NUR 634 Midterm Exam
2023 | Study Guide,
Practice Questions &
Exam Review
|Guaranteed success|
,The following information is recorded in the health ANS: C
history: "The patient completed 8th grade. He currently
lives with his wife and two children. He works on old Feedback: Personal and social history information includes educational level,
cars on the weekend. He works in a glass factory during family of origin, current household status, personal interests, employment,
the week." Which category does it belong to? religious beliefs, military history, and lifestyle (including diet and exercise
habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and
A. Chief complaint history). All of this information is documented in this example
B. Present illness
C. Personal and social history
D. Review of systems
Mrs. Hill is a 28-year-old African-American with a ANS: A
history of SLE (systemic lupus erythematosus). She has
noticed a raised, dark red rash on her legs. When you Feedback: A “palpable purpura” is usually associated with a vasculitis. This is an
press on the rash, it doesn't blanch. What would you tell inflammatory condition of the blood vessels often associated with systemic
her regarding her rash? rheumatic disease. It can cut off circulation to any portion of the body and can
mimic many other diseases in this manner. While allergic and chemical
A. It is likely to be related to her lupus. exposures may be a possible cause of the rash, this patient's SLE should make
B. It is likely to be related to an exposure to a chemical. you consider vasculitis
C. It is likely to be related to an allergic reaction.
D. It should not cause any problems.
Two weeks ago, Mary started a job which requires ANS: C
carrying 40-pound buckets. She presents with elbow
pain worse on the right. On examination, it hurts her Feedback: Mary’s injury probably occurred by lifting heavy buckets with her
elbows to dorsiflex her hands against resistance when palms down (toward the bucket). This caused her chronic overuse injury at the
her palms face the floor. What condition does she lateral epicondyle. Medial epicondylitis has reproducible pain when palmar
have? flexion against resistance is performed and also features tenderness over the
involved epicondyle. Olecranon bursitis produces erythema and swelling over
A. Medial epicondylitis (golfer's elbow) the olecranon process. A supracondylar fracture of the humerus is a major
B. Olecranon bursitis injury and would present more acutely.
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture
,Mrs. T. comes for her regular visit to the clinic. She is on ANS: B
your schedule because her regular provider is on
vacation, and she wanted to be seen. You have heard Feedback: You can also say, “I want to make sure I take good care of this
about her many times from your colleague and are problem because it is very important. We may need to talk about the others at
aware that she is a very talkative person. Which of the the next appointment. Is that okay with you?” This is a technique that can help
following is a helpful technique to improve the quality you to change the subject but, at the same time, validate the patient's
of the interview for both the provider and the patient? concerns; it also can provide more structure to the interview
A. Allow the patient to speak uninterrupted for the
duration of the appointment.
B. Briefly summarize what you heard from the patient in
the first 5 minutes and then try to have her focus on one
aspect of what she told you.
C. Set the time limit at the beginning of the interview
and stick with it, no matter what occurs in the course of
the interview.
D. Allow your impatience to show so that the patient
picks up on your nonverbal cue that the appointment
needs to end.
You feel a small mass that you think is a lymph node. It ANS: B
is mobile in both the up-and-down and side-to-side
directions. Which of the following is most likely? Feedback: A useful maneuver for discerning lymph nodes from other masses in
the neck is to check for their mobility in all directions. Many other masses are
A. Cancer mobile in only two directions. Cancerous masses may also be “fixed,” or
B. Lymph node immobile
C. Deep scar
D. Muscle
A 77-year-old retired bus driver comes to your clinic for ANS: B
a physical examination at his wife's request. He has
recently been losing weight and has felt very fatigued. Feedback: With his past history of colon cancer and with recent weight loss
He has had no chest pain, shortness of breath, nausea, and fatigue, a relapse of his colon cancer would be expected. Colon cancer
vomiting, or fever. His past medical history includes usually metastasizes to the liver, creating hard, irregular nodules, which can
colon cancer, for which he had surgery, and arthritis. He sometimes be palpated on examination. A smooth, large liver which is tender is
has been married for over 40 years. He denies any often seen in hepatitis.
tobacco or drug use and has not drunk alcohol in over
40 years. His parents both died of cancer in their 60s.
On examination his vital signs are normal. His head,
cardiac, and pulmonary examinations are unremarkable.
On abdominal examination you hear normal bowel
sounds, but when you palpate his liver it is abnormal.
His rectal examination is positive for occult blood. What
further abnormality of the liver was likely found on
examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender
, A 21-year-old college senior presents to your clinic, ANS: C
complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often
feel this way only with extreme exercise, but lately she associated with a history of allergies and can be made worse by exercise or
has felt this way continuously. She denies any other irritants such as smoke in a bar. On auscultation there can be normal to
upper respiratory symptoms, chest pain, gastrointestinal decreased air movement. Wheezing is heard on expiration and sometimes
symptoms, or urinary tract symptoms. Her past medical inspiration. The duration of wheezing in expiration usually correlates with
history is significant only for seasonal allergies, for severity of illness, so it is important to document this length (e.g., wheezes
which she takes a nasal steroid spray but is otherwise heard halfway through exhalation). Realize that in severe asthma, wheezes may
on no other medications. She has had no surgeries. Her not be heard because of the lack of air movement. Paradoxically, these patients
mother has allergies and eczema and her father has may have more wheezes after treatment, which actually indicates an
high blood pressure. She is an only child. She denies improvement in condition. Peak flow measurements help to discern this.
smoking and illegal drug use but drinks three to four
alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started
a job as a bartender in town. On examination she is in
no acute distress and her temperature is 98.6. Her
blood pressure is 120/80, her pulse is 80, and her
respirations are 20. Her head, eyes, ears, nose, and
throat examinations are essentially normal. Inspection
of her anterior and posterior chest shows no
abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling
on expiration in all lobes. Percussion reveals resonant
lungs. Which disorder of the thorax or lung does this
best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
A 17-year-old high school senior presents to your clinic ANS: A
in acute respiratory distress. Between shallow breaths
he states he was at home finishing his homework when Feedback: In left-sided heart failure, fluid starts “backing up” into the lungs
he suddenly began having right-sided chest pain and because the heart is unable to handle the volume. The excess fluid collects in
severe shortness of breath. He denies any recent the dependent areas, causing crackles in the bases of the lower lobes. Sitting
traumas or illnesses. His past medical history is up allows patients to breathe easier. The two main causes are chronic high
unremarkable. He doesn't smoke but drinks several blood pressure and coronary artery disease, which lead to myocardial ischemia
beers on the weekend. He has tried marijuana several and decreased contractility of the heart.
times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His
parents are both in good health. He denies any recent
weight gain, weight loss, fever, or night sweats. On
examination you see a tall, thin young man in obvious
distress. He is diaphoretic and is breathing at a rate of
35 breaths per minute. On auscultation you hear no
breath sounds on the right side of his superior chest
wall. On percussion he is hyperresonant over the right
upper lobe. With palpation he has absent fremitus over
the right upper lobe. What disorder of the thorax or
lung best describes his symptoms?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
2023 | Study Guide,
Practice Questions &
Exam Review
|Guaranteed success|
,The following information is recorded in the health ANS: C
history: "The patient completed 8th grade. He currently
lives with his wife and two children. He works on old Feedback: Personal and social history information includes educational level,
cars on the weekend. He works in a glass factory during family of origin, current household status, personal interests, employment,
the week." Which category does it belong to? religious beliefs, military history, and lifestyle (including diet and exercise
habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and
A. Chief complaint history). All of this information is documented in this example
B. Present illness
C. Personal and social history
D. Review of systems
Mrs. Hill is a 28-year-old African-American with a ANS: A
history of SLE (systemic lupus erythematosus). She has
noticed a raised, dark red rash on her legs. When you Feedback: A “palpable purpura” is usually associated with a vasculitis. This is an
press on the rash, it doesn't blanch. What would you tell inflammatory condition of the blood vessels often associated with systemic
her regarding her rash? rheumatic disease. It can cut off circulation to any portion of the body and can
mimic many other diseases in this manner. While allergic and chemical
A. It is likely to be related to her lupus. exposures may be a possible cause of the rash, this patient's SLE should make
B. It is likely to be related to an exposure to a chemical. you consider vasculitis
C. It is likely to be related to an allergic reaction.
D. It should not cause any problems.
Two weeks ago, Mary started a job which requires ANS: C
carrying 40-pound buckets. She presents with elbow
pain worse on the right. On examination, it hurts her Feedback: Mary’s injury probably occurred by lifting heavy buckets with her
elbows to dorsiflex her hands against resistance when palms down (toward the bucket). This caused her chronic overuse injury at the
her palms face the floor. What condition does she lateral epicondyle. Medial epicondylitis has reproducible pain when palmar
have? flexion against resistance is performed and also features tenderness over the
involved epicondyle. Olecranon bursitis produces erythema and swelling over
A. Medial epicondylitis (golfer's elbow) the olecranon process. A supracondylar fracture of the humerus is a major
B. Olecranon bursitis injury and would present more acutely.
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture
,Mrs. T. comes for her regular visit to the clinic. She is on ANS: B
your schedule because her regular provider is on
vacation, and she wanted to be seen. You have heard Feedback: You can also say, “I want to make sure I take good care of this
about her many times from your colleague and are problem because it is very important. We may need to talk about the others at
aware that she is a very talkative person. Which of the the next appointment. Is that okay with you?” This is a technique that can help
following is a helpful technique to improve the quality you to change the subject but, at the same time, validate the patient's
of the interview for both the provider and the patient? concerns; it also can provide more structure to the interview
A. Allow the patient to speak uninterrupted for the
duration of the appointment.
B. Briefly summarize what you heard from the patient in
the first 5 minutes and then try to have her focus on one
aspect of what she told you.
C. Set the time limit at the beginning of the interview
and stick with it, no matter what occurs in the course of
the interview.
D. Allow your impatience to show so that the patient
picks up on your nonverbal cue that the appointment
needs to end.
You feel a small mass that you think is a lymph node. It ANS: B
is mobile in both the up-and-down and side-to-side
directions. Which of the following is most likely? Feedback: A useful maneuver for discerning lymph nodes from other masses in
the neck is to check for their mobility in all directions. Many other masses are
A. Cancer mobile in only two directions. Cancerous masses may also be “fixed,” or
B. Lymph node immobile
C. Deep scar
D. Muscle
A 77-year-old retired bus driver comes to your clinic for ANS: B
a physical examination at his wife's request. He has
recently been losing weight and has felt very fatigued. Feedback: With his past history of colon cancer and with recent weight loss
He has had no chest pain, shortness of breath, nausea, and fatigue, a relapse of his colon cancer would be expected. Colon cancer
vomiting, or fever. His past medical history includes usually metastasizes to the liver, creating hard, irregular nodules, which can
colon cancer, for which he had surgery, and arthritis. He sometimes be palpated on examination. A smooth, large liver which is tender is
has been married for over 40 years. He denies any often seen in hepatitis.
tobacco or drug use and has not drunk alcohol in over
40 years. His parents both died of cancer in their 60s.
On examination his vital signs are normal. His head,
cardiac, and pulmonary examinations are unremarkable.
On abdominal examination you hear normal bowel
sounds, but when you palpate his liver it is abnormal.
His rectal examination is positive for occult blood. What
further abnormality of the liver was likely found on
examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender
, A 21-year-old college senior presents to your clinic, ANS: C
complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often
feel this way only with extreme exercise, but lately she associated with a history of allergies and can be made worse by exercise or
has felt this way continuously. She denies any other irritants such as smoke in a bar. On auscultation there can be normal to
upper respiratory symptoms, chest pain, gastrointestinal decreased air movement. Wheezing is heard on expiration and sometimes
symptoms, or urinary tract symptoms. Her past medical inspiration. The duration of wheezing in expiration usually correlates with
history is significant only for seasonal allergies, for severity of illness, so it is important to document this length (e.g., wheezes
which she takes a nasal steroid spray but is otherwise heard halfway through exhalation). Realize that in severe asthma, wheezes may
on no other medications. She has had no surgeries. Her not be heard because of the lack of air movement. Paradoxically, these patients
mother has allergies and eczema and her father has may have more wheezes after treatment, which actually indicates an
high blood pressure. She is an only child. She denies improvement in condition. Peak flow measurements help to discern this.
smoking and illegal drug use but drinks three to four
alcoholic beverages per weekend. She is a junior in
finance at a local university and she has recently started
a job as a bartender in town. On examination she is in
no acute distress and her temperature is 98.6. Her
blood pressure is 120/80, her pulse is 80, and her
respirations are 20. Her head, eyes, ears, nose, and
throat examinations are essentially normal. Inspection
of her anterior and posterior chest shows no
abnormalities. On auscultation of her chest, there is
decreased air movement and a high-pitched whistling
on expiration in all lobes. Percussion reveals resonant
lungs. Which disorder of the thorax or lung does this
best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
A 17-year-old high school senior presents to your clinic ANS: A
in acute respiratory distress. Between shallow breaths
he states he was at home finishing his homework when Feedback: In left-sided heart failure, fluid starts “backing up” into the lungs
he suddenly began having right-sided chest pain and because the heart is unable to handle the volume. The excess fluid collects in
severe shortness of breath. He denies any recent the dependent areas, causing crackles in the bases of the lower lobes. Sitting
traumas or illnesses. His past medical history is up allows patients to breathe easier. The two main causes are chronic high
unremarkable. He doesn't smoke but drinks several blood pressure and coronary artery disease, which lead to myocardial ischemia
beers on the weekend. He has tried marijuana several and decreased contractility of the heart.
times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His
parents are both in good health. He denies any recent
weight gain, weight loss, fever, or night sweats. On
examination you see a tall, thin young man in obvious
distress. He is diaphoretic and is breathing at a rate of
35 breaths per minute. On auscultation you hear no
breath sounds on the right side of his superior chest
wall. On percussion he is hyperresonant over the right
upper lobe. With palpation he has absent fremitus over
the right upper lobe. What disorder of the thorax or
lung best describes his symptoms?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
