(Answered corrcetly) NR509 Final Exam Solution Guide
2022.
3 year old development - ans-pedals tricycle, jumps in place.
-balance on 1 foot at 4yo
8mo old child development - ans-say dada/mama
- indicate wants
-feeds self
-sit
-cant stand
Abdomen assessment sequence - ansInspect, auscultate, and percuss the abdomen. Palpate lightly, then
deeply. Assess the liver and spleen by percussion and then palpation. Try to palpate the kidneys. Palpate
the aorta and its pulsations. If you suspect kidney infection, percuss posteriorly over the costovertebral
angles.
Appendicitis pain - ansRLQ pain or pain that migrates from the periumbilical region, combined with
abdominal wall rigidity on palpation
atopic dermatitis (eczema) - ansErythema, scaling, dry skin, and intense itching
Bacterial Vaginosis (BV) - ans-Caused by overgrowth of anaerobic bacteria (often from sex)
- Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse,
may be minimal
- Fishy/musty genital odor
-Normal vulva and vaginal mucosa
-Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after
applying KOH ("whiff test"); test the vaginal secretions for pH > 4.5
Bleeding between periods - ansMetrorrhagia
Breast masses - ansMost often found by women during self examination
Buerger test (chronic arterial insufficiency) - ans- Raise both legs to about 90o for up to 2 minutes
- Then pt sits up with feet to the floor
- see how long it takes for color to return to feet (usually 10-15 seconds)
Candidal Vaginitis - ans-Cause: Candida albicans, a yeast (normal overgrowth of vaginal flora); many
factors predispose, including antibiotic therapy
-Discharge: white and curdy, may be thin but usually thick, not as profuse as trichomonal infection, not
malodorous
- vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse)
-The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal
mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these
patches are scraped off; in mild cases, the mucosa looks normal
-Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candida
cardiovascular ROS - ansSOB, syncope, edema, chest pain, orthopnea
Cause of incr JVP - ans-acute and chronic heart failure
-tricuspid stenosis
-chronic pulmonary hypertension
-superior vena cava obstruction
-cardiac tamponade
-constrictive pericarditis
, (Answered corrcetly) NR509 Final Exam Solution Guide
2022.
Causes of dk. bloody emesis - ansHematemesis may accompany esophageal or gastric varices, Mallory-
Weiss tears, or peptic ulcer disease.
Chalazion - ansA subacute nontender, usually painless nodule caused by a blocked meibomian gland.
May become acutely inflamed but, unlike a stye, usually points inside the eyelid rather than on the lid
margin.
Characteristics of a breast cyst - ansSoft to firm, round, mobile, often tender.
cricoid cartilage - ans
Diverticulitis pain - ans-LLQ
-cramping at first, then steady
- gradual onset
- tx: analgesia, bowel rest, abx
- sx: fever, constipation, n/v
Epigastric pain - ansEpigastric pain occurs with GERD, pancreatitis, and perforated ulcers. RUQ and
upper abdominal pain are common in cholecystitis and cholangitis
Erectile dysfunction - ansIn a 47 yo male, it is most often psychologic and not testosterone related.
Forms of urinary incontinence - ans-Stress: Increased abdominal pressure causes bladder pressure to
exceed urethral resistance—there is poor urethral sphincter tone or poor support of bladder neck.
- Urge: urgency is followed by involuntary leakage due to uncontrolled detrusor contractions that
overcome urethral resistance.
- Overflow: neurologic disorders or anatomic obstruction from pelvic organs or the prostate limit bladder
emptying until the bladder becomes overdistended.
- Functional: patient is functionally unable to reach the toilet in time d/t impaired health or environmental
conditions
Functional syndromes - ans-Co-occurrence rates for common functional syndromes such as irritable
bowel syndrome, fibromyalgia, chronic fatigue, temporomandibular joint disorder, and multiple chemical
sensitivity reach 30% to 90%, depending on the disorders compared
-The prevalence of symptom overlap is high in the common functional syndromes namely, complaints of
fatigue, sleep disturbance, musculoskeletal pain, headache, and gastrointestinal problems.
-The common functional syndromes also overlap in rates of functional impairment, psychiatric
comorbidity, and response to cognitive and antidepressant therapy.
Genital Warts (Condylomata Acuminata) - ans-Single or multiple papules or plaques of variable shapes;
may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like
(verrucous).
-Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of
all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.
-Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and
pain.
-May disappear without treatment.
Hemorrhoids vs polyps vs CA - ans-H-(internal-prolapsed)reddish, moist, protruding masses, (external)
pain with defecation and sitting, tender, swollen, bluish, ovoid mass is visible at the anal margin.
-P- on the stalk, or mucosal surface, soft, difficult to feel often
-C- firm, nodular, rolled edge
Hepatitis A transmission - ansfecal-oral route
2022.
3 year old development - ans-pedals tricycle, jumps in place.
-balance on 1 foot at 4yo
8mo old child development - ans-say dada/mama
- indicate wants
-feeds self
-sit
-cant stand
Abdomen assessment sequence - ansInspect, auscultate, and percuss the abdomen. Palpate lightly, then
deeply. Assess the liver and spleen by percussion and then palpation. Try to palpate the kidneys. Palpate
the aorta and its pulsations. If you suspect kidney infection, percuss posteriorly over the costovertebral
angles.
Appendicitis pain - ansRLQ pain or pain that migrates from the periumbilical region, combined with
abdominal wall rigidity on palpation
atopic dermatitis (eczema) - ansErythema, scaling, dry skin, and intense itching
Bacterial Vaginosis (BV) - ans-Caused by overgrowth of anaerobic bacteria (often from sex)
- Discharge: Gray or white, thin, homogenous, malodorous, coats the vaginal walls, usually not profuse,
may be minimal
- Fishy/musty genital odor
-Normal vulva and vaginal mucosa
-Scan saline wet mount for clue cells (epithelial cells with stippled borders); sniff for fishy odor after
applying KOH ("whiff test"); test the vaginal secretions for pH > 4.5
Bleeding between periods - ansMetrorrhagia
Breast masses - ansMost often found by women during self examination
Buerger test (chronic arterial insufficiency) - ans- Raise both legs to about 90o for up to 2 minutes
- Then pt sits up with feet to the floor
- see how long it takes for color to return to feet (usually 10-15 seconds)
Candidal Vaginitis - ans-Cause: Candida albicans, a yeast (normal overgrowth of vaginal flora); many
factors predispose, including antibiotic therapy
-Discharge: white and curdy, may be thin but usually thick, not as profuse as trichomonal infection, not
malodorous
- vaginal soreness, pruritus, pain on urination, dyspareunia (painful intercourse)
-The vulva and surrounding skin are inflamed and sometimes swollen to a variable extent; the vaginal
mucosa is reddened, with white tenacious patches of discharge; the mucosa may bleed when these
patches are scraped off; in mild cases, the mucosa looks normal
-Scan potassium hydroxide (KOH) preparation for the branching hyphae of Candida
cardiovascular ROS - ansSOB, syncope, edema, chest pain, orthopnea
Cause of incr JVP - ans-acute and chronic heart failure
-tricuspid stenosis
-chronic pulmonary hypertension
-superior vena cava obstruction
-cardiac tamponade
-constrictive pericarditis
, (Answered corrcetly) NR509 Final Exam Solution Guide
2022.
Causes of dk. bloody emesis - ansHematemesis may accompany esophageal or gastric varices, Mallory-
Weiss tears, or peptic ulcer disease.
Chalazion - ansA subacute nontender, usually painless nodule caused by a blocked meibomian gland.
May become acutely inflamed but, unlike a stye, usually points inside the eyelid rather than on the lid
margin.
Characteristics of a breast cyst - ansSoft to firm, round, mobile, often tender.
cricoid cartilage - ans
Diverticulitis pain - ans-LLQ
-cramping at first, then steady
- gradual onset
- tx: analgesia, bowel rest, abx
- sx: fever, constipation, n/v
Epigastric pain - ansEpigastric pain occurs with GERD, pancreatitis, and perforated ulcers. RUQ and
upper abdominal pain are common in cholecystitis and cholangitis
Erectile dysfunction - ansIn a 47 yo male, it is most often psychologic and not testosterone related.
Forms of urinary incontinence - ans-Stress: Increased abdominal pressure causes bladder pressure to
exceed urethral resistance—there is poor urethral sphincter tone or poor support of bladder neck.
- Urge: urgency is followed by involuntary leakage due to uncontrolled detrusor contractions that
overcome urethral resistance.
- Overflow: neurologic disorders or anatomic obstruction from pelvic organs or the prostate limit bladder
emptying until the bladder becomes overdistended.
- Functional: patient is functionally unable to reach the toilet in time d/t impaired health or environmental
conditions
Functional syndromes - ans-Co-occurrence rates for common functional syndromes such as irritable
bowel syndrome, fibromyalgia, chronic fatigue, temporomandibular joint disorder, and multiple chemical
sensitivity reach 30% to 90%, depending on the disorders compared
-The prevalence of symptom overlap is high in the common functional syndromes namely, complaints of
fatigue, sleep disturbance, musculoskeletal pain, headache, and gastrointestinal problems.
-The common functional syndromes also overlap in rates of functional impairment, psychiatric
comorbidity, and response to cognitive and antidepressant therapy.
Genital Warts (Condylomata Acuminata) - ans-Single or multiple papules or plaques of variable shapes;
may be round, acuminate (pointed), or thin and slender. May be raised, flat, or cauliflower-like
(verrucous).
-Causative organism: HPV, usually subtypes 6, 11; carcinogenic subtypes rare, approximately 5-10% of
all anogenital warts. Incubation: weeks to months; infected contact may have no visible warts.
-Can arise on penis, scrotum, groin, thighs, anus; usually asymptomatic, occasionally cause itching and
pain.
-May disappear without treatment.
Hemorrhoids vs polyps vs CA - ans-H-(internal-prolapsed)reddish, moist, protruding masses, (external)
pain with defecation and sitting, tender, swollen, bluish, ovoid mass is visible at the anal margin.
-P- on the stalk, or mucosal surface, soft, difficult to feel often
-C- firm, nodular, rolled edge
Hepatitis A transmission - ansfecal-oral route
