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A homeless man with an extensive history of alcohol use disorder is fatigue and some confusion and combativeness when he arrives at the clinic. Friends report that he has not consumed alcohol in 2 days and has become progressively more uncontrollable. Likely causes for his behavior would include all of the following EXCEPT

The FNP is reviewing a liver biopsy report on one of their patients: Description: liver tissue replaced by neoplastic glands infiltrating parenchyma and sinusoidal spaces composed of solid sheets with lumen lined by large cells with vesicular nuclei Impression: liver with poorly differentiated metastatic adenocarcinoma (in other words, metastatic cancer) Which of the following should have stopped this disease from occurring in the patient?

The PNP is seeing a child that was never screened for lead poisoning, and unfortunately has extremely high levels with suspected neurological symptoms. The PNP is going to refer the patient to a specialist and expect which of the following treatments

The NP is reviewing labs and notes the lactic acid level is elevated. Which of the patient conditions would NOT explain this lab value?

The FNP’s patient, who was diagnosed with severe obesity, is following the recommendations and started a walking routine. During the first several minutes of walking, his skeletal muscle cells are experiencing decreased levels of oxygen. In cellular metabolism, the absence of oxygen causes the the cell to convert __________ into  __________, following glycolysis.

The NP is reviewing a endoscopy pathology report and notices the esophageal sample contains simple columnar epithelium and goblet cells, rather than healthy stratified squamous epithelium.  The NP knows this represents ___________ and would likely try to treat it with ________ . 

The FNP is concerned that her female patient admits to drinking a bottle of wine most evenings. The FNP counsels her patient that more than 1 drink per day increases the risk for many disease states including cancer. The FNP realizes this is because the body metabolizes alcohol into which substance which is toxic to most tissues? 

A 48-year-old female comes to the WHNP’s office for her well-woman exam but is also complaining of shortness of breath. The patient looks winded just walking into the exam room. She also reports abdominal distension and leg swelling for the past several months. Her past medical history is unremarkable, expect that she has been smoking a pack of cigarettes for the past 15 years, uses cannabis weekly, and drinks a bottle of wine a day. VS are within normal limits. Physical examination demonstrates a laterally displaced and enlarged apical impulse. The patient has moderate abdominal distension and pitting edema to the knees. Bibasilar rales are appreciated on pulmonary auscultation.  The WHNP feels uncomfortable given the patient’s shortness of breath, so she refers the patient to the emergency room. The patient has a chest x-ray with pulmonary vascular congestion, and an echocardiogram diagnoses a cardiomyopathy with an low ejection fraction of 23% (weak pump function). Coronary angiography is within normal limits, showing no coronary artery disease. Lab work showed the following abnormalities: Hemoglobin 10.5 (low) Platelet count 100 (low) AST 180 (high) ALT 66 (high) Other chemistries and labs were in normal ranges The WHNP suspects the likely etiology of the patient’s clinical condition is

Aller Anfang ist schwer „Aller Anfang ist schwer“. Das heißt: Es ist schwer zu beginnen; der Beginn ist nicht einfach. „Im Anfang war das Wort“. Das ist der Beginn des Johannesevangeliums im Neuen Testament. Johannes 1 beginnt: „Im Anfang war das Wort (Logos), und das Wort war bei Gott, und das Wort war Gott. Dieses war im Anfang bei Gott“. (Jh. 1, 1–3) Hier ist die englische Version des Anfangstextes des Johannesevangeliums: “In the beginning was the Word, and the Word was with God, and the Word was God. The same was in the beginning with God.“ (John 1: 1–3) „Im Anfang war das Wort“, der erste Satz des Johannesevangeliums in der Bibel, ist auch der Anfang von der Szene „Im Studierzimmer“aus Goethes Faust I. Faust sitzt und lernt in seinem Studierzimmer. Er sucht in seinen Büchern Wissen. Faust beginnt: „Geschrieben steht: Im Anfang war das Wort …“ So beginnt der philosophische Wissenschaftler eine Serie von Reaktionen und neuen Versionen vom Bibeltext. Für Faust ist „das Wort“ zu passiv, also sagt er: „Im Anfang war der Sinn …“ Aber auch „der Sinn“ ist Faust zu passiv, und so sagt er: „Im Anfang war die Kraft …“ Für Faust ist „die Kraft“ besser, aber die Kraft ist auch nicht aktiv genug. Dann sagt Faust: „Im Anfang war die Tat!“ In diesem Moment denkt Faust: die Tat sagt mehr als das Wort.

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