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NURS 612 Maryville Exam 4 MC
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Which type of assessment should be used to evaluate the mental status of a patient with head trauma? A. PHQ B. Perceptual distortion assessment C. Glasgow Coma Scale D. Functional Assessment - CORRECT ANSWER-C. Glasgow Coma Scale Which of the following indicates possible cognitive impairment? A. ability to complete personal care without assistance B. Suspiciousness or inappropriate affect C. Articulate communication D. Prudent behavior and calm demeanor - CORRECT ANSWER-B. Suspiciousness or inappropriate affect A 65-year old woman is brought to the clinic by family. They report thieve have noticed a change in her mental abilities over the past 2 weeks. Normally they say she is independent, intelligent and very socially oriented. Medical history is unremarkable except for congestive heart failure, for which she takes digoxin. She has had no major changes in her health. What questions would be most important for the examiner to ask the woman's family? A. Is there a family hx of Alzheimers? B. How much alcohol does she drink in an average week? C. When was her digoxin level last checked? D. Did you know that the mental function begins to decline after the age of 60? - CORRECT ANSWER-C. When was her digoxin level last checked? A patients inability to follow simple instructions could indicate with of the following findings? A. Dysphonia B. Amnesia C. Aphasia D. Depression - CORRECT ANSWER-D. Depression A patient scores a 3 on a mini-cog assessment instrument for dementia, What does this score indicate? A. Advanced dementia
B. Early dementia C. Need for further evaluation D. Negative screen for dementia - CORRECT ANSWER-D. Negative screen for dementia The examiner asks the patient to complete this statement: "A bird is to air as a fish is to _________." This is an example of what type of testing? A Calculation B Analogies C Judgment D Mood and feelings - CORRECT ANSWER-B. Analogies Assume that the patients response to the examiner in question 3 is scales. What does this response likely reflect? A. Left cerebral hemisphere lesion B. Depression C. eating disorder D. Aphasia - CORRECT ANSWER-A. Left cerebral hemisphere lesion A patient who has difficulty writing or drawing is most likely to have what condition? A. Temporal lobe damage B. Peripheral neuropathy C. Organic brain syndrome D. Psyciatric hallucinations - CORRECT ANSWER-B. Peripheral Neuropathy A mother brings her 18 month old to the clinic. The child rarely talks or smiles or makes eye contact. She has also notice he does not like to be held. She says his motor development seems to be normal. What are these symptoms consistent with? A. Dementia B. Autistic disorder C. ADHD D. Delirium - CORRECT ANSWER-B. Autistic disorder A patient with Alzheimers disease classically displays which of the following? A. alternating periods of mania and stupor B. Hallucinations and decorticate posturing C. Disintegration of personality D. Rapid onset of symptoms - CORRECT ANSWER-C. Disintegration of personality While examining a newborn male infant, the examiner palpates a testicle in the inguinal canal that cannot be pushed into the scrotum. this finding is consistent with what? A. A retractile testi B. Ambiguous genitalia C. Inguinal hernia
A. left teticle hangs lower than the right B. Scrotum is darker than general skin color C. Skin on scrotum is shiny and smooth D. Scrotum has a midline raphe. - CORRECT ANSWER-C. Skin on scrotum is shiny and smooth Which finding may indicate diabetes? A. the vas deferens feels lumpy or beaded B. The testicle feels hard with a lump C. Sebaceous cysts are present on the scrotal skin D. The urethra has a slit like orifice - CORRECT ANSWER-A. The vas deferens feels lumpy or beaded. During an examination for a hernia and adult male should: A. Be asked to stand B. be in a supine position C. sit on the table with heels together D. Assume a knee-chest position on the exam table. - CORRECT ANSWER-A. be asked to stand Which of the following testicular characteristics is associated with syphilis or diabetic neuropathy? A. Asymmetry or drooping B. Bilateral enlargement C. Insensitivity to pain D. Migration to abdomen - CORRECT ANSWER-C. Insensitivity to pain What type of hernia would you typically see in a 15 year old male? A. femoral B. umbilical C. direct inguinal D. indirect inguinal - CORRECT ANSWER-C. Direct inguinal hernia Which patient characteristics is associated with smegma as an expected finding? A. uncircumcised B. prepubertal C. sexually active D. transgender - CORRECT ANSWER-A. Uncircumcised A 24 year old male has scrotal pain and marked erythema. The examiner considers epidydimitis. Which other finding is most consistent with this finding? A. Absent cremasteric reflex B. Anorexia and nausea C. Acute onset of severe pain D. urethral discharge - CORRECT ANSWER-D. Urethral discharge
Hypospadias is a congenital defect in which the urethra meatus is located on the ventral surface of the glans penis. This is thought to occur embryologically during urethral development during which stage of gestation? A. 4-6 weeks B. 8-20 weeks C. 15-25 weeks D. 20-30 weeks - CORRECT ANSWER-B. 8-20 weeks Which of the following hernias occur more often in females and is the least common of all hernias? A. Indirect B. Direct C. Femoral D. Ventral - CORRECT ANSWER-C. Femoral Which finding on exam of a scrotal mass which is neither a testicle or spermatic cord, suggests a problem with an incarcerated hernia? A. mass does not transilluminate or change in size when reduction is attempted. B. Mass doe not transilluminate but decreased in size when reduction is attempted. C. Mass does transilluminate but does not change in size when reduction is attempted D. Mass does transilluminate and change size when reduction is attempted. - CORRECT ANSWER-A. Mass does not transilluminate or change in size when reduction is attempted. You examine Mr. Lacosta 22 year old male. CC is penile pain and swelling. On exam you notice a constricting band of tissue directly behind the head of the penis. You diagnosis this as: A. paraphimosis B. hypospadius C. orchitis D. torsion - CORRECT ANSWER-A. paraphimosis You examine a patient and note pearly gray, smooth umbilicated lesions. The most common cause of these is: A. syphilis B. condyloma acuminata C. molluscum contagasioum D. lymphogranuloma venereum - CORRECT ANSWER-C. Molloscum contagious Which finding indicates a normal cremasteric reflex? A. penile erection in response to light touch B. descent of testicle into scrotum in response to pressure on abdominal wall C. Drop of urine appearing at urethral meatus in response to pressing glans D. Elevation of left testicle and scrotum in response to stroking left inner thigh. - CORRECT ANSWER-D. Elevation of left testicle and scrotum in response to stroking left inner thigh.
What is the correct position in which to place a patient for breast palpation? - CORRECT ANSWER-Supine, arm over head, and small pillow under shoulder of side being assessed Which statement made by a 37 year old would make the examiner suspect fibrocystic disease? A. lump in my breast that is nontender B. right breast is larger than left C. nipples are darker than before baby was born D. I feel a lump in my breast right before my period. - CORRECT ANSWER-D. I feel a lump in my breast right before my period. A patient 3 weeks postpartum reports sore nipples and is breastfeeding. The examiner observes dry, cracked nipples, Which question would be helpful? A. Do you pump? B. How do you clean your breasts? C. Have you been able to bond with your baby? D. what medications have you been taking? - CORRECT ANSWER-B. How do you clean your breasts? 68 year old man presents with gynecomastia which factor is a potential cause of the problem? A. decrease in physical activity B. increased lactiferous duct glans C. lymphatic engorgement D. a decrease in testosterone - CORRECT ANSWER-D. a decrease in testosterone Symptoms consistent with underlying ducats malignancy include: A. erythema, heat, pain around one nipple B. red, scaling, crusty patch on one nipple C. bilateral inflammation tenderness and sticky multicolored nipple discharge D. gynecomastia, deepening color of nipple. - CORRECT ANSWER-B. Red, scaling, crusty patch on one nipple While examining the breast of a 52 year old woman the examiner notes nipple discharge which of the following diagnostic tests would be appropriate? A. cytologic examination of discharge B. C&S C. WBC Count D. estrogen level - CORRECT ANSWER-A. cytologic examination of discharge while performing a breast examination on a 68year old woman, examiner expects to find what? A. breast tissue with multiple, firm large lumps B> breast tissue has granular feel C. the tail of spence is not longer observed
D. Axillary lymph nodes are enlarged. - CORRECT ANSWER-B> breast tissue has granular feel which of the following represents the first sign of puberty in girls? A. thelarche B. menarche C. proliferation of lactiferous duct D. areolar elevation - CORRECT ANSWER-A. thelarche a benign tumor of the subareolar duct that produces nipple discharge is: A. pagets disease B. intraductal papilloma C. duct ectasia D. galactorrhea - CORRECT ANSWER-B. intraductal papilloma A 38 year old woman, is diagnosed with mastitis. what is likely causative agent? A. staph aureus B. strep C. Neissiera gonorhea D. E. coli - CORRECT ANSWER-A. staph aureus what finding on a female breast requires further investigation? A. wrinkled areolas B> prominent montgomery tubules C. one breast larger than the other D. unilateral venous network. - CORRECT ANSWER-D. unilateral venous network what finding on breast exam of a male can result from MJ use? A. galactorrhea B. subareolar mass C. gynecomastia D. dimpling - CORRECT ANSWER-C. gynecomastia Which finding is suggestive of PID? A. enlargement of ovaries B. everted cervix C. pain resulting from movement of cervix D. unilateral labial swelling redness tenderness - CORRECT ANSWER-C. pain resulting from movement of cervix which finding would be of concern during an exam of older female? A. palpable ovaries B. small pale cervix C. constriction of vaginal introitus D. absence of vaginal rugation - CORRECT ANSWER-A. palpable ovaries
D. enlargement and protrusion of cervix into vaginal vault. - CORRECT ANSWER-B. hernial protrusion through anterior wall of vagina which finding is indicative of STD? A. ulcers and vesicles on vagina B. atrophy of labia majora C. dilation of urethral orifice D. bluish color to cervix. - CORRECT ANSWER-A. ulcers and vesicles on vagina the examiner observes a slit shaped cervical os in a multiparious woman. which data in her history explains this finding? A. earl onset peroid B. multiple sex partners C. infection with HPV D. had an abortion as teenager - CORRECT ANSWER-D. had an abortion as teenager a prominent labia minora in a newborn is: A. maternal infection B> Ambiguous genitalia C. consistent with preamaturity D. normal - CORRECT ANSWER-D. normal Softness of the cervix is an expected finding for: A. An adolescent B. A pregnant woman C. A nonpregnant woman D. An older adult - CORRECT ANSWER-B. A pregnant woman By which week of pregnancy would you expect to be able to palpate the uterus at the symphysis pubis? - CORRECT ANSWER-12th week a cauliflower like mass is found on the labia of a female patient this is caused by A. syphilis B. condlyum latum C. condyloma acetinum D. herpes - CORRECT ANSWER-C. condyloma acetinum sexually active 22 year old, complains of gross vaginal discharge. Which question would help understand the symptom? A. Do you use condoms? B. What type of birth control do you use> C. at what age did you start your period D. DO you have a family history of ovarian or breast cancer? - CORRECT ANSWER-A. Do you use condoms?
a 62 year old female went through menopause 14 years ago. Which statement by the patient indicates a need for follow up" A. I have not been sexually for about 4 years B. my pubic hair has become very thin C. I have small amounts of vaginal bleeding a few times a week D. I have been taking extra calcium since I reached menopause - CORRECT ANSWER-C. I have small amounts of vaginal bleeding a few times a week A patient reports that over the last year, the interval between periods has lengthened and her last 3 periods have been about 6 weeks apart. Which term describes this problem? - CORRECT ANSWER-oligomenorrhea what is an additional piece of info that you would include on lab requisition if a cervical Pap smear has been obtained from a transgender man? A. gender genotype B. years since change in gender identity C. use of testosterone D. number and gender of sexual partners. - CORRECT ANSWER-C. use of testosterone Phimosis - CORRECT ANSWER-foreskin cannot be retracted balanitis - CORRECT ANSWER-inflammation of the glans penis Balanoposthitis is ___ - CORRECT ANSWER-inflammation of the glans and foreskin Urethral discharge occurs with - CORRECT ANSWER-infection/STI TT - CORRECT ANSWER-rubbery, smooth free of nodules vas deferens beaded or lumpy - CORRECT ANSWER-diabetes or inflammation Well woman exam to decrease anxiety - CORRECT ANSWER-show instrument, explain what they do, instructing to let know if any discomfort, warm room ,ensure privacy, see to understand anxiety. ( hx assault? bad previous exp?) STI discharge - CORRECT ANSWER-foul smelling, thicker, STI symptoms - CORRECT ANSWER-pain/burning urination, pelvic pain, bleeding between periods, itchy rash, what questions do you ask patient with CC of mood disorder such as depression? - CORRECT ANSWER-Change of outlook on life? troubling thoughts? feeling hopeless, low energy, fatigue, agitation, thoughts of suicide
Mini-Mental State Examination (MMSE) - CORRECT ANSWER-Give you a quantifiable measureof cognitive functions of MSE
- valid detector of organic disease
- normal = 27
- 18 - 23 = mild cog dysfunction
- 0 - 7 = severe cog dysfunction
- orientation to time - what's the date?
- registration - repeat back 3 words
- naming - what is this object?
- reading - please read this paper and do what it says
- attention and calculation - spell this word backwards
- langauge - repeat the following sentence.... Mini-Mental State Examination (MMSE) - CORRECT ANSWER-A test that is used to measure cognitive ability, especially in late adulthood. red rash on the breast is it eczema or Paget? - CORRECT ANSWER-unilateral is Paget breast exam post-mastectomy - CORRECT ANSWER-if malignancy occurs may be at scar site palpating axiallary position - CORRECT ANSWER-sitting position arms at sides 58 yr old woman how often mammogram - CORRECT ANSWER- 1 - 2 years if no symptoms benign tumor of subareolar ducts that has nipple discharge - CORRECT ANSWER- intraductal papilloma post Pap smear teaching - CORRECT ANSWER-bleeding possible for a few hours following 6yr old vaginal bleeding - CORRECT ANSWER-vaginal bleeding in children is always clinically important 24 yr old with scrotal pain and erythema - CORRECT ANSWER-epididymis=UA shows elevated WBC/bacteria CC of rectal pain - CORRECT ANSWER-rectal pain is almost always an indication of local disease inflammation of sacrococcygeal area pain with palpation - CORRECT ANSWER- anorectal fistula, pilonidal cyst, perianal abbess Hemmorhoids in 6 year old - CORRECT ANSWER-portal hypertension
palpate the prostate gland - CORRECT ANSWER-• On the anterior wall, note the bulging prostate gland
- Should feel smooth and muscular
- Note the following: o Size o Shape o Surface o Consistency o Mobility o Sensitivity clay colored stool - CORRECT ANSWER-biliary obstruction or absent bile pigment man unable to stand for DRE what is alternative - CORRECT ANSWER-left lateral position with knees flexed prenatal vitamins cause what change in stool - CORRECT ANSWER-darkening color palpating prostate can cause the patient to feel the urge to - CORRECT ANSWER- urinate Screening done with DRE - CORRECT ANSWER-GUIAC TEST what means possible hirshprungs disease - CORRECT ANSWER-consistently empty rectum with hx of constipation how is anal ring assessed - CORRECT ANSWER-rotation of finger within anal sphincter normal feel of prostate - CORRECT ANSWER-pencil eraser anal patency is assessed at birth by - CORRECT ANSWER-meconium stool passing in first 24-48hrs Prostate enlargement is determined by the: - CORRECT ANSWER-protrusion of the prostate into the rectum. which patient has risk factor of colorectal cancer - CORRECT ANSWER-56 year old man that diets high in red meat odd bright bulge coming out of anus that looks like donut - CORRECT ANSWER-rectal prolapse prostate is hard and irregular on palpation. median sulcus is not palpable. - CORRECT ANSWER-prostate cancer
press palms together lean forward while seated How to palpate the breast ( seated, supine, bimanual) - CORRECT ANSWER-seated; bimanual palpation. lymph nodes palpated. Help the woman into a supine position and took a small pad under the side to be palpated and raise her arm over the head. Use the pads of your first three fingers make dental circular motion on the breast Tail of Spence (axillary tail) - CORRECT ANSWER-portion of the breast that extends towards the lateral upper margin of the chest into the axilla palpation techniques of breast - CORRECT ANSWER-vertical strip, concentric circles, or wedge technique check for nipple discharge, depress areola breast tissue - CORRECT ANSWER-dense, firm, elastic with nom assess lumps or nodules. Female - Normal Exam - CORRECT ANSWER-1. observe pubic hair, surface characteristics
- skin smooth and clean
- labia soft, homogenous, symmetrical
- labia minora may be assymterical
- no swelling, redness, tenderness, discoloration female normal exam continued - CORRECT ANSWER-clitoris up to 2cm long and 0.5cm wide, no atrophy, or adhesions urethral orifice- slit should be midline near vaginal Introits vaginal introitus-vary in size, moist, no discharge, fistula, or lesions Skene gland- upper, insert finger into vagina, bartholin gland- speculum exam - CORRECT ANSWER-1. lubricate speculum with water
- tell patient you are touching
- insert finger and apply pressure downward
- when muscles relax, use fingers to separate labia
- slowly insert speculum slightly downward along the path of least resistance
- open speculum
- sweep speculum until cervix comes into view. lock to the entire cervix is within the blades. UTI versus pyelonephritis - CORRECT ANSWER-Pyelo- bilateral or unilateral flank pain, fever, chills, nausea, vomiting. appear ill. UTI-pain, frequency, urgency, bladder fullness, no fever, flank pain or chills, N/V.
Gail Model Risk Assessment Tool - CORRECT ANSWER-used to estimate any woman's 5 year and lifetime breast cancer risk
- age at period starting, age at first live birth, number of breast biopsies. breast cancer risk factors - CORRECT ANSWER-- Age over 50
- gender
- genetic risk factors
- Family history, mother, grandmother, sister
- Personal history
- First pregnancy after the age of 30
- race- white higher risk
- previous breast biopsies
- radiation to chest
- periods before age 12 or menopause after 55
- breast density
- DES therapy ( infertility)
- hormone therpay
- alcohol use
- obesity
- high fat diet
- lack of physical activity PHQ- 9 - CORRECT ANSWER-little interest or pleasure in doing things feeling down depressed or hopeless trouble falling asleep, staying asleep or too much poor appetite or overeating moving to slow or restless poor concentration feeling like a failure thoughts of hurting yourself Differential for positive PHQ 9 - CORRECT ANSWER-anxiety, depression, PPD, Columbia Suicide Severity Rating Scale - CORRECT ANSWER-have you ever wished your were dead or just goto sleep and not wake up? have you actually had any thoughts of hurting yourself? Risk factors for suicide - CORRECT ANSWER-Social isolation, older men or women, divorced, widowed, living alone. mental health concerns, depression, hopelessness, chronic or terminal health condition, family history of suicide or significant losses or challenges. access to firearms. Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. Women try more often. Men succeed more often.
C. Glasgow Coma Scale D. Functional Assessment - CORRECT ANSWER-C. Glasgow Coma Scale Which of the following indicates possible cognitive impairment? A. ability to complete personal care without assistance B. Suspiciousness or inappropriate affect C. Articulate communication D. Prudent behavior and calm demeanor - CORRECT ANSWER-B. Suspiciousness or inappropriate affect A 65-year old woman is brought to the clinic by family. They report thieve have noticed a change in her mental abilities over the past 2 weeks. Normally they say she is independent, intelligent and very socially oriented. Medical history is unremarkable except for congestive heart failure, for which she takes digoxin. She has had no major changes in her health. What questions would be most important for the examiner to ask the woman's family? A. Is there a family hx of Alzheimers? B. How much alcohol does she drink in an average week? C. When was her digoxin level last checked? D. Did you know that the mental function begins to decline after the age of 60? - CORRECT ANSWER-C. When was her digoxin level last checked? A patient who has difficulty writing or drawing is most likely to have what condition? A. Temporal lobe damage B. Peripheral neuropathy C. Organic brain syndrome D. Psyciatric hallucinations - CORRECT ANSWER-B. Peripheral Neuropathy A mother brings her 18 month old to the clinic. The child rarely talks or smiles or makes eye contact. She has also notice he does not like to be held. She says his motor development seems to be normal. What are these symptoms consistent with? A. Dementia B. Autistic disorder C. ADHD D. Delirium - CORRECT ANSWER-B. Autistic disorder A patient with Alzheimers disease classically displays which of the following? A. alternating periods of mania and stupor B. Hallucinations and decorticate posturing C. Disintegration of personality D. Rapid onset of symptoms - CORRECT ANSWER-C. Disintegration of personality While examining a newborn male infant, the examiner palpates a testicle in the inguinal canal that cannot be pushed into the scrotum. this finding is consistent with what? A. A retractile testi B. Ambiguous genitalia
C. Inguinal hernia D. undescended testicle - CORRECT ANSWER-D. Undescended testicle Genital self examination should be taught to patients who are at risk for? A. testicular cancer B. Peyronie disease C. STD D. prostate enlargement - CORRECT ANSWER-C. STD On exam of a patients scrotum you note the it is unusually thickened and it pits. What is one type of problem suggested by these findings? A. STD B. Squamous cell skin cancer C. Liver disease D. Autoimmune disease - CORRECT ANSWER-C. Liver disease While examining the genitalia of a 2 yr old boy the examiner should be aware. A. scrotum has edema until age 4 B. Foreskin of uncircumcised penis is not fully retractable until age 3-4yrs C. testicles typically do not descend into the scrotum until age 5 D. Cremasteric reflex does not become evident until age 6-7. - CORRECT ANSWER-B. Foreskin of uncircumcised penis is not fully retractable until age 3-4yrs. Which item in the patient history is considered a risk factor for cancer of the penis? A. circumcised at birth B. history of condyloma acuminatum infections C. Had congenital hydrocele D. History of untreated epispadius - CORRECT ANSWER-B. History of condyloma acuminatum infections In which of the following situations is transillumination of the scrotum indicated? A. presence of syphillis chancre is noted B. indirect hernia is palpated C. the examiner suspects a mass D. the examiners palpates the testes. - CORRECT ANSWER-C. the examiner suspects a mass The patient is asked to bear down while the examiner palpates the inguinal ring. The examiner feels a soft swelling sensation on the fingertip. the patient complains of pain while straining. These findings are consistent with which of the following? A. Indirect hernia B. Direct hernia C. Femoral hernia D. Rectal hernia - CORRECT ANSWER-A. Indirect hernia
