Question 1
When evaluating a 78-year-old man, the PMHNP notices the patient frequently leans in
with the right side of his head and frequently asks for things to be repeated. His daughter
is very worried that he has dementia or depression because he has also become
increasingly isolated, as well as increasingly irritable as he believes people are yelling at
him out of frustration of not being heard. The daughter is tearful, anxious, and frustrated.
What should the PMHNP do first?
Order a CT scan of the head
Separate the patient from the daughter and interview him alone
Examine the patient's ear canals
Provide anticipatory guidance regarding aging parents to the daughter
CORRECT ANSWER
Examine the patient's ear canals
Question 2
A 35-year-old man diagnosed with bipolar disorder mentions to his PMHNP that he had
felt a lump on his left testicle. He is concerned he has not had a physical exam in 10 years.
What is the best action by the PMHNP?
Explore the reason for not having had a physical in so long
Refer him to his primary care provider
Perform a urogenital exam and order an ultrasound
Refer him to urology
CORRECT ANSWER
1
@THE STUDY VAULT
, Explore the reason for not having had a physical in so long
Question 3
In observing the appearance of the patient with depression and a history of systemic lupus
erythematosus, the PMHNP notices a lesion on the neck of the patient about the size of a
pencil eraser, flush with the skin, uniformly colored, with discrete borders, and consistent
texture. The PMHNP should:
Refer the patient to oncology
Watch and wait
Refer the patient to rheumatology
Refer the patient to dermatology
CORRECT ANSWER
Watch and wait
Question 4
Which of the following best represent the physical exam maneuver known as Murphy's
sign?
While supine, ask the patient to grasp her knee while tucking 1 leg up to the chest. A
positive test occurs when pain prohibits elevation of the ipsilateral leg.
The examiner palpates in the right upper abdominal quadrant below the costal margin while
the patient breathes in. The test is positive if the examiner observes pain during inhalation.
Press and palpate deeply into the abdomen and release quickly observing for pain.
2
@THE STUDY VAULT
, Ask the patient to bend at the knees while holding onto a rail, observe for a loss of balance.
CORRECT ANSWER
The examiner palpates in the right upper abdominal quadrant below the costal margin
while the patient breathes in. The test is positive if the examiner observes pain during
inhalation.
Acute cholecystitis
Question 5
What does the Murphy sign assess for
CORRECT ANSWER
Cholecystitis
Question 6
A 26-year-old man has been on an antipsychotic. He requires further titration for control
of symptoms. Which of the following tests should be repeated?
EKG
Head CT scan
Liver function test
Urinalysis
CORRECT ANSWER
EKG
Question 7
3
@THE STUDY VAULT
When evaluating a 78-year-old man, the PMHNP notices the patient frequently leans in
with the right side of his head and frequently asks for things to be repeated. His daughter
is very worried that he has dementia or depression because he has also become
increasingly isolated, as well as increasingly irritable as he believes people are yelling at
him out of frustration of not being heard. The daughter is tearful, anxious, and frustrated.
What should the PMHNP do first?
Order a CT scan of the head
Separate the patient from the daughter and interview him alone
Examine the patient's ear canals
Provide anticipatory guidance regarding aging parents to the daughter
CORRECT ANSWER
Examine the patient's ear canals
Question 2
A 35-year-old man diagnosed with bipolar disorder mentions to his PMHNP that he had
felt a lump on his left testicle. He is concerned he has not had a physical exam in 10 years.
What is the best action by the PMHNP?
Explore the reason for not having had a physical in so long
Refer him to his primary care provider
Perform a urogenital exam and order an ultrasound
Refer him to urology
CORRECT ANSWER
1
@THE STUDY VAULT
, Explore the reason for not having had a physical in so long
Question 3
In observing the appearance of the patient with depression and a history of systemic lupus
erythematosus, the PMHNP notices a lesion on the neck of the patient about the size of a
pencil eraser, flush with the skin, uniformly colored, with discrete borders, and consistent
texture. The PMHNP should:
Refer the patient to oncology
Watch and wait
Refer the patient to rheumatology
Refer the patient to dermatology
CORRECT ANSWER
Watch and wait
Question 4
Which of the following best represent the physical exam maneuver known as Murphy's
sign?
While supine, ask the patient to grasp her knee while tucking 1 leg up to the chest. A
positive test occurs when pain prohibits elevation of the ipsilateral leg.
The examiner palpates in the right upper abdominal quadrant below the costal margin while
the patient breathes in. The test is positive if the examiner observes pain during inhalation.
Press and palpate deeply into the abdomen and release quickly observing for pain.
2
@THE STUDY VAULT
, Ask the patient to bend at the knees while holding onto a rail, observe for a loss of balance.
CORRECT ANSWER
The examiner palpates in the right upper abdominal quadrant below the costal margin
while the patient breathes in. The test is positive if the examiner observes pain during
inhalation.
Acute cholecystitis
Question 5
What does the Murphy sign assess for
CORRECT ANSWER
Cholecystitis
Question 6
A 26-year-old man has been on an antipsychotic. He requires further titration for control
of symptoms. Which of the following tests should be repeated?
EKG
Head CT scan
Liver function test
Urinalysis
CORRECT ANSWER
EKG
Question 7
3
@THE STUDY VAULT
