NR509 Midterm Exam Questions With Complete Solutions
"Ask Me Three" approach Correct Answers intended to help
patients become more active members of their healthcare team
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
*Modifying this approach to "Tell Them Three" can also help
clinicians keep their message focused and simple.
3 key vascular structures in the neck Correct Answers -carotid
artery
-external jugular vein
-internal jugular vein
6 cardinal directions of gaze Correct Answers Have patient
follow finger or pencil with eyes
-make a wide "H" in the air.
A 57-year-old maintenance worker comes to your office for
evaluation of pain in his legs. He has smoked two packs per day
since the age of 16, but he is otherwise healthy. You are
concerned that he may have peripheral vascular disease. Which
symptom is concerning? Correct Answers Intermittent
claudication
Rationale: PAD is an atherosclerotic disease leading to
obstruction of peripheral arteries causing exertional claudication
(muscle pain relieved by rest) and atypical leg pain. Untreated it
may progress to ischemic pain at rest. Chest pain and shortness
,of breath are generally not common or concerning symptoms of
PVD. JVP measurement of 7 cm is normal (6-8 cm).
A 78-year-old female client with a history of hypertension,
coronary artery disease, and diabetes presents to the emergency
department with persistent right jaw pain. She states she went to
the dentist earlier, but the examination was normal. There is
slight dyspnea when the client walks to the wheelchair to go to
the exam room. As the nurse practitioner (NP) assessing this
client, what would be the appropriate intervention? Correct
Answers Evaluate heart rate and rhythm on cardiac monitor
Rationale: Older adults and female clients do not present with
typical chest pain symptoms. Jaw pain can be the only indicator
of an impending cardiac event. This client did have some
exertional dyspnea with mild activity, which can be another
indicator of myocardial ischemia. The appropriate action is to
place the client on the cardiac monitor to check rate and rhythm
as well as ordering a 12 lead ECG. Placing the client in the non-
emergent waiting area or ordering an outpatient stress test is not
helpful and can potentially delay treatment of acute coronary
syndrome. Cholesterol levels are not going to be helpful
immediately.
A client presents with increasing dizziness and fatigue. Upon
auscultation, the NP notices a split S2 during expiration that
disappears on inspiration. What is the most likely cause of the
client's complaints of dizziness and fatigue? Correct Answers
Aortic stenosis
,Rationale: Aortic stenosis is characterized by a paradoxical
splitting of S2 which is present on expiration but disappears on
inspiration. Mitral regurgitation may be suspected with a
widened, split S2. Tricuspid regurgitation is typically not heard
during auscultation and is most often found on an
echocardiogram. A harsh murmur on auscultation with radiation
into the neck or back is common with pulmonic stenosis.
A fellow student asks you how to distinguish jugular venous
pulsation (JVP) from a carotid pulse. Which characteristic is
typical of the carotid pulse? Correct Answers Palpable and
height unchanged by inspiration
Rationale: The internal jugular venous pulsation (JVP) is rarely
palpable, usually has a soft biphasic undulating quality, and
eliminated by light pressure on the vein(s) just above the sternal
end of the clavicle. The height of pulsations changes with
position, normally dropping as the client becomes more upright.
The height of pulsations usually falls with inspiration. By
contrast, carotid pulsations are generally palpable and have a
more vigorous thrust with a single outward component.
Pulsations are not eliminated by pressure on veins at the sternal
end of the clavicle and the height of pulsations is unchanged by
position. In addition, the height of pulsations is not affected by
inspiration.
Abdomen Correct Answers Inspect, auscultate, and percuss the
abdomen. Palpate lightly, then deeply. Assess the liver and
spleen by percussion and then palpation. Try to palpate the
kidneys. Palpate the aorta and its pulsations. If you suspect
, kidney infection, percuss posteriorly over the costovertebral
angles.
Abnormal or Concerning Findings of the Skin, Nails, and Hair
Correct Answers -Lesions
• Basal Cell Carcinoma
• Melanoma
• Squamous Cell Carcinoma
• Actinic Keratosis
-Rashes & Itching
• Pruritus
-Hair loss
-Nail Changes
Abnormalities in JVP may raise suspicion for: Correct Answers
atrial fibrillation, tricuspid regurgitation or stenosis, pulmonary
artery hypertension, pulmonic stenosis, and cardiac tamponade
Actinic Keratosis Correct Answers Multiple lesions, varied
appearance
Occurs on sun-exposed areas
Rough textured "horn-like" surface
Precancerous lesion
Watchful waiting or removal with cryotherapy, topical
immunotherapy, or laser therapy
active listening Correct Answers closely attending to what the
client is communicating, connecting to the client's emotional
state, and using verbal and nonverbal skills to encourage the
client to expand on their feelings and concerns.
"Ask Me Three" approach Correct Answers intended to help
patients become more active members of their healthcare team
1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?
*Modifying this approach to "Tell Them Three" can also help
clinicians keep their message focused and simple.
3 key vascular structures in the neck Correct Answers -carotid
artery
-external jugular vein
-internal jugular vein
6 cardinal directions of gaze Correct Answers Have patient
follow finger or pencil with eyes
-make a wide "H" in the air.
A 57-year-old maintenance worker comes to your office for
evaluation of pain in his legs. He has smoked two packs per day
since the age of 16, but he is otherwise healthy. You are
concerned that he may have peripheral vascular disease. Which
symptom is concerning? Correct Answers Intermittent
claudication
Rationale: PAD is an atherosclerotic disease leading to
obstruction of peripheral arteries causing exertional claudication
(muscle pain relieved by rest) and atypical leg pain. Untreated it
may progress to ischemic pain at rest. Chest pain and shortness
,of breath are generally not common or concerning symptoms of
PVD. JVP measurement of 7 cm is normal (6-8 cm).
A 78-year-old female client with a history of hypertension,
coronary artery disease, and diabetes presents to the emergency
department with persistent right jaw pain. She states she went to
the dentist earlier, but the examination was normal. There is
slight dyspnea when the client walks to the wheelchair to go to
the exam room. As the nurse practitioner (NP) assessing this
client, what would be the appropriate intervention? Correct
Answers Evaluate heart rate and rhythm on cardiac monitor
Rationale: Older adults and female clients do not present with
typical chest pain symptoms. Jaw pain can be the only indicator
of an impending cardiac event. This client did have some
exertional dyspnea with mild activity, which can be another
indicator of myocardial ischemia. The appropriate action is to
place the client on the cardiac monitor to check rate and rhythm
as well as ordering a 12 lead ECG. Placing the client in the non-
emergent waiting area or ordering an outpatient stress test is not
helpful and can potentially delay treatment of acute coronary
syndrome. Cholesterol levels are not going to be helpful
immediately.
A client presents with increasing dizziness and fatigue. Upon
auscultation, the NP notices a split S2 during expiration that
disappears on inspiration. What is the most likely cause of the
client's complaints of dizziness and fatigue? Correct Answers
Aortic stenosis
,Rationale: Aortic stenosis is characterized by a paradoxical
splitting of S2 which is present on expiration but disappears on
inspiration. Mitral regurgitation may be suspected with a
widened, split S2. Tricuspid regurgitation is typically not heard
during auscultation and is most often found on an
echocardiogram. A harsh murmur on auscultation with radiation
into the neck or back is common with pulmonic stenosis.
A fellow student asks you how to distinguish jugular venous
pulsation (JVP) from a carotid pulse. Which characteristic is
typical of the carotid pulse? Correct Answers Palpable and
height unchanged by inspiration
Rationale: The internal jugular venous pulsation (JVP) is rarely
palpable, usually has a soft biphasic undulating quality, and
eliminated by light pressure on the vein(s) just above the sternal
end of the clavicle. The height of pulsations changes with
position, normally dropping as the client becomes more upright.
The height of pulsations usually falls with inspiration. By
contrast, carotid pulsations are generally palpable and have a
more vigorous thrust with a single outward component.
Pulsations are not eliminated by pressure on veins at the sternal
end of the clavicle and the height of pulsations is unchanged by
position. In addition, the height of pulsations is not affected by
inspiration.
Abdomen Correct Answers Inspect, auscultate, and percuss the
abdomen. Palpate lightly, then deeply. Assess the liver and
spleen by percussion and then palpation. Try to palpate the
kidneys. Palpate the aorta and its pulsations. If you suspect
, kidney infection, percuss posteriorly over the costovertebral
angles.
Abnormal or Concerning Findings of the Skin, Nails, and Hair
Correct Answers -Lesions
• Basal Cell Carcinoma
• Melanoma
• Squamous Cell Carcinoma
• Actinic Keratosis
-Rashes & Itching
• Pruritus
-Hair loss
-Nail Changes
Abnormalities in JVP may raise suspicion for: Correct Answers
atrial fibrillation, tricuspid regurgitation or stenosis, pulmonary
artery hypertension, pulmonic stenosis, and cardiac tamponade
Actinic Keratosis Correct Answers Multiple lesions, varied
appearance
Occurs on sun-exposed areas
Rough textured "horn-like" surface
Precancerous lesion
Watchful waiting or removal with cryotherapy, topical
immunotherapy, or laser therapy
active listening Correct Answers closely attending to what the
client is communicating, connecting to the client's emotional
state, and using verbal and nonverbal skills to encourage the
client to expand on their feelings and concerns.
