NURS 6512 ADVANCED HEALTH ASSESSMENT MIDTERM ACTUAL
PAPER VERIFIED STUDY SOLUTIONS
◉ A 37-year-old nurse comes for evaluation of colicky right upper
quadrant abdominal pain. The pain is associated with nausea and
vomiting and occurs 1 to 2 hours after eating greasy foods. Which
one of the following physical examination descriptions would be
most consistent with the diagnosis of cholecystitis?
Abdomen is soft, nontender, and nondistended, without
hepatosplenomegaly or masses.
Abdomen is soft and tender to palpation in the right lower
quadrant, without rebound or guarding.
Abdomen is soft and tender to palpation in the right upper quadrant
with inspiration, to the point of stopping inspiration, and there is no
rebound or guarding.
Abdomen is soft and tender to palpation in the mid-epigastric area,
without rebound or guarding. Answer: Abdomen is soft and tender
to palpation in the right upper quadrant with inspiration, to the
point of stopping inspiration, and there is no rebound or guarding.
,In cholecystitis, the pain, which originates from the gallbladder, is
located in the right upper quadrant. Severity of pain with inspiration
that is sufficient to stop further inhalation is also known as
Murphy's sign, which, if present, is further indicative of
inflammation of the gallbladder.
◉ A 55-year-old data entry operator comes to the clinic to establish
care. She has the following symptoms: headache, neck pain, sinus
congestion, sore throat, ringing in ears, sharp brief chest pains at
rest, burning abdominal pain with spicy foods, constipation, urinary
frequency that is worse with coughing and sneezing, and swelling in
legs. This cluster of symptoms is explained by:
One disease process
More than one disease process Answer: More than one disease
process
The patient appears to have several possible conditions: allergic
rhinitis, arthritis, conductive hearing loss, pleuritic chest pains,
heartburn, stress urinary incontinence, and venous stasis, among
other conditions. Although we always try, it is very difficult to assign
all of these symptoms to one cohesive diagnosis.
◉ A 62-year-old teacher presents to the clinic for evaluation of the
following symptoms: fever, headache, sinus congestion, sore throat,
,green nasal discharge, and cough. This cluster of symptoms is best
explained by:
One disease process
More than one disease process Answer: One disease process
This cluster of symptoms is most consistent with sinusitis. The
chance that all of these symptoms are caused by multiple
synchronous conditions in the same patient is much less than the
possibility of having one problem which accounts for all of them.
◉ Steve has just seen a 5-year-old girl who wheezes when exposed
to cats. The patient's family history is positive for asthma. You think
the child most likely has asthma. What have you just accomplished?
You have tested your hypothesis.
You have developed a plan.
You have established a working diagnosis.
You have created a hypothesis. Answer: You have created a
hypothesis
, As you go through a history and examination, you will start to
generate ideas to explain the patient's symptoms. It is best to keep
an open mind and make as many hypotheses as you can, to avoid
missing a possibility. A common mistake is to latch onto one idea too
early. Once you have committed your mind to a diagnosis, it is
difficult to change to another. To think about looking for wheezes on
examination would be an example of testing your new hypothesis.
Starting a patient on an inhaled medicine would be a plan. It is too
early to commit to a working diagnosis, given the amount of
information you have gathered.
◉ Ms. Washington is a 67-year-old who had a heart attack last
month. Now she complains of shortness of breath and not being able
to sleep in a flat position (orthopnea). On examination you note
increased jugular venous pressure, an S3 gallop, crackles low in the
lung fields, and swollen ankles (edema). This is an example of a:
Pathophysiologic problem
Psychopathologic problem Answer: Pathophysiologic problem
This is an example of a pathophysiologic problem because Ms.
Washington's symptoms are consistent with a pathophysiologic
process. The heart attack reduced the ability of her heart to handle
her volume status and subsequently produced the many features of
congestive heart failure.
PAPER VERIFIED STUDY SOLUTIONS
◉ A 37-year-old nurse comes for evaluation of colicky right upper
quadrant abdominal pain. The pain is associated with nausea and
vomiting and occurs 1 to 2 hours after eating greasy foods. Which
one of the following physical examination descriptions would be
most consistent with the diagnosis of cholecystitis?
Abdomen is soft, nontender, and nondistended, without
hepatosplenomegaly or masses.
Abdomen is soft and tender to palpation in the right lower
quadrant, without rebound or guarding.
Abdomen is soft and tender to palpation in the right upper quadrant
with inspiration, to the point of stopping inspiration, and there is no
rebound or guarding.
Abdomen is soft and tender to palpation in the mid-epigastric area,
without rebound or guarding. Answer: Abdomen is soft and tender
to palpation in the right upper quadrant with inspiration, to the
point of stopping inspiration, and there is no rebound or guarding.
,In cholecystitis, the pain, which originates from the gallbladder, is
located in the right upper quadrant. Severity of pain with inspiration
that is sufficient to stop further inhalation is also known as
Murphy's sign, which, if present, is further indicative of
inflammation of the gallbladder.
◉ A 55-year-old data entry operator comes to the clinic to establish
care. She has the following symptoms: headache, neck pain, sinus
congestion, sore throat, ringing in ears, sharp brief chest pains at
rest, burning abdominal pain with spicy foods, constipation, urinary
frequency that is worse with coughing and sneezing, and swelling in
legs. This cluster of symptoms is explained by:
One disease process
More than one disease process Answer: More than one disease
process
The patient appears to have several possible conditions: allergic
rhinitis, arthritis, conductive hearing loss, pleuritic chest pains,
heartburn, stress urinary incontinence, and venous stasis, among
other conditions. Although we always try, it is very difficult to assign
all of these symptoms to one cohesive diagnosis.
◉ A 62-year-old teacher presents to the clinic for evaluation of the
following symptoms: fever, headache, sinus congestion, sore throat,
,green nasal discharge, and cough. This cluster of symptoms is best
explained by:
One disease process
More than one disease process Answer: One disease process
This cluster of symptoms is most consistent with sinusitis. The
chance that all of these symptoms are caused by multiple
synchronous conditions in the same patient is much less than the
possibility of having one problem which accounts for all of them.
◉ Steve has just seen a 5-year-old girl who wheezes when exposed
to cats. The patient's family history is positive for asthma. You think
the child most likely has asthma. What have you just accomplished?
You have tested your hypothesis.
You have developed a plan.
You have established a working diagnosis.
You have created a hypothesis. Answer: You have created a
hypothesis
, As you go through a history and examination, you will start to
generate ideas to explain the patient's symptoms. It is best to keep
an open mind and make as many hypotheses as you can, to avoid
missing a possibility. A common mistake is to latch onto one idea too
early. Once you have committed your mind to a diagnosis, it is
difficult to change to another. To think about looking for wheezes on
examination would be an example of testing your new hypothesis.
Starting a patient on an inhaled medicine would be a plan. It is too
early to commit to a working diagnosis, given the amount of
information you have gathered.
◉ Ms. Washington is a 67-year-old who had a heart attack last
month. Now she complains of shortness of breath and not being able
to sleep in a flat position (orthopnea). On examination you note
increased jugular venous pressure, an S3 gallop, crackles low in the
lung fields, and swollen ankles (edema). This is an example of a:
Pathophysiologic problem
Psychopathologic problem Answer: Pathophysiologic problem
This is an example of a pathophysiologic problem because Ms.
Washington's symptoms are consistent with a pathophysiologic
process. The heart attack reduced the ability of her heart to handle
her volume status and subsequently produced the many features of
congestive heart failure.
