Advanced Health Assessment Exam

Which of the following is NOT an examination technique to detect appendicitis? A) McBurney's Sign B) Murphy's Sign C) Obturator Sign D) Rovsings Sign

B) Murphy's Sign All except Murphy's sign are tests for appendicitis. Murphy's sign is to detect gall bladder disease. Bates, p485-486

At what age is colorectal cancer screening started in those with "average risk?" A) 50 B) 45 C) 25 D) 35

A) 50 The recommendation for colorectal cancer screening starts at 50 years old for those with "average risk." Bates, p 469

The nurse practitioner is assessing a patient who may have hearing loss. Which of these statements is true concerning air conduction? A) Air conduction is the normal pathway for hearing. B) Vibrations of the bones in the skull cause air conduction. C) Amplitude of sound determines the pitch that is heard. D) Loss of air conduction is called a conductive hearing loss.

A) Air conduction is the normal pathway for hearing. The normal pathway of hearing is air conduction, which starts when sound waves produce vibrations on the tympanic membrane. Conductive hearing loss results from a mechanical dysfunction of the external or middle ear. The other statements are not true concerning air conduction.

Which of the following will help to optimize success from a pediatric examination? A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. B) Being very orderly, so as not to miss a portion of the examination. C) Using firmness throughout your examination, letting the child know you are in charge. D) Making sure to place the infant on the table during the examination while Mom watches close by.

A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc. With certain exceptions, physical examination does not require use of the examining table, or with the child in a parent's lap. Plan the examination to start with the least distressing procedures and end with the most distressing, usually involving the throat and ears. Patience, distraction, play flexibility in the order of the examination, and caring but firm approach are all key to successfully examining the young child.

Which of the following is the most common bloodborne pathogen in the United States? A) Hepatitis C B) HIV C) Hepatitis A D) Hepatitis B

A) Hepatitis C Hepatitis C is the most common bloodborne pathogen in the United States with about 2% of the population having the virus. Bates, p467-468

A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care? A) JM is a 59 year old male here for having "black stools" for the past 24 hours. B) JM came into the clinic complaining of black stools for the past 24 hours. C) JM is a 59 year old male here for "ulcerative colitis." D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked.

A) JM is a 59 year old male here for having "black stools" for the past 24 hours. Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care. Make every effort to quote the patient's own words.

The nurse is preparing to auscultate for heart sounds. Which technique is correct? A) Listen in the 6 auscultation areas. B) Listen for only murmurs and low pitched sounds. C) Listen to the sounds at the aortic, tricuspid, pulmonic, and mitral areas. D) Listen to the sounds only at the site where the apical pulse is felt to be the strongest.

A) Listen in the 6 auscultation areas. Bates p390-391

You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is NOT a component of guided questioning? A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer. B) Offering the patient multiple choices in order to clarify the character of the urinary symptoms she is experiencing. C) Asking her to tell you what she means when she states that she has a urinary tract infection. D) Directed questioning starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer.

A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer. Bates p 59, 69-71

A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse is aware that which of these findings would be consistent with an acute infection? A) Tonsils 3+/1-4+ with large white spots B) Tonsils 1+/1-4+ with pale coloring C) Tonsils 1+/1-4+ and pink, same color as oral mucosa D) Tonsils 2+/1-4+ and pink with white particles inside deep crypts

A) Tonsils 3+/1-4+ with large white spots With an acute infection, tonsils are bright red and swollen and may have exudate or large white spots. Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection.

Mrs. Elkins presents today with a complaint of a productive cough and fever that is worsened over the past 2-3 days. Which of the following respiratory problems is LEAST likely to have this HPI? A) acute pulmonary embolism B) bacterial pneumonia C) mycoplasma pneumonia D) acute bronchitis

A) acute pulmonary embolism Acute pulmonary embolisms usually present suddenly and are not typically associated with a fever of several days (Bates, p334)

Auscultate for abdominal bruits of the following areas during abdominal exam: A) aorta, renal arteries, iliac arteries, femoral arteries B) lower right and left quadrants C) liver and spleen only D) femoral arteries and aorta only

A) aorta, renal arteries, iliac arteries, femoral arteries Bates 472-473

The NP knows that normal newborn lung sounds: A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the sounds B) are vesicular C) are easily auscultated without the stethoscope D) are quiet in the infant compared to the adult

A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the sounds Fine crackles are commonly heard in the immediate newborn period as a result of the opening of the airways and learning of fluid. Persistent fine crackles would be noticed with pneumonia, bronchiolitis, or atelectasis. (Bates, p 831)

If a patient is reporting light, gray colored stool, it is likely that ________ is missing from the stool. A) bile B) fiber C) bacteria D) mucus

A) bile Bile is what gives stools a darker color, so lighter, gray colored stools may indicate a bile duct obstruction (Bates, p461).

Ascites would be described as ____________ with abdominal percussion. A) dullness around the outside (periphery) of the abdomen and tympany in the center of the abdomen when supine B) diffuse hyperresonance C) hyperresonance in the right upper quadrant with tympany in the rest of the abdomen D) none of the above

A) dullness around the outside (periphery) of the abdomen and tympany in the center of the abdomen when supine The percussion of the abdomen with ascites is dullness around the outside portion of the abdomen (because of the fluid) and tympany in the center (since it is above the level of the fluid). Bates, pg484-485

All of the following are a common or concerning symptom in a health history for a respiratory assessment EXCEPT? A) palpitations B) blood-streaked sputum C) chest pain D) snoring

A) palpitations Chest pain, blood-streaked sputum, and snoring are all common or concerning symptoms in a health history for respiratory assessment.

During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse practitioner knows that this occurs because of a decrease in: A) pigmentation B) thyroid stimulating hormone C) phagocytes D) fungacytes

A) pigmentation Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of melanocytes) so the hair looks gray or white and feels thin and fine. The other options are not correct.

Rhonchi suggests: A) secretions is large airways B) secretions in the pleural sac C) secretions in alveoli D) secretions in bronchioles

A) secretions is large airways Rhonchi are suggestive of secretions in large airways (Bates, p325).

Ethel is a 68 year old Caucasian female who is new to your area. She shows you multiple brown colored, flat lesions on her face, chest, and hands that have been present for years. You respond that these are likely: A) solar lentigos B) melanomas C) keloids D) fissures

A) solar lentigos solar lentigos are from sun damage, are more common on the face, shoulders, and hands.

Physiologic splitting of the S2 in the 2nd and 3rd interspace, which is usually accentuated by inspiration, is caused by: A) the closing of the aortic and pulmonic valves B) the addition of the S4 sound C) the addition of the S3 sound D) the closing of the tricuspid and mitral valves

A) the closing of the aortic and pulmonic valves Physiologic splitting of the S2 = closing of the aortic and pulmonic valves. Usually, the pulmonic valve closure is too faint to be heart but at the apex. The split is accentuated upon inspiration and disappears on expiration (Bates, p405).

Which of the following is true about auscultating the heart? A) the diaphragm is better for picking up the sounds of S1 and S2 and the bell is better for picking up the sounds of S3 and S4. B) The bell is better for picking up the sounds of S1 and S2 and the diaphragm is better for picking up the sounds of S3 and S4. C) The diaphragm is not necessary for accurate auscultation during the cardiac exam. D) The bell is not necessary for the cardiac exam, but it is necessary for accurate auscultation during the abdominal exam.

A) the diaphragm is better for picking up the sounds of S1 and S2 and the bell is better for picking up the sounds of S3 and S4. (Bates, p390)

A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. B) at 30 feet the patient can read the entire chart. C) the patient can read the chart from 20 feet in the left eye and 30 feet in the right eye, D) the patient can read from 30 feet what a person with normal vision can read from 20 feet.

A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. Visual acuity is expressed as 2 numbers (e.g. 20/30): the first indicates the distance of the patient from the chart, and the second the distance at which a normal eye can read the line of letters (Bates, p 231).

What is the correct way to perform the Whisper test to assess hearing? A) whisper a combination of 3 letters and numbers out of the patient's sight while occluding the other ear and have them repeat it, then test the other side. B) whisper, "Can you hear me?" C) have someone whisper a sentence outside the exam room door and have the patient repeat it D) whisper a sentence of 5 words and have the patient repeat it.

A) whisper a combination of 3 letters and numbers out of the patient's sight while occluding the other ear and have them repeat it, then test the other side. The Whisper test is recommended to be a combination of 3 letters and numbers while occluding the other ear. Have the patient repeat it, then test the other ear. (Bates, p246-247)

The diameter of the PMI is approximately: A) 1-2.5 cm in diameter and any larger is evidence of mitral valve prolapse B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy C) .5-1 cm in diameter and any larger is evidence supporting left ventricular hypertrophy D) .5-1 cm in diameter and any larger is evidence of mitral valve prolapse

B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy (Bates p 344)

Normal blood pressure would be best described as: A) < 130/90 B) < 120/80 C) < 100/50 D) 110/60

B) < 120/80 Normal blood pressure is 120/80 (Bates, p130)

You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

An Annual Low Dose Computed Tomography (LDCT) screening would be recommended for which patient? A) Tammy, age 57, who smokes a half pack of cigarettes a day for the last 20 years. B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. C) Angela, age 43, and started smoking when she was 15 years old. D) George, age 80, who lives with his wife and is a smoker.

B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. LDCT screenings are recommended to patients 55-74 years, a 30-pack year smoking history or current smoking or have quit in the last 15 years (Bates, p315-316).

Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.

B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. Give the patient free rein for the first 5-10 minutes, listening closely to the conversation. Focus on what seems most important to the patient. Learn to set limits when needed. A brief summary may help you change the subject yet validate any concerns. Do no show your impatience.

A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't catch my breath." His symptoms indicates sleep related symptoms of a certain type of disease, so which question would the NP want to ask? A) Have you had a recent sinus infection or URI? B) Do you have any history of problems with your heart? C) Do you think it is because it's been so hot at night? D) When was your last electroencephalogram?

B) Do you have any history of problems with your heart? Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air. (Bates, p357)

Which of the following enables optimal examination of the adult's tympanic membrane? A) Grasp the auricle firmly and pull it downward, backward, and pressed close to the head. B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. C) Pull the ear lobe toward the chin and keep the auricle pulled away from the head. D) Grasp the auricle keeping it in normal position and pressed close to the head.

B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. To straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head (Bates, p 245).

Which abdominal quadrant pain would most likely occur with diverticulitis? A) LUQ B) LLQ C) RLQ D) RUQ

B) LLQ Bates, p488

When performing posterior palpation of the thyroid gland, you should do all fo the following, EXCEPT: A) Have the patient tip his or her head forward and slightly to the side. B) Place your index fingers above the cricoid cartilage. C) Palpate between the sternocleidomastoid muscle and the trachea for the lobes of the thyroid. D) Move your fingers laterally to palpate for the thyroid lobes.

B) Place your index fingers above the cricoid cartilage. Place the fingers of both hands on the patient's neck so that your index fingers are just BELOW the cricoid cartilage.

The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." A) Medical B) Surgical C) Obstetrics/gynecology D) Psychiatric

B) Surgical Provide information relative to Adult Illnesses in each of four areas: Medical, Surgical, Obstetric/Gynecologic, and Psychiatric.

All of the following are true about assessing the jugular venous pressure EXCEPT: A) The jugular venous pressure is affected by changes in the right atrial filling. B) The pulsation from the internal jugular vein reflects the left ventricle pressure. C) The jugular venous pressure is determined by the highest point of oscillation in the internal jugular vein. D) The jugular venous pressure is considered abnormal if it is greater than 4 cm above the sternal angle or greater than 9 cm above the right atrium.

B) The pulsation from the internal jugular vein reflects the left ventricle pressure. The jugular venous pressure is affected by changes in R atrial filling. The JVP is abnormal at a height greater than 4 cm and is determined by the highest point of oscillation. The pulsation from the internal jugular vein is not palpable. (Bates, p354-355)

The nurse practitioner is auscultating the chest in an adult. Which technique is correct? A) Instruct the patient to breathe in and out only through his or her nose. B) Use the diaphragm of the stethoscope held firmly against the chest. C) Instruct the patient to take deep, rapid breaths. D) Use the bell of the stethoscope held lightly against the chest to avoid friction.

B) Use the diaphragm of the stethoscope held firmly against the chest. The diaphragm of the stethoscope held firmly against the chest is the correct way to auscultate breath sounds. The patient should be instructed to breathe through his or her mouth, a little deeper than usual, but not to hyperventilate. (Bates, p323)

Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Wheals, urticaria, or hives C) Psoriasis D) Purpura

B) Wheals, urticaria, or hives Wheals/urticaria - a somewhat irregular, relatively transient, superficial area of localized skin edema.

Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem? A) You are an alcoholic, aren't you? B) When was your last drink? C) Do you drink 2 to 3 beers every weekend? D) Do you drink alcohol when you are supposed to be working?

B) When was your last drink? Positive answers to two additional questions are highly suspicious for problem drinking: "Have you every had a drinking problem?" and "When was your last drink?" especially if the night before (Bates, p 96-97)

When listening to heart sounds, the nurse knows that the valve closures that can be heard for S2 is: A) pulmonic B) aortic C) tricuspid D) mitral

B) aortic The second heart sound (S2) occurs with the closure of the aortic valve and signals the end of systole. Although it is heard over all the precordium, S2 is loudest at the base of the heart. (Bates, p347)

A 27 year old female patient has three furuncles connected around a hair follicle. You use the following term in your charting: A) nodules B) carbuncle C) macules D) bulla

B) carbuncle Multiple furuncles around a hair follicle form a carbuncle.

In using the ophthalmoscope to assess a patient's eyes, the nurse notices a red glow in the patient's pupils. On the basis of this finding, the nurse would: A) check the light source of the ophthalmoscope to verify that it is functioning. B) consider this a normal reflection of the ophthalmoscope light off the inner retina. C) continue with the ophthalmoscopic examination and refer the patient for further evaluation. D) suspect that there is an opacity in the lens or cornea.

B) consider this a normal reflection of the ophthalmoscope light off the inner retina. Shine the light beam on the pupil and look for the orange glow in the pupil - the red reflex. (Bates, p239). The other responses are not correct.

Kidney pain is commonly described as "flank pain." Which of the following would be considered in the flank area? A) periumbilical B) costovertebral angle C) suprapubic D) epigastric

B) costovertebral angle Costovertabal angle (CVA) pain or tenderness with percussion is a common test for kidney pain (Bates, p463-464).

A 53-year-old obese man comes in for an exam. When he starts to sit up, you notice a ridge/bulge vertically just under the sternum that resolves once he sits up. This is most likely: A) lipoma B) diastasis recti C) a direct hernia D) an indirect hernia

B) diastasis recti A diastasis recti is the separation of the two rectus abdominus muscles that happens when the head and shoulders are raised in some patients, especially obese, chronic lung disease, or after repeated pregnancies (Bates, p499).

During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse? A) fourth left intercostal space at the anterior axillary line B) fifth left intercostal space at the midclavicular line C) third left intercostal space at the midclavicular line D) fourth left intercostal space at the sternal border

B) fifth left intercostal space at the midclavicular line The apical pulse should occupy only one intercostal space, the fourth or fifth, and it should be at or medial to the midclavicular line (Bates, p385-387).

The prevalence of strokes in women ages 45-54 are: A) half that of men in the same age group B) greater than that of men in the same age group C) women have less strokes, but more heart attacks than men the same age D) none of the above

B) greater than that of men in the same age group Women have about 60% of the total number of strokes in the 45-54 years old age group, which is important when evaluating their health risks (Bates, p361).

In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would: A) palpate the artery in the upper one third of the neck. B) listen with the bell of the stethoscope to assess for bruits. C) palpate both arteries simultaneously to compare amplitude. D) instruct the patient to take slow deep breaths during inspiration.

B) listen with the bell of the stethoscope to assess for bruits. If cardiovascular disease is suspected, the nurse should auscultate each carotid artery for the presence of a bruit. The NP should avoid compressing the artery because this could create an artificial bruit, and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the carotid sinus area higher in the neck; excessive vagal stimulation here could slow down the heart rate, especially in older adults. Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain. The bell of the stethoscope is best for picking up bruits. The diaphragm is more attuned to relatively high-pitched sounds; the bell is more sensitive to low-pitched sounds like bruits. (Bates, 381)

Wheezes are a result of: A) abnormal lung tissue B) narrowed air passages C) fibrosis D) fluid in the lungs

B) narrowed air passages Wheezes are the result of narrowed airways, like in asthma, COPD, or bronchitis (Bates, p338)

The cone of light of the tympanic membrane is found: A) on the posterior lower TM B) on the lower anterior part of the TM C) on the posterior upper TM D) on the upper anterior TM

B) on the lower anterior part of the TM The cone of light is found on the anterior lower TM (Bates, p243)

Psoriasis lesions are best described as: A) clustered pustules B) silvery scaly plaques/papules C) vesicular lesions progressing to craters D) macular patches

B) silvery scaly plaques/papules Bates, p192

The projections in the nasal cavity that increase the surface area are called the: A) Kiesselbach plexus B) turbinates C) meatus D) septum

B) turbinates The lateral walls of each nasal cavity contain 3 parallel bony projections: the superior, middle, and inferior turbinates. They increase the surface area so that more blood vessels and mucous membrane are available to warm, humidify, and filter the inhaled air (Bates, p250).

What is the measurement of the liver in the right mid-clavicular line? A) 10-14 cm B) 4-6 cm C) 6-12 cm D) 3-5 cm

C) 6-12 cm Bates, p 476

The nurse practitioner is doing an assessment on a 21 year old patient and notices that his nasal mucosa appears pale and bluish. What would be the most appropriate question to ask the patient? A) Have you had any symptoms of a cold? B) Don't ask any questions. This is a normal finding. C) Are you aware of having any allergies? D) Have you been having frequent nosebleeds?

C) Are you aware of having any allergies? With chronic allergy, mucosa looks swollen, boggy, pale, and gray. Colds and nosebleeds do not cause these mucosal changes.

Which of the following statements represents subjective data obtained from the patient regarding his skin? A) Skin appears dry. B) No obvious lesions C) Denies color change D) Lesion noted lateral aspect right arm

C) Denies color change Remember that the history (from the chief complaint through review of systems) should be limited to patient statements or subjective data—factors that the person says were or were not present. Subjective data is what the patient tells you.

All of the following are true of the nasal inspection EXCEPT: A) Tilt the patient's head back a bit and insert the speculum gently into the vestibule of each nostril. Avoid contact with the nasal septum. You should inspect the inferior and middle turbinates, the nasal septum, and the narrow passage between them. B) In viral rhinitis, the mucosa is usually reddened and swollen, and in allergic rhinitis the mucosa is often pale, bluish, or red. C) Examine the inside of the nose without a speculum on the otoscope keeping the otoscope 6-10 inches away from the tip of the patient's nose are you look at each nostril. D) Use the largest available ear speculum on the otoscope during inspection.

C) Examine the inside of the nose without a speculum on the otoscope keeping the otoscope 6-10 inches away from the tip of the patient's nose are you look at each nostril. Tilt the patient's head back a bit and insert the speculum gently into the vestibule of each nostril. Avoid contact with the nasal septum. Use the largest available speculum. In viral rhinitis, the mucosa is usually reddened and swollen, and in allergic rhinitis the mucosa is often pale, bluish, or red.

A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis? A) Epicanthus B) Ptosis C) Exophthalmos D) Ectropion

C) Exophthalmos Eye protrusion (proptosis or exophthalmos)

Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview? A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story. B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport. C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.

C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan. The sequence of the interview: Greeting the patient and establishing rapport. Taking notes. Establishing the agenda for the interview. Inviting the patient's story. Expanding and clarifying the patient's story. Sharing the treatment plan.

The nurse practitioner is reviewing the immunization history of a new 24 year old female patient. Which is the best to ask the patient to obtain the needed information for your records? A) Do you need vaccines today? B) When was your last flu shot, tetanus shot? C) Have you received these vaccines in your lifetime? When did you receive them? Tetanus, pertussis, diphtheria, polio, measles, mumps, rubella, influenza, varicella, hepatitis B, haemophilus influenzae type B, pneumococcal, HPV? D) Are your immunizations up to date?

C) Have you received these vaccines in your lifetime? When did you receive them? Tetanus, pertussis, diphtheria, polio, measles, mumps, rubella, influenza, varicella, hepatitis B, haemophilus influenzae type B, pneumococcal, HPV? Find out whether the patient has received required and recommended vaccines. (Bates, 10)

While counting the apical pulse on a 16-year-old patient, the nurse notices an irregular rhythm. His rate speeds up on inspiration and slows on expiration. What would be the nurse's response? A) Talk with the patient about his intake of caffeine. B) Refer the patient to a cardiologist for further testing. C) No further response is needed because this is a normal variation. D) Perform an echocardiogram after the examination.

C) No further response is needed because this is a normal variation. The rhythm should be regular, although sinus arrhythmia occurs normally in young adults and children. With sinus arrhythmia, the rhythm varies with the person's breathing. Increasing at the peak of inspiration and slowing with expiration (Bates, p401).

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection

C) Psoriasis Psoriasis: silvery scaly papules or plaques, mainly on the extensor surfaces. Pitting: punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. Usually associated with psoriasis.

The direction of blood flow through the heart is best described by which of the following? A) Aorta - R atrium - R ventricle - lungs - pulmonary vein - L atrium - L ventricle - vena cava B) R atrium - R ventricle - pulmonary vein - lungs - pulmonary artery - L atrium - L ventricle C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle D) Vena cava - R atrium - R ventricle - lungs - pulmonary artery- L atrium - L ventricle

C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle Returning blood from the body empties into the R atrium and flows into the R ventricle, then goes to the lungs through the pulmonary artery. The lungs oxygenate the blood and it is then returned to the L atrium by the pulmonary vein. It goes from there to the L ventricle and then out to the body through the aorta (Bates, pg 345)

A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter with damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of this pressure ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

C) Stage 3 A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through underlying muscle.

A 46 year old female patient is in the clinic with a chief complaint of chest pain. You are wanting to best understand the patient's perception of the chest pain. Which fo the following questions would you ask first? A) How do you rate your pain on a scale of 0-10? B) Is the pain related to exertion? C) Tell me about your chest discomfort. D) Are you taking all of your medications?

C) Tell me about your chest discomfort. Move from open ended to focused questions to allow for the flow of ideas and thoughts from the patient.

During an assessment of an adult, the nurse practitioner has noted abnormally located bronchovesicular breath sounds and asks the patient to say "ee" which sounds like "a." Which of the following is true? A) The NP suspects the patient has had a pneumothorax. B) The NP suspects the patient is in the early phases of COPD. C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia. D) The NP concludes that there is only a low likelihood that the patient has pneumonia.

C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia. If "ee" sounds like "a" then egophony is present and it could be a sign of pneumonia. (Bates, p327).

A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with: A) acute pneumonia B) an asthmatic attack C) a pneumothorax D) bronchitis

C) a pneumothorax With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax is large then tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus, tracheal deviation to the unaffected side, decreased chest expansion, hyperresonnant percussion tones, and decreased or absent breath sounds are found with the presence of a pneumothorax. (Bates, p 340)

A serous (otitis) effusion looks like: A) bright red bulging B) dull and retracted C) amber fluid or bubbles behind the tympanic membrane D) like a hole in the tympanic membrane

C) amber fluid or bubbles behind the tympanic membrane A serous (otitis) effusion appears as an air/fluid level or bubbles with amber colored fluid (Bates, p288).

A patient notes that they have a history of goiter. What is a goiter? A) a type of skin lesion B) the primary lymph node used for cancer staging C) an enlargement of the thyroid D) an ear abnormality

C) an enlargement of the thyroid Bates, p221, 262

Macular degeration effects: A) lateral vision B) peripheral vision C) central vision D) none of the above

C) central vision Bates, p 242

Which of the following is not an ABCDE screening for melanoma? A) asymmetry B) borders C) clarity D) diameter

C) clarity Asymmetry, Border, Color, Diameter, and Evolution are the ABCDE for melanoma detection. (Bates, p179)

When assessing a patient's lungs, the nurse recalls that the left lung: A) is shorter than the right lung because of the underlying stomach. B) is divided by the horizontal fissure. C) consists of 2 lobes. D) consists primarily of an upper lobe on the posterior chest.

C) consists of 2 lobes. The left lung has 2 lobes, and the right lung has 3 lobes. The right lung is shorter than the left lung because of the underlying LIVER. The left lung is narrower than the right lung because the heart bulges to the left. The posterior chest is almost all lower lobe (Bates, p307).

The primary muscles of respiration include the : A) trapezius and rectus abdominis. B) sternomastoids and scaleni. C) diaphragm and intercostals. D) external obliques and pectoralis major.

C) diaphragm and intercostals. The major muscle of respiration is the diaphragm. The intercostal muscles life the sternum and elevate the ribs during inspiration, increasing the anteroposterior diameter. Expiration is primarily passive. Forced inspiration involves the use of other muscles, such as the accessory neck muscles (sternomastoids, scalene, trapazii). Forced expiration involves the abdominal muscles (Bates, p309).

Hepatitis A is transmitted via: A) IV drug use B) sexual contact C) fecal-oral route D) blood and body fluids

C) fecal-oral route Bates, p466

Ms. Jones complains of visible blood in her urine. This is called: A) hematochezia B) melena C) gross hematuria D) microscopic hematuria

C) gross hematuria Blood visible in urine with the naked eye is called gross hematuria. If the blood is not visible with the human eye and only when examined with a microscope, it is microscopic hematuria. (Bates, p463)

When looking at the retina, a macular star is usually caused by: A) diabetes B) trauma C) hypertension D) none of the above

C) hypertension A macular star is also known as hypertensive retinopathy with macular star and is caused by high blood pressure. (Bates, p283)

You can tell that you hear bronchovesicular sounds by the: A) soft, low pitch sound you hear over most of both lung. The inspiratory sounds last longer than the expiratory sounds. B) very loud and relatively high pitch of the sounds heard over the trachea in the neck C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae D) crepitus palpated at the costochrondral junctions

C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae Bronchovesicular breath sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae. They are intermediate in intensity. Inspiration to expiration periods are equal. Inspiration and expiration are equal. (Bates, p324)

The nurse practitioner aucultates the heart and hears a murmur which she documents as 4/6 at its loudest point. She means the murmur is: A) moderately loud B) very loud, with thrill. May be heard when the stethoscope is partly off the chest. C) loud with a palpable thrill. D) quiet, but heard immediately after placing the stethoscope on the chest.

C) loud with a palpable thrill. Grade 4 is loud with a palpable thrill (Bates, p396).

The nurse is taking a family history. Important diseases or problems to ask the patient about include: A) emphysema. B) head trauma. C) mental illness. D) fractured bones.

C) mental illness. Specifically ask for any family history of heart disease, high blood pressure, stroke, diabetes, obesity, blood disorders, ovarian cancer, colon cancer, sickle cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness, suicide, seizure disorder, kidney disease, and tuberculosis. The other answers are acquired.

A 15 month old is brought to you for a fever of 101 F and fussiness. The ear examination is as follows: external ear - normal appearance and no tenderness with manipulation; canal - normal diameter without evidence of inflammation; tympanic membrane - bulging, erythematous, and the light reflex is dull. Insufflation is deferred due to pain. What is your diagnosis? A) ruptured tympanic membrane B) cholesteatoma C) otitis media D) otitis externa

C) otitis media Acute otitis media in a symptomatic child typically has a red, bulging tympanic membrane, with a dull or absent light reflex.

A patient has come in for an examination and states, "I have this spot in front of my ear lobe here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his: A) occipital node B) thyroid gland C) parotid gland D) none of the above

C) parotid gland The swelling of the parotid gland is seen anterior to the ear lobes and above the angles of the jaw.

You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this? A) macule B) papule C) vesicle D) spider angioma

C) vesicle Vesicle - up to 1.0 cm filled with serous fluid

When auscultating the lungs of an adult patient, the nurse practitioner notes that over the posterior lower lobes low-pitched, soft breath sounds are heard, with inspiration being longer than expiration. The nurse interprets that these are: A) bronchial breath sounds and are normal in that location B) sounds normally auscultated over the trachea C) vesicular breath sounds and are normal in that location D) bronchovesicular breath sounds and are normal in that location

C) vesicular breath sounds and are normal in that location Vesicular breath sounds are low-pitched, soft sounds with inspiration being longer than expiration. These breath sounds are expected over peripheral lung fields where air flows through smaller bronchioles and alveoli (Bates, p324)

A patient tells the nurse practitioner that she has had abdominal pain for the past week. What would be the best response by the nurse practitioner? A) We'll talk more about that later in the interview." B) "Have you ever had any children?" C) "What have you had to eat in the last 4 hours?" D) "Can you point to where it hurts?"

D) "Can you point to where it hurts?" Each principle symptom should be well-characterized, with descriptions of location; along with the other seven attributes. Location: Ask the patient to point to the pain because lay terms may not be specific enough to localize the site of origin.

A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the following would be an appropriate response by the nurse to her statement? A) "How does your family react to your pain?" B) "That must be terrible. You probably pinched a nerve." C) "I've had back pain myself and it can be excruciating." D) "How would you say the pain affects your ability to do your daily activities?"

D) "How would you say the pain affects your ability to do your daily activities?" Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity.

A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information? A) "Are you allergic to any other drugs?" B) "How often have you received penicillin?" C) "I'll write your allergy on your chart so you won't receive any." D) "Please describe what happens to you when you take penicillin."

D) "Please describe what happens to you when you take penicillin." Allergies, including specific reactions to each medication, such as rash or nausea, must be recorded.

When listening to heart tones, you hear a murmur that is quiet but heard immediately after placing your stethoscope on the chest. How would you classify this murmur? A) 4/6 B) 1/6 C) 3/6 D) 2/6

D) 2/6 Bates, p396

The normal abdominal aorta in a 50 year old adult should be no bigger in diameter than: A) 5cm B) 6cm C) 1.5cm D) 3cm

D) 3cm Bates, p483

When examining the ear of a young child, which of the following is the proper technique to use? A) Examine the ear canal and tympanic membrane as the last steps in the exam if the child is sensitive or fearful. B) Pull the auricle downward, outward, and backward for the best view. C) Use the largest speculum possible on the otoscope. D) All of the above.

D) All of the above. If a child is fearful or sensitive because she can't see the ear exam, you might need to restrain her so wait until the end of the exam. Use the largest speculum for the best view. For best visualization, pull the auricle downward, outward, and backward (Bates 867-869).

A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely? A) CN IX lesion on the left B) CN X lesion on the left C) CN IX lesion on the right D) CN X lesion on the right

D) CN X lesion on the right In cranial nerve X paralysis, the soft palate fails to rise and the uvula deviates to the opposite side.

You are assessing a patient with Wilson's disease and you see a golden/brown ring around the iris. This is called: A) chalazion B) pterygium C) pinguecula D) Kayser-Fleischer ring

D) Kayser-Fleischer ring A ring around the iris from Wilson's disease is called a Kayser-Fleischer ring and it is from excessive copper (Bates, p276).

The nurse practitioner might see which of the following physical findings in a patient with otitis externa? A) a bulging, red tympanic membrane B) an unusually prominent short process and prominent handle. C) a chalky, white patch with irregular margins on the inferior part of the tympanic membrane. D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal.

D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal. Frank blood or clear watery drainage (cerebrospinal leak) after trauma suggest a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. (Bates, 245-246)

In recording the childhood illnesses of a patient who denies having had any, which of the following notes by the nurse would be most accurate? A) Patient denies usual childhood illnesses. B) Patient states he was a "very healthy" child. C) Patient states sister had measles, but he didn't. D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio.

D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio. Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic fever, scarlet fever, and polio. They are included in the past history.

The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems

D) Review of systems Most review of systems questions pertain to systems. You may also draw on Review of Systems questions related to the Chief Complaint to establish positives and negatives that help clarify the diagnosis.

In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history? A) Personality type, high cholesterol, diabetes, smoking B) Family history, hypertension, stress, age C) Alcohol consumption, obesity, diabetes, stress, high cholesterol D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history

D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history For major risk factors for coronary artery disease, collect data regarding elevated serum cholesterol, elevated blood pressure, blood glucose levels above 130 mg/dL or known diabetes mellitus, obesity, cigarette smoking, low activity level (Bates, p358)

A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis? A) Conjunctivitis B) Acute iritis C) Corneal abrasion D) Subconjunctival hemorrhage

D) Subconjunctival hemorrhage Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area. The pupil is not affected, vision is not affected and the cornea is clear. May result from trauma, bleeding disorders, or sudden increase in venous pressure, as from a cough.

NP is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? A) Immobility of the drum is a normal finding. B) The light reflex is cone shaped in the first few days of life. C) The appearance of the membrane is identical to that of an adult. D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life.

D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life. During the first few days, the tympanic membrane often looks thickened and opaque because there is vernix caseosa obscuring the tympanic membrane (Bates, p825).

Generalized lymphadenopathy is seen in A) lymphoma B) infectious mononucleosis C) leukemia D) all of the above

D) all of the above All of the above can cause generalized lymphadenopathy (Bates, p261)

The assessment of a COPD patient will most likely reveal: A) resonant percussion sounds, no adventitious sounds and vesicular breath sounds B) dull percussion sounds and absent breath sounds. No crackles or wheezes C) resonant to hyper-resonant sounds with percussion and wheezes present D) diffusely hyper-resonant sounds with percussion, decreased or absent breath sounds per auscultation, decreased tactile fremitus, and no crackles, wheezes, or rhonchi.

D) diffusely hyper-resonant sounds with percussion, decreased or absent breath sounds per auscultation, decreased tactile fremitus, and no crackles, wheezes, or rhonchi. COPD is characterized by diffusely hyper-resonant sounds with percussion, decreased or absent breath sounds per auscultation, decreased tactile fremitus, and no crackles, wheezes, or rhonchi. (Bates, p340)

Which of following is not found in the upper left quadrant of the abdomen? A) spleen B) left kidney C) pancreas D) gallbladder

D) gallbladder All except the gallbladder are found in the upper left abdominal quadrant. (Bates, p450-451)

Which of the following is a vesicular lesion? A) psoriasis B) nevus C) café au lait spots D) herpes simplex

D) herpes simplex Herpes simplex presents initially as a vesicle/vesicles. Café au lait spots are macules, psoriasis is a plaque or papule, a nevus is a papule (Bates, p290).

In which order should the abdomen be examined in? A) auscultation, inspection, percussion, palpation B) inspection, percussion, auscultation, palpation C) percussion, palpation, inspection, auscultation D) inspection, auscultation, percussion, palpation

D) inspection, auscultation, percussion, palpation Bates 471-475

The nurse practitioner is reviewing for a class in age-related changes in the eye. Which of these physiological changes is responsible for presbyopia? A) degeneration of the cornea B) decreased adaptation to darkness C) decreased distance vision abilities D) loss of lens elasticity

D) loss of lens elasticity The lens gradually loses its elasticity, and the eye grows progressively less able to accommodate and focus on nearby objects. Ensuing presbyopia usually becomes noticeable during the fifth decade. (Bates, p 959, 991)

The nurse practitioner is performing an eye examination using the ophthalmoscope. Which component is NOT part of the ophthalmoscope? A) lens disc B) aperature C) indicator of diopters D) speculum

D) speculum See picture of ophthalmoscope (Bates p 238)

While performing a fundoscopic examination on a 38 year old African American female, the color of the fundus is a grayish brown, almost purple. You determine: A) this is a sign of diabetic retinopathy B) this is a sign of hypertensive retinopathy C) this indicates retinal detachment and requires immediate intervention D) this is a normal variation, no action is needed

D) this is a normal variation, no action is needed There are normal variants for darker skinned patients (Bates, p283).