NRNP 6540 Study Guide Latest Update
2025
Case Study 1:
Question
CC: Mrs. L., a 68-year-old woman, presents to your office today with a complaint of feelingtired all the
time and now, more recently, feeling weak and like "I can't catch my breath sometimes."
HPI: She has been healthy except for high cholesterol, managed by Lipitor. Her husband died 9
months ago, and she has attributed her fatigue to dealing with his death but realizesthat she is feeling
worse and not better as time passes.
No known drug allergies. Medications: Takes only Lipitor.
Past surgical history: Appendectomy in childhood; hysterectomy for uterine myoma 10years ago.
No significant medical history. Has two daughters living nearby.
Blood pressure (BP) 106/70 mm Hg, heart rate (HR) 98 beats/min and regular, respiratoryrate 18
breaths/min and afebrile, body mass index (BMI) 22 (10-pound weight loss since death of husband).
Slender, quiet-spoken older woman appearing tired.
PE: Conjunctiva pale, mucous membranes moist. No lymphadenopathy of neck or femoralarea.
Heart tachyarrhythmia with regular rate, soft midsystolic murmur. Chest (CTA), good airmovement.
Abdomen soft, bowel sounds × 4.
Diagnostics:
Urine dipstick negative.
The results of a colonoscopy show a neoplasm in the colon.
What additional subjective data should we look for?
What additional objective data will be assessing for?
What medical history to obtain from the patient? List at least three.
What tests to order? Describe at least four lab tests.
What are the differential diagnoses to consider? Describe two.
What is the plan of care? List at least two diagnostic tests to be ordered to evaluatethe cause of
her condition.
Page 1 of 6
, Answered by Expert Tutors
1.
The additional subjective data we should look for include -
How long have she had the symptoms?
Are her symptoms getting worse?
Do she smoke or use other types of tobacco?
2.
Additional objective data will be assessing for -
Persistent change in her bowel habits, including diarrhea or constipation or achange in the
consistency of her stool
Rectal bleeding or blood in her stool
Persistent abdominal discomfort, such as cramps, gas or pain
3.
Medical history(importantly family ) to obtain from the patient is -
Making sure to document her mother's side of the family and her father's side of thefamily with
any significant findings
Documenting which relatives have had cancer, the type(s) of cancer they have had,and the
ages at which they were diagnose
4.
Tests to order -
Colonoscopy (best), look for synchronous lesions
Alternative: air contrast barium enema ("apple core" lesion) + sigmoidoscopy
Metastatic workup: CXR, abdominal CT/ultrasound
5.Differential diagnoses to consideR
1. IBS
Ulcerative colitiss-
3.Chrons disease
6.
Plan of care-
Page 2 of 6
2025
Case Study 1:
Question
CC: Mrs. L., a 68-year-old woman, presents to your office today with a complaint of feelingtired all the
time and now, more recently, feeling weak and like "I can't catch my breath sometimes."
HPI: She has been healthy except for high cholesterol, managed by Lipitor. Her husband died 9
months ago, and she has attributed her fatigue to dealing with his death but realizesthat she is feeling
worse and not better as time passes.
No known drug allergies. Medications: Takes only Lipitor.
Past surgical history: Appendectomy in childhood; hysterectomy for uterine myoma 10years ago.
No significant medical history. Has two daughters living nearby.
Blood pressure (BP) 106/70 mm Hg, heart rate (HR) 98 beats/min and regular, respiratoryrate 18
breaths/min and afebrile, body mass index (BMI) 22 (10-pound weight loss since death of husband).
Slender, quiet-spoken older woman appearing tired.
PE: Conjunctiva pale, mucous membranes moist. No lymphadenopathy of neck or femoralarea.
Heart tachyarrhythmia with regular rate, soft midsystolic murmur. Chest (CTA), good airmovement.
Abdomen soft, bowel sounds × 4.
Diagnostics:
Urine dipstick negative.
The results of a colonoscopy show a neoplasm in the colon.
What additional subjective data should we look for?
What additional objective data will be assessing for?
What medical history to obtain from the patient? List at least three.
What tests to order? Describe at least four lab tests.
What are the differential diagnoses to consider? Describe two.
What is the plan of care? List at least two diagnostic tests to be ordered to evaluatethe cause of
her condition.
Page 1 of 6
, Answered by Expert Tutors
1.
The additional subjective data we should look for include -
How long have she had the symptoms?
Are her symptoms getting worse?
Do she smoke or use other types of tobacco?
2.
Additional objective data will be assessing for -
Persistent change in her bowel habits, including diarrhea or constipation or achange in the
consistency of her stool
Rectal bleeding or blood in her stool
Persistent abdominal discomfort, such as cramps, gas or pain
3.
Medical history(importantly family ) to obtain from the patient is -
Making sure to document her mother's side of the family and her father's side of thefamily with
any significant findings
Documenting which relatives have had cancer, the type(s) of cancer they have had,and the
ages at which they were diagnose
4.
Tests to order -
Colonoscopy (best), look for synchronous lesions
Alternative: air contrast barium enema ("apple core" lesion) + sigmoidoscopy
Metastatic workup: CXR, abdominal CT/ultrasound
5.Differential diagnoses to consideR
1. IBS
Ulcerative colitiss-
3.Chrons disease
6.
Plan of care-
Page 2 of 6
