NURS 6512, Week 6 Midterm Exam QUESTIONS 1. Before performing an abdominal examination, the examiner should: Have the patient empty their bladder 2.
... [Show More] During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should: offer a tissue and let him know it is all right to cry 3. Which of the following is the most accurate reflection of an individual’s food intake? Food Diary 4. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: Lower liver border 5. A fixed image of any group that rejects its potential for originality or individuality is known as a: Stereotype 7. Brittle nails are typical findings in: Older adults 8. Which of the following is an expected change in the assessment of the thyroid during pregnancy? A Bruit is auscultated d/t increased vascularity 9. You are planning to palpate the abdomen of your patient. Which part of the examiner's hand is best for palpating vibration? Ulnar Surface 10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness you should palpate over the: Maxillary sinuses only - Only the maxillary and the frontal sinuses are accessiblefor physical examination; however, the young child doesnot develop frontal sinuses until 7 to 8 years of age 12. Unusual white areas on the skin may be due to Vitiligo 13. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for: Myopia (nearsighted) (or hyperopia (farsighted) 14. Mrs. Webb is a 38-year old patient who has been changing her lifestyle to eat in a healthy way and lose weight: during your health promotion education regarding her nutritional status, you explain the function of dietary protein as: Building and maintaining tissues 15. Mr. Akins is a 78-y/o patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply. c. Loss of high frequency e. Sounds may be garbled, difficult to localize f. Unable to hear in a crowded room contact:[email protected] 16. The most superior part of the stomach is the Fundus 17. Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia? B12 18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: Come to the laboratory for a stool guaiac test. 19. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for: Lateralization of Sound 20. Which technique is most likely to result in the patients understanding of questions? Use the patient’s own terms if possible. 21. Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of the history? Past medical data 22. Nasal symptoms that imply an allergic response include: Bluish gray turbinates. ("Turbinates that appear bluish gray or pale pink with a swollen, boggy consistency may indicate allergies") 23. Mr. Franklin is speaking with you the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more, that’s why I am here! You tell me what’s wrong.” Which caregiver response would be the most appropriate for enhancing communication? After 3 days, you're tired of coughing. Have you had a fever?" 24. When taking a history, you should: Use a chronologic and sequential framework. 25. Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)? Brief SOAP note 26. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to: Pull the auricle down and back - in an effort to straighten the upward curvature of the canal 27. Which question would be considered a leading question? You don't get headaches often, do you?" 28. Mr. Black is a 44y/o patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at? C 4 to C 5: C4 and C5 or C5 and C 6 provide the greatest horizontal mobility in adults 29. The term denoting the caregiver’s need to do no harm to the patient is: Nonmaleficence 30. A tool used to screen adolescents for alcoholism is the: CRAFFT 31. Under normal circumstances, how much water is lost daily by the body? Under normal circumstances, approximately 2 to 2.5 liters of water is lost daily 32. You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish: fluid-filled from solid cysts or masses. Transillumination is used to determine the presence of fluid in cysts and masses. Fluid-filled lesions will transilluminate with a red glow, and solid masses will not transilluminate. 33. Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of activities of daily living is part of a(n): Functional assessment. 34. Sweat glands, hair, and nails are all formed from? Invagination of epidermis into dermis 35. A brief statement of the reason the patient is seeking health care is called the? Chief complaint 36. Which part of the information contained in the patient’s record may be used in court? All information - Anything that is entered into a patient’s record in paper or electronic form, is a legal document and can be used 37. Which cranial nerves innervate the face? 5 and 7 - (V and VII) 38. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for? Linoleic acid, found abundantly in milk and dairy fat, is required for normal growth and development, it has been suggested that it can reduce body fat in overweight patient 39. When are open-ended questions generally most useful? During the initial part of the interview – during the sensitive part of the interview – allows you to gather more info and est. you as an empathic listener. 40. Knowledge of the culture or cultures represented by the patient should be used to? Help make interview questions more pertinent 41. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process? Auscultation 42. A guideline for history taking is for caregivers to? Make notes sparingly so that patients can be observed during the history taking 43. Which type of speculum should be used to examine a patient’s tympanic membrane? The largest speculum that will fit comfortably in ear 44. You are palpating a patient’s thyroid and find that its broadest dimension measures 4cm. the right lobe is 25% larger than the left. These data would indicate: a normal thyroid gland. 45. Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response? "With your father's permission, we will examine the stone and request that it be returned to him." Healthcare provider should be willing to modify delivery and respectful of wishes/culture background 47. You are examining a pregnant patient and have noted a vascular lesion. When you Blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a? Spider Angioma – are dilated arterioles. A network of dilated capillaries radiate from the center arteriole, outward like a spider’s legs. They are often associated with high estrogen levels as in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Telangiectasias refill erratically. Petechiae and purpura do not blanch. 48. As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to? Ask whether he has any questions - The English worry about being overheard and tend to speak in a modulated voice, so when they lean toward you, they probably have a question 50. Expected normal percussion tones include? Renaissance - Normal lungs Tympany - Empty stomach Dull percussion - liver 51. Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to? Inform the patient of the reason for the exam and ask if it is acceptable to him 52. Fluorescing lesions are best distinguished using a(n)? Wood’s lamp ( some tinea lesions ) show a characteristic yellow-green color under a Wood’s lamp 53. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? Proteins, calcium, iron, Vitamin B12, and vitamin D 54. Underestimation of blood pressure will occur if the blood pressure cuff’s bladder: width covers? Cuff that are too wide will underestimate blood pressure, which would occur with a cuff that covers more than two thirds of the upper arm. Cuffs that are too narrow will give an artificially high reading. 55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a? Plaque – an elevated, firm, rough lesion with a flat top surface larger than 1 cm in diameter, as seen in someone with, for example, psoriasis. 56. Penicillin was considered a “Miracle drug” for all of the following reasons EXCEPT: It was the first antibiotic. 57. Small, minute bruises are called? Petechiae 58. After thorough inspection of the abdomen, the next assessment step is? Auscultation 59. When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate? What amount and what kind of alcohol do you drink in a week? 60. Regardless of the origin, discharge is described by noting? Color and consistency 61. Recommended carbohydrate content of total dietary intake (% total calories) is? 50% 62. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure? Hearing range of normal speech 63. Auscultation should be carried out last, except when examining the? abdomen 64. Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence? Realize the cultural values are difficult to change and must be respected 65. Which of the following is an “ABCD” characteristic of malignant melanoma? Asymmetric borders ABCD melanoma mnemonic: Asymmetry, Borders that are irregular, Color that is not the same all over, and Diameter larger than 6 mm and growing. 66. Tracheal tug suggests the presence of a(n)? Aortic aneurysm (aortic arch) 67. A patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course? Positive psoas sign Positive McBurney sign History of periumbilical pain Rebound tenderness Obturator muscle test Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis. Conditions that cause irritation of the obturator muscle are later findings usually associated with a ruptured appendix or pelvic abscess. 68. The review of systems is a component of the: Personal and social history 69. Cherry angiomas are a common finding in: Adults older than 30 years 70. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted: with illumination provided by daylight. 71. To correctly document absent bowel sounds, one must listen continuously for: 5 minutes 72. The adult recommended dietary fat intake should be ____g/day. 20 to 35 73. Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets? Vitamin D 74. A flat, non-palpable lesion is described as a macule if the diameter is: Less than 1 cm - and is measurable (Ex. Measles) 75. Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient? Fat 76. Which of the following organs is part of the alimentary tract? continuous tract from the mouth to the esophagus, stomach, small intestine, large intestine, and anus 77. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator? Race 78. To approximate vocal frequencies, which tuning fork should be used to assess hearing? 500 to 1000 Hz 79. During percussion, a dull tone is expected to be heard over: The liver (more dense area) 80. The attitudes of the health care professional: Culturally derived/ are largely irrelevant to the success of relationships with the patient 81. When recording physical findings, which data are recorded first for all systems? Inspection 82. Spasmodic muscular contractions of the head, face, or neck are called: tics 83. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin? It functionally converts to a diaphragm end-piece. 84. Differential diagnoses belong in the: Assessment 85. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: seborrheic keratoses from actinic keratoses. 86. Mr. Walter’s, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the: tympanometer 87. Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to: a poorly developed subcutaneous fat layer. 88. Tympanic thermometers measure body temperature when a probe is placed: In the auditory canal - Eardrum (in the ear) 89. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the: peritoneum 90. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are: aphthous ulcers (canker sores) 91. When assessing abdominal pain in a college-age woman, one must include: the first day of the last menstrual period. 92. Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: inspect for ecchymosis of the flank – abd pain that radiates to the back could be caused by pancreatitis or a gastric ulcer 93. The infant should be placed in which position to have his or her height or length measured? Supine on a measuring board 94. Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem? "Why do you think you are having these symptoms?" 95. Which of the following is the most vital nutrient? water 96. What finding is unique to the documentation of a physical examination of an infant? Fontanel size 97. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: CAGE questionnaire 98. Mr. D. complains of a headache. During the history he mentions his use of alcohol and illicit drugs. This information would most likely belong in the: personal and social history 99. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: flex his or her knees – to help relax the abdominal musculature, it is also helpful to place a small pillow under the patient’s head and under slightly flexed knees. 100. When communicating with older children and teenagers, you should be sensitive to their: typical reluctance to talk Periods of silence during the interview can serve important purposes, such as: Providing time for reflection, summoning of courage, and displaying compassion. It is usually a clue for you to go slower and not to push too hard. The recommended minimum daily protein requirement for the normal adult is: 10% – 35% of total calories To perform the Rinne test, place the tuning fork on the: Mastoid bone – test for sensorineural loss. Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: thyroglossal duct cyst – at the base of the tongue. A parotid gland tumor occurs in the ear & cheek bone area. Branchial cleft cyst occurs in the lateral neck area. A Stenson duct stone occurs in the parotid duct. Nuchal rigidity is most commonly associated with: meningeal irritation Bulging of an amber tympanic membrane without mobility is most often associated with: Middle ear effusion – amber color, w/ bulging and without mobility or redness, most often indicated presence of fluid in the middle ear. The most common form of birth trauma of the scalp is: caput succedaneum A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, "Yeah," "No," or "I guess so." Which of the following is appropriate for the interviewer to say or ask? Are you uncomfortable talking with me? When examining the skull of a 4-month-old baby, you should normally find closure of the posterior fontanel - should be closed (or ossified w/ anterior fontanel at 2 months Peritonitis produces bowel sounds that are: Hypoactive – decreased Tangential lighting is best used for inspecting skin: Countour – ( light is shed laterally to the skin) Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating: A progress note – note any updates to the condition Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth? Matrix Expected hair distribution changes in older adults include increased terminal hair follicles to the tragus of men’s ears A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: binges and vomits Coarse, dry, and brittle hair is associated with which metabolic disorder? Hypothyroidism As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include: repeated trauma or irritation to skin Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be Obese = 30.0 or > Overweight = 25.0 - <30 Normal = 18.5 to <25 Penicillin is considered a “hot” medicine Small, minute bruises are called: petechiae. When hearing is evaluated, which cranial nerve is being tested? VIII You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: given the opportunity to be interviewed without the parent at some point during the interview. Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of: Hyperthyroidism. A detailed description of the symptoms related to the chief complaint is presented in the: history of present illness. In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: cricoid. A flat, nonpalpable lesion is described as a macule if the diameter is: less than 1 cm. During physical examination of a 30-year-old Chinese man, you notice slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to: record the finding in the patient’s chart. A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly: lean meat and fish – carbs are the only source of fuel for the brain and nervous system. A diet low in carbs (most meats and fish) can effect brain function. When palpating the abdomen, you should note whether the liver is enlarged in the: right upper quadrant. Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain? Steroids – also oral contraception, antidepressants, and insulin In issues surrounding ethical decision making, beneficence refers to the: need to do good for the patient. George Michaels, a 22-year-old patient, tells the nurse that he is here today to "check his allergies." He has been having "green nasal discharge" for the last 72 hours. How would the nurse document his reason for seeking care? G.M. is a 22-year-old male here for having “green nasal discharge” for the past 72 hours. Which statement is true regarding the relationship of physical characteristics and culture? There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. Subjective and symptomatic data are: Placed in the history section Inspection of the abdomen should begin with the patient supine and the examiner: seated on the patient's right. The position on a clock, topographic notations, and anatomic landmarks: are methods for recording locations of findings. Macronutrients are so named because they: are required in large amounts. A blood pressure cuff bladder should be long enough to: cover 75% to 80% of the arm circumference. The examiner's evaluation of a patient's mental status belongs in the: physical examination. Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.'s _____ history. personal and social Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning? Eustachian tube During an interview, you have the impression that a patient may be considering suicide. Which action is essential? Ask whether the patient has considered self-harm. Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence? Nose and thyroid cartilages Which is the best way to position a patient's neck for palpation of the thyroid? Flexed toward the side being examined [Show Less]