NR509 / NR 509: Advanced Physical Assessment Final Exam Latest Update: Chamberlain College of Nursing

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NR 509: Advanced Physical Assessment Final Exam 1. Mr. O., age 50, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O.... mentions that he routinely engages in light exercise. At this time, you should: - 2. What is the correct procedure when percussing the chest? - 3. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 3-cm, rough, elevated area of psoriasis. This is an example of a: - 4. Which question would be considered a "leading question"? - 5. During a gastrointestinal exam, the purpose of light palpation of the abdomen is to: - 6. Explain the difference between a sprain and a strain - 7. Describe how you would have tested for the Kernig's sign. - 8. According to the AUDIT scale, a person who receives a score of 14 is: - 9. Suppose that Tina had been unable to identify the pen you were holding. What is the name of this symptom? - 10. Suppose you had found that Tina's pupils were reactive to both direct and consensual light, yet unequal in size. Which condition would you suspect? - 11. Imagine that, during your physical exam with Tina, you had palpated an enlarged left supraclavicular lymph node. What would this finding have indicated? - 12. If you had observed Arteriovenous (AV) nicking during the retinal exam on Tina, what would you have seen? - 13. Suppose that you had detected a click while palpating Tina's temporomandibular joint (TMJ). What could have been the cause? - 14. If Tina had reported new onset ear pain, what would have been the most useful finding to determine otitis media? - 15. Imagine that you inspected Tina's throat and noted that her tonsils touched each other. How would you grade her tonsils on the tonsillar hypertrophy grading scale? - 16. If Tina had mentioned that she was just diagnosed with pneumonia, what would you have expected to find during percussion? - 17. If the results of Tina's pulse oximetry had been 97%, which of the following would have been true? - 18. Suppose that, during your lung exam on Tina, you had heard bronchial breath sounds in the left lower lung posteriorly. What would you have suspected based on this finding? - 19. Suppose that while auscultating, you assessed a few scattered expiratory wheezes. Why would this be an expected finding for a patient with Tina's history? - 20. Your 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? - 21. You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive: - 22. While examining the breasts of a 53-year-old woman, you detect a nontender, fixed, 2-cm hard mass beneath the left areola, associated with prominent veins. The mass should be further evaluated: - 23. During palpation of a 30-year-old woman's breast, she complains that the procedure is painful. You suspect that this may be due to the fact that she is: - 24. In which of the following patient populations could a a S3 be considered a normal finding? - 25. The NP knows that the correct auscultatory site for the aortic area is the: - 26. The NP is examining a client with a history of rheumatic fever who is being followed for the development of endocarditis. During the cardiac auscultation, where on the chest wall is the stethoscope placed to determine the most common murmurs associated with this condition? - 27. The NP notes that the patient has lymphadenopathy to the left axillary area. The expected lymph duct that is area will travel to is the: - 28. A third heart sound is created by: - 29. In assessing for potential appendicitis in your patient you perform the following exam. With the patient lying supine, you flex the patient's right leg by bending the knee, as you bring the knee in toward the chest and rotate it inward toward the navel, you stop because of the patient's increased pain. You would chart this as? - 30. Visible intestinal peristalsis may indicate: - 31. After thorough inspection of the abdomen, the next assessment step is to: - 32. Percussion of the abdomen begins with establishing: - 33. When palpating the abdomen, you should note whether the liver is enlarged in the: - 34. Auscultation of borborygmi is associated with: - 35. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? - 36. In order to assess for liver enlargement in the obese person, you should: - 37. The patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low-grade fever attributed to eating some "bad food" 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis? - 38. Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: - 39. Inspection of the abdomen should begin with the patient supine and the examiner: - 40. An examiner can recognize a friction rub in the liver by a sound that is: - 41. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: - 42. In percussing the liver span, you know that in a patient with a normal sized liver, you would percuss dullness at the midsternal line of? - 43. Which organ(s) are located in the retroperitoneal space? - 44. Before performing an abdominal examination, the examiner should: - 45. You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): - 46. When palpating the aorta, a prominent lateral pulsation suggests: - 47. Which of the following is the most useful adjunct to the history of present illness when assessing the quantity and degree of a patient's abdominal pain? - 48. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the: - 49. The musculoskeletal examination should begin when: - 50. The physical assessment technique most frequently used to assess joint symmetry is: - 51. You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient's neurologic status, you would: - 52. The finger-to-nose test allows assessment of: - 53. The awareness of body position is known as: - 54. Bones around a joint are held together by: - 55. You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating: - 56. When palpating joints, crepitus may be caused when: - 57. Environmental hazards and cognitive function are data needed for the personal and social history section of a neurologic assessment for: - 58. Injuries to long bones and joints are more likely to result in fractures than in sprains until: - 59. In differentiating osteoarthritis from rheumatoid arthritis (RA), the osteoarthritis patient typically exhibits: - 60. Light skin and thin body habitus are risk factors for: - 61. Bones are attached to muscles by: - 62. As Mr. B. enters the room, you observe that his gait is wide based and he staggers from side to side while swaying his trunk. You would document Mr. B.'s pattern as: - 63. To determine cerebellar functioning in the geriatric client, the nurse practitioner evaluates: - 64. A client is seen in the ER with complaints of foot pain after an injury. The X-ray revealed a foot fracture. Which reason explains why the foot is placed in a brace? - 65. Which fracture is commonly seen in the upper extremities and is related to physical abuse? - 66. Osteomyelitis most commonly results from trauma to a surrounding area such as a fish hook being removed from a foot? (T/F) - 67. Documentation of a breast mass location is: - 68. While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should: - 69. When examining axillary lymph nodes, the patient's arm is: - 70. The greatest concern for breast cancer is when you palpate _____ nodes. - 71. Which condition is more common in African American women than in white women? - 72. The prostatic sulcus: - 73. Which finding, found on inspection, is related to fibrotic tissue changes that occur with breast carcinoma? - 74. Venous patterns on breasts are suggestive of pathology when they are: - 75. If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40-year-old patient's breast, you should: - 76. When palpating breast tissue, the examiner should use the _____ at each site. - 77. In males, which surface of the prostate gland is accessible by digital examination? - 78. A healthy prostate protrudes into the rectal wall a distance of _____ cm. - 79. Recent unilateral inversion of a previously everted nipple suggests: - 80. Factors associated with increased risk of prostate cancer include: - 81. Caliber of urinary stream is routine information in the history of: - 82. Inspection of the breast usually begins with the patient in which position? - 83. The tail of Spence extends: - 84. Lymphatic flow of the breast primarily drains: - 85. can be assessed by asking the patient to interpret a common proverb or to identify similarities between two objects - 86. Which of the following is a component of assessing cognition? - 87. In order to determine which heart sound is S1, which of the following should you assess? - 88. The assessment of Jugular Venous Pressure (JVP) correlates with: - 89. Tina had brisk capillary refill (less than 3 seconds). What does this mean? - 90. Describe where on the body and when in the cardiac cycle you are most likely to auscultate a murmur caused by mitral valve prolapse. - 91. Imagine you had heard a murmur on Tina. Why would it have been important to ask Tina to change positions while auscultating the heart? - 92. You decide to order an arterial blood gas on Tina. Which physical exam test should you perform before drawing blood from the radial artery? - 93. Which of the following physical exam tests could be used if you suspected cholecystitis in Tina? - 94. Suppose that you were concerned that Tina may have had an enlarged spleen. How would you have proceeded? - 95. If you had heard bowel sounds occurring about 15 times per minute in 1-2 quadrants while examining Tina, what would have been the significance of this finding? - 96. Imagine that you had heard a swishing sound while auscultating Tina's epigastric region. Identify where this bruit would have been likely to originate. - 97. Suppose that after examining Tina, you were concerned she may have peritonitis. How would you have assessed Tina to confirm your diagnosis? - 98. If you were assessing range of motion (ROM) for a healthy 28-year-old woman with no known joint issues, which of the following would indicate limited ankle ROM? - 99. When palpating joints in a musculoskeletal exam, crepitus indicates: - 100. Imagine that Tina has hard painless bumps on the dorsolateral aspects of the distal interphalangeal joints that had limit flexion during a range of motion test. How would you have documented these abnormalities? - 101. Describe the major differences in acute versus passive range of motion (ROM) when distinguishing between an articular and non-articular joint issue. - 102. To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested? - 103. Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening? - 104. Which of the following is not a common symptom of Parkinson's disease? - 105. A brief statement of the reason the patient is seeking health care is called the: - 106. Which of the following is an "ABCD" characteristic of malignant melanoma? - 107. A flat, nonpalpable lesion is described as a macule if the diameter is: - 108. When you are questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate? - " 109. Painful vesicles are associated with: - 110. A 29-year-old white woman appears jaundiced. An etiology of liver disease has been excluded. What history questions should the nurse ask? - 111. 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: - 112. The thyroid gland is partially obscured by the: - 113. To perform the Rinne test, place the tuning fork on the: - 114. You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for: - 115. Normal tympanic membrane color is: - 116. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the: - 117. Bulging of an amber tympanic membrane without mobility is most often associated with: - 118. You ask your patient to perform the DAST questionnaire, and note that he scored a "5". You understand this means: - 119. After you have the patient complete the AUDIT questionnaire, your tally the score and realize the patient has scored a "9" . Your next communication with the patient should be: - 120. You are conducting a brief negotiated interview with your young male patient after you have reviewed his AUDIT questionnaire results. You discuss the safe drinking limits per day for his gender. You explain to him that this number is: - 121. You are discussing the amount of alcohol in different drinks with your patient. You explain to your patient what constitutes a standard drink. You review that 12 oz of regular beer is equal to: - 122. With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because: - 123. The characteristic barrel chest of the older adult is due to a combination of factors including: - 124. You would expect to document the presence of a pleural friction rub for a patient being treated for: - 125. Both pleural effusion and lobar pneumonia are characterized by _____ percussion. - 126. Mr. L. has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect he is having cardiac or pulmonary difficulty. What additional sign would support this impression? - 127. Breath sounds normally auscultated over most of the lung fields are called: - 128. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the: - 129. Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies? - 130. What term would you use to document a respiratory rate greater than 20 breaths per minute in an adult? - 131. The NP would document this assessment finding as: - 132. On assessment of the client's respiratory status, crepitation is felt over the third rib at the midaxillary line on the left side. What is the interpretation of this finding? - 133. Normal physiologic changes in the respiratory system of the geriatric client include an increased rigidity of rib cage and increase in anteroposterior (AP) diameter of the chest. (T/F) - 134. During a new patient physical exam, you are ausculting the lungs and assess a few scattered expiratory wheezes. Which of the following review of system responses by the patient confirm that this is an expected and not unusual finding for this patient? - 135. Your 76-year-old male patient's chief complaint today is a productive cough times two weeks. What percussion finding over the posterior chest during your physical exam would lead you to include pneumonia as one of your differential diagnoses? - 136. During your review of system questions for a new patient annual exam, you ask the patient - "Do you ever have shortness of breath or difficulty breathing? If the patient answers yes to this question, what additional questions related to using OLDCART would you need to ask? Mark all that apply. - 137. COPD is most commonly caused by: - 138. Risk factors for TB include: - 139. Risk factors for pulmonary embolism include: - 140. What should always be considered for a patient with hemoptysis? - 141. The "pacing" structure of the heart's electrical activity is the: - 142. If pitting edema is unilateral, you would suspect occlusion of a: - 143. Which ECG change would not be expected as an age-related pattern? - 144. The amplitude of pulses is recorded on a(n): - 145. In the adult, the apical impulse should be most visible in a thin person or palpable when the patient is in what position? - 146. Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the: - 147. The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg. - 148. A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father had died of heart trouble. The most important follow-up question you should pose is which of the following? - " 149. Which arterial pulse is most useful in evaluating heart activity? - 150. The term claudication refers to: - 151. Postural hypotension is defined as a _____ when the patient stands, compared with sitting or supine readings. - 152. Contraction of the ventricles causes: - 153. Which of the following information belongs in the past medical history section related to heart and blood vessel assessment? - 154. In which location would carotid bruits best be heard? [Show More]

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