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NRP 531 Advanced Health Assessment Final Exam with 100% verified solutions-2023-2024, Exams of Health sciences

NRP 531 Advanced Health Assessment Final Exam with 100% verified solutions-2023-2024 stion 1. What is the primary purpose of initially assessing an apical pulse?

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Download NRP 531 Advanced Health Assessment Final Exam with 100% verified solutions-2023-2024 and more Exams Health sciences in PDF only on Docsity! NRP 531 Advanced Health Assessment Final Exam- with 100% verified solutions-2023-2024 Quiz Questions Question 1. What is the primary purpose of initially assessing an apical pulse? Your Answer: B Establishment of a baseline as part of the patient’s vital signs Question 2. What instruction should the nurse give nursing assistive personnel (NAP) regarding the appropriate technique when measuring the adult patient’s apical pulse? Your Answer: D Place your stethoscope at the fifth intercostal space over the left midclavicular line. Question 3. Which action would take priority if a patient’s apical pulse has an irregular rhythm? Your Answer: A Reassess the pulse for 1 full minute. Question 4. Which statement demonstrates an understanding of the importance of communicating changes in the patient’s apical pulse rate? Your Answer: D “The apical pulse increased from 78 to 110, but the patient had just returned from the bathroom.” Question 5. The nurse can best determine the effect of crying on a patient’s apical pulse by doing what? Your Answer: C Comparing the patient’s post-crying apical pulse rate with her baseline or previous rate. Question 1. What is the major health problem resulting from a pulse deficit? Your Answer: C Decreased cardiac output Question 2. What should the nurse do when a pulse deficit is suspected? Your Answer: D Ask another health care provider to count the radial pulse while the nurse counts the apical pulse. Question 3. Which action should the nurse perform after identifying a pulse deficit? Your Answer: B Assess the patient for signs of decreased cardiac output. Question 4. You have the following information: Oral temperature–36.8°C. Radial Pulse–112 weak, thready Apical pulse–117 regular Respirations–24 regular Blood Pressure–104/56 right arm –102/50 left arm What is the pulse deficit? Your Answer: B 5 Question 5. Which of the following is an early manifestation of decreased cardiac output? Your Answer: A Fatigue Question 1. On the last assessment of a patient’s respiration, her respiratory rate was 10 breaths per minute. What should the nurse do when conducting the next assessment of this patient’s respiratory rate? Your Answer: D Count breaths for 60 seconds. Question 3. When measuring a patient’s respiratory rate, the nurse will count the number of completed respiratory cycles per minute. What is the definition of a respiratory cycle? Your Answer: A The number of inspirations and expirations per minute. Question 4. During the assessment of a patient’s respiratory rate, when the second hand reaches the 15- second mark, the respiratory count is 8. What should the nurse do at this time? Your Answer: D Continue to count the patient’s breaths for a full 60 seconds. Question 5. The nurse plans to assess a patient’s respiratory rate; however, the patient has just returned from ambulating to the bathroom. What should the nurse do to minimize the effect of exercise on the patient’s respiratory rate? Your Answer: C Encourage the patient to rest for 10 minutes before assessing respiration. Question 1. What is the correct order for abdominal assessment? Your Answer: B Inspection, auscultation, percussion, palpation Question 2. How often should normal bowel sounds be heard in each quadrant of the abdomen? Your Answer: A 5–35 times per minute Question 3. Which of the following is an important part of performing an abdominal assessment? Your Answer: C Explaining each step of the assessment to the patient Question 4. What should you do if a patient is ticklish when you are palpating the abdomen? Your Answer: D Place your hand over the patient’s hand during palpation. Question 5. Moderate and deep palpation of the abdomen: Your Answer: D All of the above Question 1. A nurse is palpating the breasts of a patient. Which of the following are important aspects of proper palpation of the breasts? Your Answer: D All of the above Question 2. What is the most important information to document if a mass is palpated in the breast or axilla? Your Answer: C Consistency, borders, mobility, location, size, shape, tenderness, and retraction of the mass Question 3. What are the five danger signs to watch for when assessing nipples? Your Answer: B Discharge, depression, discoloration, dermatologic changes, and deviation Question 4. Which of the following statements is the most complete description of the tail of Spence? Your Answer: D Both A and B Question 5. When assessing the breasts, which of the following is considered normal? Your Answer: A Long-standing, unchanging nevi Question 1. Which of the following methods is correct for examining the ear of an adult patient with an otoscope? Your Answer: D Both A and C. Question 2. Assessment of the ears includes which of the following? Your Answer: D All of the above Question 3. A nurse is inspecting the patient’s ears with an otoscope. Which of the following findings would be considered abnormal? Your Answer: C Perforation of the tympanic membrane A nurse is assessing a patient’s neck. Which of the following is considered an expected finding? Your Answer: B Midline trachea Question 2. Which symptom found when examining the head would be a cause for concern? Your Answer: C Bruits in the temporal arteries Question 3. What information should be included when entering documentation of an enlarged lymph node? Your Answer: D All of the above Question 4. When assessing lymph nodes, it is important to do which of the following? Your Answer: D Both comparing the lymph nodes bilaterally and providing privacy for the patient. Question 5. Which lymph nodes are located in the depression above and posterior to the medial condyle of the humerus? Your Answer: C Epitrochlear lymph nodes Question 1. Where is the apical impulse located? Your Answer: A In the fifth intercostal space at the midclavicular line Question 2. Auscultatory sites of the heart include: Your Answer: C Aortic, pulmonic, tricuspid, and mitral areas Question 3. Which of the following findings during a cardiac assessment of an adult patient are considered normal? Your Answer: D S1 and S2 sounds Question 4. The S1 heart sound: Your Answer: D All of the above Question 5. When palpating the carotid arteries: Your Answer: D Both A and B Question 1. Which of the following should be included in a male genital exam? Your Answer: D All of the above Question 2. Nocturia, urine dribbles, difficulty voiding, and a small urine stream are common symptoms of which of the following conditions? Your Answer: B Benign prostatic hypertrophy Question 3. In which patient population does benign prostatic hypertrophy occur most commonly? Your Answer: A Males over 50 years of age Question 4. Which of the following patients are considered at increased risk for colon cancer? Your Answer: D Both A and B Question 5. Which possible signs and symptoms of testicular cancer should be reported to a physician? Your Answer: D All of the above Question 1. Which of the following techniques is used to assess muscle strength in a patient? Your Answer: A Apply an opposing force or resistance. Question 2. What is an increased thoracic curvature, common in older adults, called? Your Answer: C Kyphosis Question 3. Neck flexion and extension should be: Your Answer: D 45 degrees Question 4. Which of the following is the correct way to assess a patient’s nose for patency? Your Answer: B Occlude one naris, and have the patient breathe through the open naris. Question 2. What is the correct way to palpate the frontal sinuses? Your Answer: A Press the thumbs against the brow bones. Question 3. The gag reflex should be: Your Answer: D Both A and B Question 4. Which structures are included in a complete assessment of the mouth? Your Answer: D All of the above Question 5. During vocalization, the soft palate: Your Answer: B Raises symmetrically Question 1. In which position should the patient be placed in order to palpate the popliteal pulse? Your Answer: A Have the patient lie prone with the knee flexed. Question 2. Hearing a bruit in an artery is a sign of which of the following conditions? Your Answer: C An obstruction Question 3. What is a depression that is left after pressing a finger or thumb on swollen tissue called? Your Answer: B Pitting edema Question 4. Normal capillary refill is less than 2 seconds and is assessed by: Your Answer: D Pressing on the nail bed until it blanches, and observing how quickly full color returns Question 5. When should you check the patient’s blood pressure to assess for orthostatic hypotension? Your Answer: B While the patient is sitting and standing Question 1. Skin inspection and palpation includes assessment for: Your Answer: D All of the above Question 2. An ABNORMAL angle between the nail base and the nail is called clubbing and may indicate which of the following conditions? Your Answer: C Cardiopulmonary disorder Question 3. Which are the best places to check the skin for tenting, which is a sign of dehydration? Your Answer: D Forearm and sternum Question 4. Which of the following is considered an ABNORMAL finding in an older adult? Your Answer: A Malignant melanoma Question 5. The ABCD rule of melanoma includes: Your Answer: D All of the above Question 1. Which of the following indicates normal respiratory function? Your Answer: A Symmetrical chest expansion Question 2. When palpating the thorax, which of the following would be an abnormal finding? Your Answer: D All of the above Question 3. When percussing the thorax, which of the following would be a normal finding? Your Answer: D Both B and C Question 4. Your Answer: D The patient allows the father to participate. Question 1. A nursing report is an important component of care. During the report, what is the primary purpose of an effective exchange of information? Your Answer: A The patient receives continuity of care Question 2. Which of the following strategies is safest when providing a recorded nursing report? Your Answer: D Stay until after the accepting nurse listens to the report. Question 3. The progressive care unit uses a recorded system for nursing reports. In the past, nurses have designated positions in the chall where they could record and listen to reports. Now, the unit governance council has mandated that recording and listening to reports must be done in the medication room, nurse lounge, or dictation room. What is the reason for this change? Your Answer: B Confidentiality Question 4. What is the benefit of completing a bedside report during hand-off? Your Answer: B The patient and family can participate. Question 5. When preparing a nursing report, which of the following steps should the reporting nurse take? Your Answer: B Prioritize information on the basis of the patient’s needs and problems. Question 1. What is the nurse’s primary goal for appropriate, effective pain management when considering the patient’s risk for injury? Your Answer: C To maximize pain relief while maintaining the patient’s ability to function Question 2. What is one step the nurse would take if a patient receiving patient-controlled analgesia (PCA) were difficult to arouse? Your Answer: C Assess respiration, and then notify the health care provider immediately. Question 3. When a patient is using PCA, which statement is appropriate for the nurse to make to nursing assistive personnel (NAP)? Your Answer: C “Tell me if the patient is in too much pain to assist with his bath.” Question 4. Which patient outcome best reflects adequate management for pain originally rated as 8 out of 10 on a pain scale? Your Answer: B The patient rates current pain as 4 out of 10. Question 5. What will the nurse do when discontinuing PCA? Your Answer: A Ensure that the main intravenous line is intact. Question 1. When preparing to measure the height and weight of a newly admitted patient, why would the nurse ask about the patient’s ability to stand? Your Answer: B To determine if the patient is steady enough to stand without assistance Question 2. A nursing assistive personnel (NAP) is preparing to weigh a resident in a skilled nursing facility. The patient is usually weighed in street clothing and socks, with his shoes off. The patient is currently wearing street clothing with shoes and socks. What will the NAP do to ensure that the patient’s weight is correctly measured? Your Answer: B Take off the patient’s shoes, but leave his socks on. Question 3. Which step must be taken to ensure accurate measurement of a patient’s daily weight? Your Answer: B Ask the patient to void before he or she is weighed. Question 4. As the nurse is conducting an admission interview, the patient states, “I’ve lost 30 pounds over the last 4 months.” Which question might the nurse ask to determine if the weight loss was intentional or unintentional? Your Answer: C “Have you been following a specific diet?” Question 5. For which patient would the nurse instruct nursing assistive personnel (NAP) to weigh a patient with a bed scale? Your Answer: D Patient who has heart failure and a consequent inability to bear weight Question 1. What is the primary purpose of the preoperative assessment? Your Answer: D To identify conditions or factors that may compromise the surgical outcome Your Answer: B “Let me know when the patient actually begins exercising.” Question 4. Which instruction might a nurse give a patient in order to protect a surgical incision when turning in bed? Your Answer: B Use a pillow to splint the incision. Question 5. The nurse is concerned that a patient will not be able to turn independently in bed after having surgery. What must the nurse do to help this patient? Your Answer: C Communicate that the staff must turn the patient after surgery. Chapter 1 Jarvis The concept of health and healing has evolve in recent years. Which is the best description of health? C. Health depends on an interaction of mind, body and spirit within the environment. Which would be included in the database for a new patient admission to a surgical unit? D. All subjective and objective, and data gathered from a patient and the results of any laboratory or diagnostic studied completed. You are reviewing assessment data of a 45-year-old male pt and note pain of 8 on a scale of 10, labored breathing, and pale skin color on the EMR. This documentation is an example of: C. Data cluster A pt is in the emergency department with N/V. Which would you include in the database? B. A diet and GI history A pt has recently received health insurance and would like to know how often he should visit the provider. How do you respond? C. "Your visits may vary, depending on your level of wellness." You are reviewing concepts related to steps in the nursing process for determining prioritization and developing patient outcomes. To what are these actions attributed? A. Planning Which best describes evidence-based nursing practice? A. Combining clinical expertise with the use of nursing research to provide the best care for patients while considering the patient's values and circumstances. What can be determined when the nurse clusters data as part of the critical- thinking process? C. The nurse recognizes relevant information among the data. A patient says she is very nervous and nauseated, and she feels like she will vomit. This data would be what type of data? C. Subjective The expert nurse differs from the novice nurse by acting without consciously thinking about the actions. This is referred to as: B. Intuition Which would be considered a risk of diagnosis? C. Identifying potential problems the individual may develop Which would be included in a holistic model of assessment? C. A patient's perception of his or her health status The nurse uses health promotion activities with a new patient. What would this focus include? D. The nurse would empower the patient to choose a healthier lifestyle. Which is an example of objective data? D. 2- X 5-cm scar present on the right lower forearm. During the evaluation phase of the nursing process, which action would be included? C. Providing information to the patient and family members. Chapter 3 Jarvis The practitioner, entering the examining room to meet a patient for the first time, states: "Hello, I'm M.M., and I'm here to gather some information from you and to perform your examination. This will take about 30 minutes. D.D. is a student working with me. If it's all right with you, she will remain during the examination." Which of the following must be added to cover all aspects of the interview contract? A. A statement regarding confidentiality, patient costs, and the expectations of each person. is exhibiting an accurate understanding of the other person's feelings within a communication context. A. Empathy You conduct an admission interview. Because you are expecting a phone call, you stand near the door. Which would be a more appropriate approach? B. Have someone else answer the phone so you can sit facing the patient. A patient asks the nurse, "May I ask you a question?" This is an example of: C. A closed question Which statement best describes interpretation as a communication technique? D. Interpretation is based on the interviewer's inference from the data that have been presented. Which demonstrates a good understanding of the interview process? B. The nurse spends more time listening to the patient than talking. During an interview, a patient denies having any anxiety. The patient frequently changes position in the chair, and has little eye contact with the interviewer. The interviewer should: A. Use confrontation to bring the discrepancy between verbal and nonverbal behavior to the patient's attention. For what or with whom should touch be used during the interview? D. Only if the interviewer knows the person well Children usually come for health care with a parent. At about what age should the interviewer begin to question the child himself or herself regarding presenting symptoms? B. 7 years Because of adolescents' developmental level, not all interviewing techniques can be used with them. Which techniques should be avoided? D. Silence and reflection Knowledge of the use of personal space is helpful for the health care provider. Personal distance is generally considered to be: B. 1 1/2 to 4 feet Mr. B tells you "Everyone here ignores me." You respond, "Ignores you?" This technique is best described as: C. Reflecting What does active listening NOT include? A. Taking detailed notes during the interview When interviewing a patient who does not speak English, the examiner should: B. Use a qualified medical interpreter who is culturally literate With older adults, how should the examiner proceed with the interview? B. Consider the fatigue of the older person and break the interview into shorter segments. Chapter 4 Jarvis When reading a medical record, you see the following notation: Patient states "I have had a cold for about a week, and now I am having difficulty breathing." This is an example of: a reason for seeking care You have reason to question the reliability of the information being provided by a patient. One way to verify the reliability within the context of the interview is to: When assessing mental status in children, what statement is true? A. All aspects of mental status in children are interrelated. You are assessing a 75-year-old man. What is an expected finding? C. It may take him a little longer to respond but his general knowledge and abilities should not have declined. What is a priority assessment of aging adults? D. Sensory perceptive abilities Chapter 6 Jarvis The phase of addiction characterized by tolerance, increasing time spent in substance-related activities, unsuccessful attempts to quit and continued use despite known harm is: Dependency The unpleasant effect that occurs when use of a drug is stopped is called: Withdrawal The need for increasingly larger doses of a substance to achieve the same effect that was initially experienced from using is called: Tolerance Which health issue is NOT a result of prolonged heavy drinking? Increased resistance to pneumonia and other infectious diseases How many drinks does a person consume in one sitting for it to be considered binge drinking? 5 A pregnant woman explains she does not intend to stop drinking because her friends continued to drink during pregnancy, and "nothing happened" to them or their kids. How should the clinician respond? "No amount of alcohol has been determined to be safe for a pregnant woman so I would ask you to stop drinking alcohol completely." Which is the most commonly used laboratory test to identify chronic alcohol drinking? Gamma-glutamyl transferase (GGT) The CAGE screening tool is used to assess: Problem alcohol use While assessing a man during a physical exam for work, you suspect alcohol use. Which assessment tool is appropriate in this situation? AUDIT screening tool You are screening patients for excessive alcohol consumptions. Which patient would be considered over the recommended limit? Woman who reports drinking 2 glasses of wine and 2 vodka martinis each day You are performing a sports physical on a 16year old girl. Which question would be more likely yield an accurate substance abuse assessment? "Many teenagers have tried street drugs. Have you tried these drugs?" During the assessment, you will observe which problems in addition to alcohol withdrawal syndrome? Pancreatitis You are assessing a pt's cardiac risk factors secondary to chronic alcohol use. Which condition might this patient exhibit? Hypertension You are assessing a male pt's alcohol consumption. Which statement would alert you to investigate further? "No matter how much I drink I don't get drunk" Chapter 7 Jarvis Which scenario is an example of intimate partner violence? D. All of the above - An ex-boyfriend stalks his ex-girlfriend - Marital Rape - Hitting a date Routine universal screening for domestic violence includes: A. Asking all women each time they come to the health care system if they are abused. Patients are at a high risk for which mental health problem associated with intimate partner violence? B. Suicidality Which gynecologic problem is not usually associated with intimate partner violence? B. Ovarian cysts Risk factors for intimate partner homicide include: A. Abuse during pregnancy Elder abuse and neglect assessments include: E. All of the above - willful infliction of force - withholding prescription medications without medical orders - Not replacing broken eyeglasses - threatening to place someone in a nursing home When assessing an injury on a child, which should be considered? D. All of the above - The child's developmental level - The child's medical and medication history - The history of how the injury occurred What is a known risk factor for child maltreatment? D. All of the above - Substance abuse - Intimate partner violence - Physical disability and/ or mental retardation in the child Bruising on a non-walking or non-cruising child: B. Needs to be further evaluated for either an abusive or medical explanation Which is a forensic term that is related to "purpura" but is not related to blunt force trauma? C. Ecchymosis Which should be routinely included in evaluating a case of elder abuse? B. Baseline laboratory tests During an examination, you notice a patterned injury on a patient's back. Which is most likely? D. A welt from a leather belt During an interview, a woman has answered "yes" to 3 Abuse Assessment Screen questions. How should you proceed? B. Proceed by asking more questions about the items she answered "yes." Which clinical situation would require the examiner to report to the proper authorities? D. Suspicion of elder abuse and/or neglect Which would you include on the chart of the patient who has been the victim of abuse? A. Photographic documentation of injuries Chapter 8 Jarvis During the assessment, which part of the hand is best for detecting vibration? D. Ulnar surface of the hand When performing indirect percussion, the stationary finger is struck: C. At the distal interphalangeal joint The best description of the pitch of a sound wave obtained by percussion is: B. The number of vibrations per second The bell of the stethoscope is used: A. For soft, low-pitched sounds The ophthalmoscope has 5 apertures. Which aperture is used to access the eyes of a patient with undilated pupils? C. Small As a questionnaire or interview of everything eaten within the last 24 hours Mary, a 15-year old, has come for a school physical. During the interview, you learn that menarche has not yet occured. The BMI is 17. You suspect: Nutritional deficiency Which older adult is at lowest risk for alteration in nutritional status? 65-year-old widower who visits a senior center with a meal program 5 days per week The examiner is completing an initial assessment for a patient admitted to a long-term facility. The patient is unable to stand for a measurement of height. To obtain this important anthropometric information, the examiner would: Measure arm span Which assessment finding indicated a patient at nutrition risk? Waist circumference at 43 inches Marasmus is often characterized by: Low weight for height Which BMI category in adults is indicative of obesity? 30.0 to 39.9 kg/m² Why should you ask about the use of medications when assessing a patient's nutritional status? Many drugs can interact with nutrients and impair their digestion, absorption, metabolism, or uptake Chapter 12 Jarvis Select the best description of the secretion of the eccrine glands. Dilute saline solution To assess for early jaundice, you will assess: Sclera and hard palate Checking for skin temperature is best accomplished by using: The dorsal surface of the hands. Assessing a patient's skin turgor is done to assess which clinical finding? Dehydration You note a lesion during a skin assessment. Which is the best way to document this finding? Dark brown raised lesion, with irregular border, on dorsum of right foot, 3 cm in size, with no drainage You examine the nail beds of a patient. Which finding indicates a normal angle? 160 degrees You are assessing capillary refill. The room is warm. Which finding would be considered normal? <1 second During a routine visit, M.B., age 78, asks about small, round, flat, brown macules on the hands. What is your best response after assessing the areas? "These are the result of sun exposure and do not require treatment." An area of thin shiny skin with decreased visibility of normal skin markings is most likely: Atrophy Flattening of the angle between the nail and its base is: Described as clubbing. A configuration of individual lesions arranged in circles or arcs, as occurs with ringworm, is described as a Annular lesion The "A" in the ABCDE rule for skin cancer stands for: Asymmetry A risk factor for melanoma is: Skin that freckles or burns before tanning Herpes zoster infection (shingles) is characterized by: Lesion on only one side of body; does not cross midline Chapter 13 Jarvis 1. Which facial bones articulate at a joint instead of a suture? d. Mandible 2. Identify the blood vessel that runs diagonally across the sternomastoid muscle. c. External jugular vein 3. The isthmus of the thyroid gland lies just below the: b. Cricoid cartilage 4. Which is true regarding cluster headaches? a. They may be precipitated by alcohol and daytime napping. 5. Which is least likely to indicate a possible malignancy? d. Marked tenderness. 6. Providing resistance while the patient shrugs his or her shoulders is a test of which cranial nerve? d. XI 7. On examination, the infant's fontanels should feel: c. Firm, slightly concave, and well defined 8. If the thyroid gland were enlarged bilaterally, which maneuver would be appropriate for you to assess? d. Listen for a bruit over the thyroid lobes. 9. It is normal to palpate a few lymph nodes in the neck of a healthy person. What are the characteristics of these nodes? a. Mobile, soft, nontender 10. Cephalhematoma is associated with: a. Subperiosteal hemorrhage 11. Normal cervical nodes are: a. Smaller than 1 cm 12. A throbbing, unilateral pain associated with nausea, vomiting, and photophobia is characteristic of: c. Migrane headache 13. Bell palsy is characterized by: a. Unilateral paralysis of half of the face 14. You suspect an infant's head is of abnormal size and can use which procedure to verify these findings? b. Measuring tape Chapter 14 The palpebral fissure is: b) the open space between the eyelids The corneal reflex is mediated by cranial nerves: c) V and VII The retinal structures viewed through the opthalmoscope are: a) the optic disc, the retinal vessels, the general background, and the macula c) Kiesselbach plexus The sinus that are accessible to examination are the: d) frontal and maxillary The frenulum is: a) the midline fold of tissue that connects the tongue to the floor of the mouth The largest salivary gland is located: a) within the cheeks in front of the ear A 70-year-old woman complains of dry mouth. The most frequent cause of this problem is: b) related to medications she may be taking. During an inspection of the nares, a deviated septum is noted. The best action is to: b) document the deviation in the medical record in case the person needs to be suctioned. Oral malignancies are most likely to develop: d) in the mucosal "gutter" under the tongue. In a medical record, the tonsils are graded as 3+. The tonsils would be: c) touching the uvula The function of the nasal turbinates is to: a) warm the inhaled air The opening of an adult's parotid gland (Stensen's duct) is opposite the: d) upper 2nd molar A nasal polyp may be distinguished from the nasal turbinates for 3 of the following reasons. Which reason is false? a) The polyp is highly vascular. The examiner notes small, round, white, shiny papules on the hard palate and gums of a 2-month-old. What is the significance of this finding? c) This is a normal finding called Epstein pearls. When assessing the tongue, the examiner should: a) palpate the U-shaped area under the tongue. Chapter 17 Jarvis The reservoirs for storing milk in the breast are: lactiferous sinuses The most common site of breast tumors is: The upper outer quadrant During a visit for a school physical, the 13 year old girl being examined questions the assymetry of her breasts. The best response is: "One breast may grow faster than the other during development" When teaching the breast self-examination, you would inform the woman that the best time to conduct breast self-examination is: on the 4th to 7th day of the cycle You are providing health promotion teaching for a 40 year old woman. What is the current recommendation for women 40 years of age and older for breast cancer screening with mammography? Every year You are going to inspect a female patient’s breasts for retraction. The best position for this part of the examination is: Sitting with hand pushing onto hips A bimanual technique may be the preferred approach for a woman. with pendulous breasts During the examination of a 70 year old man, you notice gynecomastia. You would: review the medications for drugs that have gynecomastia as a side effect. During a breast examination, you detect a mass. Identify the description that is most consistent with cancer rather than breast disease. B. irregular, poorly defined, fixed During the examination of the breasts of a pregnant woman, you would expect to find: a blue vascular pattern over both breasts Which of the following women should not be referred to a physician for further evaluation? C. a 25 year old with asymmetric breasts and inversion of nipples since adolescence Any lump found in the breast should be referred for further evaluation. a benign lesion will usually have 3 of the following characteristics. Which one is characteristic of a malignant lesion? D. irregular shape Gynecomastia is: enlargement of the male breast Which is the first physical change associated with puberty in girls? breast bud development During the examination of a 30 year old women, she questions you about "the 2 large moles "that are below her left breast. After examining the area, how do you respond? "This appears to be a normal finding of supernumeray nipples, due to the small areolae and nipples that are present." Chapter 18 The manubriosternal angle is: A. The articulation of the manubrium and the body of the sternum. Select the correct description of the left lung. B. Narrower than the right lung with two lobes. You assess a patient who reports a cough. The characteristic timing of the cough of chronic bronchitis is described as: B. Productive cough for at least 3 months of the year for 2 consecutive years. Which of the following assessments best confirms symmetric chest expansion? A. Placing hands on the posterolateral chest wall with thumbs at the level of T9 or T10 and then sliding the hands up to pinch a small fold of skin between the thumbs. Absence of diaphragmatic excursion occurs with: C. Pleural effusion or atelectasis of the lower lobes You are auscultating breath sounds on a patient. Which of the following best describes how to proceed? B. Hold the diaphragm of the stethoscope against the chest wall; listen to one full respiration in each location, being sure to do side to side comparisons. Select the best description of bronchovesicular breath sounds. B. Moderate-pitched, inspiration equal to expiration. After examining a patient, you make the following notation: increased respiratory rate, chest expansion decreased on left side, dull to percussion over left lower lobe, breath sounds louder with fine crackles over left lower lobe. These findings are consistent with: D. Lobar pneumonia On examining a patient's nails, you note that the angle of the nail base is >160 degrees and that the nail base feels spongy to palpation. These findings are consistent with: C. Congenital heart disease and COPD On auscultating a patient, you note a coarse, low-pitched sound during both inspiration and expiration. This patient reports pain with breathing. These findings are consistent with: D. Pleural friction rub You assess a patient who has 4+ edema of the right leg. What is the best way to document this finding? D. Very deep pitting, indentation last a long time. You assess a patient for arterial deficit in the lower extremities. After raising the legs 12 inches off the table and then having the person sit up and dangle the leg, the color should return to: B. 10 seconds or less. A 54-year-old woman with 5 children has varicose veins of the lower extremities. Her most characteristics sign is: D. Dilated, tortuous superficial bluish vessels. Atrophic skin changes that occur with peripheral arterial insufficiency include: A. Thin, shiny skin with loss of hair Intermittent claudication includes: C. Muscular pain brought on by exercise A known risk factor for venous ulcer development is: A. Obesity Arteriosclerosis is caused by: B. Loss of elasticity of the walls of blood vessels. Raynaud phenomenon occurs: B. In hands and feet as a result of exposure to cold, vibration, and stress. Select the sequence of techniques used during an examination of the abdomen. C. Inspection, auscultation, percussion, palpation Which of the following can be noted through inspection of a patient's abdomen? C. Venous pattern, peristaltic waves, and abdominal contour Right upper quadrant tenderness may indicate pathology in the: A. Liver, pancreas, or ascending colon Hyperactive bowel sounds are: D. All of the above - high pitched, rushing, tinkling The absence of bowel sounds is established after listening for: C. 5 full minutes Auscultation of the abdomen may reveal bruits of the arteries. A. Aortic, renal, iliac and femoral The normal range of liver span in the right midclavicular line in the adult is: D. 6-12 cm The left upper quadrant (LUQ) contains the: D. Spleen A female patient has striae on the abdomen. Which color indicates long-standing striae? D. Silvery white Auscultating the abdomen is begun in the right lower quadrant (RLQ) because: A. Bowel sounds are always normally present here. A dull percussion note forward of the left midaxillary line is: D. Indicative of splenic enlargement Shifting dullness is a test for: A. Ascites Tenderness during abdominal palpation is expected when palpating the: C. Sigmoid colon A positive Murphy's sign is best described as: B. Pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflamed gallbladder. A positive Blumberg sign indicates: D. Peritoneal inflammation