NURS 6512 Week 7 Test Comprehensive Questions and

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NURS 6512 Week 7 Test/ Comprehensive Questions and Correct Verified Answers.

Advanced Health Assessment (Walden University)

Section: NURS 6512

Patient: Brian Foster

Week 7

Shadow Health Digital Clinical Experience Focused Exam: Chest Pain

Documentation SUBJECTIVE DATA:

Chief Complaint (CC): “I have been having some troubling chest pain in my chest now and then for the past month.” History of Present Illness (HPI): B.F., a 58-year-old Caucasian man, arrives at the clinic complaining of three episodes of intermittent, non-radiating mid-sternal chest pain this month.He describes this ache as "tight and painful" and claims that rest is the only way to get rid of it.Denies experiencing any dyspnea throughout these incidents. Pt claims he does not have a cardiac specialist and only monitors his BP during routine checkups with his PCP.

1. Location: Mid-chest/sternal area

2. Quality: 5/10

• Quantity or severity: three episodes of the chest in the past month happened during

physical activity and pain; he described the pain as “uncomfortable and feeling like tightness,” rated as 5/10, but right now, it is 0/10.

• Timing, including onset, duration, and frequency: Pain occurs during physical

activity, such as working in the yard and climbing the stairs. It lasts five minutes and subsides with rest. 1 / 3

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• Setting in which it occurs During activities of exertion.
• Factors that have aggravated or relieved the symptom Exertion aggravates the chest

pain, and rest improves it.

• Associated manifestations: Denies night sweating, dyspnea, shortness of breath, nausea,

or dizziness. He denied pain radiating to his neck, arm, jaw, or shoulders.

Medications:

Lisinopril (Prinivil, Zestril) 20mg PO daily Lipitor (atorvastatin) 20mg PO daily at bedtime Omega-3 Fish Oil 1200mg PO BID Tylenol 650 mg PRN Ibuprofen 600 mg PRN

Allergies: Codeine- Nausea and Vomiting

Past Medical History (PMH):

Hypertension Dx-2021 Hyperlipidemia Dx-2021

Past Surgical History (PSH): None reported.

Sexual/Reproductive History: Sexually active with the wife of 27 years.

Personal/Social History: B.F., an engineer who works full-time, says his life is "quite stressfree" and that he and his wife of 27 years have two children. He claims to eat nutritious meals but does not frequently exercise because his bike was stolen. However, he plans to resume exercise if his doctors clear him. He denied any tobacco use. Denied using any illicit drugs. Consumes 2-3 beers per week.

Immunization History: Up to date with immunizations, had covid-19 series.

Significant Family History:

• Father: Hypertension, hyperlipidemia, obesity. (Died from Colon Cancer at age 75) Mother: Type 2 Diabetes, Hypertension (age 80) Brother: Died at age 24 in a car accident.

• Sister: Type 2 Diabetes, Hypertension (age 52)

• Maternal Grandmother: Died from breast cancer (age 65)

• Maternal Grandfather: Died from a heart attack (age 54)

• Paternal Grandmother: Died from pneumonia (age 78)

• Paternal Grandfather: Died from “old age” (age 85)

• Son: Healthy (age 26) Daughter: Asthma (age 19) Review of Systems: 2 / 3

pg. 3 3 General: Alert and oriented to person, place, and time. Denies any current vision or hearing changes. No fever, chill, or sweats; gained twenty pounds over the past few years.

Cardiovascular/Peripheral Vascular: Negative for orthopnea; reports no edema in

BLE. Reports tight, uncomfortable chest pain that occurs on exertion and subsides after five minutes of rest. Denies racing heart, skipping beats, or flushing. No vertigo reported Respiratory: Denies any dyspnea on exertion when not active. Experience SOB with exercise and climbing a flight of stairs at work; denies cough or hemoptysis.Gastrointestinal: Denied any problem with constipation or abdominal pain. Denies changes in bowel or bladder routine. No diarrhea, nausea, constipation, vomiting, or abdominal pain

Musculoskeletal: Denies any changes in balance or gait

Psychiatric: Denies anxiety, depression, and mood changes.

OBJECTIVE DATA:

Physical Exam:

Vital signs: VS: B/P 140/90; P 104; R 19; o2 98% room air; WT 197; HT 5’11’.General: Alert and oriented to person, place, and time. He denies any recent weight loss and states he gained weight over the years. No vision or hearing changes, no distress, mood and affect bright, pleasant, and cooperative; Hygiene is good.

Cardiovascular/Peripheral Vascular:

The chest is symmetrical, with no signs of abnormalities. Heart rate tachycardic at 104 bpm. PMI displaced laterally, brisk, and tapping; less than 3 cm. S3 noted midclavicular five inter-costal space. No murmurs or rubs. No cyanosis on lips or toes. No clubbing.Precordium with no visible pulsations and palpable lifts, heaves, or thrills; Right carotid bruit present +3 thrill, left carotid no bruit present +2; Bilateral brachial, no bruit +2 thrill; bilateral radial no bruit +2 thrill; bilateral popliteal no bruit +1 thrill; bilateral tibial no bruit +1 thrill; bilateral dorsalis pedis no bruit +1 thrill. Bilateral femoral, iliac, and renal arteries no bruit.Respiratory: Respirations are even and unlabored. Inspiratory crackles right lower lobe and left lower lobes. And lungs clear to auscultate throughout except for minor fine crackles to posterior bilateral lower lobes. No use of accessory muscles and denies any dyspnea or history of asthma.Gastrointestinal: Abdomen is symmetrical with tympanic sound and without distention: bowel sounds are normal in all four quadrants normoactive. Denies pain or discomfort with light or deep palpation—no masses, tenderness, or guarding. Liver palpated at 1cm below right inter-costal margin- 7cm in the midclavicular line and dull sound with

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