PSYC 660 Final Exam | Verified with 100% Correct Answers

PSYC 660 Final Exam | Verified with 100% Correct Answers Where would you listen for aortic heart sounds? 1) 2nd ICS on right side 2) 3rd ICS on left side 3) 2nd ICS on left side 4) 4th ICS on right side What is NOT a common finding in peripheral arterial disease? 1) claudication 2) decreased pulses 3) dependent edema 4) smooth, shiny skin ________ is palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking. 1) tactile fremitus 2) respiratory auscultation 3) chest percussion 4) pneumothorax In normal heart sounds, S1 results from what? 1) the end of systole 2) closure of the aortic and pulmonic valves 3) mitral regurgitation 4) The closure of the mitral and tricuspid valves What area of the abdomen would you assess for splenic enlargement? 1) right upper quadrant 2) left upper quadrant 3) right lower quadrant 4) left lower quadrant While palpating the precordium, a heave is identified with lateral and lower displacement of the apical pulse. Such a finding may indicate: 1) left ventricular hypertrophy 2) aortic stenosis 3) pleurisy 4) mitral regurgitation A mother tells the NP that her 2-year-old child has a cough that "sounds just like a bark." Given this history, what other findings should the NP anticipate during respiratory examination? 1) labored breathing and inspiratory stridor 2) wheezing and coarse crackles bilaterally 3) productive, blood tinged, or rusty sputum 4) hyperresonance with percussion You are seeing a 62-year-old male patient. When listening to his carotid artery with the bell of your stethoscope you note a positive bruit. What would this most likely indicate? 1) JVD 2) pulmonic stenosis 3) mitral stenosis 4) stenosis, or narrowing, of his carotid artery Which murmur is NOT a systolic murmur? 1) mitral regurgitation 2) pulmonic stenosis 3) mitral stenosis 4) aortic stenosis Which of the following identifies Murphy's sign? 1) pain down the medial aspect of the thigh to knees 2) right lower quadrant pain intensified by left lower abdominal palpation 3) rebound tenderness and sharp pain when the right lower quadrant is palpated 4) abrupt cessation of inspiration on palpation of the gallbladder _______ is heard as a leathery, scratchy, grating sound. 1) Wheezing 2) A diastolic murmur 3) A pericardial friction rub 4) A pneumothorax Which of the following examination findings is indicative of appendicitis? 1) tenderness in the right upper quadrant of the abdomen 2) swelling in the lower abdominal area 3) rebound tenderness on palpation 4) auscultation of a bruit over the abdominal aorta A patient complains of left lower quadrant pain. Which would NOT be part of your differential diagnosis? 1) diverticulitis 2) gallstones 3) constipation 4) colon cancer The NP is performing a respiratory assessment on a patient and finds unequal chest expansion. The NP would conclude that this may be caused by which of the following factors? 1) patient's physical stature 2) COPD 3) collapse or obstruction of part of the lung 4) diaphragmatic breathing The carotid artery is considered the most suitable artery for evaluation of cardiac function because it: 1) is the largest artery in the body 2) is the most accessible artery closest to the heart 3) has the thickest layer of smooth muscle within the vessel walls 4) is the most palpable artery in the vascular system The patient tells the NP, "I have been coughing up a lot of yellowish green phlegm." The NP should suspect: 1) pulmonary edema 2) COPD 3) tuberculosis 4) bacterial infection A young child comes in with worsening "cold symptoms." On exam you note she is drooling, has a muffled voice, and has an increased respiratory rate. What do you suspect she has? 1) Pneumonia 2) Influenza 3) Epiglottitis 4) Bronchitis When listening to heart sounds in an elderly patient, you note a very loud murmur with a thrill that is heard with your stethoscope partially off his chest. What grade murmur is this? 1) Grade 5 2) Grade C 3) Grade 4 4) Grade D When feeling the mid abdomen, you palpate a pulse in an area of about 5 cm with lateral pulsation. You would be concerned for what? 1) hepatitis 2) pancreatitis 2) abdominal aorta aneurysm 4) diverticulitis Which of the following is the correct sequence for examining the abdomen? 1) auscultation, inspection, percussion, palpation 2) inspection, palpation, auscultation, percussion 3) inspection, auscultation, percussion, palpation 4) percussion, inspection, palpation, auscultation Which of the following answers represent subjective data collected during a health history interview? 1) patient's in-office glucose was 127 2) patient has experienced palpitations x1 week 3) patient appears anxious and in distress 4) patient has an erythematous rash on face and neck Which of the following answers represent objective data collected during a patient visit? 1) patient complains of bright red blood in stool 2) patient presents with tinnitus 3) patient admits to suicidal ideation 4) rhonchi present bilaterally Which statement is true about subjective and objective data? 1) Objective information is what the patient experiences and subjective information is what the provider finds through assessment 2) Subjective data is not as relevant as objective data 3) Subjective and objective information are both found through asking the patient about their symptoms 4) Subjective information is what the patient experiences and objective information is what the provider finds through assessment Which of the following answers represent subjective data collected during a health history interview? 1) patient has limited ROM in neck 2) tonsils are enlarged with white exudate 3) patient complains of sore throat x 3 days 4) patients blood pressure is 132/84 Which of the following questions may lead to an inaccurate patient response? 1) What happened after you noticed the injury? 2) Where do you feel the pain? 3) That was a horrible experience, wasn't it? 4) How does this situation make you feel? When performing a physical examination, you should consider the examination to begin: 1) after the patient has put on an examination gown 2) after you explain to the patient everything you are going to do 3) as soon as you meet the patient 4) after the vital signs are taken Which of the following answers represent objective data collected during a patient visit? 1) patient has a positive family history of heart disease 2) patient smokes 1 PPD 3) patient has a 5mm light brown macule on right anterior shoulder 4) patient is complaining of chest pain All of the following answers represent objective data collected during a patient visit? 1) urinary function 2) skin color 3) nutritional status 4) mobility All of the following can be assessed initially during the general inspection except 1) cardiac sounds 2) skin color 3) nutritional status 4) mobility Repeating a patient's answer is an attempt to: 1) teach the patient new medical terms 2) discourage patient anger or hostility 3) confirm an accurate understanding 4) test the patient's knowledge A 16-year-old patient comes into the office with a rash on his face. On examination, you note small (approx. 1 cm) lesions with an erythematous base and honey-colored crusting drainage. What is the most likely diagnosis 1) MRSA 2) candida 3) impetigo 4) tinea corporis Failure to elicit a red reflex in a young child may indicate: 1) retinoblastoma 2) congenital glaucoma 3) retinopathy 4) myosis Which cervical lymph node finding would be the most concerning? 1) 1cm soft, non-fixed node x 2 bilaterally anterior cervical 2) 1cm firm, fixed, non-tender node supraclavicular 3) 1cm soft occipital node that has been present and unchanged x 2 years 4) multiple palpable, slightly enlarged nodes in a young child with history of fever 1 week ago A 43-year-old female presents to the office with right ear pain x 2 days. She just returned from vacation. She states she believes it is from flying in the airplane. On exam you note her external auditory canal is swollen, erythematous, and there is a scant amount of purulent drainage from the canal. You suspect what condition? 1) otitis media 2) TM perforation 3) eustachian tube dysfunction 4) otitis externa A 22-year-old male presents with a rash. He states his hands, groin, knees, and axilla have been itching for the past week, with itching being most intense at night. On exam you notice 2mm linear burrows between his fingers and small open sores where patient has been scratching. Patient states nothing has helped the rash. He lives alone. What would be the most likely diagnosis? 1) scabies 2) poison ivy 3) impetigo 4) contact dermatitis When a patient presents with yellow-soft plaques under the skin around the eyes, what lab test would you want to order? 1) urine culture 2) blood culture 3) lipid panel 4) magnesium What findings are consistent with acute otitis media? 1) pearly grey TM with small perforation 2) pearly grey, non-bulging TM 3) retracted, erythematous TM 4) bulging, erythematous TM A young male is being evaluated for a possible ear infection. He has a low-grade fever. On exam you notice his right ear is turned forward and behind his ear there is an area that is swollen, red, and tender. What are you most concerned for? 1) MRSA 2) mastoiditis 3) otitis externa 4) perforated TM During the examination, which of the following questions would be most appropriate for the examiner to ask a patient to elicit information about the lymph system? 1) "Do your lymph nodes hurt?" 2) "Where are your largest lymph nodes?" 3) "Are you aware of any new areas of swelling or lumps?" 4) "Have you had a change in appetite?" Which of the following is the correct technique while performing an ophthalmoscopic examination? Examine the patient's___ 1) right and left eyes with your nondominant eye 2) right eye with your right eye and their left eye with your left eye 3) right and left eyes with your dominant eye 4) right eye with your left eye and the left eye with your right eye A female patient presents with unilateral, small blister like lesions across left lateral trunk area that is painful and burning. The is the most likely diagnosis? 1) herpes zoster 2) poison ivy 3) contact dermatitis 4) impetigo Candida and Psoriasis can mimic each other in presentation. Which of the following notations would describe Psoriasis? 1) patient complains of chronic, nontender rash that is silvery pink, scaly in appearance, and bilateral 2) patient complains of vague aches and discomfort in affected area; rash is vesicular 3) patient complains of extreme itching and burning of affected area. Rash is erythematous, inflamed, and moist 4) patient complains of sudden onset of honey crusted eruptions of affected area without pruritis The nurse practitioner notes that a patient's tonsils are enlarged and that they touch the side of the uvula but do not touch each other. This is documented as 1) 1+ 2) 2+ 3) 3+ 4) 4+ You are palpating a thyroid gland and note that it is enlarged bilaterally. What is your next step in the examination process? 1) check for a deviated trachea 2) examine the patient for enlarged lymph nodes 3) listen for a bruit over the carotid arteries 4) listen for a bruit over the thyroid lobes A ______ is a benign growth of tissue on the conjunctiva. 1) stye 2) pterygium 3) strabismus 4) skin tag Which of these would be considered a benign skin lesion? 1) symmetrical lesion, border regular, brown color throughout, diameter 3mm, no evolution or elevation 2) encapsulated, inflamed lesion, erythematous base, 8mm, increased in size overnight 3) umbilicated symmetrical lesion, clearly defined reddened border, red, diameter 4 mm, has increased in size over last 3 months 4) asymmetrical lesion, border bleeds into surrounding tissue, dark brown color throughout, diameter 6mm, no change from visit 1 week ago A ______ is a small, clear, fluid-filled blister <10mm diameter. 1) pustule 2) furuncle 3) cyst 4) vesicle You are doing an eye exam on a 4-year-old child and when doing the corneal light reflex test you notice the left eye turns inward. What would you suspect the child has? 1) strabismus 2) conjunctivitis 3) retinoblastoma 4) retinopathy Which findings would be more common in hypothyroidism? 1) weight gain, constipation, heavy periods 2) weight loss, diarrhea, tachycardia 3) weight gain, goiter, palpitations 4) amenorrhea, hair loss, heat intolerance What is the correct order of the SOAP note? 1) CC, HPI, ROS, Assessment, Physical Exam, Plan 2) HPI, CC, ROS, Physical Exam, Assessment, Plan 3) CC, ROS, HPI, Assessment, Physical Exam, Plan 4) CC, HPI, ROS, Physical Exam, Assessment, Plan The plan should always include which component: 1) a medication 2) a diagnostic test 3) a follow-up plan 4) a referral Diagnostic testing and referrals go under which part of the SOAP note? 1) S 2) O 3) A 4) P Which data are all considered objective? 1) BP 120/78, TM pearly grey, lungs clear, appropriate affect 2) no murmur present, no headache, no heaves, no dizziness 3) no heaves or thrills, tragus non-tender, no nausea, depressed mood 4) no shoulder pain, no chest pain with exertion, no dyspnea, hair loss present Allergies, list of medications, and immunizations are included in which part of the SOAP note? 1) S 2) O 3) A 4) P What is a differential diagnosis? 1) the final diagnosis after further testing is completed 2) a process a provider uses to reach the proper diagnosis from a list of possible competing diagnoses 3) a summary of the patient's family medical history 4) a tool providers use to research diagnostic testing for presenting symptoms Which part of the SOAP note is the following statement: "47-year old female presents with nausea and vomiting x 3 days. Symptoms started 2 hours after eating at a restaurant. She has had a total of 5 episodes of vomiting. No diarrhea." 1) CC 2) HPI 3) ROS 4) Assessment The "review of systems" is 1) subjective data 2) part of the HPI 3) objective data 4) the same as the physical exam Which data are all considered subjective? 1) normal lung expansion, denies cough, no recent fever 2) elevated BMI, urine dip negative, no visual changes 3) no fatigue, pain with bending, not sexually active 4) negative office pregnancy test, no recent infections, laceration to forehead What part of the SOAP note would you document OLDCARTS format? 1) history of present illness 2) chief complaint 3) review of systems 4) physical exam ________ connect muscles to bones. 1) Ligaments 2) Cartilage 3) Tendons 4) Bursa sacs When would you use Phalen's Test? 1) when checking for a torn ACL 2) when checking for impingement syndrome 3) when checking for torn meniscus 4) when checking for carpal tunnel syndrome Which of the following questions asked by the NP would be most helpful in understanding the cause of acute back pain? 1) "What medications do you currently take?" 2) "Was there any activity or injury that occurred before the onset of the pain?" 3) "Where you born with any congenital deformities of the spine?" 4) "Have you recently lost weight?" A patient comes in with bilateral wrist pain. Wrists are red, swollen, and tender. Her sed rate is elevated. What do you suspect? 1) inflammatory disease 2) non-inflammatory disease 3) acute injury 4) carpal tunnel A 52-year-old female comes in to see you for pain in her hand. She fell 10 days ago and went to urgent care that same evening. Her xray was negative at that time. She states pain has continued to worsen, she can not use hand, and on exam you note swelling, tenderness, and bruising along dorsal side of hand and wrist. What would you recommend? 1) repeat the xray 2) send patient to the ER 3) inform patient that the xray was negative and she should continue to rest it and apply ice 4) order labs to check for inflammatory disease, including a sed rate, rheumatoid factor, and ANA Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert you to the more serious finding of a herniated or ruptured disc? 1) muscle stiffness in the morning 2) low back pain that spreads across entire low back 3) unilateral radiating pain down one leg 4) pain that worsens with rest A 15-year-old male presents to your office for bilateral knee pain and swelling. He participates in basketball and track during the school year. He states it has been hard to run due to the pain. On exam you notice bony swelling bilaterally at the tibial tuberosity. What diagnosis do you suspect? 1) torn ACL 2) osteoarthritis 3) Osgood-Schlatter Disease 4) knee dislocation One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or non-articular in origin. Which of the following is an example of an articular structure? 1) femur 2) bicep muscle 3) skull 4) shoulder joint When assessing for carpal tunnel syndrome, the Tinel sign can be performed by tapping the 1) median nerve 2) volar carpal ligament 3) radial artery 4) dorsal aspect of the wrist "Normal" muscle strength is documented as grade: 1) 10/10 2) 1/5 3) 1/10 4) 5/5 The NP is assessing deep tendon reflex responses in a 12-year-old boy. Which of the following scores should be documented as a normal finding? 1) 1+ 2) 2+ 3) 3+ 4) 4+ Which cranial nerve is not routinely tested unless a problem is suspected? 1) II 2) I 3) V 4) XI For a patient who presents with low-back pain, you would send for immediate evaluation in all symptoms except what? 1) acute incontinence of urine 2) radicular pain down one leg 3) numbness in pelvic area 4) acute severe weakness Which test would most accurately assess for impingement in the shoulder? 1) Straight leg raise 2) McMurray test 3) Hawkin's test 4) Weber test Mr. Mann is a 48-year-old patient who presents for the examination of his knee. On examination, you note a positive anterior drawer test of his knee. This may indicate: 1) laxity in the anterior cruciate ligament 2) genu valgum 3) weakness of the collateral ligament 4) weakness of the posterior cruciate ligament A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. You examine her and find she has moderate swelling and bruising but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds. What should you do? 1) put her in a splint and send her for an immediate xray 2) tell her that it takes time for these bruises to improve, so she should be patient. 3) make an immediate referral for an orthopedic evaluation without further assessment. 4) send her to the emergency room for reduction of this obvious wrist fracture The Snellen chart assesses what cranial nerve? 1) I 2) II 3) IV 4) VI Which cranial nerve affects sound and balance? 1) II 2) V 3) XII 4) VIII Which of the following statements concerning the musculoskeletal examination is true? 1) the uninvolved side should be examined initially and then compared to the involved side 2) bilateral assessment is not necessary when a patient presents with unilateral complaints. 3) radiographs should always be obtained prior to examination so as not to cause further injury to the patient. 4) palpation is the primary type of assessment and inspection is not necessary when dealing with MS complaints The patient is able to stand upright without swaying when the Romberg test is performed. What does this finding mean? The patient has 1) an intact frontal lobe. 2) an intact spinal accessory nerve. 3) intact trochlear and abducens cranial nerves. 4) appropriate kinesthetic sensation. What statement is true about HPV? 1) HPV is cured by antibiotics if caught early. 2) HPV is a rare STD.