NSG 464: Physical Assessment for Advanced
|\ |\ |\ |\ |\ |\
Practice Midterm exam with correct answers |\ |\ |\ |\ |\
A 19 y/o college student, Todd, is brought to your clinic by his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mother. She is concerned that there is something seriously wrong
|\ |\ |\ |\ |\ |\ |\ |\ |\
with him. She states for the past 6 months his behavior has
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
become peculiar and he has flunked out of college. Todd denies
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
any recent illness or injuries. His past medical history is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
remarkable only for a broken foot. His parents are both healthy. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He has a paternal uncle who had similar symptoms in college.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
The patient admits to smoking cigarettes and drinking alcohol.
|\ |\ |\ |\ |\ |\ |\ |\ |\
He also admits to marijuana use but none in the last week. He
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
denies using any other substances. He denies any feelings of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
depression or anxiety. While speaking with Todd and his mother |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
you do a complete physical examination, which is essentially
|\ |\ |\ |\ |\ |\ |\ |\ |\
normal. When you question him on how he is feeling, he says
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
that he is very worried that Microsoft has stolen his software for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
creating a better browser. He tells you he has seen a - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔D. Schizophrenia |\ |\ |\
Rationale: Schizophrenia generally occurs in the late teens to
|\ |\ |\ |\ |\ |\ |\ |\ |\
early 20s. It often is seen in other family members, as in this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
case. Symptoms must be present for at least 6 months and must
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
have at least two features of 1. delusions (e.g. Microsoft is after
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
his programs); 2. hallucinations (e.g. technicians sending
|\ |\ |\ |\ |\ |\ |\
telepathic signals); 3. disorganized speech, 4. disorganized
|\ |\ |\ |\ |\ |\ |\
behavior, and 5. negative symptoms such as flat affect|\ |\ |\ |\ |\ |\ |\ |\
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 chief complaint of "I am here to establish
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care"
D. A new patient with the chief complaint of "I cut my hand" -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔C. A new patient with chief complaint of
|\ |\ |\ |\ |\ |\ |\ |\ |\
"I am here to establish care"
|\ |\ |\ |\ |\ |\
rationale: this patient is here to establish care, and because she
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is new to you, a comprehensive health history is appropriate
|\ |\ |\ |\ |\ |\ |\ |\ |\
The components of the health history include all of the following
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
except which one? |\ |\
A. Review of systems
|\ |\ |\
B. Thorax and Lungs
|\ |\ |\ |\
C. Present Illness
|\ |\
D. Personal and social items - CORRECT ANSWERS ✔✔B. Thorax
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and Lungs |\ |\
rationale: the thorax and lungs are part of the physical|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
examination, not part of the health history. The other answers are |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
all part of a complete health history
|\ |\ |\ |\ |\ |\ |\
Is the following information subjective or objective? Mr. M has
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
shortness of breath that has persisted for the past 10 days, it is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
worse with activity, and relieved by rest.
|\ |\ |\ |\ |\ |\ |\
,A. Subjective
|\
B. Objective - CORRECT ANSWERS ✔✔A. Subjective
|\ |\ |\ |\ |\ |\ |\
Rationale: This is information given by the patient about the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
circumstances of his chief complaint. It doesn't represent an |\ |\ |\ |\ |\ |\ |\ |\ |\
objective observation by the examiner |\ |\ |\ |\
Is the following information subjective or objective? Mr. M has a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
respiratory rate of 32 and a pulse rate of 120. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A. Subjective
|\ |\
B. Objective - CORRECT ANSWERS ✔✔B. Objective
|\ |\ |\ |\ |\ |\ |\
Rationale: This is a measurement obtained by the examiner, so it
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is considered objective data. The patient is unlikely to be able to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
give this information to the examiner
|\ |\ |\ |\ |\
The following information is recorded in the health history: "The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
patient had had abdominal pain for 1 week. The pain lasts for 30
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minutes at a time, it comes and goes. The severity is 7 to 9 on a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
scale of 1-10. It is accompanied by nausea and vomiting. It is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
located in the mid-epigastric area". Which of these categories
|\ |\ |\ |\ |\ |\ |\ |\ |\
does it belong to? |\ |\ |\
A. Chief complaint
|\ |\ |\
B. Present Illness
|\ |\ |\
C. Personal and social history
|\ |\ |\ |\ |\
D. Review of systems - CORRECT ANSWERS ✔✔B. Present Illness
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
, Rationale: This info describes the problem of abdominal pain,
|\ |\ |\ |\ |\ |\ |\ |\ |\
which is the present illness. The interviewer has obtained the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
location, timing, severity, and associated manifestations of the
|\ |\ |\ |\ |\ |\ |\ |\
pain, the setting in which it occurred, and the factors that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
aggravate and relieve the pain. You will notice that it does
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
include portions of the pertinent review of systems, but because
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
it related directly to the chief complaint, it is included in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
history of present illness.|\ |\ |\
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 ANSWERS ✔✔C. Personal and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
social history |\ |\
Rationale: Personal and social history information includes
|\ |\ |\ |\ |\ |\ |\
educational level, family of origin, current household status,
|\ |\ |\ |\ |\ |\ |\ |\
personal interest, employment, religious beliefs, military history,
|\ |\ |\ |\ |\ |\ |\
and lifestyle (including diet and exercise habits; use of alcohol,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tobacco, and drugs; sexual preferences and history). All of this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information is documented in this example |\ |\ |\ |\ |\
The following information is recorded in the health history: "I feel
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
really tired". Which category does this belong to?
|\ |\ |\ |\ |\ |\ |\
A. Chief complaint
|\ |\ |\
|\ |\ |\ |\ |\ |\
Practice Midterm exam with correct answers |\ |\ |\ |\ |\
A 19 y/o college student, Todd, is brought to your clinic by his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
mother. She is concerned that there is something seriously wrong
|\ |\ |\ |\ |\ |\ |\ |\ |\
with him. She states for the past 6 months his behavior has
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
become peculiar and he has flunked out of college. Todd denies
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
any recent illness or injuries. His past medical history is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
remarkable only for a broken foot. His parents are both healthy. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He has a paternal uncle who had similar symptoms in college.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
The patient admits to smoking cigarettes and drinking alcohol.
|\ |\ |\ |\ |\ |\ |\ |\ |\
He also admits to marijuana use but none in the last week. He
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
denies using any other substances. He denies any feelings of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
depression or anxiety. While speaking with Todd and his mother |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
you do a complete physical examination, which is essentially
|\ |\ |\ |\ |\ |\ |\ |\ |\
normal. When you question him on how he is feeling, he says
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
that he is very worried that Microsoft has stolen his software for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
creating a better browser. He tells you he has seen a - CORRECT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
ANSWERS ✔✔D. Schizophrenia |\ |\ |\
Rationale: Schizophrenia generally occurs in the late teens to
|\ |\ |\ |\ |\ |\ |\ |\ |\
early 20s. It often is seen in other family members, as in this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
case. Symptoms must be present for at least 6 months and must
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
have at least two features of 1. delusions (e.g. Microsoft is after
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
his programs); 2. hallucinations (e.g. technicians sending
|\ |\ |\ |\ |\ |\ |\
telepathic signals); 3. disorganized speech, 4. disorganized
|\ |\ |\ |\ |\ |\ |\
behavior, and 5. negative symptoms such as flat affect|\ |\ |\ |\ |\ |\ |\ |\
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 chief complaint of "I am here to establish
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care"
D. A new patient with the chief complaint of "I cut my hand" -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔C. A new patient with chief complaint of
|\ |\ |\ |\ |\ |\ |\ |\ |\
"I am here to establish care"
|\ |\ |\ |\ |\ |\
rationale: this patient is here to establish care, and because she
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is new to you, a comprehensive health history is appropriate
|\ |\ |\ |\ |\ |\ |\ |\ |\
The components of the health history include all of the following
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
except which one? |\ |\
A. Review of systems
|\ |\ |\
B. Thorax and Lungs
|\ |\ |\ |\
C. Present Illness
|\ |\
D. Personal and social items - CORRECT ANSWERS ✔✔B. Thorax
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and Lungs |\ |\
rationale: the thorax and lungs are part of the physical|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
examination, not part of the health history. The other answers are |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
all part of a complete health history
|\ |\ |\ |\ |\ |\ |\
Is the following information subjective or objective? Mr. M has
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
shortness of breath that has persisted for the past 10 days, it is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
worse with activity, and relieved by rest.
|\ |\ |\ |\ |\ |\ |\
,A. Subjective
|\
B. Objective - CORRECT ANSWERS ✔✔A. Subjective
|\ |\ |\ |\ |\ |\ |\
Rationale: This is information given by the patient about the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
circumstances of his chief complaint. It doesn't represent an |\ |\ |\ |\ |\ |\ |\ |\ |\
objective observation by the examiner |\ |\ |\ |\
Is the following information subjective or objective? Mr. M has a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
respiratory rate of 32 and a pulse rate of 120. |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A. Subjective
|\ |\
B. Objective - CORRECT ANSWERS ✔✔B. Objective
|\ |\ |\ |\ |\ |\ |\
Rationale: This is a measurement obtained by the examiner, so it
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
is considered objective data. The patient is unlikely to be able to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
give this information to the examiner
|\ |\ |\ |\ |\
The following information is recorded in the health history: "The
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
patient had had abdominal pain for 1 week. The pain lasts for 30
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
minutes at a time, it comes and goes. The severity is 7 to 9 on a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
scale of 1-10. It is accompanied by nausea and vomiting. It is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
located in the mid-epigastric area". Which of these categories
|\ |\ |\ |\ |\ |\ |\ |\ |\
does it belong to? |\ |\ |\
A. Chief complaint
|\ |\ |\
B. Present Illness
|\ |\ |\
C. Personal and social history
|\ |\ |\ |\ |\
D. Review of systems - CORRECT ANSWERS ✔✔B. Present Illness
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
, Rationale: This info describes the problem of abdominal pain,
|\ |\ |\ |\ |\ |\ |\ |\ |\
which is the present illness. The interviewer has obtained the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
location, timing, severity, and associated manifestations of the
|\ |\ |\ |\ |\ |\ |\ |\
pain, the setting in which it occurred, and the factors that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
aggravate and relieve the pain. You will notice that it does
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
include portions of the pertinent review of systems, but because
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
it related directly to the chief complaint, it is included in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
history of present illness.|\ |\ |\
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 ANSWERS ✔✔C. Personal and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
social history |\ |\
Rationale: Personal and social history information includes
|\ |\ |\ |\ |\ |\ |\
educational level, family of origin, current household status,
|\ |\ |\ |\ |\ |\ |\ |\
personal interest, employment, religious beliefs, military history,
|\ |\ |\ |\ |\ |\ |\
and lifestyle (including diet and exercise habits; use of alcohol,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tobacco, and drugs; sexual preferences and history). All of this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information is documented in this example |\ |\ |\ |\ |\
The following information is recorded in the health history: "I feel
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
really tired". Which category does this belong to?
|\ |\ |\ |\ |\ |\ |\
A. Chief complaint
|\ |\ |\
