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NR 509 / NR509 Advanced Physical Assessment
Final Exam - Chamberlain
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- A 31-year-old female presents to the clinic with a worsening stiff, painful neck. On inspection, the patients head is laterally deviated toward the shoul- der and rotated. Given this specific physical assessment finding, what condi- tion should the NP suspect as a differential diagnosis? A-torticollis B-ankylosing spondylitis C- osteoarthritis (OA)
2 / D-spondylolisthesis E-thoracic kyphosis Answer A Torticollis
- A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are expected assessment findings consistent with the diagno- sis? A-Swelling of the synovial tissue in joints and tendon sheaths B-The first metatarsophalangeal joint is frequently involved. C-Asymmetrical joint distribution. D-Tophi present in the subcutaneous tissue E-Stiffness follows joint activity. Answer A Swelling of the synovial tissue in joints and tendon sheaths
4 / D-Deny her request, inform the patient she is not due to be screened for two more years, and focus on the reason for the visit. E-Honor her request, perform the screening today, and inform her that if the results are negative, she will no longer require screening Answer C Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no longer requires screening, and focus on the reason for the visit.
- A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well as Crohns disease. Her family medical history includes a maternal aunt who died of colon cancer at age 49 years. Which of the following
5 / historical elements would be most concerning for colon cancer in this patient? A-recent onset of small-caliber stools B-new-onset anal fissures C-recent history of black, tarry stools D-long-term history of hemorrhoids E-remote history of anal pruritus Answer A recent onset of small-caliber stools
- Which of the following physical assessment finding is most suggestive of peritonitis secondary to a ruptured appendix? A pain with internal rotation of the right hip B abdominal pain that increases with hip flexion
7 / A several shallow ulcers with a red base B translucent nodules C bright red, soft lesions arising from the cervical canal D small red granular spots or petechiae on the cervix E - raised friable or lobed lesions Answer E raised friable or lobed lesions
- A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step? A Reassure her that this is a common pattern with migraines B Evaluate her for possible sinus infection. C Order studies to evaluate potential transient ischemic attacks (TIAs) be- cause she is on OCPs.
8 / D Take a further history and perform a very careful neurological examination. E Prescribe a strong medication for her migraines. Answer D Take a further history and perform a very careful neurological examination.
- The NP is observing a full-term infant male. He can pull to a stand, use "mama" or "dada" specifically, and indicates his wants by vocalization and pointing. Based on your observations, determine his developmental age A 12 months B 4 months C 8 months D 10 months E 6 months Answer A
10 / B vertebral body C transverse process D vertebral arch E intervertebral disk Answer B vertebral body
- Pain in the right-lower quadrant (RLQ) during deep, even palpation of the left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what positive assessment A psoas sign B Murphy sign C Blumberg sign D Roving sign E McBurney sign Answer
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C
Blumberg sign
- Cervical motion tenderness and/or adnexal tenderness are hallmarks of all the following conditions, EXCEPT? A pelvic inflammatory disease B bacterial vaginosis C endometriosis D ectopic pregnancy E appendicitis Answer B Bacterial Vaginosis
- The NP is conducting a physical assessment on a woman in her 26th week of pregnancy. Which of the examination finding is worrisome for a potential, emergent condition?
13 / TMs with good cone of light. Weber midline. AC > BC. Nasal mucosa erythe- matous, septum deviated to the right, turbinate's mildly enlarged. No sinus tenderness. Oralmucosa pink. Dentition fair. Caries present. Tongue midline, slight beefy redness. Pharynx is mildly erythematous with cobble stoning. Which of the following is the most accurate interpretation of the findings? A The patient has chronic allergies B The patient has cataracts. C The patient has a sinus infection. E The patient has hearing loss. Answer A The patient has chronic allergies
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- A 74-year-old man presents to the clinic for a scheduled annual exami- nation. He has a history of hypertension and diabetes, both controlled with medication. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal assessment findings in this image. ADA Description Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina A cotton-wool spots B Drusen spots C vitreous floaters D AV nicking E papilledema Answer A Cotton-wool spots
- A 20-year-old male presents to the clinic with complaints of a severe headache. During the exam, the patient is instructed to lie down on the exam table while the NP flexes his head and neck toward his chest.The
16 / C The patient reports fever, night sweats, and thinks she lost weight D The patient had a car accident and minor head trauma about 6 weeks ago E The patient lost her glasses. Answer C The patient reports fever, night sweats, and thinks she lost weight
- ADA Description Anatomical landmark right anterior shoulder. Emphasis on the middle bony prominence. A acromioclavicular joint B coracoid process of the scapula C clavicle D tip of the acromion E greater tubercle Answer B
17 / coracoid process of the scapula
- Which of the following statements is true regarding changes in the breasts associated with menopause? Select all that apply. A lifetime Breast density is affected by several factors, among which is a genetic contribution as well as estrogen from endogenous and exogenous sources over the B Estrogen in hormone replacement therapy (HRT) has no effect on breast density after menopause C Glandular tissue of the breast atrophies with menopause, primarily due to
19 / The transformation to primarily fatty tissue with menopause increases the utility of mammograms.
- A 48-year-old female presents to the clinic with complaints of heavy vagi- nal discharge and severe itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examina- tion, there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. Which of the following js the most accurate interpretation of these findings? A These findings suggest bacterial vaginosis. B These findings suggest chlamydia trachomatis. C These findings suggest atrophic vaginitis D These findings suggest trichomonas vaginitis. E These findings suggest candida vaginitis. Answer E
20 / These findings suggest candida vaginitis.
- A 2-month-old female is accompanied by her parents for her first visit to the practice. When reviewing the hospital medical records of her birth, the NP notes documentation regarding significantly edematous hands and feet
