Final Exam: NR 509/ NR509 Advanced Physical Assessment Final Practice Questions with Verified Answers (Latest 2023/ 2024)- Chamberlain
1. A 42-year-old ... [Show More] school teacher with a history of irregular periods who underwent successful intrauterine insemination (IUI) on January 25th presents to the clinic for care on March 19th. Her last menstrual period (LMP) was November 11th of the previous year. Which of the following is true about the gestational age of her pregnancy?
Answer: It is determined by date of insemination plus 2 weeks.
2. A 32-year-old patient with two prior pregnancies presents to clinic concerned that she may be pregnant after missing one cycle of her menses, which was previously very regular. A urine human chorionic gonadotropin (HCG) test is positive. Presuming a normal pregnancy, what can the physician expect to find on examination and ultrasound?
Answer: A bluish hue of the cervix known as the Chadwick sign
3. A 22-year-old G1P0 presents for a routine prenatal visit at 32 weeks' gestational age. Leopold maneuvers indicate that the fetus is in a transverse lie, with the fetal skull palpable at the woman's left side. Fetal heart tones are heard at the uterine fundus with a baseline rate of 140 and beat-to-beat variability noted. Which of the following steps is appropriate to take at this time?
Answer: schedule a return visit in ~2 weeks.
4. A woman presenting in the late second trimester of her third pregnancy reports that she is experiencing several abdominal symptoms that she attributes to pregnancy: nausea, vomiting, urinary frequency, discomfort in the lower abdomen, tenderness over the suprapubic area, and severe constipation. Which of the following is true regarding these pregnancy symptoms?
Answer: iron supplementation, hormonal changes, slowed intestinal transit, physical pressure from the gravid uterus, and increased blood volume all contribute to abdominal symptoms in pregnant women.
5. A 42-year-old G2P1 arrives at clinic for a routine prenatal visit late in her third trimester. On exam, the physician notes a subtle murmur; on further auscultation, it becomes apparent that the murmur occurs during the diastolic phase. The patient has minimal complaints but does reveal that she has had swelling in her feet and shortness of breath. Because these symptoms have been only slightly more severe than during her last pregnancy, she assumed this was normal for pregnancy. Which of the following is true about her presentation?
Answer: a diastolic murmur during pregnancy is likely pathological and should always be investigated.
6. A 17-year-old G1P0 presents at a routine prenatal check. By last menstrual period (LMP), her gestational age at this visit is 36 weeks, 2 days. A first-trimester ultrasound confirmed her estimated delivery date. On exam, her fundus measures 31 centimeters. Ultrasound imaging might reveal which of the following anatomical findings that would explain this size?
Answer: Renal agenesis of the fetus resulting in intrauterine growth restriction.
7. A 26-year-old G0P0 is interested in becoming pregnant and presents for prepregnancy counseling. She was not vaccinated as a child and unsure if she wishes to be vaccinated now. She asks if she can change her mind during pregnancy and receive vaccinations during that time. What should she be told?
Answer: If a pregnant woman does not show sufficient titers to rubella, measles/mumps/rubella (MMR) vaccination should be given postpartum to protect future pregnancies from the effects of congenital rubella.
8. A 31-year-old marathon runner presents for prenatal care with her first pregnancy. She is in her second trimester and is experiencing some fatigue and muscle aches. Her prepregnancy body mass index (BMI) was noted at 19.2. How should she be counseled on exercise and nutrition during pregnancy?
Answer: she should increase her calorie intake to 300 calories per day or more from her pre pregnancy baseline.
9. A 29-year-old G2P1 presents to the clinic after a positive home pregnancy test. She confides at the appointment that her male partner has become increasingly abusive lately and once struck her while she was holding her older child. How should she be counseled?
Answer: Ask open-ended questions, allow her to make decisions that she feels are best for herself given he circumstance, and provide immediate or long-term referrals to domestic violence resources.
10. A 34-year-old G3P2 at 27 weeks' gestation is referred to the clinic upon discharge from a correctional institution where she has been incarcerated for 25 days for a drug offense. She denies any further substance abuse, but her behavior is concerning for intoxication, and she smells of alcohol and cigarettes. The clinician inquires about her drug use with open-ended questions and counsels her that which of the following is true?
Answer: Pregnant women are not routinely screened for hep c, but this test should be added to the panel of prenatal blood tests for patients with a history of intravenous drug use.
11. A 78-year-old woman presents to clinic with her two daughters, who are concerned about her continued ability to live independently. She has thus far been highly self-reliant and is opposed to the idea of leaving of her home of 30 years. The clinician performs a complete history and physical exam (including mental status and memory testing) as well as orders laboratory tests before providing the patient and her family the finding that she has age-appropriate changes that do not reflect any particular disease process. Which of the following findings is most consistent with the normal aging process and does not impair the ability to live alone? [Show Less]
