A 47-Year-Old Man Comes to a Homeless Shelter Clinic Due

question 241

Multiple Choice

A 47-year-old man comes to a homeless shelter clinic due to 2 weeks of skin rash.  The patient was recently hospitalized and treated for an infection, but he is unsure of the details.  He was diagnosed with HIV 10 months ago and is not on antiretroviral therapy.  He also has a history of chronic kidney disease and hypertension.  He takes no medication regularly.  The patient drinks 1-2 cans of beer daily and does not use tobacco.  Temperature is 37.2 C (99.0 F) , blood pressure is 120/70 mm Hg, pulse is 80/min, and respirations are 14/min.  BMI is 17 kg/m².  Oropharyngeal thrush is present.  Cardiopulmonary auscultation reveals clear lung fields, and normal first and second heart sounds without murmur or gallop.  The abdomen is soft and nontender.  The liver is palpable 3 cm below the costal margin, and mild splenomegaly is present.  Neurological examination shows no abnormalities.  Multiple small papules with central umbilication are present on the face, neck, trunk, and upper thighs.  Some of the lesions have central necrosis and are covered with a hemorrhagic crust.
Which of the following is the most likely diagnosis for this patient?

• A)Basal cell carcinoma
• B)Cutaneous cryptococcosis
• C)Disseminated Mycobacterium avium-intracellulare
• D)Kaposi sarcoma
• E)Pyoderma gangrenosum

Recognize documentation necessary for the reimbursement of home nursing care by Medicare, Medicaid, and insurance companies.

Comprehend the benefits of electronic medical record (EMR) systems in healthcare.

Understand the essentials of effective hand-off communication between nurses.

Know patient rights concerning their medical records and privacy.

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Definitions:

Severe Depression

A major depressive disorder with intense symptoms that substantially impair an individual's ability to function in daily life.

Nursing Diagnosis

An appraisal by medical personnel of the reactions or experiences of individuals, families, or communities to real or potential health problems or life processes.

Suicide Precautions

Measures taken to prevent a person at risk of suicide from harming themselves, typically involving close supervision and removal of harmful objects.

Older Client

Refers to an individual of advanced age receiving care or services, often pertaining to health-related needs.