Question 1: 

A 28-year-old male patient presents to the ER with a fever of 38.9°C, shortness of breath (SOB), a productive cough and fatigue. He comments that he has been feeling unwell for the last 3 days gradually feeling worse. His O2 stats on room air are 92%.

A. What is the probable diagnosis for your patient? 

B. What is the reasoning behind your diagnosis? 

C. Explain the pathophysiology of the condition you have diagnosed.

Question 2

A 14-year-old female patient presents to the ER with extreme fatigue. Her mother comments that she has been feeling unwell for the last week and this morning she had difficulty waking her daughter. She has noticed her daughter has been losing weight but she has been eating more food than regular. Her mother also comments on the amount of water her daughter has been drinking and how often she has been using the bathroom. Her mother is worried her daughter may have an eating disorder. 

A. What is the probable diagnosis for your patient? 

B. What tests would you run to confirm your diagnosis? 

C. Explain the pathophysiology of the symptoms your patient has presented with based on the condition you have diagnosed.

Question 3

Explain the 5 steps involved in the development of an atherosclerotic plaque. Include in your answer conditions a patient with atherosclerosis will have an increased risk for.

Question 4

Explain the pathophysiology of myocardial infarction including the pathophysiology of the process that occurs following the myocardial infarct over the following weeks. Also include in your answer potential complications of a myocardial infarct?

Question 5

A 62-year-old male patient, Matthew Nelson, presents to the emergency department with SOB. dry cough, and fatigue. On examination it was found he is afebrile, has a barrel chest and slight cyanosis of the extremities. When asking Matthew about his past medical history it is found he has been a pack-a-day smoker for the last 45 years. His doctor has told him to quit smoking due to the damage he has caused to his lungs, but Matthew has not followed that advice. His doctor has prescribed some medication to help with his breathing but Matthew can't remember the name. He admits he doesn't always take his medication as he doesn't think it helps. Matthew comments that he has had a cough 'for years' and only occasionally does he cough anything up.

A. Explain which acid/base disorder the patient is suffering from. Include justification for your answer including which test results support your conclusion and why. 

B. What other disorder is the patient most likely suffering from? 

C. Explain the pathophysiology of this disorder.

Question 6

Tom is a 65 year old man with a history of ischaemic heart disease. He has no central pulse and is making no respiratory effort. This is his ECG.

A. What rhythm is the patient in? 

B. What rate is the rhythm? 

C. In your own words, list the treatment (s) of choice for this patient with rationales.

Question 7

Jane is a 25 year old lady who has arrived at the Emergency Department with acute shortness of breath. She had just been on a bush walk on a cold day, when she became short of breath and wheezing On examination, her the pulse rate is 110 beats/ minute, blood pressure is 130/80, the temperature is 37.5. respiratory rate is 26 breaths/minute. The pulse oximeter on room air is 91%. She has an unusual red rash on her leg. When taking her nursing history, she had difficulty saying more than a few words at a time and felt her chest is getting tight.

A. Explain how you will manage Jane in the first four hours in order of priority. And by what reasoning did you come to these management strategies.

Question 8

Kevin is a 65 years old man who has been brought into the ED via an ambulance with a history of 2 days of vomiting. The vomiting has been getting increasingly worse over the last 12 hours, he cannot recall how many times he has vomited, but he has not been eating or drinking much over the past 24 hours. On exam, his respiratory rate is 12 breaths/minute and the pattern is shallow, heart rate is 100 beats/minute and you notice it is irregular, BP at 110/70 mmHg and the pulse oximeter on room air is at 98%. His hands appear to be shaking as he has just vomited again. You as the ED nurse looking after Kevin leave the cubicle for a moment to remove the emesis bag and when you return you find Kevin is unconscious and having a violent muscle contraction of his entire body.

A. What are your priorities when you return to Kevin's cubicle?

When you have finished handling the emergency situation of Kevin, he is now stable and alert. The doctor ordered some blood tests for Kevin. They are urea and electrolytes, full blood count and liver function, as well as an arterial blood sample. The Arterial blood results come back with pH 7.47 and HCO3 30mmol/L. While you are looking after Kevin, you notice in Kevin's backpack that there is a box of medication named, Frusemide 40 mgs daily. This medication was dispensed 7 days ago and there are 7 tables missing from the box.

B. What do you think is the main concern with Kevin now? Why might Kevin be experiencing this? 

C. Thinking about your responses above, can you formulate a management plan in the first one hour. Give a rationale for each suggestion.

Question 9

Marie, a 67-year-old patient, is two weeks post-op after a fracture of the left greater trochanter. The patient complains of unilateral lower limb pain on palpation, shortness of breath, the respiratory rate is 30 breaths/minute, the pulse rate is 110 beats/minute, the temperature is 38°C, and the blood pressure is 90/50. The patient complains of feeling anxious and having stabbing chest pain which gets worse with inspiration. She complains that she feels like she is going to pass out or possibly die.

A. What is the most probable underlying explanation of Marie's presentations? And what are your immediate steps in the nursing management of Marie?