Maryville NURS 612 Final Exam with 100% Correct Answers 2023, Exams of Nursing

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Maryville NURS 612 Final Exam with 100%

Correct Answers 2023

Which of the Following disorders is known to be heredity? Peripheral neuropathy Meningitis Huntington Chorea Seizure disorder - Correct answer Huntington Chorea The Examiner asks the patient to close her eyes and then place a vibrating tuning fork on the patients ankle and asks her to indicate what is felt. What is being assessed? - Correct answer Primary sensory function Multiple sclerosis - Correct answer Fatigue, bowel and bladder dysfunction, sexual dysfunction, sensory changes, muscle weakness Myasthenia gravis - Correct answer An autoimmune disorder of neuromuscular junction involved with muscle activation. Whisper Test - Correct answer CN V111 acoustic Patient sticks out tongue and moves it from side to side - Correct answer CN X11 Hypoglossal Taste test with sugar, salt, and lemon - Correct answer CN V11 and CN 1X Facial and glossopharyngeal Patient puffs out cheeks and shows teeth - Correct answer CN V11 facial Patient shrugs shoulders against examiner's hands - Correct answer CN X1 Spinal accessary Smell test with coffee, orange and cloves - Correct answer CN 1 Olfactory Eyes constrict and dilate in response to light - Correct answer CN 111 oculomotor

patient clinches teeth (temporal muscles contracted) - Correct answer CN V Trigeminal positive Babinski sign be considered a normal finding in what ages? - Correct answer 0- months The nurse observes the gait of a client as he enters the room. He uses short steps, keeps his knees in contact, and walks with considerable effort. What term is used to describe this gait? - Correct answer Scissors gait A nurse observes very fine, rapid, continuous twitching of a patient's finger while at rest. How should the nurse document this finding? - Correct answer Fasciculation A fasciculation is a fine, rapid twitching that may occur with some lower motor neuron disease. Paralysis is loss of motor function. Spasticity is abnormally increased muscle tone. An intention tremor is an involuntary contraction of a muscle group occurring with voluntary movement Under what conditions should a patient be tested for clonus? - Correct answer When deep tendon reflexes are hyperactive Clonus, repeated reflex muscle movement, is tested when a patient has hyperactive reflexes. It is found with diseases of the upper motor neuron. Nuchal rigidity, neck stiffness, is a sign of meningeal irritation. Absent reflexes are associated with lower motor neuron diseases. Decorticate positioning, a state of flexion with the arms adducted, occurs with hemispheric lesion of the cerebral cortex. The abdominal reflexes are tested to assess functioning of the nerves in which location of the spine? - Correct answer Thoracic Which change is most commonly observed in aging patients? - Correct answer Kyphosis, advanced posterior curvature of the thoracic spine, occurs commonly with age. Lordosis, scoliosis, and ankylosis are not as commonly associated with age. While palpating the patient's knee, the nurse finds effusion in the joint. What further assessment will support this finding? - Correct answer Testing for ballottement is a test to detect fluid in the joint

Which assessment finding is associated with lumbar stenosis? - Correct answer Pain associated with prolonged standing Lumbar stenosis, narrowing of the spinal canal, causes pain associated with prolonged standing. Pain is improved by bending forward. Risk factors for osteoarthritis - Correct answer Risk factors for osteoarthritis include obesity, aging, and a family history of osteoarthritis. overuse of joints, as with certain sport activities and occupations, is a risk factor. A patient states he injured his right ankle while walking the previous day. How should the nurse assess the ankle initially? - Correct answer Initial assessment is inspection of the ankle and comparison with the other ankle. Palpation, performing passive range of motion, and asking the patient to walk are done after the initial inspection. Which assessment finding is consistent with carpal tunnel syndrome? - Correct answer Carpal tunnel syndrome, compression of the median nerve, causes weakness in the thumb and episodes of numbness and burning that awaken the patient from sleep. McMurray sign test for? - Correct answer Anterior cruciate ligament injury (ACL) Neer Test - Correct answer Shoulder rotator cuff impingement or tear Hawkins test - Correct answer Shoulder rotator cuff impingement or tear Katz hand diagram - Correct answer Median nerve integrity (carpel tunnel) Thumb abduction test - Correct answer Median nerve integrity (carpel tunnel) Tinal sign - Correct answer Median nerve integrity (carpal tunnel) Phalen test - Correct answer Median nerve integrity (carpal tunnel) Straight leg raising - Correct answer L4, L5, S1 nerve root irritation

Femoral stretch test - Correct answer L1, L2, L3, L4 nerve root irritation Bulge sign - Correct answer Effusion of the knee Anterior and posterior drawer test - Correct answer Anterior and posterior cruciate ligament integrity (ACL and PCL) Varus-valgus stress test - Correct answer Medial or lateral collateral ligament instability of the knee (MCL) Lachman test - Correct answer Anterior cruciate ligament integrity (ACL) Thomas test - Correct answer Flexion contracture of hip Trendlenburg sign - Correct answer Weak hip abductor Herberden nodes and bouchard nodes noted on the hands - Correct answer Osteoarthritis Low back pain that radiates to the buttocks and posterior thigh with tenderness over the spine - Correct answer Lumbar disk herniation (lumbaosacral radiculopathy) Heat redness, swelling, and tenderness to the metatarsophalangeal joint - Correct answer Gouty arthritis of the great toe Subcutaneous nodules on the forearm near the elbow - Correct answer Rheumatoid arthritis tenderness, swelling, and boggy sensation with palpation along the grooves of the olecranon process; increased pain with pronation and supination - Correct answer Epicondylitis (tennis elbow) or tendonitis A child with muscle atrophy and symptoms of progressive muscle weakness - Correct answer Muscular dystrophy

A child complaining of pain in the elbow and wrist; will not move his or her arm; maintains arm in a flexed and pronated position - Correct answer Radial head subluxation Chronic inflammatory disease involving the spine and sacroiliac joints - Correct answer Ankylosing spondylitis Numbness, burning, and tingling in the hands - Correct answer Carpal tunnel syndrome Unilateral facial pain that worsens with joint movement - Correct answer Temporomandibular joint syndrome Sudden onset of hot, swollen joint(s) - Correct answer Gout Excessive bone resorption and bone formation - Correct answer Paget disease Painful, nonarticular musculoskeletal condition - Correct answer Fibromyalgia Inflammation of this structure adjacent to a joint leads to limitation with motion, point tenderness, and swelling - Correct answer Bursitis Avascular necrosis of the femoral head - Correct answer Legg-Callve-Perthe disese The spine of a newborn infant should e palpated with the examiner noting the shape of each spinal process. If a split is noted in one of the spinal process, which problem is suspected? - Correct answer Bifid defect What degree of knee flexion is considered a normal finding? 15 90 130 160 - Correct answer 130

Mrs. wood is a 28-year-old patient who is pregnant in her last trimester and presents to your office with complaints of numbness in her left hand. You diagnosis her with carpel tunnel syndrome most likely related to Repetitive movement Fluid retention postural changes in the neck caused by pregnancy Eclampsia - Correct answer Fluid retention Lumbar Stenosis - Correct answer Pain with walking or standing upright that often seems to originate in the buttocks and may then radiate down the legs. Pain relief may occur with sitting or bending forward Pain may be worsened by prolonged standing, walking, or hyperextending the back. In early stages, the neurological examination is frequently normal. With progression, the examination my show lower extremity weakness and sensory loss. What is normal full extension of the knee? - Correct answer up to 15 degrees hyperextension The nurse teaches a young adult male genital self-examination for men. What is the purpose of this instruction? - Correct answer Teaching young male patients about genital self-examination includes observation for signs of sexually transmitted diseases, including skin lesions and discharge. Men at risk can seek treatment if they are aware that they have signs of commonly sexually transmitted diseases. A nurse reviews the health history with a male patient previously diagnosed with condyloma acuminata. What does the nurse expect to observe during the examination? - Correct answer Condyloma acuminata is a sexually transmitted disease that causes wartlike lesions in the genital area Infertility is associated with which condition? - Correct answer A varicocele, a mass of varicose (dilated and tortuous) veins within the spermatic cord, is a common cause of infertility. The infertility is caused by decreased sperm viability related to increased venous pressure and testicular temperature.

What term is used to describe a loop of bowel that cannot be reduced? - Correct answer An incarcerated hernia is a loop of bowel that cannot be reduced or returned to its normal position within the abdominal cavity by gravity or gentle pressure. Which assessment finding is associated with a left testicular torsion? - Correct answer With testicular torsion, the spermatic cord turns on itself, and blood supply to the testicle is obliterated. This causes severe pain in the affected testicle, often accompanied by nausea and vomiting, scrotal discoloration, and absence of the cremasteric reflex on the affected side. What health benefits has research shown for males who are circumcised? - Correct answer A report from the American Pediatric Association (2012) stated benefits associated with circumcision include prevention of cancer of the penis, urinary tract infections, acquiring HIV, and transmission of some sexually transmitted diseases. Which is a correct description of the procedure to palpate the breasts? - Correct answer Breast examination includes bimanual palpation to compress breast tissue between the fingers and the other hand. Inspection of the breasts with the patient assuming different positions is done before palpation. The nurse includes squeezing the nipples only if the patient states she is having discharge from the nipples. The fingers should be kept in contact with the skin to apply light, medium, and deep pressure while palpating the breast with the patient supine. An adolescent male has observable enlargement of one breast and is very concerned. What is the significance of this finding? - Correct answer An enlargement of one breast in a male adolescent is a normal finding during puberty. The condition usually resolves within 1 year with no treatment. Which is a normal assessment finding in adult female breasts? - Correct answer Montgomery follicles are tiny sebaceous glands that are visible in the areola and are a normal finding. Which is a risk factor for breast cancer? - Correct answer An increased risk of developing breast cancer is associated with use of hormone replacement after menopause and having a first- degree relative who was diagnosed with breast cancer. Risk factors for breast cancer - Correct answer Risk increase with age

Gender mare female than men develop breast cancer Genetic risk, BRCA1 or BRCA2 35-85 present higher chance of developing breast cancer Personal history of breast cancer Family history of breast cancer Previous breast biopsies, atypical hyperplasia or lobular cancer in stiu Race white women are higher risk Previous breast radiation menarche before are 12 or menopause after age 55 Breast density, more dense tissue increases risk Diethylstibestrol (DES) therapy Childbirth Nulliparity or late age at birth of first child Hormone therapy use of estrogen and progesterone hormone replacement therapy after menopause more than 4 years Alcohol Obesity and high fat diets lack of physical activity Inspection of breast - Correct answer Patient sits with arms hanging loosely at sides, inspect each breast and compare it with the other for size, symmetry, contour, skin, color and texture, venous patterns, and lesions. Lift breast with finger tips, inspecting the lower and lateral aspects to determine changes in the color or texture of the skin. Retractions and dimpling of breast - Correct answer Signify the contraction of fibrotic tissue that may occur with carcinoma Peu d`orange (orange skin) appearence - Correct answer Indicates edema of the breast caused by blocked lymph drainage in advanced or inflammatory breast cancer. The skin appears thickened with enlarged pores and accentuated skin markings. Venous pattern of breast - Correct answer Usually pronounced only in the breast of pregnant or obese women. venous pattern should be symmetric. Unilateral pattern can be produced by dilated superficial veins as a result of increased blood flow to a malignancy, this finding need further evaluation.

Abnormalities in nipples - Correct answer Recent unilateral inversion of a previously inverted nipple suggest malignancy Retraction is seen as a flattening or pulling back of the nipple and areola, which indicates inward pulling by inflammatory or malignant tissue. positions for inspection of breast - Correct answer Arms extended overhead hands pressed against hips pressing hands together leaning forward at waist Galactorrhea - Correct answer Administration of phenothiazines Mastitis - Correct answer clogged milk duct fibrocystic disease - Correct answer Ductal enlargement Dimpling in breast - Correct answer Malignant breast tumor Nipple retraction - Correct answer Possible sign of breast malignancy 2 to 3cm subareolar duct lesion - Correct answer intraductal papillomas Paget disease - Correct answer Red, scaling, crusty, patch Mammary duct estasia - Correct answer Blocked subareolar ducts While palpating the introitus of the vagina, the patient jumps and complains of severe tenderness. A mass is palpated that is warm to touch. with which of the following problems are these clinical findings consistent? - Correct answer Inflammation of the Bartholin glands What is indicative of a pelvic mass? The cervix is ... - Correct answer deviating to the right

An examiner plans to collect samples for cytological studies during a vaginal examination. Before the examination, the examiner should lubricate the speculum with... - Correct answer Warm Water Symptoms associated with premenstrual syndrome (PMS) are caused by - Correct answer Fluctuations of Hormones A patient complains of urinary incontinence when she is active. Which associated finding might explain this problem? - Correct answer Hernial protrusion through the anterior wall of the vagina. Which finding suggests an infection with a sexually transmitted infection. - Correct answer Ulcers and vesicles on the vulva In what way is the pelvic outlet estimated on a pregnant patient? - Correct answer Use a Thom pelvimeter to measure the bi-ischial diameter. The examiner observes venous return on the abdomen of the patient that moves upward from the pubis to the chest. This finding should make the examiner consider. - Correct answer Inferior vena cava obstruction The examiner palpates an organ in the left costal margin. which technique should the should the examiner use to differentiate between an enlarged left kidney and an enlarged spleen? - Correct answer Percussion, listening for dullness. A history of chest pain is collected as part of an abdominal history because it may be... - Correct answer Perceived as esophagus and stomach pain. You note that the midclavicular liver span of an adult male patient is 18cm. With palpation, you not that the liver is enlarged, hard, and non-tender. What do these findings suggest? - Correct answer Cirrhosis In which group is abdominal palpation easiest and most accurate? young children

adolescents young adults older adult - Correct answer Older adult A 61-year-old man has a presenting complaint of frequent constipation. he tells the examiner that there has been a change in his bowel movement habits; he gets constipated easily, the stool is very skinny looking, and it is a different color than usual. He denies pain. What do these symptoms suggest? - Correct answer Colon or rectal cancer Which rule states that the farther away from the navel abdominal pain occurs, the more likely it is to be of physical importance? - Correct answer Apley rule Abdominal pain radiating to the left shoulder may be indicative of which of the following? - Correct answer Splenic rupture What is the purpose of the liver scratch test? - Correct answer The liver scratch test is used to define liver borders in a patient with abdominal distention. Changes in sound while scratching the abdomen are heard with the stethoscope over the liver. The scratch test is not used to identify bruit or ascites or differentiate types of liver disease. How does a nurse assess for pain related to peritonitis? - Correct answer Rebound tenderness is a sign of peritonitis, acute inflammation of the peritoneum. The nurse pushes slowly and deeply on a site away from the area of pain. Upon quick release, the patient has pain over the area of tenderness. Light palpation or indirect percussion of the costovertebral angle is not specific to peritonitis. Ascites is not associated with peritonitis. Which type of incontinence is caused by dementia in patients? - Correct answer Functional incontinence occurs in persons with dementia because decreased mental capacity limits the ability to attend to the urge to void. The urge type is the uncontrollable constant need to urinate. Stress type is small volume incontinence that occurs with coughing or sneezing. Overflow type is dribbling in small amounts while the bladder remains full and overdistended.

Which condition is associated with episodes of bloating, abdominal pain, and constipation alternating with diarrhea? - Correct answer Which condition is associated with episodes of bloating, abdominal pain, and constipation alternating with diarrhea? The nurse observes a bluish discoloration around the umbilicus in a patient (Cullen sign). What is this sign associated with? - Correct answer A bluish discoloration around the umbilicus is a sign of bleeding within the abdomen. An umbilical hernia causes a bulge at the umbilicus. Liver enlargement is detected by percussing the borders of the liver. Rebound tenderness in the right lower quadrant is associated with appendicitis. Which method should the nurse use to determine if a patient has ascites? - Correct answer The nurse notes a fluid wave by striking the side of the abdomen with the patient supine and feeling the fluid wave impulse on the opposite side. Shifting dullness is detected by percussing dullness with the patient supine and noting a shift in the dullness when the patient turns on his side. The iliopsoas muscle test is used to assess pain related to appendicitis. A bulge at the umbilicus may be present with ascites but is actually caused by a hernia. Tenderness in the right upper quadrant may be associated with cholelithiasis. The nurse assesses hypoactive and absent bowel sounds in the four quadrants of the abdomen in a female patient. Which finding from the patient history is likely the cause? - Correct answer Taking a diuretic predisposes the patient to hypokalemia, a cause of decreased peristalsis. Taking narcotics also decreases peristaltic activity.