cultural final exam back of book questions

During history collection, a 66-year-old man tells you he has trouble urinating, and his provider says his prostate gland is enlarged. He says, "Why do I even have a prostate gland?" Which is your best response?

"It makes thin, milky fluid to help the sperm stay alive during intercourse."

You have examined the following women during one shift. Which ones should you refer for further evaluation? Select all that apply.

A 28-year-old with multiple distinct nodules palate in each breast. A 48-year-old who has a 6-month history of reddened and sore left nipple/areolar area. A 64-year-old with an ulcerated area at the tip of the right nipple; no masses, tenderness, or enlarged lymph nodes present.

You are examining a 10-year-old girl for a sports physical. What is the first physical change associated with puberty in girls? Select all that apply.

A small mound of breast tissue develops under the nipple. Pubic hair development.

Identify the appropriate order for the development of the normal spinal curvature from infancy to adulthood. Not all choices will be used.

C-shaped curvature of spine. Anterior curve in lumbar region. Anterior curve in cervical neck region

You are taking a history of a 25-year-old woman with a rash on her upper chest and neck. Which question would give you further information on the woman's rash?

Have you tried a new food or medication?

During your skin assessment of a 65-year-old white landscaper, you noticed a raised, thickened area of increased pigmentation of 1.5 cm that looks dark brown and greasy. What is your next most appropriate action?

Interpret this as seborrheic keratosis and move on with the examination.

During assessment of a newborn baby boy, you note the urethral meatus is positioned ventrally, on the underside of the penis. Your next best action is to: Select all that apply.

Notice if the penis is straight or curved. Ask a physician or AP provider to repeat the examination.

During the examination of a 70-year-old man, you note gynecomastia. Your next best action is to:

Review the medications for drugs that have gynecomastia as a side effect.

You are inspecting an adult woman's breasts for retraction signs. Her best position is:

Sitting with hands pushing onto hips.

You are presenting the internal anatomy of the breast for a community healthcare clinic. Which of the following are accurate points to include? Select all that apply.

The fibrous connective tissue extends from inside the breast skin surface toward the chest wall muscles. The breast tissue slopes upward into the axilla.

An 11 year old girl comes to your clinic for a sports physical and shows breast bud development. How can you help her understand usual growth and development? What is your best approach?

Use Tanner's sexual development charts to show her where she is now in the stages and what to expect.

The bimanual technique is your preferred approach for a woman:

With large pendulous breasts.

A 48 year old woman seeks care because of a depressed feeling, episodes of unusual heat, not sleeping well, and feeling exhausted and irritable. Her last menstrual period (LMP) was 14 days prior to this appointment. She describes these symptoms in detail, then states, "This cant be menopause, because I still have my periods." What is your next best response.

"Actually, 'perimenopause' can start well before your periods stop, and you may now be having symptoms of low estrogen."

You are collecting a health history of a 52-year-old woman. Vital signs and weight are within normal range. At one point, she reports, "the last few weeks, I have had sudden drenching sweating through my shirt." How would you proceed with data collection?

"Can you please tell me the date of your last menstrual period?"

During the health history, a 64-year-old man tells you he "never has sex anymore." Check the following appropriate follow-up questions you could use that are associated with withdrawal from sex. Select all that apply.

"Have you been told about any side effects of your medication?" "Would you say you have had feelings of depression in the last few months?" "How many alcoholic drinks do you have each day?" "Have you experienced the loss of your loss of your spouse or your partner?

During a sports physical for a 14-year-old adolescent, you observe many papules, pustules, nodules, and blackheads covering the cheeks and jaw on the face. Which of these statements would be your most appropriate response?

"How do you feel about the acne on your face?"

You are an advanced provider about to inspect and palpate a 55-year-old man for a suspected inguinal hernia. What is your best instruction to prepare this man?

"I will ask you to bear down when my gloved finger is in the inguinal canal."

You are teaching a 19-year-old how to perform a testicular self-examination. Which of the following statements is the most appropriate?

"If you notice an enlarged testicle or a firm lump, call your health care provider."

You visit the home of a 35-year-old mother with her first baby. She is 4 days postpartum. She has a tender thickening in one breast with the overlaying skin reddened and tender. She has fatigue but no fever What teaching would you give? Select all that apply.

"Nurse the baby on the affected side first at each nursing." "Nurse the baby frequently to keep the breast as empty as possible." 'This condition is common when you and the baby are both learning the nurse."

When discussing sexuality or sexual feelings with teenagers, a permission statement helps to communicate that it is normal and healthy to think or to feel a certain way. Which of the following would you choose to be a permission statement?

"Often girls your age have questions about sex and sexual activity. What questions do you have?"

A 13-year-old presents to your clinic for a school physical examination. She asks you why her breasts "don't match" in size. What is your best response?

"One breast may temporarily grow faster than the other during development."

A 25 year old woman has some vaginal discharge and is worried she has a sexually transmitted infection (STI). What is your next best response?

"Tell me more about the discharge: Color? Smell? Amount?"

During telephone triage, a new mother calls you to report her newborn has just passed a dark green "poop, the first one." The newborn is 30 hours of age. Your best response would be:

"The dark green stool shows the rectum and anus are open and working."

A 78-year-old retired physical examination teacher comes to your clinic for a routine assessment. The teacher asks about small, round, flat, evenly brown macules on the backs of the hands. After assessing the area, what is your best response?

"These are the result of sun exposure and do not require treatment."

During the examination of a 30-year-old woman, she asks about "the large mole" below her left breast. After inspecting a 1 cm circular brown area with a central bump, what is your best response?

"This is a common finding of an extra, undeveloped nipple."

A 65 year old woman tells you she "wets" herself a little when she sneezes or coughs. Your next best response is:

"This sounds like 'stress incontinence' due to some weakness in the pelvic muscles."

A 60-year-old man has been told he has benign prostatic hypertrophy. His close friend just died from prostate cancer. "What if this happens to me?" What si your best response? Select all that apply.

"Your prostate gland is enlarged because of expected hormone changes, not cancer." "Your friend's death is very sad, but this is not a risk for you personally."

You are providing health promotion for a 50-year-old woman. What is the current recommendation for women aged 45-54 for screening mammography?

Annual mammogram.

A 10-month-old, uncircumcised boy comes to your clinic for a well-baby check-up. How would you proceed with the genital exam?

Avoid retracting the foreskin.

You perform a genital examination on a 48-year-old man and note deeply pigmented wrinkled scrotal skin, with multiple, yellowish, 1-cm, firm, non-tender nodules. What would be your next most appropriate action?

Consider these sebaceous follicles an expected finding and proceed with the examination.

You perform a genital examination on a 25-year-old man and palpate testes that feel ovoid and movable yet somewhat sensitive to compression. What would be your next most appropriate action?

Consider this an expected finding and proceed with the examination.

You are preparing a patient for a pelvic examination in the lithotomy position. What measure can you employ to case comfort? Select all that apply

Elevate patient's head and shoulders to keep eye contact during the exam. Position a chaperone standing by the patient's head. Make sure bladder is empty before the exam. State, "Now I'm going to . . ." before each step in the exam. Touch the inner thigh before you directly touch the vuvlva.

A 62-year-old man states his doctor told him he has an "inguinal hernia." He asks you to explain what a hernia is. Your best response is:

Explain that a hernia is a loop of bowel protruding through a weak spot in the belly muscles.

A 74-year-old woman presents with a history of intense and raised red linear rash on one side of the upper back. You know that these findings are consistent with:

Herpes zoster infection (shingles) History of childhood chickenpox infection

During the health history, a man tells you he has trouble in starting his urine stream when he arrives at the toilet. This symptom is known as:

Hesitancy.

While teaching a 63-year-old man with a family history of colorectal cancer (his father), you cover lifestyle factors to reduce future CRC risk. Which foods are helpful in reducing CRC risk?

High in fiber

You are assessing a patient with a suspected rotator cuff tear. What assessment findings do you expect if the rotator cuff is torn? Select all that apply.

Hunched position. Limited abduction. Positive arm drop test.

You are preparing to care for a 63-year-old black man with a history of heart attacks who now presents with heart failure. What is the best technique to assess for cyanosis?

Inspect the nail beds for a dusky pale color.

You are assessing the skin of a 57-year-old during a clinic appointment. Which technique is the best to assess for increased skin temperature?

Laying the dorsal surface on your hands on the person's back.

During routine assessment of a 35-year-old, you notice linear streaks on the nail beds of the patient. These makings are appropriately recorded as:

Leukonychia striata.

You are assessing the general skin color of a darkly pigmented person. You would expect which finding?

Lighter pigmentation on the palms of the hands.

A 50-year-old is admitted to your med surg unit with chronic obstructive lung disease. Signs are: alert and oriented, on low-flow oxygen, with BP 156/78, HR 88 bpm and regular, respirations 20 per minute and unlabored. During the initial assessment, you observe a rounded appearance of the nail beds to their base in all 10 fingers. Your next most appropriate action is to:

Note this is an expected finding for this person and move on.

Which of the following describes a normal and expected finding when inspecting the adult female's genetalia?

Occasioanal yellowish, 1-cm nodules that are firm and nontender

When teaching breast self-examination, you should inform the woman that the best time to conduct breast self-examination is:

On the 4th to 7th days of the cycle.

You are caring for a person with jaundice from hepatitis. You expect the person's urine to be:

Orange in color.

You are about to examine the genitalia of a 93-year-old man who has an adhesion of the prepuce of the head of the penis, making the foreskin impossible to retract. You recognize this as:

Phimosis

An advanced practitioner prepares to palpate the anus and lower rectum. Which approach to palpation is correct?

Place pad of examiner's index finger gently on the anal opening.

You are examining a 1 day old baby girl following an uncomplicated vaginal delivery. The mother is present, an both are to be discharged to return home. Duing the exam, you note the baby's labia majora are swollen, the clitorsis appers large, there is small amount of mucoid discharge, and the vaginal opening is difficult to see. What is your next best action?

Proceed with the exam; this is a normal finding.

A 3-day-old infant has had healthy assessments since birth. On his 3rd day, you notice a yellowing of the skin, sclera, and mucous membranes. Your next most appropriate action is:

Record this as a physiologic jaundice and proceed with the assessment.

During rectal examination, the practitioner palpates a firm, irregularly shaped mass along the mucosal wall. What is the practitioner's most appropriate response?

Refer the patient to a specialist for further assessment.

The provider palpate the adnexa on a 23 year old woman who presents tot he clinic following two missed menstural periods. The findings regarding the adnexa are: nonpalpble ovaries; a firm, smooth uterine wall; a fallopian tube tat fels firm and pulsating. What is your next best action?

Refer the woman promptly to the ED.

A mother and father in the 7th month of their first pregnancy ask you about the benefits of circumcising their expected baby boy. Check all the facts you can share to help them with their decision.

Removal of the foreskin decreases the incidence of urinary tract infections. Most surgical risks of infant circumcision are minor and treatable.

A 57-year-old woman presents to your clinic for a health checkup, having preferred any healthcare visits for 1.5 years. During a breast examination, you palpate a 2 cm firm mass with irregular edges. What is your next best action?

Request a mammogram.

Lifestyle factors amount to one-half of cases of CRC. To help a person reduce future CRC risk, select all that apply.

Stop smoking and heavy alcohol drinking. Daily fruit and vegetable intake. Keeping a healthy weight. Daily exercise.

You are caring for a 52-year-old woman with a 5-year history of rheumatoid arthritis. As you complete the musculoskeletal assessment, you identify the following assessment and history findings that are expected deviations with rheumatoid arthritis. Select all that apply.

Symmetric joint involvement. Lymphadenopathy. Fatigue. Ulnar drift. Anorexia.

A parent of three biological daughters has a 10-year-old boy the family adopted at age 2 years. The parent is learning about raising boys and asks you the first physical sign of puberty in the male genitalia:

Testes and scrotum begin to enlarge.

You are teaching a 34-year-old woman who is 2 months pregnant what common breast changes to expect. You would include: Select all that apply.

The areolae become darker brown. Blue vascular pattern over both breasts.

You are conducting a class for new graduates on skin assessment. Which statement is true regarding the epidermis?

The epidermis cells are continuously lost and replaced with new cells.

Underline the findings that are normal and expected.

The provider examines the internal cervix and it is os a 36 year old woman who has had a 3 full term pregnancies - all vaginal deliveries. The findings are: slit-like appearance of the of the os; occasional small, smooth yellow nodules on the cervix; thick, opaque, stringy cervical secretions; foul smelling secretions.

Underline the findings that are normal and expected.

The provider preforms a bimanual examination on a 54 year old woman. The findings are: cervix feels smooth; cervix feels hard; cervix is equally rounded; cervix does not move with examiner's finger movement; cervical movement produces some pain.

You inspect the perineal area of a 38-year-old woman and not: anal pigment darker than surrounding skin, anal opening closed, a shiny, blue skin sac. The woman reports pain with bowel movements and an occasional spot of red blood. These findings most likely indicate:

Thrombosed hemorrhoids.

You are beginning a health history for a 25-year-old female who comes to the clinic for her first pelvic examination. Her knees are jumpy, and her voice is a bit breathless. You choose to begin the history with questions about her menstrual cycle. What directs your question choice?

Young women are used to discussing their menstrual periods, so this is a comfortable line of questioning to start.

You are providing osteoporosis education to a 67-year-old female who is at your clinical for her annual check-up. She has chronic medical conditions, and her bone mineral density was normal. The following is the most appropriate teaching for this patient.

Your last BMD was normal. It's important that you continue to eat a healthy diet and maintain a healthy weight. You should exercise at least five times a week and consider a combination of cardiovascular, balance, and strength training.

You are in the ED when a 70-year-old woman is brought by ambulance after failing in her assisted living space and then not being found for 14 hours. Vital signs are stable. Imaging shows no broken bones. She is alert and oriented. One e]of your assessment findings is that the skin on her upper chest "tents" after you lift it. This finding is consistent with:

dehydration

You are caring for a 48-year-old with a history of chronic alcohol abuse and liver disease. Which site is the best technique to assess for early jaundice?

sclera and hard palate