The most important part of this scenario is recognizing that the client is showing signs and symptoms of hypovolemic shock. At this stage of shock, the goal is to restore fluid volume and prevent further complications by providing oxygen therapy, fluid replacement therapy, and drug therapy (Workman, 2021). The nurse should maintain a patent airway first, followed by starting an IV catheter. The most common forms of fluid replacement is normal saline and lactated ringers solution. Depending on the client’s status, surgery may be required if the underlying cause is bleeding (Workman 2021).5. What additional lab assessments would you anticipate?There are many crucial labs the nurse should anticipate assessing after an episode of hypovolemic shock. Blood pH should be checked to ensure adequate tissue oxygenation as well as prevention of acidosis. The Pao2, Paco2, and lactate should be checked to assess anaerobic metabolism. The hematocrit and hemoglobin should be assessed to determine fluid status and the possibility of hemorrhage. The client’s potassium level should be checked to rule out dehydration and acidosis (Workman, 2021).6. Provide additional thoughts and insights.Medications used to treat hypovolemic shock include vasoconstrictors such norepinephrine or phenylephrine. These drugs help improve the arterial pressure by increasing peripheral resistance, venous return, and myocardial contractility (Workman, 2021). Inotropic agents such as dobutamine or milrinone. These medications are used to directly stimulate beta-adrenergic receptors on the heart muscle which improving contractility (Workman, 2021). Other medications such as nitroglycerin or sodium nitroprusside can be used to improve myocardial perfusion by dilating the coronary arteries (Workman, 2021).References:Shagana, J. A., Dhanraj, M., Jain, A. R., & Osa, T. N. (2018). Hypovolemic shock - A review. Drug Invention Today, 10(7), 1102–1105.Workman, D.I.M. L. (2021). Medical-Surgical Nursing (10th Edition). Elsevier Health Sciences (US). https://ambassadored.vitalsource.com/books/9780323654050

QUESTION 1An 18-year-old sexually active female comes to clinic and asks how often she should obtain a pap smear. Your best response is:You should wait until you are between the ages of 21 and 29 years old.You should have a Pap test every 3 years beginning at 21 years of ageYou do not need a Pap test you are too young right now give yourself more timeYou can have an annual pap test beginning at age 18 or within six months of first sexual intercourse1 points QUESTION 2A 30-year-old bisexual female is asking about treatment for uterine fibroids. She is asking you about treatment options. The NP knows that:Uterine fibroids are associated with sexual activitySince the patient is gay, she should opt to have a hysterectomyMRI with guided ultrasoundUterine artery embolization1 points QUESTION 3A 20-year-old lesbian is asking about being a mother with her partner. A NP can educate patient about what options for being a mother.AdoptSame sex relationship partners cannot have a babyInvitro fertilizationA and C only1 points QUESTION 4What are risk factors for acquiring HPV?SmokingImmunosuppressionMultiple birthsAll of the aboveNone of the above1 points QUESTION 5What NSAIDs are approved by FDA for the treatment of dysmenorrhea?DiclofenacCelebrexBaralganAcetaminophen1 points QUESTION 6A common side effect of a topical therapy with imiquimod used to treat VIN that has not progressed to invasive disease is:severe headachemild burning or stingingcellulitisnausea, vomiting, and diarrhea1 points QUESTION 7Endometrial cancer occurs most frequently in a woman whoMenopausal and between the ages of 40 – 50Postmenopausal women between the ages of 60-65Perimenopausal women between the ages of 50-55none of the above1 points QUESTION 8What step can a clinician take to learn more about any chemicals used in a woman’s workplace?Contact OSHA (Occupational Health and Safety Administration).Contact the woman’s workplace.Ask the woman to obtain her workplace MSDs (material safety data sheets).Conduct research on the OSHA website.1 points QUESTION 9Cyclic mastalgia:More likely causes unilateral, localized pain that is sharp or burning in natureHas an increased risk of occurrence in women whose diets are low in fatOccurs most frequently in women who are 18 to 30 years oldIs caused by hormonal changes associated with menstruation1 points QUESTION 10What is one factor that can reduce the risk for the development of ovarian cancer?Multiple pregnanciesTransvaginal ultrasoundsIdentification of recurrenceWeight loss1 points QUESTION 11Which of the following is a preventive measure for vulvar cancer?Avoiding exposure to HIVNot smokingThere is no way to prevent it.Colposcopy1 points QUESTION 12The Bethesda System is used toreport breast cytologyreport colon cytologyreport cervical cytologyreport Bartholin gland cyst cytology1 points QUESTION 13The infertility evaluation is an opportune time to suggest health promotion behaviors that may specifically improve fertility, including:Achieving a BMI in the range of 30 to 35, if the woman is under- or overweightReducing alcohol consumption to about 4 drinks per weekReducing caffeine consumption to no more than 350 per dayNone of the above1 points QUESTION 14A 40-year-old white female mother died from ovarian cancer. The patient is asking the nurse practitioner, is there a way to prevent ovarian cancer?There is nothing you can do to prevent cancer because you have a genetic predisposition for the disease.You can prevent ovarian cancer by having a tubal ligation.There are factors that inhibit ovulation that can reduce the risk of developing ovarian cancer.None of the above1 points QUESTION 15A nurse practitioner suspects a patient may have vulvar cancer based but is uncertain what are some possible differential diagnoses based on NPs suspicion.Vulvar candidiasisVulvar vaginitisVulvar psoriasisHSV 21 points QUESTION 16The most common sites of metastatic spread of invasive breast cancer include all of the following except:BonesLungsPituitaryLymph nodes1 points QUESTION 17A 65-year-old female reports to clinic with complaints of urinary tract infection. She reports blood with urination. The NP confirms UTI with POC urine analysis test. The patient also reports low back pain. The NP will more than likely treat patient for what type of UTI?Asymptomatic bacteriuriaCystitisPyelonephritisNephrolithiasis1 points QUESTION 18The HPV vaccine has been proven to be effective in protecting against the four types of HPV that cause genital warts and cervical cancers for as long as:10 years2 years15 years5 years1 points QUESTION 19The first line of treatment for mastalgia, which is effective for 85 percent of women who have mild or moderate symptoms, is:ReassuranceReduction mammoplastyIsoflavones, or naturally occurring phytoestrogens2% lidocaine injection and 40 mg of methyl prednisone1 points QUESTION 20What is now thought to be the most important causative agent in cervical cancer?PCOSVulvar cancerHerpes simplexHPV1 points