Advanced Health Assessment & Clinical Diagnosis 6th Edition By Dains - Test Bank

Chapter 1: Clinical reasoning, differential diagnosis, evidence-based practice, and symptom ana Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Which type of clinical decision-making is most reliable? A. Intuitive B. Analytical C. Experiential D.Augenblick ____ 2. Which of the following is false? To obtain adequate history, health-care providers must be: A. Methodical and systematic B. Attentive to the patient’s verbal and nonverbal language C. Able to accurately interpret the patient’s responses D.Adept at reading into the patient’s statements ____ 3. Essential parts of a health history include all of the following except: A. Chief complaint B. History of the present illness C. Current vital signs D.All of the above are essential history components ____ 4. Which of the following is false? While performing the physical examination, the examiner must be able to: A. Differentiate between normal and abnormal findings B. Recall knowledge of a range of conditions and their associated signs and symptoms C. Recognize how certain conditions affect the response to other conditions D.Foresee unpredictable findings ____ 5. The following is the least reliable source of information for diagnostic statistics: A. Evidence-based investigations B. Primary reports of research C. Estimation based on a provider’s experience D.Published meta-analyses ____ 6. The following can be used to assist in sound clinical decision-making: A. Algorithm published in a peer-reviewed journal article B. Clinical practice guidelines C. Evidence-based research D. All of the above ____ 7. If a diagnostic study has high sensitivity, this indicates a: A. High percentage of persons with the given condition will have an abnormal result B. Low percentage of persons with the given condition will have an abnormal result C. Low likelihood of normal result in persons without a given condition D.None of the above ____ 8. If a diagnostic study has high specificity, this indicates a: A Low percentage of healthy individuals will show a normal result . B. High percentage of healthy individuals will show a normal result C. High percentage of individuals with a disorder will show a normal result D.Low percentage of individuals with a disorder will show an abnormal result ____ 9. A likelihood ratio above 1 indicates that a diagnostic test showing a: A. Positive result is strongly associated with the disease B. Negative result is strongly associated with absence of the disease C. Positive result is weakly associated with the disease D. Negative result is weakly associated with absence of the disease ____ 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A.Clinical practice guideline B. Clinical decision rule C. Clinical algorithm Chapter 2. Evidence-based health screening Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The first step in the genomic assessment of a patient is obtaining information regarding: A. Family history B. Environmental exposures C. Lifestyle and behaviors D.Current medications ____ 2. An affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained is called a(n): A. Consultand B. Consulband C. Index patient D.Proband ____ 3. An autosomal dominant disorder involves the: A. X chromosome B. Y chromosome C. Mitochondrial DNA D.Non-sex chromosomes ____ 4. To illustrate a union between two second cousin family members in a pedigree, draw: A. Arrows pointing to the male and female B. Brackets around the male and female C. Double horizontal lines between the male and female D.Circles around the male and female ____ 5. To illustrate two family members in an adoptive relationship in a pedigree: A. Arrows are drawn pointing to the male and female B. Brackets are drawn around the male and female C. Double horizontal lines are drawn between the male and female D.Circles are drawn around the male and female ____ 6. When analyzing the pedigree for autosomal dominant disorders, it is common to see: A. Several generations of affected members B. Many consanguineous relationships C. More members of the maternal lineage affected than paternal D. More members of the paternal lineage affected than maternal ____ 7. In autosomal recessive (AR) disorders, individuals need: A.Only one mutated gene on the sex chromosomes to acquire the disease B. Only one mutated gene to acquire the disease C. Two mutated genes to acquire the disease D Two mutated genes to become carriers . ____ 8. In autosomal recessive disorders, carriers have: A.Two mutated genes; one from each parent that cause disease B. A mutation on a sex chromosome that causes a disease C. A single gene mutation that causes the disease D. One copy of a gene mutation but not the disease ____ 9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a mutation, the following are the risks to each of their offspring (each pregnancy): A.50% chance that offspring will carry the disease B. 10% chance of offspring affected by disease C. 25% chance children will carry the disease D. 10% chance children will be disease free ____ 10. A woman with an X-linked dominant disorder will: A.Not be affected by the disorder herself B. Transmit the disorder to 50 % of her offspring (male or female) C. Not transmit the disorder to her daughters D. Transmit the disorder to only her daughters ____ 11. In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic disorder. Although neither of her parents had indications of the disorder, her paternal grandmother and her paternal grandmother’s two sisters were affected by the same condition. This pattern suggests: A.Autosomal dominant disorder B. Chromosomal disorder C. Mitochondrial DNA disorder D. X-linked dominant disorder ____ 12. A woman affected with an X-linked recessive disorder: A.Has one X chromosome affected by the mutation B. Will transmit the disorder to all of her children C. Will transmit the disorder to all of her sons D. Will not transmit the mutation to any of her daughters ____ 13. Which of the following are found in an individual with aneuploidy? A.An abnormal number of chromosomes B. An X-linked disorder C. Select cells containing abnormal-appearing chromosomes D. An autosomal recessive disorder ____ 14. The pedigree of a family with a mitochondrial DNA disorder is unique in that: A.None of the female offspring will have the disease B. All offspring from an affected female will have disease C. None of the offspring of an affected female will have the disease D. All the offspring from an affected male will have disease ____ 15. Which population is at highest risk for the occurrence of aneuploidy in offspring? A.Mothers younger than 18 B. Fathers younger than 18 C. Mothers over age 35 D. Fathers over age 35 ____ 16. Approximately what percentage of cancers is due to a single-gene mutation? A. 50% to 70% B. 30% to 40% C. 20% to 25% D. 5% to 10% ____ 17. According to the Genetic Information Nondiscrimination Act (GINA): A. NPs should keep all genetic information of patients confidential B. NPs must obtain informed consent prior to genetic testing of all patients C. Employers cannot inquire about an employee’s genetic information D.All of the above ____ 18. The leading causes of death in the United States are due to: A. Multifactorial inheritance B. Single gene mutations C. X-linked disorders D.Aneuploidy ____ 19. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? A. Colon cancer in family member at age 70 B. Breast cancer in family member at age 75 C. Myocardial infarction in family member at age 35 D.All of the above ____ 20. When patients express variable forms of the same hereditary disorder, this is due to: A. Penetrance B. Aneuploidy C. De novo mutation D.Sporadic inheritance ____ 21. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: A.Variable expressivity related to inherited disease B. Dysmorphic features related to genetic disease C. De novo mutations of genetic disease D. Different penetrant signs of genetic disease ____ 22. In order to provide a comprehensive genetic history of a patient, the NP should: A.Ask patients to complete a family history worksheet B. Seek out pathology reports related to the patient’s disorder C. Interview family members regarding genetic disorders D.All of the above Chapter 3. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. When performing abdominal assessment, the clinician should perform examination techniques in the following order: A.Inspection, palpation, percussion, and auscultation B. Inspection, percussion, palpation, and auscultation C. Inspection, auscultation, percussion, and palpation D.Auscultation, palpation, percussion, and inspection ____ 2. The clinician should auscultate the abdomen to listen for possible bruits of the: A.Aorta B. Renal artery C. Iliac artery D.All of the above ____ 3. On abdominal examination, which of the following is assessed using percussion? A.Liver B. Kidneys C. Pancreas D.Esophagus ____ 4. In abdominal assessment, a digital rectal examination is performed to assess for: A.Hemorrhoids B. Prostate size C. Blood in stool D.Ureteral stenosis ____ 5. Rebound tenderness of the abdomen is a sign of: A.Constipation B. Peritoneal inflammation C. Elevated venous pressure D.Peritoneal edema ____ 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: A.Constipation B. Diverticulitis C. Appendicitis D.Hepatitis ____ 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: A. Percuss the right lower quadrant of the abdomen B. Deeply palpate the right lower quadrant of the abdomen C. Auscultate the right lower quadrant for hyperactive bowel sounds D. Strike the plantar surface of the patient’s heel while the patient is supine ____ 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: A.Psoas sign B. Obturator sign C. Rovsing’s sign D.Murphys’ sign ____ 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen while the patient inhales. The examiner is testing the patient for: A.Psoas sign B. Obturator sign C. Rovsing’s sign D.Murphys’ sign ____ 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: A.Diverticulitis B. Cholecystitis C. Appendicitis D.Mesenteric adenitis ____ 11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: A.Acute hepatitis B. Right ventricular failure C. Cholecystitis D.Left ventricular failure ____ 12. Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of: A.Cholecystitis B. Appendicitis C. Ascites D.Hepatitis ____ 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: A.Acute pancreatitis B. Biliary duct obstruction C. Acute hepatitis D.Atypical appendicitis ____ 14. The most common cause of acute pancreatitis is: A.Trauma B. Hepatitis virus A C. Hyperlipidemia D.Alcohol abuse ____ 15. Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of: A.Pleural involvement B. Alcoholism C. High mortality D.Bile duct obstruction ____ 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: A.Hematopoetic disorders B. Hepatomegaly C. Esophageal varices D.Pleural effusion ____ 17. A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: A.Bacterial endocarditis B. Infectious mononucleosis C. Pneumonia with pleural effusion D.Pancreatic cancer ____ 18. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: A.Diverticulitis B. Appendicitis C. Colon cancer D.Peptic ulcer disease ____ 19. Which of the following is the most common cause of heartburn-type epigastric pain? A.Decreased lower esophageal sphincter tone B. Helicobacteria pylori infection of stomach C. Esophageal spasm D.Excess use of NSAIDs ____ 20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: A.Digital rectal examination B. Endoscopy C. Ultrasound D.Pelvic examination ____ 21. The major sign of ectopic pregnancy is: A. Sudden onset of severe epigastric pain B. Amenorrhea with unilateral lower quadrant pain C. Lower back and rectal pain D. Palpable abdominal mass ____ 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: A Culdocentesis B. CT scan C. Abdominal x-ray D.Digital rectal examination ____ 23. The majority of colon cancers are located in the: A.Transverse colon B. Cecum C. Rectosigmoid region D.Ascending colon ____ 24. The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: A.Alternating constipation and diarrhea B. Narrowed caliber of stool C. Hematochezia D.All of the above ____ 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? A.Urinalysis B. Serum electrolyte levels C. Digital rectal exam D.Lumbar x-ray ____ 26. Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: A.Digital rectal exam B. Transvaginal ultrasound C. Pap smear D.Urinalysis ____ 27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: A.Lie flat and take a deep breath B. Stand and bear down against your hand C. Prepare for a digital rectal examination D.Lie in a left lateral recumbent position ____ 28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: A.Appendicitis B. Cholecystitis C. Bowel obstruction D.Diverticulitis ____ 29. A 76-year-old patient presents to the emergency department with severe left lower quadrant abdominal pain, diarrhea, and fever. On physical examination, you note the patient has a positive heel strike, and left lower abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions? A.Diverticulitis B. Salpingitis C. Inflammatory bowel disease D.Irritable bowel syndrome ____ 30. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? A.Viral gastroenteritis B. Staphylococcal food poisoning C. Acute hepatitis A D.E.coli gastroenteritis ____ 31. A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis contains bile. On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel sounds. Which of the following diagnoses would be most likely? A.Gastric outlet obstruction B. Small bowel obstruction C. Distal intestinal blockage D.Colonic obstruction ____ 32. Your 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103 degree fever, photophobia, and nuchal rigidity. She has an episode of projectile vomiting while you are examining her. The clinician should recognize that the following should be done: A.Abdominal x-ray B. Fundoscopic examination C. Lumbar puncture D.Analysis of vomitus ____ 33. A 9-year-old boy accompanied by his mother reports that since he came home from summer camp, he has had fever, nausea, vomiting, severe abdominal cramps and watery stools that contain blood and mucus. The clinician should recognize the importance of: A. Stool for ova and parasites B. Abdominal x-ray C. Stool for clostridium D. Fecal occult blood test ____ 34. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: A.CBC with differential B. Stool culture and sensitivity C. Abdominal x-ray D.Colonoscopy ____ 35. A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: A Inflammatory bowel disease B. Irritable bowel syndrome C. Laxative abuse D.Norovirus gastroenteritis ____ 36. A 78-year-old female patient is suffering from heart failure, GERD, diabetes, and depression. She presents with complaints of frequent episodes of constipation. Her last bowel movement was 1 week ago. Upon examination, you palpate a hard mass is the left lower quadrant of the abdomen. You review her list of medications. Which of the following of her medications cause constipation? A.Digitalis (Lanoxin) B. Amlodipine (Norvasc) C. Sertraline (Zoloft) D.Metformin (Glucophage) ____ 37. You are examining a 55-year-old female patient with a history of alcohol abuse. She complains of anorexia, nausea, pruritus, and weight loss over the last month. On physical examination, you note yellow hue of the skin and sclera. Which of the following physical examination techniques is most important? A.Scratch test B. Heel strike C. Digital rectal examination D.Pelvic examination ____ 38. You observe Charcot’s triad of sign and symptoms in a patient under your care. This is commonly seen in which of the following disorders? A.Cirrhosis B. Pancreatitis C. Cholangitis D.Portal hypertension ____ 39. A 59-year-old patient with history of alcohol abuse is admitted for hematemesis. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: A.Peptic ulcer disease B. Barrett’s esophagus C. Pancreatitis D.Esophageal varices ____ 40. A 16-year-old female with anorexia and bulimia is admitted for hematemesis. She admits to inducing vomiting often. On physical examination, you note pallor, BMI less than 15, and hypotension. A likely reason for hematemesis is: A.Mallory-Weiss tear B. Cirrhosis C. Peptic ulcer disease D.Esophageal varies ____ 41. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear B. Esophageal varices C. Gastric ulcer D.Colon cancer ____ 42. A 48-year-old male presents to the clinic with complaints of anorexia, nausea, weakness, and unintentional weight loss over the last few weeks. On physical examination, the patient has jaundice of the skin as well as sclera and a palpable mass in the epigastric region. In addition to CBC and bilirubin levels, all of the following tests would be helpful except: A.Liver enzymes B. Amylase C. Lipase D.Uric acid ____ 43. Your 66-year-old male patient complains of weakness, fatigue, chronic constipation for the last month, and dark stools. On CBC, his results show iron deficiency anemia. Colon cancer is diagnosed. Which of the following laboratory tests is used to follow progress of colon cancer? A.Alpha fetoprotein (AFP) B. Carcinogenic embryonic antigen (CEA) C. Carcinoma antigen 125 (CA-125) D.Beta-human chorionic gonadotropin (beta HCG) ____ 44. Your patient is a 33-year-old female gave birth last week. She complains of constipation, rectal pain, and itching. She reports bright red blood on the toilet tissue. The clinician should recognize the need for: A.Digital rectal exam B. CEA blood test C. Colonoscopy D.Fecal occult blood test