NURS 6512 ADVANCED HEALTH ASSESSMENT MIDTERM EXAM 2024 AND PRACTICE EXAM TEST BANK, Exams of Nursing

Download NURS 6512 ADVANCED HEALTH ASSESSMENT MIDTERM EXAM 2024 AND PRACTICE EXAM TEST BANK and more Exams Nursing in PDF only on Docsity! NURS 6512 ADVANCED HEALTH ASSESSMENT MIDTERM EXAM 2024 AND PRACTICE EXAM TEST BANK WITH STUDY GUIDE WALDEN UNIVERSITY | 300 ACCURATE QUESTIONS WITH DETAILED ANSWERS | GUARANTEED PASS GRADED A Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration? A) Bronchovesicular B) Vesicular C) Bronchial D) Tracheal C) Bronchial When percussing the chest in a patient who has left sided heart failure, the sound emanated would be: Resonant Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted? A) Setting in which the symptom occurs B) Associated manifestations C) Quality D) Timing B) Associated manifestations Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description? A) Severity B) Setting in which the symptom occurs C) Timing D) Associated manifestations A) Severity You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning? A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer B) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection B) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer For which of the following patients would a comprehensive health history be appropriate? A) A new patient with the chief complaint of "I sprained my ankle" B) An established patient with the chief complaint of "I have an upper respiratory infection" C) A new patient with the chief complaint of "I am here to establish care" D) A new patient with the chief complaint of "I cut my hand" C) A new patient with the chief complaint of "I am here to establish care" Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception works in a glass factory during the week." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems C) Personal and social history The following information is recorded in the health history: "I feel really tired." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems A) Chief complaint The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems D) Review of systems Is the following information subjective or objective? Mr. M. has a respiratory rate of 32 and a pulse rate of 120. A) Subjective B) Objective B) Objective Which of the following is consistent with good percussion technique? A) Allow all of the fingers to touch the chest while performing percussion. B) Maintain a stiff wrist and hand. C) Leave the plexor finger on the pleximeter after each strike. D) Strike the pleximeter over the distal interphalangeal joint D) Strike the pleximeter over the distal interphalangeal joint Which of the following percussion notes would you obtain over the gastric bubble? A) Resonance B) Tympany C) Hyperresonance D) Flatness B) Tympany Which of the following conditions would produce a hyperresonant percussion note? A) Large pneumothorax B) Lobar pneumonia C) Pleural effusion D) Empyema A) Large pneumothorax A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 C) Stage 3 A patient is observed to have pressure related alteration of intact skin along with changes in temperature, consistency, sensation, and color. Which stage of pressure ulcer is consistent with this? Stage I which stage of pressure ulcer is consistent with a particular thickness loss of the dermis presenting as a shallow open ulcer with a red pink wound bed, without slough? Stage II A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema A) Pityriasis rosea A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema B) Tinea versicolor Skin lesions that appear hypo or hyperpigmented with slightly scaly macules on the trunk, neck, and upper arms are likely: Tinea versicolor A child presents with erythematous papules and vesicles, that are weeping, oozing, and crusty. These lesions are located over the forehead, wrists, elbows, and the backs of the knees. With which of the following conditions are these symptoms associated? Atopic dermatitis Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems. A) It is likely to be related to her lupus. 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma A) Actinic keratosis A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon? A) Direct reaction B) Consensual reaction C) Near reaction D) Accommodation B) Consensual reaction • Define Visual Accommodation o Convergence reflex • What Is a Snellen Test, and How Do You Interpret Results? Tests visual acuity: A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true? A) She obtains a 20% correct score at 100 feet. B) She can accurately name 20% of the letters at 20 feet. C) She can see at 20 feet what a normal person could see at 100 feet. D) She can see at 100 feet what a normal person could see at 20 feet. C) She can see at 20 feet what a normal person could see at 100 feet. We have an expert-written solution to this problem! When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology? A) Bronchitis B) Simple asthma C) Cystic fibrosis D) Heart failure A) Bronchitis A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best describe? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia C) Asthma A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. Although he has had worsening of symptoms occasionally with a cold, his symptoms have stayed about the same. The cough has occasional mucous drainage but never any blood. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married and has two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer's disease. On examination you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing comfortably with respirations of 12. His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia B) Chronic obstructive A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type 2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood pressure. Her father passed away from colon cancer. On examination you see a middle- aged woman appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation. What disorder of the thorax or lung best describes her symptoms? A) Spontaneous pneumothorax B) Chronic obstructive pulmonary disease (COPD) C) Asthma D) Pneumonia D) Pneumonia We have an expert-written solution to this problem! A 25-year-old accountant presents to your clinic, complaining of intermittent lower right-sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from recurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. He has taken some Tylenol and put a heating pad on his side but neither has helped. He remembers that 2 weeks ago he had an upper respiratory infection with a severe hacking cough. He denies any recent trauma. His past medical history is unremarkable. His parents and siblings are in good health. He has recently married, and his wife has a baby due in 2 months. He denies any smoking or illegal drug use. He drinks two to three beers once a month. He states that he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, gastrointestinal, or musculoskeletal symptoms. On examination he is lying on his right side but appears quite comfortable. His temperature, blood pressure, pulse, and respirations are unremarkable. His chest has normal breath sounds on auscultation. Percussion of the chest is unremarkable. During palpation the ribs are nontender. What disorder of the chest best describes his symptoms? A) Pericarditis B) Chest wall pain C) Pleural pain D) Angina pectoralis C) Pleural pain Pain from pleurisy may be referred to the: Epigastric area. Factors that aggravate costochondritis may include. Movement of the chest, trunk, and arms. A 62-year-old woman has been followed by you for 3 years and has had recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next? A) Add a fourth medicine B) Refer to nephrology C) Get a CT scan D) Listen closely to her abdomen D) Listen closely to her abdomen Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next? A) Obtain abdominal ultrasound B) Reassess by examination in 6 months C) Reassess by examination in 3 months D) Refer to a vascular surgeon A) Obtain abdominal ultrasound • Where Is McBurney's Point and What Does Signify if Positive? McBurney's Point and What Does Signify if Positive? o Two thirds between umbilicus and anterior superior iliac crest. o Acute appendicitis • What Is a Murphy's Sign and What Does It Signify if Positive? Costal margin in right upper quadrant and asking pt to breathe deep o Pain is positive for inflamed gall bladder (cholecystitis) o Mallory-Weiss Tear Coughing or retching can cause tear in esophageal mucosa. Hematemesis and melena may occur. Endoscopy for diagnosis and heals spontaneously or with cauterization A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He denies any recent use. He is currently unemployed and has never been married. On examination you find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a prominent abdomen. You note multiple "spider angiomas" at the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive fluid wave. He is positive for occult blood on his rectal examination. What cause of black stools most likely describes his symptoms and signs? A) Infectious diarrhea B) Mallory-Weiss tear C) Esophageal varices C) Esophageal varices Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect? A) Bleeding from a diverticulum B) Bleeding from a peptic ulcer C) Bleeding from a colon cancer D) Bleeding from cholecystitis B) Bleeding from a peptic ulcer Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely? A) Colon cancer B) Cholecystitis C) Inflammatory bowel disease D) Irritable bowel syndrome D) Irritable bowel syndrome A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable. What is most likely the etiology of her diarrhea? A) Secretory infections B) Inflammatory infections C) Irritable bowel syndrome D) Malabsorption syndrome C) Irritable bowel syndrome o Inflammatory Bowel Inflammatory bowel disease is often associated with fever and hematochezia A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs? A) Acute diverticulitis B) Acute cholecystitis C) Acute appendicitis D) Mesenteric ischemia A) Acute diverticulitis o Cholecystitis Murphy's sign Hook left thumb R hand lateral border of rectus muscle and costal margin and have patient take deep breath- there will be tenderness. A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination he appears ill and is lying on his right side. His temperature is 100.4 and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal. What is the most likely cause of his pain? A) Acute appendicitis B) Acute mechanical intestinal obstruction C) Acute cholecystitis D) Mesenteric ischemia A) Acute appendicitis -vagus -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech CN XI (11) Spinal Accessory- shoulder shrug head movement side/side CN XII (12) Hypoglossal- tongue muscles speech and swallowing A tool used to screen adolescents for alcoholism is the - CORRECT ANSWER CRAFFT Which question would be considered a leading question? - CORRECT ANSWER "You don't get headaches often, do you?" Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process? - CORRECT ANSWER Auscultation Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient's cultural beliefs related to a health problem? - CORRECT ANSWER "Why do you think you are having these symptoms?" Which technique is most likely to result in the patient's understanding of questions? - CORRECT ANSWER Use the patient's own terms if possible. You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: - CORRECT ANSWER given the opportunity to be interviewed without the parent at some point during the interview. The most superior part of the stomach is the: - CORRECT ANSWER fundus White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are - CORRECT ANSWER aphthous ulcers. You are using an ophthalmoscope to examine a patient's inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for - CORRECT ANSWER myopia Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient? - CORRECT ANSWER Fat Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of: - CORRECT ANSWER hyperthyroidism he adult recommended dietary fat intake should be _____ g/day - CORRECT ANSWER 20 to 35 g a day for an adult Which of the following is the most accurate reflection of an individual's food intake? - CORRECT ANSWER Food Diary Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: - CORRECT ANSWER D. seborrheic keratoses from actinic keratoses. Bulging of an amber tympanic membrane without mobility is most often associated with - CORRECT ANSWER middle ear effusion. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted - CORRECT ANSWER C. with illumination provided by daylight. Sweat glands, hair, and nails are all formed from: - CORRECT ANSWER C. invaginations of epidermis into dermis. Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of his history - CORRECT ANSWER Past medical data Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an): - CORRECT ANSWER functional assessment. Before performing an abdominal examination, the examiner should: - CORRECT ANSWER have the patient empty his or her bladder. Which part of the information contained in the patient's record may be used in court? - CORRECT ANSWER All information When taking a history, you should: - CORRECT ANSWER use a chronologic and sequential framework. Which is the best way to position a patient's neck for palpation of the thyroid? - CORRECT ANSWER C. Flexed toward the side being examined In examining the neck of a 34-year-old female patient, you note that the uppermost ridge When assessing abdominal pain in a college-age woman, one must include: - CORRECT ANSWER the first day of the last menstrual period. During percussion, a dull tone is expected to be heard over: - CORRECT ANSWER the liver. In issues surrounding ethical decision making, beneficence refers to the: - CORRECT ANSWER need to do good for the patient. Nuchal rigidity is most commonly associated with: - CORRECT ANSWER B. meningeal irritation. Subjective and symptomatic data are: - CORRECT ANSWER placed in the history section. As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include - CORRECT ANSWER repeated trauma or irritation to skin. Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth? - CORRECT ANSWER C. Matrix To correctly document absent bowel sounds, one must listen continuously for: - CORRECT ANSWER 5 minutes. Which of the following is an "ABCD" characteristic of malignant melanoma? - CORRECT ANSWER Asymmetric borders You are planning to palpate the abdomen of your patient. Which part of the examiner's hand is best for palpating vibration? - CORRECT ANSWER Ulnar surface Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets? - CORRECT ANSWER Vitamin D Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: - CORRECT ANSWER thyroglossal duct cyst. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for: - CORRECT ANSWER normal growth and development. Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning? - CORRECT ANSWER Eustachian tube Regardless of the origin, discharge is described by noting: - CORRECT ANSWER color and consistency. Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first? - CORRECT ANSWER Inspection Penicillin is considered a - CORRECT ANSWER "hot" medicine. Peritonitis produces bowel sounds that are: - CORRECT ANSWER hypoactive. When are open-ended questions generally most useful? - CORRECT ANSWER During the initial part of the interview Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence? - CORRECT ANSWER D. Nose and thyroid cartilages Before performing an abdominal examination, the examiner should: - CORRECT ANSWER have the patient empty his or her bladder. Nasal symptoms that imply an allergic response include: - CORRECT ANSWER bluish gray turbinates. Coarse, dry, and brittle hair is associated with which metabolic disorder? - CORRECT ANSWER Hypothyroidism The infant should be placed in which position to have his or her height or length measured? - CORRECT ANSWER Supine on a measuring board Cherry angiomas are a common finding in: - CORRECT ANSWER adults older than 30 years. Underestimation of blood pressure will occur if the blood pressure cuff's width covers: - CORRECT ANSWER more than two-thirds of the upper arm. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: - CORRECT ANSWER hearing range of normal speech. Auscultation should be carried out last, except when examining the: - CORRECT ANSWER abdomen You have just completed a skin assessment on Mr. Baker. During your assessment, you As you explain your patient's condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to: - CORRECT ANSWER ask whether he has any questions A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she - CORRECT ANSWER binges and vomits. Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the: - CORRECT ANSWER personal and social history. A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly: - CORRECT ANSWER lean meat and fish. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient - CORRECT ANSWER flex his or her knees. What finding is unique to the documentation of a physical examination of an infant? - CORRECT ANSWER Fontanel sizes When communicating with older children and teenagers, you should be sensitive to their: - CORRECT ANSWER typical reluctance to talk. Under normal circumstances, how much water is lost daily by the body? - CORRECT ANSWER 2 to 2.5 L A fixed image of any group that rejects its potential for originality or individuality is known as a(n) - CORRECT ANSWER stereotype. Knowledge of the culture or cultures represented by the patient should be used to: - CORRECT ANSWER help make the interview questions more pertinent. Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as - CORRECT ANSWER building and maintaining tissues. When recording physical findings, which data are recorded first for all systems? - CORRECT ANSWER Inspection Brittle nails are a typical finding in: - CORRECT ANSWER older adults Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: A. descending aorta. B. lower liver border. C. medial border of the spleen. D. upper right kidney ridge. - CORRECT ANSWER Lower liver border Which of the following is an expected change in the assessment of the thyroid during pregnancy? - CORRECT ANSWER A bruit is auscultated due to increased vascularity Unusual white areas on the skin may be due to: ○ adrenal disease ○ polycythemia ○ vitiligo ○ Down syndrome - CORRECT ANSWER Vitiligo A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness your should palpate over the: - CORRECT ANSWER Maxillary sinuses only Mr. Atkins is a78-year-old patient who presents to the clinic with complaints of hearing loss. Which of t he following changes in hearing occur in the elderly? - CORRECT ANSWER Loss of high frequency Sounds may be garbled, difficult to locate Unable to hear in a crowded room Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia? - CORRECT ANSWER B12 You are examining a pregnant patient and have noted a vascularized lesion. When you blanche over the vascularized lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesions as a: - CORRECT ANSWER Spider angioma When palpating the abdomen, you should note whether the liver is enlarged in the: - CORRECT ANSWER right upper quadrant Expected hair distribution changes in older adults include: - CORRECT ANSWER increased terminal hair follicles to the tragus of men's ears Which part of the information contained in the patient's record may be used in court? - CORRECT ANSWER All information A guideline for history taking is for caregivers to: - CORRECT ANSWER make notes sparingly so that patients can be observed during the history taking. Which action would best promote accurate translations as well as confidentiality when the caregiver does not speak the patient's language? - CORRECT ANSWER Ask a person unfamiliar with the patient to translate. Behaviors that diffuse anxiety during the interview include - CORRECT ANSWER providing forthright answers to questions. Periods of silence during the interview can serve important purposes, such - CORRECT ANSWER providing time for reflection Mr. F. is speaking with you, the health care provider, about his respiratory problem. Mr. F. says, "I've had this cough for 3 days, and it's getting worse." You reply, "Tell me more about your cough." Mr. F. states, "I wish I could tell you more. That's why I'm here. You tell me what's wrong!" Which caregiver response would be most appropriate for enhancing communication? - CORRECT ANSWER "After 3 days, you're tired of coughing. Have you had a fever?" A patient becomes restless during the history and says, "I don't have time for all of this conversation. I've got to get back to work." Your most appropriate response would be to - CORRECT ANSWER acknowledge his anger and proceed with the history and examination. When questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate? - CORRECT ANSWER "What amount and what kind of alcohol do you drink in a week?" Ms. T. is crying and states that her mother couldn't possibly have a tumor. "No one else in the family has ever had cancer!" exclaims the daughter. The most appropriate response to Ms. T. would be - CORRECT ANSWER "Why do you think that your mother's tumor is cancerous?" A 50-year-old man comes to the primary care clinic. He tells you he is worried because he has had severe chest pains for the past 2 weeks. Which initial history interview question is most appropriate? - CORRECT ANSWER "Can you describe the pain?" A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to - CORRECT ANSWER continue to collect information regarding the chief concern in an unhurried manner. Ms. A. states, "My life is just too painful. It isn't worth it." She appears depressed. Which one of the following statements is the most appropriate caregiver response? - CORRECT ANSWER "What in life is causing you such pain?" During a history-taking session, Mr. B appears to be avoiding certain questions. He keeps looking out the window. What should the caregiver do? - CORRECT ANSWER Make a note to pursue sensitive issues later in the interview You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should - CORRECT ANSWER be given the opportunity to be interviewed without the parent at some point Information that is needed during the initial interview of a pregnant woman includes all of the following except - CORRECT ANSWER the gender that the woman hopes the baby will be. When communicating with older children and teenagers, you should be sensitive to their - CORRECT ANSWER typical reluctance to talk. When interviewing older adults, the examiner should - CORRECT ANSWER position himself- or herself face to face with the patient. When you suspect that your 81-year-old patient has short-term memory loss because he cannot remember what he had for breakfast, you should - CORRECT ANSWER validate the concern with his family or caregivers. A brief statement of the reason the patient is seeking health care is called the - CORRECT ANSWER chief concern When questioning the patient regarding his or her sexual history, which question should be asked initially? - CORRECT ANSWER "Do you have any worries or concerns regarding your sex life?" Direct questioning about intimate partner violence in the home should be - CORRECT ANSWER a routine component of history taking with female patients. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the - CORRECT ANSWER CAGE questionnaire. When you enter the examination room of a 3-year-old girl, you find her sitting on her father's lap. She turns away from you when you greet her. Initially, your best response is to - CORRECT ANSWER leave the child sitting in the father's lap while you talk to the father. Tom is a 16-year-old young man with diabetes who does not follow his diet. He enjoys his dirt bike and seems unconcerned about any consequences of his activities. Which factor is typical of adolescence and pertinent to Tom's health? - CORRECT ANSWER Propensity for risk taking Pain is difficult to assess in older adults because - CORRECT ANSWER sharp pain may be felt as a dull ache. A survey of mobility and activities of daily living (ADLs) is part of a(n) - CORRECT ANSWER functional assessment. Constitutional symptoms in the ROS refer to: - CORRECT ANSWER fever, chills, fatigue, and malaise. if it is acceptable to him. A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly: - CORRECT ANSWER Lean meat and fish When hearing is evaluated, which cranial nerve is being tested? - CORRECT ANSWER VIII Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be - CORRECT ANSWER obese Which of the following is the most vital nutrient? - CORRECT ANSWER Water Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.'s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? - CORRECT ANSWER "With your father's permission, we will examine the stone and request that it be returned to him." Recommended carbohydrate content of total dietary intake (% total calories) is ____% - CORRECT ANSWER 45% to 65% Tympanic thermometers measure body temperature when a probe is placed - CORRECT ANSWER in the auditory canal Which of the following is an "ABCD" characteristic of malignant melanoma? - CORRECT ANSWER Asymmetric borders The position on a clock, topographic notations, and anatomic landmarks: - CORRECT ANSWER are methods for recording locations of findings What finding is unique to the documentation of a physical examination of an infant? - CORRECT ANSWER Fontanel sizes Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of: - CORRECT ANSWER hyperthyroidism Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient? - CORRECT ANSWER fat The review of systems is a component of the: - CORRECT ANSWER health history The recommended minimum daily protein requirement for the normal adult is - CORRECT ANSWER 10% to 35% of total calories or 45 grams You are palpating a patient's thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate - CORRECT ANSWER A normal thyroid gland A flat, nonpalpable lesion is described as a macule if the diameter is: - CORRECT ANSWER less than 1 cm Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain? - CORRECT ANSWER Steroids George Michaels, a 22-year-old patient, tells the nurse that he is here today to "check his allergies." He has been having "green nasal discharge" for the last 72 hours. How would the nurse document his reason for seeking care - CORRECT ANSWER G.M. is a 22-year-old male here for having "green nasal discharge" for the past 72 hours. Expected normal percussion tones include: a. dullness over the lungs. b. hyperresonance over the lungs. c. tympany over an empty stomach. d. flatness over an empty stomach. - CORRECT ANSWER tympany over an empty stomach. Which type of speculum should be used to examine a patient's tympanic membrane? - CORRECT ANSWER The largest speculum that will fit comfortably in the ear Differential diagnoses belong in the: - CORRECT ANSWER Assessment Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.'s _____ history - CORRECT ANSWER personal and social The attitudes of the health care professional: - CORRECT ANSWER are culturally derived. Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning? - CORRECT ANSWER Eustachian tube