Bates Chapters 18–24 Exam Review: Abdomen, Musculoskeletal, Neuro, Reproductive – Questions & Answers

Downloaded by Mike Splendid () Bates Chapters 18–24 Exam Review: Abdomen, Musculoskeletal, Neuro, Reproductive – Questions & Answers ---------------------------------------------------------------------------------------------------------------------------------------------------------- Chapter 18: Breasts and Axilla (Q25) Chapter 19: The Abdomen (Q25) Chapter 20: Male Genitalia and Hernias (Q25) Chapter 21: Female Genitalia (Q25) Chapter 22: Anus, rectum, and Prostate (Q25) Chapter 23: The Musculoskeletal System (Q25) Chapter 24: Nervous System (Q25) ------------------------------------------------------------------------------------------------------------------------------------------------------- Chapter 18: Breasts and Axilla 1. Which of the following statements is true regarding the internal structures of the breast? The breast is made up of: Fibrous, glandular, and adipose tissues. 2. In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper outer quadrant is: The location of most breast tumors. 3. In performing an assessment of a woman's axillary lymph system, the nurse should assess which of these nodes? Central, lateral, pectoral, and subscapular 4. If a patient reports a recent breast infection, then the nurse should expect to find node enlargement. Ipsilateral axillary 5. A 9-year-old girl is in the clinic for a sport physical examination. After some initial shyness she finally asks, Am I normal? I don’t seem to need a bra yet, but I have some friends who do. What if I never get breasts? The nurse’s best response would be: I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age. 6. A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the nurse’s best response? Tell the mother that: Although an examination of her daughter would rule out a problem, her breast development is most likely normal.Downloaded by Mike Splendid () 7. A 14-year-old girl is anxious about not having reached menarche. When taking the health history, the nurse should ascertain which of the following? The age that: The girl began to develop breasts. 8. A woman is in the family planning clinic seeking birth control information. She states that her breasts change all month long and that she is worried that this is unusual. What is the nurse’s best response? The nurse should tell her that: Because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common. 9. A woman has just learned that she is pregnant. What are some things the nurse should teach her about her breasts? She can expect her areolae to become larger and darker in color. 10. The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy. 11. A 65-year-old patient remarks that she just cannot believe that her breasts sag so much. She states it must be from a lack of exercise. What explanation should the nurse offer her? After menopause: The glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag. 12. In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurse’s best course of action? Explain that this condition may be the result of hormonal changes, and recommend that he see his physician. 13. During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding. What should the nurse do next? Assess the girl’s weight and body mass index (BMI). 14. The nurse is reviewing statistics regarding breast cancer. Which woman, aged 40 years in the United States, has the highest risk for developing breast cancer? Black 15. The nurse is preparing for a class in early detection of breast cancer. Which statement is true with regard to breast cancer in black women in the United States? Black women are more likely to die of breast cancer at any age. 16. During a breast health interview, a patient states that she has noticed pain in her left breast. The nurses most appropriate response to this would be: I would like some more information about the pain in your left breast. 17. During a health history interview, a female patient states that she has noticed a few drops of clear discharge from her right nipple. What should the nurse do next? Ask the patient some additional questions about the medications she is taking.Downloaded by Mike Splendid () 18. During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for approximately 2 weeks. In trying to find the cause of the rash, which question would be important for the nurse to ask? Where did the rash first appearon the nipple, the areola, or the surrounding skin? 19. A patient is newly diagnosed with benign breast disease. The nurse recognizes which statement about benign breast disease to be true? The presence of benign breast disease: Makes it hard to examine the breasts. 20. During an annual physical examination, a 43-year-old patient states that she does not perform monthly breast self-examinations (BSEs). She tells the nurse that she believes that mammograms do a much better job than I ever could to find a lump. The nurse should explain to her that: BSEs may detect lumps that appear between mammograms. 21. During an interview, a patient reveals that she is pregnant. She states that she is not sure whether she will breastfeed her baby and asks for some information about this. Which of these statements by the nurse is accurate? Breastfeeding provides the perfect food and antibodies for your baby. 22. The nurse is reviewing risk factors for breast cancer. Which of these women have risk factors that place them at a higher risk for breast cancer? 65-year-old whose mother had breast cancer 23. During an examination of a woman, the nurse notices that her left breast is slightly larger than her right breast. Which of these statements is true about this finding? Asymmetry is not unusual, but the nurse should verify that this change is not new. 24. The nurse is assisting with a BSE clinic. Which of these women reflect abnormal findings during the inspection phase of breast examination? Woman whose nipples are in different planes (deviated). 25. During the physical examination, the nurse notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate? Whether the inversion is a recent change should be determined. Chapter 19: The Abdomen 1. The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear? Dullness 2. Which structure is located in the left lower quadrant of the abdomen? Sigmoid colonDownloaded by Mike Splendid () 3. A patient is having difficulty swallowing medications and food. The nurse would document that this patient has: Dysphagia. 4. The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition? Percuss and palpate the midline area above the suprapubic bone. 5. The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is: Decreased gastric acid secretion. 6. A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handle bars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of the spleen in this situation? An enlarged spleen should not be palpated because it can easily rupture. 7. A patient’s abdomen is bulging and stretched in appearance. The nurse should describe this finding as: Protuberant. 8. The nurse is describing a scaphoid abdomen. To the horizontal plane, a scaphoid contour of the abdomen depicts a profile. Concave 9. While examining a patient, the nurse observes abdominal pulsations between the xiphoid process and umbilicus. The nurse would suspect that these are: Normal abdominal aortic pulsations. 10. A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is: Peritonitis. 11. The nurse is watching a new graduate nurse perform auscultation of a patient’s abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen? Auscultation prevents distortion of bowel sounds that might occur after percussion and palpation. 12. The nurse is listening to bowel sounds. Which of these statements is true of bowel sounds? Bowel sounds: Are usually high-pitched, gurgling, and irregular sounds. 13. The physician comments that a patient has abdominal borborygmi. The nurse knows that this term refers to: Hyperactive bowel sounds.Downloaded by Mike Splendid () 14. During an abdominal assessment, the nurse would consider which of these findings as normal? Tympanic percussion note in the umbilical region 15. The nurse is assessing the abdomen of a pregnant woman who is complaining of having acid indigestion all the time. The nurse knows that esophageal reflux during pregnancy can cause: Pyrosis. 16. The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include: Tympany, hyperresonance, and dullness. 17. An older patient has been diagnosed with pernicious anemia. The nurse knows that this condition could be related to: Decreased gastric acid secretion. 18. A patient is complaining of a sharp pain along the costovertebral angles. The nurse is aware that this symptom is most often indicative of: Kidney inflammation. 19. A nurse notices that a patient has ascites, which indicates the presence of: Fluid. 20. The nurse knows that during an abdominal assessment, deep palpation is used to determine: Enlarged organs. 21. The nurse notices that a patient has had a black, tarry stool and recalls that a possible cause would be: Gastrointestinal bleeding. 22. During an abdominal assessment, the nurse elicits tenderness on light palpation in the right lower quadrant. The nurse interprets that this finding could indicate a disorder of which of these structures? Appendix 23. The nurse is assessing the abdomen of an older adult. Which statement regarding the older adult and abdominal assessment is true? Abdominal musculature is thinner. 24. During an assessment of a newborn infant, the nurse recalls that pyloric stenosis would be exhibited by: Projectile vomiting. 25. The nurse is reviewing the assessment of an aortic aneurysm. Which of these statements is true regarding an aortic aneurysm? A pulsating mass is usually present. Chapter 20: Male Genitalia and Hernias 1. The external male genital structures include the: Scrotum.Downloaded by Mike Splendid () 2. An accessory glandular structure for the male genital organs is the: Prostate. 3. Which of these statements is true regarding the penis? The corpus spongiosum expands into a cone of erectile tissue called the glans. 4. When performing a genital examination on a 25-year-old man, the nurse notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the nurse would: Consider this finding as normal, and proceed with the examination. 5. Which statement concerning the testes is true? The cremaster muscle contracts in response to cold and draws the testicles closer to the body. 6. A male patient with possible fertility problems asks the nurse where sperm is produced. The nurse knows that sperm production occurs in the: Testes. 7. A 62-year-old man states that his physician told him that he has an inguinal hernia. He asks the nurse to explain what a hernia is. The nurse should: Explain that a hernia is a loop of bowel protruding through a weak spot in the abdominal muscles. 8. The mother of a 10-year-old boy asks the nurse to discuss the recognition of puberty. The nurse should reply by saying: The first sign of puberty is an enlargement of the testes. 9. During an examination of an aging man, the nurse recognizes that normal changes to expect would be: Decreased penis size. 10. An older man is concerned about his sexual performance. The nurse knows that in the absence of disease, a withdrawal from sexual activity later in life may be attributable to: Side effects of medications. 1 1. A 59-year-old patient has been diagnosed with prostatitis and is being seen at the clinic for complaints of burning and pain during urination. He is experiencing: Dysuria. 12. A 45-year-old mother of two children is seen at the clinic for complaints of losing my urine when I sneeze. The nurse documents that she is experiencing: Stress incontinence.Downloaded by Mike Splendid () 13. When the nurse is conducting sexual history from a male adolescent, which statement would be most appropriate to use at the beginning of the interview? Often adolescents your age have questions about sexual activity. 14. Which of these statements is most appropriate when the nurse is obtaining a genitourinary history from an older man? Do you need to get up at night to urinate? 15. When the nurse is performing a genital examination on a male patient, the patient has an erection. The nurses most appropriate action or response is to: Reassure the patient that this is a normal response and continue with the examination. 16. The nurse is examining the glans and knows which finding is normal for this area? Smegma may be present under the foreskin of an uncircumcised male. 17. When performing a genitourinary assessment, the nurse notices that the urethral meatus is ventrally positioned. This finding is: Called hypospadias. 18. The nurse is performing a genital examination on a male patient and notices urethral drainage. When collecting urethral discharge for microscopic examination and culture, the nurse should: Compress the glans between the examiners thumb and forefinger, and collect any discharge. 19. When assessing the scrotum of a male patient, the nurse notices the presence of multiple firm, nontender, yellow 1-cm nodules. The nurse knows that these nodules are most likely: Sebaceous cysts. 20. When performing a scrotal assessment, the nurse notices that the scrotal contents show a red glow with transillumination. On the basis of this finding the nurse would: Suspect the presence of serous fluid in the scrotum. 21. When the nurse is performing a genital examination on a male patient, which action is correct? Having the patient shift his weight onto the left (unexamined) leg when palpating for a hernia on the right side 22. The nurse is aware of which statement to be true regarding the incidence of testicular cancer? Men with a history of cryptorchidism are at the greatest risk for the development of testicular cancer. 23. The nurse is describing how to perform a testicular self-examination to a patient. Which statement is most appropriate? If you notice an enlarged testicle or a painless lump, call your health care provider.Downloaded by Mike Splendid () 24. A 2-month-old uncircumcised infant has been brought to the clinic for a well-baby checkup. How would the nurse proceed with the genital examination? Retracting the foreskin should be avoided until the infant is 3 months old. 25. A 2-year-old boy has been diagnosed with physiologic cryptorchidism. Considering this diagnosis, during assessment the nurse will most likely observe: Absence of the testis in the scrotum, but the testis can be milked down. Chapter 21: Female Genitalia 1. During a health history, a 22-year-old woman asks, Can I get that vaccine for human papilloma virus (HPV)? I have genital warts and I’d like them to go away! What is the nurse’s best response? The vaccine cannot protect you if you already have an HPV infection. 2. During an examination, the nurse observes a female patient’s vestibule and expects to see the: Urethral meatus and vaginal orifice. 3. During a speculum inspection of the vagina, the nurse would expect to see what at the end of the vaginal canal? Cervix 4. The uterus is usually positioned tilting forward and superior to the bladder. This position is known as: Anteverted and anteflexed. 5. An 11-year-old girl is in the clinic for a sport’s physical examination. The nurse notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. The nurse should use which of these techniques to best assist the young girl in understanding the expected sequence for development? The nurse should: Use the Tanner scale on the five stages of sexual development. 6. A woman who is 8 weeks pregnant is in the clinic for a checkup. The nurse reads on her chart that her cervix is softened and looks cyanotic. The nurse knows that the woman is exhibiting sign and sign. Goodell; Chadwick 7. Generally, the changes normally associated with menopause occur because the cells in the reproductive tracts are: Estrogen dependent.Downloaded by Mike Splendid () 8. The nurse is reviewing the changes that occur with menopause. Which changes are associated with menopause? Uterine and ovarian atrophy, along with a thinning of the vaginal epithelium 9. A 54-year-old woman who has just completed menopause is in the clinic today for a yearly physical examination. Which of these statements should the nurse include in patient education? A postmenopausal woman: Should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions. 10. A woman is in the clinic for an annual gynecologic examination. The nurse should plan to begin the interview with the: Menstrual history, because it is generally nonthreatening. 11. A patient has had three pregnancies and two live births. The nurse would record this information as grav , para ___, AB . 3; 2; 1 12. During the interview with a female patient, the nurse gathers data that indicate the patient is perimenopausal. Which of these statements made by this patient leads to this conclusion? I have been noticing that I sweat a lot more than I used to, especially at night. 13. A 50-year-old woman calls the clinic because she has noticed some changes in her body and breasts and wonders if these changes could be attributable to the hormone replacement therapy (HRT) she started 3 months earlier. The nurse should tell her: HRT has several side effects, including fluid retention, breast tenderness, and vaginal bleeding. 14. A 52-year-old patient states that when she sneezes or coughs she wets herself a little. She is very concerned that something may be wrong with her. The nurse suspects that the problem is: Stress incontinence. 15. During the interview, a patient reveals that she has some vaginal discharge. She is worried that it may be a sexually transmitted infection. The nurse’s most appropriate response to this would be: I'd like some information about the discharge. What color is it? 16. A woman states that 2 weeks ago she had a urinary tract infection that was treated with an antibiotic. As a part of the interview, the nurse should ask, have you noticed any: Unusual vaginal discharge or itching? 17. Which statement would be most appropriate when the nurse is introducing the topic of sexual relationships during an interview? Women often have questions about their sexual relationship and how it affects their health. Do you have any questions?Downloaded by Mike Splendid () 18. A 22-year-old woman has been considering using oral contraceptives. As a part of her health history, the nurse should ask: If you smoke, how many cigarettes do you smoke per day? 19. A married couple has come to the clinic seeking advice on pregnancy. They have been trying to conceive for 4 months and have not been successful. What should the nurse do first? Explain that couples are considered infertile after 1 year of unprotected intercourse. 20. A nurse is assessing a patient’s risk of contracting a sexually transmitted infection (STI). An appropriate question to ask would be: Do you use a condom with each episode of sexual intercourse? 21. When the nurse is interviewing a preadolescent girl, which opening question would be least threatening? When did you notice that your body was changing? 22. When the nurse is discussing sexuality and sexual issues with an adolescent, a permission statement helps convey that it is normal to think or feel a certain way. Which statement is the best example of a permission statement? Girls your age often have questions about sexual activity. Do you have any questions? 23. The nurse is preparing to interview a postmenopausal woman. Which of these statements is true as it applies to obtaining the health history of a postmenopausal woman? The nurse should ask a postmenopausal woman if she has ever had vaginal bleeding. 24. During the examination portion of a patients visit, she will be in lithotomy position. Which statement reflects some things that the nurse can do to make this position more comfortable for her? Elevate her head and shoulders to maintain eye contact. 25. An 18-year-old patient is having her first pelvic examination. Which action by the nurse is appropriate? Raising the head of the examination table and giving her a mirror so that she can view the examination Chapter 22: Anus, rectum, and Prostate 1. Which statement concerning the anal canal is true? The anal canal: Is the outlet for the gastrointestinal tract. 2. Which statement concerning the sphincters is correct? The external sphincter is under voluntary control.Downloaded by Mike Splendid () 3. The nurse is performing an examination of the anus and rectum. Which of these statements is correct and important to remember during this examination? The anorectal junction cannot be palpated. 4. The structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm is the: Prostate gland. 5. A 46-year-old man requires an assessment of his sigmoid colon. Which instrument or technique is most appropriate for this examination? Colonoscope 6. The nurse is caring for a newborn infant. Thirty hours after birth, the infant passes a dark green meconium stool. The nurse recognizes this is important because the: Stool indicates anal patency. 7. During the assessment of an 18-month-old infant, the mother expresses concern to the nurse about the infant’s inability to toilet train. What would be the nurse’s best response? The nerves that will allow your baby to have control over the passing of stools are not developed until at least 18 to 24 months of age. 8. A 60-year-old man has just been told that he has benign prostatic hypertrophy (BPH). He has a friend who just died from cancer of the prostate. He is concerned this will happen to him. How should the nurse respond? The enlargement of your prostate is caused by hormonal changes, and not cancer. 9. A 30-year-old woman is visiting the clinic because of pain in my bottom when I have a bowel movement. The nurse should assess for which problem? Hemorrhoids 10. A patient who is visiting the clinic complains of having stomach pains for 2 weeks and describes his stools as being soft and black for approximately the last 10 days. He denies taking any medications. The nurse is aware that these symptoms are mostly indicative of: Occult blood, resulting from gastrointestinal bleeding. 11. After completing an assessment of a 60-year-old man with a family history of colon cancer, the nurse discusses with him early detection measures for colon cancer. The nurse should mention the need for a(n): Colonoscopy every 10 years. 12. The mother of a 5-year-old girl tells the nurse that she has noticed her daughter scratching at her bottom a lot the last few days. During the assessment, the nurse finds redness and raised skin in the anal area. This finding most likely indicates: Pinworms. 13. The nurse is examining only the rectal area of a woman and should place the woman in what position? Left lateral decubitusDownloaded by Mike Splendid () 14. While performing an assessment of the perianal area of a patient, the nurse notices that the pigmentation of anus is darker than the surrounding skin, the anal opening is closed, and a skin sac that is shiny and blue is noted. The patient mentioned that he has had pain with bowel movements and has occasionally noted some spots of blood. What would this assessment and history most likely indicate? Thrombosed hemorrhoid 15. The nurse is preparing to palpate the rectum and should use which of these techniques? The nurse should: Flex the finger, and slowly insert it toward the umbilicus. 16. While performing a rectal examination, the nurse notices a firm, irregularly shaped mass. What should the nurse do next? Report the finding, and refer the patient to a specialist for further examination. 17. During an assessment of the newborn, the nurse expects to see which finding when the anal area is slightly stroked? Quick contraction of the sphincter 18. A 13-year-old girl is visiting the clinic for a sport’s physical examination. The nurse should remember to include which of these tests in the examination? Inspection of the perianal area 19. During an assessment of a 20-year-old man, the nurse finds a small palpable lesion with a tuft of hair located directly over the coccyx. The nurse knows that this lesion would most likely be a: Pilonidal cyst. 20. During an examination, the nurse asks the patient to perform the Valsalva maneuver and notices that the patient has a moist, red, doughnut-shaped protrusion from the anus. The nurse knows that this finding is consistent with a: Rectal prolapse. 21. A 70-year-old man is visiting the clinic for difficulty in passing urine. In the health history, he indicates that he has to urinate frequently, especially at night. He has burning when he urinates and has noticed pain in his back. Considering this history, what might the nurse expect to find during the physical assessment? Asymmetric, hard, and fixed prostate gland 22. A 40-year-old black man is in the office for his annual physical examination. Which statement regarding the PSA blood test is true, according to the American Cancer Society? The PSA: Should be performed at age 45 years. 23. A 62-year-old man is experiencing fever, chills, malaise, urinary frequency, and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. These symptoms are most consistent with which condition? ProstatitisDownloaded by Mike Splendid () 24. During a discussion for a men's health group, the nurse relates that the group with the highest incidence of prostate cancer is: Blacks. 25. Which characteristic of the prostate gland would the nurse recognize as an abnormal finding while palpating the prostate gland through the rectum? Tenderness to palpation Chapter 23: The Musculoskeletal System 1. A patient is being assessed for range-of-joint movement. The nurse asks him to move his arm in toward the center of his body. This movement is called: Adduction. 2. A patient tells the nurse that she is having a hard time bringing her hand to her mouth when she eats or tries to brush her teeth. The nurse knows that for her to move her hand to her mouth, she must perform which movement? Flexion 3. The functional units of the musculoskeletal system are the: Joints. 4. When reviewing the musculoskeletal system, the nurse recalls that hematopoiesis takes place in the: Bone marrow. 5. Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: Ligaments. 6. The nurse notices that a woman in an exercise class is unable to jump rope. The nurse is aware that to jump rope, ones shoulder has to be capable of: Circumduction. 7. The articulation of the mandible and the temporal bone is known as the: Temporomandibular joint. 8. To palpate the temporomandibular joint, the nurse’s fingers should be placed in the depression of the ear. Anterior to the tragus 9. Of the 33 vertebrae in the spinal column, there are: 5 lumbar. 10. An imaginary line connecting the highest point on each iliac crest would cross the vertebra. Fourth lumbarDownloaded by Mike Splendid () 11. The nurse is explaining to a patient that there are shock absorbers in his back to cushion the spine and to help it move. The nurse is referring to his: Intervertebral disks. 12. The nurse is providing patient education for a man who has been diagnosed with a rotator cuff injury. The nurse knows that a rotator cuff injury involves the: Glenohumeral joint. 13. During an interview the patient states, I can feel this bump on the top of both of my shoulder-sit doesn't hurt but I am curious about what it might be. The nurse should tell the patient that it is his: Acromion process. 14. The nurse is checking the range of motion in a patient’s knee and knows that the knee is capable of which movement(s)? Flexion and extension 15. A patient is visiting the clinic for an evaluation of a swollen, painful knuckle. The nurse notices that the knuckle above his ring on the left hand is swollen and that he is unable to remove his wedding ring. This joint is called the joint. Metacarpophalangeal 16. The nurse is assessing a patient’s ischial tuberosity. To palpate the ischial tuberosity, the nurse knows that it is best to have the patient: Flexing the hip. 17. The nurse is examining the hip area of a patient and palpates a flat depression on the upper, lateral side of the thigh when the patient is standing. The nurse interprets this finding as the: Greater trochanter. 18. The ankle joint is the articulation of the tibia, fibula, and: Talus. 19. The nurse is explaining the mechanism of the growth of long bones to a mother of a toddler. Where does lengthening of the bones occur? Epiphyses 20. A woman who is 8 months pregnant comments that she has noticed a change in her posture and is having lower back pain. The nurse tells her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. This shift in posture is known as: Lordosis. 21. An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. The nurse should explain that decreased height occurs with aging because: The vertebral column shortens. 22. A patient has been diagnosed with osteoporosis and asks the nurse, what is osteoporosis? The nurse explains that osteoporosis is defined as: Loss of bone density.Downloaded by Mike Splendid () 23. The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? Performing physical activity, such as fast walking 24. A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The nurse examines her hand and would expect a fracture if the girl complains of a: Sharp pain that increases with movement. 25. A patient is complaining of pain in his joints that is worse in the morning, better after he moves around for a while, and then gets worse again if he sits for long periods. The nurse should assess for other signs of what problem? Rheumatoid arthritis Chapter 24: Nervous System 1. The two parts of the nervous system are the: Central and peripheral. 2. The wife of a 65-year-old man tells the nurse that she is concerned because she has noticed a change in her husband’s personality and ability to understand. He also cries very easily and becomes angry. The nurse recalls that the cerebral lobe responsible for these behaviors is the lobe. Frontal 3. Which statement concerning the areas of the brain is true? The hypothalamus controls body temperature and regulates sleep. 4. The area of the nervous system that is responsible for mediating reflexes is the: Spinal cord. 5. While gathering equipment after an injection, a nurse accidentally received a prick from an improperly capped needle. To interpret this sensation, which of these areas must be intact? Lateral spinothalamic tract, thalamus, and sensory cortex 6. A patient with a lack of oxygen to his heart will have pain in his chest and possibly in the shoulder, arms, or jaw. The nurse knows that the best explanation why this occurs is which one of these statements? The sensory cortex does not have the ability to localize pain in the heart; consequently, the pain is felt elsewhere. 7. The ability that humans have to perform very skilled movements such as writing is controlled by the: Corticospinal tract.Downloaded by Mike Splendid () 8. A 30-year-old woman tells the nurse that she has been very unsteady and has had difficulty in maintaining her balance. Which area of the brain that is related to these findings would concern the nurse? Cerebellum 9. Which of these statements about the peripheral nervous system is correct? The peripheral nerves carry input to the central nervous system by afferent fibers and away from the central nervous system by efferent fibers. 10. A patient has a severed spinal nerve as a result of trauma. Which statement is true in this situation? The adjacent spinal nerves will continue to carry sensations for the dermatome served by the severed nerve. 11. A 21-year-old patient has a head injury resulting from trauma and is unconscious. There are no other injuries. During the assessment what would the nurse expect to find when testing the patient’s deep tendon reflexes? Reflexes will be normal. 12. A mother of a 1-month-old infant asks the nurse why it takes so long for infants to learn to roll over. The nurse knows that the reason for this is: Myelin is needed to conduct the impulses, and the neurons of a newborn are not yet myelinated. 13. During an assessment of an 80-year-old patient, the nurse notices the following: an inability to identify vibrations at her ankle and to identify the position of her big toe, a slower and more deliberate gait, and a slightly impaired tactile sensation. All other neurologic findings are normal. The nurse should interpret that these findings indicate: Normal changes attributable to aging. 14. A 70-year-old woman tells the nurse that every time she gets up in the morning or after she's been sitting, she gets really dizzy and feels like she is going to fall over. The nurse’s best response would be: You need to get up slowly when you've been lying down or sitting. 15. During the taking of the health history, a patient tells the nurse that it feels like the room is spinning around me. The nurse would document this finding as: Vertigo. 16. When taking the health history on a patient with a seizure disorder, the nurse assesses whether the patient has an aura. Which of these would be the best question for obtaining this information? Do you have any warning sign before your seizure starts? 17. While obtaining a health history of a 3-month-old infant from the mother, the nurse asks about the infant’s ability to suck and grasp the mother’s finger. What is the nurse assessing? ReflexesDownloaded by Mike Splendid () 18. In obtaining a health history on a 74-year-old patient, the nurse notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold things. With this information, what response should the nurse make? Does the tremor change when you drink alcohol? 19. A 50-year-old woman is in the clinic for weakness in her left arm and leg that she has noticed for the past week. The nurse should perform which type of neurologic examination? Complete neurologic examination 20. During an assessment of the CNs, the nurse finds the following: asymmetry when the patient smiles or frowns, uneven lifting of the eyebrows, sagging of the lower eyelids, and escape of air when the nurse presses against the right puffed cheek. This would indicate dysfunction of which of these CNs? Motor component of CN VII 21. The nurse is testing the function of CN XI. Which statement best describes the response the nurse should expect if this nerve is intact? The patient: Moves the head and shoulders against resistance with equal strength. 22. During the neurologic assessment of a healthy 35-year-old patient, the nurse asks him to relax his muscles completely. The nurse then moves each extremity through full range of motion. Which of these results would the nurse expect to find? Mild, even resistance to movement 23. When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. The nurse would document this finding as: Positive Romberg sign. 24. The nurse is performing an assessment on a 29-year-old woman who visits the clinic complaining of always dropping things and falling down. While testing rapid alternating movements, the nurse notices that the woman is unable to pat both of her knees. Her response is extremely slow and she frequently misses. What should the nurse suspect? Dysfunction of the cerebellum 25. During the taking of the health history of a 78-year-old man, his wife states that he occasionally has problems with short-term memory loss and confusion: He can’t even remember how to button his shirt. When assessing his sensory system, which action by the nurse is most appropriate? Before testing, the nurse would assess the patient’s mental status and ability to follow directions.Downloaded by Mike Splendid () Dains_ Ch 3, 13, 18, 22-24 --------------------------------------------------------------------------------------------------------------------------------------------------------- Chapter 11. Genitourinary System (Q20) Chapter 14. Musculoskeletal System (Q31) Chapter 15. Neurological System (Q25) Chapter 3: Abdominal Pain Chapter 13: Dizziness Chapter 18: Genitourinary Problems in Males Chapter 22: LE Limb Pain Chapter 23: UE Limb Pain Chapter 24: Low Back Pain (acute) Chapter 17. Psychiatric Mental Health (Q34) Chapter 21: Assessing the Sensory-Neurologic System (Q43) Chapter 11. Genitourinary System (Q20) 1. When performing a dipstick test on a patient’s urine sample, a positive leukocyte esterase and nitrite is indicative of: A. Microscopic hematuria B. Urinary tract infection C. Calculi in the urine D. Possible bladder tumor 2. An intravenous pyelogram should not be performed if serum creatinine is: A. Less than 1.5 B. Greater than 1.0 C. Greater than 1.6 D. Less than 1.0 3. Your 55-year-old male patient presents to the emergency department with complaints of sudden development of severe right-sided, colicky lower abdominal pain. He cannot sit still on the examining table. The patient has previously been in good health. On physical examination, there are no signs of peritoneal inflammation. A urine sample reveals hematuria and crystalluria. Which is the next diagnostic test that should be done immediately?Downloaded by Mike Splendid () A. Ultrasound of the abdomen B. Abdominal x-ray C. Digital rectal examination D. Spiral CT scan 4. The most common complication of an untreated urinary obstruction due to a ureteral calculus is: A. Hydronephrosis B. Renal artery stenosis C. Ureteral rupture D. Kidney mass 5. A 43-year-old male patient complains of right-sided abdominal and pain in the back in the right costovertebral angle region, fever, chills, dysuria, and nausea. On physical examination, there is 102 degree fever, tachycardia, and right costovertebral angle tenderness to percussion. The most likely condition is: A. Lower urinary tract infection B. Pyelonephritis C. Nephrolithiasis D. Hydronephrosis 6. On a physical examination for employment, a 45-year-old male shows no significant findings and takes no medications. Past medical history and surgery are unremarkable. On urinalysis, hematuria is present. The urinalysis is repeated on another day and still reveals microscopic hematuria. It is important to recognize that painless hematuria can be diagnostic of: A. Urinary tract infection B. Bladder cancer C. Nephrolithiasis D. Pyelonephritis 7. On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient’s PSA is within normal limits for the patient’s age. The clinician should: A. Refer the patient for transrectal ultrasound guided prostate biopsy B. Obtain an abdominal x-ray of kidneys, ureter, and bladder C. Recognize this as a normal finding that requires periodic follow-up D. Obtain urine culture and sensitivity for prostatitis 8. Your 77-year-old patient complains of frequent urination, hesitation in getting the stream started,Downloaded by Mike Splendid () and nocturnal frequency of urination that is bothersome. On DRE, there is an enlarged, firm, nontender, smooth prostate. The clinician should recognize these as symptoms of: A. Prostatitis B. Prostate cancer C. Urethritis D. Benign prostatic hyperplasia 9. Your 66-year-old patient complains of frequency of urination and hesitancy of the urine stream. On DRE, there is a hard, nodular, enlarged, non-tender prostate. The clinician should recognize these as symptoms of: A. Prostatitis B. Prostate cancer C. Urethritis D. Benign prostatic hyperplasia 10. A 27-year-old male comes in to the clinic for symptoms of dysuria, urinary frequency, as well as urgency and perineal pain. Transrectal palpation of the prostate reveals a very tender, boggy, swollen prostate. The clinician should recognize these as signs of: A. Prostatitis B. Prostate cancer C. Urethritis D. Benign prostatic hyperplasia 11. Your 24-year-old female patient complains of dysuria as well as frequency and urgency of urination that develops the day after she uses her diaphragm. Urine culture reveals a bacterial count of 100 CFU/mL. These signs and symptoms indicate: A. Upper urinary tract infection B. Lower urinary tract infection C. Normal bacteriuria D. Urethritis 12. An 18-year-old female patient presents with repeated urinary tract infections. She has no risk factors in her history, and her physical examination is unremarkable. She also has a normal pelvic exam. Which of the following should be obtained if anatomic abnormalities are suspected? A. Intravenous pyelogram B. Ultrasound of the kidneys C. CystoscopyDownloaded by Mike Splendid () D. Transvaginal ultrasound of the bladder 13. A 33-year-old female patient visits the clinic multiple times over the last year complaining of dysuria, frequency, urgency, suprapubic pain, and dyspareunia. Her physical examination, including a pelvic exam, is normal. Urinalysis and urine culture is repeatedly negative. Her intravenous pyelogram is also normal. The clinician should recognize that this presentation is consistent with symptoms of: A. Asymptomatic bacteriuria B. Upper urinary tract infection C. Interstitial cystitis D. Polycystic kidneys 14. A 65-year-old male patient complains of frequency, urgency, hesitancy, and weak urine stream. Physical examination is unremarkable except DRE reveals an enlarged, firm, non-tender prostate gland. Urine culture reveals 100 bacteria CFU/mL. The clinician should suspect: A. Lower urinary tract infection due to benign prostatic hyperplasia B. Bacteriuria due to prostatitis C. Obstructive uropathy due to prostate cancer D. Upper urinary tract infection due to benign prostatic hyperplasia 15. An important sign that indicates nerve compression at the cauda equina section of the spinal cord is: A. Urinary incontinence B. Urinary retention C. Bladder spasms D. All of the above 16. A 77-year-old female patient with heart failure complains of frequency and urgency of urination during the day and nocturia of 2 to 3 times a night. Which of the following medications can cause these symptoms? A. Beta adrenergic blocker B. Diuretic C. ACE inhibitor D. Digitalis 17. A 15-year-old female patient presents with complaints of constant thirst, urination up to 20 times a day, and recent unintentional weight loss of 10 pounds over the last month. It is important for the clinician to recognize these symptoms as those of:Downloaded by Mike Splendid () A. Renal cancer B. Bladder cancer C. Diabetes mellitus D. Interstitial cystitis 18. What it the normal capacity of the urinary bladder? A. 700 mL B. 400 mL C. 200 mL D. 100 mL 19. Which of the following disorders can cause urinary incontinence? A. Cystocele B. Overactive bladder C. Uterine prolapse D. All of the above 20. A major reason for the atrophic changes that occur in the pelvic floor muscles of the elderly woman is: A. Diminished levels of estrogen B. Increased levels of testosterone C. Autonomic neuropathy D. Decreased glycogen in the vagina Chapter 14. Musculoskeletal System (Q31) 1. To assess muscle tone, the clinician should: A. Palpate the patient’s muscle as the muscle is passively stretched B. Examine how the patient performs active range of motion C. Palpate the muscles comparing side to side D. A and C 2. Muscle strength is assessed by: A. Having the patient move their muscle against the clinician’s resistance B. Examining how the patient performs active range of motion C. Passively stretching the patient’s muscle D. Performing passive range of motion on the patient’s muscle 3. Which of the following serological diagnostic tests is most specific for rheumatoid arthritis?Downloaded by Mike Splendid () A. C-reactive protein (CRP) B. Rheumatoid factor (RF) C. Anti-nuclear antibodies (ANA) D. Anti-citrullinated protein autoantibodies (ACPA) 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: A. Osteoarthritis B. Rheumatoid arthritis C. Fibromyalgia D. Polymyalgia rheumatica 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical examination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of: A. Osteoarthritis B. Rheumatoid arthritis C. Scleroderma D. Sarcoidosis 6. Your patient is a 55-year-old male who presents with sudden, severely tender, swollen, erythematous elbow. The patient reports that he experienced similar symptoms in the past. You note the right elbow has a swollen, tender, soft 3 cm round nodule. The clinician should recognize these are signs and symptoms of: A. Gouty arthritis B. Rheumatoid arthritis C. Epicondylitis D. Reiter’s syndrome 7. Sarcoidosis is an autoimmune disease that presents with non-specific symptoms of fatigue, fever, and arthralgias. Which of the following signs should raise suspicion of this disorder? A. Facial rash across nose and cheeksDownloaded by Mike Splendid () B. Bilateral hilar lymphadenopathy on chest x-ray C. Specific tender points on the body D. Swelling of metacarpophalangeal joints 8. Which of the following infectious diseases is often the cause of a reactive arthritis? A. Gonococcus infection B. Beta-hemolytic streptococcus infection C. Chlamydia infection D. Norovirus infection 9. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical examination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: A. Fibromyalgia B. Sarcoidosis C. Systemic lupus erythematosus D. Rheumatoid arthritis 10. Which of the following microorganisms causes Lyme disease? A. Clostridia B. Shigella C. Borrelia D. Epstein-Barr virus 11. A 60-year-old female patient complains of pain in the hands that is worse in the morning. On physical examination, the thumb metacarpophalangeal joint is swollen on both hands. There is swelling of the proximal and distal interphalangeal joints bilaterally. These are typical signs of: A. Osteoarthritis B. Rheumatoid arthritis C. Normal aging D. Gouty arthritis 12. A 56-year-old male presents with complaints of right-sided neck pain with radiation down the right arm into the right index finger and thumb. He reports a recent fall from a scaffold while painting on the job. On physical examination, you note a 0/4 biceps reflex on the right compared to 2/4 on the left and 1/5 grip strength of the right hand compared to 5/5 of the left hand. Which of theDownloaded by Mike Splendid () following is a test that can be performed to assist in the diagnosis of cervical disk herniation? A. Spurling’s sign B. Apley’s sign C. Lhermitte’s sign D. A and C 13. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? A. Beta blocker B. ACE inhibitor C. Statin medication D. Metformin 14. A 75-year-old female patient complains of fatigue as well as pain and stiffness of the shoulders and neck. There is no history of trauma or exercised-induced pain. Medications include a beta blocker and ACE inhibitor. Medical history includes giant cell arteritis and Raynaud’s syndrome. Physical examination is unremarkable. There is no swelling or erythema over the temporal arteries. There is no swelling, erythema, limitation in range of motion or point tenderness over the shoulder joints. The neck has normal range of motion and no tenderness or swelling. Which of the following disorders should be included in the list of possible diagnoses? A. Rheumatoid arthritis B. Polymyalgia rheumatic C. Drug-induced myalgia D. Fibromyalgia 15. A 20-year-old male construction worker is experiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical examination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? A. Joint infection B. Chondromalacia patellaDownloaded by Mike Splendid () C. Prepatellar bursitis D. All of the above 16. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical examination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate: A. Knee ligament injury B. Osgood-Schlatter disease C. Prepatellar bursitis D. Chondromalacia patella 17. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical examination, the patient has diminished ability to dorsiflex the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon? A. Straight leg raising sign B. Lumbar herniated disc on x-ray C. Loss of left sided patellar reflex D. Urinary incontinence 18. Your patient is 40-year-old baseball player who needs his yearly physical exam. He reports a 5- year history of chronic lower back pain due to spinal stenosis. Which of the following findings indicate spinal stenosis? A. Lumbar x-ray demonstrates vertebral osteophytes B. Positive straight leg raising sign upon physical exam C. Lumbar MRI shows decreased intervertebral space D. A and C 19. Which of the following disorders has a strong genetic component and causes loss of spinal mobility and progressive erosion of the sacroiliac joint? A. Syringomyelia B. Spinal stenosis C. Ankylosing spondylitis D. None of the above 20. Whenever a patient presents with acute non-traumatic shoulder pain, the clinician should make sure to exclude a:Downloaded by Mike Splendid () A. Cardiac origin of symptoms B. Gastrointestinal condition C. Cervical spine disorder D. All of the above 21. A 34-year-old baseball pitcher complains of pain in the left shoulder, particularly with raising the left arm when attempting to pitch. Which of the following is a test used to diagnose rotator cuff injury? A. Apley’s test B. Trousseau test C. Hawkin’s test D. A and C 22. Which of the following is a sign of glenohumeral instability? A. Positive Lachman test B. Negative Spurling’s sign C. Positive apprehension test D. Negative Lhermitte sign 23. Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician’s resistance. These are typical signs of: A. Carpal tunnel syndrome B. Osteoarthritis of the wrist C. Epicondylitis D. Cervical osteoarthritis 24. A 3-year-old male toddler complains of sudden arm pain. The mother indicated that pain occurred suddenly while his 9-year-old sister was helping him get dressed. The child presents with the arm flexed while protecting his elbow. On physical examination, there is tenderness along the radius with no swelling or evidence of trauma. This is a typical history of: A. Nursemaid’s elbow B. Epicondylitis C. Smith fracture D. Nursery pseudo-fracture 25. A 46-year-old administrative assistant complains of pain in the wrist that radiates into the palm and into the fingers. The clinician can test the patient for carpal tunnel syndrome by eliciting which of the following signs?Downloaded by Mike Splendid () A. Tinel’s sign B. Apley’s sign C. Finkelstein sign D. Lhermitte’s sign 26. Which of the following describes the pathology of De Quervain’s tenosynovitis? A. Irritation of a tendon located on the radial side of the wrist, near the thumb. B. Impingement of the median nerve, causing pain in the palm and fingers C. Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist D. Ulnar nerve compression at the olecranon process 27. What is the most common cause of hip pain in older adults? A. Osteoporosis B. Osteoarthritis C. Trauma due to fall D. Trochanteric bursitis 28. A 33-year-old male marathon runner presents with knee pain. Which of the following tests is positive if the meniscus of the knee is torn? A. McMurray’s test B. Straight leg raising sign C. Anterior drawer sign D. Lachman test 29. A 23-year-old female presents with ankle pain due to a fall while walking on ice 1 hour ago. You watch her limp as she walks into the emergency room. On physical examination, the ankle is erythematous, swollen, and tender to touch. The patient cannot stand on the affected ankle. Range of motion is severely limited on inversion of the ankle. On palpation, there is no pain with pressure on the medial or lateral malleolus. Should this patient be sent for ankle x-rays according to the Ottawa ankle rules? A. No, the ankle shows no tenderness over the medial or lateral malleolus B. Yes, the patient is unable to bear weight on the ankle C. Yes, ankle range of motion is limited D. No, range of motion of the ankle is not limited in all planes 30. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical examination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness except at the base of theDownloaded by Mike Splendid () fifth metatarsal bone. According to the Ottawa foot rules, should an x-ray of the feet be ordered? A. Yes, there is tenderness over the fifth metatarsal B. No, there is not tenderness over the navicular bone C. Yes, the patient cannot bear weight on the foot D. A and C 31. A 36-year-old female patient complains of foot pain when she wears high heels. There is no history of trauma or arthritis. On physical examination, there is tenderness at the space between the third and fourth metatarsal bones. Foot x-ray shows no evidence of stress fracture. This history is typical of: A. Plantar fasciitis B. Morton’s neuroma C. Achilles tendonitis D. None of the above Chapter 15. Neurological System (Q25) 1. When carrying out a mental status exam on a non-English speaking patient, it is important to have a(n): A. Patient’s family member, who is bilingual, interpret for the patient B. Objective interpreter ask the questions for the patient C. Friend of the patient interpret the questions for the patient D. Any of the above is acceptable 2. When examining the carotid arteries, the clinician should: A. Ask the patient to hold his/her breath while auscultating the carotid arteries B. Use the bell of the stethoscope to listen over the carotid arteries C. Palpate one carotid artery at a time D. All of the above 3. A 44-year-old male presents to the emergency room with the “worst headache of his life.” He is holding his head and appears severely distressed. This is a patient symptom that should prompt a clinician to look for signs of a: A. Migraine headache B. Subdural hematoma C. Subarachnoid haemorrhage D. Brain tumor 4. An 8-year-old child presents to the emergency room with a severe unilateral, throbbing headache.Downloaded by Mike Splendid () She is lying on the gurney with her eyes closed while holding her head. She denies ever having this kind of headache in the past. She complains of sensitivity to light and noise. An appropriate history question to ask the parent would be: A. What do you think triggered the headache? B. Have you had a fever? C. Does anyone in your family suffer from migraine headache? D. B and C 5. A 41-year-old male patient presents to the emergency department complaining of severe headache pain. He describes it as a piercing, right sided head pain that occurred earlier in day for about 1 hour and now is recurring. You note lacrimation and rhinorrhea on the right side of the face. Which of the following types of headache is the patient describing? A. Sinusitis B. Cluster headache C. Migraine D. Subdural hematoma 6. An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her husband. He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician who prescribed azithromycin twice a day. The husband reports that he is making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last night and was extremely agitated, left the house, and was walking outside. She did not recognize her husband and wanted to call the police. Which of the following is an appropriate question for the history? A. Does your wife have dementia or frequent episodes of confusion? B. Has your wife been running a fever? C. Is your wife allergic to any medication? D. Has your wife ever had a mental status exam? 7. A 60-year-old female complains of several episodes of dizziness and nausea that started this morning. She denies trauma, falling, or loss of consciousness. She has a 5-year history of hypertension and takes a beta blocker daily. On physical examination, there are no neurologic deficits or any abnormal findings and ECG is normal. Which of the following tests should be performed? A. Test the patient for Kernig’s sign B. Test the patient for Brudzinski sign C. Perform the Hallpike maneuver D. Assess for Babinski’s sign 8. Ménière’s ’disease presents with the following triad of symptoms:Downloaded by Mike Splendid () A. Vertigo, nystagmus, hearing loss B. Vertigo, tinnitus, hearing loss C. Vertigo, syncope, hearing loss D. None of the above 9. A 77-year-old male is brought into the emergency department accompanied by his daughter. She reports that her father has been complaining of right-handed weakness for 2 to 3 hours and that she has noticed him slurring his speech. On physical examination, the right hand grip strength is 1/ 5 compared to the left hand grip of 5/5. A facial droop is noted on the right side of the face. Cranial nerve dysfunction is noted in the right-sided CNVII, CN V, CNIX, CNX, CNXI, and CNXII. The clinician should request the following diagnostic test immediately: A. MRI of head B. CT of the head C. Lumbar puncture D. ECG 10. A female patient presents to the clinic with complaints of a severe, throbbing, unilateral headache. She complains of seeing flashes of light prior to the headache. She complains of sound and light sensitivity as well as nausea. The clinician should recognize these as symptoms of: A. Epilepsy with aura B. Cluster headache C. Migraine headache D. Normal pressure hydrocephalus 11. On a history and physical examination of a 34-year-old patient, during the review of systems, he reports occasional episodes of headache. He describes the headache pain as a “band is around his head” and tightness in the neck and shoulders. The clinician should recognize these symptoms as: A. Tension headache B. Cluster headache C. Sinusitis D. Migraine headache 12. An 81-year-old patient with heart failure comes into the emergency room accompanied by his daughter. The daughter reports that her father “banged his head” as he was getting out of the car 4 days ago. He did not complain of headache pain, so she did not obtain medical advice. She reports that she noticed a mild facial droop, slurring of speech, and gait disturbance in her father today. She reports that her father takes Coumadin, digoxin, and an ACE inhibitor. On physical examination, there is decreased right hand grip 2/5 strength and decreased right quadriceps strength 2/ 5 compared to the left side 5/5. CT scan shows an intracranial bleed. Which of the following is the most probable diagnosis?Downloaded by Mike Splendid () A. Subarachnoid hemorrhage B. Epidural hematoma C. Subdural hematoma D. Intracerebral hemorrhage 13. Which of the following microorganisms is a common cause of meningitis? A. Enterococcus B. Haemophilus influenza C. Influenza virus D. Chlamydia 14. A 43-year-old male presents to the emergency department in a stupor accompanied by his wife. She called the ambulance because her husband was difficult to awaken this morning. She reports that for the last 3 days, he has had fever and upper respiratory infection. Yesterday he had a headache. He has had no medical treatment. On physical examination, the patient demonstrates 103 fever, sluggish pupil response, and nuchal rigidity. Which of the following should the clinician attempt to elicit next? A. Hallpike maneuver B. Kernig’s sign C. Epley maneuver D. Babinski’s sign 15. Spina bifida is a disorder that is associated with a headache syndrome caused by: A. Chiari malformation B. Normal pressure hydrocephalus C. Meningioma D. Temporal arteritis 16. Which of the following is a common trigger of migraine headache? A. Missed meals B. Menses C. Alcohol D. All of the above 17. Your patient with a cervical herniated disc presents with a weakened biceps reflex. The biceps reflex is a test of the following spinal nerves: A. C3 to C4 B. C4 to C5 C. C5 to C6Downloaded by Mike Splendid () D. C7 to T1 18. In order to test abstract thought on the mental status exam, the clinician can ask: A. Count by serial 7’s backward B. Spell the word “world” backward C. Draw a clock that shows 2:30 D. How is you