NR509 FINAL Bates Questions Study Set, Study notes of Nursing

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NR509 FINAL Bates Questions

Study Set

Nr 509

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Nr 509

Nr 509

44-year-old female mathematician c/o mass to right breast. no family history of breast cancer. benign cyst shown. what advice should be given about screening? this patient was in compliance with the U.S. Preventative Services Task Force (USPSTF) recommendations for her age group and risk factors prior to her current complaint. 42-year-old female website developer. has questions about breast cancer screening. concerned about radiation exposure. which of the following is true about MRI as a screening modality for breast cancer in the general population? sensitivity screening for breast cancer increases with breast MRI at the expense of specificity. A 35-year-old G0P0 woman presents to clinic with a complaint of bilateral nipple discharge. This discharge started several weeks ago and has occurred at irregular intervals since that time. She does not complain of local tenderness, redness, fever, or any other systemic symptoms aside from slightly irregular periods over the last few months. On examination, she is able to express a small amount of discharge, which is sent to the laboratory and found to be consistent with breast milk but without any signs of blood or pus. Screening laboratories are also sent, which reveal a normal blood count, metabolic panel, thyroid-stimulating hormone, and human chorionic gonadotropin (HCG) level. Further laboratories are still pending. Which of the following is the most likely diagnosis? Prolactinoma A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass on breast self-examination (BSE) at home. The mass is nontender without skin changes, erythema, or overlying swelling. She has heard that most breast cancers are found by patients themselves, and she is very concerned that she may have breast cancer. Which of the following is true about BSE and self-detection of breast cancer? This patient is more likely to find a fibroadenoma than a cancer on self-examination

"Rubbery, mobile, nontender mass located in the right breast, in the 10:30 position from the nipple" 54 year old female dietician presents for a routine examination. reports has had many breast findings over several years, including one biopsy with normal pathology. She feels that her breasts have become far less lumpy since she underwent menopause 3 years ago. Which of the following is true regarding changes in the breasts with menopause? Glandular tissue of breast atrophies with menopause, primarily due to decrease in the number of lobules. An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her β-human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely diagnosis? ruptured tubal (or ectopic) pregnancy A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He presents for a follow-up appointment and the clinician performs an abdominal exam to assess his liver. Which of the following findings would be most consistent with hepatomegaly? Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration

A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents with a several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the following is her most significant risk factor for an AAA? History of smoking A 76-year-old retired man with a history of prostate cancer and hypertension has been screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for follow-up of his hypertension, during which the clinician scans his chart to ensure he is up to date with his preventive health care. He has a positive FOBT on one occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He has no first-degree relatives with a history of colorectal cancer or adenomatous polyps. What are the U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient? Do not screen routinely an otherwise healthy 31 year old accountant presents to an outpatient clinic with a 3 year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks associated with the onset of constipation....... Which of the following is the most likely physiological mechanism for her constipation? Functional change in bowel movement A 23 year old woman comes to the respirology clinic for follow-up of her chronic sinusitis and bronchiectasis that is associated with rare congenital condition called KARTAGENER SYNDROME. the preceptor notes that she has situs inversus and asks for a physical exam. Which of the following descriptions best fits with findings on the abdominal exam? Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant.

29 year old graduate student states that he is able to achieve an erection and ejaculate during sexual intercourse; however, he does not experience any pleasurable sensation of orgasm. He is otherwise healthy and is not on any medications. What is the most likely cause of his problem? Psychogenic multiple processes must take place in order for a male to sustain an erection. various cues stimulate sympathetic outflow from higher brain centers to the T11- L2........ local vasodilation within the penis erectile tissue results from increased levels of which of the following? Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) The human papillomavirus (HPV) can cause genital warts in males and females as well as cervical cancer in females. Vaccination against HPV is available and should be offered to males between what ages? 9-21 years A 32-year-old male complains of a painless, cystic mass just above his left testicle. During the physical examination, a strong flashlight is placed behind the scrotum through the area in question and transillumination is noted. What is the most likely diagnosis? Spermatocele A 25-year-old graduate student presents to the clinic complaining of scrotal pain, which has been increasing over the past 2 days. He is sexually active and has had unprotected intercourse with multiple partners in the past couple of weeks. On examination, some mild to moderate swelling of the scrotum on the right and tenderness with palpation of the right testicle are notes. What is the most likely diagnosis? Acute epididymitis

A 32-year-old elementary teacher requests a workup for infertility. He and his wife have been trying to conceive for the last 2 years. He reports that his wife has been evaluated and does not appear to have any infertility issues. The overall examination does not reveal any significant abnormalities. He is of average height and weight and has normal secondary sex characteristics of the genitalia. Of the following, which would be most likely be abnormal and causing male infertility? Follicle-stimulating hormone (FSH) While performing a physical examination on male patients, it is possible to palpate multiple structures in relation to the inguinal canal and related hernias. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region? Internal inguinal ring A 20-year-old college student presents for his annual physical examination. He recently becamesexually active and is inquiring about the best means of preventing sexually transmitted infections (STIs).Of the following, which would be the most effective means of prevention? Male condoms A 21-year-old college student presents to the student health clinic for a full physical examination. He is generally healthy; however, he reports that he has had sexual intercourse with multiple partners in the past couple of months. He noticed a small lesion on the shaft of his penis a few days ago. While performing the examination, he unwillingly achieves an erection. How should the clinician proceed at this point? Explain this is a normal response and finish the examination A 45-year-old driver's education instructor presents to the clinic for heavy periods and pelvic pain during her menses. She reached menarche at age 13 years and has had regular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states this has been going on for about a year but seems to be getting worse. Her last period was 1week

A 21-year-old college student presents for her first annual exam. She has been sexually active for 1year and has had two partners. She is not aware of having had any sexually transmitted diseases (STIs).She is using condoms for birth control and STI prevention but admits to not always using them regularly. Her last menses was 2 weeks ago. On speculum exam, an unusual appearance is noted, which is diagnosed as warts. What is the best description for these lesions? Raised friable or lobed lesions A 23-year-old female comes to the clinic to discuss her birth control options. Although she has been sexually active since age 16 years, she has been with one partner for the last year. She has decided to discontinue condoms and would like a different birth control option. She has not had a pelvic exam for 2years. She had a normal Pap smear that year and negative sexually transmitted infection (STI) testing. Her last menstrual period was 2 days ago. She states that she is still spotting. She also states that she last had sex with her boyfriend 1 week ago, so the clinician elects to postpone her speculum exam. What is the best explanation for the decision to postpone her exam? She is on her menses An 18-year-old high school senior presents to the clinic complaining of a vaginal discharge. She states that it is thick and yellow and that she has had some recent pelvic pain. She is sexually active and is not using any type of birth control or sexually transmitted infection (STI) prevention. She denies any burning with urination, nausea, vomiting, or diarrhea. She has had some fever and chills with a temperature up to 101.5ºF. Her last menstrual period was last week. After a physical exam, she is diagnosed with pelvic inflammatory disease (PID). Visualization of purulent discharge in which of the following areas would best support a diagnosis of PID? Cervical OS A 27-year-old G0 bus driver presents to the clinic complaining of an itchy vaginal discharge for the lastweek. She reached menarche at age 12 years, became sexually active at age 18 years, and has had atotal of five sexual partners. She has been with her current partner for 1 month. She is on oral contraceptive pills and does not use condoms as she is allergic to latex. Her last menstrual period was 3weeks ago. She is not having any pelvic pain, fever, nausea,

or vomiting. Her vitals are normal with a body mass index of 22. The clinician places the metal medium Graves speculum in the vagina but cannot find the cervix. What is the best next maneuver to visualize the cervix? Withdraw the speculum slightly and reposition it on a different slope A 63-year-old office worker comes to the clinic for her women's health exam. Her last Pap smear was5 years ago and was normal. She is married and has been with the same sexual partner for the last 35years. After performing the majority of the exam, the clinician decides to do a speculum exam to collect cytology for Pap smear. What is the correct position to have the patient in for her speculum exam? Lithotomy A 68-year-old retired patient presents to the clinic complaining about feeling like something is falling out of her vagina. She is a G6P6007 and had all her children vaginally, even the twins. She went through menopause at age 55 years, and, for the last few months, she has felt this falling sensation. On exam, an anterior bulge in the vaginal wall is apparent when she bears down. Weakness in which muscle would best account for the anterior bulge in the vaginal wall? Levatori ani A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a person without his injuries. Which of the following is true regarding the muscle control of the anal sphincter? The internal anal spincter is under involuntary control, whereas the external is under voluntary control. A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a rectal examination, stating that, "Some trainee once did that and it hurt badly." Which of the following is true about the innervation of the anus and rectum that may explain this patient's experience of discomfort? The anal canal has a rich somatosensory innervation, making poorly directed examinations painful in this area.

mother and sisters are healthy. Which of the following is true about recommended screening for colon cancer in this patient? The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer. A 49-year-old male with well-controlled HIV undergoes a proctoscopic examination as routine screening for anal cancer. The patient is asymptomatic and specifically denies complaints of frequent urination (frequency), large volume of urination (polyuria), or repeated urination at night (nocturia).Under direct visualization, the clinician observes a clear, circumferential demarcation of proximal versus distal tissue. This demarcation was not palpable on digital rectal examination (DRE) prior to proctoscopy. What is the most likely origin of this finding? Normal anatomy of the mucosal surface A 34-year-old female reports anal pain with defecation. She notes incidentally to this complaint that she has developed episodic abdominal discomfort and sores in her mouth. Anoscopic examination reveals anal fissures that appear to be her source of pain. Which of the following underlying conditions is the clinician most likely to find? Inflammatory bowel disease (IBD) A 53-year-old African American advertising agent presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about risk and screening for prostate cancer? This patient is at an elevated risk of prostate cancer due to his family history, thus screening modalities should be discussed between the patient and provider. A 64-year-old retired architect presents to his primary care provider with a magazine article about prostate cancer screening that states, "You should talk to your doctor about the ups and downs of prostate cancer screening." The patient hands this to

the clinician and states, "Tell me about the ups and down of prostate screening." Which of the following is true about prostate cancer screening? Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing the risk of overdiagnosis with the risk of underdiagnosis A thin, 58-year-old patient complains of lower back pain for years. On examination, the clinician finds that the patient has tenderness over the sacroiliac area. Which of the following conditions is most consistent with this physical sign? Ankylosing spondylitis During an evaluation of an athletic 30-year-old patient, the clinician conducts an active range of motion evaluation at the neck. Which muscle is being assessed when the patient is asked to flex the neck? Sternocleidomastoid (SCM) An obese 50-year-old patient presents with a long history of back trouble. What structure in the spine supports the body's weight? Vertebral body A 31-year-old day care worker presents with a worsening stiff, painful neck. On inspection, the patient's head is laterally deviated toward the shoulder and rotated. At this point of the examination, what is the most likely diagnosis? Torticollis A young adult patient presents to the clinic stating that something is wrong as he looks in the mirror and sees that his shoulders are uneven. He fractured his left arm 8 weeks ago and remains in a cast. He noticed the uneven shoulders over the last week. Upon inspection, his shoulder heights are unequal and there is winging of the scapula. As the examination continues, which of the following maneuvers would confirm a likely diagnosis?

A 55-year-old woman with a headache explains to the clinician that she has had headaches before, but this one is unusual because of some new symptoms. Which of the following symptoms would prompt an immediate investigation? The patient also has developed fever and night sweats and thinks she lost some weight