Advanced Nursing Practice
2025/2026
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, Examine the patient's ear canals
When evaluating a 78-year-old
man, the PMHNP notices the
patient frequently leans in with
the right side of his head and
frequently asks for things to be
repeated. His daughter is very
worried that he has dementia or
depression because he has also
become increasingly isolated, as
well as increasingly irritable as he
believes people are yelling at him
out of frustration of not being
heard. The daughter is tearful,
anxious, and frustrated. What
should the PMHNP do first?
Order a CT scan of the head
Separate the patient from the
daughter and interview him alone
Examine the patient's ear canals
Provide anticipatory guidance
regarding aging parents to the
daughter
Explore the reason for not having had a physical in so long
A 35-year-old man diagnosed
with bipolar disorder mentions to
his PMHNP that he had felt a
lump on his left testicle. He is
concerned he has not had a
physical exam in 10 years. What
is the best action by the PMHNP?
Explore the reason for not having
had a physical in so long
Refer him to his primary care
provider
Perform a urogenital exam and
order an ultrasound
Refer him to urology
, Watch and wait
In observing the appearance of
the patient with depression and a
history of systemic lupus
erythematosus, the PMHNP
notices a lesion on the neck of
the patient about the size of a
pencil eraser, flush with the skin,
uniformly colored, with discrete
borders, and consistent texture.
The PMHNP should:
Refer the patient to oncology
Watch and wait
Refer the patient to rheumatology
Refer the patient to dermatology
The examiner palpates in the right upper abdominal quadrant
below the costal margin while the patient breathes in. The test is
positive if the examiner observes pain during inhalation.
Acute cholecystitis
Which of the following best
represent the physical exam
maneuver known as Murphy's
sign?
While supine, ask the patient to
grasp her knee while tucking 1
leg up to the chest. A positive test
occurs when pain prohibits
elevation of the ipsilateral leg.
The examiner palpates in the
right upper abdominal quadrant
below the costal margin while the
patient breathes in. The test is
positive if the examiner observes
pain during inhalation.
Press and palpate deeply into the
abdomen and release quickly
observing for pain.
Ask the patient to bend at the
knees while holding onto a rail,
observe for a loss of balance.
Cholecystitis
What does the Murphy sign
assess for