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Extra credit: Summarize the acute and chronic neuromuscular changes that occur with training. Be sure to note the type of training you are referring to in your response. 

Select the correct answer: A 35-year-old adult presents to the primary care nurse practitioner with complaints of right calf discomfort. The patient assigns a pain rating of 3 out of 10.  The patient is employed as a cashier and stands for long periods of time and reports driving from Orlando to Tampa last week. She is taking low dose oral contraceptives for treatment of perimenopausal symptoms.  Vitals: B/P 114/70; Pulse 64 regular; Respirations 16 and unlabored; Temperature 98.2. BMI 34.5 kg/m2 Physical exam Unremarkable general exam. Both extremities are equal in size, color and warm to touch. Obvious varicosities bilaterally. 1+ pedal edema bilaterally. No abnormalities of the foot are noted. Homan’s sign is negative. Pedal pulses are 2+ bilaterally. Laboratory findings: CBC – all measures within normal limits Prothrombin time and partial thromboplastin time – within normal limits Highly sensitivite D-dimer test negative SED rate -within normal limts According to American Chest Physician Guidelines, what is the appropriate clinical management plan for this patient at this time? 

Select the correct answer: A 57-year-old Black adult with a 15-year history of diabetes presents for diabetes follow-up and a blood pressure recheck. The last b/p in clinic was 145/88. Vitals: 158/92; pulse 70; resp 16; Weight 223 lb; Height 70 inches; BMI 32.0 Medications: metformin 1000 mg bid, semaglutide (Ozempic) 1 mg subcutaneously weekly Allergies: penicillin The physical exam in not remarkable. Chemistry panel (fasting) Glucose                  124 mg/dL Sodium                   140 mEq/L Potassium                3.9 mEq/L BUN                          15 mg/dL Creatinine                 1.2 mg/dL eGFR                           78 mL/min A1c                            7.1% Urine albumin/creatinine ratio (repeated x 3)       325 mg/g Cr; 303 mg/g Cr; 313 mg/g Cr Which of the following interventions should be incorporated into this patient’s clinical management plan?

Select the correct answer:    A 58-year-old adult with excess weight presents to the primary care nurse practitioner with complaints of intermittent swelling and discomfort in both lower extremities after a day of work. The patient is a store cashier and states that the discomfort is worse on work days which require more standing.  The following is observed on physical exam:    Based upon these findings, what recommendation by the primary care nurse practitioner is indicated?

Select the correct answer: The primary care nurse practitioner is completing a first visit with a 58-year-old adult. During the course of the visit, the patient reports a prior history of “Barrett’s esophagus”. The patient lost health insurance 3 years ago after experiencing a job loss.  What is an appropriate plan for this patient to address this finding?

Select the correct answer: A middle-aged adult presents to the primary care nurse practitioner for evaluation of “heartburn” symptoms after meals. Symptoms have been present for about the past two months but “came and went” in the past based upon meal composition. The discomfort is worse when lying down or when eating late. The patient’s partner has made comments describing halitosis and that a dentist has noticed some wearing on the tooth enamel. The patient has noticed worsening of asthma symptoms in the past several months.  Which of the following first-line treatments should be incorporated into the clinical management plan of this patient?

Question 5: a. Identify the fifth lung sound. b. Indicate when you hear the lung sound in the respiratory cycle. 

Question 4: a. Identify the fourth lung sound. b. Indicate when you hear the lung sound in the respiratory cycle. 

Select the correct answer:    A 55-year-old adult presents to the primary care nurse practitioner for follow-up for an annual wellness exam and review of laboratory test results after a 2-year lapse in care. The patient smokes 1/2 pack per day. The patient is currently using no regular prescription medicines.  The patient has no medication allergies or other chronic health problems. Current laboratory findings are diagnostic for prediabetes and hyperlipidemia. The nurse practitioner develops a health promotion plan inclusive of referral to a dietitian for self-management education and smoking cessation recommendations.  Which of the following interventions will most likely support successful smoking cessation? 

Select the correct answer: A 67-year-old adult with a 50-year history of smoking and 10-year history of hypertension presents to the primary care nurse practitioner for a Welcome to Medicare visit. The patient has complaints of cramping leg pain when walking to the mailbox or grocery shopping. The pain intensity during this events is rated as 8 of 10.  Current medications:  hydrochlorothiazide 12.5 mg po daily. amlodipine (Norvasc) 5 mg po daily Vitals: 142/84 (smoked before visit); pulse 82 and regular; respirations 22 and regular; BMI 20.2 kg/m2 Physical exam:  General: alert and oriented; obvious smell of cigarette smoke. HEENT: AV nicking noted; carotids 2+ without bruit Cardiac: S1/S2, regular rate and rhythm Chest: barrel chested; breath sounds clear but diminished Abdomen: unremarkable; no bruit Extremities: Nails thickened, foot dry, skin shiny, no hair noted below the level of the knee. No edema in noted. Right leg is ruborous when dependent and shows pallor when elevated. Left leg shows pallor. Pedal pulses 1+.  Based upon these findings, which, of the following interventions should next be incorporated into this patient’s diagnostic/management plan by the nurse practitioner?