NR509 Bates Test Bank - Midterm Question & Answers 2024, Exams of Nursing

Download NR509 Bates Test Bank - Midterm Question & Answers 2024 and more Exams Nursing in PDF only on Docsity! NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to? A) Musculoskeletal B) Reproductive C) Urinary D) Endocrine - Correct Answers ✅A) Musculoskeletal Chest pain may be due to a musculoskeletal condition, such as costochondritis or intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic chest pain is also a sharp chest pain which increases with a deep breath. This type of pain can occur with inflammation of the pleura from pneumonia or other conditions and pulmonary embolus. A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom? A) Reproductive B) Urinary NR509 Bates Test Bank – Midterm Question & Answer’s 2024 C) Cardiac D) Hematologic - Correct Answers ✅C) Cardiac Cardiac disorders such as congestive heart failure are the most likely on this list to result in shortness of breath. There are cases within the other categories which may also result in shortness of breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis with UTI in the urinary category. A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough? A) Ophthalmologic B) Auditory C) Cardiac D) Endocrine - Correct Answers ✅C) Cardiac The cardiac system can cause a cough if the patient has congestive heart failure. This results in fluid buildup in the lungs, which in turn can cause a cough that produces pink, NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process? A) Infection B) Inflammation C) Allergic D) Vascular - Correct Answers ✅C) Allergic This description is most consistent with allergic rhinitis. A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range NR509 Bates Test Bank – Midterm Question & Answer’s 2024 of motion B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion - Correct Answers ✅C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of motion are consistent with neck stiffness, which in this scenario is likely to be caused by meningeal inflammation. Kernig's and Brudzinski's signs are also helpful in testing for meningeal irritation on exam. A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses. B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding. C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding. D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding. - Correct Answers ✅C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding. In cholecystitis, the pain, which originates from the gallbladder, is located in the right upper quadrant. Severity of pain with inspiration that is sufficient to stop further inhalation is also known as Murphy's sign, which, if present, is further indicative of inflammation of the gallbladder. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 as you can, to avoid missing a possibility. A common mistake is to latch onto one idea too early. Ms. Washington is a 67-year-old who had a heart attack last month. Now she complains of shortness of breath and not being able to sleep in a flat position (orthopnea). On examination you note increased jugular venous pressure, an S3 gallop, crackles low in the lung fields, and swollen ankles (edema). This is an example of a: A) Pathophysiologic problem B) Psychopathologic problem - Correct Answers ✅A) Pathophysiologic problem This is an example of a pathophysiologic problem because Ms. Washington's symptoms are consistent with a pathophysiologic process. The heart attack reduced the ability of her heart to handle her volume status and subsequently produced the many features of congestive heart failure. On the way to see your next patient, you glance at the calendar and make a mental note to buy a Mother's Day card. Your patient is Ms. Hernandez, a 76-year-old widow who lost her NR509 Bates Test Bank – Midterm Question & Answer’s 2024 husband in May, two years ago. She comes in today with a headaches, abdominal pain, and general malaise. This happened once before, about a year ago, according to your detailed office notes. You have done a thorough evaluation but are unable to arrive at a consistent picture to tie these symptoms together. This is an example of a: A) Pathophysiologic problem B) Psychopathologic problem - Correct Answers ✅B) Psychopathologic problem It is not uncommon for patients to experience psychopathologic symptoms around the anniversary of a traumatic event. The time of year and the lack of an obvious connection between Ms. Hernandez's symptoms would make you consider this as a possibility. You will note that although this might have been an early consideration in your hypothesis generation, it is key to convince yourself that there is not a physiologic explanation for these symptoms, by performing a careful history and examination. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He works in a sales office to support his family. Recently he has injured his back and you are thinking he would benefit from physical therapy, three times a week, for an hour per session. What would be your next step? A) Write the physical therapy prescription. B) Have your office staff explain directions to the physical therapy center. C) Discuss the plan with Mr. Larson. D) Tell Mr. Larson that he will be going to physical therapy three times a week. - Correct Answers ✅C) Discuss the plan with Mr. Larson. You should discuss your proposed plan with the patient before implementing it. In this case, you and Mr. Larson will need to weigh the benefit of physical therapy against the ability to provide for his family. You may need to consider other ways of helping the patient, perhaps through prescribed back exercises he can do at home. It is a common mistake to implement a plan without coming to an agreement with the patient first. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your "routine" when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers? A) Continue asking these questions in a more selective way. B) Stop asking these questions, because they are low yield. C) Question the validity of the questions. D) Ask these questions of all your patients. - Correct Answers ✅A) Continue asking these questions in a more selective way. The predictive value of a positive finding depends upon the prevalence of a given disease in a population. The prevalence of malaria in the Midwest is almost zero, except in people immigrating from areas of high prevalence. You will waste time and resources applying NR509 Bates Test Bank – Midterm Question & Answer’s 2024 these questions and maneuvers to all patients. It would be wise to continue applying what you learned to those who are from areas of high prevalence of a given disease. You will learn to tailor your examination to the population you are serving. For which of the following patients would a comprehensive health history be appropriate? A) A new patient with the chief complaint of "I sprained my ankle". B) An established patient with the chief complaint of "I have an upper respiratory infection". C) A new patient with the chief complaint of "I am here to establish care". D) A new patient with the chief complaint of "I cut my hand". - Correct Answers ✅C) A new patient with the chief complaint of "I am here to establish care". This patient is here to establish care, and because she is new to you, a comprehensive health history is appropriate. The components of the health history include all of the following except which one? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Review of systems B) Thorax and lungs C) Present illness D) Personal and social items - Correct Answers ✅B) Thorax and lungs The thorax and lungs are part of the physical examination, not part of the health history. Is the following information subjective or objective? Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest. A) Subjective B) Objective - Correct Answers ✅A) Subjective This is information given by the patient about the circumstances of his chief complaint. It does not represent an objective observation by the examiner. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Review of systems - Correct Answers ✅C) Personal and social history. Personal and social history information includes educational level, family of origin, current household status, personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). The following information is recorded in the health history: "I feel really tired." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems - Correct Answers ✅A) Chief complaint The chief complaint is an attempt to quote the patient's own words. It is brief, like a headline, and further details should be sought in the present illness section. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems - Correct Answers ✅D) Review of systems Review of systems documents the presence or absence of common symptoms related to each major body system. The following information is best placed in which category? "The patient has had three cesarean sections." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric - Correct Answers ✅B) Surgeries NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A cesarean section is a surgical procedure. Approximate dates or the age of the patient at the time of the surgery should also be recorded. The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric - Correct Answers ✅A) Adult illnesses The adult illnesses category is reserved for chronic illnesses, significant hospitalizations, significant injuries, and significant procedures. A stent is a major procedure but does not involve a surgery. The following information is best placed in which category? "The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated." NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport. - Correct Answers ✅C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. This is the most productive sequence for the interview. Greeting patients and establishing rapport allows them to feel more comfortable before "inviting" them to relate their story. After hearing the patient's story, together you establish the agenda regarding the most important items to expand upon. At the end, together you negotiate the plan of diagnosis and treatment. Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating NR509 Bates Test Bank – Midterm Question & Answer’s 2024 greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted? A) Setting in which the symptom occurs B) Associated manifestations C) Quality D) Timing - Correct Answers ✅B) Associated manifestations The interviewer has not recorded whether or not the pain has been accompanied by nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional symptoms that may accompany the initial chief complaint and that help the examiner to start refining his or her differential diagnosis. Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on NR509 Bates Test Bank – Midterm Question & Answer’s 2024 for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description? A) Severity B) Setting in which the symptom occurs C) Timing D) Associated manifestations - Correct Answers ✅A) Severity The severity of the symptom was not recorded by the interviewer, so we have no understanding as to how bad the symptom is for this patient. This allows the comparison of pain intensity before and after an intervention. You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component NR509 Bates Test Bank – Midterm Question & Answer’s 2024 B) Angry patient C) Silent patient D) Hearing-impaired patient - Correct Answers ✅C) Silent patient This is one example of a silent patient. There are many possibilities for this patient's silence: depression, dementia, the manner in which you asked the question, and so on. Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs NR509 Bates Test Bank – Midterm Question & Answer’s 2024 in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. - Correct Answers ✅B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. You can also say, "I want to make sure I take good care of this problem because it is very important. We may need to talk about the others at the next appointment. Is that okay with you?" This is a technique that can help you to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the interview. Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't call in an antibiotic for her. Which of the following techniques is not useful in helping to calm NR509 Bates Test Bank – Midterm Question & Answer’s 2024 this patient? A) Avoiding admission that you had a part in provoking her anger because you were late B) Accepting angry feelings from the patient and trying not to get angry in return C) Staying calm D) Keeping your posture relaxed - Correct Answers ✅A) Avoiding admission that you had a part in provoking her anger because you were late In this scenario, the provider was 1 hour late in seeing the patient. The provider should acknowledge that he was late and apologize for this, no matter the reason for being late. It often helps to acknowledge that a patient's anger with you is understandable and that you might be angry in a similar situation. A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As the provider, you need to get a sexual history. Which one of the following questions is inappropriate for eliciting the information? A) Are you sexually active? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Sometimes, the patient's greatest need is for support and empathy. It would be inappropriate to ignore this comment today. She may have relied heavily upon Bill for care and may be in danger. She may be depressed and even suicidal, but you will not know unless you discuss this with her. Most importantly, you should empathize with her by saying something like "It must be very difficult not to have him at home" and allow a pause for her to answer. You may also ask "What did you rely on him to do for you?" A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this? A) Write down as much as you can, as quickly as possible. B) Ask her to repeat key phrases or to pause at regular intervals, so you can get almost every word. C) Tell her that she can go over the notes later to make sure they are accurate. D) Push away from the keyboard or put down your pen and listen. - Correct Answers ✅D) Push away from the keyboard or put down your pen and listen. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 This is a common event in clinical practice. It is much more important to listen actively with good eye contact at this time than to document the story verbatim. You want to minimize interruption (e.g., answer B). It is usually not appropriate to ask a patient to go over the written notes, but it would be a good idea to repeat the main ideas back to her. You should be certain she has completed her story before doing this. You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next? A) Carry out your examination, focusing on the neurologic portion, and then cover her properly. B) Carry out your examination and let the nurse assigned to her "put her back together." C) Put her socks back on and cover her completely before beginning the evaluation. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Apologize for the last examiner but let the next examiner dress and cover her. - Correct Answers ✅C) Put her socks back on and cover her completely before beginning the evaluation. It is crucial to make an effort to make a patient comfortable. In this scenario, the patient can neither speak nor move well. Take a moment to imagine yourself in her situation. As a matter of respect as well as comfort, you should cover the patient appropriately and consider returning a little later to do your examination if you feel she is cold. When you enter your patient's examination room, his wife is waiting there with him. Which of the following is most appropriate? A) Ask if it's okay to carry out the visit with both people in the room. B) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him. C) Ask his wife to leave the room for reasons of confidentiality. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Reassurance B) Empathy C) Summarization D) Validation - Correct Answers ✅D) Validation This is an example of validation to legitimize her emotional experience. You are performing a young woman's first pelvic examination. You make sure to tell her verbally what is coming next and what to expect. Then you carry out each maneuver of the examination. You let her know at the outset that if she needs a break or wants to stop, this is possible. You ask several times during the examination, "How are you doing, Brittney?" What are you accomplishing with these techniques? A) Increasing the patient's sense of control B) Increasing the patient's trust in you as a caregiver C) Decreasing her sense of vulnerability D) All of the above - Correct Answers ✅D) All of the above NR509 Bates Test Bank – Midterm Question & Answer’s 2024 These techniques minimize the effects of transitions during an examination and empower the patient. Especially during a sensitive examination, it is important to give the patient as much control as possible. When using an interpreter to facilitate an interview, where should the interpreter be positioned? A) Behind you, the examiner, so that the lips of the patient and the patient's nonverbal cues can be seen B) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient C) Between you and the patient so all parties can make the necessary observations D) In a corner of the room so as to provide minimal distraction to the interview - Correct Answers ✅B) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Interpreters are invaluable in encounters where the examiner and patient do not speak the same language, including encounters with the deaf. It should be noted that deaf people from different regions of the world use different sign languages. The priority is for you to have a good view of the patient. A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter's weight. You measure her daughter's height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate? A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic. B) Reassure the mother that this is a normal body weight. C) Give the patient information about exercise because the patient is obese. D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese. - Correct Answers ✅B) Reassure the mother that this is a normal body weight. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer? A) Have you tried to force yourself to vomit after eating a meal? B) Do you have heartburn/indigestion and diarrhea? C) Do you have enough food to eat? D) Have you tried to lose weight? - Correct Answers ✅D) Have you tried to lose weight? This is important: If the patient hasn't tried to lose weight, then this weight loss is inadvertent and poses concern for a neoplastic process, especially given his smoking history. Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except: A) Changes in weight NR509 Bates Test Bank – Midterm Question & Answer’s 2024 B) Fatigue and weakness C) Cough D) Fever and chills - Correct Answers ✅C) Cough This symptom is more appropriate to the respiratory review of systems. You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except: A) Level of consciousness B) Signs of distress C) Dress, grooming, and personal hygiene D) Blood pressure - Correct Answers ✅D) Blood pressure Blood pressure is a vital sign, not part of the General Survey. A 55-year-old bookkeeper comes to your office for a routine visit. You note that on a previous visit for treatment of contact dermatitis, her blood pressure was elevated. She does not have prior elevated readings and her family history is negative for hypertension. You measure her blood pressure in your office today. Which of the following factors can result in a false high reading? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Blood pressure cuff is tightly fitted. B) Patient is seated quietly for 10 minutes prior to measurement. C) Blood pressure is measured on a bare arm. D) Patient's arm is resting, supported by your arm at her mid-chest level as you stand to measure the blood pressure. - Correct Answers ✅A) Blood pressure cuff is tightly fitted. A blood pressure cuff that is too tightly fitted can result in a false high reading. The other answers are important to observe to obtain an accurate blood pressure reading. JNC-7 also mentions the importance of having the back supported when obtaining blood pressure in the sitting position. A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Mrs. 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? A) Attribute this to some overeating at the holidays. B) Attribute this to wearing different clothing. C) Attribute this to body fluid. D) Attribute this to instrument inaccuracy. - Correct Answers ✅C) Attribute this to body fluid. This amount of weight over a short period should make one think of body fluid changes. You may consider a kidney problem or heart failure in your differential. The other reasons should be considered as well, but this amount of weight gain over a short period usually indicates causes other than excessive caloric intake. Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) "When you get down to your goal weight, you will feel so much better." B) "Some people seem to be able to lose weight and others just can't, no matter how hard they try." C) "We are coming up with new medicines and methods to treat your conditions every day." D) "Even a weight loss of 10% can make a noticeable improvement in the problems you mention." - Correct Answers ✅D) "Even a weight loss of 10% can make a noticeable improvement in the problems you mention." Many patients trying to change a habit are overwhelmed by how far they are from their goal. Many patients find it empowering to know that they can achieve a small goal, such as a loss of 1 pound per week. Research has shown that significant benefits often come with even a 10% weight loss. Jenny is one of your favorite patients who usually shares a joke with you and is nattily dressed. Today she is dressed in old jeans, lacks NR509 Bates Test Bank – Midterm Question & Answer’s 2024 makeup, and avoids eye contact. To what do you attribute these changes? A) She is lacking sleep. B) She is fatigued from work. C) She is running into financial difficulty. D) She is depressed. - Correct Answers ✅D) She is depressed. It is important to use all of your skills and memory of an individual patient to guide your thought process. She is not described as sleepy. Work fatigue would most likely not cause avoidance of eye contact. Financial difficulties would not necessarily deplete a nice wardrobe. It is most likely that she is depressed or in another type of difficulty. You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn't correlate with the other findings? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 C) Kussmaul's respiration D) COPD with prolonged expiration - Correct Answers ✅B) Cheyne- Stokes respiration Cheyne-Stokes respiration can be seen in patients with heart failure and is usually not a sign of an immediate problem. Mr. 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. What type of pain is this? A) Idiopathic pain B) Neuropathic pain C) Nociceptive or somatic pain D) Psychogenic pain - Correct Answers ✅B) Neuropathic pain This vignette is consistent with a diagnosis of herpes zoster, or shingles. The characteristic burning quality without a history of an actual burn makes one think of neuropathic pain. It will most likely remain for months after the rash has resolved. There is no NR509 Bates Test Bank – Midterm Question & Answer’s 2024 evidence of physical injury and this is a peculiar distribution, making nociceptive pain less likely. There is no evidence of a psychogenic etiology for this, and the presence of a rash makes this possibility less likely as well. A 50-year-old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as "high risk" because of obesity. What should you do next? A) Explain that even small amounts of weight gain can classify you as obese. B) Place him on a high-protein, low-fat diet. C) Advise him to increase his aerobic exercise for calorie burning. D) Measure his waist. - Correct Answers ✅D) Measure his waist. The patient most likely had a high BMI because of increased muscle mass. In this situation, it is important to measure his waist. It is most likely under 40 inches, which makes obesity unlikely (even to an insurance company). It is important that you personally contact the company and explain your reasoning. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual "lub dup." How would you document your examination? A) Regular rate and rhythm B) Irregularly irregular rhythm C) Regularly irregular rhythm D) Bradycardia - Correct Answers ✅C) Regularly irregular rhythm Because this unusual beat occurs every fourth set of heart sounds, it is regularly irregular. This is most consistent with premature ventricular contractions (or PVCs). This is generally a common and benign rhythm. A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both NR509 Bates Test Bank – Midterm Question & Answer’s 2024 months ago he had a stroke and ever since she has been frustrated with his problems with communication. They were at a restaurant after church one Sunday when he suddenly became quiet. When she realized something was wrong he was taken to the hospital by EMS. He spent 2 weeks in the hospital with right-sided weakness and difficulty speaking. After hospitalization he was in a rehab center, where he regained the ability to walk and most of the use of his right hand. He also began to speak more, but she says that much of the time "he doesn't make any sense." She gives an example that when she reminded him the car needed to be serviced he told her "I will change the Kool-Aid out of the sink myself with the ludrip." She says that these sayings are becoming frustrating. She wants you to tell her what is wrong and what you can do about - Correct Answers ✅A) Wernicke's aphasia With Wernicke's aphasia the patient can speak effortlessly and fluently, but his words often make no sense. Words can be malformed or completely invented. Wernicke's area is found on the temporal lobes. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Susanne is a 27 year old who has had headaches, muscle aches, and fatigue for the last 2 months. You have completed a thorough history, examination, and laboratory workup but have not found a cause. What would your next action be? A) A referral to a neurologist B) A referral to a rheumatologist C) To tell the patient you can't find anything D) To screen for depression - Correct Answers ✅D) To screen for depression Although you may consider referrals to help with the diagnosis and treatment for this patient, screening is a time-efficient way to recognize depression. You ask a patient to draw a clock. He fills in all the numbers on the right half of the circle. What do you suspect? A) Hemianopsia B) Fatigue C) Oppositional defiant disorder NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Depression - Correct Answers ✅A) Hemianopsia You should suspect a visual problem because there is no writing on one half of the circle. This is consistent with a hemianopsia, sometimes seen in stroke. A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Actinic lentigines D) Heavy sun exposure - Correct Answers ✅A) Age The risk for melanoma is increased in people over the age of 50; our patient is 35 NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema - Correct Answers ✅A) Pityriasis rosea This is a classic description of pityriasis rosea. The description of a large single or "herald" patch preceding the eruption is a good way to distinguish this rash from other conditions. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea NR509 Bates Test Bank – Midterm Question & Answer’s 2024 B) Tinea versicolor C) Psoriasis D) Atopic eczema - Correct Answers ✅B) Tinea versicolor This is a typical description of tinea versicolor. The information that the patient is sweating more also helps support this diagnosis, because tinea is a fungal infection and is promoted by moisture. A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma - Correct Answers ✅This is a typical description of actinic keratosis. Actinic keratosis may be easier to feel than to see. If left untreated, approximately 1% of cases can develop into squamous cell NR509 Bates Test Bank – Midterm Question & Answer’s 2024 carcinoma. A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma - Correct Answers ✅B) Seborrheic keratosis This is a typical description for seborrheic keratosis. The "stuck on" appearance and the rough, wartlike texture are key features for the diagnosis. They often produce a greasy scale when scratched with a fingernail, which further helps to distinguish them from other lesions. Frequently, these benign lesions actually meet several of the ABCDEs of melanoma, so it is important to distinguish these lesions to prevent unnecessary biopsy. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Ethnicity of the child - Correct Answers ✅A) Diet The lack of jaundice in the sclerae is an important clue. Typically, this is the first place where one sees jaundice. This examination should also be carried out in natural light (sunlight) as opposed to fluorescent lighting, which can alter perceived colors. Many infants this age have a large proportion of carrots, tomatoes, and yellow squash, which are rich in carotene. Liver and blood diseases can cause jaundice, but this should involve the sclerae. A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story - Correct Answers ✅A) Reassure her that this is normal. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 This is an example of peripheral cyanosis. This is a very common and benign condition which typically occurs when the child is slightly cold and his peripheral circulation is adjusting to keep his core warm. Without other problems, there is no need for further workup. If the lips or other central locations are involved, you must consider other etiologies. You are examining an unconscious patient from another region and notice Beau's lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next? A) Conclude this is caused by a cultural practice. B) Conclude this finding is most likely secondary to trauma. C) Look for information from family and records regarding any problems which occurred 3 months ago. D) Ask about dietary intake. - Correct Answers ✅C) Look for information from family and records regarding any problems which occurred 3 months ago These lines can provide valuable information about previous significant illnesses, some of which are forgotten or are not able to be reported by the patient. Because the NR509 Bates Test Bank – Midterm Question & Answer’s 2024 fingernails grow at about 0.1 mm per day, you would ask about an illness 100 days ago. Thisbpatient may have been hospitalized for endocarditis or may have had another significant illness which should be sought. Trauma to all 10 nails in the same location is unlikely. Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do? A) Prescribe a steroid cream to decrease inflammation. B) Consider admitting the patient to the hospital. C) Reassure the parents and the patient that this should resolve within a week. D) Tell him not to scratch them, and follow up in 3 days. - Correct Answers ✅B) Consider admitting the patient to the hospital. Although this may not be an impressive rash, the fact that they do not "blanch" with pressure is very concerning. This generally means that there is pinpoint bleeding under the NR509 Bates Test Bank – Midterm Question & Answer’s 2024 and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection - Correct Answers ✅C) Psoriasis This is a classic presentation of plaque psoriasis. Eczema is usually over the flexor surfaces and does not scale, whereas psoriasis affects the extensor surfaces. Pityriasis usually is limited to the trunk and proximal extremities. Tinea has a much finer scale associated with it, almost like powder, and is found in dark and moist areas. Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites NR509 Bates Test Bank – Midterm Question & Answer’s 2024 B) Urticaria, or hives C) Psoriasis D) Purpura - Correct Answers ✅B) Urticaria, or hives This is a typical case of urticaria. The most unusual aspect of this condition is that the lesions "move" from place to place. This would be distinctly unusual for the other causes listed. Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 cm in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient. - Correct Answers ✅C) Ask how she acquired them. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 These are consistent with ecchymoses, or bruises. It is important to ask about antiplatelet medications such as aspirin, trauma history, and history of blood disorders in the patient and her family. Because of the different ages of the bruises and the isolation of them to the ulnar forearms, these may be a result of abuse or other violence. It is your duty to investigate the cause of these lesions. A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office. - Correct Answers ✅A) Reassure him that there is nothing to worry about. These represent cherry angiomas, which are very common, benign lesions. Further NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Which of the following is a symptom involving the eye? A) Scotomas B) Tinnitus C) Dysphagia D) Rhinorrhea - Correct Answers ✅A) Scotomas Scotomas are specks in the vision or areas where the patient cannot see; therefore, this is a common/concerning symptom of the eye. A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes last a few seconds and then go away, and they are accompanied by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical examination of the head and neck and note that the patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma - Correct Answers ✅A) Benign positional vertigo This is a classic description of benign positional vertigo. The vertigo is episodic, lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is no tinnitus or sensorineural hearing loss as occurs in Ménière's disease and acoustic neuroma. A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea with vomiting; the episode resolved spontaneously. He has had five episodes in the past 1.5 weeks. He does note some tinnitus that comes and goes. Upon physical examination, you note that he has a normal gait. The Weber localizes to the right side and the air conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based on this description, what is the most likely diagnosis? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) Benign positional vertigo B) Vestibular neuronitis C) Ménière's disease D) Acoustic neuroma - Correct Answers ✅C) Ménière's disease Ménière's disease is characterized by sudden onset of vertiginous episodes that last several hours to a day or more, then spontaneously resolve; the episodes then recur. On physical examination, sensorineural hearing loss is present. The patient does complain of tinnitus. A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient's symptoms? A) Cushing's syndrome B) Nephrotic syndrome C) Myxedema NR509 Bates Test Bank – Midterm Question & Answer’s 2024 On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? A) Conjunctivitis B) Acute iritis C) Corneal abrasion D) Subconjunctival hemorrhage - Correct Answers ✅D) Subconjunctival hemorrhage A subconjunctival hemorrhage is a leakage of blood outside of the vessels, which produces a homogenous, sharply demarcated bright red area; it fades over several days, turning yellow, then disappears. There is no associated eye pain, ocular discharge, or changes in visual acuity; the cornea is clear. Many times it is associated with severe cough, choking, or vomiting, which increase venous pressure. NR509 Bates Test Bank – Midterm Question & Answer’s 2024 Which of the following is a "red flag" regarding patients presenting with headache? A) Unilateral headache B) Pain over the sinuses C) Age over 50 D) Phonophobia and photophobia - Correct Answers ✅C) Age over 50 A unilateral headache is often seen with migraines and may commonly be accompanied by phonophobia and photophobia. Pain over the sinuses from sinus congestion may also be unilateral and produce pain. Migraine and sinus headaches are common and generally benign. A new severe headache in someone over 50 can be associated with more serious etiologies for headache. A sudden, painless unilateral vision loss may be caused by which of the following? A) Retinal detachment B) Corneal ulcer C) Acute glaucoma NR509 Bates Test Bank – Midterm Question & Answer’s 2024 D) Uveitis - Correct Answers ✅A) Retinal detachment Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain. Retinal detachment is generally painless, as is chronic glaucoma. Sudden, painful unilateral loss of vision may be caused by which of the following conditions? A) Vitreous hemorrhage B) Central retinal artery occlusion C) Macular degeneration D) Optic neuritis - Correct Answers ✅D) Optic neuritis In multiple sclerosis, sudden painful loss of vision may accompany optic neuritis. The other conditions are usually painless. Diplopia, which is present with one eye covered, can be caused by which of the following problems? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) The whisper test B) The finger rub test C) The tuning fork test D) Audiometric testing - Correct Answers ✅D) Audiometric testing While it is important to screen for hearing complaints with methods available to you, it should be realized that some physical examination techniques are limited. Which area of the fundus is the central focal point for incoming images? A) The fovea B) The macula C) The optic disk D) The physiologic cup - Correct Answers ✅A) The fovea The fovea is the area of the retina which is responsible for central vision. It is NR509 Bates Test Bank – Midterm Question & Answer’s 2024 surrounded by the macula, which is responsible for more peripheral vision. The optic disc and physiologic cup are where the optic nerve enters the eye. A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon? A) Direct reaction B) Consensual reaction C) Near reaction D) Accommodation - Correct Answers ✅The constriction of the contralateral pupil is called the consensual reaction. The response of the ipsilateral eye is the direct response. The dilation of the pupil when focusing on a close object is the near reaction. Accommodation is the changing of the shape of the lens to sharply focus on an object. A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) She obtains a 20% correct score at 100 feet. B) She can accurately name 20% of the letters at 20 feet. C) She can see at 20 feet what a normal person could see at 100 feet. D) She can see at 100 feet what a normal person could see at 20 feet. - Correct Answers ✅C) She can see at 20 feet what a normal person could see at 100 feet. The denominator of an acuity score represents the line on the chart the patient can read. In the example above, the patient could read the larger letters corresponding with what a normal person could see at 100 feet. On visual confrontation testing, a stroke patient is unable to see your fingers on his entire right side with either eye covered. Which of the following terms would describe this finding? A) Bitemporal hemianopsia B) Right temporal hemianopsia C) Right homonymous hemianopsia D) Binasal hemianopsia - Correct Answers ✅C) Right homonymous hemianopsia NR509 Bates Test Bank – Midterm Question & Answer’s 2024 The above pattern is consistent with a conductive loss on the left side. Causes would include: foreign body, otitis media, perforation, and otosclerosis of the involved side. A young man is concerned about a hard mass he has just noticed in the midline of his palate. On examination, it is indeed hard and in the midline. There are no mucosal abnormalities associated with this lesion. He is experiencing no other symptoms. What will you tell him is the most likely diagnosis? A) Leukoplakia B) Torus palatinus C) Thrush (candidiasis) D) Kaposi's sarcoma - Correct Answers ✅B) Torus palatinus Torus palatinus is relatively common and benign but can go unnoticed by the patient for many years. The appearance of a bony mass can be concerning. A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely? NR509 Bates Test Bank – Midterm Question & Answer’s 2024 A) CN IX lesion on the left B) CN IX lesion on the right C) CN X lesion on the left D) CN X lesion on the right - Correct Answers ✅D) CN X lesion on the right The failure of the right side of the palate to rise denotes a problem with the right 10th cranial nerve. The uvula deviates toward the properly functioning side. A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this? A) Submandibular B) Tonsillar C) Occipital D) Posterior cervical - Correct Answers ✅D) Posterior cervical NR509 Bates Test Bank – Midterm Question & Answer’s 2024 The group of nodes posterior to the sternocleidomastoid muscle is the posterior cervical chain. These are common in mononucleosis. You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely? A) Cancer B) Lymph node C) Deep scar D) Muscle - Correct Answers ✅B) Lymph node A useful maneuver for discerning lymph nodes from other masses in the neck is to check for their mobility in all directions. Many other masses are mobile in only two directions. Cancerous masses may also be "fixed," or immobile. You are conducting a pupillary examination on a 34-year-old man. You note that both pupils dilate slightly. Both are noted to constrict briskly when the light is placed on the right eye. What is the most likely problem? A) Optic nerve damage on the right