Advanced Health Assessment Exam 2

When writing a SOAP note, the nurse practitioner is aware that "A" represents - Correct Ans-The diagnosis When reading a healthcare record you see the following notation: Patient states "I have had a runny nose and a cough for 1 week now" This is an example of: - Correct Ans-Chief complaint Which of the following is an appropriate recording of the subjective information provided by a patient? - Correct Ans-"grabbing" chest pain for 2 hours You receive results from the laboratory, a metabolic panel and a CBC. Where should that information appear in the SOAP note? - Correct Ans-Objective The nurse asks "Mr. S. tell me what you do when your headaches occur," with this question you are seeking information about: - Correct Ans-Aggravating and relieving factors What is the best terminology to describe significant symptoms associated with each area of the patient's body? - Correct Ans-Review of systems Mrs. Ellis is being seen for a routine physical examination. She is a college graduate and president of a research firm. She attends the local Methodist church weekly. She has adequate health insurance. Most of this information belongs in her: - Correct Ans-Personal and social history Mr. S complains of a headache. During the history, he mentions his use of alcohol and street drugs. Where is the most appropriate place for this information? - Correct Ans-Social history You are a nurse practitioner in a busy primary care practice, when should you ask your patient about substance use? A) when prescribing medication B) At an episodic visit C) At the patient's annual health assessment D) All of the above - Correct Ans-All of the above It is important to ask your patient about their sexual history. Why? Select all that apply. - Correct Ans-1. To assess their risk for potential pregnancy in females of childbearing age 2. It is important to know their sexual preferences 3. So that you can provide patient centered sex education 4. To learn their potential risk for sexually transmitted infection Documentation of the general survey includes - Correct Ans-Posture, gait, motor activity and personal hygiene The normal appearance of the tympanic membrane is - Correct Ans-Pearly grey with a visible cone of light shining downward & forward from center While undergoing the Rinne test for air conduction (AC) and bone conduction (BC), normal findings would reveal that - Correct Ans-AC is greater than BC Which of the following describes a normal thyroid examination finding? Select all that apply. - Correct Ans-1. nonpalpable 2. Slightly palpable, smooth, symmetrical Macule - Correct Ans-Flat, non-palpable 1cm lesion Common mole (nevi) - Correct Ans-Hyperpigmented papule 0.75 cm Patch - Correct Ans-flat 1cm lesion Bullae - Correct Ans-fluid-filled, well circumscribed lesion 1com Fissure - Correct Ans-narrow linear crack into epidermis, exposing dermis Vesicle - Correct Ans-fluid-filled, well circumscribed lesion 5mm The most lethal skin cancer is - Correct Ans-melanoma A 4 by 3 cm, well circumscribed, rough, elevated area of skin is an example of a - Correct Ans-plaque The mental status exam consists of assessment of a patient's appearance and behavior, speech and language, mood, thoughts and perceptions and cognitive function. By questioning orientation to time, person, and place, recent and remote memory, you are assessing - Correct Ans-Cognitive function You are seeing a 37 year old female that you suspect is suffering from depression and you are concerned about her risk of suicide. Which of the following findings is of greatest concern that would cause you to recommend immediate hospitalization or referral to the emergency room or crisis for further evaluation - Correct Ans-History of previous suicide attempt with current intent and means What is responsible for the inspiratory splitting of S2 - Correct Ans-Closure of the aortic, then pulmonic valves When recording results of heart murmurs, it is important to include - Correct Ans-quality, pitch, location, grade A grade 2 murmur is best described as - Correct Ans-Quiet, heard immediately after placing stethoscope on the chest A 23-year old optical assistant comes to your office for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a Grade 2 murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur? - Correct Ans-Mitral You listen to the chest and hear a murmur that falls between S1 and S2. This murmur is identified as - Correct Ans-a systolic murmur Jugular venous pressure is considered elevated when: - Correct Ans-It is 3-4 cm above the sternal angle Restrictions of internal and external hip rotation are sensitive indicators of a disease such as - Correct Ans-Arthritis The purpose in asking a patient who complains of neck or lower back pain about bowel or bladder dysfunction is to assess for - Correct Ans-Associated deficit indicating neurological involvement When testing for carpal tunnel syndrome, numbness or tingling in the distribution of the median nerve (palmar surface of thumb, index, middle and medial 4th finger) when hands are pressed together in acute flexion for 60 seconds is a positive - Correct Ans-Phalen's sign Which of the following areas of musculoskeletal examination tests joint function and stability - Correct Ans-Range of Motion Which test is used to detect an injury or tear or the medial or lateral collateral ligament - Correct Ans-Stress test (Abduction/ Adduction) The area of the body surface innervated by a particular spinal nerve is called a - Correct Ans-Dermatome Two of the most common symptoms patients with neurologic disorders describe are - Correct Ans-generalized weakness and pain One way to test cranial nerves IX and X - Correct Ans-Assess gag reflex Cranial nerves III, IV, and VI are all related to - Correct Ans-Ocular movement One way to test cranial nerve XI is - Correct Ans-Ask the patient to shrug shoulders against resistant pressure of examiner's hands One way to test cranial nerve VIII is - Correct Ans-Weber test The best test to assess cranial nerve II is - Correct Ans-Perform snellen chart and reading newspaper print Cranial nerve VII assesses nerves associated with - Correct Ans-The face, facial movement One way to test cranial nerve XII - Correct Ans-Ask the patient to stick out tongue One way to test cranial nerve V is - Correct Ans-Check for facial sensation The best test for assessing cranial nerve I is - Correct Ans-Ask the patient to sniff vanilla The ability to identify a number or letter written on the palm of your hand - Correct Ans-Graphesthesia A test to evaluate position sense - Correct Ans-Romberg test The ability to identify an object by feeling it (tactile sensation) - Correct Ans-Stereognosis Components of cultural humility include all of the following except - Correct Ans-discussing "cinco de mayo" with your patient of Mexican background Key components of peripheral arterial examination include - Correct Ans-Measurement of blood pressure and assessment for aortic, renal, and femoral bruits A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency? - Correct Ans-Pallor of the foot when raised to 60 degrees for one minute Normal pulses are - Correct Ans-+2 Risk factors for lower extremity peripheral vascular disease iclude - Correct Ans-Age 70+, obesity, and smoking Mark is a 35 year old police officer who is seeing you for his annual check up. When taking his sexual history it is important to: select all that apply. - Correct Ans-1. Ask about sexual partners and any history of sexually transmitted infections 2. As he states he is sexually active, ask about safer sex with condoms The NP is preparing to complete a vaginal examination. Best practice includes - Correct Ans-Avoid unexpected or sudden movements, drape patient from midabdomen and depress drape between the knees to provide eye contact Common scrotal swellings include - Correct Ans-Indirect inquinal hernias When discussing modifiable risk factors for breast cancer in a 57 year old female, the NP recognizes that he/she can include discussion about which of the following? - Correct Ans-Use of hormonal replacement treatment (HRT) Normal findings of a prostate exam include which of the following - Correct Ans-Prostate measures 2.5 cm, rubbery, nontender Which of the following is most likely benign on breast examination? - Correct Ans-One breast larger than the other Mary is a 48 year old female who is seen today for a change in her menstrual flow. Her normal periods are have been every 28-30 days, but in the last 6 months she only had a period twice. A pregnancy test is negative and pelvic exam is normal. You schedule a follow up visit in 2 months and encourage her to call with any questions. You discuss peri-menopausal symptoms with her. When documenting her office visit the best choice for a differential diagnosis is: - Correct Ans-Oligomenorrhea What does a high level of thyroid stimulating hormone (TSH) indicate? - Correct Ans-Hypothyroidism Which of the following findings on a urine dipstick is indicative of an infection - Correct Ans-Positive leukocytes, nitrites and blood Iron deficiency anemia causes which of the following changes in RBC indices - Correct Ans-Microcytic, hypochromic The preferred order for examination of the abdomen is - Correct Ans-Inspection, auscultation, percussion, palpation To identify the lower border of the liver, the NP would: - Correct Ans-Percuss starting at the level of the umbilicus in the right lower quadrant, percussing up toward the liver at the midclavicular line There are 3 main types of abdominal pain including visceral, parietal, and referred pain. Which type of pain is described as gnawing, burning, cramping, or aching and may be difficult to localize? - Correct Ans-Visceral pain Which of the following will help to optimize yield from a pediatric examination? - Correct Ans-Doing the examination out of order if necessary to take advantage of quiet periods for auscultation When interviewing children or adolescents, it is important to - Correct Ans-Always interview adolescents separately after inquiring about concerns from the parent or guardian Dullness noted during percussion of the abdomen could indicate all of the following Except: - Correct Ans-Air filled intestines When performing a genital exam on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the practitioner would - Correct Ans-Consider this a normal finding and proceed with the examination A 22 year old woman is being seen at the clinic for problems with vulvar pain, dysuria, and fever. On physical examination, the practitioner notices clusters of small shallower vesicles with surrounding erythema on the labia. There is also inguinal lymphadenopathy present. The most likely cause of these lesions is - Correct Ans-Herpes simplex virus type 2 When performing the bimanual examination, the practitioner notices that the cervix feels smooth and firm, is round, and is fixed in place (does not move). When cervical palpation is performed, the patient complains of some pain. The nurse practitioner's interpretation of these results should be which of these? - Correct Ans-The cervix should move when palpated; an immobile cervix may indicate malignancy When assessing for symptoms of diarrhea, it is most important to assess the patient for - Correct Ans-Current prescription and non-prescription medications After completing an assessment of a 60 year old man with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. The nurse should mention the need for a - Correct An