NR 509 Advanced physical assessment -Final examination
2024 Graded A;(Chamberlain)
A 37-year-old nurse comes for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to
2 hours after eating greasy foods. Which one of the following physical
examination descriptions would be most consistent with the diagnosis of
cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly
or masses.
B) Abdomen is soft and tender to palpation in the right lower quadrant, without
rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with
inspiration, to the point of stopping inspiration, and there is no rebound or
guarding.
D) Abdomen is soft and tender to palpation in the mid-epigastric area, without
rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration,
to the point of stopping inspiration, and there is no rebound or guarding.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is
a likely etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure
A. Bronchitis
A patient with longstanding COPD was told by another practitioner that his liver
was enlarged and this needed to be assessed. Which of the following would be
reasonable to do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver
A) Percuss the lower border of the liver
Mr. Patel is a 64-year-old man who was told by another care provider that his liver
is enlarged. Although he is a life-long smoker, he has never used drugs or
alcohol and has no knowledge of liver disease. Indeed, on examination, a liver
edge is palpable 4 centimeters below the costal arch. Which of the following
would you do next?
A) Check an ultrasound of the liver
B) Obtain a hepatitis panel
,C) Determine liver span by percussion
D) Adopt a "watchful waiting" approach
c. Determine liver span by percussion
You are palpating the abdomen and feel a small mass. Which of the following
would you do next?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion
B) Examination with the abdominal muscles tensed
Mr. Kruger is an 84-year-old man who presents with a smooth lower abdominal
mass in the midline which is minimally tender. There is dullness to percussion up
to 6 centimeters above the symphysis pubis. What does this most likely
represent?
A) Sigmoid mass
B) Tumor in the abdominal wall
C) Hernia
D) Enlarged bladder
D) Enlarged bladder
Which of the following is consistent with obturator sign?
A) Pain distant from the site used to check rebound tenderness
B) Right hypogastric pain with the right hip and knee flexed and the hip internally
rotated
C) Pain with extension of the right thigh while the patient is on her left side or
while pressing her knee against your hand with thigh flexion
D) Pain that stops inhalation in the right upper quadrant
B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated
A 57-year-old maintenance worker comes to your office for evaluation of pain in
his legs. He has smoked two packs per day since the age of 16, but he is
otherwise healthy. You are concerned that he may have peripheral vascular
disease. Which of the following is part of common or concerning symptoms for
the peripheral vascular system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain
A) Intermittent claudication
You are a student in the vascular surgery clinic. You are asked to perform a
physical examination on a patient with known peripheral vascular disease in the
legs. Which of the following aspects is important to note when you perform your
examination?
, A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength
A) Size, symmetry, and skin color
As the internal diameter of a blood vessel changes, the resistance changes as
well. Which of the following descriptions depicts this relationship?
A) Resistance varies linearly with the diameter.
B) Resistance varies proportionally to the second power of the diameter.
C) Resistance varies proportionally to the third power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter.
A 32-year-old warehouse worker presents for evaluation of low back pain. He
notes a sudden onset of pain after lifting a set of boxes that were heavier than
usual. He also states that he has numbness and tingling in the left leg. He wants
to know if he needs to be off of work. What test should you perform to assess for
a herniated disc?
A) Leg-length test
B) Straight-leg raise
C) Tinel's test
D) Phalen's test
B) Straight-leg raise
A 50-year-old realtor comes to your office for evaluation of neck pain. She was in
a motor vehicle collision 2 days ago and was assessed by the emergency medical
technicians on site, but she didn't think that she needed to go to the emergency
room at that time. Now, she has severe pain and stiffness in her neck. On
physical examination, you note pain and spasm over the paraspinous muscles on
the left side of the neck, and pain when you make the patient do active range of
motion of the cervical spine. What is the most likely cause of this neck pain?
A) Simple stiff neck
B) Aching neck
C) Cervical sprain
D) Cervical herniated disc
c. cervical sprain
A 28-year-old graduate student comes to your clinic for evaluation of pain "all
over." With further questioning, she is able to relate that the pain is worse in the
neck, shoulders, hands, low back, and knees. She denies swelling in her joints;
she states that the pain is worse in the morning; there is no limitation in her
range of motion. On physical examination, she has several points on the muscles
of the neck, shoulders, and back that are tender to palpation; muscle strength
and range of motion are normal. Which of the following is likely the cause of her
pain?
2024 Graded A;(Chamberlain)
A 37-year-old nurse comes for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to
2 hours after eating greasy foods. Which one of the following physical
examination descriptions would be most consistent with the diagnosis of
cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly
or masses.
B) Abdomen is soft and tender to palpation in the right lower quadrant, without
rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with
inspiration, to the point of stopping inspiration, and there is no rebound or
guarding.
D) Abdomen is soft and tender to palpation in the mid-epigastric area, without
rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration,
to the point of stopping inspiration, and there is no rebound or guarding.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is
a likely etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure
A. Bronchitis
A patient with longstanding COPD was told by another practitioner that his liver
was enlarged and this needed to be assessed. Which of the following would be
reasonable to do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver
A) Percuss the lower border of the liver
Mr. Patel is a 64-year-old man who was told by another care provider that his liver
is enlarged. Although he is a life-long smoker, he has never used drugs or
alcohol and has no knowledge of liver disease. Indeed, on examination, a liver
edge is palpable 4 centimeters below the costal arch. Which of the following
would you do next?
A) Check an ultrasound of the liver
B) Obtain a hepatitis panel
,C) Determine liver span by percussion
D) Adopt a "watchful waiting" approach
c. Determine liver span by percussion
You are palpating the abdomen and feel a small mass. Which of the following
would you do next?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion
B) Examination with the abdominal muscles tensed
Mr. Kruger is an 84-year-old man who presents with a smooth lower abdominal
mass in the midline which is minimally tender. There is dullness to percussion up
to 6 centimeters above the symphysis pubis. What does this most likely
represent?
A) Sigmoid mass
B) Tumor in the abdominal wall
C) Hernia
D) Enlarged bladder
D) Enlarged bladder
Which of the following is consistent with obturator sign?
A) Pain distant from the site used to check rebound tenderness
B) Right hypogastric pain with the right hip and knee flexed and the hip internally
rotated
C) Pain with extension of the right thigh while the patient is on her left side or
while pressing her knee against your hand with thigh flexion
D) Pain that stops inhalation in the right upper quadrant
B) Right hypogastric pain with the right hip and knee flexed and the hip internally rotated
A 57-year-old maintenance worker comes to your office for evaluation of pain in
his legs. He has smoked two packs per day since the age of 16, but he is
otherwise healthy. You are concerned that he may have peripheral vascular
disease. Which of the following is part of common or concerning symptoms for
the peripheral vascular system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain
A) Intermittent claudication
You are a student in the vascular surgery clinic. You are asked to perform a
physical examination on a patient with known peripheral vascular disease in the
legs. Which of the following aspects is important to note when you perform your
examination?
, A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength
A) Size, symmetry, and skin color
As the internal diameter of a blood vessel changes, the resistance changes as
well. Which of the following descriptions depicts this relationship?
A) Resistance varies linearly with the diameter.
B) Resistance varies proportionally to the second power of the diameter.
C) Resistance varies proportionally to the third power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter.
A 32-year-old warehouse worker presents for evaluation of low back pain. He
notes a sudden onset of pain after lifting a set of boxes that were heavier than
usual. He also states that he has numbness and tingling in the left leg. He wants
to know if he needs to be off of work. What test should you perform to assess for
a herniated disc?
A) Leg-length test
B) Straight-leg raise
C) Tinel's test
D) Phalen's test
B) Straight-leg raise
A 50-year-old realtor comes to your office for evaluation of neck pain. She was in
a motor vehicle collision 2 days ago and was assessed by the emergency medical
technicians on site, but she didn't think that she needed to go to the emergency
room at that time. Now, she has severe pain and stiffness in her neck. On
physical examination, you note pain and spasm over the paraspinous muscles on
the left side of the neck, and pain when you make the patient do active range of
motion of the cervical spine. What is the most likely cause of this neck pain?
A) Simple stiff neck
B) Aching neck
C) Cervical sprain
D) Cervical herniated disc
c. cervical sprain
A 28-year-old graduate student comes to your clinic for evaluation of pain "all
over." With further questioning, she is able to relate that the pain is worse in the
neck, shoulders, hands, low back, and knees. She denies swelling in her joints;
she states that the pain is worse in the morning; there is no limitation in her
range of motion. On physical examination, she has several points on the muscles
of the neck, shoulders, and back that are tender to palpation; muscle strength
and range of motion are normal. Which of the following is likely the cause of her
pain?
