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The advanced practice nurse is conducting a newborn exam and suspects the child has Down syndrome (trisomy 21). Which of the following physical characteristics should increase the advanced practice nurse’s suspicions?

A recently divorced mother brings her 10 year old daughter in to the clinic for an examination of the scalp and hair. She states that the child has developed some places where there are irregularly shaped patches on her scalp with no hair, no scaling, and she is worried that this could be some form of premature baldness as this came on suddenly. The advanced practice nurse tells her that it is:

During pregnancy the irregular brownish patches around the forehead, cheeks, nose, and jaw are known as:

A 52-year-old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The advance practice nurse suspects which condition?

Name the test in which the provider presses on the scapula with one hand to prevent scapular motion, while raising the patient’s arm straight up with the other hand, while compressing the greater tuberosity of the humerus against the acromion.  

The difference between acute and chronic pain is

During an admission assessment, the advanced practice nurse notices that a patient has facial swelling anterior to the ear lobe and above the jaw angle. The advanced practice nurse should suspect:

A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her medical provider evaluated the lump and determined that it “was nothing to worry about.” Your examination validates the presence of a mass in the right upper outer portion of the right breast. It is fixed, hard, nontender, with borders that are not well defined. The advanced practice nurse’s recommendation to her is:

A 65 year old female patient who works part-time cleaning houses presents to the clinic with a gradual onset of right shoulder pain and difficulty moving her right shoulder.  She has tenderness over the SITS muscle insertions (supraspinatus, infraspinatus, Teres minor, Subscapularis muscles) and an inability to abduct her right arm above her shoulder level.  Which of the following most likely causes this presentation upon physical exam?

A successful 15-year-old student-athlete’s mother brings him in today because he no longer studies, works out, or sees his friends.  This has gone on for a month and a half.  His parent agrees to let you speak with the patient alone in the room. What should you do next?