Advanced Health Assessment - Quiz 2
During a routine physical exam of a 44 yo woman you note she has an inverted left nipple. You
decide to investigate because: - ANSThe inversion may be a recent change
A 30 yo F is in the office c/o palpitations and some lightheadedness for the past ?, random
episodes, no detectable pattern. NP notes a mid systolic click with a late systolic murmur heard
best in the apical area. You suspect - ANSMitral valve prolapse (MVP)
All of the following tests require the patient's voice to perform correctly except: - ANS-egophany
-tactile fremitus
-whispered pectoriloquy
auscultation
59 yo M with history of COPD presents with worsening dyspnea. Patient is afebrile, breath
sounds are decreased bilaterally, noted to have JVD and pitting edema of lower extremities.
What is the most likely cause of his dyspnea? - ANSCHF
James Jones 55 yo M smoker presents with thick sputum producing cough. Exam: +tactile
fremitus, resonant percussion, and normal voice transmission. You suspect: - ANSbronchitis
During the breast exam of a 30 year old nulliparous female. The NP palpates several rubbery
areas of the breast tissue. They are slightly tender to palpation and present in both breasts.
Expecting menses in 5 days. Which intervention is best? - ANSTell her to recheck 1 week after
her menses
All of the following symptoms associated with chest pain are likely to represent CAD except? -
ANSpain with inspiration
60 yo landscaper presents to your office to establish care, history of CHF controlled with
medications. Denies cp, edema. Early diastolic ? with opening snap ___. You suspect? -
ANSMitral stenosis
A patient states that she has had a rash on her breast for about 2 weeks. In order to determine
if it is pagets disease you would expect to have all of the following on physical exam EXCEPT -
ANSinverted nipple
You notice a medium-pitched harsh systolic murmur during a routine exam or R upper border of
the sternum. Which of the following is most likely? - ANSAortic stenosis
Which of the following statements in NOT typical of the murmur it is describing? - ANSGrade
II/Grade VI murmur is associated with a thrill?
, A 58 yo dentist presents for routine check up. He has been healthy. Non smoker, does not drink
alcohol. You hear a moderately loud murmur, no palpable thrill. What is the appropriate grade
for this murmur? - ANSGrade 3
57 yo college professor is hospitalized for SOB. As you examine her in ER, JVP of 45 degrees 8
cm above the clavicle. finding is most consistent with which of the following diagnoses? -
ANSRight sided heart failure
What technique should be used to best auscultate the 2nd heart sounds? - ANSDiaphragm of
the stethoscope at 2nd intercostal space at the base of the heart
You hear a split s2 on auscultation of a 25 yo client. What is your best action? - ANSTell them to
hold their breath and repeat
The client has been told he has a heart murmur. He asks you what this means. You explain -
ANSIt is the rushing sound blood makes moving through narrow places. Some are harmless
and others indicate problems
Where would you expect to hear best an abnormal sound with mitral valve insufficiency? -
ANS5th ICS at MCL
when auscultating the heart sounds of a 72 yo client with history of HTN. NP notes an S4. This
finding could indicate - ANSAn increased resistance to ventricular filling
As you assess Ms Jones you recall that the most prevalent cardiac symptom is - ANSFatigue
Joe Tiger presents with complaints of pain in his leg when walking that is relieved with rest. You
perform ABI. Which result would be consistent with physical symptoms? - ANS0.6
As you assess your patient you document Osler's nodes. You realize that this could be a sign
of? - ANSEndocarditis
During the physical exam of 72 yo Mary Rose you note a BP of 140/90. According to JNC 8,
what would you do first? - ANSCalculate cardiac risk
When auscultating a clients heart you note short, high-frequency click (opening snap) after S2
during the beginning of diastole. What could this indicate? - ANSMitral stenosis
To rule out middle lobe pneumonia you would make sure to auscultate - ANSUnder the right
axillae
In assessing a patient with a positive cardiac history, you utilize CHADS scoring. What are the
elements of this scoring system? - ANSHTN, DM, CHF
During a routine physical exam of a 44 yo woman you note she has an inverted left nipple. You
decide to investigate because: - ANSThe inversion may be a recent change
A 30 yo F is in the office c/o palpitations and some lightheadedness for the past ?, random
episodes, no detectable pattern. NP notes a mid systolic click with a late systolic murmur heard
best in the apical area. You suspect - ANSMitral valve prolapse (MVP)
All of the following tests require the patient's voice to perform correctly except: - ANS-egophany
-tactile fremitus
-whispered pectoriloquy
auscultation
59 yo M with history of COPD presents with worsening dyspnea. Patient is afebrile, breath
sounds are decreased bilaterally, noted to have JVD and pitting edema of lower extremities.
What is the most likely cause of his dyspnea? - ANSCHF
James Jones 55 yo M smoker presents with thick sputum producing cough. Exam: +tactile
fremitus, resonant percussion, and normal voice transmission. You suspect: - ANSbronchitis
During the breast exam of a 30 year old nulliparous female. The NP palpates several rubbery
areas of the breast tissue. They are slightly tender to palpation and present in both breasts.
Expecting menses in 5 days. Which intervention is best? - ANSTell her to recheck 1 week after
her menses
All of the following symptoms associated with chest pain are likely to represent CAD except? -
ANSpain with inspiration
60 yo landscaper presents to your office to establish care, history of CHF controlled with
medications. Denies cp, edema. Early diastolic ? with opening snap ___. You suspect? -
ANSMitral stenosis
A patient states that she has had a rash on her breast for about 2 weeks. In order to determine
if it is pagets disease you would expect to have all of the following on physical exam EXCEPT -
ANSinverted nipple
You notice a medium-pitched harsh systolic murmur during a routine exam or R upper border of
the sternum. Which of the following is most likely? - ANSAortic stenosis
Which of the following statements in NOT typical of the murmur it is describing? - ANSGrade
II/Grade VI murmur is associated with a thrill?
, A 58 yo dentist presents for routine check up. He has been healthy. Non smoker, does not drink
alcohol. You hear a moderately loud murmur, no palpable thrill. What is the appropriate grade
for this murmur? - ANSGrade 3
57 yo college professor is hospitalized for SOB. As you examine her in ER, JVP of 45 degrees 8
cm above the clavicle. finding is most consistent with which of the following diagnoses? -
ANSRight sided heart failure
What technique should be used to best auscultate the 2nd heart sounds? - ANSDiaphragm of
the stethoscope at 2nd intercostal space at the base of the heart
You hear a split s2 on auscultation of a 25 yo client. What is your best action? - ANSTell them to
hold their breath and repeat
The client has been told he has a heart murmur. He asks you what this means. You explain -
ANSIt is the rushing sound blood makes moving through narrow places. Some are harmless
and others indicate problems
Where would you expect to hear best an abnormal sound with mitral valve insufficiency? -
ANS5th ICS at MCL
when auscultating the heart sounds of a 72 yo client with history of HTN. NP notes an S4. This
finding could indicate - ANSAn increased resistance to ventricular filling
As you assess Ms Jones you recall that the most prevalent cardiac symptom is - ANSFatigue
Joe Tiger presents with complaints of pain in his leg when walking that is relieved with rest. You
perform ABI. Which result would be consistent with physical symptoms? - ANS0.6
As you assess your patient you document Osler's nodes. You realize that this could be a sign
of? - ANSEndocarditis
During the physical exam of 72 yo Mary Rose you note a BP of 140/90. According to JNC 8,
what would you do first? - ANSCalculate cardiac risk
When auscultating a clients heart you note short, high-frequency click (opening snap) after S2
during the beginning of diastole. What could this indicate? - ANSMitral stenosis
To rule out middle lobe pneumonia you would make sure to auscultate - ANSUnder the right
axillae
In assessing a patient with a positive cardiac history, you utilize CHADS scoring. What are the
elements of this scoring system? - ANSHTN, DM, CHF
