Canvas Quiz Questions

true or false: Leg shortening and external rotation are common in hip fractures.

true

A client is brought to the emergency department in a confused state. Upon examination of the client's mouth, the NP detects a fruity odor to the breath. The NP recognizes this finding as a characteristic of what disease process? a. Small-bowel obstruction b. Diabetic ketoacidosis c. End-stage liver disease d. Respiratory infection

b. Diabetic ketoacidosis

true or false: Radicular pain signals spinal nerve compression and/or irritation. Any level can be affected, but the C6 and C7 levels are most common. Unlike low back pain, foraminal impingement from degenerative joint changes is more common (70% to 75%) than disc herniation (20% to 25%).

true

true or false: Severe pain of rapid onset in a red swollen joint in children should raise concerns for osteomyelitis in a bone contiguous to a joint.

true

true or false: Stumbling or "giving way" of the knee during heel strike suggests quadriceps weakness or abnormal patellar tracking.

true

true or false: Swelling over the olecranon process is suspicious for olecranon bursitis. Inflammation of synovial fluid suggests arthritis.

true

true or false: Tenderness over the distal radius after a fall is suspicious for a fracture. Bony step-offs may also suggest fracture.

true

true or false: The peripheral nervous system is neatly partitioned along dermatomes, whereas the central nervous system is not. Therefore, a sensory deficit along a dermatome, particularly when accompanied by local pain, suggests a peripheral nerve lesion.

true

true or false: Tinel and Phalen signs do not reliably predict positive electrodiagnosis of carpal tunnel disease.

true

true or false: Your knowledge of the soft tissue structures, ligaments, tendons, and bursae will help you evaluate inflammatory disorders, traumatic injuries, and overuse syndromes.

true

true or false: pGALS is a simple, quick assessment of the musculoskeletal system and validated for use in the school aged child

true

true or false: "Snuffbox" tenderness with the wrist in ulnar deviation and pain at the scaphoid tubercle are suspicious for occult scaphoid fracture.

true Rationale Poor blood supply increases the risk of scaphoid bone avascular necrosis, making this a diagnosis that should not be missed.

true or false: A distended bladder may be palpable above the symphysis pubis.

true Rationale The urinary bladder is a hollow reservoir with strong smooth muscle walls composed chiefly of detrusor muscle. It accommodates roughly 400 to 500 mL of urine filtered by the kidneys into the renal pelvis and the ureters.

An NP is conducting a focused ear and hearing assessment of an adult client who has a history of mild hearing loss. When performing the whisper test, what instruction should the NP begin with? a. "Please close your eyes and listen carefully to what I say." b. "Please repeat the words that I say." c. "Please cover your ear that has the weakest hearing." d. "Please tell me when you can hear me talking."

c. "Please cover your ear that has the weakest hearing."

For which of the following clients should the NP choose to perform a focused examination? a. A woman who is new to the community and has presented to the clinic to establish care b. A woman who has an especially complex medical history c. A man who has presented with an acute onset of chest pain d. A man whose mobility is compromised by disability

c. A man who has presented with an acute onset of chest pain

The NP notes that a client's right lobe of the thyroid gland is larger than the left. What should the NP consider as being the reason for this finding? a. Hyperthyroidism b. Thyroiditis c. A normal finding d. Malignancy

c. A normal finding

An NP is interviewing a client whose chief complaint is temporomandibular joint pain. Which of the following questions should the NP ask regarding a causative factor? a. "Is there a history of mouth cancer in your family?" b. "Do you drink alcohol?" c. "How often do you brush and use dental floss?" d. "Do you grind your teeth?

d. "Do you grind your teeth?

The nurse detects paradoxical pulses in an adult client during an examination. The nurse should explain to the client that paradoxical pulses are usually indicative of: a. Aortic stenosis b. Left-sided heart failure. c. Premature ventricular contractions d. Obstructive lung disease.

d. Obstructive lung disease.

true or false: A lesion at the spinal level of the pathway for conscious proprioception (the ability to sense the position and movement of the limbs) and stereognosis (the ability to identify objects by touch) will result in the loss of these senses ipsilaterally, below the level of the lesion.

true

true or false: A lesion in the pons causes cranial nerve deficits (CN V, VI, VII, and VIII) and long tract signs involving the corticospinal tract, spinothalamic, and dorsal column-medial lemniscus system.

true

true or false: A lesion of the pain-temperature pathway (spinothalamic tract), whether within the brain stem or spinal cord, will result in loss of pain-temperature sensation contralaterally, below the level of the lesion.

true

true or false: Abductor weakness, arthritis, unequal leg lengths, or chronic hip subluxation can cause the pelvis to drop on the opposite side and produce what appears to be a waddling gait also known as a Trendelenburg gait.

true

true or false: Decreased ROM is present in arthritis, joints with effusion, joints with tissue inflammation or surrounding fibrosis, or bony fixation (ankylosis).

true

true or false: Diffuse tenderness and warmth over a thickened synovium suggest arthritis or infection; focal tenderness suggests injury and trauma.

true

true or false: Inflammation with high-grade fever and chills is usually seen in septic arthritis. Low-grade fever can be present in crystal-induced arthritis or inflammatory arthritis like RA.

true

true or false: Ipsilateral involvement of the dorsal column-medial lemniscus system results in loss of fine touch, vibration, and proprioception.

true

true or false: Oligoarticular (pauciarticular) arthritis can result from infection (e.g., gonorrhea or rheumatic fever, connective tissue disease, and OA) and should be ruled out first.

true

true or false: Pain in a single joint suggests injury; monoarticular arthritis; or extraarticular causes like tendinitis, bursitis, or soft tissues injury.

true

true or false: Pathology of articular structures typically involves swelling and tenderness of the joint, crepitus, instability, "locking," or deformity and limits both active and passive range of motion (ROM) due to stiffness, mechanical blockage, or pain.

true

A 31-year-old woman presents to the clinic with shortness of breath, palpitations, and fatigue. She has had these symptoms over the last several weeks. She had been tolerating these symptoms until last night when she could not fall asleep due to palpitations. She has a past medical history of infective endocarditis 6 months ago that was successfully treated with antibiotics. She does not smoke or drink alcohol. Her blood pressure is 138/89 mm Hg and her pulse is 76/min and regular. The cardiac exam reveals a soft S1, S3 gallop, a hyperdynamic apex beat, and a pansystolic murmur that radiates to the axilla on auscultation. Echocardiography reveals incompetence of one of the valves. Which of the following sites is the best position to auscultate this defect? a. Medial end of the 2nd intercostal space on the right side b. 5th intercostal space at the midclavicular line on the left side c. Right lower end of the body of the sternum d. Medial end of the 2nd intercostal space on the left side

b. 5th intercostal space at the midclavicular line on the left side

An NP palpates an enlarged and tender left sided supraclavicular lymph node in a client. Where should the NP focus the physical assessment to obtain more data about this finding? a. Spinal cord area for signs of degeneration and decreased mobility b. Abdomen and thoracic area for changes associated with malignancy c. Upper extremities for changes in sensation, movement, and range of motion d. Head and neck area for signs of infection or inflammation

b. Abdomen and thoracic area for changes associated with malignancy

In an adult patient, the plantar reflex is found to be extensor on the right. What does this indicate? a. Normal Babinski response b. An abnormal Babinski response c. A lower motor neuron problem d. A parietal lobe problem e. A frontal lobe problem

b. An abnormal Babinski response

When examining the uterus, a nurse finds that the cervix is pointed posteriorly and the body of the uterus is at the level of the pubis over the bladder. How should the nurse document this uterine finding? a. Retroverted b. Anteverted c. Retroflexed d. Anteflexed

b. Anteverted Rationale Anteverted uterus is the most typical position of the uterus; wherein the cervix is pointed posteriorly, and the body of the uterus is at the level of the pubis over the bladder. Retroverted uterus is a normal variation that consists of the cervix and body of the uterus tilting backward. Anteflexed uterus is a normal variation that consists of the uterine body flexed anteriorly in relation to the cervix. Retroflexed uterus is a normal variation that consists of the uterine body being flexed posteriorly in relation to the cervix.

A nurse is preparing to assess the cranial nerves of a client. The nurse is about to test CN I. What would the nurse do? a. Use a Snellen chart to test visual acuity. b. Ask a client to identify scents. c. Test extraocular eye movements d. Perform a Weber test.

b. Ask a client to identify scents.

The patient is complaining of nausea vomiting and obstipation. The patient is likely suffering from: a. Pancreatitis b. Bowel obstruction c. Diverticulitis d. Appendicitis

b. Bowel obstruction Rationale Vomiting and nausea with constipation or obstipation (severe constipation with inability to pass both stool and gas) is indicative of a bowel obstruction and warrants further imaging workup.

A 55-year-old woman is brought to the emergency department due to a sudden onset of retrosternal chest pain. An ECG shows ST-segment elevation. A diagnosis of myocardial infarction is made and later confirmed by elevated levels of troponin I. She is sent to the cardiac catheter laboratory to undergo percutaneous catheterization. She is found to have 2 occluded coronary vessels and stents are implanted to restore blood flow in the affected arteries. She complains of flank pain during post-procedure evaluation a few hours later. A significant drop in hematocrit is observed, as well as a decline in her blood pressure to 90/60 mm Hg. Physical exam reveals extensive ecchymoses in the flanks and loin as shown in the image. Which of the following conditions is this patient most likely experiencing? a. Ventricular septal defect b. Complication from femoral artery access c. Patent ductus arteriosus d. Fat embolism

b. Complication from femoral artery access

When conducting the Weber test a client reports hearing the sound better in the right ear. What should this finding indicate to the NP? a. Conductive hearing loss in the left ear b. Conductive hearing loss in the right ear c. Infection of the auditory canal of the left ear d. Ruptured tympanic membrane of the right ear

b. Conductive hearing loss in the right ear

A NP is conducting an assessment of a client's eyes and vision and has completed the positions test. Following this test, the NP will be able to document data that address what aspects of eye health? Select all that apply. a. Near visual acuity b. Cranial nerve function c. Accommodation d. Distant visual acuity e. Eye muscle strength

b. Cranial nerve function e. Eye muscle strength

An NP is assessing a child who got lost on a camping trip in November and was exposed all night to the elements. Which finding about the lips would support a diagnosis of hypoxia in this client? a. Swelling b. Cyanotic c. Pallor d. Reddish

b. Cyanotic

The nurse performing an admission assessment on an older adult. What would be an expected finding? a. Numbness and tingling b. Decreased vision c. Delirium d. Dizziness

b. Decreased vision Rationale Decreased vision is part of the aging process and may be a safety concern. Dizziness, delirium, numbness and tingling would not be an expected finding.

true or false: Visceral pain in the RUQ suggests liver distention against its capsule from the various causes of hepatitis, including alcoholic hepatitis or biliary pathology.

true Rationale Visceral pain occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched. Solid organs such as the liver can also become painful when their capsules are stretched. Visceral pain is typically nonspecific and difficult to localize.

You are an RN working on an inpatient neurology floor for a patient who sustained a stroke 3 days ago. In reviewing the chart, you find it noted that the patient sustained damage to oculomotor nerve III. You see that this history is consistent with the above finding and make a note of it during your shift assessment. Which of the following findings do you document? a. Lid retraction and exophthalmos b. Ptosis c. Entropion d. Ectropion

Rationale Ptosis is a drooping of the upper lid. Causes include senescence, myasthenia gravis, damage to the oculomotor nerve (CN III), and damage to the sympathetic nerve supply (Horner syndrome). A weakened muscle, relaxed tissues, and the weight of herniated fat may cause senile ptosis. Ptosis may also be congenital.

You are evaluating a patient who came into the urgent care center. You run your finger over the lesions shown in the picture above but do not feel the lesion, the lesion is flat. You document these as... a. Scattered hypopigmented macules b. Scattered hypopigmented patches c. Scattered hyperpigmented patches d. Scattered hyperpigmented macules

Rationale These lesions are hypopigmented. If you run your finger over the lesion but do not feel the lesion, the lesion is flat. If a flat spot is small (<1 cm), it is a macule.

Which question asked by the NP is assessing problems with tinnitus? a. "Do you experience buzzing in your ears?" b. "In what situations is it hard for you to hear?" c. "Have you ever had drainage from your ears?" d. "Do you ever have problems with balance?"

a. "Do you experience buzzing in your ears?"

During a health history of the respiratory system, a client reports experiencing a cough for several months. Which questions would the nurse ask for more information about the duration of this symptom? Select all that apply. a. "Does it occur at rest or with exercise? b. "Do you cough up mucus or phlegm?" c. "Does it wake you at night?" d. "Is it continuous or intermittent?" e. "Does this occur at a particular time of day?"

a. "Does it occur at rest or with exercise? c. "Does it wake you at night?" d. "Is it continuous or intermittent?" e. "Does this occur at a particular time of day?"

When assessing for factors that increase the risk for pelvic floor muscle weakness, the nurse should ask which questions? Select all that apply. a. "Have you ever been diagnosed with diabetes?" b. "How old will you be on your next birthday?" c. "Has any female family member been treated for a cystocele?" d. "Do your bowels move regularly with the help of a laxative?" e. "How many children have you given birth to?"

a. "Have you ever been diagnosed with diabetes?" b. "How old will you be on your next birthday?" d. "Do your bowels move regularly with the help of a laxative?" e. "How many children have you given birth to?" Rationale Weakness of the pelvic floor muscles may cause pain, urinary incontinence, fecal incontinence, and prolapse of the pelvic organs. Risk factors are advancing age, prior pelvic surgery or trauma, number of pregnancies and births, medical conditions (diabetes, multiple sclerosis, Parkinson disease), medications (anticholinergics, alpha adrenergic blockers), and chronically increased intra-abdominal pressure from chronic obstructive pulmonary disease (COPD), chronic constipation, or obesity. A cystocele is a possible result of weakened pelvic floor muscles, but there is no evidence that family history is a risk factor for cystocele.

Which client reports support a diagnosis of a prostate disorder? Select all that apply. a. "I'm up 3 to 4 times a night to urinate." b. "I can't seem to completely empty my bladder." c. "It burns when I urinate." d. "It is difficult to start urinating." e. "I sometimes have blood in my urine."

a. "I'm up 3 to 4 times a night to urinate." b. "I can't seem to completely empty my bladder." d. "It is difficult to start urinating." e. "I sometimes have blood in my urine." Rationale Men with symptoms of prostate disorders report incomplete emptying of the bladder, urinary frequency or urgency, weak or intermittent stream or straining to initiate flow, hematuria, nocturia, or even bony pains in the pelvis. Burning associated with urination is more likely a symptom of an infection.

The NP tests the distant visual acuity of several clients and records the findings. Which finding indicates that the client with the poorest vision? a. 20/60 b. 20/40 c. 20/50 d. 20/30

a. 20/60

What are the components of S1? Select all that apply. a. A later tricuspid sound b. An earlier mitral sound c. An earlier tricuspid sound d. A later pulmonic sound

a. A later tricuspid sound b. An earlier mitral sound

Which of the following would the NP suspect if assessment reveals a skull and facial bones that are larger and thicker than normal? a. Acromegaly b. Parkinson disease c. Paget disease d. Brain tumor

a. Acromegaly

Acute pain can be differentiated from chronic pain because: a. Acute pain is associated with a recent onset of illness or injury with a duration of less than 6 months, whereas chronic pain persists longer than 6 months. b. Acute pain is not treated and left to subside on its own, whereas chronic pain is referred for treatment. c. Acute pain occurs only in persons aged less than 45 years, whereas chronic pain occurs in persons aged 46 or above. d. Acute pain always scores more on the visual analog scale than chronic pain.

a. Acute pain is associated with a recent onset of illness or injury with a duration of less than 6 months, whereas chronic pain persists longer than 6 months.

A nurse is completing a neurological assessment in an adult patient. The plantar reflex is extensor on the left. This is a very important sign that indicates which of the following? a. An upper motor neuron lesion b. A lower motor neuron lesion c. A positive Kernig sign d. A positive Brudzinski sign

a. An upper motor neuron lesion Rationale A positive Babinski reflex is a very important sign that points towards an upper motor neuron lesion.

A nurse is interviewing a client who complains of dyspnea. Which of the following findings would tend to indicate an underlying cardiovascular problem in the client? Select all that apply. a. Angina b. Coughing occurring at night c. Orthopnea d. Coughing that produces white sputum e. Edema f. Snoring and gasping while sleeping

a. Angina c. Orthopnea e. Edema

The nurse is asked to prepare material on erectile dysfunction to be placed in a urologist's office waiting room. What should the nurse include as reasons for the development of this disorder? Select all that apply. a. Antihypertensive medications b. Alcohol use c. Myocardial infarction d. Diabetes e. Depression

a. Antihypertensive medications b. Alcohol use d. Diabetes e. Depression Rationale Erectile dysfunction occurs frequently in adult males and may be attributed to diabetes, depression, alcohol use, and antihypertensive medications. Myocardial infarction is not associated with the development of erectile dysfunction.

A nurse inspects a client's abdomen and notices that a bulge is present in the right lower quadrant. How should the nurse further assess this finding using inspection? a. Ask the client to raise the head off the bed b. Palpate to measure the diameter of the mass c. Percuss to determine if the mass is fluid filled d. Have the client cough forcefully a few times

a. Ask the client to raise the head off the bed Rationale Asking the client to raise the head off the bed will help the nurse to determine the location of the mass. A mass within the abdominal wall is more prominent when the head is raised, whereas a mass below the abdominal wall is obscured. Palpation and percussion should come after inspection is completed. Coughing will not assist the nurse with assessment of the abdominal mass.

During a physical assessment, the nurse identifies unequal chest expansion. The nurse knows this could be due to what? Select all that apply. a. Atelectasis b. Pneumothorax c. Emphysema d. Pneumonia e. Trauma

a. Atelectasis b. Pneumothorax d. Pneumonia e. Trauma

A client is admitted for the new onset of heart failure. The nurse recognizes that which finding is the earliest sign of heart failure? a. Auscultation of an S3 heart sound b. Grade III/VI systolic murmur c. Split S1 heard over the apex of the heart d. Jugular venous distention at 30 degrees

a. Auscultation of an S3 heart sound

You are an RN working at a dermatology clinic and a patient sends an electronic message through the clinic's secure messaging system with the picture above. The patient notes that this pink patch will not heal, though it has been present for several months now. You recommend that the patient come for evaluation because you are concerned that this is a... a. Basal cell carcinoma b. Actinic keratosis c. Squamous cell carcinoma d. Amelanotic melanoma

a. Basal cell carcinoma Rationale - Pink patch that does not heal - May have focal scaling

An APRN is observing the red reflex in a client during an eye assessment. During this component of the assessment, the client states, "I hope you can see it because I have cataracts." What finding should the NP expect? a. Black spokes pointing inward b. Thickened bulbar conjunctiva c. White arc around the limbus d. A red spot on the retina

a. Black spokes pointing inward

A nurse palpates a mass in the client's right lower quadrant. The nurse suspects that this mass could be associated with which of the following organs? Select all that apply. a. Bladder b. Ascending colon c. Transverse colon d. Right kidney e. Appendix

a. Bladder b. Ascending colon e. Appendix Rationale The organs that can be palpated through the right lower quadrant of the abdomen include the appendix, the bladder, and the ascending colon. The right kidney is accessible through the right upper quadrant. The transverse colon is accessible through the right and left upper quadrants of the abdomen.

The NP is palpating a client's neck as part of a physical assessment. Which of the following blood vessels should the NP be especially careful to avoid bilaterally compressing during the assessment? a. Carotid artery b. Internal jugular vein c. Temporal artery d. External jugular vein

a. Carotid artery

The nurse walks into a client's room and finds that the client is disoriented to time and place but is awake and responsive. What term best describes this client? a. Confused b. Alert c. Lethargic d. Obtunded

a. Confused

The nurse is doing a brainstem assessment on an unconscious client. Which of the following will the nurse examine during this part of the acute assessment? Select all that apply. a. Corneal Reflex b. Gag reflex c. Oculocephalic reflex (doll's eye maneuver) d. Pupillary assessment e. Level of consciousness assessment via the Glasgow coma scale

a. Corneal Reflex b. Gag reflex c. Oculocephalic reflex (doll's eye maneuver)

An NP is examining a client's nose. Which characteristics of the nasal mucosa should the NP expect to find if the client is healthy? a. Dark pink, moist, and free of discharge b. Pale pink, swollen, with watery exudate c. Bluish-gray, swollen, with watery exudate d. Red, swollen, with purulent discharge

a. Dark pink, moist, and free of discharge

You are a nurse assisting with skin checks at a high school health fair day. A teenage student presents with a solitary blue-brown 1.2-cm firm nodule with positive dimple sign and hyperpigmented rim on left lateral thigh. You recommend having a dermatologist look at it but suspect that it is benign. This description is most consistent with a: a. Dermatofibroma b. Keloid c. Urticarial wheal

a. Dermatofibroma Rationale dermatofibroma: a hyperpigmented firm nodule with a positive dimple sign and hyperpigmented rim.

While performing the physical examination of a client, the NP lightly taps certain parts of the body to produce sound waves. What is the purpose of this method of assessment? a. Determine if a structure is filled with air or fluid or is a solid structure b. Determine tenderness, moisture, and the surface of skin texture c. Observe for abnormalities on the skin's surface d. Feel for deep organs or structures covered by thick muscles

a. Determine if a structure is filled with air or fluid or is a solid structure

A 79 year old women comes to the ED with complaints of indigestion. She said she was out walking her dog when she first felt the indigestion and it was so bad she had to come get it checked out. She reports she feels better now after waiting to see the doctor. What should the nurse do first? a. ECG b. Place an IV c. Take her vitals d. Wait for orders from the provider

a. ECG Rationale Note that angina from inferior wall coronary artery disease may present as "indigestion," but is precipitated by exertion and relieved by rest.

How should the testis feel to the nurse's fingers when performing palpation of the scrotal contents? Select all that apply. a. Firm b. Left larger than right c. Hard d. Rubbery e. Smooth f. Soft

a. Firm d. Rubbery e. Smooth Rationale The testis should feel smooth, firm, rubbery, mobile, free of nodules, and rather tender to palpation. A hard testicle may be a sign of testicular cancer. The left side of the scrotal sac hangs lower than the right, but the testicles are equal in size.

An NP in the otolaryngology clinic is asked by the NP, what findings during a sinus examination suggest infection. Which of the following findings would the NP include in her response? Select all that apply. a. Fullness b. Bluish turbinates c. Absence of mucous d. Tenderness e. Bright red septum

a. Fullness d. Tenderness

A client complains of shortness of breath for the past few days. Examination reveals late inspiratory crackles in the lower third of the chest that were not present 1 week ago. What is the most likely explanation? a. Heart failure b. Asthma c. Bronchiectasis d. COPD

a. Heart failure

This patient is a 26-year-old male with complaints of a painful, tender area at the margin of the eyelid. You recognize the above finding as... a. Hordeolum b. Xanthelasma c. Episcleritis d. Pinguecula e. Chalazion f. Blepharitis

a. Hordeolum Rationale A painful, tender, red infection at the inner or outer margin of the eyelid, usually from Staphylococcus aureus (at the inner margin—from an obstructed meibomian gland; at the outer margin—from an obstructed eyelash follicle or tear gland).

A male client tells the nurse about experiencing problems with urination. What should the nurse assess in this client? Select all that apply. a. If there is any blood or semen in the urine b. The number of times the client voids during the day c. If there is any difficulty starting the urine stream d. If the client has ever been diagnosed with a sexually transmitted infection e. If there is any pain at the base of the penis

a. If there is any blood or semen in the urine b. The number of times the client voids during the day c. If there is any difficulty starting the urine stream e. If there is any pain at the base of the penis Rationale For the male client with urination problems, the nurse should assess the number of times the client urinates during the day, the presence of blood or semen in the urine, if there is difficulty starting the urine stream, and for pain at the base of the penis. Assessing for sexually transmitted infections would be appropriate if the client were experiencing penile discharge or lesions.

The nurse hears a murmur in a client with a known mitral valve prolapse. The murmur most likely occurs in a. Late systole b. Mid-systole c. Mid-diastole d. Early diastole

a. Late systole

Which type of vessels filter pathogens from the body and drain the fluid that has moved outside of the circulation back into the vessels? a. Lymphatic b. Arteries c. Veins d. Aortic

a. Lymphatic

A client presents to the health care clinic with a 3-day history of fever, chills, neck pain and stiffness, and headache. The nurse observes an elevated temperature of 102.5°F and pain with rotation of the head side to the side and decreased ability to flex the head forward. The nurse recognizes these findings as most likely the onset of what infectious process? a. Meningitis b. Arthritis c. Spondylitis d. Bursitis

a. Meningitis Rationale Impaired range of motion and neck pain associated with fever, chills, and a headache may be indicative of a serious infection such as meningitis. Arthritis is inflammation or infection within a joint. Spondylitis is an inflammation of the vertebra. Bursitis is an inflammation in the bursa (small sacs) of synovial fluid in the body.

What structure in the abdomen provides the blood vessels to the intestinal tract? a. Mesentery b. Peritoneum c. Aorta d. Spleen

a. Mesentery Rationale The fan-like mesentery supplies blood vessels and nerves to the intestinal tract. The aorta and inferior vena cava supply oxygenated blood to the cells and organs in the lower half of the body. The spleen produces and stores red blood cells. It also produces macrophages. The spleen stores platelets and activates B and T lymphocytes. The peritoneum is the membrane that lines the abdominal cavity.

You are an RN working in an ophthalmology office and are responsible for assisting with new patient intakes. A 66-year-old male patient presents for evaluation from primary care with a history of diabetes. You use the ophthalmoscope to make your initial assessment and see the following (flip over for image). You know that this is a hallmark sign of diabetic retinopathy and note this finding in your documentation. a. Microaneurysms b. Neovascularization c. Preretinal hemorrhage d. Superficial retinal hemorrhages

a. Microaneurysms Rationale Tiny, round, red spots commonly seen in and around the macular area. They are minute dilatations of very small retinal vessels; the vascular connections are too small to be seen with an ophthalmoscope. A hallmark of diabetic retinopathy.

A client suffering from a headache complains of throbbing, severe, unilateral pain that feels worse when exposed to bright lights. The client also complains of nausea and vomiting. What are the symptoms likely related to? a. Migraine b. Aneurysm c. Meningitis d. Common cold

a. Migraine

A nurse would like to check a patient's hypoglossal nerve. The nurse will ask the patient to: a. Move the tongue from side-to-side. b. Turn the head from side-to-side c. Puff out their cheeks. d. Smile and show their teeth. e. Stand with their eyes closed for at least 60 seconds.

a. Move the tongue from side-to-side. Rationale The hypoglossal nerve has the motor function of controlling the muscles in the tongue for manipulation of food.

A NP cares for a client with acute pericarditis. The NP should monitor the client for the onset of which clinical manifestation of cardiac tamponade? a. Paradoxical pulse b. Third heart sound c. Flattened jugular veins d. Bounding heart sounds

a. Paradoxical pulse

The nurse notes that a client has decreased fremitus in the left upper lung lobe. What should the nurse consider as causing this assessment finding? Select all that apply. a. Pneumothorax b. Bronchial obstruction c. Asthma d. Pleural effusion e. Pneumonia

a. Pneumothorax b. Bronchial obstruction d. Pleural effusion

When assessing for appendicitis, what signs might the nurse look for? Select all that apply. a. Psoas sign b. Murphy sign c. Rovsing sign d. Obturator sign

a. Psoas sign c. Rovsing sign d. Obturator sign Rationale Pain in the right lower quadrant during left-sided pressure suggests appendicitis (a positive Rovsing sign). So does right lower quadrant pain on quick withdrawal (referred rebound tenderness). Look for a psoas sign. Place your hand just above the client's right knee and ask the client to raise that thigh against your hand. Alternatively, ask the client to turn onto the left side. Then extend the client's right leg at the hip. Flexion of the leg at the hip makes the psoas muscle contract; extension stretches it. Increased abdominal pain on either maneuver constitutes a positive psoas sign, suggesting irritation of the psoas muscle by an inflamed appendix. Look for an obturator sign. Flex the client's right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This maneuver stretches the internal obturator muscle. Right hypogastric pain constitutes a positive obturator sign, suggesting irritation of the obturator muscle by an inflamed appendix.

You are an RN working in a skilled nursing facility. You receive a new admission for an older adult patient who can no longer take care of themself at home due to a history of multiple falls. While you realize that falls in the elderly are usually multifactorial, you recognize that their vision may be part of the problem. You know this because you recognize the above finding as... a. Pterygium b. Corneal scar c. Corneal arcus d. Peripheral cataract

a. Pterygium Rationale A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening and irritation may occur. May interfere with vision as it encroaches on the pupil.

Upon assessment of the external genitalia of an adolescent, which finding should the nurse expect with a Tanner Stage 4? a. Scrotal skin that has started darkening b. Testes and scrotum that are reddened c. Pubic hair that extends to medial aspects of the thighs d. Pubic hair that is sparse and slightly curly

a. Scrotal skin that has started darkening Rationale At Stage 4 as per Tanner's sexual maturity rating for boys, the scrotal skin starts darkening. At stage 2, pubic hair is sparse and slightly curly, both the testes and scrotum are larger, reddened, and exhibit textural changes. At stage 5, pubic hair extends to medial aspect of the thighs.

The NP is concerned that a client is at risk for the development of head and neck cancer. What finding caused the NP to have this concern? Select all that apply. a. Smokes cigarettes b. Ingests alcohol every day c. Has bleeding gums d. Takes acetaminophen e. Wears dentures

a. Smokes cigarettes b. Ingests alcohol every day

Which accessory muscles are most important when considering inspiratory breathing needs during exercise? a. Sternocleidomastoids b. Lateral neck muscles c. Intercostal muscles d. Abdominal muscles

a. Sternocleidomastoids

An NP is assessing a client who was stung in the face by a bee. Which finding about the lips supports the diagnosis of local allergic reaction? a. Swelling b. Pallor c. Cyanotic d. Reddish

a. Swelling

A nurse is working with a client who is victim of a shooting. The client has an increased pulse rate and pupil dilation and is clearly in stress. The nurse recognizes the "fight-or-flight" response in this client and understands that this represents an activation of which of the following? a. Sympathetic nervous system b. Parasympathetic nervous system c. Central nervous system d. Somatic nervous system

a. Sympathetic nervous system

The NP is caring for a client who comes to the clinic reporting a lump by her ear. What are the symptoms of a cancerous lymph node? a. The node is fixed and rubbery. b. The node is less than 1 cm in size and feels boggy. c. The node matches the node on the opposite side of the body. d. The node is soft and moves freely.

a. The node is fixed and rubbery.

A medical NP is preparing to administer a topical antifungal medication to a client who has just been diagnosed with an oral candida infection. On inspection of the client's tongue, the NP should anticipate what appearance? a. Thick, white plaques on the tongue surface b. Diffuse reddened lesions that bleed easily c. Dry appearance with fissures present d. Firm, raised nodules that are pink or red

a. Thick, white plaques on the tongue surface

The nurse notes that a male client's scrotal sac is documented as being "normal." What should the nurse expect to see when assessing this client? Select all that apply. a. Thin skin b. Scattered lesions c. Few strands of hair d. Rugated e. Color darker than the penis

a. Thin skin c. Few strands of hair d. Rugated e. Color darker than the penis Rationale For a scrotal sac to be considered "normal," the skin should appear thin and rugated. There will be few strands of hair and the color of the skin is darker than the penis. Lesions on the scrotal sac indicate an infection and would not be considered "normal."

The NP notes that a client's trachea is pushed to the right side of the neck. What health problem could this client be experiencing? Select all that apply. a. Tumor b. Pneumothorax c. Aortic aneurysm d. Pulmonary embolism e. Enlarged thyroid lobe

a. Tumor b. Pneumothorax c. Aortic aneurysm e. Enlarged thyroid lobe

The nurse is caring for an adult client who has acute bronchitis. What is the most probable cause of this condition? a. Virus b. Fungus c. Algae d. Bacteria

a. Virus

The NP is preparing to perform a physical examination on a female client who has been transferred to the medical unit from the emergency department. The NP should begin the collection of objective data with which examination? a. Vital signs b. Breast examination c. Palpation of lymph nodes d. Head and neck examination

a. Vital signs

What important questions guide the approach to physical assessment of the nervous system? Select all that apply. a. Where does the lesion lie? b. Is the central nervous system intact? c. Is the mental status intact? d. Are right-sided and left-sided examination findings symmetric?

a. Where does the lesion lie? c. Is the mental status intact? d. Are right-sided and left-sided examination findings symmetric?

The client is known to have a bundle branch block that delays activation of the right ventricle as a result of a recent myocardial infarction (MI). What would the nurse expect to hear when auscultating the client's heart sounds? a. Wide splitting b. Arrhythmia c. S3 sound d. An opening snap

a. Wide splitting

When assessing a patient with abdominal pain that is radiating to the back the provider knows this is: a. Splenic pain b. Duodenal or pancreatic pain c. Kidney pain d. Small intestine pain

b. Duodenal or pancreatic pain Rationale Referred pain is felt in more distant sites that are innervated at approximately the same spinal levels as the disordered structures. Referred pain often develops as the initial pain becomes more intense and seems to radiate or travel from the initial site. Palpation at the site of referred pain often does not result in tenderness. Pain of duodenal or pancreatic origin may be referred to the back, pain from the biliary tree, to the right scapular region or the right posterior thorax

Which abnormal respiratory finding should the nurse expect to observe upon assessment of a client with a pleural effusion? a. Coarse rhonchi with periods of short periods of apnea b. Dyspnea on exertion and dry, nonproductive cough c. Dyspnea at rest and dry, nonproductive cough d. Coarse rhonchi with an accelerated respiratory rate

b. Dyspnea on exertion and dry, nonproductive cough

An upper motor neuron problem might present with all of the following EXCEPT: a. Spastic weakness b. Flaccid weakness c. No significant muscle atrophy d. No fasciculations e. Hyperreflexia f. Babinski reflex

b. Flaccid weakness

A client comes to the clinic complaining of waking during the night with sudden shortness of breath. She is diagnosed with paroxysmal nocturnal dyspnea. Before leaving the clinic, the client asks the nurse what causes paroxysmal nocturnal dyspnea. What would be the nurse's best response? a. Congestive heart failure b. Fluid overload from elevation of the legs c. Cardiac decompensation d. Fluid overload related to renal failure

b. Fluid overload from elevation of the legs

The NP is conducting a health history. The client states he has lost 30 pounds in the last couple months without really trying. The client also states he feels warm all the time and sometimes feels like he has heart palpitations. The NP would evaluate the client for: a. Hyperbilirubinemia b. Hyperthyroidism c. Hyperproteinemia d. Hypernatremia

b. Hyperthyroidism

A group of students is reviewing information about the different types of murmurs. Which of the following would they identify as examples of midsystolic murmurs? a. Mitral regurgitation b. Innocent c. Ventricular septal defect d. Mitral stenosis

b. Innocent

A 24-year-old man is rushed to the emergency room following an injury sustained in a motor vehicle accident. He complains of breathing difficulty and right-sided chest pain, which he describes as 8/10, sharp in character, and worse with deep inspiration. His vitals are: blood pressure 90/65 mm Hg; respiratory rate 30/min; pulse 120/min; and temperature 37.2°C (99.0°F). The patient is alert and oriented but in severe distress due to multiple bruises over the anterior chest wall and significant jugular venous distention as well as subcutaneous emphysema at the base of the neck. There is also absence of breath sounds on the right and hyper-resonance to percussion. A bedside chest radiograph shows evidence of a collapsed right lung with a depressed right hemidiaphragm and tracheal deviation to the left. Which of the following findings is the strongest indicator of cardiogenic shock in this patient? a. Hyperresonance to percussion b. Jugular vein distention c. Tracheal shift to the left d. Subcutaneous emphysema

b. Jugular vein distention

A client is coughing copious amounts of purulent mucous. What disease condition is related to this finding? a. Cystic fibrosis b. Lung abscess c. Lung cancer d. Pneumococcal pneumonia

b. Lung abscess

Suzanne is a 20-year-old college student who complains of chest pain. The pain is intermittent and located to the left of her sternum. There are no associated symptoms. Examination reveals a short, high-pitched sound in systole, followed by a murmur that increases in intensity until S2. It is heard best over the apex. When she squats, this noise moves later in systole along with the murmur. Which of the following is the most likely diagnosis? a. Mitral valve papillary muscle ischemia b. Mitral valve prolapse c. Mitral insufficiency d. Mitral stenosis

b. Mitral valve prolapse Rationale The description above is classic for mitral valve prolapse. The extra sound is a mid-systolic click, which is typically a short, high- pitched sound. Mitral stenosis is a soft, low-pitched rumbling murmur that is difficult to hear unless the bell is used in the left lateral decubitus position. Mitral insufficiency is a holosystolic murmur heard best over the apex, and papillary muscle ischemia often creates a mitral insufficiency with its accompanying murmur.

Which disorders are controlled by the autonomic nervous system? Select all that apply. a. Muscle strain b. Orthostatic hypotension c. Arrhythmia d. Gastroparesis e. Hypertension

b. Orthostatic hypotension c. Arrhythmia d. Gastroparesis e. Hypertension Rationale Muscle movement is not controlled by the autonomic nervous system. Skeletal muscles are under the control of the somatic nervous system. The somatic nervous system controls the motor and sensory information to and from the central nervous system and is responsible for all voluntary muscle movements as well as processing sensory information.

You are an RN assessing an elderly patient with a history of stroke and left-sided hemiparesis in a skilled nursing facility after receiving report. You notice a yellow lump in this patient's left eye. You recognize this as a... a. Xanthelasma b. Pinguecula c. Blepharitis d. Chalazion e. Hordeolum f. Episcleritis

b. Pinguecula Rationale A harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris. Appears frequently with aging, first on the nasal and then on the temporal side.

Which characteristic of the gums should a NP expect to assess in a client who is healthy? a. Red, bleeding b. Pink, moist, firm c. A grey-white line d. Enlarged, reddened

b. Pink, moist, firm

You see the following and document this as multiple round to oval scaling violaceous plaques on abdomen and back. You also notice a single, oval, flat-topped superficial erythematous to skin-colored plaque on right abdomen You know this is consistent with... a. Plaque psoriasis b. Pityriasis rosea c. Nummular dermatitis d. Atopic dermatitis

b. Pityriasis rosea Rationale Multiple round to oval scaling violaceous plaques on abdomen and back accompanied by a single, oval, flat-topped superficial erythematous to skin-colored plaque known as a herald patch.

During the abdominal examination, a nurse hyperextends a client's right leg. At this point, the client reports pain in the right lower quadrant. This test is positive for which sign? a. Rovsing's b. Psoas c. Murphy's d. Obturator

b. Psoas Rationale The obturator sign involves pain in the right lower quadrant as a result of the nurse flexing the client's hip and rotating the leg externally and internally while supporting the client's right knee and ankle. Psoas sign involves pain in the right lower quadrant on hyperextension of the client's right leg and indicates appendicitis. Murphy's sign is for assessment of cholecystitis and is elicited by pressing the fingers at the client's right costal margin and telling the client to inhale. Rovsing's sign involves pain caused by deep palpation in the left lower quadrant.

The nurse's auscultation of a 22-year-old client's apical heart rate reveals the presence of S3. When the client stands upright, the S3 is no longer audible. How should the nurse respond to this assessment finding? a. Recognize this as an early sign of left-sided heart failure. b. Recognize this as a normal assessment finding in this client. c. Perform a focused respiratory assessment. d. Make a referral to the client's primary care provider promptly.

b. Recognize this as a normal assessment finding in this client.

A client expresses pain when the left costovertebral angle is palpated. What should the nurse suspect is occurring with this client? Select all that apply. a. Hepatitis b. Renal calculi c. Kidney infection d. Hydronephrosis e. Cholecystitis

b. Renal calculi c. Kidney infection d. Hydronephrosis Rationale Tenderness or sharp pain elicited over the costovertebral angle occurs with renal calculi, hydronephrosis, or a kidney infection. Tenderness over the liver is associated with hepatitis and cholecystitis.

When assessing the tympanic membrane, a variation of normal is a tympanic membrane with what? a. Yellow areas b. Sclerosis c. Prominent stapes d. Pink color

b. Sclerosis

A client says that an object placed in the hand is a pair of scissors when the object is a paper clip. Which aspect of the client's neurologic system should the nurse identify as being compromised? a. Motor b. Sensory c. Position sense d. Responsiveness

b. Sensory

The nurse notes that client's breathing pattern is regular but has periods of deep, rapid breathing followed by periods of apnea. What should the nurse consider as causing this client's breathing patterns? Select all that apply. a. Diabetic ketoacidosis b. Severe congestive heart failure c. Renal failure d. Drug overdose e. Increased intracranial pressure

b. Severe congestive heart failure c. Renal failure d. Drug overdose e. Increased intracranial pressure

How should the normal cervix feel to the nurse's fingers? Select all that apply. a. Hard b. Soft c. Round d. Immobile e. Firm

b. Soft c. Round e. Firm Rationale The normal cervix should feel firm and soft (like the tip of the nose). It is rounded and can be moved slightly from side to side without tenderness. A hard, immobile cervix may indicate cancer.

Which of the following would a nurse suspect if dullness is percussed at the last interspace at the anterior axillary line on deep inspiration? a. Intestinal air b. Splenomegaly c. Abdominal mass d. Hepatomegaly

b. Splenomegaly Rationale Normally, tympany or resonance is heard at the last left interspace. Dullness suggest splenomegaly. The liver would be percussed anteriorly. An increased liver span would suggest hepatomegaly. Percussion and palpation in any area of the abdomen might reveal an abdominal mass. Intestinal air would be noted by tympany.

Which body functions are related to the hypothalamus? Select all that apply. a. Withdrawing a hand from a hot stove b. Sweating on a hot day c. Feeling worried about an exam d. Experiencing a regular menstrual cycle e. Learning a new dance move

b. Sweating on a hot day c. Feeling worried about an exam d. Experiencing a regular menstrual cycle Rationale The hypothalamus is responsible for regulation of temperature, governing emotions, and secretion of hormones. Withdrawing a hand from a hot stove involves production of sensory impulse; this is the role of the thalamus. Learning a dance move requires coordination of movement; this is the role of the cerebellum.

The patient is having difficulty moving the eyes up and down during a neurological assessment. Which nerve is likely to be involved? a. Optic nerve b. Trochlear Nerve c. Facial Nerve d. Abducens Nerve e. Cochlear nerve

b. Trochlear Nerve Rationale The trochlear nerve, along with the oculomotor nerve, is responsible for the motor movement of the eyeballs. The trochlear nerve is specifically responsible for moving the eyes up and down.

An adult client tells the NP that his father had cataracts. He asks the NP about risk factors for cataracts. Which of the following should the NP mention to the client as potential risk factors? Select all that apply. a. Use of antibiotics. b. Ultraviolet light exposure. c. Lack of vitamin C in the diet d. Obesity.

b. Ultraviolet light exposure. d. Obesity.

An NP auscultates the heart of a client with hypertension for the past ten (10) years. With the client in the left lateral position, the NP hears a heart sound that occurs just before S1. The NP recognizes this sound as what pathological process? a. Turbulence within the ventricles caused by rapid filling b. Splitting of S2 that does not disappear with expiration c. Atrial contractions heard as vibrations against stiff walled ventricles d. Abnormal contraction of the ventricles due to a conduction delay

c. Atrial contractions heard as vibrations against stiff walled ventricles

You are a triage nurse assessing a patient in an emergency room after he sustained a fall from a 6-foot ladder. You further assess the patient's pupils in bright and dim light to identify what you initially see as an abnormal pupillary reaction. You notice that anisocoria is greater in bright light than in dim light and that the larger pupil cannot constrict properly. You know this is an emergency situation that requires immediate attention as it most likely represents: a. A new lesion in the sympathetic pathways b. A dysconjugate gaze c. Blunt trauma d. One blind eye

c. Blunt trauma Rationale Unequal Pupils (Anisocoria)—Anisocoria represents a defect in the constriction or dilatation of one pupil. Constriction to light and near effort is mediated by parasympathetic pathways, and pupillary dilatation by sympathetic pathways. The light reaction in bright and dim light identifies the abnormal pupil. When anisocoria is greater in bright light than in dim light, the larger pupil cannot constrict properly. Causes include blunt trauma to the eye, open-angle glaucoma

A client is concerned because the sclera of the right eye has been pink in color for several days and tearing. What should the NP suspect is occurring with this client? a. Hyphema b. Anisocoria c. Conjunctivitis d. Exophthalmos

c. Conjunctivitis

An NP is performing a head and neck assessment of a client who is newly admitted to the hospital unit. When preparing to assess the client's thyroid gland, what landmarks should the NP first identify? Select all that apply. a. Esophagus b. Sternocleidomastoid muscle c. Cricoid cartilage d. Hyoid bone e. Carotid artery

c. Cricoid cartilage d. Hyoid bone

When assessing an adult client experiencing diarrhea, the NP notes a round "moon" face, a buffalo hump at the nape of the neck, and a velvety discoloration around the neck. What is the possible cause of these signs? a. Scleroderma b. Myxedema c. Cushing's syndrome d. Bell's palsy

c. Cushing's syndrome

When assessing deep tendon reflexes in an elderly client what finding would the nurse anticipate? a. Normal reaction time b. Increased reaction time c. Decreased reaction time d. Absent

c. Decreased reaction time

Why is it important to ask the client regarding discharge or drainage from the eyes? a. Discharge is associated with a detached retina b. Discharge is associated with glaucoma c. Discharge is associated with inflammation or infection d. Discharge is associated with presbyopia

c. Discharge is associated with inflammation or infection

Which characteristic of the apical pulse should a nurse expect to find in the client diagnosed with left ventricular hypertrophy? a. Diminished b. Bounding c. Displaced d. Normal

c. Displaced

A nurse is evaluating a client's jugular venous pressure. Which of the following findings would tend to indicate obstructive pulmonary disease? a. Elevated venous pressure only during inspiration b. Jugular vein visible when the client is supine c. Elevated venous pressure only during expiration d. Distention of the jugular vein when the head of the bed is elevated to 60 degrees

c. Elevated venous pressure only during expiration

The NP is using a Wood's light for a client who has complaints of itching, burning, and peeling of the skin between his toes. The NP is assessing for what etiology of the client's symptoms? a. Parasitic infection b. Allergic reaction c. Fungal infection d. Bacterial infection

c. Fungal infection

A client reports to the NP that he experiences fatigue during the day, has difficulty sleeping lying down, and often wakes up at night feeling short of breath. The NP should assess this client for other findings related to what disease process? a. Paroxysmal nocturnal dyspnea b. Upper respiratory infection c. Heart failure d. Sleep apnea

c. Heart failure

Your 40 year old patient they have heart burn once a month. You diagnose them with GERD. The attending see this diagnosis and states that the patient might not have GERD. What is the correct diagnostic criteria? a. Only mucosal damage on endoscopy b. Heart burn once a month for a year c. Heartburn and effortless regurgitation together more than once a week or mucosal damage on endoscopy

c. Heartburn and effortless regurgitation together more than once a week or mucosal damage on endoscopy Rationale Many patients with chronic upper abdominal discomfort or pain complain of heartburn, dysphagia, or effortless regurgitation. If patients report heartburn and effortless regurgitation together more than once a week, the accuracy of diagnosing GERD is over 90%. These symptoms or mucosal damage on endoscopy are the diagnostic criteria for GERD. Risk factors include reduced salivary flow, which increases mucosal acid exposure by dampening the actions of the bicarbonate buffer; obesity; delayed gastric emptying; selected medications; hiatal hernia and increased intraabdominal pressure.

A nurse assesses a client's jugular venous pulse to gather information about which of the following? a. Right ventricular pressure b. Left arterial pressure c. Hemodynamics of the right side of the heart d. Left ventricular diastolic filling

c. Hemodynamics of the right side of the heart

While assessing a client's abdomen, the nurse observes involuntary reflex guarding on expiration. The nurse would interpret this as most likely indicating what complication? a. Hernia b. Aneurysm c. Infection d. Malignancy

c. Infection Rationale Involuntary reflex guarding is a serious sign and reflects peritoneal irritation. Hernia would be noted as a protrusion or bulging of the abdomen. A malignancy would be noted as a palpable abdominal mass. An aneurysm would noted by the presence of a bruit.

A 13-year-old swimmer presents to your office with her mother. Her mother noted a new lesion that seems like it popped up overnight and would like you to evaluate. You see the below and are concerned this may be which of the following? a. Cherry angioma b. Seborrheic keratosis c. Melanoma d. Blue nevus

c. Melanoma Rationale May be uniform in color but asymmetric; key feature is rapid change or evolution

A nurse observes a thick, white, cheesy discharge at the vaginal opening, with irritation and swelling of the labia. The nurse recognizes this finding as most likely indicating what type vaginal infection? a. Trichomoniasis b. Bacterial Vaginosis c. Moniliasis d. Chlamydia

c. Moniliasis Rationale Candidal vaginitis (moniliasis) is caused by an overgrowth of yeast in the vagina. It causes a thick, white, cheesy discharge. Trichomoniasis vaginal infection is caused by a protozoan organism and is sexually transmitted. The discharge is typically yellow-green, frothy, and foul-smelling. Chlamydia produces a mucopurulent, yellowish discharge from the cervical os and is not always visible on the external genitalia. Bacterial vaginosis produces a thin, gray-white discharge that has a positive amine (fishy smell) and coats the vaginal walls and ectocervix.

The NP is having difficulty visualizing the apical impulse during a physical examination of the cardiovascular system. Which assessment tool is required for a more accurate assessment? a. Stethoscope b. Tape measure c. Penlight d. Cup of water

c. Penlight

When assessing the abdomen, the nurse auscultates before percussing because: a. Auscultation will identify any painful regions. b. Percussion may alter the character of bowel sounds. c. Percussion may alter the frequency of bowel sounds. d. Percussion and palpation may increase the frequency of bruits.

c. Percussion may alter the frequency of bowel sounds. Rationale Auscultation should precede percussion and palpation, because they may alter the frequency of the client's bowel sounds.

During a client's eye assessment, the NP is testing for consensual pupillary constriction. Which technique should the NP implement? a. Use an ophthalmoscope to inspect the inner eye. b. Shine a light directly into one eye of the client. c. Place a barrier between the client's eyes. d. Hold a pencil about 12 inches from the tip of the nose.

c. Place a barrier between the client's eyes.

The NP is assessing hospitalized post-operative pain and has asked the client to rate his pain, describe it, state the location and onset of when it started. What other question should the NP include in this pain assessment? a. Financial resources to obtain medication b. Availability of medication c. Provoking and alleviating factors d. Medications taken in the past

c. Provoking and alleviating factors

A client who inhaled carbon monoxide (CO) presents in the trauma emergency center with headache, dizziness, weakness, chest pain, and confusion. What does the nurse recognize about the use of conventional pulse oximetry for this client? a. Accurately measures oxygenated and deoxygenated hemoglobin b. Uses two wavelengths of light and measures the carbon monoxide c. Readings inaccurate due to CO-bound hemoglobin d. Measures carboxyhemoglobin as a percentage

c. Readings inaccurate due to CO-bound hemoglobin

During the auscultation of a client's heart sounds, the nurse hears a fixed S2 split. What does this heart sound indicate to the nurse? a. Pulmonic stenosis b. Left bundle branch block c. Right ventricular failure d. Right bundle branch block

c. Right ventricular failure

When assessing a client with Graves disease, how would you expect the thyroid gland to be? a. Firm b. Nodular c. Soft d. Tender

c. Soft

This fluid filled lesion is > 1 cm. Which of the following best describes this lesion? a. A vesicle on an erythematous base b. An unroofed bulla c. Solitary dusky oval patch with smaller inner violaceous patch and central 3.5-cm tense bulla d. A pustule on erythematous base, grouped together

c. Solitary dusky oval patch with smaller inner violaceous patch and central 3.5-cm tense bulla

Which of the following is a symptom related to vertigo? a. Fainting b. Loss of consciousness c. Spinning sensation d. Syncope

c. Spinning sensation

The nurse is preparing to perform the Romberg test on an adult male client. The nurse should instruct the client to: a. Squat down as far as he is able to do so. b. Keep his eyes open while he bends at the knees. c. Stand erect with arms at the sides and feet together. d. Touch the tip of his nose with his finger.

c. Stand erect with arms at the sides and feet together.

The ossicles contained in the middle ear include the malleus, the incus, and the: a. Pars tensa b. Umbo c. Stapes d. Pars flaccida

c. Stapes

Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites? a. Dullness that remains despite change in position b. Dullness centrally when the client is supine c. Tympany that changes location with client position d. Bilateral flank tympany

c. Tympany that changes location with client position Rationale A diagnosis of ascites is supported by findings that are consistent with movement of fluid and gas with changes in position. Gas-filled loops of bowel tend to float, so dullness when supine would argue against this. Likewise, because fluid gathers in dependent areas, the flanks should ordinarily be dull with ascites. Tympany that changes location with client position ("shifting dullness") would support the presence of ascites. A fluid wave and edema would support this diagnosis as well.

This is a patient following up in the dermatology clinic with acne vulgaris. Which best describes what you see on this patient's buccal and parotid cheeks bilaterally? a. Scattered erythematous round flat-topped well-circumscribed scaling plaques b. ~ 15-20 ink pearly papules with overlying telangiectasias c. ∼15-20 pustules and acneiform papules d. ∼30 2-5-mm erythematous pustules

c. ∼15-20 pustules and acneiform papules Rationale Pustule: Small palpable collection of neutrophils or keratin that appears white

true or false: Generalized muscle "aches and pains" are called arthralgias.

false Rationale Generalized muscle "aches and pains" are called myalgias

Which situation indicates that there is damage to the amygdala? a. An adult cannot say what they are thinking. b. An adult cannot remember what they ate 5 minutes ago. c. A newborn baby has delayed growth despite adequate nutrition and care. d. A child's expression remains the same while the child rides on a roller coaster.

d. A child's expression remains the same while the child rides on a roller coaster. Rationale The amygdala controls how emotions should be interpreted and attaches associations and responses to them. Damage to the amygdala would hinder this ability.

The nurse is caring for a client who knows what to say but cannot produce the speech to communicate it. Which area of the cerebral cortex is dysfunctional? a. Wernicke's area b. Prefrontal cortex c. Primary motor cortex d. Broca's area

d. Broca's area Rationale Aphasia that involves the inability to produce the correct words for communication is caused by dysfunction to Broca's area.

What lines the cheeks? a. Labial mucosa c. Alveolar mucosa c. Lingual mucosa d. Buccal mucosa

d. Buccal mucosa

The S4 heart sound: a. Is often termed ventricular gallop. b. Can be heard during systole. c. Is usually due to a heart murmur. d. Can be heard during diastole.

d. Can be heard during diastole.

This patient is a 26-year-old female with complaints of a painless nodule under his eyelid that has grown in size over the past week. Which of the following correctly describes the lump and swelling in/around the eye? a. Episcleritis b. Xanthelasma c. Hordeolum d. Chalazion e. Blepharitis f. Pinguecula

d. Chalazion Rationale A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May become acutely inflamed but, unlike a stye, usually points inside the lid rather than on the lid margin.

A patient visits the clinic with reports of itchy and watery eyes for three days. The NP observes a generalized redness to the conjunctiva. The NP recognizes this as what condition? a. Hordeolum b. Blepharitis c. Chalazion d. Conjunctivitis

d. Conjunctivitis

What eye function is the NP preparing to assess when the client is asked to stand 20 feet from a Snellen chart that is mounted on the examination room wall? a. Peripheral vision b. Near vision c. External eye structures d. Distant vision

d. Distant vision

a. Hordeolum b. Ptosis c. Lid retraction and exophthalmos d. Entropion e. Chalazion f. Ectropion

d. Entropion Rationale Entropion, more common in the elderly, is an inward turning of the lid margin. The lower lashes, which are often invisible when turned inward, irritate the conjunctiva and lower cornea. This is different from trichiasis where there is aberrant inward growth of the eyelashes, but the eyelid position remains normal. Ask the patient to squeeze the lids together and then open them; then check for an entropion that is less obvious.

During the physical examination of a client's eyes, the NP asks the client to follow the tracing of a giant H with the eyes. What function is the NP assessing in this client? a. Pupil reaction to light b. Corneal light reflex c. Convergence d. Extraocular movements

d. Extraocular movements

The NP is preparing to examine the ears of an adult client with an otoscope. The NP should plan to: a. Ask the client to tilt the head slightly forward. b. Use a speculum that measures 10 mm in diameter. c. Release the auricle during the examination. d. Firmly pull the auricle out, up, and back.

d. Firmly pull the auricle out, up, and back.

While conducting an abdominal physical examination, the client complains of pain with deep palpation of the right kidney. Which of the following should be the nurse's next step in the physical examination? a. Light palpation of the abdominal right lower quadrant b. Deep palpation of the abdominal left upper quadrant c. Auscultate sounds in the abdominal left lower quadrant d. Fist percussion of the costovertebral angles

d. Fist percussion of the costovertebral angles Rationale Further assessment of tenderness in the region of the right kidney is to include fist percussion of the costovertebral angle. Assessment of right kidney discomfort is not done by deep palpation of the left upper quadrant, light palpation of the right lower quadrant, or auscultation of sounds in the left lower quadrant.

The nurse is assessing the neurological status of an unconscious client. The nurse should use which assessment scale? a. Norton b. Braden c. Morse d. Glasgow

d. Glasgow Rationale An appropriate scale to assess the neurological status of an unconscious client is the Glasgow Coma Scale (GCS). The Norton and Braden scales are used to assess skin. The Morse Fall scale is used to assess the risk for falls.

A client presents to the health care clinic with red, watery eyes and constant tearing. The NP understands that which of the following is the organ that produces tears? a. Sebaceous gland b. Eccrine gland c. Meibomian gland d. Lacrimal gland

d. Lacrimal gland

When performing an assessment of the nervous system, it is most appropriate for a nurse to complete it in which sequence? a. Cranial nerves, motor/cerebellar, sensory, reflexes, mental status b. Motor/cerebellar, sensory, reflexes, cranial nerves, mental status c. Reflexes, sensory, motor/cerebellar, cranial nerves, mental status d. Mental status, cranial nerves, motor/cerebellar, sensory, reflexes

d. Mental status, cranial nerves, motor/cerebellar, sensory, reflexes

A nurse expects to find which abnormal heart sound in a client diagnosed with mitral valve prolapse? a. Ventricular gallop b. Venous hum c. Opening snap d. Mid-systolic click

d. Mid-systolic click

While auscultating heart sounds, asking the client to turn onto a left lying position would help the nurse assess the presence of which of the following? a. The first heart sound b. Aortic murmurs c. Atrial repolarization d. Mitral stenosis

d. Mitral stenosis

A client reports the onset of pain in the left upper quadrant of the abdomen with the ingestion of alcohol. The nurse recognizes that alteration in function of which organ is most likely to be the cause of this pain? a. Kidney b. Spleen c. Gallbladder d. Pancreas

d. Pancreas Rationale The pancreas is most likely to be the cause of the pain in the left upper quadrant with ingestion of alcohol because chronic use causes inflammation of this organ. The gallbladder is in the right upper quadrant. The kidney and spleen are not affected by alcohol ingestion.

A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates the correct way to assess the client for ascites? a. Palpate the abdomen lightly for areas of tenderness b. Auscultate for bowel sounds in all quadrants of abdomen c. Inspect the abdominal skin for vascularity and striae d. Percuss the flanks from bed upward toward the umbilicus

d. Percuss the flanks from bed upward toward the umbilicus Rationale The nurse should test for shifting dullness by percussing the flanks from bed upward toward the umbilicus to assess for ascites. Auscultating for bowel sounds in all quadrants of abdomen may not give any indication about ascites. Inspecting the abdominal skin for vascularity and striae may indicate ascites but it does not confirm the presence of fluids. Palpating the abdomen lightly for areas of tenderness may not contribute to ascites assessment.

An adult client has been diagnosed with bronchitis. What would the nurse most likely hear on auscultation? a. Fine crackles b. Sibilant wheezes c. Coarse crackles d. Sonorous wheezes

d. Sonorous wheezes

Which statements are true concerning the location and structure of the trachea and major bronchi? a. The major bronchi originate posteriorly at the spinous process of T4. b. Both bronchi are equal in width. c. The right main bronchus is longer than the left bronchus. d. The trachea divides or bifurcates anteriorly at the sternal angle.

d. The trachea divides or bifurcates anteriorly at the sternal angle.

When the NP is preparing to assess the thyroid gland of a client with suspected hypothyroidism, why could it be helpful to bring a cup of water to the physical examination? a. To assist the client to feel more comfortable b. To promote the NP-client relationship c. To prevent further dehydration d. To observe the movement of the thyroid gland

d. To observe the movement of the thyroid gland

While performing a physical examination on an older adult, the NP should plan to: a. Provide only minimal teaching related to health care. b. Complete the examination as quickly as possible. c. Ask the client to change positions frequently. d. Use minimal position changes.

d. Use minimal position changes.

During the physical exam, the NP identifies the client has a smooth, glossy tongue. The NP understands this is caused by what? a. Accumulation of food b. Sun exposure c. Poor oral care d. Vitamin B12 deficiency

d. Vitamin B12 deficiency

Which of the following are TRUE? Select all that apply. a. Motor neurons above the level of this synapse are considered upper motor neurons (UMN) b. Upper and lower motor neuron injuries produce different clinical signs c. Peripheral nerve cells and their extensions beyond the synapse are lower motor neurons (LMN) d. The corticospinal tract and related motor pathways synapse in the spinal cord, just before leaving the cord e. All of the above

e. All of the above

A 54-year-old man is referred to your hospital with a 5-month history of progressive difficulty in walking and left leg numbness. He first noticed mild gait unsteadiness and, gradually, he later developed right leg weakness. His left leg developed progressive numbness and tingling. His blood pressure is 138/88 mm Hg, heart rate is 72/min and regular, and temperature is 36.7°C (98.2°F). On physical examination, he is alert and oriented x4. The cranial nerves are intact. Muscle strength is 5/5 in the left upper extremity and in the left lower extremity, but 3/5 in the right leg with an increased tone. The plantar reflex is extensor on the right. Pinprick sensation is decreased on the left side below the umbilicus. Vibration and joint position senses are decreased in the right foot and leg. All sensations are normal in the upper extremities. Finger-to-nose and heel-to-shin testing are normal. This patient's lesion is most likely located in which of the following parts of the nervous system? a. Right parietal Lobe b. Left parietal Lobe c. Right pons d. Left pons e. Right hemi-spinal cord f. Left hemi-spinal cord

e. Right hemi-spinal cord Rationale The most important clinical features are: 1. Right leg upper motor neuron weakness (weakness, increased tone, and positive Babinski's sign) 2. Decreased vibration and joint position sense in the right leg 3. Decreased pinprick sensation on the left side below the umbilicus Unilateral weakness and upper motor neuron signs (increased tone, weakness, and positive Babinski's sign) in the leg is likely caused by a lesion in the ipsilateral spinal cord. The associated sensory abnormalities in this case support a right hemi-spinal cord lesion.

true or false: Articular joint pain usually involves decreased active range of motion only.

false Rationale Articular joint pain usually involves BOTH decreased active range of motion and passive range of motion.

true or false: Atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 6 to 8 weeks of a rotator cuff tear.

false Rationale Atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 2 to 3 weeks of a rotator cuff tear.

true or false: Ipsilateral involvement of the spinothalamic tract results in the loss of pain and temperature senses.

false Rationale Contralateral involvement of the spinothalamic tract results in the loss of pain and temperature senses.

true or false: Facial symmetry is a common finding in temporomandibular disorders.

false Rationale Facial asymmetry is a common finding in temporomandibular disorders.

true or false: For injured joints with concern for fracture, an x-ray before attempting movement is never necessary.

false Rationale For injured joints with concern for fracture, consider an x-ray before attempting movement.

true or false: Patients with peritonitis move around frequently trying to find a comfortable position.

false Rationale In contrast to peritonitis, patients with colicky pain from a renal stone move around frequently trying to find a comfortable position. Somatic or parietal pain originates from inflammation of the parietal peritoneum, called peritonitis, which can be localized or diffuse. It is a steady, aching pain that is usually more severe than visceral pain and more precisely localized over the involved structure. It is typically aggravated by movement or coughing. Patients with parietal pain usually prefer to lie still.

true or false: Contralateral involvement of the corticospinal tract would result in upper motor neuron weakness, increased tone, and positive Babinski's sign.

false Rationale Ipsilateral involvement of the corticospinal tract would result in upper motor neuron weakness, increased tone, and positive Babinski's sign.

true or false: Nonspecific low back pain is not usually related to musculoligamentous injuries and age-related degenerative processes of the intervertebral discs and facet joints.

false Rationale Nonspecific low back pain IS usually from musculoligamentous injuries and age-related degenerative processes of the intervertebral discs and facet joints.

true or false: Pathology involving extraarticular structures often causes intraarticular joint swelling, instability, or joint deformity typically involves "point or focal tenderness in regions adjacent to articular structures," and limits active ROM only.

false Rationale Pathology involving extraarticular structures RARELY causes intraarticular joint swelling, instability, or joint deformity typically involves "point or focal tenderness in regions adjacent to articular structures," and limits active ROM only.

true or false: Prepatellar bursitis is rarely triggered by excessive kneeling.

false Rationale Prepatellar bursitis is often triggered by excessive kneeling

true or false: RLQ pain or pain that migrates from the periumbilical region, combined with nausea, vomiting, and loss of appetite is suspicious for cholecystitis.

false Rationale RLQ pain or pain that migrates from the periumbilical region, combined with nausea, vomiting, and loss of appetite is suspicious for appendicitis.

true or false: ROM is not affected in bursitis, capsulitis, rotator cuff tears or sprains, and tendinitis.

false Rationale Restricted ROM occurs in bursitis, capsulitis, rotator cuff tears or sprains, and tendinitis.

true or false: Causes of symmetric arthritis usually include bacterial infection or mechanical injury.

false Rationale Symmetrical arthritis is usually viral/post-viral or inflammatory (e.g., RA, SLE, post-viral syndrome, etc.)

true or false: If age < 60 years, look for osteoarthritis (OA), gout and pseudogout, polymyalgia rheumatica (PMR), osteoporotic fracture, and septic bacterial arthritis.

false Rationale These ddx should be suspected if a person is > 60-years-old.

true or false: To test Tinel's sign, ask the patient to hold the wrists in full flexion and juxtaposing the dorsum of each hand against each other for 60 seconds with the elbows fully extended. Numbness and tingling in the median nerve distribution within 60 seconds is a positive test.

false Rationale This is the procedure for testing Phalen's sign

true or false: You are easily able to palpate the ACL and PCL within the knee joint.

false Rationale You will not be able to palpate the ACL and PCL since they lie transversely within the knee joint