Nur-634 Midterm Questions with Complete Solutions
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand" Correct Answer-ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health history is appropriate.
The following information is recorded in the health history: "The patient
completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems Correct Answer-ANS: C Feedback: Personal and social history information includes educational level, family of origin, current household status, personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in
this example
Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
D. It should not cause any problems. Correct Answer-ANS: A
Feedback: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory condition of the blood vessels often associated with systemic 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 exposures may be a possible cause of the rash, this
patient's SLE should make you consider vasculitis
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance
when her palms face the floor. What condition does she have? A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture Correct Answer-ANS: C
Feedback: Mary's injury probably occurred by lifting heavy buckets with
her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely.
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-ANS: B
Feedback: You can also say, "I want to make sure I take good care of this problem because it is very important. We may need to talk about the
others at the next appointment. Is that okay with you?" This is a technique that can help you to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the interview
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely?
A. Cancer
B. Lymph node
C. Deep scar
D. Muscle Correct Answer-ANS: B
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 mobile in only two directions. Cancerous masses may also be "fixed," or immobile
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand" Correct Answer-ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health history is appropriate.
The following information is recorded in the health history: "The patient
completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems Correct Answer-ANS: C Feedback: Personal and social history information includes educational level, family of origin, current household status, personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in
this example
Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
D. It should not cause any problems. Correct Answer-ANS: A
Feedback: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory condition of the blood vessels often associated with systemic 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 exposures may be a possible cause of the rash, this
patient's SLE should make you consider vasculitis
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance
when her palms face the floor. What condition does she have? A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture Correct Answer-ANS: C
Feedback: Mary's injury probably occurred by lifting heavy buckets with
her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely.
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-ANS: B
Feedback: You can also say, "I want to make sure I take good care of this problem because it is very important. We may need to talk about the
others at the next appointment. Is that okay with you?" This is a technique that can help you to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the interview
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely?
A. Cancer
B. Lymph node
C. Deep scar
D. Muscle Correct Answer-ANS: B
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 mobile in only two directions. Cancerous masses may also be "fixed," or immobile
