ACC 305 Advanced Health Assessment & Clinical Diagnosis 6th Edition

ACC 305 Advanced Health Assessment & Clinical Diagnosis 6th Edition Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which type of clinical decision-making is most reliable? A. Intuitive 1. Analytical 2. Experiential D.Augenblick 2. Which of the following is false? To obtain adequate history, health-care providers must be: A. Methodical and systematic 1. Attentive to the patient’s verbal and nonverbal language 2. Able to accurately interpret the patient’s responses D.Adept at reading into the patient’s statements 3. Essential parts of a health history include all of the following except: A. Chief complaint 1. History of the present illness 2. Current vital signs D.All of the above are essential history components 4. Which of the following is false? While performing the physical examination, the examiner must be able to: A. Differentiate between normal and abnormal findings 1. Recall knowledge of a range of conditions and their associated signs and symptoms 2. Recognize how certain conditions affect the response to other conditions D.Foresee unpredictable findings 5. The following is the least reliable source of information for diagnostic statistics: A. Evidence-based investigations 1. Primary reports of research 2. Estimation based on a provider’s experience D.Published meta-analyses 6. The following can be used to assist in sound clinical decision-making: 1. Algorithm published in a peer-reviewed journal article 2. Clinical practice guidelines 3. Evidence-based research 4. All of the above 7. If a diagnostic study has high sensitivity, this indicates a: A. High percentage of persons with the given condition will have an abnormal result 1. Low percentage of persons with the given condition will have an abnormal result 2. Low likelihood of normal result in persons without a given condition D.None of the above 8. If a diagnostic study has high specificity, this indicates a: A Low percentage of healthy individuals will show a normal result . 1. High percentage of healthy individuals will show a normal result 2. High percentage of individuals with a disorder will show a normal result D.Low percentage of individuals with a disorder will show an abnormal result 9. A likelihood ratio above 1 indicates that a diagnostic test showing a: 1. Positive result is strongly associated with the disease 2. Negative result is strongly associated with absence of the disease 3. Positive result is weakly associated with the disease 4. Negative result is weakly associated with absence of the disease 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients? A.Clinical practice guideline 1. Clinical decision rule 2. Clinical algorithm Chapter 2. Evidence-based health screening Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The first step in the genomic assessment of a patient is obtaining information regarding: A. Family history 1. Environmental exposures 2. Lifestyle and behaviors D.Current medications 2. An affected individual who manifests symptoms of a particular condition through whom a family with a genetic disorder is ascertained is called a(n): A. Consultand 1. Consulband 2. Index patient D.Proband 3. An autosomal dominant disorder involves the: A. X chromosome 1. Y chromosome 2. Mitochondrial DNA D.Non-sex chromosomes 4. To illustrate a union between two second cousin family members in a pedigree, draw: A. Arrows pointing to the male and female 1. Brackets around the male and female 2. Double horizontal lines between the male and female D.Circles around the male and female 5. To illustrate two family members in an adoptive relationship in a pedigree: A. Arrows are drawn pointing to the male and female 1. Brackets are drawn around the male and female 2. Double horizontal lines are drawn between the male and female D.Circles are drawn around the male and female 6. When analyzing the pedigree for autosomal dominant disorders, it is common to see: 1. Several generations of affected members 2. Many consanguineous relationships 3. More members of the maternal lineage affected than paternal 4. More members of the paternal lineage affected than maternal 7. In autosomal recessive (AR) disorders, individuals need: A.Only one mutated gene on the sex chromosomes to acquire the disease 1. Only one mutated gene to acquire the disease 2. Two mutated genes to acquire the disease D Two mutated genes to become carriers . 8. In autosomal recessive disorders, carriers have: A.Two mutated genes; one from each parent that cause disease 1. A mutation on a sex chromosome that causes a disease 2. A single gene mutation that causes the disease D. One copy of a gene mutation but not the disease 9. With an autosomal recessive disorder, it is important that parents understand that if they both carry a mutation, the following are the risks to each of their offspring (each pregnancy): A.50% chance that offspring will carry the disease 1. 10% chance of offspring affected by disease 2. 25% chance children will carry the disease D. 10% chance children will be disease free 10. A woman with an X-linked dominant disorder will: A.Not be affected by the disorder herself 1. Transmit the disorder to 50 % of her offspring (male or female) 2. Not transmit the disorder to her daughters D. Transmit the disorder to only her daughters 11. In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic disorder. Although neither of her parents had indications of the disorder, her paternal grandmother and her paternal grandmother’s two sisters were affected by the same condition. This pattern suggests: A.Autosomal dominant disorder 1. Chromosomal disorder 2. Mitochondrial DNA disorder D. X-linked dominant disorder 12. A woman affected with an X-linked recessive disorder: A.Has one X chromosome affected by the mutation 1. Will transmit the disorder to all of her children 2. Will transmit the disorder to all of her sons D. Will not transmit the mutation to any of her daughters 13. Which of the following are found in an individual with aneuploidy? A.An abnormal number of chromosomes 1. An X-linked disorder 2. Select cells containing abnormal-appearing chromosomes D. An autosomal recessive disorder 14. The pedigree of a family with a mitochondrial DNA disorder is unique in that: A.None of the female offspring will have the disease 1. All offspring from an affected female will have disease 2. None of the offspring of an affected female will have the disease D. All the offspring from an affected male will have disease 15. Which population is at highest risk for the occurrence of aneuploidy in offspring? A.Mothers younger than 18 1. Fathers younger than 18 2. Mothers over age 35 D. Fathers over age 35 16. Approximately what percentage of cancers is due to a single-gene mutation? 1. 50% to 70% 2. 30% to 40% 3. 20% to 25% 4. 5% to 10% 17. According to the Genetic Information Nondiscrimination Act (GINA): A. NPs should keep all genetic information of patients confidential 1. NPs must obtain informed consent prior to genetic testing of all patients 2. Employers cannot inquire about an employee’s genetic information D.All of the above 18. The leading causes of death in the United States are due to: A. Multifactorial inheritance 1. Single gene mutations 2. X-linked disorders D.Aneuploidy 19. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? A. Colon cancer in family member at age 70 1. Breast cancer in family member at age 75 2. Myocardial infarction in family member at age 35 D.All of the above 20. When patients express variable forms of the same hereditary disorder, this is due to: A. Penetrance 1. Aneuploidy 2. De novo mutation D.Sporadic inheritance 21. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as: A.Variable expressivity related to inherited disease 1. Dysmorphic features related to genetic disease 2. De novo mutations of genetic disease D. Different penetrant signs of genetic disease 22. In order to provide a comprehensive genetic history of a patient, the NP should: A.Ask patients to complete a family history worksheet 1. Seek out pathology reports related to the patient’s disorder 2. Interview family members regarding genetic disorders D.All of the above Chapter 3. Abdomen Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When performing abdominal assessment, the clinician should perform examination techniques in the following order: A.Inspection, palpation, percussion, and auscultation 1. Inspection, percussion, palpation, and auscultation 2. Inspection, auscultation, percussion, and palpation D.Auscultation, palpation, percussion, and inspection 2. The clinician should auscultate the abdomen to listen for possible bruits of the: A.Aorta 1. Renal artery 2. Iliac artery D.All of the above 3. On abdominal examination, which of the following is assessed using percussion? A.Liver 1. Kidneys 2. Pancreas D.Esophagus 4. In abdominal assessment, a digital rectal examination is performed to assess for: A.Hemorrhoids 1. Prostate size 2. Blood in stool D.Ureteral stenosis 5. Rebound tenderness of the abdomen is a sign of: A.Constipation 1. Peritoneal inflammation 2. Elevated venous pressure D.Peritoneal edema 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this causes pain in the patient’s right lower abdomen. This is most commonly indicative of: A.Constipation 1. Diverticulitis 2. Appendicitis D.Hepatitis 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for peritoneal inflammation, the examiner should: 1. Percuss the right lower quadrant of the abdomen 2. Deeply palpate the right lower quadrant of the abdomen 3. Auscultate the right lower quadrant for hyperactive bowel sounds 4. Strike the plantar surface of the patient’s heel while the patient is supine 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh. The examiner is testing the patient for: A.Psoas sign 1. Obturator sign 2. Rovsing’s sign D.Murphys’ sign 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen while the patient inhales. The examiner is testing the patient for: A.Psoas sign 1. Obturator sign 2. Rovsing’s sign D.Murphys’ sign 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip inward with the knee bent and the obturator internus muscle is stretched. This is a sign of: A.Diverticulitis 1. Cholecystitis 2. Appendicitis D.Mesenteric adenitis 11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size, jugular vein distension becomes obvious. Hepatojugular reflux is indicative of: A.Acute hepatitis 1. Right ventricular failure 2. Cholecystitis D.Left ventricular failure 12. Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of: A.Cholecystitis 1. Appendicitis 2. Ascites D.Hepatitis 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow, and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect: A.Acute pancreatitis 1. Biliary duct obstruction 2. Acute hepatitis D.Atypical appendicitis 14. The most common cause of acute pancreatitis is: A.Trauma 1. Hepatitis virus A 2. Hyperlipidemia D.Alcohol abuse 15. Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of: A.Pleural involvement 1. Alcoholism 2. High mortality D.Bile duct obstruction 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising. The clinician should recognize that these symptoms are often related to: A.Hematopoetic disorders 1. Hepatomegaly 2. Esophageal varices D.Pleural effusion 17. A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of: A.Bacterial endocarditis 1. Infectious mononucleosis 2. Pneumonia with pleural effusion D.Pancreatic cancer 18. Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider: A.Diverticulitis 1. Appendicitis 2. Colon cancer D.Peptic ulcer disease 19. Which of the following is the most common cause of heartburn-type epigastric pain? A.Decreased lower esophageal sphincter tone 1. Helicobacteria pylori infection of stomach 2. Esophageal spasm D.Excess use of NSAIDs 20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: A.Digital rectal examination 1. Endoscopy 2. Ultrasound D.Pelvic examination 21. The major sign of ectopic pregnancy is: 1. Sudden onset of severe epigastric pain 2. Amenorrhea with unilateral lower quadrant pain 3. Lower back and rectal pain 4. Palpable abdominal mass 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important: A Culdocentesis 1. CT scan 2. Abdominal x-ray D.Digital rectal examination 23. The majority of colon cancers are located in the: A.Transverse colon 1. Cecum 2. Rectosigmoid region D.Ascending colon 24. The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer: A.Alternating constipation and diarrhea 1. Narrowed caliber of stool 2. Hematochezia D.All of the above 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical examination is unremarkable. Which of the following lab tests is most important for the diagnosis? A.Urinalysis 1. Serum electrolyte levels 2. Digital rectal exam D.Lumbar x-ray 26. Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating. On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative. The diagnostic tool that would be most helpful is: A.Digital rectal exam 1. Transvaginal ultrasound 2. Pap smear D.Urinalysis 27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and goes for the past couple of weeks. When examining the abdomen, you should have the patient: A.Lie flat and take a deep breath 1. Stand and bear down against your hand 2. Prepare for a digital rectal examination D.Lie in a left lateral recumbent position 28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air- fluid levels in the bowel. This is a diagnostic finding found in: A.Appendicitis 1. Cholecystitis 2. Bowel obstruction D.Diverticulitis 29. A 76-year-old patient presents to the emergency department with severe left lower quadrant abdominal pain, diarrhea, and fever. On physical examination, you note the patient has a positive heel strike, and left lower abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions? A.Diverticulitis 1. Salpingitis 2. Inflammatory bowel disease D.Irritable bowel syndrome 30. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea? A.Viral gastroenteritis 1. Staphylococcal food poisoning 2. Acute hepatitis A D.E.coli gastroenteritis 31. A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis contains bile. On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel sounds. Which of the following diagnoses would be most likely? A.Gastric outlet obstruction 1. Small bowel obstruction 2. Distal intestinal blockage D.Colonic obstruction 32. Your 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103 degree fever, photophobia, and nuchal rigidity. She has an episode of projectile vomiting while you are examining her. The clinician should recognize that the following should be done: A.Abdominal x-ray 1. Fundoscopic examination 2. Lumbar puncture D.Analysis of vomitus 33. A 9-year-old boy accompanied by his mother reports that since he came home from summer camp, he has had fever, nausea, vomiting, severe abdominal cramps and watery stools that contain blood and mucus. The clinician should recognize the importance of: 1. Stool for ova and parasites 2. Abdominal x-ray 3. Stool for clostridium 4. Fecal occult blood test 34. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of: A.CBC with differential 1. Stool culture and sensitivity 2. Abdominal x-ray D.Colonoscopy 35. A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with: A Inflammatory bowel disease 1. Irritable bowel syndrome 2. Laxative abuse D.Norovirus gastroenteritis 36. A 78-year-old female patient is suffering from heart failure, GERD, diabetes, and depression. She presents with complaints of frequent episodes of constipation. Her last bowel movement was 1 week ago. Upon examination, you palpate a hard mass is the left lower quadrant of the abdomen. You review her list of medications. Which of the following of her medications cause constipation? A.Digitalis (Lanoxin) 1. Amlodipine (Norvasc) 2. Sertraline (Zoloft) D.Metformin (Glucophage) 37. You are examining a 55-year-old female patient with a history of alcohol abuse. She complains of anorexia, nausea, pruritus, and weight loss over the last month. On physical examination, you note yellow hue of the skin and sclera. Which of the following physical examination techniques is most important? A.Scratch test 1. Heel strike 2. Digital rectal examination D.Pelvic examination 38. You observe Charcot’s triad of sign and symptoms in a patient under your care. This is commonly seen in which of the following disorders? A.Cirrhosis 1. Pancreatitis 2. Cholangitis D.Portal hypertension 39. A 59-year-old patient with history of alcohol abuse is admitted for hematemesis. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is: A.Peptic ulcer disease 1. Barrett’s esophagus 2. Pancreatitis D.Esophageal varices 40. A 16-year-old female with anorexia and bulimia is admitted for hematemesis. She admits to inducing vomiting often. On physical examination, you note pallor, BMI less than 15, and hypotension. A likely reason for hematemesis is: A.Mallory-Weiss tear 1. Cirrhosis 2. Peptic ulcer disease D.Esophageal varies 41. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: A. Mallory-Weiss tear 1. Esophageal varices 2. Gastric ulcer D.Colon cancer 42. A 48-year-old male presents to the clinic with complaints of anorexia, nausea, weakness, and unintentional weight loss over the last few weeks. On physical examination, the patient has jaundice of the skin as well as sclera and a palpable mass in the epigastric region. In addition to CBC and bilirubin levels, all of the following tests would be helpful except: A.Liver enzymes 1. Amylase 2. Lipase D.Uric acid 43. Your 66-year-old male patient complains of weakness, fatigue, chronic constipation for the last month, and dark stools. On CBC, his results show iron deficiency anemia. Colon cancer is diagnosed. Which of the following laboratory tests is used to follow progress of colon cancer? A.Alpha fetoprotein (AFP) 1. Carcinogenic embryonic antigen (CEA) 2. Carcinoma antigen 125 (CA-125) D.Beta-human chorionic gonadotropin (beta HCG) 44. Your patient is a 33-year-old female gave birth last week. She complains of constipation, rectal pain, and itching. She reports bright red blood on the toilet tissue. The clinician should recognize the need for: A.Digital rectal exam 1. CEA blood test 2. Colonoscopy D.Fecal occult blood test Chapter 4: Affective Changes MULTIPLE CHOICE 1. When performing a physical assessment, the first technique the nurse will always use is: a.Palpation. b.Inspection. 1. Percussion. d.Auscultation. 2. The nurse is preparing to perform a physical assessment. Which statement is true about the physical assessment? The inspection phase: a.Usually yields little information. b.Takes time and reveals a surprising amount of information. 1. May be somewhat uncomfortable for the expert practitioner. d.Requires a quick glance at the patients body systems before proceeding with palpation. 3. The nurse is assessing a patients skin during an office visit. What part of the hand and technique should be used to best assess the patients skin temperature? a. Fingertips; they are more sensitive to small changes in temperature. b.Dorsal surface of the hand; the skin is thinner on this surface than on the palms. c.Ulnar portion of the hand; increased blood supply in this area enhances temperature sensitivity. d.Palmar surface of the hand; this surface is the most sensitive to temperature variations because of its increased nerve supply in this area. 4. Which of these techniques uses the sense of touch to assess texture, temperature, moisture, and swelling when the nurse is assessing a patient? a.Palpation b. Inspection 1. Percussion d.Auscultation 5. The nurse is preparing to assess a patients abdomen by palpation. How should the nurse proceed? a.Palpation of reportedly tender areas are avoided because palpation in these areas may cause pain. b.Palpating a tender area is quickly performed to avoid any discomfort that the patient may experience. c.The assessment begins with deep palpation, while encouraging the patient to relax and to take deep breaths. d.The assessment begins with light palpation to detect surface characteristics and to accustom the patient to being touched. 6. The nurse would use bimanual palpation technique in which situation? a Palpating the thorax of an infant b.Palpating the kidneys and uterus 1. Assessing pulsations and vibrations d.Assessing the presence of tenderness and pain 7. The nurse is preparing to percuss the abdomen of a patient. The purpose of the percussion is to assess the of the underlying tissue. a.Turgor b.Texture 1. Density d.Consistency 8. The nurse is reviewing percussion techniques with a newly graduated nurse. Which technique, if used by the new nurse, indicates that more review is needed? a.Percussing once over each area b.Quickly lifting the striking finger after each stroke 1. Striking with the fingertip, not the finger pad d.Using the wrist to make the strikes, not the arm 9. When percussing over the liver of a patient, the nurse notices a dull sound. The nurse should: a.Consider this a normal finding. b.Palpate this area for an underlying mass. 1. Reposition the hands, and attempt to percuss in this area again. d.Consider this finding as abnormal, and refer the patient for additional treatment. 10. The nurse is unable to identify any changes in sound when percussing over the abdomen of an obese patient. What should the nurse do next? a.Ask the patient to take deep breaths to relax the abdominal musculature. b.Consider this finding as normal, and proceed with the abdominal assessment. 1. Increase the amount of strength used when attempting to percuss over the abdomen. d.Decrease the amount of strength used when attempting to percuss over the abdomen. 11. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: a.Palpate over the area for increased pain and tenderness. b.Ask the child to take shallow breaths, and percuss over the area again. 1. Immediately refer the child because of an increased amount of air in the lungs. d.Consider this finding as normal for a child this age, and proceed with the examination. 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? a.Count the patients respirations. b.Bilaterally percuss the thorax, noting any differences in percussion tones. 1. Call for a chest x-ray study, and wait for the results before beginning an assessment. d.Inspect the thorax for any new masses and bleeding associated with respirations. 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? a.Slope of the earpieces should point posteriorly (toward the occiput). b.Although the stethoscope does not magnify sound, it does block out extraneous room noise. 1. Fit and quality of the stethoscope are not as important as its ability to magnify sound. d.Ideal tubing length should be 22 inches to dampen the distortion of sound. 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: a. Is used to listen for high-pitched sounds. b. Is used to listen for low-pitched sounds. 1. Should be lightly held against the persons skin to block out low-pitched sounds. d.Should be lightly held against the persons skin to listen for extra heart sounds and murmurs. 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: a.Warm the endpiece of the stethoscope by placing it in warm water. b.Leave the gown on the patient to ensure that he or she does not get chilled during the examination. 1. Ensure that the bell side of the stethoscope is turned to the on position. d.Check the temperature of the room, and offer blankets to the patient if he or she feels cold. 16. The nurse will use which technique of assessment to determine the presence of crepitus, swelling, and pulsations? a.Palpation b.Inspection 1. Percussion d.Auscultation 17. The nurse is preparing to use an otoscope for an examination. Which statement is true regarding the otoscope? The otoscope: a Is often used to direct light onto the sinuses. b.Uses a short, broad speculum to help visualize the ear. 1. Is used to examine the structures of the internal ear. d.Directs light into the ear canal and onto the tympanic membrane. 18. An examiner is using an ophthalmoscope to examine a patients eyes. The patient has astigmatism and is nearsighted. The use of which of these techniques would indicate that the examination is being correctly performed? a.Using the large full circle of light when assessing pupils that are not dilated b.Rotating the lens selector dial to the black numbers to compensate for astigmatism 1. Using the grid on the lens aperture dial to visualize the external structures of the eye d.Rotating the lens selector dial to bring the object into focus 19. The nurse is unable to palpate the right radial pulse on a patient. The best action would be to: a.Auscultate over the area with a fetoscope. b.Use a goniometer to measure the pulsations. 1. Use a Doppler device to check for pulsations over the area. d.Check for the presence of pulsations with a stethoscope. 20. The nurse is preparing to perform a physical assessment. The correct action by the nurse is reflected by which statement? The nurse: a.Performs the examination from the left side of the bed. b.Examines tender or painful areas first to help relieve the patients anxiety. 1. Follows the same examination sequence, regardless of the patients age or condition. d.Organizes the assessment to ensure that the patient does not change positions too often. 21. A man is at the clinic for a physical examination. He states that he is very anxious about the physical examination. What steps can the nurse take to make him more comfortable? a.Appear unhurried and confident when examining him. b.Stay in the room when he undresses in case he needs assistance. 1. Ask him to change into an examining gown and to take off his undergarments. d.Defer measuring vital signs until the end of the examination, which allows him time become comfortable. 22. When performing a physical examination, safety must be considered to protect the examiner and the patient against the spread of infection. Which of these statements describes the most appropriate action the nurse should take when performing a physical examination? a.Washing ones hands after removing gloves is not necessary, as long as the gloves are still intact. b.Hands are washed before and after every physical patient encounter. c.Hands are washed before the examination of each body system to prevent the spread of bacteria from one part of the body to another. d.Gloves are worn throughout the entire examination to demonstrate to the patient concern regarding the spread of infectious diseases. 23. The nurse is examining a patients lower leg and notices a draining ulceration. Which of these actions is most appropriate in this situation? a.Washing hands, and contacting the physician b.Continuing to examine the ulceration, and then washing hands c.Washing hands, putting on gloves, and continuing with the examination of the ulceration d.Washing hands, proceeding with rest of the physical examination, and then continuing with the examination of the leg ulceration 24. During the examination, offering some brief teaching about the patients body or the examiners findings is often appropriate. Which one of these statements by the nurse is most appropriate? a.Your atrial dysrhythmias are under control. b.You have pitting edema and mild varicosities. 1. Your pulse is 80 beats per minute, which is within the normal range. d.Im using my stethoscope to listen for any crackles, wheezes, or rubs. 25. The nurse keeps in mind that the most important reason to share information and to offer brief teaching while performing the physical examination is to help the: a. Examiner feel more comfortable and to gain control of the situation. b. Examiner to build rapport and to increase the patients confidence in him or her. 1. Patient understand his or her disease process and treatment modalities. d.Patient identify questions about his or her disease and the potential areas of patient education. Chapter 5: Amenorrhea 1. If amenorrhea is reported by the female patient, the clinician should attribute this to until proven otherwise. A.Pregnancy 1. Ovarian failure 2. Lack of progesterone D.Menopause 2. A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms and chest, and development of acne. Pelvic examination is normal. The clinician should recognize these are signs of: A.Ovarian cancer 1. Endometriosis 2. Hormonal imbalance D.Stress-induced anovulation 3.. A 55-year-old woman complains of amenorrhea and hot flashes for the last 3 months. Pregnancy test is negative. The clinician should recognize that menopause is defined as the absence of menses for: A.3 months 1. 6 months 2. 1 year D.18 months 4. To confirm the diagnosis of amenorrhea due to menopause, blood should be drawn for hormones. Which are the changes that occur with menopause? A.FSH rises 1. LH decreases 2. LH rises D.A & C Chapter 6. Breasts lumps and nipple discharge Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Your patient has a rubbery, firm, mobile breast mass. In order to completely exclude the possibility of cancer, the triple test is necessary, which includes: A.CT scan 1. MRI 2. Biopsy D.All of the above 2. A 23-year-old woman is concerned about a mass she found on palpation. Upon examination of the patient, the mass feels cystic, round, and mobile with discrete borders. The diagnostic study that is recommended is: A.CT scan 1. Mammogram 2. Biopsy D.Ultrasound 3. Which of the following variables is not a component of the Gail Model? A.Age at menarche 1. Number of breast biopsies 2. Age at first live birth D.Number of live births 4. A 62-year-old female presents with a singular, hard, 1 cm, non-tender, non-mobile mass in the right breast. There are no nipple or skin changes, however, you palpate an enlarged right-sided supraclavicular lymph node. The clinician should recognize these are signs of: A.Fibroadenoma 1. Breast cyst 2. Malignancy D.Paget’s disease 5. A 45-year-old female patient presents in the emergency department due to multiple chest injuries as a result of a motor vehicle accident. There is a palpable, tender, irregular 3 cm soft mass located in the left breast, with erythema and swelling of the breast. Which of the following is indicated? 1. Compression wrap for chest and breast trauma 2. Mammogram 3. Re-evaluation following complete resolution of obvious injuries 4. Ultrasound 6. Your patient is a 46-year-old woman suffering from psychosis complains of milky discharge from both her breasts. Upon examination, there are no significant findings and the patient is not pregnant, breastfeeding, or in the postpartum period. You should: 1. Order CT scan of head to rule out pituitary tumor 2. Obtain a complete list of the patient’s medications 3. Have the patient keep a menstrual cycle diary 4. Refer the patient for mammogram 7.. Your patient is a 36-year-old woman who complains of milky discharge from both her breasts, episodes of headache, and menstrual irregularity. The patient is on no medications. Upon examination, there are no significant findings, and the patient is not pregnant, breastfeeding, or in the postpartum period. It is important to: A.Order prolactin level 1. Obtain an MRI of head 2. Have the patient keep a menstrual cycle diary D. Refer the patient for mammogram 8. Bloody breast discharge is associated with which of the following? A.Bleeding disorder such as von Willebrand disease 1. Malignancy 2. Excessive non-steroidal anti-inflammatories D.A and C 9. Your patient is a 64-year-old female who presents with complaints of a red, scaly rash on her nipple and areola of one breast. It has been present for a few months. There is no mass or nipple discharge. You should be suspicious of: A.Contact dermatitis 1. Mastitis 2. Paget’s disease D.Eczema 10. A 12-year-old boy is brought into the clinic by his mother. The teen boy is embarrassed because he has developed breast tissue and would like to know if there is any treatment. The physical examination reveals early stages of puberty, otherwise it is normal. This presentation is: 1. Associated with a high rate of malignancy 2. Most often due to altered hormonal levels in puberty 3. Commonly indicative of pituitary tumor triggered by puberty 4. Too dense for a mammogram and requires biopsy 11 A condition that increases risk of breast cancer in a male is: A.Pseudogynecomastia 1. BRCA1 and 2 2. Klinefelter’s syndrome D.B and C Chapter 7. Breast Pain Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When examining the breasts of a 45-year-old female patient, you note nodularity throughout both breasts. There is no dominant mass, tenderness, nipple change, or skin change. Which of the following condition is most likely? A.Multiple fibroadenomas 1. Fibrocystic breasts 2. Mastalgia D.Mastitis 2. A 23-year-old female presents with episodic bilateral breast tenderness. Upon palpation, there are multiple areas of nodularity with no dominant breast mass and no tenderness, nipple, or skin changes. It is best to recommend: A. Ultrasound of the breasts 1. Mammogram of the breasts 2. Fine needle aspiration of one nodule within a breast D.Diary of menstrual cycle and breast symptoms 3.. A 34-year-old female who gave birth 2 weeks ago developed fever and pain in the right breast while nursing her baby. The patient has tenderness, eythema, and swelling of the nipple on the right breast. Which of the following diagnostic studies is indicated? 1. White blood cell (WBC) count 2. Breast milk culture 3. Ultrasound 4. Fine needle biopsy 4.. A 52-year-old female complains of discharge from one of her breasts. There is no pain, no mass, and no skin changes. The physical examination is normal. When putting pressure on the affected breast, the nipple expresses a small amount of thick, white discharge. These findings are consistent with: A.Duct ectasia 1. Mastitis 2. Fibroadenoma D.Fibrocystic breasts Chapter 8: Chest Pain 1. Cardiac chest pain is most often described as: A.Stabbing, piercing pain B. Pain with inhalation C.Crushing, squeezing pain D.Burning, gnawing pain 2. The pain associated with pericarditis is . A.Crushing and squeezing B. Constant C. Worse with inspiration D. Only present with fever 3. Pain associated with a dissecting thoracic aortic aneurysm is commonly described as: 1. Retrosternal crushing and squeezing 2. Chest stabbing and sharp 3. Ripping and tearing in the chest or thoracic back 4. Worse with inspiration 4. The pain of can frequently be mistaken for cardiac chest pain. A.Gastroesophageal reflux disease (GERD) 1. Peptic ulcer disease (PUD) 2. Cholecystitis D.All of the above 5. The pain of pancreatitis is described as: A.Abdominal sharp and piercing pain in the left upper quadrant 1. Dull and cramping pain in the right upper quadrant 2. Severe, epigastric pain radiating straight into the back D.Sharp pain radiating to the shoulder 6. The pain of costochondritis typically . A.Mimics cardiac crushing and squeezing pain 1. Worsens with movement and full inspiration 2. Radiates from epigastrium into the back D.Is a tearing and ripping pain 7. Patients with anxiety frequently complain of: A.Chest pain 1. Dizziness 2. Shortness of breath D.A and B 8. . During a cardiac assessment on a 38-year-old patient in the hospital for chest pain, the nurse finds the following: jugular vein pulsations 4 cm above the sternal angle when the patient is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty breathing when supine, and an S3 on auscultation. Which of these conditions best explains the cause of these findings? 1. Fluid overload 2. Atrial septal defect 3. MI 4. Heart failure Chapter 9. Confusion in older adults Multiple Choice Identify the choice that best completes the statement or answers the question. 1. 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? 1. Does your wife have dementia or frequent episodes of confusion? 2. Has your wife been running a fever? 3. Is your wife allergic to any medication? 4. Has your wife ever had a mental status exam? 2. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8 hours, his condition has stabilized and he is transferred to a medical unit. The family is wondering whether he will be able to go back home. Which assessment instrument is most appropriate for the nurse to choose at this time? 1. Lawton IADL instrument 2. Hospital Admission Risk Profile (HARP) 3. Mini-Cog 4. NEECHAM Confusion Scale 3. During a functional assessment of an older persons home environment, which statement or question by the nurse is most appropriate regarding common environmental hazards? 1. These low toilet seats are safe because they are nearer to the ground in case of falls. 2. Do you have a relative or friend who can help to install grab bars in your shower? 3. These small rugs are ideal for preventing you from slipping on the hard floor. 4. It would be safer to keep the lighting low in this room to avoid glare in your eyes. 4. When assessing aging adults, the nurse knows that one of the first things that should be assessed before making judgments about their mental status is: 1. Presence of phobias 2. General intelligence 3. Presence of irrational thinking patterns 4. Sensory-perceptive abilities 5. 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 cant even remember how to button his shirt. When assessing his sensory system, which action by the nurse is most appropriate? a.The nurse would not test the sensory system as part of the examination because the results would not be valid. b.The nurse would perform the tests, knowing that mental status does not affect sensory ability. c.The nurse would proceed with an explanation of each test, making certain that the wife understands. d.Before testing, the nurse would assess the patients mental status and ability to follow directions. 6. The nurse is assessing orientation in a 79-year-old patient. Which of these responses would lead the nurse to conclude that this patient is oriented? 1. I know my name is John. I couldnt tell you where I am. I think it is 2010, though. 2. I know my name is John, but to tell you the truth, I get kind of confused about the date. 3. I know my name is John; I guess Im at the hospital in Spokane. No, I dont know the date. d. I know my name is John. I am at the hospital in Spokane. I couldnt tell you what date it is, but I know that it is February of a new year2010. 7. A 69-year-old patient has been admitted to an adult psychiatric unit because his wife thinks he is getting more and more confused. He laughs when he is found to be forgetful, saying Im just getting old! After the nurse completes a thorough neurologic assessment, which findings would be indicative of Alzheimer disease? Select all that apply. a. Occasionally forgetting names or appointments b.Difficulty performing familiar tasks, such as placing a telephone call c.Misplacing items, such as putting dish soap in the refrigerator d.Sometimes having trouble finding the right word e.Rapid mood swings, from calm to tears, for no apparent reason f.Getting lost in ones own neighborhood 8. The nurse is assessing orientation in a 79-year-old patient. Which of these responses would lead the nurse to conclude that this patient is oriented? a.I know my name is John. I couldnt tell you where I am. I think it is 2010, though. b.I know my name is John, but to tell you the truth, I get kind of confused about the date. c.I know my name is John; I guess Im at the hospital in Spokane. No, I dont know the date. d.I know my name is John. I am at the hospital in Spokane. I couldnt tell you what date it is, but I know that it is February of a new year2010. Chapter 11: Cough 1. A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for hypertension. On physical examination, vital signs are 98 degrees, 18 resps/ min, pulse 56, and BP 100/60. Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These signs and symptoms are characteristic of: A.Chronic renal failure 1. Congestive heart failure 2. Metabolic syndrome D.Liver failure 2. A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness of breath, chronic cough, and wheezing. On physical examination, patient shows barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields. Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and nontender. Extremities show no significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and symptoms are characteristic of: A.Congestive heart failure 1. Chronic obstructive pulmonary disease 2. Asthma D.Lung cancer 3. A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with rust-colored sputum, low-grade afternoon fevers, and night sweats for the past 2 months. The nurses preliminary analysis, based on this history, is that this patient may be suffering from: a.Bronchitis. b.Pneumonia. 1. Tuberculosis. d.Pulmonary edema. 4. A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe in this patient? a.Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema b.Rasping cough, thick mucoid sputum, wheezing, and bronchitis 1. Productive cough, dyspnea, weight loss, anorexia, and tuberculosis d.Fever, dry nonproductive cough, and diminished breath sounds 5. A person with heart failure often exhibits increased respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, ankle edema, and pallor in light-skinned individuals. A patient with rasping cough, thick mucoid sputum, and wheezing may have bronchitis. Productive cough, dyspnea, weight loss, and dyspnea indicate tuberculosis; fever, dry nonproductive cough, and diminished breath sounds may indicate Pneumocystis jiroveci (P. carinii) pneumonia 6. A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the day. The nurse recognizes that this cough may indicate: a.Pneumonia. b.Postnasal drip or sinusitis. 1. Exposure to irritants at work. d.Chronic bronchial irritation from smoking. 7. During a morning assessment, the nurse notices that the patients sputum is frothy and pink. Which condition could this finding indicate? a.Croup b.Tuberculosis 1. Viral infection d.Pulmonary edema 8. A patient has been admitted to the emergency department with a possible medical diagnosis of pulmonary embolism. The nurse expects to see which assessment findings related to this condition? a.Absent or decreased breath sounds b.Productive cough with thin, frothy sputum 1. Chest pain that is worse on deep inspiration and dyspnea d.Diffuse infiltrates with areas of dullness upon percussion 9. The nurse is auscultating the lungs of a patient who had been sleeping and notices short, popping, crackling sounds that stop after a few breaths. The nurse recognizes that these breath sounds are: a.Atelectatic crackles that do not have a pathologic cause. b.Fine crackles and may be a sign of pneumonia. 1. Vesicular breath sounds. d.Fine wheezes. Chapter 12: Diarrhea 1. A patient with Crohn’s disease complains of extreme muscle weakness, fatigue, diarrhea, bruising, 10-pound weight loss over the last few weeks, and dypnea on exertion. On physical examination, the patient is afebrile, pulse 110, resps 20/min, and BP 100/ 50. BMI is 15. The patient is pale and frail looking, with bilateral ankle edema and bruises noted on cachetic thighs. Which of the following diagnostic tests is most helpful in the diagnosis of intestinal malabsorption? A.Liver enzymes 1. Vitamin B12 assay 2. Stool for fat D.INR 2.A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is: 1. Diarrhea. 2. Peritonitis. 3. Laxative use. 4. Gastroenteritis. 3. The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms? 1. Eat a diet high in fiber content 2. Increase dietary fat intake 3. Exercise to increase intra-abdominal pressure 4. Take daily laxatives 4. Which of the following are indicators of colorectal cancer? (Select all that apply.) 5. Constant diarrhea 6. Excessive flatulence 7. Cachexia 8. Cramps 9. Rectal bleeding 10. Anemia 4. The home health nurse is caring for a patient who has frequent abdominal pain and diarrhea. The nurse uses the Rome Criteria to direct assessment for irritable bowel syndrome. What is included in the Rome Criteria? (Select all that apply.) 1. Discomfort at least 3 days a month 2. Blood in stool 3. Pain relieved by defecation 4. Excessive flatulence 5. Nausea and vomiting associated with onset 6. Onset associated with change in stool consistency or frequency 5. Celiac sprue in the adult can lead to systemic problems. Arrange the pathophysical events of this in order of their appearance. (Separate letters by a comma and space as follows: A, B, C, D) 1. Malabsorption 2. Weight loss/vitamin deficiency 3. Systemic involvement 4. Diarrhea 5. Ingestion of gluten 6. Destruction of villi in the small intestine 6. A nurse is teaching a client about magnesium hydroxide with aluminum hydroxide (Maalox). What instruction is most appropriate? 1. Aspirin must be avoided. 2. Do not worry about black stools. 3. Report diarrhea to your provider. 4. Take 1 hour before meals. 7. After teaching a client who was hospitalized for Salmonella food poisoning, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? 1. I will let my husband do all of the cooking for my family. 2. Ill take the ciprofloxacin until the diarrhea has resolved. 3. I should wash my hands with antibacterial soap before each meal. 4. I must place my dishes into the dishwasher after each meal. 8. After teaching a client with perineal excoriation caused by diarrhea from acute gastroenteritis, a nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? 1. Ill rinse my rectal area with warm water after each stool and apply zinc oxide ointment. 2. I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel. 1. I must take a sitz bath three times a day and then pat my rectal area gently but thoroughly to make sure I am dry. 1. I shall clean my rectal area with a soft cotton washcloth and then apply vitamin A and D ointment. 9. A nurse assesses a client who has ulcerative colitis and severe diarrhea. Which assessment should the nurse complete first? 1. Inspection of oral mucosa 2. Recent dietary intake 3. Heart rate and rhythm 4. Percussion of abdomen 10. A nurse assesses a client with Crohns disease and colonic strictures. Which clinical manifestation should alert the nurse to urgently contact the health care provider? 1. Distended abdomen 2. Temperature of 100.0 F (37.8 C) 3. Loose and bloody stool 4. Lower abdominal cramps 11. A nurse cares for a client with ulcerative colitis. The client states, I feel like I am tied to the toilet. This disease is controlling my life. How should the nurse respond? 1. Lets discuss potential factors that increase your symptoms. 2. If you take the prescribed medications, you will no longer have diarrhea. 3. To decrease distress, do not eat anything before you go out. 4. You must retake control of your life. I will consult a therapist to help. 12. A nurse teaches a community group ways to prevent Escherichia coli infection. Which statements should the nurse include in this groups teaching? (Select all that apply.) 1. Wash your hands after any contact with animals. 2. It is not necessary to buy a meat thermometer. 3. Stay away from people who are ill with diarrhea. 4. Use separate cutting boards for meat and vegetables. 5. Avoid swimming in backyard pools and using hot tubs. 13. A nurse teaches a community group about food poisoning and gastroenteritis. Which statements should the nurse include in this groups teaching? (Select all that apply.) 1. Rotavirus is more common among infants and younger children. 2. Escherichia coli diarrhea is transmitted by contact with infected animals. 3. To prevent E. coli infection, dont drink water when swimming. 4. Clients who have botulism should be quarantined within their home. 5. Parasitic diseases may not show up for 1 to 2 weeks after infection. 14. A nurse cares for an older adult client who has Salmonella food poisoning. The clients vital signs are heart rate: 102 beats/min, blood pressure: 98/55 mm Hg, respiratory rate: 22 breaths/min, and oxygen saturation: 92%. Which action should the nurse complete first? 1. Apply oxygen via nasal cannula. 2. Administer intravenous fluids. 3. Provide perineal care with a premedicated wipe. 4. Teach proper food preparation to prevent contamination. Chapter 13: Dizziness 1. 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 1. Test the patient for Brudzinski sign 2. Perform the Hallpike maneuver D.Assess for Babinski’s sign 2. You are an emergency room clinician that assisted with CPR on a 20-year-old trauma patient. The CPR was unsuccessful, the patient expired, and you need to explain this to the family in the waiting room. Upon telling the mother about the death of her son, she becomes dizzy and faints. What is the most likely cause for the woman fainting? A.Cardiogenic shock 1. Vasovagal response 2. Syncope due to hypoxia D.Dizziness and vertigo 3. A client is in the emergency department reporting a brief episode during which he was dizzy, unable to speak, and felt like his legs were very heavy. Currently the clients neurologic examination is normal. About what drug should the nurse plan to teach the client? 1. Alteplase (Activase) 2. Clopidogrel (Plavix) 3. Heparin sodium 4. Mannitol (Osmitrol) 4. clients manifestations are consistent with a transient ischemic attack, and the client would be prescribed aspirin or clopidogrel on discharge. Alteplase is used for ischemic stroke. Heparin and mannitol are not used for this condition. A nurse is evaluating a client who is being treated for dehydration. Which assessment result should the nurse correlate with a therapeutic response to the treatment plan? 1. Increased respiratory rate from 12 breaths/min to 22 breaths/min 2. Decreased skin turgor on the clients posterior hand and forehead 3. Increased urine specific gravity from 1.012 to 1.030 g/mL 4. Decreased orthostatic light-headedness and dizziness 5. During an examination, the patient tells the nurse that she sometimes feels as if objects are spinning around her. The nurse would document that she occasionally experiences: 1. Vertigo. 2. Tinnitus. 3. Syncope. 4. Dizziness.Chapter 14. Dyspnea Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: A.50 x 2-pack years A. 100-pack years B. 50-year, 2-pack history D.100 pack history 2. Which of the following is characteristic of COPD? A.Asymmetric chest expansion C. Increased lateral diameter D. Increased anterior-posterior diameter D.Pectus excavatum 3. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of: A.Pneumonia E. Emphysema F. Pneumothorax D.Asthma 4. During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with: A.COPD G. Pneumothorax H. A normal finding D.Pleural effusion 5. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? A.Computed tomography (CT) scan I. Chest xray with PA, lateral, and lordotic views J. Ultrasound D.Positron emission tomography (PET) scan 6. Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with: A.Exercise-induced cough K. Bronciectasis L. COPD D.Pericarditis 7. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to: A.Pneumothorax M. Pleural effusion N. Pneumonia D.Pulmonary embolism 8. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: A.Pneumonia O. Pleuritis P. Pneumothorax D.A and B 9. While assessing auscultated spoken sounds, the ausculated sound is heard as “a-a-a” when he is asked to repeat “e-ee.” This is indicative of: A.Asthma Q. Tumor R. Pneumonia D.Pleural effusion 10. A cough is described as chronic if it has been present for: A.2 weeks or more S. 8 weeks or more T. 3 months or more D.6 months or more 11. Which of the following medications are commonly associated with the side effect of cough? A.Beta blocker U. Diuretic V. ACE inhibitor D.Calcium antagonist 12. Which of the following details are NOT considered while staging asthma? A.Nighttime awakenings W. Long-acting beta agonist usage X. Frequency of symptoms D.Spirometry findings 13. When asthma is suspected, which of the following is NOT useful in making a diagnosis? A.Decreased FEV1/FVC ratio Y. Decreased FEV1 Z. Some reversibility with administration of bronchodilator D.Peak flow meter reading 14. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home: A.Age over 40 AA. Fever greater than 101 BB. Tachypnea greater than 30 breaths/minute D Productive cough . 15. The most common etiologic organism for community-acquired pneumonia is: A.Streptococcus pneumoniae CC. Beta hemolytic streptococcus DD. Mycoplasma D.Methicillin resistant staphylococcus 16. A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient: A.Can be treated as an outpatient EE. Requires hospitalization for treatment FF. Requires a high dose of parenteral antibiotic D.Can be treated with oral antibiotics 17. Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for: A.Immediate endotracheal intubation GG. Broad spectrum intravenous antibiotics HH. Thoracentesis to rule out empyema D.Gram stain and culture of sputum 18. If on physical examination the clinician auscultates rhonchi, the clinician should ask the patient to take a deep breath and cough in order to: A.Mobilize secretions II. Diagnose pleural effusion JJ. Accurately distinguish lung sounds D.A & C 19. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia? A.Fever of 102 KK. Infiltrates on chest x-ray LL. Pleural effusion on chest x-ray D.Elevated white blood cell count 20. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following: A.Barrel-shaped chest MM. Clubbing NN. Pectus excavatum D.Prolonged capillary refill 21. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect: A.Legionaire’s disease OO. Malaria PP. Tuberculosis D Pneumonia 22. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest x-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of: A.Lung cancer QQ. Tuberculosis RR. Pneumonia D.COPD 23. Causes of pleural effusions include: A.Malignancy SS. Pneumonia TT. Cardiomegaly D.All of the above 24. Patients with pulmonary fibrosis show decreased lung tissue compliance and diminished forced vital capacity (FVC). Pulmonary fibrosis is a type of: A.Obstructive disease UU. Restrictive disease VV. Hyperreactive airway disease D.None of the above 25. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect: A.Pulmonary embolism WW. Pleural effusion XX. Pneumothorax D.Fracture of ribs Chapter 15. Earache 1. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: A.Acoustic neuroma YY. Cerumen impaction ZZ. Otitis media D.Ménière’s disease 2. A patient presents to the emergency department due to head trauma