ADVANCED HEALTH ASSESSMENT EXAM QUESTIONS AND ANSWERS ALL CORRECT

ADVANCED HEALTH ASSESSMENT EXAM QUESTIONS AND ANSWERS ALL CORRECT A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care? A) JM is a 59 year old male here for having "black stools" for the past 24 hours. B) JM came into the clinic complaining of black stools for the past 24 hours. C) JM is a 59 year old male here for "ulcerative colitis." D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. Correct Answer: A) JM is a 59 year old male here for having "black stools" for the past 24 hours. Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care. Make every effort to quote the patient's own words. A patient tells the nurse practitioner that she has had abdominal pain for the past week. What would be the best response by the nurse practitioner? A) We'll talk more about that later in the interview." B) "Have you ever had any children?" C) "What have you had to eat in the last 4 hours?" D) "Can you point to where it hurts?" Correct Answer: D) "Can you point to where it hurts?" Each principle symptom should be well-characterized, with descriptions of location; along with the other seven attributes. Location: Ask the patient to point to the pain because lay terms may not be specific enough to localize the site of origin. A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the following would be an appropriate response by the nurse to her statement? A) "How does your family react to your pain?" B) "That must be terrible. You probably pinched a nerve." C) "I've had back pain myself and it can be excruciating." D) "How would you say the pain affects your ability to do your daily activities?" Correct Answer: D) "How would you say the pain affects your ability to do your daily activities?" Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity. In recording the childhood illnesses of a patient who denies having had any, which of the following notes by the nurse would be most accurate? A) Patient denies usual childhood illnesses. B) Patient states he was a "very healthy" child. C) Patient states sister had measles, but he didn't. D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio. Correct Answer: D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio. Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic fever, scarlet fever, and polio. They are included in the past history. A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information? A) "Are you allergic to any other drugs?" B) "How often have you received penicillin?" C) "I'll write your allergy on your chart so you won't receive any." D) "Please describe what happens to you when you take penicillin." Correct Answer: D) "Please describe what happens to you when you take penicillin." Allergies, including specific reactions to each medication, such as rash or nausea, must be recorded. The nurse is taking a family history. Important diseases or problems to ask the patient about include: A) emphysema. B) head trauma. C) mental illness. D) fractured bones. Correct Answer: C) mental illness. Specifically ask for any family history of heart disease, high blood pressure, stroke, diabetes, obesity, blood disorders, ovarian cancer, colon cancer, sickle cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness, suicide, seizure disorder, kidney disease, and tuberculosis. The other answers are acquired. The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems Correct Answer: D) Review of systems Most review of systems questions pertain to systems. You may also draw on Review of Systems questions related to the Chief Complaint to establish positives and negatives that help clarify the diagnosis. Which of the following statements represents subjective data obtained from the patient regarding his skin? A) Skin appears dry. B) No obvious lesions C) Denies color change D) Lesion noted lateral aspect right arm Correct Answer: C) Denies color change Remember that the history (from the chief complaint through review of systems) should be limited to patient statements or subjective data—factors that the person says were or were not present. Subjective data is what the patient tells you. The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." A) Medical B) Surgical C) Obstetrics/gynecology D) Psychiatric Correct Answer: B) Surgical Provide information relative to Adult Illnesses in each of four areas: Medical, Surgical, Obstetric/Gynecologic, and Psychiatric. During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse practitioner knows that this occurs because of a decrease in: A) pigmentation B) thyroid stimulating hormone C) phagocytes D) fungacytes Correct Answer: A) pigmentation Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of melanocytes) so the hair looks gray or white and feels thin and fine. The other options are not correct. You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter 6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter 6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter 6 mm; E = evolution Correct Answer: B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter 6 mm; E = evolution You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this? A) macule B) papule C) vesicle D) spider angioma Correct Answer: C) vesicle Vesicle - up to 1.0 cm filled with serous fluid A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's skin condition. On her sacrum there is fullthickness skin loss that is 5 cm in diameter with damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of this pressure ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 Correct Answer: C) Stage 3 A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through underlying muscle. Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Wheals, urticaria, or hives C) Psoriasis D) Purpura Correct Answer: B) Wheals, urticaria, or hives Wheals/urticaria - a somewhat irregular, relatively transient, superficial area of localized skin edema. Ethel is a 68 year old Caucasian female who is new to your area. She shows you multiple brown colored, flat lesions on her face, chest, and hands that have been present for years. You respond that these are likely: A) solar lentigos B) melanomas C) keloids D) fissures Correct Answer: A) solar lentigos solar lentigos are from sun damage, are more common on the face, shoulders, and hands. A 27 year old female patient has three furuncles connected around a hair follicle. You use the following term in your charting: A) nodules B) carbuncle C) macules D) bulla Correct Answer: B) carbuncle Multiple furuncles around a hair follicle form a carbuncle. A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection Correct Answer: C) Psoriasis Psoriasis: silvery scaly papules or plaques, mainly on the extensor surfaces. Pitting: punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. Usually associated with psoriasis. Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview? A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story. B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport. C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport. Correct Answer: C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. The sequence of the interview: Greeting the patient and establishing rapport. Taking notes. Establishing the agenda for the interview. Inviting the patient's story. Expanding and clarifying the patient's story. Sharing the treatment plan. A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely? A) CN IX lesion on the left B) CN X lesion on the left C) CN IX lesion on the right D) CN X lesion on the right Correct Answer: D) CN X lesion on the right In cranial nerve X paralysis, the soft palate fails to rise and the uvula deviates to the opposite side. When performing posterior palpation of the thyroid gland, you should do all fo the following, EXCEPT: A) Have the patient tip his or her head forward and slightly to the side. B) Place your index fingers above the cricoid cartilage. C) Palpate between the sternocleidomastoid muscle and the trachea for the lobes of the thyroid. D) Move your fingers laterally to palpate for the thyroid lobes. Correct Answer: B) Place your index fingers above the cricoid cartilage. Place the fingers of both hands on the patient's neck so that your index fingers are just BELOW the cricoid cartilage. You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is NOT a component of guided questioning? A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer. B) Offering the patient multiple choices in order to clarify the character of the urinary symptoms she is experiencing. C) Asking her to tell you what she means when she states that she has a urinary tract infection. D) Directed questioning starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer. Correct Answer: A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer. Bates p 59, 69-71 Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? 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. Correct Answer: 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. Give the patient free rein for the first 5-10 minutes, listening closely to the conversation. Focus on what seems most important to the patient. Learn to set limits when needed. A brief summary may help you change the subject yet validate any concerns. Do no show your impatience. Which of the following will help to optimize success from a pediatric examination? A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. B) Being very orderly, so as not to miss a portion of the examination. C) Using firmness throughout your examination, letting the child know you are in charge. D) Making sure to place the infant on the table during the examination while Mom watches close by. Correct Answer: A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. With certain exceptions, physical examination does not require use of the examining table, or with the child in a parent's lap. Plan the examination to start with the least distressing procedures and end with the most distressing, usually involving the throat and ears. Patience, distraction, play flexibility in the order of the examination, and caring but firm approach are all key to successfully examining the young child. A patient has come in for an examination and states, "I have this spot in front of my ear lobe here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his: A) occipital node B) thyroid gland C) parotid gland D) none of the above Correct Answer: C) parotid gland The swelling of the parotid gland is seen anterior to the ear lobes and above the angles of the jaw. All of the following are a common or concerning symptom in a health history for a respiratory assessment EXCEPT? A) palpitations B) blood-streaked sputum C) chest pain D) snoring Correct Answer: A) palpitations Chest pain, blood-streaked sputum, and snoring are all common or concerning symptoms in a health history for respiratory assessment. A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? A) Epicanthus B) Ptosis C) Exophthalmos D) Ectropion Correct Answer: C) Exophthalmos Eye protrusion (proptosis or exophthalmos) The nurse practitioner is performing an eye examination using the ophthalmoscope. Which component is NOT part of the ophthalmoscope? A) lens disc B) aperature C) indicator of diopters D) speculum Correct Answer: D) speculum See picture of ophthalmoscope (Bates p 238) A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? A) Conjunctivitis B) Acute iritis C) Corneal abrasion D) Subconjunctival hemorrhage Correct Answer: D) Subconjunctival hemorrhage Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area. The pupil is not affected, vision is not affected and the cornea is clear. May result from trauma, bleeding disorders, or sudden increase in venous pressure, as from a cough. The nurse practitioner is reviewing for a class in age-related changes in the eye. Which of these physiological changes is responsible for presbyopia? A) degeneration of the cornea B) decreased adaptation to darkness C) decreased distance vision abilities D) loss of lens elasticity Correct Answer: D) loss of lens elasticity The lens gradually loses its elasticity, and the eye grows progressively less able to accommodate and focus on nearby objects. Ensuing presbyopia usually becomes noticeable during the fifth decade. (Bates, p 959, 991) Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem? A) You are an alcoholic, aren't you? B) When was your last drink? C) Do you drink 2 to 3 beers every weekend? D) Do you drink alcohol when you are supposed to be working? Correct Answer: B) When was your last drink? Positive answers to two additional questions are highly suspicious for problem drinking: "Have you every had a drinking problem?" and "When was your last drink?" especially if the night before (Bates, p 96-97) A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. B) at 30 feet the patient can read the entire chart. C) the patient can read the chart from 20 feet in the left eye and 30 feet in the right eye, D) the patient can read from 30 feet what a person with normal vision can read from 20 feet. Correct Answer: A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. Visual acuity is expressed as 2 numbers (e.g. 20/30): the first indicates the distance of the patient from the chart, and the second the distance at which a normal eye can read the line of letters (Bates, p 231). Which of the following enables optimal examination of the adult's tympanic membrane? A) Grasp the auricle firmly and pull it downward, backward, and pressed close to the head. B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. C) Pull the ear lobe toward the chin and keep the auricle pulled away from the head. D) Grasp the auricle keeping it in normal position and pressed close to the head. Correct Answer: B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. To straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head (Bates, p 245). In using the ophthalmoscope to assess a patient's eyes, the nurse notices a red glow in the patient's pupils. On the basis of this finding, the nurse would: A) check the light source of the ophthalmoscope to verify that it is functioning. B) consider this a normal reflection of the ophthalmoscope light off the inner retina. C) continue with the ophthalmoscopic examination and refer the patient for further evaluation. D) suspect that there is an opacity in the lens or cornea. Correct Answer: B) consider this a normal reflection of the ophthalmoscope light off the inner retina. Shine the light beam on the pupil and look for the orange glow in the pupil - the red reflex. (Bates, p239). The other responses are not correct. A 15 month old is brought to you for a fever of 101 F and fussiness. The ear examination is as follows: external ear - normal appearance and no tenderness with manipulation; canal - normal diameter without evidence of inflammation; tympanic membrane - bulging, erythematous, and the light reflex is dull. Insufflation is deferred due to pain. What is your diagnosis? A) ruptured tympanic membrane B) cholesteatoma C) otitis media D) otitis externa Correct Answer: C) otitis media Acute otitis media in a symptomatic child typically has a red, bulging tympanic membrane, with a dull or absent light reflex. The nurse practitioner is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction? A) Air conduction is the normal pathway for hearing. B) Vibrations of the bones in the skull cause air conduction. C) Amplitude of sound determines the pitch that is heard. D) Loss of air conduction is called a conductive hearing loss. Correct Answer: A) Air conduction is the normal pathway for hearing. The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction. When examining the ear of a young child, which of the following is the proper technique to use? A) Examine the ear canal and tympanic membrane as the last steps in the exam if the child is sensitive or fearful. B) Pull the auricle downward, outward, and backward for the best view. C) Use the largest speculum possible on the otoscope. D) All of the above. Correct Answer: D) All of the above. If a child is fearful or sensitive because she can't see the ear exam, you might need to restrain her so wait until the end of the exam. Use the largest speculum for the best view. For best visualization, pull the auricle downward, outward, and backward (Bates 867-869). The nurse practitioner might see which of the following physical findings in a patient with otitis externa? A) a bulging, red tympanic membrane B) an unusually prominent short process and prominent handle. C) a chalky, white patch with irregular margins on the inferior part of the tympanic membrane. D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal. Correct Answer: D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal. Frank blood or clear watery drainage (cerebrospinal leak) after trauma suggest a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. (Bates, 245-246)