ADVANCED HEALTH ASSESSMENT FINAL

patient tells you they are taking ASA everyday. What do you ask next? - correct answer Why are you taking ASA daily? what is the most important rule as an APN regarding sensitive topics - correct answer be nonjudgmental still have to be succinct, focused, and direct too cultural competence is best enhanced when the HCP? - correct answer 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? - correct answer 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? - correct answer secondary prevention secondary prevention - correct answer screening means you are looking for a disease thats already there patients presents with RLQ pain, as you document his HPI you note his c/o nausea. In your symptom analysis this would be considered: - correct answer associated symptom Pt's daughter is explaining why her mother is at the office. This is an example of: - correct answer subjective information Pt has a BMI of 27. Is this normal, underweight, or overweight? - correct answer 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? - correct answer he has physical dependence and needs intervention what does question 4 on the CAGE questionnaire ask? what is the significance of it? - correct answer 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? - correct answer HEADS & RAFFT what does HEADS & RAFFT assess - correct answer behavior of the teenager patient scores a 29 on the mini-mental exam. what do you document this as? - correct answer a normal finding what are the components of the adult health history? - correct answer 1. identifying data 2. history of present illness 3. review of systems NOT physical exam what does the CAGE questionnaire look for - correct answer alcoholism coronary artery disease risk factors (4) - correct answer 1. smoking 2. HTN 3. family history 4. age 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 - correct answer at least 55% of the visit how do you define an established patient - correct answer 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 - correct answer 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 - correct answer history exam decision making when performing a history & physical on a pediatric patient, which important factor affects the outcome the most: - correct answer child's development level the key element for all levels of CPT code documentation is: - correct answer chief complaint when obtaining a health history from an older client, which characteristics of the older client must be taken into consideration? - correct answer 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 - correct answer have you ever had this before? the development of screening and prevention guidelines is based on? - correct answer increase in average life expectancy limiting public smoking is what type of prevention? - correct answer primary prevention-trying to prevent disease what is the leading cause of mortality in teenagers - correct answer motor vehicle accidents according to the ABCDE approach to preventive cardiology, the items to assess for the "A" include: (3 Things) - correct answer 1. assessment of risk 2. antiplatelet therapy 3. anticoagulation therapy NOT apple shape patients presents to have a TB test read. how is this billed? - correct answer 99211 b/c it doesn't have to be seen as a provider teenager moved to the community and doesn't have any immunization records. what do you do - correct answer repeat vaccines learning how to drive with a therapist after a stroke is considered what type of prevention - correct answer tertiary prevention already have the disease and the manifestation of the disease adding a community youth center to an area with a history of gangs is what type of prevention - correct answer primary prevention trying to prevent more gangs the SCOFF screening too is used to diagnose eating disorders: true or false - correct answer False no screening tool diagnoses affects of aging on our body - correct answer 1. fat replaces muscle 2. decrease in lean body mass 3. lowered protein reserves slow the body's response 4. total caloric needs decrease you do a physical exam of a healthy 58 y/o patient and you hear a moderately loud murmur and there is no palpable thrill. what is the appropriate grade of this murmur? - correct answer grade 3 what's the difference between a grade 3 and grade 4 murmur? - correct answer grade 4 has a thrill you exam a patient in the ER who presents with SOB. Her JVP at 45 degrees is 7cm above the clavicle. Understanding the formula for determining JVP in relation to the right atria, this finding is most consistent with what diagnosis? - correct answer right-sided heart failure where can you best auscultate the 2nd heart sound? - correct answer place the diaphragm of the stethoscope at the 2nd ICS at the base of the heart you hear a split S2 on auscultation of a 25 y/o client. what is your best action? - correct answer ask the client to hold their breath and repeat physiology S2 is related to respirations where would you expect to hear best an abnormal heart sound when the client has mitral valve insufficiency? - correct answer 5th ICS, left MCL what does an S3 heart sound indicate - correct answer volume what does an S4 heart sound indicate - correct answer stiffness you hear an S4 on a 72 y/o client with a history of HTN. What could this finding indicate? - correct answer an increased resistance to ventricular filling which result for an ABI would be consistent with physical symptoms? patient c/o of pain in his leg when walking that is relieved with rest - correct answer ABI of 0.6 what is the normal ABI - correct answer 1.0 what could oslers nodes be a sign of - correct answer endocarditis During the physical exam of a 72 y/o you note a BP of 140/90. According to the JNC 8, what would you do first? - correct answer calculate cardiac risk pulsus paradoxus is more likely to be associated with: - correct answer status asthmaticus what is arcus senilis - correct answer bilateral gray ring around the irises of older patients. pt will deny visual changes bilateraly gray ring around the iris NOT in an elderly patient - correct answer hyperlipidemia to r/o middle lobe pneumoia where would you auscultate? - correct answer under the right axillae 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? - correct answer mitral valve prolapse what is acute bronchitis characterized by - correct answer paroxysms of coughing that is dry or productive of mucoid sputum a positive clinical sign on physical exam indicating pneumonia is: - correct answer 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: - correct answer positive egophony what does hyperresonance in percussion of the lungs indicate? - correct answer 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: - correct answer emphysema happens at the lung where does external respiration happen - correct answer at the lung where does internal respiration happen - correct answer 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: - correct answer bronchitis you review a chart of a patient with positive whispered pectoriloquy. you understand this to be: - correct answer abnormal-loud and clear finding what does the presence of increased tactile fremitus indicate - correct answer fluid or solid mass within the lungs what are 3 risk factors for breast cancer? - correct answer ry of maternal breast cancer (premenopausal onset) 2. first pregnancy after age 35 3. late menopause after 54 is asymmetric breast development a risk factor for breast cancer - correct answer no what is a good description of a breast cancer lump - correct answer single, firm, non-tender, ill-defined what is the classic description of a fibroadenoma? - correct answer single, firm, rubbery lump what types of tissues compose the internal structures of the breast - correct answer fibrous, glandular, and adipose tissue in an older man, gynecomastia may be secondary to: - correct answer a change in testosterone what would you expect to find on physical exam in a patient with Paget's disease? (3 things) - correct answer 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? - correct answer 1. HTN 2. DM 3. CHF you noticed a thrill at the apex during systole. this could indicate: - correct answer 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: - correct answer 1. Pickwician syndrome 2. CHF 3. metabolic syndrome not AFib! what would you expect to find with tactile fremitus in a patient with pneumonia - correct answer increased tactile fremitus would symmetric expansion be normal or abnormal in pneumonia - correct answer abnormal how would you interpret this murmur: 5th ICS, timing of diastole with radiation to axilla - correct answer mitral stenosis 3 risk factors for men to get breast cancer - correct answer 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: - correct answer bulla the history and physical of a client indicates past occurrences of lichenification. The NP identifies the characteristics of this lesion as: - correct answer 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: - correct answer macule description of a possible melanoma - correct answer 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 - correct answer a circle or ring shape when educating patients about the risk factors for skin cancer you list 3 risk factors - correct answer 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? - correct answer 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? - correct answer refer immediately to a dermatologist sounds like a possible melanoma and DO NOT want to do a punch biopsy your patient is 2 weeks old and has pinhead size, smooth, white raised areas across the nose and forehead. How do you document this? - correct answer milia what type of skin lesion is directly related to chronic sun exposure and photo damage - correct answer actinic keratoses what labs do you order if your patient has white nail syndrome - correct answer BUN & Creatinine sign of renal insufficiency what term would you use to describe an elderly patient with multiple solar lentingos <1cm. These are not uncommon for their age. - correct answer macules flat against the skin, like very large freckles what is tinea capitis caused by? - correct answer dermatophyte how would you document a patient with dependent edema with <1" indentation up to the mid-tibia bilaterally - correct answer 4+ what is the most common type of melanoma - correct answer superficial assessment of a patients skin reveals a positive Auspitzs sign. What diagnosis does this help you with? - correct answer psoriasis you note a history of atophic dermatitis in a patient. what other items in the personal or family history would you look for? - correct answer asthma what do the A's stand for in the triad of A's? - correct answer 1. atopic dermatitis 2. asthma 3. allergic rhinitis how would you best describe squamous cell carcinoma? - correct answer often has a keratinous horn how long should it take for jaundice to resolve in a newborn in order for it to be normal? - correct answer 1 week what are the 4 major components to be documented for a skin lesion? - correct answer 1. distribution 2. configuration 3. palpable features 4. pattern what is the most common cutaneous malignancy - correct answer basal cell carcinoma where do you most commonly find basal cell carcinoma - correct answer in sun exposure areas a bruit above and to the left of the umbilicus is most consistent with: - correct answer history of HTN as you palpate the abdomen, +rebound tenderness at McBurney's point would alert you to what? - correct answer appendicitis what sign would you see in a patient with cholecystitis - correct answer + Murphy's sign what do you typically see in later disease presentation of colorectal cancer - correct answer often includes iron deficiency anemia A cullen's sign after surgery may indicate: - correct answer intra-abdominal bleeding what does hyperresonance while percussing the abdomen most likely represent? - correct answer gaseous distention what 3 conditions might you see a positive fluid wave test - correct answer 1. congestive heart failure 2. portal hypertension 3. cirrhosis NOT inflammation of the spleen a liver span of 3.0 cm MCL would indicate: - correct answer liver atrophy small liver span for a male how would you test for a positive obturator sign in a client with abdominal pain? - correct answer passively rotate the right hip from the 90 degree hip/knee flexion position a client complains of extreme pain in his abdomen and points to the RLQ. In examining the acute abdominal pain the NP would: - correct answer 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 - correct answer rule out emergent conditions what could purple striae on an abdominal assessment imply - correct answer Cushing's disease ask about heat/cold intolerance how long after a diagnosis of ulcerative colitis do you need a colonoscopy? how frequent - correct answer every 10 years is the spleen easily palpable in an infant - correct answer yes what do you suspect if you elicit let costo-vertebral angle tenderness - correct answer 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 - correct answer the abdominal aorta patient presents with abdominal pain. You note +AWT (abdominal wall tenderness). This leads you to what possible diagnosis - correct answer muscle strain abdominal disorders in the older patient are more difficult to diagnose because they usually present with: - correct answer vague symptoms & often little or no abdominal pain female patient with a history of ETOH abuse. your abdominal exam should include what test? - correct answer 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: - correct answer normal visual accomodation on ophthalmic exam, there appears to be a narrowing or blocking of the vessels. the significant of this finding is: - correct answer the client needs to be evaluated for chronic hypertension positive bruit on exam of the thyroid most likely indicates: - correct answer hyperthyroidism you notice patients history shows a bilateral lid lag of the eye. you should ask the patient about what other problems? - correct answer 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? - correct answer cataract what age do children approximate adult vision - correct answer 4 y/o how would you describe a normal Rinne test - correct answer 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 - correct answer 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 - correct answer sound lateralizes to the right ear how do you correctly palpate the thyroid gland - correct answer 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 - correct answer leukoplakia which lymph nodes would you expect to find enlarged with conjunctivitis - correct answer pre-auricular & anterior cervical patient has chronic hypertension. what would you expect to visualize on funduscopic exam - correct answer 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? - correct answer hordeolum what two things are important when getting your history involving an injury - correct answer 1. how the injury occurred (activity, trauma) 2. if and how the patient has self treated