Nur-634 Midterm
For which of the following patients would
a comprehensive health history be ap-
propriate?
ANS: C
A. A new patient with the chief complaint
of "I sprained my ankle"
Feedback: This patient is here to estab-
B. An established patient with the chief
lish care, and because she is new to
complaint of "I have an upper respiratory
you, a comprehensive health history is
infection"
appropriate.
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"
The following information is recorded in ANS: C
the health history: "The patient complet-
ed 8th grade. He currently lives with his Feedback: Personal and social histo-
wife and two children. He works on old ry information includes educational lev-
cars on the weekend. He works in a glass el, family of origin, current household
factory during the week." Which category status, personal interests, employment,
does it belong to? religious beliefs, military history, and
lifestyle (including diet and exercise
A. Chief complaint habits; use of alcohol, tobacco, and/or
B. Present illness drugs; and sexual preferences and histo-
C. Personal and social history ry). All of this information is documented
D. Review of systems in this example
ANS: A
Mrs. Hill is a 28-year-old African-Ameri-
can with a history of SLE (systemic lu-
Feedback: A "palpable purpura" is usu-
pus erythematosus). She has noticed a
ally associated with a vasculitis. This is
raised, dark red rash on her legs. When
an inflammatory condition of the blood
you press on the rash, it doesn't blanch.
vessels often associated with systemic
What would you tell her regarding her
rheumatic disease. It can cut off circu-
rash?
lation to any portion of the body and
can mimic many other diseases in this
A. It is likely to be related to her lupus.
manner. While allergic and chemical ex-
B. It is likely to be related to an exposure
posures may be a possible cause of the
to a chemical.
rash, this patient's SLE should make you
C. It is likely to be related to an allergic
consider vasculitis
, Nur-634 Midterm
reaction.
D. It should not cause any problems.
ANS: C
Two weeks ago, Mary started a job which
Feedback: Mary's injury probably oc-
requires carrying 40-pound buckets. She
curred by lifting heavy buckets with her
presents with elbow pain worse on the
palms down (toward the bucket). This
right. On examination, it hurts her elbows
caused her chronic overuse injury at
to dorsiflex her hands against resistance
the lateral epicondyle. Medial epicondyli-
when her palms face the floor. What con-
tis has reproducible pain when palmar
dition does she have?
flexion against resistance is performed
and also features tenderness over the
A. Medial epicondylitis (golfer's elbow)
involved epicondyle. Olecranon bursitis
B. Olecranon bursitis
produces erythema and swelling over the
C. Lateral epicondylitis (tennis elbow)
olecranon process. A supracondylar frac-
D. Supracondylar fracture
ture 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 col-
ANS: B
league and are aware that she is a very
talkative person. Which of the following is
Feedback: You can also say, "I want to
a helpful technique to improve the quality
make sure I take good care of this prob-
of the interview for both the provider and
lem because it is very important. We
the patient?
may need to talk about the others at the
next appointment. Is that okay with you?"
A. Allow the patient to speak uninterrupt-
This is a technique that can help you
ed for the duration of the appointment.
to change the subject but, at the same
B. Briefly summarize what you heard
time, validate the patient's concerns; it
from the patient in the first 5 minutes and
also can provide more structure to the
then try to have her focus on one aspect
interview
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 inter-
view.
, Nur-634 Midterm
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 is mobile in both ANS: B
the up-and-down and side-to-side direc-
tions. Which of the following is most like- Feedback: A useful maneuver for dis-
ly? cerning lymph nodes from other masses
in the neck is to check for their mobility
A. Cancer in all directions. Many other masses are
B. Lymph node mobile in only two directions. Cancerous
C. Deep scar masses may also be "fixed," or immobile
D. Muscle
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 can-
ANS: B
cer, for which he had surgery, and arthri-
tis. He has been married for over 40
Feedback: With his past history of colon
years. He denies any tobacco or drug
cancer and with recent weight loss and
use and has not drunk alcohol in over 40
fatigue, a relapse of his colon cancer
years. His parents both died of cancer in
would be expected. Colon cancer usually
their 60s. On examination his vital signs
metastasizes to the liver, creating hard,
are normal. His head, cardiac, and pul-
irregular nodules, which can sometimes
monary examinations are unremarkable.
be palpated on examination. A smooth,
On abdominal examination you hear nor-
large liver which is tender is often seen
mal bowel sounds, but when you palpate
in hepatitis.
his liver it is abnormal. His rectal exam-
ination 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
, Nur-634 Midterm
C. Smooth, large, tender liver
D. Irregula
A 21-year-old college senior presents
to your clinic, complaining of shortness ANS: C
of breath and a nonproductive noctur-
nal cough. She states she used to feel Feedback: Asthma causes shortness of
this way only with extreme exercise, but breath and a nocturnal cough. It is of-
lately she has felt this way continuously. ten associated with a history of aller-
She denies any other upper respiratory gies and can be made worse by exer-
symptoms, chest pain, gastrointestinal cise or irritants such as smoke in a bar.
symptoms, or urinary tract symptoms. On auscultation there can be normal to
Her past medical history is significant decreased air movement. Wheezing is
only for seasonal allergies, for which she heard on expiration and sometimes in-
takes a nasal steroid spray but is other- spiration. The duration of wheezing in ex-
wise on no other medications. She has piration usually correlates with severity
had no surgeries. Her mother has aller- of illness, so it is important to document
gies and eczema and her father has high this length (e.g., wheezes heard halfway
blood pressure. She is an only child. She through exhalation). Realize that in se-
denies smoking and illegal drug use but vere asthma, wheezes may not be heard
drinks three to four alcoholic beverages because of the lack of air movement.
per weekend. She is a junior in finance Paradoxically, these patients may have
at a local university and she has recently more wheezes after treatment, which ac-
started a job as a bartender in town. On tually indicates an improvement in con-
examination she is in no acute distress dition. Peak flow measurements help to
and her temperature is 98.6. Her blood discern this.
pressure is
A 17-year-old high school senior pre-
sents to your clinic in acute respira-
tory distress. Between shallow breaths
ANS: A
he states he was at home finishing
his homework when he suddenly began
Feedback: In left-sided heart failure, flu-
having right-sided chest pain and severe
id starts "backing up" into the lungs be-
shortness of breath. He denies any re-
cause the heart is unable to handle the
cent traumas or illnesses. His past med-
volume. The excess fluid collects in the
ical history is unremarkable. He doesn't
dependent areas, causing crackles in
smoke but drinks several beers on the
weekend. He has tried marijuana several
times but denies any other illegal drugs.
For which of the following patients would
a comprehensive health history be ap-
propriate?
ANS: C
A. A new patient with the chief complaint
of "I sprained my ankle"
Feedback: This patient is here to estab-
B. An established patient with the chief
lish care, and because she is new to
complaint of "I have an upper respiratory
you, a comprehensive health history is
infection"
appropriate.
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"
The following information is recorded in ANS: C
the health history: "The patient complet-
ed 8th grade. He currently lives with his Feedback: Personal and social histo-
wife and two children. He works on old ry information includes educational lev-
cars on the weekend. He works in a glass el, family of origin, current household
factory during the week." Which category status, personal interests, employment,
does it belong to? religious beliefs, military history, and
lifestyle (including diet and exercise
A. Chief complaint habits; use of alcohol, tobacco, and/or
B. Present illness drugs; and sexual preferences and histo-
C. Personal and social history ry). All of this information is documented
D. Review of systems in this example
ANS: A
Mrs. Hill is a 28-year-old African-Ameri-
can with a history of SLE (systemic lu-
Feedback: A "palpable purpura" is usu-
pus erythematosus). She has noticed a
ally associated with a vasculitis. This is
raised, dark red rash on her legs. When
an inflammatory condition of the blood
you press on the rash, it doesn't blanch.
vessels often associated with systemic
What would you tell her regarding her
rheumatic disease. It can cut off circu-
rash?
lation to any portion of the body and
can mimic many other diseases in this
A. It is likely to be related to her lupus.
manner. While allergic and chemical ex-
B. It is likely to be related to an exposure
posures may be a possible cause of the
to a chemical.
rash, this patient's SLE should make you
C. It is likely to be related to an allergic
consider vasculitis
, Nur-634 Midterm
reaction.
D. It should not cause any problems.
ANS: C
Two weeks ago, Mary started a job which
Feedback: Mary's injury probably oc-
requires carrying 40-pound buckets. She
curred by lifting heavy buckets with her
presents with elbow pain worse on the
palms down (toward the bucket). This
right. On examination, it hurts her elbows
caused her chronic overuse injury at
to dorsiflex her hands against resistance
the lateral epicondyle. Medial epicondyli-
when her palms face the floor. What con-
tis has reproducible pain when palmar
dition does she have?
flexion against resistance is performed
and also features tenderness over the
A. Medial epicondylitis (golfer's elbow)
involved epicondyle. Olecranon bursitis
B. Olecranon bursitis
produces erythema and swelling over the
C. Lateral epicondylitis (tennis elbow)
olecranon process. A supracondylar frac-
D. Supracondylar fracture
ture 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 col-
ANS: B
league and are aware that she is a very
talkative person. Which of the following is
Feedback: You can also say, "I want to
a helpful technique to improve the quality
make sure I take good care of this prob-
of the interview for both the provider and
lem because it is very important. We
the patient?
may need to talk about the others at the
next appointment. Is that okay with you?"
A. Allow the patient to speak uninterrupt-
This is a technique that can help you
ed for the duration of the appointment.
to change the subject but, at the same
B. Briefly summarize what you heard
time, validate the patient's concerns; it
from the patient in the first 5 minutes and
also can provide more structure to the
then try to have her focus on one aspect
interview
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 inter-
view.
, Nur-634 Midterm
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 is mobile in both ANS: B
the up-and-down and side-to-side direc-
tions. Which of the following is most like- Feedback: A useful maneuver for dis-
ly? cerning lymph nodes from other masses
in the neck is to check for their mobility
A. Cancer in all directions. Many other masses are
B. Lymph node mobile in only two directions. Cancerous
C. Deep scar masses may also be "fixed," or immobile
D. Muscle
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 can-
ANS: B
cer, for which he had surgery, and arthri-
tis. He has been married for over 40
Feedback: With his past history of colon
years. He denies any tobacco or drug
cancer and with recent weight loss and
use and has not drunk alcohol in over 40
fatigue, a relapse of his colon cancer
years. His parents both died of cancer in
would be expected. Colon cancer usually
their 60s. On examination his vital signs
metastasizes to the liver, creating hard,
are normal. His head, cardiac, and pul-
irregular nodules, which can sometimes
monary examinations are unremarkable.
be palpated on examination. A smooth,
On abdominal examination you hear nor-
large liver which is tender is often seen
mal bowel sounds, but when you palpate
in hepatitis.
his liver it is abnormal. His rectal exam-
ination 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
, Nur-634 Midterm
C. Smooth, large, tender liver
D. Irregula
A 21-year-old college senior presents
to your clinic, complaining of shortness ANS: C
of breath and a nonproductive noctur-
nal cough. She states she used to feel Feedback: Asthma causes shortness of
this way only with extreme exercise, but breath and a nocturnal cough. It is of-
lately she has felt this way continuously. ten associated with a history of aller-
She denies any other upper respiratory gies and can be made worse by exer-
symptoms, chest pain, gastrointestinal cise or irritants such as smoke in a bar.
symptoms, or urinary tract symptoms. On auscultation there can be normal to
Her past medical history is significant decreased air movement. Wheezing is
only for seasonal allergies, for which she heard on expiration and sometimes in-
takes a nasal steroid spray but is other- spiration. The duration of wheezing in ex-
wise on no other medications. She has piration usually correlates with severity
had no surgeries. Her mother has aller- of illness, so it is important to document
gies and eczema and her father has high this length (e.g., wheezes heard halfway
blood pressure. She is an only child. She through exhalation). Realize that in se-
denies smoking and illegal drug use but vere asthma, wheezes may not be heard
drinks three to four alcoholic beverages because of the lack of air movement.
per weekend. She is a junior in finance Paradoxically, these patients may have
at a local university and she has recently more wheezes after treatment, which ac-
started a job as a bartender in town. On tually indicates an improvement in con-
examination she is in no acute distress dition. Peak flow measurements help to
and her temperature is 98.6. Her blood discern this.
pressure is
A 17-year-old high school senior pre-
sents to your clinic in acute respira-
tory distress. Between shallow breaths
ANS: A
he states he was at home finishing
his homework when he suddenly began
Feedback: In left-sided heart failure, flu-
having right-sided chest pain and severe
id starts "backing up" into the lungs be-
shortness of breath. He denies any re-
cause the heart is unable to handle the
cent traumas or illnesses. His past med-
volume. The excess fluid collects in the
ical history is unremarkable. He doesn't
dependent areas, causing crackles in
smoke but drinks several beers on the
weekend. He has tried marijuana several
times but denies any other illegal drugs.
