NR 509 Final Exam: Advanced Physical Assessment Questions and Answers .

NR 509 Final Exam: Advanced Physical Assessment Questions and Answers . Know that in a 47-year-old man ED is usually ___________ rather than testosterone (Ans- psychologic Erectile dysfunction may be from psychogenic causes, especially if (Ans- early morning erection is preserved. it may also reflect decreased testosterone, decreased blood flow in the hypogastric arterial system, impaired neural innervation, and diabetes When performing a breast exam, know what abnormal masses should do when the arm (Ans- may be fixed to skin or underlying tissues (may cause dimpling of skin or retraction when arms are lifted over head or hands are pressed against hips) Fibroadenoma and cysts mobility (Ans- very mobile/mobile Know that a high proportion of breast masses are noted during ________ (Ans- BSE Breast stage 1 (Ans- preadolescent- elevation of nipple only NR 509 Final Exam: Advanced Physical Assessment Questions and Answers Breast stage 2 (Ans- breast bud stage- elevation of breast and nipple as a small mound; enlargement of areolar diameter breast stage 3 (Ans- further enlargement of elevation of breast and areola, with no separation of their contours breast stage 4 (Ans- projection of areola and nipple to form a secondary mound above the level of breast breast stage 5 (Ans- mature stage- projection of nipple only; areola has receded to general contour of the breast (although in some individuals the areola continues to form a secondary mound) Know where pain is located with pancreatitis: acute (Ans- epigastric, may radiation straight to the back of other areas of the abdomen; 20% with severe sequelae of organ failure Know where pain is located with pancreatitis: chronic (Ans- epigastric, radiating to back Know how hepatitis A is transmitted (Ans- Transmitted through fecal-oral route. Fecal shedding followed by poor handwashing contaminates water and foods leading to infection of household and sexual contacts Stress incontinence (Ans- the urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise the bladder pressure to levels that exceed urethral resistance. Causes include childbirth and surgery, postmenopausal atrophy of the mucosa, and urethral infection. May follow prostate surgery in men. urge incontinence (Ans- detrusor contractions are stronger than normal and overcome the normal urethral resistance. The bladder is typically small. Mechanisms: Decreased cortical inhibition of detrusor contractions from stroke, brain tumor, dementia, and lesions of the spinal cord above sacral level. Also hyperexcitability of sensory pathways ie: bladder infections, tumors, and fecal impaction. Deconditioning of voiding reflexes ie: frequent voluntary voiding at low bladder volumes. overflow incontinence (Ans- detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention. The bladder is typically flaccid and large, even after an effort to void. Mechanisms: obstruction of the bladder outlet ie: BPH or tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at S2-4 level. Impaired bladder sensation that interrupts the reflex arc ie: diabetic neuropathy. functional incontinence (Ans- the patient is functionally able to reach the toilet in time because of impaired health or environmental conditions. Mechanism: problems in mobility resulting from weakness, arthritis, poor vision, or other conditions. Also environmental factors such as an unfamiliar setting, distant bathroom facilities, bed rails, or physical restraints. Incontinence secondary to medications (Ans- drugs may contribute to any type of incontinence listed. Ex: sedatives, tranquilizers, anticholinergics, sympathetic blockers, and potent diuretics Know where lymph nodes should be with strep (Ans- · Strep throat àstreptococcal pharyngitis, bacterial infection that may cause a sore, scratchy throat · Common childhood infection has a classic presentation of erythema of the posterior pharynx and palatal petechiae · Enlarged swollen cervical lymph nodes -> superficial cervical lymph nodes Superficial cervical -> superficial to the sternocleidomastoid What vaccines are safe during pregnancy (Ans- tdap, flu, Pneumococcal, meningococcal, Hepatitis B, rho gam *NOT MMR, polio, or varicella Know what to be concerned about if you note an irregular rectal mass (Ans- · Any masses with irregular borders suspicious for rectal cancer A tender purulent reddened mass with fever or chills suggests an anal abscess. Abscesses tunneling to the skin surface from the anus or rectum may form a clogged or draining ano-rectal fistula. Fistulas may ooze blood, pus, or feculent mucus. Consider anoscopy or sigmoidoscopy for better visualization. Know what HPV Vac protects against (Ans- · Prevents infection from HPV subtypes 16, 18, 6 & 11 which cause 90 % of genital warts · The bivalent vaccine prevents infection from subtypes 16 and 18. · Recommended for prevention of cervical, vulvar, and vaginal cancers and precancers in females as well as anal cancer, precancers, and genital warts in both female and males · Vaccinated women should still get cervical cancer screening because vaccines do not prevent all HPV subtypes · Condoms do not eliminate the risk of cervical HPV infection Recommended for those with compromised immune systems including HIV Know what a 3-year-old can do in regard to jumping and balancing (Ans- · Climbs well, runs easily · Pedals a tricycle · Walks up and down stairs, one foot on each step Know where to place measuring tape when measuring uterus in a pregnant patient (Ans- · Measure the fundal height if gestational age is >20 weeks - fundus should reach the umbilicus · Place tape measure on pubic symphysis and place the "zero" end of the tape measure when you can firmly feel that bone. · Extend the tape measure to the very top of uterine fundus and note the number of cm measured. o Subject to error between 16-36 weeks · Number should roughly equal the number of weeks of gestation o If fundal height is >4cm than expected -multiple gestation, large fetus, extra amniotic fluid, uterine leiomyoma o If fundal height is < 4cm than expected - low-level amniotic fluid, missed abortion, intrauterine growth retardation, or fetal anomaly The _______ _______ occupies most of the anterior cardiac surface (Ansright ventricle Know what bleeding between periods is called (Ans- Abnormal uterine bleeding, Intermenstrual bleeding Know types of vaginosis (Ans- Trichomonal vaginitis, Candidal Vaginitis, Bacterial vaginosis miliaria rubra (Ans- Scattered vesicles on an erythematous base, usually on the face and trunk, result from obstruction of the sweat gland ducts; disappears spontaneously within weeks Know the characteristics of a breast cyst (Ans- Usually soft to firm, round, mobile and often tender. Most common between the ages of 25-50 Know the signs of peritonitis (Ans- When tender area is palpated for guarding, early voluntary guarding may be replaced by involuntary muscular rigidity and signs of peritoneal inflammation. There may also be RLQ pain on quick withdrawal or deferred rebound tenderness. Know where pain is with diverticulitis (Ans- LLQ Know what position to have pt in to listen for mitral stenosis (Ans- Left lateral decubitus Know what to ask in regards to cardiovascular review of systems (pick the one that belongs) (Ans- Ask questions related to: chest pain, palpitations, shortness of breath, swelling (edema), syncope Know how a bartholin's gland infection presents (Ans- Acutely, the gland appears as a tense, hot, very tender abscess. Possible labial swelling. Look for pus emerging from the duct or erythema around the duct opening. Chronically, a nontender cyst is felt that may be large or small. Know where pain is with appendicitis (Ans- RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall rigidity on palpation is suspicious for appendicitis Know how syphilis presents genitally (Ans- Female: syphilitic chancre- firm, painless ulcer from primary syphilis, forms approx. 21 days after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals regardless of treatment in 3-6 weeks. Secondary syphilis (Condyloma lantum)- large raised, round or oval, flattopped gray or white lesions point to condylomata lata. These are contagious and, along with rash and mucus membrane sores in the mouth, vagina, or anus are manifestations of secondary syphilis.