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The anticipation of the first meeting among psychotherapy group attendees may cause feelings of dread and uneasiness among clients. How does the PMHNP demonstrate awareness and promote the success of this first psychotherapy meeting?

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A 9-year-old child who witnessed a fatal car accident has come to therapy with her parents to get treatment. The child has been irritable since the event and has not wanted to talk about it. Utilizing a trauma-focused cognitive behavior therapy (TF-CBT) approach, the PMHNP has reviewed skills that the parents may use to help their child at home. Based on the PMHNP’s suggestion, which is a statement the parents might make after the child has a temper tantrum?

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A 15-year-old boy is seen in the clinic for complaints of “dull pain and pulling” in the scrotal area. On examination the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright.

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A client with history of bilateral tympanostomy tube insertion presents to the clinic c/o otorrhea. The provider confirms the complaint. What is the best treatment for this condition?

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The PMHNP conducts a specialized individual interview with a patient named Sandy. During this interview, Sandy expresses her want of the other members to like her, and she has a deep dread for the first group meeting. How does the PMHNP correctly interpret Sandy’s interpersonal circumplex?


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A PMHNP has a therapy group in which many members have been dropping out over the past several weeks. Members have complained that they do not feel part of the group. What is an appropriate step for the PMHNP to take?


A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?

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A patient has attended three group therapy sessions and has remained silent throughout each. The patient has, however, been listening to the other members. When the therapist makes eye contact with the patient, he or she forces a smile but has clenched fists. What is the most appropriate response by the PMHNP to help the patient?


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Following the PMHNP’s cancellation of a group session, he or she notices a decrease in compliance and attendance within the group. What does the PMHNP identify as the group’s reason for noncompliance?


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A woman has just been diagnosed with HPV, or genital warts. The nurse should counsel her to receive regular examinations because this virus makes her at a higher risk for _____ cancer.


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When doing the history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. Which of the following would be the best question for obtaining this information?


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You are examining a 6 month old baby. You place the baby’s feet flat on the table and flex his knees up. you note that the right knee is significantly lower than the left. Which of the following is true of this finding?

I can see it on your faces without even seeing them. For 3 CMC you can just search your library for multiple mana equal to your tapped creature count. Fun fact, green plays creatures and likes to turn them sideways. Equally fun fact, green likes to ramp. If only we had a card that took advantage of these things. Sure, it’s dead in hand when you’re behind, but that doesn’t stop cards from going into decks or even end up being all-stars for their color. Non-narrow deck builder’s will enjoy running this card, why not try it?


That being said, there are many rivers (usually with reasonably clear water) where a good size caddis imitation or a nice terrestrial beetle "splatted" down on the surface can pull fish up - even if they are not actively rising to a hatch of natural flies. Great training for this style is to get good at reading current features by developing your Euro nymphing tactics.

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A few days after a summer hiking trip, a 25-year-old man comes to the clinic with a rash. On examination, the nurse notes that the rash is red, macular, with a bull’s eye pattern across his midriff and behind his knees.

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Adam has type I diabetes and plays tennis for his university. He exhibits knowledge deficit about his insulin and his diagnosis.

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During a group session, a member turns to the PMHNP and says, “I need some advice. My manager asked me to take on an extra project, and now I’m overwhelmed. I don’t want to seem incompetent, so I agreed to the extra work.

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Age is a factor in different responses to pain. Which of the following age-related statements about pain is not true?

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There are several standardized training events in large organizations that are required annually or biannually. One of these is often sexual harassment. For this assignment, write a training plan for all employees in your firm to educate and develop their awareness of sexual harassment and understanding of legal and organizational policies. Be sure to include training aspects of planning, design, implementation, and evaluation.


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A 5-year-old client presents to the clinic for an annual physical. While performing the physical exam, the provider attempts to examine the client’s ears.

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With the same two (2) forces assessed and evaluated in the sections above, predict what the company might do to improve its ability to address these forces in the near future. Your writing here should provide a thorough prediction of what the company should do to address impacts from the selected forces. Your prediction should be your own, not predictions from your sources or actions your corporation has taken or plans to take. Remember that a thorough response is defined as providing a complete response that is not superficial or partial regarding every detail of the concepts as described in the course. Read Chapter 2 in the course textbook as each chapter provides a solid background and clues that apply to this section. Review the Week 2 Learn video Lecture for supporting content. Cite all sources and there should be no direct quotes in this section.


Prominent in some Italian schools of casting – this has the advantage of making the fly splat down BEFORE your fly line lands on the water. By drawing the trout’s attention to your fly (rather than to potential danger), you can get a split-second “reaction bite”. For this reason, it is best to aim directly at the point where the trout is LOOKING at the water before taking natural flies from the surface. In other words - in shooting terms you would say to use less "lead" as we will discuss below.

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First, the issue with it is that most Watcher decks are long-term decks. And, realistically speaking, you can’t play it for x more than 1-2. So it just doesn’t do enough for you. Second, it’s only good in the + version where you can play it for free, but your upgrades are not exactly endless (unless they are). So chances are good that you get it in your initial hand and it’s a dud. And, with your honest defenses, you really cannon afford having any duds in your hands. I can see it being workable in faster archetypes if it’s a plus version, but otherwise it’s meh.

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During a first group therapy session, a member is outgoing and participates actively. Based on this information, what is an appropriate prediction about this group member by the PMHNP?


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Her mother has Alzheimer’s disease and coronary artery disease. Her father died of a stroke and also had diabetes. She denies any tobacco, alcohol, or drug use. On examination she has decreased deep tendon reflexes in the patellar and Achilles tendons. She has decreased sensation of fine touch, pressure, and vibration on both feet. She has decreased two-point discrimination on her hands. Her grip strength is decreased and her plantar and dorsiflexion strength is decreased. Where is the disorder of the peripheral nervous system in this patient?


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A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?


Self-disclosure is a very important part of group therapy. Which of the following conditions does the PMHNP identify in his or her own life as a possible hindrance to self-disclosure?

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A 8-year-old client was recently discharged from the hospital following an episode of meningitis. The client presented to the clinic for a follow-up appointment post discharge.


To assess the head control of a 4-month-old infant, the nurse lifts the infant up in a prone position while supporting his chest. The nurse looks for what normal response?

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Examine the benefits and drawbacks of each proposed alternative. Provide careful consideration to the factors that influence the outcome of each alternative.

A PMHNP is leading a group therapy session for patients with substance abuse problems. After a productive session in which all members participated, the following week was not as productive. In order to help the group members assume responsibility for evaluating the meeting, what is an appropriate comment for the PMHNP to make?


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Historical Development of Each Theory—For each theory, discuss prominent persons and their corresponding historic research. Include how the theory has been developed over time. Have there been significant changes from its development to what current researchers in the area believe?

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Both the strengths and weakness must be addressed. Your justifications should be sound and thoroughly explained. For example, do not simply state that the corporation should choose a selected strategy, but rather explain why the strategy is a good choice for your corporations’ specific strengths or weakness. Read Chapter 2 and 3 in the course textbook as it provides a solid background and clues for this section. Review the Week 2 and Week 3 Learn video/Lecture for supporting content. Cite all sources and limit the use of direct quotes.


Discuss and contrast extrinsic versus intrinsic motivation. Give an example of each type of motivation from your personal experience.

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And you're right, rounding off would be crass. Probability is the shadow of ignorance, and we'd just be jumping into the larger shadow.

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Complete the Management Decision Problem 6-8 on p. 247 in your textbook. Create a one page summary document addressing the question at the end of the problem. In addition to the textbook, you may use external sources or select sources from the CSU Online library. Be sure to reference and cite all sources used with proper APA formatting.


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While obtaining a history of a 3-month old infant from the mother, the nurse practitioner asks about the baby’s ability to suck and grasp the mother’s finger. What is the nurse practitioner assessing?


You also need to have that desired card in your library to play it, so there are some potential dud draws – say, both this and Deva in starting hand is real bad. It’s much more honest than it seems to be.

Evaluate – pretty close in meaning to Swivel. Only whereas that funnels more Energy into your Exodia turn, this one adds more cards to play during it. And, I suppose, both are pretty important so the gap between the two here is minimal.


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From here stems the very defining aspect of this class – Watcher is always Energy starved. While there are ways of generating extra energy, they are fewer and less efficient than those of the other classes. With just a couple of exceptions and, needless to say, you’re going to abuse those exceptions intensely. This also means that energy generating relics should be prioritized – you really want to get one from the first boss or, at the very least, Snecko Eye. Scry is a great enabler of Snecko, btw. You also can use Runic Dome with minimal suffering as it suits your needs all right – it’s full defense then Exodia anyways. Just don’t be fighting too much on the stage-3 then as spaghetti monsters are too much of a pain with it.


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A 37-year-old insurance agent comes to your office, complaining of trembling hands. She says that for the past 3 months when she tries to use her hands to fix her hair or cook they shake badly. She says she doesn’t feel particularly nervous when this occurs but she worries that other people will think she has an anxiety disorder or that she’s a drinker. She admits to having some recent fatigue, trouble with vision, and difficulty maintaining bladder control. Her past medical history is remarkable for hypothyroidism. Her mother has lupus and her father is healthy. She has an older brother with type 1 diabetes. She is married and has three children. She denies tobacco, alcohol, or drug use. On examination, when she tries to reach for a pencil to fill out the health form she has obvious tremors in her dominant hand.

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A twenty-four-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type __ ADR when he no longer requires the opioids.


A 6/881-g sample containing magnesium chloride and sodium chloride was dissolved in sufficient water to give 500 mL of solution. Analysis for the chloride content of a 50/0-mL aliquot resulted in the formation of 0/5923 g of AgCl. The magnesium in a second 50/0-mL aliquot was precipitated as MgNH⁴PO⁴; on ignition, 0/1796 g of Mg²P²O⁷ was found. Calculate the % of MgCl²•6H²O and of NaCl on the sample.

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The title image is a detail of the Pillars of Creation in the Eagle Nebula. I made all the illustrations with Picbreeder, which also trained me to follow a thread of ideas without knowing where they come from or where they're going. The starfield margin is a layering of two images from Pixabay.

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The following article presents practical information from top financial executives regarding how they use business intelligence in support of corporate strategies. You are highly encouraged to view this article.

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Let us assume you are trying to make decisions about what items to discount in one of your hundred company gas/markets. It would not be too hard to query the sales data from that store for the past hour. You might get a hundred transactions. What can you do with that information? What if you pull the information for the last week or month? You could get thousands to millions of rows of data. At what point do you have too much data to deal with in your database?

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End-point nystagmus at an extreme lateral gaze occurs normally. Assess any other nystagmus carefully. Severe nystagmus occurs with disease of the vestibular system, cerebellum, or brainstem.


An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use.

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In fact the pharate adults are fully-formed adult flies which are covered in a kind of membrane which provides them with a temporary oxygen supply to get them to the surface - where a different system (of "spiracles" and "tracheae") will let them breathe air! The important things for you to know are that Caddis flies can look a little bit like moths and there are hundreds of different species.

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Length: Your paper should be between 7-9 pages, not including title and reference page. References: Include a minimum of five (5) scholarly sources. Your presentation should demonstrate thoughtful consideration of the ideas and concepts presented in the course and provide new thoughts and insights relating directly to this topic.


Poor APA formatting with many errors noted. Five or more direct quotes used.

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A PMHNP is treating a 7-year-old child exhibiting signs of aggression and attention problems. Before suggesting an intervention using a common elements approach, what may the PMHNP consider?


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A female patient is 8 months pregnant. She comments that she has noticed a change in posture and is having lower back pain. The nurse tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus.


One very important thing to understand about both Wrath & Calm is that the cheaper their source is, the better they are. That’s why the initial deck of this class sucks so much – both Eruption and Vigilance are abysmal at what they do. Eruption means that you do double damage, only now you’re not really having any energy to play cards. Vigilance says you draw 2 cards, only now you’re out of energy to play them. Sure, Eruption’s flaw is supposed to be compensated by a previous Calm setup and Vigilance is more about finding Retain cards, but that’s just making lemonade out of lemons which are given to you. So you’re starting with 10 cards to clean out (11 at later Ascension) and that’s tough. At least you’re having Scry and exhaust-others card so you can manage having a bit of chaff in your deck.

In this section you will consider the five (5) forces of competition and choose the two (2) that you estimate are the most significant for the corporation you chose. Hint: see figure 2/2 in the textbook. You will then, evaluate how well the company has addressed these two (2) forces in the recent past.


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Describe Maslow’s hierarchy of needs. Provide an example of a deficiency need overpowering the need for growth.


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Explain the results in everyday language. Recommend reviewing the text and information from the classroom for examples on how to report results in everyday language.

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An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You measure the patient’s temperature and it is 104 degrees Fahrenheit. What type of pulse would you expect to feel during his initial examination?

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Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side.


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A PMHNP is creating a therapy group and is including a patient with borderline personality disorder. Which action would most likely reduce the patient’s chance of separation anxiety?


The assessment of an 80-year-old patient, the nurse notes that his hands show tremors when he reaches for something and that his head is always nodding. There is no associated rigidity with movement. Which of the following statements is most accurate?

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A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?


In a group therapy session for patients with anxiety problems, a patient named Eve was afraid to disclose to the other members that she was a victim of sexual abuse. She kept the secret for months, although she hinted at it to other members. During a meeting, another member tried to pressure Eve to disclose her secret, but she was flustered and not ready to share. What is an appropriate response by the PMHNP?

The patient is in her first trimester of pregnancy. She complains of feeling nauseated and has vomited on occasion. She tells the nurse that she did not have this with her first pregnancy.


Peter, a successful businessman, is introduced to the group during the twelfth week. Following Peter’s introduction, Joseph, a long-term member in the group, begins to lead the group and discuss all of the things that he has personally accomplished. In what way does the PMHNP correctly interpret Joseph’s behavior?

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During an external genitalia examination of a woman, the nurse notices several lesions around the vulva. The lesions are pink, moist, soft, and pointed papules. The patient states that she is not aware ofany problems in that area.


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You are required to research the two companies to provide a company overview, to identify identify the issues and to identify stakeholders. You will be using the course to address the questions and support the ideas, reasoning and conclusions made. Course material use goes beyond defining terms but is used to explain the ‘why and how’ of a situation. Using one or two in-text citations from the course material and then relying on Internet source material will not earn many points on the project. A variety of source material is expected and what is presented must be relevant and applicable to the topic being discussed. Avoid merely making statements but close the loop of the discussion by explaining how something happens or why something happens, which focuses on importance and impact. In closing the loop, you will demonstrate the ability to think clearly and rationally showing an understanding of the logical connections between the ideas presented in a case scenario, the course material and the question(s) being asked.


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The PMHNP recognizes that extra group behavior involves behavior that occurs outside of the group or during subgrouping. Which statement best describes extra group behavior as it pertains to group therapy?


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Design: In what format should the training be given, and why? What modalities will be used for employees on multiple shifts or in multiple locations? What are the core elements of the training that will align with the learning objectives?


Explain, in everyday language, the results. If any of the assumptions were not met, describe how it might affect conclusions. Address issues of Type I and/or Type II Error, where appropriate. Recommend reviewing the text and information from the classroom for examples on how to report results in everyday language.

Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?


A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?

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Lenzo weighs herself every day with a very accurate balance-type scale. She has noticed that over the past 2 days she has gained 4 pounds. How would you best explain this?

Both of the above patterns probably best represent "duns" or adult insects (or at least are a tolerably-good imitation of that situation). For more pronounced "emerger" imitations, a dropped/angled abdomen is a powerful trigger. The shape of the hook and position of the part of the fly which makes the fly float can control this. The buoyant, fuzzy "CDC" (cul-de-canard) feathers from close to the preen gland on ducks is very good for this purpose (as well as curved-abdomen parachute hackle flies in the "klinkhåmer special" mould). See below for examples in the "Abdomen Angle" section.


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You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office are: T 98/6, HR 78, BP 118/92, and RR 14, and she denies pain. You noticed that she had had some hypertensive changes in her retinas and mild proteinuria on a urine test on prior medical records. You expected the BP to be higher.

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Fooddiaries require the individual to write down everything consumed for a certaintime period. Because of the erratic eating patterns of this individual,assessing dietary intake over a few days would produce more accurateinformation regarding eating patterns. Direct observation is best used withyoung children or older adults.

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The PMHNP is meeting with an older married couple. The couple reports having concerns about becoming dependent on their adult children someday, since several of their other friends have had to move in with their kids. They make it clear to the PMHNP that they aren’t keen on therapy or taking medicine but would be willing to try some alternative therapies. What does the PMHNP suggest for evidence-based CAM modalities?

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A PMHNP is treating an 8-year-old child who was at a cousin’s house during a domestic violence situation. Using a common factors model, the PMHNP wants to pay attention to cultivating the relationship with the parents and child. After the child talks about how nervous he or she has been since witnessing the trauma, what is an appropriate response by the PMHNP?


The PMHNP understands that conflicts within the psychotherapy group can be troublesome for clients and have the potential to reduce the effectiveness of the group process. As it pertains to group meetings, the PMHNP understands which statement to be true about conflict?

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A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?

The second part of the trick is to use waxy water-repelling cells towards the centre of the "anchoring" ring of water-loving cells. Those waxy cells push apart the water molecules to make an "escape hatch" for the adult fly to push through as they escape their larval/pupal skin.


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A 70-year-old patient is scheduled for open-heart surgery. The surgeon plans to use the great saphenous vein for the coronary bypass grafts.

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A patient named Tyrone was nervous sharing personal information with the group. To compensate, he makes comments on other members’ problems as if he were the therapist.

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Evaluation: How will you know if the training was successful? What measures will you use to know if employees 1) learned from the training, 2) behaved differently after the training, and 3) the training has a bottom line impact to the firm?

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During an examination, you note that a male patient has a red, round, superficial ulcer with a yellowish-serous discharge on his penis. Upon palpation, you note a nontender base that feels like a small button between your thumb and fingers.

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A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead.


The nurse is bathing an 80-year-old man and notices that his skin is wrinkled,thin, lax, and dry. This finding would be related to which factor?

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The nurse is testing superficial reflexes on an adult patient. When stroking up the lateral side of the sole and across the ball of the foot, the nurse notices the plantar flexion of the toes. How would the nurse document this finding?


When performing the bimanual examination, the nurse notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. The nurse’s interpretation of these results should be which of these?

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A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?

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Two PMHNPs are in charge of a therapy group that has experienced several maladaptive interpersonal dramas lately. One of the patients has been described by other members as argumentative. After a particularly awkward session, one of the therapists feels that his own interpersonal distortion of the session may be clouding his observation. What is an appropriate step by that PMHNP?

A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%.


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An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?

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How could each one meet a need in your business? What financial institutions do you finally settle on? What services or products will you use?


However, the resulting adults may crash-land on the water during the mating scramble - or the females will return to the water to lay eggs. So they can still create viable targets for the dry fly angler to imitate.

Their trick (which you can see in action above) is to have the nymphs/pupae "glue" themselves to the underside of the surface-film of the water using special "water-loving" cells on their thorax. That gives them something to pull on (otherwise if they just pushed up against the surface, they'd simply bounce off).



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There are many ways to achieve a hanging abdomen for an emerger pattern (see photos of different parachute dressings below for examples). The two diagrams above show options using cul-de-canard feather (which is buoyant more because of its structure of thousands of tiny, fine air-trapping barbs - rather than being coated with preen-gland oil as popular myth would have it).


As this is a nongraded activity, this work cannot be uploaded to Blackboard. If you would like your professor’s feedback on your work, send this document to them in an email with a note that you would like to receive feedback on your non-graded activity.

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Two or more supporting scholarly references are required. Textbooks are not allowed and should not be used as a scholarly source. Use the Chamberlain Library to locate relevant, scholarly sources.


A school-age client presents to the clinic to establish care. The child has autism, facial dysmorphia, and growth retardation. The provider suspects the child has what condition?