TEXAS WASTEWATER CLASS A EXAM 2024-2025, Exams of Nursing

Download TEXAS WASTEWATER CLASS A EXAM 2024-2025 and more Exams Nursing in PDF only on Docsity! 1 | P a g e ADVANCED HEALTH ASSESSMENT FINAL EXAM 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS |FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST|GUARANTEED PASS|LATEST UPDATE Russell's sign (scars on knuckles) can be indicative of: a. Anorexia nervosa b. Bulimia nervosa c. Methamphetamine use d. Anabolic steroid use b. Bulimia nervosa Constricted pupils on exam in a child or teen with no significant past medical history except history of drug use by be a sign of: a. Inhalant use b. Opioid use c. Cocaine use d. Benzodiazepine use b. Opioid use Which of the following statements is not correct regarding potentially abusive families? a. A teenage mother is less likely to release frustration by striking out at her child. b. Abusive parents have difficulty controlling their anger. c. Domestic violence often occurs in families that physically abuse their children. d. Abusive families are often more socially isolated and have fewer support systems. a. A teenage mother is less likely to release frustration by striking out at her child. 2 | P a g e Which of the following is a true statement? a. Intentional burns tend to be asymmetrical, irregular, partial thickness, and reflective of the child's motor abilities. b. Spiral and metaphyseal chip fractures in children carry a low index of suspicion for abuse. c. Before reporting suspected inflicted injuries to a child, the healthcare provider must be able to prove an infant or child has been abused. d. Bruises over bony prominences such as the extensor surfaces of the lower leg, knee, elbows, and forehead are the most common sites of accidental bruising. d. Bruises over bony prominences such as the extensor surfaces of the lower leg, knee, elbows and forehead are the most common sites of accidental bruising. Which of the following characteristics of infants and young children places them at high risk for abuse? a. Prolonged weaning time b. Extended bedtime rituals c. Crying and toilet training d. Early achievement of expressive language c. Crying and toilet training A 2-year-old child is brought to the clinic after falling off a slide at the park and sustaining three small bruises to the face. All of the following components of the health history should raise suspicion of child abuse except: a. The parents seek medical assistance immediately after the injury. b. The type and degree of injury is incompatible with the history. c. The parents delay seeking medical attention for the injury. d. The parents give different histories when asked to describe what happened. a. The parents seek medical assistance immediately after the injury. Which of the following is a red flag for nonorganic failure to thrive in a 12-month-old? a. Clinging to the primary caregiver during the physical examination. b. No stranger anxiety. c. Weight-for-age at the 10th percentile on growth chart d. Weight-for-length at the 10th percentile on growth chart b. No stranger anxiety Which of the following assessments of a child's family and social history can indicate an increased risk for child abuse? a. Maternal depression b. The parent leaves the children with a babysitter or family member several afternoons a week c. The parents attend parenting classes d. The mother's primary support system is several women in the area with children of similar ages a. Maternal depression An inflicted immersion burn is characterized by: a. A tapering distribution 5 | P a g e c. Knee-chest position d. Prone a. Supine or lying on the left side A 30-month-old boy is in the office for his annual health maintenance examination. The pediatric healthcare provider notes anal fissures, perianal skin tags, and some other flesh-colored pedunculated lesions. His mother denies that the child has any history of constipation, but does recall seeing blood in his diaper on a few occasions. His health history is otherwise unremarkable. The social history reveals that the child has no siblings, the child's biological father is not involved, and the child's mother has had several live-in male partners. In order to ensure a correct diagnosis, what should the healthcare provider do next? a. Nothing; these are normal findings b. Ask for the contact information for the mother's partners and interview them c. Contact a board-certified sexual assault nurse examiner (SANE) to interview the mother, examine the child further, and collect evidence d. Call the police; this represents sexual abuse c. Contact a board-certified sexual assault nurse examiner (SANE) to interview the mother, examine the child further, and collect evidence Signs of shaken baby syndrome may include all of the following except: a. Extensive bruising to the head b. Subdural hematoma c. Intracranial edema d. Retinal hemorrhages a. Extensive bruising to the head The body mass index should be measured in all children beginning at age: a. 1 year b. 2 years c. 3 years d. 4 years b. 2 years In a sleeping infant, which of the following assessments should be conducted first? a. Inspect tone and general appearance b. Gently palpate skin for temperature c. Palpate pedal pulses d. Auscultate lung and heart sounds a. Inspect tone and general appearance Which of the following children may be more cooperative and less fearful during the physical examination if allowed to touch and listen through the stethoscope? a. A crying 12-month-old b. A 2-year-old who is pushing you away during the otoscopic examination 6 | P a g e c. An adolescent who is curious and wants to delay the physical examination d. A preschooler who is asking why you have to listen to his lungs and if something is inside his chest d. A preschooler who is asking why you have to listen to his lungs and if something is inside his chest In the infant, which of the following systems is examined last? a. Genitalia b. Ears, nose, throat c. Spine and extremities d. Chest and heart b. Ears, nose, throat In the adolescent, which of the following systems is examined last? a. Genitalia b. Ears, nose, throat c. Spine and extremities d. Chest and heart a. Genitalia Part of your assignment as a nurse practitioner is to make rounds in the nursery two mornings a week. You are about to examine Pablo, a 2-day-old with an unremarkable history, when he begins to cry virgorously. The appropriate next step is to: a. Delay the exam until Pablo stops crying b. Try to get him to stop crying by feeding him, then proceed with the exam c. Take the opportunity to examine his oral cavity while he is crying, then try to console him so he keeps quiet d. Proceed with the physical examination as usual, beginning with the chest and heart c. Take the opportunity to examine his oral cavity while he is crying, then try to console him so he keeps quiet At what age should the child's standing height begin to be measured? a. 1 year b. 2 years c. 3 years d. 4 years b. 2 years In which of the following age groups would you normally conduct a portion of the history and physical examination with the parent out of the room? a. Toddlers - they cry more when they see their parent b. Preschoolers - they like to show off in front of the parent by asking a lot of questions c. School-aged children - they are more likely to talk about what they like to eat with their parent out of the room d. Adolescents - they are less likely to give honest answers about drugs or alcohol use, depression or school problems with the parent present 7 | P a g e d. Adolescents - they are less likely to give honest answers about drugs or alcohol use, depression or school problems with the parent present Frida is a toddler who is very uncooperative during the physical examination. Which of the following can help you to conduct the exam? a. Ask the mother or primary caregiver to step out of the room; this may be causing the crying b. Ask the mother or primary caregiver to feed Frida; this may quiet her down c. Ask Frida's mother to hold her on her lap and face you as you sit facing the mother, knee-to-knee, and examine Frida there d. Give Frida a pacifier c. Ask Frida's mother to hold her on her lap and face you as you sit facing the mother, knee-to-knee, and examine Frida there In which age group can the provider begin to conduct the complete physical examination in a head-to- toe sequence? a. Infants b. Toddlers c. Preschoolers d. School-aged children c. Preschoolers Select the correct sequence of techniques used during an examination of a child's abdomen: a. Percussion, inspection, palpation, auscultation b. Inspection, palpation, percussion, auscultation c. Inspection, auscultation, percussion, palpation d. Auscultation, inspection, palpation, percussion c. Inspection, auscultation, percussion, palpation When percussing a child's abdomen, you note tympany. This is indicative of the presence of: a. Fluid b. Air c. Feces d. Hepatomegaly b. Air When inspecting the child's abdomen, the examiner notes a midline muscular separation with bulging at the child cries. This finding is a(n): a. Umbilical hernia b. Inguinal hernia c. Omphalocele d. Diastasis recti d. Diastasis recti 10 | P a g e c. More abdominal subcutaneous tissue d. Decreased hepatic enzyme function b. Weak abdominal musculature A young child's kidney is more susceptible to trauma because: a. Until age 5 years, kidneys rupture more easily b. More of the kidney is exposed because of the thin abdominal wall c. There is a proportionately larger abdomen in young children d. The urinary bladder capacity varies b. More of the kidney is exposed because of the thin abdominal wall Which of the following is an appropriate response by the provider to a 30-month-old child who is resistant to the abdominal exam? a. Inspect only; auscultate and palpate only if necessary b. Ask the child to describe the symptoms in more detail c. Ask the child if he or she would like to listen to the stomach through the stethoscope and press on the stomach with his or her own hands d. Defer the exam c. Ask the child if he or she would like to listen to the stomach through the stethoscope and press on the stomach with his or her own hands Which of the following findings in the child's prenatal history is relevant when conducting the abdominal assessment? a. Maternal oligohydramnios b. Amount of maternal weight gain c. Perinatal asphyxia d. Timing of the first meconium stool a. Maternal oligohydramnios The RLQ contains the: a. Liver (right lobe) b. Pancreas c. Ascending colon d. Cecum d. Cecum The provider palpates the child's abdomen slowly and deeply away from an area of tenderness, then quickly removes the palpating hand. The child experiences pain when the palpating hand is removed quickly. This describes: a. Light palpation b. Rebound tenderness c. Deep palpation d. Costovertebral tenderness 11 | P a g e b. Rebound tenderness Deep palpation is used to assess: a. Areas of abdominal tenderness b. Underlying abdominal structures c. Areas of abdominal rigidity d. Abdominal tympany b. Underlying abdominal structures Deep tenderness at McBurney's point is a sign of: a. Acute appendicitis b. Peritonitis c. Peptic ulcer disease d. Pelvic inflammatory disease a. Acute appendicitis A 10-year-old child presents to the clinic with acute RLQ abdominal pain and fever. The examiner positions the child supine, then flexes each leg at the hip and rotates the hip internally and externally. The child complains of pain when this maneuver is conducted on the right leg. This is an elicitation of: a. The iliopsoas sign b. The obturator sign c. Murphy's sign d. Rebound tenderness b. The obturator sign Which of the following terms defines movement away from the midline? a. Abduction b. Adduction c. Flexion d. Extension a. Abduction Physical findings associated with talipes equinovarus are: a. Medial deviation of the forefoot that is flexible and can be abducted beyond the midline b. Laxity of ligaments supporting the foot's longitudinal arch, causing the feet to be positioned in abduction c. Internal rotation of the foot with forefoot adduction involving muscles, tendons and bone d. Marked inward deviation of the hand and an extremely short forearm c. Internal rotation of the foot with forefoot adduction involving muscles, tendons and bone Assessment findings in an infant with developmental dysplasia of the hip can include: a. Negative Ortolani sign b. Positive Galeazzi sign 12 | P a g e c. Positive Trendelenburg sign d. Negative Barlow sign b. Positive Galeazzi sign Sustained clonus that extends beyond six to eight beats or clonus that continues past the neonatal period may indicate: a. Cerebral palsy b. Increased intracranial pressure c. Talipes equinovarus d. Dystonia a. Cerebral palsy Which of the following assessment findings is within normal limits for the child's age? a. A toddler with lordosis b. A 3-year-old with genu varum c. A 12-year-old with genu valgum A 2-day-old with syndactyly a. A toddler with lordosis An antalgic gait indicates: a. Pain b. Infection c. Clubfoot d. Developmental dysplasia of the hip a. Pain A visible lateral curvature of the spine when the child is standing indicates: a. Lordosis b. Spina bifida c. Kyphosis d. Scoliosis d. Scoliosis Assessment of the hips to detect developmental dysplasia of the hip is done at every well-child exam until age: a. 6 months b. 1 year c. 18 months d. 2 years b. 1 year Tibial torsion can be caused by: a. Birth injury b. Trauma 15 | P a g e c. 15-18 months d. 18-21 months b. 12-15 months A 7-year-old child is asked to stand straight and then raise the right leg off the ground. When bearing weight on the left hip, the pelvis will drop on the right side. This finding is the: a. Trendelenburg sign b. Barlow sign c. Ortolani sign d. Galeazzi sign a. Trendelenburg sign Which of the following statements regarding pes planus (flat feet) is true? a. A normal variation, beginning at 2 to 3 years and resolving by approximately 7 to 8 years b. A normal variation in infants as they first begin to walk, then slowly resolving as the child grows c. A normal variation in infants until approximately age 3 to 4 months d. A normal variation, beginning at 2 to 3 years, resolving by adolescence b. A normal variation in infants as they first begin to walk, then slowly resolving as the child grows The most sensitive indicator of a child's neurologic status is: a. Mood and affect b. Gait and balance c. Cranial nerve assessment d. Level of consciousness d. Level of consciousness Which of the following assessments indicates potential cerebellar dysfunction? a. Ataxia b. Graphesthesia c. Hearing deficits d. Stereognosis a. Ataxia To assess vestibular function of the acoustic nerve in a child, the examiner would: a. Perform the whisper test b. Perform the Romberg test c. Perform the Weber test d. Perform the Rinne test b. Perform the Romberg test To examine for the function of the hypoglossal nerve in a child, the examiner would: a. Ask the child to identify tastes b. Ask the child to stick out his or her tongue 16 | P a g e c. Test the child's ability to swallow d. Ask the child to nod his or her head from side to side b. Ask the child to stick out his or her tongue Which of the following is the most appropriate method of evaluating cerebellar function in a preschool- age child? a. Perform the Romberg test b. Conduct a cranial nerve examination c. Observe heel-to-toe walking d. Ask the child to perform the finger-to-nose test a. Perform the Romberg test Injury to Wernicke's area of the cerebral cortex results in: a. Executive function deficits b. Expressive aphasia c. Receptive aphasia d. Memory loss c. Receptive aphasia The presence of Brudzinski's sign indicates: a. Increased intracranial pressure b. Meningeal irritation c. Cerebellar dysfunction d. Spinal cord injury B. Meningeal irritation A 3-year-old child suffered a severe traumatic brain injury. The examiner would expect this child's Babinski reflex to be: a. Negative b. Positive c. Fluctuating, depending on intracranial pressure d. Unable to be assessed b. Positive A 5-year-old boy is new to the clinical practice and presents for a kindergarten physical. During the examination, his gait is assessed. No limp or ataxia is noted, but he is toe walking. The provider asks his parents if this is how he normally walks and they say yes. Which of the following parts of the child's past medical history are important to assess? a. Previous history of hyperactive deep tendon reflexes b. Previous history of lower extremity injury c. History of perinatal or neonatal hypoxia or asphyxia d. History of high fever in infancy c. History of perinatal or neonatal hypoxia or asphyxia 17 | P a g e Which of the following developmental assessment findings requires an in-depth neurologic assessment? a. Delayed expressive language milestone achievement b. Poor school performance c. Loss of developmental skills d. Poor social skills with peers c. Loss of developmental skills Which of the following assessment findings indicates increased intracranial pressure? a. Papilledema on fundoscopic examination b. Nuchal rigidity c. Numbness and tingling d. Hyperactive deep tendon reflexes a. Papilledema on fundoscopic examination A normal response to the elicitation of the Achilles tendon reflex is: a. Flexion of the toes b. Plantar flexion c. Extension of the great toe with fanning of the remaining toes d. Extension of the toes b. Plantar flexion To test the sensory function of the trigeminal nerve in an infant, the examiner would: a. Elicit the startle reflex b. Elicit the gag reflex c. Assess direct and consensual pupillary response to light d. Elicit the corneal (blink) reflex d. Elicit the corneal (blink) reflex To elicit the plantar reflex: a. Ask the child to slide the heel of the foot along the opposite shin b. Place a vibrating tuning fork on the child's ankle and ask the child when the vibration stops c. Strike the lateral aspect of the sole of the foot with the end of the reflex hammer d. Ask the child to perform a heel-to-toe walk c. Strike the lateral aspect of the sole of the foot with the end of the reflex hammer A child has been hit by a car while riding her bicycle. The Glasgow Coma Scale assessment reveals a total score of 10. This is considered indicative of a: a. Mild head injury b. Moderate head injury c. Severe head injury d. Normal finding b. Moderate head injury 20 | P a g e b. Wearing long-sleeved clothing in warm weather c. Overt suicidal ideation d. Scarring on visible skin c. Overt suicidal ideation Common fears among school-aged children include: a. Loud noises b. Separation c. Peer rejection d. Physical well-being c. Peer rejection Somatic indicators of anxiety in children may include: a. Nightmares b. Abdominal complaints c. Irritability d. Shaking b. Abdominal complaints The mother of an 11-year-old boy is concerned because he has recently begun refusing to go to school, his teachers state that he seems extremely nervous when asked to speak in class, and he refuses invitations to school events or parties. Based on this information, the healthcare provider suspects: a. Social phobia b. Panic disorder c. Selective mutism d. Conduct disorder a. Social phobia Which of the following signs in a 13-year-old girl raises suspicion for bulimia nervosa? a. Lanugo b. Dull hair c. Hypertension d. Enlarged parotid glands d. Enlarged parotid glands The hallmark of obsessive-compulsive disorder is: a. Fear b. Worry c. Impulsivity d. Repetition d. Repetition When conducting an overall screening for cognitive, emotional, and behavioral disorders in children aged 11 years and older, a suggested screening tool is: 21 | P a g e a. SAD PERSONS Scale b. Modified Checklist for Autism in Toddlers (M-CHAT) c. DSM-5 based diagnostic criteria d. Pediatric Symptom Checklist d. Pediatric Symptom Checklist Signs of anorexia nervosa may include: a. Amenorrhea b. Hypertension c. Tachycardia d. 90% of expected weight a. Amenorrhea The parents of a 6-year-old child bring him to the clinic with concerns about his behavior The parents have received numerous notes from the teacher and school social worker regarding his inability to stay in his seat during class, his failure to pay attention to the teacher, frequent class interruptions, and forgetting to bring completed assignments to class. The child has no cognitive delays, nor has he demonstrated any oppositional behavior. The provider should screen this child for: a. Anxiety disorder b. Autistic spectrum disorders c. Attention deficit hyperactivity disorder d. Oppositional defiant disorder c. Attention deficit hyperactivity disorder Which of the following events in a 6-year-old child's life would prompt screening for posttraumatic stress disorder (PTSD)? a. Change of schools twice in the past year b. Death of the family pet c. Family dislocation due to a hurricane d. Loss of a beloved security object c. Family dislocation due to a hurricane The most important component in the diagnosis of depression in children and adolescents is: a. The physical examination b. The clinical interview c. Results of self-report questionnaires d. Assessment of comorbid psychiatric disorders b. The clinical interview A school-aged child displays a pattern of behavior that includes bullying, excessive teasing of the family dog, deliberate destruction of siblings' toys, and excessive lying. This child is displaying signs of: a. Conduct disorder b. Oppositional defiant disorder 22 | P a g e c. Sociopathy d. Bipolar disorder a. Conduct disorder The likelihood of suicidality increases with: a. Obesity b. Social phobia c. Attention deficit hyperactivity disorder d. Mood disorders d. Mood disorders The assessment finding of high concern for acute suicide risk in a highly depressed teen is: a. Low self-esteem b. Active hallucinations c. Excessive sleep d. History of substance abuse b. Active hallucinations Adolescents with bipolar disorder are at risk for all of the following except: a. Suicide b. Sexually transmitted infections c. Self-mutilation d. Sleep disturbances c. Self-mutilation A 9-year-old child of political refugees has recently arrived from a country that has been war-torn for 10 years. This child requires a school physical. During the health encounter, this child should be screened for all the following except: a. PTSD b. Depression c. Anxiety and panic disorder d. Obesity d. Obesity BMI Classifications Underweight: <18.5 Normal: 18.5-24.9 Overweight: 25.0-29.9 Obesity class • I: 30.0-34.9 • II: 35.0-39.9 • III: at or over 40 How do you calculate BMI? 25 | P a g e Brudzinski Pt supine, your hands behind pt's head and flex the neck forward, until chin touches the chest if possible. Neck stiffness with resistance and flexion of hips and knees is a positive sign. May be a sign of acute bacterial meningitis or subarachnoid hemorrhage Straight Leg Raising Lift the straight leg, if pt has low back pain with nerve pain that radiates down the leg = sciatica from compression of the spinal nerve root as it passes through the vertebral foramen Plantar (Babinski) Reflex Dorsiflexion of the big toe is a positive Babinski response from a CNS lesion in the corticospinal tract Finkelstein Test Pt grabs thumb with hand and you pull down to see if there is tendon tenderness - if positive, might mean tendonitis Tinel's Sign Tap on the Median Nerve 26 | P a g e Phalen's Test Bend wrists at 90 degrees and put back of hands against each other for 1 minute and see if there is numbness/tingling Ballotment Leg extended, compress the suprapatellar pouch and then push the patella sharply against the femur, watching for fluid returning to the pouch Bulge Sign Knee extended, hand on knee above the patella and milk downward. Apply medial pressure and tap laterally. Watch for a fluid wave Drawer Sign Pt supine with knee flexed, your thumbs at the medial/lateral joint line and fingers wrapped around. Then sharply push/pull, watching for laxity McMurray Test Pt supine with knee flexed, one hand medial knee and the other medial ankle. Extend the leg and laterally rotate, watching for clicking Directions for Self-Breast Exam 27 | P a g e 5-7 days after period OR same time every month for menopausal women. Lawn Mower pattern What Abdominal locations do you listen for bruits with the Bell of the stethoscope? Aoritc, Illiac, Femoral What Abdominal locations do you listen for bruits with the diaphragm of the stethoscope? Epigastric and Renal Murphey's Sign Assessing gallbladder, pt will stop breathing d/t pain when pushing up on the liver if positive. Rovsing's Sign Pressure on LLQ causes referred pain in RLQ Rebound Tenderness Pain in RLQ increases when pressure is released quickly Psoas Sign Place hand just above right knee and ask pt to raise that thigh against your hand and turn onto the left side. then extend the right leg at the hip.Flexion of th leg at the hip makes the psoas muscle contract; extension stretches it. Increased abd pain with either maneuver constitutes a positive sign Obturator Sign Flex pt's right thigh at the hip, with knee bent, and rotate the leg internally at the hip. It stretches the internal obturator muscle. Right hypogastric pain = positive sign Normal size of aorta 30 | P a g e Sarcopenia loss of lean body mass and strength with aging Axillary Lymph Nodes Lateral Pectoral (Anterior) Subscapular (Posterior) Supraclavicular Infraclavicular Self Breast Exam Instructions 5-7 days after period for women still menstruating or can choose a time of month if menopausal. Vaginal Speculum Exam lubricate with water so that sample is not contaminated, insert two fingers first and then speculum vertically, putting pressure on the posterior vaginal wall Obtaining Vaginal Specimens Pap Smear: Rotate 5X and obtain sample before any other test samples Then any swabs for infection Skene's Glands Near urethra- can milk to see if there is discharge. Bartholin's Glands 5 and 7 Do you listen for Epigastric and Renal Bruits with the bell or the diaphragm? Diaphragm Do you listen for aortic, illiac, and femoral bruits? Bell Shifting Dullness Shifting Dullness: Indicates ascites - fluid shifts dependently when the patient lies supine vs laying on the side. Percuss to determine or look for fluid wave 31 | P a g e Do you listen for carotid Bruits with the bell or the diaphragm? Both Cardiac Landmarks Epitrochlear Nodes Inguinal Nodes Ankle-Brachial Index Arterial Vs. Venous 32 | P a g e Cervical Lymph Nodes Pre-auricular Post-auricular Tonsillar Occipital Submental Submandibular Posterior cervical Superficial cervical Deep cervical chain Supraclavicular Retinal Structures Macula/Fovea Optic Disc Red Reflex Vessels Convergence Eye converge symmetrically at the nose Accommodation Look far away and then close up, pupils will constric Direct light reflex Light goes into the eye and that eye's pupil constricts 35 | P a g e louder, harsher, and higher in pitch, with a short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.. Egophony "ee" sounds like "A". This sound is present with consolidation/pneumonia Bronchophony "ninety-Nine" - if louder than normal Whispered pectoriloquy whisper "ninety-nine" or "one-two-three" and if louder, clearer whispered sounds, then whispered pectoriloquy Light palpation use one hand and press 1cm - think kneading dough Deep palpation use two hands and press 2-3cm Methods for assessing cognitive functioning •A&O: person, time, place •Remote, immediate, and recent memory •Cognitive function: tell me what a proverb means, "if you found an envelope on the ground, what would you do", calculations ABCDE of skin assessment 36 | P a g e •A: Asymmetry •B: Irregular Borders •C: changes in color •D: Diameter over 1/4in or 6mm •E: evolving/changing How do you interpret a Snellen Chart? Vision of 20/200 means that at 20 ft the pt can read print that a person with normal vision could read at 200ft. The larger the second number, the worse the vision. Exopthalamus protrusion of the eyeball, a common feature of Graves', triggered by autoreactive T lymphocytes. Xanthelasma slightly raised, yellowish, well-circumscibed plaques that appear along the nasal portions of one or both eyelids. May accompany lipid disorders Lid Lag the eyelid should follow the eye if it moves down, almost always covering a little bit of the iris. Perforated ear drum 37 | P a g e -Central perforation: don't extend to the margin of the drum -Marginal perforations: involve the margin -Reddened internal ear, might have drainage, no cone of light Serous effusion of the ear -Usually caused by viral URI or by sudden changes in atmospheric pressure as from flying or diving. Eustachian tube can't equalize the air pressure in middle ear and outside air. Air absorbed from middle ear into the bloodstream, and serous fluid accumulated there instead. -Symptoms: fullness and popping sensation in the ear, mild conduction hearing loss, ,and sometimes pain -Amber fluid behind the eardrum. Air bubbles can be seen, but not always Acute otitis media with purulent effusion-ear -Commonly caused by bacterial infection with S. penumoniae and H. influenza -s/s: earache, fever, hearing loss. Eardrum reddens, loses its landmarks, and bulges laterally toward the examiner -hearing loss is conductive Bullous Myringitis -Painful hemorrhagic vesicles appear on TM or ear canal or both -s/s earache, blood-tinged discharge from the ear and conductive hearing loss -caused by mycoplasma, viral, or bacterial otitis media Torus Palatinus Midline bony growth in hard palate that is fairly common in adults. Size and lobulation vary. Harmless Kaposi's sarcoma in AIDs 40 | P a g e Hypertrophy Some component of the skin such as a scar is enlarged or has grown excessively. The opposite is atrophy or thinned skin. Percussion Sounds for Respiratory Murmur Grades patient tells you they are taking ASA everyday. What do you ask next? Why are you taking ASA daily? what is the most important rule as an APN regarding sensitive topics be nonjudgmental still have to be succinct, focused, and direct too cultural competence is best enhanced when the HCP? uses self-awareness and reflection you assess a patients broken arm and you suspect she may be a victim of violence. which statement triggers your concern? I hurt it about 4 days ago=delay of treatment you are going to organize a BP screening fair at the mall. you are involved in what type of prevention? secondary prevention secondary prevention screening means you are looking for a disease thats already there 41 | P a g e patients presents with RLQ pain, as you document his HPI you note his c/o nausea. In your symptom analysis this would be considered: associated symptom Pt's daughter is explaining why her mother is at the office. This is an example of: subjective information Pt has a BMI of 27. Is this normal, underweight, or overweight? overweight You administered the CAGE questionnaire as part of a screening policy and the patient answers yes to 2 and 4. what is the significance of this if any? he has physical dependence and needs intervention what does question 4 on the CAGE questionnaire ask? what is the significance of it? do they need an eye opener? it indicates physical dependence you are meeting for the first time a 14 y/o female patient. you would want to include the what in her exam? HEADS & RAFFT what does HEADS & RAFFT assess behavior of the teenager patient scores a 29 on the mini-mental exam. what do you document this as? a normal finding what are the components of the adult health history? 1. identifying data 2. history of present illness 3. review of systems NOT physical exam what does the CAGE questionnaire look for alcoholism coronary artery disease risk factors (4) 1. smoking 2. HTN 3. family history 4. age 42 | P a g e you have a new patient and in order to get reimbursed at a higher level for education you provide, you must document the time spent on this education at least what percentage of the visit at least 55% of the visit how do you define an established patient patient presents for a checkup in your office. you have not seen her before but she was last seen by the MD in your group 2 years ago how long would it be since a patient has been seen in the same practice for them to be considered a new patient 3 years ago as you review your note for your patient you realize that the keys to select the right level of billing include what 3 things history exam decision making when performing a history & physical on a pediatric patient, which important factor affects the outcome the most: child's development level the key element for all levels of CPT code documentation is: chief complaint when obtaining a health history from an older client, which characteristics of the older client must be taken into consideration? auditory acuity is the most common sensory loss in the aged population and may hinder the interview what's the most important question to ask as you build your HPI have you ever had this before? the development of screening and prevention guidelines is based on? increase in average life expectancy limiting public smoking is what type of prevention? primary prevention-trying to prevent disease what is the leading cause of mortality in teenagers motor vehicle accidents according to the ABCDE approach to preventive cardiology, the items to assess for the "A" include: (3 Things) 45 | P a g e 30 y/o patient c/o palpitations and some light-headedness for past 6 months. NP notices a mid-systolic click with a late systolic murmur heard best in the apical area. what would you suspect? mitral valve prolapse what is acute bronchitis characterized by paroxysms of coughing that is dry or productive of mucoid sputum a positive clinical sign on physical exam indicating pneumonia is: dullness on percussion when auscultating for vocal resonance in a client with possible consolidation of lung tissue, the NP hears "a" when the client says "e". this is called: positive egophony what does hyperresonance in percussion of the lungs indicate? an expected finding with emphysema b/c of air trapping as you assess a client you understand that their dyspnea is basically a dysfunction with external respiratory physiology due to her: emphysema happens at the lung where does external respiration happen at the lung where does internal respiration happen at the tissue level assess a 55 y/o smoker with a thick sputum producing cough. on exam you notice a positive tactile fremitus, resonant percussion, and normal voice sounds. you suspect: bronchitis you review a chart of a patient with positive whispered pectoriloquy. you understand this to be: abnormal-loud and clear finding what does the presence of increased tactile fremitus indicate fluid or solid mass within the lungs what are 3 risk factors for breast cancer? 1.history of maternal breast cancer (premenopausal onset) 2. first pregnancy after age 35 3. late menopause after 54 46 | P a g e is asymmetric breast development a risk factor for breast cancer no what is a good description of a breast cancer lump single, firm, non-tender, ill-defined what is the classic description of a fibroadenoma? single, firm, rubbery lump what types of tissues compose the internal structures of the breast fibrous, glandular, and adipose tissue in an older man, gynecomastia may be secondary to: a change in testosterone what would you expect to find on physical exam in a patient with Paget's disease? (3 things) 1. c/o itching and crusting 2. scaly appearance of nipple 3. redness & thickening of areola NOT an inverted nipple in assessing a patient with a positive cardiac history you utilize the CHADS scoring. what are the elements that this scoring system is based on to determine risk? 1. HTN 2. DM 3. CHF you noticed a thrill at the apex during systole. this could indicate: mitral regurg patient c/o excessive daytime sleepiness, flushed fash. SOB ambulating to the room, BMI>30, +JVD, +HJR, HTN. what are 3 possible list of diagnoses: 1. Pickwician syndrome 2. CHF 3. metabolic syndrome not AFib! what would you expect to find with tactile fremitus in a patient with pneumonia increased tactile fremitus would symmetric expansion be normal or abnormal in pneumonia abnormal 47 | P a g e how would you interpret this murmur: 5th ICS, timing of diastole with radiation to axilla mitral stenosis 3 risk factors for men to get breast cancer 1. testosterone level 2. low levels of physical activity 3. h/o bone fracture after 45 NOT 45-55 y/o a circumscribed, elevated lesion >1 cm in diameter and containing clear serous fluid is best described as what: bulla the history and physical of a client indicates past occurrences of lichenification. The NP identifies the characteristics of this lesion as: rough, thickened epidermis; accentuated skin markings the NP finds a lesion that is about 0.75 cm in diameter, brown, circumscribed, flat and nonpalpable. the correct term for this lesion is: macule description of a possible melanoma a new 2-mm mole that is brown with a red, irregular border, and is occasionally pruritic an annular skin lesion is usually arranged in what kind of shape a circle or ring shape when educating patients about the risk factors for skin cancer you list 3 risk factors 1. genetic predisposition 2. high mole count 3. high altitude NOT dark eyes elderly retired farmer presents with a rolled border, pearly, firm nodule with telangiectasia on his nose. what would you list in his differential diagnosis? basal cell carcinoma an adult female presents with an irregular variegated nevus on her lower left back that has doubled in size. what should the NP do? refer immediately to a dermatologist sounds like a possible melanoma and DO NOT want to do a punch biopsy 50 | P a g e a client complains of extreme pain in his abdomen and points to the RLQ. In examining the acute abdominal pain the NP would: palpate the left side of the abdomen, then gently palpate the right side, noting guarding and tenderness what is the most important goal of assessing a client with abdominal pain rule out emergent conditions what could purple striae on an abdominal assessment imply Cushing's disease ask about heat/cold intolerance how long after a diagnosis of ulcerative colitis do you need a colonoscopy? how frequent every 10 years is the spleen easily palpable in an infant yes what do you suspect if you elicit let costo-vertebral angle tenderness pyelonephritis when listening to a patients abdomen you hear a systolic bruit in the epigastric area. It occurs at a fixed interval after the apical impulse. what do you suspect is the most likely source of the bruit the abdominal aorta patient presents with abdominal pain. You note +AWT (abdominal wall tenderness). This leads you to what possible diagnosis muscle strain abdominal disorders in the older patient are more difficult to diagnose because they usually present with: vague symptoms & often little or no abdominal pain female patient with a history of ETOH abuse. your abdominal exam should include what test? scratch test-looks at liver size pupils change in size when the client focuses from a close object to a distant object. this is interpreted as: normal visual accomodation on ophthalmic exam, there appears to be a narrowing or blocking of the vessels. the significant of this finding is: the client needs to be evaluated for chronic hypertension 51 | P a g e positive bruit on exam of the thyroid most likely indicates: hyperthyroidism you notice patients history shows a bilateral lid lag of the eye. you should ask the patient about what other problems? thyroid client is older (70 y/o) c/o blurred vision that has been getting increasingly worse over past 2 years and has a problem with glare but no pain. What would you first check for? cataract what age do children approximate adult vision 4 y/o how would you describe a normal Rinne test air conduction twice as long as bone conduction which sinus is most likely affected if patient presents with pain and pressure over her cheeks and discolored nasal discharge. you cannot transilluminate the sinuses maxillary 72 y/o retired factory worker has hearing loss in his right ear due to excessive cerumen (means theres no air conduction). what would you expect when performing a Weber test sound lateralizes to the right ear how do you correctly palpate the thyroid gland have the client lower their chin and lean head slightly toward the side being evaluated patient has dipped tobacco for past 35 years. when examining the tongue there is an area of white painless plaques that he cannot get off with brushing. what is the most likely diagnosis leukoplakia which lymph nodes would you expect to find enlarged with conjunctivitis pre-auricular & anterior cervical patient has chronic hypertension. what would you expect to visualize on funduscopic exam cotton wool patches & flame hemorrhages patient presents with eye pain. when you examine the external eye you note a red, tender, swollen, raised area pointing upward from along the lower lash border. what would you document this as? hordeolum what two things are important when getting your history involving an injury 52 | P a g e 1. how the injury occurred (activity, trauma) 2. if and how the patient has self treated what are 7 risk factors for musculoskeletal problems 1. obesity 2. poor nutrition 3. low calcium intake 4. medication history 5. chronic illness 6. age 7. gender what does a 4/5 on muscle strength mean full ROM/some resistance what does a 3/5 on muscle strength mean full ROM w/ gravity what does a 2/5 on muscle strength mean full ROM gravity removed what does a 1/5 on muscle strength mean slight contraction what does a muscle strength test of a grade 3 or less indicate disability what would a positive drop arm test indicate rotator cuff tear what would a positive arc test indicate bursitis what 2 hand deformities do you see with rheumatoid arthritis? 1. swan neck deformity 2. boutonniere deformity what 2 hand deformities do you see with oseoarthritis? 1. Heberdon's 2. Bouchard's what does a positive Tinnels and a positive Phalens tell you carpal tunnel syndrome