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NU 518 EXAM QUESTIONS WITH SIMPLIFIED
SOLUTION
Question 1 1.32 / 1.32 pts A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to? Musculoskeletal Reproductive Urinary Endocrine Question 2 1.32 / 1.32 pts A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally. The patient denies a rash and also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? Infectious Inflammatory Hematologic Traumatic IncorrectQuestion 3 0 / 1.32 pts 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? Write the physical therapy prescription. Have your office staff explain directions to the physical therapy center. Discuss the plan with Mr. Larson. Tell Mr. Larson that he will be going to physical therapy three times a week. Question 4 1.32 / 1.32 pts You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list? Arthritis, war injury pain, headaches, chest pain War injury pain, arthritis, headaches, chest pain Headaches, arthritis, war injury pain, chest pain Chest pain, headaches, arthritis, war injury pain Question 5 1.32 / 1.32 pts A 37-year-old nurse comes for evaluation of constant right upper quadrant abdominal pain. The pain is worse 1 to 2 hours after eating greasy foods and is associated with nausea and vomiting. Which one of the following physical examination descriptions would be most consistent with the diagnosis of acute cholecystitis? Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses. Abdomen is soft and slightly tender to palpation in the left lower quadrant, without rebound or guarding. Abdomen is soft and tender to palpation in the right upper quadrant with positive Murphy sign. Abdomen is soft and slightly tender to palpation in the left flank area. Question 6 1.32 / 1.32 pts 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, and nonproductive cough. Which is the most likely pathologic process? Infection Inflammation Allergic Vascular
IncorrectQuestion 7 0 / 1.32 pts You have just seen a 5-year-old girl who wheezes when exposed to cats. The patient's family history is positive for asthma. You think the child possibly has asthma, but is uncertain if asthma is actual cause of child's symptom. What have you just accomplished?
Present illness
Personal and social history Review of systems Question 15 1.32 / 1.32 pts 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? Chief complaint Family history Personal and social history Review of systems Question 16 1.32 / 1.32 pts The following information is recorded in the health history: The patient was hospitalized and treated for an asthma exacerbation last year. The patient has never been intubated. Which category does it belong to? Past history Personal and social history Present illness Chief complaint Question 17 1.32 / 1.32 pts Is the following information subjective or objective? Mr. Smith has a respiratory rate of 22 and a pulse rate of 100. Subjective Objective Question 18 1.32 / 1.32 pts The following information is recorded in the health history: The patient completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week. Which category does it belong to? Chief complaint Present illness Personal and social history Review of systems Question 19 1.32 / 1.32 pts The following information is recorded in the health history: The patient is a 34 year old Caucasian female and is a reliable source of information. What category does it belong to? Chief complaint Personal and social history Present illness Identifying data Question 20 1.32 / 1.32 pts The four classic techniques that are essential components of the physical examination are: Inspection, percussion, investigation, analysis Palpation, percussion, analysis, evaluation Percussion, auscultation, inspection, investigation Inspection, palpation, percussion, auscultation Question 21 1.32 / 1.32 pts Sensitivity and specificity of a diagnostic test help determine the validity of the results. Sensitivity is defined as: The probability that a person with disease has a positive test. The probability that a non-diseased person has a negative test. The true negative rate. The negative predictive value.
Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. Question 28 1.32 / 1.32 pts Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient? Talkative patient Angry patient Silent patient Seductive patient Question 29 1.32 / 1.32 pts When using an interpreter to facilitate an interview, where should the interpreter be positioned? Behind the patient, so the examiner can focus on communicating with the interpreter. Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient. Between you and the patient, so all parties can make the necessary observations. In a corner of the room, so as to provide minimal distraction to the interview. Question 30 1.32 / 1.32 pts Mr. Jones is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem? You are an alcoholic, aren't you? When was your last drink? Do you drink 2 to 3 beers every weekend? Do you drink alcohol when you are supposed to be working? Question 31 1.32 / 1.32 pts A patient is describing a very personal part of her history very quickly and in great detail. How should you react to this? Write down as much as you can, as quickly as possible. Ask her to repeat key phrases or to pause at regular intervals, so you can get almost every word. Tell her that she can go over the notes later to make sure they are accurate. Push away from the keyboard or put down your pen and listen. Question 32 1.32 / 1.32 pts To prevent disruption of the quality and outcomes of patient care, you move toward the principles of cultural humility that includes the following three dimensions: Self-awareness, respectful communication, thoughtful prejudgment attitude. Self-sufficient collaboration, respectful communication, thoughtful prejudgment attitude. Self-awareness, respectful communication, collaborative partnerships. Thoughtful prejudgment attitude, self-awareness, respectful communication. Question 33 1.32 / 1.32 pts You form collaborative relationships with your patients and make every effort to be respectful of patients' right to determine what is in their own best interest. This is an example of which of the following professional ethics that approaches health care congruent with patient beliefs and effective clinical care? Confidentiality Autonomy Communitarianism Utilitarianism Question 34 1.32 / 1.32 pts Julie has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that
Complete Focused or problem-oriented Comprehensive Temporary Question 35 1.32 / 1.32 pts A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 28.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit? Refer the patient to a nutritionist because he is anorexic. Reassure the patient that he has a normal body mass index. Give the patient information about healthy lifestyle changes including reduction of fat and calories because he is overweight. Give the patient information about healthy lifestyle changes including reduction of fat and calories because he is obese. Question 36 1.32 / 1.32 pts You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except: Level of consciousness Signs of distress Dress, grooming, and personal hygiene Lab results Question 37 1.32 / 1.32 pts 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? Blood pressure cuff is loosely secured with the upper border of the cuff below the antecubital crease. Patient is seated quietly for 5 minutes prior to measurement. Blood pressure is measured on a bare arm. Patient's arm is supported and positioned so that the brachial artery, at the antecubital crease, is at heart-level as you measure the blood pressure. Question 38 1.32 / 1.32 pts You are observing a patient with heart failure and notice that there are pauses in his breathing. On closer examination, you notice that periods of deep breathing are followed by periods of apnea (no breathing). The patient is not in any distress. You make the diagnosis of: Tachypnea Cheyne-Stokes respiration Bradypnea hyperventilation Question 39 1.32 / 1.32 pts Mr. Garcia comes to your office for a reddened rash with small blisters (vesicles) on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. The rash overlies an entire rib on his right side affecting the somatosensory system. What type of pain is this? Idiopathic pain Neuropathic pain Nociceptive (somatic) pain Psychogenic pain Question 40 1.32 / 1.32 pts A 17-year-old high school senior 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 20 kg/m2. Based on this information, which of the following is appropriate? Refer the patient to a nutritionist and a psychologist because the patient is anorexic. Reassure the mother that this is a normal body weight.
Give the patient information about exercise because the patient is overweight. Give the patient information about reducing fat and carbohydrates in her diet because she is obese. Question 41 1.32 / 1.32 pts A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m2. What is a safe goal for weekly weight reduction? .5 to 2 pound per week 1 to 2.5 pounds per week 2.5 to 3.5 pounds per week 3.5 to 4.5 pounds per week Question 42 1.32 / 1.32 pts Common or concerning symptoms to inquire about in the Health History include all of the following except: Change in weight Fever and chills Fatigue and weakness History of seasonal allergies Question 43 1.32 / 1.32 pts 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 "dream weight" is 158 pounds away. What would you tell him? When you get down to your goal weight, you will feel so much better. Some people seem to be able to lose weight and others just can't, no matter how hard they try. We are coming up with new medicines and methods to treat your conditions every day. A more realistic weight loss of 5% to 10% can make a noticeable improvement in your health. Question 44 1.32 / 1.32 pts 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 5 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? Explain that even small amounts of weight gain can cause denial of life insurance. Place him on a high-protein, low-fat diet. Advise him to increase his aerobic exercise for calorie burning. Measure his waist circumference. Question 45 1.32 / 1.32 pts You are examining a healthy alert patient in the outpatient clinic and ready to measure the vital signs. While taking a tympanic temperature, you notice a below normal reading. What is your next appropriate step? Check the auditory canal for cerumen. Document the reading. Refer patient to specialist. Admit to hospital. Question 46 1.32 / 1.32 pts When assessing a patient's heart rhythm, you palpate the radial pulse and notice irregularities. Your next step should include: Listening with your stethoscope at the radial artery. Palpating the femoral pulse. Listening with your stethoscope at the cardiac apex. Inspecting the radial pulse for irregularities. Question 47 1.32 / 1.32 pts A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal fatigue, bradycardia, and multiple erosions of dental enamel. She appears healthy otherwise. You should ask her if she:
A father brings his 22-year-old son to your office to discuss his son's mental health disorder. The patient was diagnosed with schizophrenia 6 months ago and has been taking medication since. The father states that his son's dose isn't high enough and you need to raise it. He states that his son has been hearing things that don't exist. You ask the young man what is going on and he tells you that his father is just jealous because his sister talks only to him and not to his father. His father turns to him and says "Son, you know your sister died 2 years ago." His son replies "Well, she still talks to me in my head all the time." Which abnormality of perception best describes this patient? Illusion Hallucination Delusion Anxiety Question 55 1.32 / 1.32 pts Which of the following will help to optimize a pediatric examination? Performing the examination out of order if necessary to take advantage of quiet periods. Making sure to place the infant on the table during the examination while mom watches close by. Using firmness as needed to make it through the examination. Performing the examination in an orderly manner to avoid missing a portion of the examination. Question 56 1.32 / 1.32 pts A 1-year-old is brought in for a well check. The advanced nurse practitioner is aware that the physical growth during infancy is faster than at any other age. With this in mind, the advanced nurse practitioner relates to the mother that: By 1 year, the infant's birth weight should have doubled and height increased by 25%. By 1 year, the infant's birth weight should have tripled and height increased by 10%. By 1 year, the infant's birth weight should have tripled and height increased by 50%. By 1 year, the infant's birth weight should have quadrupled and height increased by 75%. IncorrectQuestion 57 0 / 1.32 pts A toddler is able to balance well on one foot and walk on tiptoes. She can also define words and play games. What is the approximate developmental age of this child? 2 years 3 years 4 years 5 years Question 58 1.32 / 1.32 pts A 4-month-old infant is brought in for a well check. It is noted that his weight is significantly different than anticipated. What should you do next? Remeasure to ensure accuracy. Recommend an endocrinology consult. Admit the infant to the hospital for further workup. Order a CT of the body. Question 59 1.32 / 1.32 pts You are having trouble examining the abdomen of a 3-year old toddler due to resistance. What strategy should you consider? Make the child realize that this is part of the examination and must be done. Ask the parent to leave the room. Have the parent restrain the child so you can complete the examination. Have the child hold your hand and help you with the exam. Question 60 1.32 / 1.32 pts A 6-year old child who appears upset presents to the clinic for a well check. When obtaining vital signs, you recognize an elevated blood pressure. What step(s) should you take next to confirm or refute the elevated reading? Perform at least four more blood pressure readings back-to-back on each arm. Give the patient a can of soda and bag of chips, and recheck blood pressure in 1 month.
Reassure the child, explain and demonstrate the procedure for measuring blood pressure, and perform blood pressure reading again at the end of the examination. Start child on blood pressure medication. Question 61 1.32 / 1.32 pts You are going to obtain a social history on an early adolescent boy. How should you proceed to obtain the best information? Ask his mother how she would like to proceed. Ask your questions with his mother in the room. Explain to both mother and adolescent that the best health care allows adolescents some degree of independence and confidentiality, then ask his mother to leave the room for part of the interview. Omit the social history since this is not considered important when assessing the adolescent. Question 62 1.32 / 1.32 pts A woman has a positive pregnancy test and is interested in knowing the expected date of delivery (EDD). Using Naegele's Rule, the advanced nurse practitioner estimates the EDD by: Counting the number of weeks and days from the first day of the last menstrual period. Taking the last menstrual period, adding 7 days, subtracting 3 months, and adding 1 year. Counting the number of hours and minutes from the first day of the last menstrual period. Taking the last menstrual period, adding 3 days, subtracting 7 months, and adding 1 year. Question 63 1.32 / 1.32 pts A young woman comes in for a routine wellness examination. You notice that her vaginal walls have deep rugae and are slightly bluish in color. She also has thick white profuse discharge. What should you suspect? Hypoxia Varicosities Sexually transmitted infection Pregnancy Question 64 1.32 / 1.32 pts A young mother presents with a pregnancy confirmed by urine HCG. Her LMP was June 20. Using Naegele's rule, you estimate what day of delivery? March 27 April 13 February 20 February 13 Question 65 1.32 / 1.32 pts A women in the second trimester of pregnancy presents to clinic in October for routine check up. The advanced nurse practitioner is aware that the following vaccines are safe during pregnancy: Measles/mumps/rubella Polio Influenza/pneumococcal Varicella Question 66 1.32 / 1.32 pts Fetal alcohol syndrome is the leading cause of preventable mental retardation in the United States True False Question 67 1.32 / 1.32 pts Lucille is in her 24th week and feels good. You notice a new onset of high blood pressure. Today's reading is 150/96. Her urine is normal. What do you suspect initially? Preeclampsia Chronic hypertension
Question 74 1.32 / 1.32 pts Mr. White's son brings him in today because he notes that Mr. White has not been himself lately. He seems forgetful and has not taken care of himself as he normally does. He has reported falling twice at home to his son and has telephoned late at night because of insomnia. His blood pressure and diabetes have been difficult to control and his warfarin dosing has become more difficult. Which of the following should you suspect? Vertigo Alcohol use Urinary tract infection Stroke Question 75 1.32 / 1.32 pts Claire is 75 years old and lives alone. Her daughter brings her in today concerned about a recent fall Claire experienced at her home. Which assessments are indicated at this time? Orthostatic vital signs Review of her medications Assessment of gait and balance All of the above Question 76 1 / 1 pts I do solemnly affirm that I have not violated the Honor Code of the USA College of Nursing by either giving or receiving unauthorized assistance on this exam, nor have I been aware of such conduct without reporting it appropriately. True False Quiz Score: 94.72 out of 100
