Final Exam: Advanced Health Assessment - 2024, Exams of Nursing

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6512 Final Exam - Final Exam Advanced Health

Assessment 2024 verified graded A+

1. During chest assessment, you note the patient's voice quality while auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and the e's sound like a s. This sound is indicative of:
   • Lung consolidation
2. As Mr. B. enters the room, you observe that his gait is wide based, and he staggers from side to side while swaying his trunk. You would document Mr. B.'s pattern as:
   • Cerebellar ataxia
3. Diabetic peripheral neuropathy will likely produce:
   • Diminished pain sensation
4. Montgomery tubercles are most prominent in the breasts of:
   • Pregnant women
5. Which one of the following techniques is used to detect a torn meniscus?
   • McMurray test
6. Ulnar deviation and boutonniere deformities are characteristic of:
   • Rheumatoid arthritis
7. A pulsation that is diminished to the point of being barely palpable would be graded as:
   • 1
8. When palpating joints, crepitus may occur when:
   • Irregular bony surfaces rub together
9. While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding:
   • Alcohol, tobacco, and caffeine use
10. Postural hypotension is defined as a when the patient stands, compared with sitting or supine readings.
    • Systolic pressure drop of more than 15mm Hg with a pulse rate increase

11. A positive straight leg raise test usually indicates:

• Lumbar nerve root irritation

12. The best way to ease the apprehension of a 3 - year-old child before a physical examination is to:

• Let the child hold the stethoscope while you listen

13. An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?

• Cytology smear

14. The finger-to-nose test allows assessment of:

• Coordination and fine motor function

15. Which medical condition would exclude a person from sports participation?

• fever

16. Palpation of epitrochlear nodes is part of the:

• Examinations of the upper extremities

17. A grade IV mitral regurgitation murmur would:

• Radiate to the axilla

18. The musculoskeletal examination should begin when:

• The patient enters the examination room

19. Facial muscle or tongue weakness may result in:

• Aphasia

20. The physical assessment technique most frequently used to assess joint symmetry is:

• inspection

21. Part of the screening orthopedic component of the examination includes evaluating the person while he or she is:

• Duck walking

22. The Mini-Mental State Examination should be administered for the patient who:

• Gets lost in her neighborhood

23. The Mini-Mental State Examination:
    • May be used to quantitatively estimate cognitive changes
24. Which of the following statements is true regarding the examination of peripheral arteries?
    • The pulses are most readily felt over bony prominences
25. Which portion of the physical examination is best done with the patient standing?
    • spinal
26. In the adult, the apical impulse should be most visible when the patient is in what position?
    • Upright
27. You are conducting a clinical breast examination for your 30 - year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with:
    • Fibrocystic changes
28. During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:
    • Are usual conditions during pregnancy
29. To hear diastolic heart sounds, you should ask patients to:
    • Lie on their left sides
30. A red, hot swollen joint in a 40 - year-old man should lead you to suspect:
    • gout
31. While interviewing a 70 - year-old female clinic patient, she tells you that she takes ginkgo biloba and St. John's wort. You make a short note to check for results of the:
    • Mini-Mental State Examination
32. Loss of immediate and recent memory with retention of remote memory suggests:
    • dementia

33. When the Goodenough-Harris Drawing Test is administered to a child, the evaluator principally observes the:
    • Presence of form of body parts
34. Palpation of a normal prostate in an older adult is likely to feel:
    • rubbery
35. One of the most important aspects to consider in the orthopedic screening examination is:
    • symmetry
36. A 12 - year-old boy relates that his left scrotum has a soft swollen mass. The scrotum is not painful upon palpation. The left inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with:
    • hydrocele
37. The rectal past medical history of all patients should include inquiry about:
    • Hemorrhoid surgery
38. A common finding in markedly obese and pregnant women is:
    • Lordosis
39. Kawasaki disease is suspected when assessments of a child reveal:
    • Conjunctival injection, strawberry tongue, and edema of the hands and feet
40. At your first meeting with a patient, it is usually best to say:
    • Tell me about yourself
41. While examining a 30 - year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should:
    • Note the finding in the patients record
42. Nancy Walker is a 16 - year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, Nancy is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Nancy's current problem?

• Cocaine use

43. An apical PMI palpated beyond the left fifth intercostal space may indicate:

• Left ventricular hypertrophy

44. You are conducting an examination of Mr. Curtis's heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is:

• Moderately loud

45. When conducting a geriatric assessment, basic activities of daily living (ADLs)include:

• bathing

46. Recent unilateral inversion of a previously everted nipple suggests:

• cancer

47. The examiner percusses for diaphragmatic excursion along the:

• Scapular line

48. Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:

• uremia

49. Assessing orientation to person, place, and time helps determine:

• State of consciousness

50. The goals of preparticipation sports evaluation include:

• Identifying risk of injury or death during sports participation

51. If your patient has nipple discharge, you will most likely need a:

• Glass slide and fixative

52. The difference in blood pressure readings between the right and the left arms is considered normal up to mm Hg.

• 10

53. An ophthalmoscopic eye examination involves:

• Lens inspection

54. Adrian Thompson is a 19 - year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Adrian, apart from occasional sinus infections, Adrian is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Adrian’s current problem?
    • Cocaine use
55. If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?
    • CN XI, spinal accessory
56. The checkout station for preparticipation physical evaluation (PPE) is critical because at this point:
    • Coordination of follow-ups is reviewed
57. Your 15 - year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:
    • Menstrual cycles
58. Tarry black stool should make you suspect:
    • Upper intestinal bleeding
59. To assess a cremasteric reflex, the examiner strokes the:
    • Inner thigh and observes whether the testicle and scrotum rise on the stroked side
60. The family history for a patient with joint pain should include information about siblings with:
    • Genetic disorders
61. A finding that is indicative of osteoarthritis is:
    • Heberden nodes
62. When you attempt to move a 10 - month-old child from his mother's lap to the examination table, he screams loudly. Your best action is to:
    • Perform the examination while the child is in the mother’s lap
63. The strength of the trapezius muscle is evaluated by having the patient:
    • Push her head against the examiners hand

64. You are examining Mr. S., a 79 - year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial occlusion?
    • Loss of hair over the extremity
65. The adnexa of the uterus are composed of the:
    • Fallopian tubes and ovaries
66. You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?
    • Cervical spine radiograph
67. Cranial nerve XII may be assessed in an infant by:
    • Observing the infant suck and swallow
68. When assessing superficial pain, touch, vibration, and position perceptions, you are testing:
    • Sensory function
69. An idiopathic spasm of arterioles in the digits is termed:
    • Raynaud disease
70. You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient's neurologic status, you would:
    • Test the six cardinal points of gaze
71. A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is:
    • riflery
72. The reliability of health-related findings and observations is the responsibility of the:
    • Professional and the patient
73. You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive:
    • Romberg sign
74. Examination of the patient in the lithotomy, or knee-chest, position includes:

• Palpation of anal sphincter

75. The foramen ovale should close:

• Within minutes of birth

76. A cervical polyp usually appears as a:

• Bright-red soft protrusion from the endocervical canal

77. Anterior cruciate ligament integrity is assessed via the test.

• lachman

78. Temporalis and masseter muscles are evaluated by:

• Having the patient clench his or her teeth

79. Functional assessment is most important during the examination of a(n):

• Older adult

80. A patient in the deepest coma would be scored a on the Glasgow Coma Scale.

• 3

81. Your older clinic patient is being seen today as a follow-up for a 2 - day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:

• Auscultating the lung bases

82. In the most effective percussion technique of the posterior lung fields, the patient cooperates by:

• Folding the arms in front

83. If pitting edema is unilateral, you would suspect occlusion of a:

• Major vein

84. You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is apathetic and has disturbed thoughts and language patterns. The nurse recognizes this behavior pattern as consistent with a diagnosis of:

• Schizophrenia

85. When palpating breast tissue, the examiner should use the at each site.
    • Finger pads, gliding
86. You are reviewing an ECG of a 43 - year-old new patient. The patient has a history of second- degree heart block. The ECG shows the PR interval is increases with each beat until a QRS is dropped. What is this type of block called?
    • Second degree heart block, type 1: Wenckebach/Mobitz 1
87. Throughout the history and physical examination, the clinician should:
    • Evaluate the whole patient
88. The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:
    • QRS complex
89. You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should:
    • Inquire about previous penile infections
90. To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with:
    • One arm overhead and a pillow under her shoulder
91. You order an ECG on a patient that c/o feeling heart palpitations, chest pain, shortness of breath. Your ECG shows irregular heart rate, and you determine that you need to call EMS immediately because this rhythm can cause death. What rhythm would you suspect the ECG is showing?
    • Ventricular Tachycardia
92. Breath sounds normally heard over the trachea are called:
    • Bronchial
93. Darian is a 14-year-old adolescent who states his right testicle has a soft swollen mass. The testicle is not painful upon palpation. The right inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with:
    • Hydrocele
94. When assessing a 17-year-old for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test, you would also perform a test for the sign.
    • Kernig
95. A 25 yo AA female has come to the clinic because she has missed her menstrual period this month and 2 months before. She says her cycles are irregular and she wants to be on birth control to help regulate them. She states that her breasts have enlarged and that her nipples

have turned a darker color. Your further response to this finding is to:

• Suggest a pregnancy test

96. Normal changes of the aging brain include:

• Diminished perception of touch A 62 - year-old female presents to the clinic with complains of chest pain and heart palpitations that started 3 days ago. Patient states she is healthy and only has a history of hypertension and tachycardia. Patient is currently taking Norvasc 10mg daily and Coreg 6.25 mg BID. You order an EKG and it shows heart rate above 200 beats/min and the ECG may look like a sawtooth cog. What is the most likely diagnosis of this patient?
• Atrial flutter

97. Which one of the following is a proper technique for use of a speculum during a vaginal examination?
    • Press introitus downward; insert closed speculum obliquely
98. An elderly female was recently diagnosed with osteoporosis 2 weeks ago. What is the hallmark appearance of a patient with this diagnosis?
    • Dowager hump
99. Bimanual examination of the uterus includes:
    • Grasping the cervix between the examining fingers
100. The Denver II is a tool used to determine:

- Whether a child is developing as expected 

101. Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of:

- Older adults 

102. When is the mental status portion of the neurologic system examination performed?

- Constantly, throughout the entire interaction with a patient 

103. A 56 - year-old male presents to the clinic to see the nurse practitioner with complaints of shortness of breath for 1 months, 15-pound weight gain and lower extremity edema. Vitals are as follows: HR: 120, Respirations 30, Blood Pressure: 138/90, BMI: 40; Oxygen saturation of 90%. On examination patient is noted to have jugular venous distention, enlarged liver, and crackles are noted on examination. A chest x-ray is completed and shows findings consistent with which diagnosis? Based on this scenario and imaging what is the most likely diagnosis?

- Right sided congestive heart failure 

104. You are assessing Mr. Z.'s fluid volume status as a result of heart failure. If your finger depresses a patient's edematous ankle to a depth of 6 mm, you should record this pitting as:

- 3+ 

105. Nerves that arise from the brain rather than the spinal cord are called:

- Cranial 

106. A 40 yr old female presents to the clinic with complaints of low back and buttock pain. Pt states the buttock pain radiates from one side to the other. On examination, the patient is noted to have limited ROM of the shoulders, chest wall, hips, and knees. Upon x ray, you find gross postural changes and there is a severe deformity of the vertebral column. What is the most likely diagnosis for this patient?

- Ankylosing Spondylitis 

107. A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of "heart trouble." The most important follow-up question you

should pose is which of the following?

• What age was your father at the time of his death

108. It is especially important to test for ankle clonus if:

- Deep tendon reflexes are hyperactive 

109. For purposes of examination and communication of physical findings, the breast is divided into:

- Four quadrants plus a tail 

110. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the:

- Fingertip 

111. A chest radiography is performed on your patient that complains of having dyspnea, coughing productive sputum and chest pain. The image results show consolidation and infiltrates. You compare this to your physical exam findings of distant or absent breath sounds and absent vocal fremitus. What is the most likely diagnosis?

- Pneumonia 

112. Which condition is considered progressive rather than reversible?

- Dementia 

113. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:

- P wave 

114. Which cranial nerves are usually evaluated during the examination of the eyes?

- III and VI 

115. Inspection of the scrotum should reveal:

- Left scrotal sac lower than the right 

116. To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?

- Patellar 

117. The presence of cervical motion tenderness may indicate:

- Pelvic inflammatory disease 

118. Your patient's chief complaint is repeated pencil-like stools. Further examination should include:

- Digital rectal examination (DRE)