NU 673 Assessment Midterm Exam Questions And Answers

A patient is suspected to have COPD. The APRN instructs the patient to take a deep breath in, and then with his mouth open, breathe out as fast and completely as he can. For what is the APRN checking? A. Whispered pectoriloquy B. Forced expiratory time C. Egophony D. Tactile fremitusANS - B. Forced expiratory time A pt presents to the clinic with severe right sided abdominal pain for 12 hours. He began having a "stomach ache" yesterday, with decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea & vomiting, but no constipation or diarrhea. His last BM was last night and was normal. He has had no fever or chills. He denies any recent illness or injuries. His PMH is unremarkable. He denies any tobacco or drug use and drinks 4-6 beers/week. on exam, he appears ill and is lying on his right side. His temp is 100.4 F and HR is 110. His bowel sounds are decreased and he has rebound pain and guarding one third of the way between anterior superior iliac spine and the umbilicus in the right lower quadrant. What is the most likely cause of his pain? A. Acute appendicitis B. Mesenteric ischemia C. Acute mechanical intestinal obstruction D. Acute cholecystitisANS - A. Acute appendicitis An APRN notes a 12 mm Hg difference in systolic BP during inspiration. How should the APRN document this finding? A. Acute stenosis B. Carotid arterial disease C. Paradoxical pulse D. Pulsus alternansANS - C. Paradoxical pulse Which of the following percussion notes is obtained over a gastric bubble? A. Flatness B. Hyperresonance C. Tympany D. ResonanceANS - C. Tympany The APRN is performing a cardiac exam on a pt with SOB and palpitations. She listens to the heart with the pt sitting upright, then has the pt change to a supine position, and finally she has the pt turn onto the left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position? A. Mitral B. Aortic C. Tricuspid D. PulmonicANS - A. Mitral A 20 year old male has a history of leukemia and an enlarged spleen. Today he presents with a fairly significant left upper quadrant pain. On exam of the area a rough grating noise is heard. What is this sound known as? A. It is a variant of bowel noise B. It is a splenic rub C. Vascular noise D. It represents borborygmiANS - B. It is a splenic rub An elderly pt with a history of smoking 2 packs/day for 50 years reports to the APRN prolonged shortness of breath. On cardiac exam, the APRN feels the most prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition? A. COPD B. Aortic stenosis C. Mitral regurgitation D. Pulmonary hypertensionANS - D. Pulmonary hypertension A pt reports "chest pain" during a visit to the APRN. The pt describes it as "severe" and "sharp" and worse when taking a deep breath. PMH is unremarkable and there is no history of tobacco use. VS are normal. Pt appears comfortable. Cardiac and respiratory exam are unremarkable. What is the most likely diagnosis? A. GERD B. Aortic dissection C. Myocardial infarction D. Pleuritic painANS - D. Pleuritic pain The APRN would anticipate a bounding radial pulse in: A. Aortic regurgitation B. Arterial embolism C. Mitral stenosis D. HyperthyroidismANS - A. Aortic regurgitation A pt with longstanding COPD reports that he was told his liver was enlarged. The APRN needs to assess the pt. Which of the following should the APRN do first? A. Order a hepatitis panel B. Measure the span of the liver C. Obtain an ultrasound of the liver D. Percuss the lower border of the liverANS - D. Percuss the lower border of the liver A 68 year old retired truck driver comes to the office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. The APRN is concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition? A. CT scan of the lower legs B. Ankle brachial index (ABI) C. Venogram D. PET scanANS - B. Ankle brachial index (ABI) A thin, 58 year old pt complains of lower back pain for years. On exam, the APRN finds that the pt has tenderness over the sacroiliac area. Which of the following conditions is most consistent with this physical sign? A. Torticolis B. Ankylosing spondylitis C. Malignancy D. OsteoporosisANS - B. Ankylosing spondylitis A 26 year old female pt presents to the office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. The APRN suspects: A. Tumor of the mandible B. Trigeminal neuralgia C. Temporal arthritis D. TMJ syndromeANS - D. TMJ syndrome An APRN evaluating a pt for valvular competency in the communicating veins of the saphenous system, starts with the patient supine, then elevates on leg to about 90 deg to empty it of venous blood. Next, the great saphenous vein in the upper part of the thigh is occluded with manual compression, and the pt stands. The APRN keeps the vein occluded while watching for venous filling in the leg. Which test is being performed?