ADVANCED HEALTH ASSESSMENT MIDTERM REVIEW OF QUIZ QUESTIONS AND ANSWERS 2023/2024 GRADED A+ BEST EXAM FOR NURSING

ADVANCED HEALTH ASSESSMENT MIDTERM REVIEW OF QUIZ QUESTIONS AND ANSWERS 2023/2024 GRADED A+ BEST EXAM FOR NURSING The following information belongs in which section of the Comprehensive Heath History (H&P)? "3 day history of rash and swelling" A. History of Present Illness B. Review of Systems C. Allergies D. Chief Complaint - CORRECT ANSWERS D. Chief Complaint A patient with abdominal pain describes "what" the pain feels like and "how long" it lasts. In which part of the H&P would you place this information? A. History of Present Illness B. Past Medical History C. Sexual History D. Review of Systems - CORRECT ANSWERS A. History of present illness Which of the following best describes the patient record? A. describes the approach to a problem B. serves a dual purpose as it reflects your anaylsis of the patient's health status and documents examination findings C. shows your clinical thought process D. reflects you interpersonal skills with the patient - CORRECT ANSWERS B. serves a dual purpose as it reflects your anaylsis of the patient's health status and documents examination findingsThe consideration of culture and ethnicity during the interview process are important because: A. similar cultures always provide similar responses B. some cultures consider certain questions and gestures offensive C. it is politically correct D. none of the above - CORRECT ANSWERS B. some cultures consider certain questions and gestures offensive During an interview, your patient admits to feeling worthless and having a sleep disturbance for the last 3 weeks. These are clues that warrant exploration of: A. risk for suicide B. split personality C. cognitive function D. functional assessment - CORRECT ANSWERS A. risk for suicide Worries persisting for =6 months most likely reflects one of the most prevalent psychiatric conditions in the United States known as: A. posttraumatic stress disorder B. generalized anxiety disorder C. fatigue D. social phobia - CORRECT ANSWERS B. generalized anxiety disorder Risk factors for fatal overdose of pain medications include all of the following except: A. age 65 or olderB. depression C. arthritis D. concurrent benzodiazepine use - CORRECT ANSWERS C. arthritis A healthy BMI can best be described as: A. 18.5-24.9 B. 30.0-34.9 C. 25.0-29.9 D. 35.0-39.9 - CORRECT ANSWERS A. 18.5-24.9 The comprehensive health history: A. has a completely different format that varies with each institution B. varies from country to country C. follows the same general format regardless of the institution or geographical location D. follows the exact same format across the world, except Europe - CORRECT ANSWERS C. follows the same general format regardless of the institution or geographical location Which of the following is not a common symptom of depression? A. Anhedonia B. Dry lips C. Appetite disturbance D. Worthlessness - CORRECT ANSWERS B. Dry lips During a mental status exam, which question might you ask to assess abstraction ability?A. What does a rolling stone gathers no moss mean? B. Start with 100 and keep subtracting by 7 C How long have you been here? D. What's your mother's maiden name? - CORRECT ANSWERS A. What does a rolling stone gathers no moss mean? Dave, age 76, is brought in by his wife, who states that within the last 2 days Dave has become agitated and restless, has had few lucid moments, slept very poorly last night and can remember only recent events. Of the following differential diagnoses, which best fits the symptoms from this brief history? A. Depression B. Dementia C. Delirium D. Schizophrenia - CORRECT ANSWERS C. Delirium Which technique is applied throughout the entire examination and interview process? A. Inspection B. Palpation C. Percussion D. Auscultation - CORRECT ANSWERS A. Inspection During a patient's pain assessment, the most important element is the patient's: A. Sleep hygiene B. Perception of his/her own painC. Vital signs D. Fear of addiction - CORRECT ANSWERS B. Perception of his/her own pain The general survey of the patient includes all of the following except: A. appearance B. tanner stage C. height D. weight - CORRECT ANSWERS B. tanner stage One of the main differences between a comprehensive and focused assessment is: A. for the comprehensive assessment you will select the methods relevant to thorough assessment of the targeted problem B. for the focused assessment you will select the methods relevant to thorough assessment of the targeted problem C. for the focused assessment you perform a thorough head to toe examination D. for the comprehensive assessment you always refer the patient to a specialist at the end of the examination - CORRECT ANSWERS B. for the focused assessment you will select the methods relevant to thorough assessment of the targeted problem Which of the following is an example of subjective data: A. Mr. D's vital signs are BP 138/66 P 107 T 99.9 SPO2 92% RR 20 B. Mr. D has inspiratory and expiratory wheezes noted during auscultation of the lungs C. Mr D's CXR shows an infiltrate in the left lower lobe consistent with pneumonia D. Mr D is a 53 year old male who presents to the clinic complaining of shortness of breath and says "it hurts to take deep breaths." He reports this started 2 days ago and says he's been having fever and chills. - CORRECT ANSWERS D. Mr D is a 53 year old male who presents to the clinic complainingof shortness of breath and says "it hurts to take deep breaths." He reports this started 2 days ago and says he's been having fever and chills. All of the following are included in the Review of Systems except: A. general B. Cardiovascular C. Psychiatric D. All of the above - CORRECT ANSWERS D. All of the above Which of the following is not a goal when developing a systematic sequence of examination: A. maximize the patients' comfort B. perform invasive imaging first C. avoid unnecessary changes in position D. enhance clinical efficiency - CORRECT ANSWERS B. perform invasive imaging first All of the following are examples of health promotion except: A. using USPSTF guidelines for practice during the exam B. using American College of Chest Physicians grading criteria during the exam C. removing baby aspirin 81 mg from the medication list of a patient with know coronary artery disease during the exam D. using CDC recommendations for exercise during the exam - CORRECT ANSWERS C. removing baby aspirin 81 mg from the medication list of a patient with know coronary artery disease during the examThe initial moments of your encounter with a patient lay the foundation for your ongoing relationship. Which of the following best helps lay that foundation: A. ensure there is more than adequate lighting in the exam room B. explain your role, your status as a student provider and how you will be involved in the patient's care C. check the light source in the otoscope D. check the light source in the opthalmascope - CORRECT ANSWERS B. explain your role, your status as a student provider and how you will be involved in the patient's care Which of the following is not one of the seven attributes of a symptom: A. location B. quality C. timing D. immunization status - CORRECT ANSWERS D. immunization status All of the following are examples of empathic responses except: A. "I cannot imagine how hard this must be for you" B. "I think you need a psych consult immediately" C. "You must be feeling sad" D. "That sounds upsetting" - CORRECT ANSWERS B. "I think you need a psych consult immediately" Which of the following are components of the three dimensions of cultural humility: A. self-awarenessB. respectful communication C. collaborative partnership D. all of the above - CORRECT ANSWERS D. all of the above When performing the general survey which of the following is not considered a sign of distress: A. pain B. labored breathing C. large mole on forehead D. anxiety - CORRECT ANSWERS C. large mole on forehead You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter 6 mm; E = evolution A = actinic; B = basal cell; C = color changes, especially blue; D = diameter 6 mm; E = evolution A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter 6 mm; E = evolution - CORRECT ANSWERS A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter 6 mm; E = evolutionA 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? Tinea versicolor Pityriasis rosea Psoriasis Atopic eczema - CORRECT ANSWERS Pityriasis rosea A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? Tinea versicolor Pityriasis rosea PsoriasisAtopic eczema - CORRECT ANSWERS Tinea versicolor Which skin lesions are most commonly found on sun-exposed skin of older, fair-skinned people? Skin tags Seborrheic keratoses Actinic keratoses Angiomas - CORRECT ANSWERS Actinic keratoses A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? Seborrheic keratosis Actinic keratosis Basal cell carcinomaSquamous cell carcinoma - CORRECT ANSWERS Actinic keratosis Which type of lesion often grows out of already present nevi that are changing or atypical, especially if the patient is over 50 years old: malignant melanoma basal cell carcinoma squamous cell carcinoma karposi sarcoma - CORRECT ANSWERS malignant melanoma Nail involvement characterized by painless separation of the nail plate from the nail bed is termed: Hippocratic nails Onycholysis KoilonychiaAnonychia - CORRECT ANSWERS Onycholysis A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? Stage 1 Stage 2 Stage 3 Stage 4 - CORRECT ANSWERS Stage 3 Sammy, age 12, presents with claerly demarcated round or oval patches of hair loss without visible scaling or inflammation. What do you suspect? Psoriasis Erythema multiformeAlopecia Areata Syphilis - CORRECT ANSWERS Alopecia Areata A basal cell carcinoma is: an epithelial tumor that originates from either the basal layer of the epidermis or cells in the surrounding dermal structures and are usually found in sun-exposed areas a malignant tumor of the squamous epithelium of the skin or mucous membranes an overgrowth and thickening of the cornified epithelium lined with epithelium and contains a fluid or semisolid material - CORRECT ANSWERS an epithelial tumor that originates from either the basal layer of the epidermis or cells in the surrounding dermal structures and are usually found in sun-exposed areas You ask a patient to follow your finger laterally when evaluating extraocular movements. Which cranial nerves are you testing? IV, VII III, VIIII, X II, III - CORRECT ANSWERS III, VI The mental status examination enables the nurse practitioner to identify: Intelligence quotient and reasoning Abstract thinking and memory functioning Reasoning and psychomotor skills Memory functioning and intelligence - CORRECT ANSWERS Abstract thinking and memory functioning An assessment of a client experiencing hallucinations would most likely reveal all of the following except: experiences that seem real but lack actual external stimulation may be auditory may be visual only occurs in the setting of schizophrenia - CORRECT ANSWERS only occurs in the setting of schizophreniaThe nurse practitioner is examining an adolescent who has been a long-term IV cocaine user. What other findings would alert the nurse practitioner to a frequent complication. Epistaxis and chronic rhinorrhea Cardiac arrhythmias and hypertension Chest congestion and wheezing Hepatitis and cellulitis - CORRECT ANSWERS Hepatitis and cellulitis The nurse practitioner is completing a history and physical on a child who she suspects may be autistic. Findings associated with autism include: Delay in language development Delay in physical growth Overprotective parents who provide minimal social interaction for the child Warm, cuddling child with excessive need for interaction. - CORRECT ANSWERS Delay in language development A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the-counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?Tension Cluster Migraine Analgesic rebound - CORRECT ANSWERS Migraine A middle aged pateint presents with diffuse facial swelling. Upon further assessment of the face you note hair is dry, course and sparse; thinning of lateral eyebrows; periorbital edema. This represents a finding of: Cishing's syndrome Myxedema Nephrotic syndrome Angioedema - CORRECT ANSWERS Myxedema Symptoms and assessment findings related to hypothyroidism include all of the following except:Palpitations Fatigue Dry, coarse skin Cold intolerance - CORRECT ANSWERS Palpitations Enlarged or tender lymphnodes, if unexplained, call for: Immediate biopsy Re-examination of the regions they drain Immediate soft-tissue CT Stat referral to ENT - CORRECT ANSWERS Re-examination of the regions they drain Jaxson is a 10 year-old male patient that presents to the clinic today complaining of a headache. His mother reports that he has just not been acting himself for the past two days. All of the following would be pertinent in your examination, except:Assessing for cranial trauma or deformity Incorrect Response Assessing for nuchal rigidity Assessing for cervical spine tenderness or deformity Assessing for Jugular Vein Distension - CORRECT ANSWERS Assessing for Jugular Vein Distension Tonsillar lymphnodes are located: at the angle of the mandible in the midline, a few centimeters behind the tip of the mandible behind the tonsilis in the oropharynx superficial to the sternomastoid - CORRECT ANSWERS at the angle of the mandible A skin and tissue disorder usually caused by increased adrenal cortisol production; characterized by round or "moon" face appearance is:myxedema acromegaly cushing's syndrome nephrotic syndrome - CORRECT ANSWERS cushing's syndrome The test that compares air conduction and bone conduction is known as: Weber test Whispered voice test Tug tes Rinne test - CORRECT ANSWERS Rinne test A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?Dacryocystitis Chalazion Hordeolum Xanthelasma - CORRECT ANSWERS Hordeolum When performing an examination using the opthalmoscope, place yourself about 15 inches away from the patient and at a 15 degree angle from the patient's line of vision. The first thing that should come into view is called: physiologic cup Red Reflex optic disc papilledema - CORRECT ANSWERS Red Reflex Small, mobile, discrete, non-tender nodes are termed:shotty fluctuant matted fixed - CORRECT ANSWERS shotty A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? Ptosis Ectropion Epicanthus Exophthalmos - CORRECT ANSWERS Exophthalmos The thyroid gland is best assessed:above the hyoid bone behind the cricoid below the suprasternal notch The thyroid gland is best assessed: above the hyoid bone behind the cricoid below the suprasternal notch Correct Response above the suprasternal notch - CORRECT ANSWERS above the suprasternal notch All of the following are considered bony landmarks of the eardrum except: cone of lightshort process of the malleus handle of the malleus umbo - CORRECT ANSWERS cone of light What is the correct procedure for palpation of a client's thyroid gland? stand behind the client, hyperextend th head and palpate both sides simultaneoulsy stand behind the client, have the client flex the neck slightly forward to relax the sternomastoid muscles stand in front of the client, hyperextend the head and have the client lean away from the side being evaluated stand next to the client and have the cliient lean away from the side being examined and take a swallow of water - CORRECT ANSWERS stand behind the client, have the client flex the neck slightly forward to relax the sternomastoid muscles When a client sips water and swallows, the thyroid isthmus: moves down and slightly posterior and feels smooth on palpationelongates and enlarges during the swallow and immediately returns to a resting position moves slightly out during the sipping and backward during the swallowing moves upward during the swallow and feels symmetric and smooth to palpation - CORRECT ANSWERS moves upward during the swallow and feels symmetric and smooth to palpation Types of ocular discharge found in the setting of conjunctivitis include all of the following except: hemorrhagic mucoid mucoidpurulent watery - CORRECT ANSWERS hemorrhagic Which of the following are common characteristics of acute otitis media: gray, retracted TMchalky, white patches with irregular margins on the surface of the TM erythema of the external ear canal erythema, bulging TM with loss of bony landmarks - CORRECT ANSWERS erythema, bulging TM with loss of bony landmarks Thrush is most often characterized as: white exudate on the tonsils thick, white plaques adhering to the underllying mucosa white specks found only on the buccal mucosa fissures on the tongue - CORRECT ANSWERS thick, white plaques adhering to the underllying mucosa Which of the following are associated causes of epistaxis: anticoagulantsnsaids coagulopathies all of the above - CORRECT ANSWERS all of the above A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last week. He denies using any other substances. He denies any feelings of depression or anxiety. While speaking with Todd and his mother you do a complete physical examination, which is essentially normal. When you question him on how he is feeling, he says that he is very worried that Microsoft has stolen his software for creating a better browser. He tells you he has seen a black van in his neighborhood at night and he is sure that it is full of computer tech workers stealing his work through special gamma waves. You ask him why he believes they are trying to steal his programs. He replies that the technicians have been telepathing their intents directly into his head. He says he hears these conversations at night so he knows this is happening. Todd's mother then tells you, "See, I told you . . . he's crazy. What do I do about it?" While arranging for a psychiatry consult, what psychotic disorder do you think Todd has? This is normal teenaged behavior Psychotic disorder due to a medical illness Substance-induced psychotic disorderSchizophrenia - CORRECT ANSWERS Schizophrenia A 32-year-old white female comes to your clinic, complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable. What type of mood disorder do you think she has? Dysthymic disorder Manic (bipolar) disorder Major depressive episode Schizophrenia - CORRECT ANSWERS Major depressive episode Which of the following occurs in respiratory distress?Speaking in sentences of 10-20 words Skin between the ribs moves inward with inspiration Neck muscles are relaxed Patient torso leans laterally - CORRECT ANSWERS Skin between the ribs moves inward with inspiration Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration? Bronchial Bronchovesicular Vesicular Tracheal - CORRECT ANSWERS Bronchial A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?Heart failure Asthma COPD Bronchiectasis - CORRECT ANSWERS Heart failure A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way with extreme exercise a few years ago and used to have to use some kind of inhaler 20 minutes before exercise. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially unremarkable. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs. Which disorder of the thorax or lung does this best describe? Spontaneous pneumothoraxChronic obstructive pulmonary disease (COPD) Asthma Pneumonia - CORRECT ANSWERS Asthma A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married and has two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer's disease. On examination you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus. What thorax or lung disorder is most likely causing his symptoms? Spontaneous pneumothorax Chronic obstructive pulmonary disease (COPD) Asthma Pneumonia - CORRECT ANSWERS Chronic obstructive pulmonary disease (COPD)Which of the following is consistent with good percussion technique? Allow all of the fingers to touch the chest while performing percussion. Maintain a stiff wrist and hand. Leave the plexor finger on the pleximeter after each strike. Strike the pleximeter over the distal interphalangeal joint. - CORRECT ANSWERS Strike the pleximeter over the distal interphalangeal joint. The following are examples of transmitted voice sounds except: ask the patient to say their name and then repeat it again backwards ask the patient to say "ninety-nine" ask the patient to whisper "one-two-three" as the patient to say "ee" - CORRECT ANSWERS ask the patient to say their name and then repeat it again backwardsA client is complaining of dyspnea. During your subjective assessment, you are able to best assess the degree the patient's dyspnea by asking about: age severity based on the patient's daily activities body weight height - CORRECT ANSWERS severity based on the patient's daily activities CDC guidelines recommend smoking prevention and cessation should begin when a patient is: A middle-aged female A geriatric male A teenager Of legal drinking age - CORRECT ANSWERS A teenagerWhile performing percussion you identify an area of dullness in the left lower lobe. This could represent all of the following except: lobar pneumonia pneumothorax pleural effusion empyema - CORRECT ANSWERS pneumothorax A classic assesment of patient with angina pectoris would include the following: exertional pain chest pressure discomfort in the shoulder, back, neck or arm all of the above - CORRECT ANSWERS all of the above Orthopnea is differentiated from other forms of dyspnea as it:occurs when the patient is lying down and improves when the patient sits up occurs when the patient is lying down and improves when the rolls over occurs when the patient is sitting up and improves when the patient lays down is always accompanied by heart palpitations - CORRECT ANSWERS occurs when the patient is lying down and improves when the patient sits up When assessing a patient for cardiovascular disease, you are aware that it strikes a disproportionate number of: hispanics and women native americans and men african americans and women african americans and men - CORRECT ANSWERS african americans and women A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?Mitral Tricuspid Aortic Pulmonic - CORRECT ANSWERS Mitral Where is the point of maximal impulse (PMI) normally located? In the left 5th intercostal space, 7 to 9 cm lateral to the sternum In the left 5th intercostal space, 10 to 12 cm lateral to the sternum In the left 5th intercostal space, in the anterior axillary line In the left 5th intercostal space, in the midaxillary line - CORRECT ANSWERS In the left 5th intercostal space, 7 to 9 cm lateral to the sternum To hear a soft murmur or bruit, which of the following may be necessary? Ask the patient to hold their breathAsk the patient to silence their cell phone Check the tubing of your stethescope for any cracks that could cause an air leak All of the above - CORRECT ANSWERS All of the above How should you determine whether a murmur is systolic or diastolic? Palpate the carotid pulse. Palpate the radial pulse Judge the relative length of systole and diastole by auscultation. Correlate the murmur with a bedside heart monitor. - CORRECT ANSWERS Palpate the carotid pulse. Which of the following best describes a grade 4-intensity murmur? It is moderately loud. It can be heard with the stethoscope off the chest.It can be heard with the stethoscope partially off the chest. It is associated with a "thrill." - CORRECT ANSWERS It is associated with a "thrill." When assessing a patient for peripheal arterial disease (PAD), it is important to ask about all of the following except: leg coldness leg numbness leg length loss of hair over the anterior tibial surfaces - CORRECT ANSWERS leg length An abnormal finding during the peripheal arterial examination would include: symmetric pulses symmetric blood pressuresasymmetric blood pressures abscence of claudication - CORRECT ANSWERS asymmetric blood pressures When grading the amplitude of arterial pulses, brisk (or normal) pulses would be: 3+ 2+ 1+ 0 - CORRECT ANSWERS 2+ Assessment of pitting edema in the foot should include pressing firmly but gently with your thumb for at least 2 seconds over all of the following areas except: Incorrect Response the dorsum of each foot the plantar surface of the heelbehind each medial malleolus over the shins - CORRECT ANSWERS the plantar surface of the heel Which of the following best describes the assessment findings of chronic venous insufficiency: swollen foot, pitting swollen foot, ulcer swollen foot, no pitting, thick skin swollen foot, swollen calf and inflammation - CORRECT ANSWERS swollen foot, ulcer A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know her if she has this or not. Which of the following disease processes is a risk factor for peripheral vascular disease? Gastroesophageal reflux disease Coronary artery diseaseMigraine headaches Osteoarthritis - CORRECT ANSWERS Coronary artery disease When assessing for DVT using Homan sign you understand that evaluating for discomfort behind the knee with forced dorsiflexion on the foot is neither sensitive or specific and discredited by Homan himself. True False - CORRECT ANSWERS True You suspect that a patient has actue cholecystitis, you would expect to find which of the following to be positive upon exam: murphy sign grey-turner sign mcmurray sign kehr sign - CORRECT ANSWERS murphy sign To differentiate among the different diagnoses of imflammatory bowel diseases, you look at the client's histological, culture and physical features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, involving the terminal ileum and proximal colon. What do you suspect:crohn's disease ulcerative colitis infectious colitis ischemic colitis - CORRECT ANSWERS crohn's disease Visceral pain is best described as: pain that originates from the parietal peritoneum pain that occurs when organs contract unusually and forcefully or are distended and stretched pain that is felt in distant sites pain that is felt after a loose bowel movement - CORRECT ANSWERS pain that occurs when organs contract unusually and forcefully or are distended and stretched A 52-year-old secretary comes to your office, complaining about accidentally leaking urine when she coughs or sneezes. She says this has been going on for about a year now. She relates that she has not had a period for 2 years. She denies any recent illness or injuries. Her past medical history issignificant for four spontaneous vaginal deliveries. She is married and has four children. She denies alcohol, tobacco, or drug use. During her pelvic examination you note some atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are unremarkable. Which type of urinary incontinence does she have? stress urge overflow neurologic - CORRECT ANSWERS stress What is the most common origination of melena: esophagus stomach duodenumall of the above - CORRECT ANSWERS all of the above You are assessing a patient who reports a history of a positive Helicobacter Pylori test. You interpret this finding as an infection associated with: GERD irritable bowel syndrome duodenal or stomach ulcer esophageal dysphagia - CORRECT ANSWERS duodenal or stomach ulcer A careful history of a client with a chief complaint of diarrhea reveals that this adult has recurrent abdominal pain and diarrhea that alternates with constipation. The symptoms have been present 6 months and the client also reports change in stool frequency and appearance. This most likely represents: drug-induced diarrhea inflammatory bowel disease giardiasisirritable bowel syndrome - CORRECT ANSWERS irritable bowel syndrome An elderly client presents with fever, leukocytosis and cramps. Upon physical exam you find lower left quadrant tenderness. The most likely diagnosis is: appendicitis diverticulitis irritable bowel syndrome pancreatitis - CORRECT ANSWERS diverticulitis 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? order a liver ultrasound order a hepatitis panel determine liver span by percussionoder a stat GI referral - CORRECT ANSWERS determine liver span by percussion A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells. What type of urinary tract pain is she most likely to have? pain from the cervix ureteral pain from a stone musculoskeletal pain ischemic bowel pain - CORRECT ANSWERS ureteral pain from a stone Functional incontinence may arise from impaired cognition, musculoskeletal problems or immobility. True False - CORRECT ANSWERS TrueColorectal cancer is the third most common cancer in men only. True False - CORRECT ANSWERS False Which is the proper sequence for examination of the abdomen: Auscultation, inspection, palpation, percussion Inspection, percussion, palpation, auscultation Inspection, auscultation, percussion, palpation Auscultation, percussion, inspection, palpation - CORRECT ANSWERS Inspection, auscultation, percussion, palpation Which of the following examination techniques would best assess for the presence of ascites: test for a fluid wave test for a gas wavetest for tenderness at McBurney's point test for hematuria - CORRECT ANSWERS test for a fluid wave Which of the following is true regarding breast self-examination? It has been shown to reduce mortality from breast cancer. It is recommended unanimously by organizations making screening recommendations. A high proportion of breast masses are detected by breast self-examination. The undue fear caused by finding a mass justifies omitting instruction in breast self-examination. - CORRECT ANSWERS A high proportion of breast masses are detected by breast self-examination. Which is the most effective pattern of palpation for breast cancer? Beginning at the nipple, make an ever-enlarging spiral. Examine in lines resembling the back and forth pattern of mowing a lawn. Divide the breast into quadrants and inspect each systematically.Beginning at the nipple, palpate outward in a stripe pattern. - CORRECT ANSWERS Examine in lines resembling the back and forth pattern of mowing a lawn. Which of the following lymph node groups is most commonly involved in breast cancer? Incorrect Response lateral subscapular pectoral central - CORRECT ANSWERS central Which of the following is most likely benign on breast examination? Incorrect Response Dimpling of the skin resembling that of an orange One breast larger than the otherOne nipple inverted One breast with dimple when the patient leans forward - CORRECT ANSWERS One breast larger than the other All of the following are characteristics of the assessment of breast nodules except: location size shape color - CORRECT ANSWERS color A fibroadenoma is known as a benign breast tumor. True False - CORRECT ANSWERS true