Nur-634 Midterm 2025
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"
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
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.
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
We have an expert-written solution to this problem!
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
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.
We have an expert-written solution to this problem!
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.
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
We have an expert-written solution to this problem!
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
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
We have an expert-written solution to this problem!
A 77-year-old retired bus driver comes to your clinic for a physical examination at his
wife's request. He has recently been losing weight and has felt very fatigued. He has had
no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history
includes colon cancer, for which he had surgery, and arthritis. He has been married for
over 40 years. He denies any 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
ANS: B
Feedback: With his past history of colon cancer and with recent weight loss and fatigue,
a relapse of his colon cancer would be expected. Colon cancer usually metastasizes to
the liver, creating hard, irregular nodules, which can sometimes be palpated on
examination. A smooth, large liver which is tender is often seen in hepatitis.
A 21-year-old college senior presents to your clinic, complaining of shortness of breath
and a nonproductive nocturnal cough. She states she used to feel this way only with
extreme exercise, but lately she has felt this way continuously. She denies any other
upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract
symptoms. Her past medical history is significant only for seasonal allergies, for which
she takes a nasal steroid spray but is otherwise on no other medications. She has had no
surgeries. Her mother has allergies and eczema and her father has high blood pressure.
She is an only child. She denies 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
ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often
associated with a history of allergies and can be made worse by exercise or irritants
such as smoke in a bar. On auscultation there can be normal to decreased air movement.
Wheezing is heard on expiration and sometimes inspiration. The duration of wheezing in
expiration usually correlates with severity of illness, so it is important to document this
length (e.g., wheezes heard halfway through exhalation). Realize that in severe asthma,
wheezes may not be heard because of the lack of air movement. Paradoxically, these
patients may have more wheezes after treatment, which actually indicates an
improvement in condition. Peak flow measurements help to discern this.
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"
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
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.
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
We have an expert-written solution to this problem!
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
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.
We have an expert-written solution to this problem!
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.
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
We have an expert-written solution to this problem!
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
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
We have an expert-written solution to this problem!
A 77-year-old retired bus driver comes to your clinic for a physical examination at his
wife's request. He has recently been losing weight and has felt very fatigued. He has had
no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history
includes colon cancer, for which he had surgery, and arthritis. He has been married for
over 40 years. He denies any 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
ANS: B
Feedback: With his past history of colon cancer and with recent weight loss and fatigue,
a relapse of his colon cancer would be expected. Colon cancer usually metastasizes to
the liver, creating hard, irregular nodules, which can sometimes be palpated on
examination. A smooth, large liver which is tender is often seen in hepatitis.
A 21-year-old college senior presents to your clinic, complaining of shortness of breath
and a nonproductive nocturnal cough. She states she used to feel this way only with
extreme exercise, but lately she has felt this way continuously. She denies any other
upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract
symptoms. Her past medical history is significant only for seasonal allergies, for which
she takes a nasal steroid spray but is otherwise on no other medications. She has had no
surgeries. Her mother has allergies and eczema and her father has high blood pressure.
She is an only child. She denies 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
ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often
associated with a history of allergies and can be made worse by exercise or irritants
such as smoke in a bar. On auscultation there can be normal to decreased air movement.
Wheezing is heard on expiration and sometimes inspiration. The duration of wheezing in
expiration usually correlates with severity of illness, so it is important to document this
length (e.g., wheezes heard halfway through exhalation). Realize that in severe asthma,
wheezes may not be heard because of the lack of air movement. Paradoxically, these
patients may have more wheezes after treatment, which actually indicates an
improvement in condition. Peak flow measurements help to discern this.
