6512 final exam.docx - Question 1 The musculoskeletal...

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Unformatted text preview: Question 1 The musculoskeletal examination should begin when: Selected Answer: the patient enters the examination room. Question 2 A 40 yr old female presents to the clinic with complaints of low back and buttock pain. Pt states the buttock pain radiates from one side to the other. On examination, the patient is noted to have limited ROM of the shoulders, chest wall, hips, and knees. Upon xray, you find gross postural changes and there is a severe deformity of the vertebral column. What is the most likely diagnosis for this patient? Selected Answer: Ankylosing Spondylitis Question 3 While interviewing a 70-year-old female clinic patient, she tells you that she takes ginkgo biloba and St. John's wort. You make a short note to check for results of the: Selected Answer: Mini-Mental State Examination. Question 4 If your patient has nipple discharge, you will most likely need a: Selected Answer: glass slide and fixative. Question 5 A 62 year old female presents to the clinic with complains of chest pain and heart palpitations that started 3 days ago. Patient states she is healthy and only has a history of hypertension and tachycardia. Patient is currently taking Norvasc 10mg daily and Coreg 6.25 mg BID. You order an EKG and it shows heart rate above 200 beats/min and the ECG may look like a sawtooth cog. What is the most likely diagnosis of this patient? Selected Answer: Atrial Flutter Question 6 If pitting edema is unilateral, you would suspect occlusion of a: Selected Answer: major vein. Question 7 To assess a cremasteric reflex, the examiner strokes the: Selected Answer: inner thigh and observes whether the testicle and scrotum rise on the stroked side. Question 8 A positive straight leg raise test usually indicates: Selected Answer: lumbar nerve root irritation. Question 9 An ophthalmoscopic eye examination involves: Selected Answer: lens inspection. Question 10 Which of the following statements is true regarding the examination of peripheral arteries? Selected Answer: The pulses are most readily felt over bony prominences. Question 11 Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her: Selected Answer: menstrual cycles. Question 12 You are conducting a clinical breast examination for your 30-year-old patient. Her breasts are symmetrical with bilateral, multiple tender masses that are freely moveable with well-defined borders. You recognize that these symptoms and assessment findings are consistent with: Selected Answer: fibrocystic changes. Question 13 Facial muscle or tongue weakness may result in: Selected Answer: aphasia. Question 14 The finger-to-nose test allows assessment of: Selected Answer: coordination and fine motor function. Question 15 You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her? Selected Answer: Cervical spine radiograph Question 16 A cervical polyp usually appears as a: Selected Answer: bright-red soft protrusion from the endocervical canal. Question 17 Bimanual examination of the uterus includes: Selected Answer: grasping the cervix between the examining fingers. Question 18 An apical PMI palpated beyond the left fifth intercostal space may indicate: Selected Answer: left ventricular hypertrophy. Question 19 Tarry black stool should make you suspect: Selected Answer: upper intestinal bleeding. Question 20 The examiner percusses for diaphragmatic excursion along the: Selected Answer: scapular line. Question 21 The rectal past medical history of all patients should include inquiry about: Selected Answer: hemorrhoid surgery. Question 22 Darian is a 14-year-old adolescent who states his right testicle has a soft swollen mass. The testicle is not painful upon palpation. The right inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with: Selected Answer: hydrocele Question 23 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: Selected Answer: cerebellar ataxia. Question 24 An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection? Selected Answer: Cytology smear Question 25 You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is apathetic and has disturbed thoughts and language patterns. The nurse recognizes this behavior pattern as consistent with a diagnosis of: Selected Answer: schizophrenia. Question 26 Which one of the following techniques is used to detect a torn meniscus? Selected Answer: McMurray test Question 27 While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding: Selected Answer: alcohol, tobacco, and caffeine use. Question 28 The best way to ease the apprehension of a 3-year-old child before a physical examination is to: Selected Answer: let the child hold the stethoscope while you listen. Question 29 Which cranial nerves are usually evaluated during the examination of the eyes? Selected Answer: III and VI Question 30 A common finding in markedly obese and pregnant women is: Selected Answer: lordosis. Question 31 The physical assessment technique most frequently used to assess joint symmetry is: Selected Answer: inspection. Question 32 Montgomery tubercles are most prominent in the breasts of: Selected Answer: pregnant women. Question 33 Functional assessment is most important during the examination of a(n): Selected Answer: older adult. Question 34 Throughout the history and physical examination, the clinician should: Selected Answer: evaluate the whole patient. Question 35 The strength of the trapezius muscle is evaluated by having the patient: Selected Answer: push her head against the examiner's hand. Question 36 A 25 yo AA female has come to the clinic because she has missed her menstrual period this month and 2 months before. She says her cycles are irregular and she wants to be on birth control to help regulate them. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to: Selected Answer: suggest a pregnancy test Question 37 Ulnar deviation and boutonniere deformities are characteristic of: Selected Answer: rheumatoid arthritis. Question 38 The presence of cervical motion tenderness may indicate: Selected Answer: pelvic inflammatory disease. Question 39 Adrian Thomas is a 19-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her father reports that Adrian, apart from occasional sinus infections, Adrian is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Adrian's current problem? Selected Answer: Cocaine use Question 40 The adnexa of the uterus are composed of the: Selected Answer: fallopian tubes and ovaries. Question 41 The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: Selected Answer: QRS complex. Question 42 Recent unilateral inversion of a previously everted nipple suggests: Selected Answer: cancer. Question 43 The Mini-Mental State Examination: Selected Answer: may be used to quantitatively estimate cognitive changes. Question 44 If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation? Selected Answer: CN XI, spinal accessory Question 45 A patient in the deepest coma would be scored a _____ on the Glasgow Coma Scale. Selected Answer: 3 Question 46 A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is: Selected Answer: riflery. Question 47 Loss of immediate and recent memory with retention of remote memory suggests: Selected Answer: dementia. Question 48 When assessing a 17-year-old for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test, you would also perform a test for the _____ sign. Selected Answer: Kernig Question 49 Examination of the patient in the lithotomy, or knee-chest, position includes: Selected Answer: palpation of anal sphincter tone. Question 50 When assessing superficial pain, touch, vibration, and position perceptions, you are testing: Selected Answer: sensory function. Question 51 You order an ECG on a patient that c/o feeling heart palpitations, chest pain, shortness of breath. Your ECG shows irregular heart rate and you determine that you need to call EMS immediately because this rhythm can cause death. What rhythm would you suspect the ECG is showing? Selected Answer: Ventricular Fibrillation Question 52 At your first meeting with a patient, it is usually best to say: Selected Answer: "Tell me about yourself." Question 53 Palpation of epitrochlear nodes is part of the: Selected Answer: examination of the upper extremities. Question 54 Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of: Selected Answer: older adults. Question 55 When the Goodenough-Harris Drawing Test is administered to a child, the evaluator principally observes the: Selected Answer: presence and form of body parts. Question 56 Assessing orientation to person, place, and time helps determine: Selected Answer: state of consciousness. Question 57 Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify: Selected Answer: uremia. Question 58 Which one of the following is a proper technique for use of a speculum during a vaginal examination? Selected Answer: Press introitus downward; insert closed speculum obliquely. Question 59 A 56-year-old male presents to the clinic to see the nurse practitioner with complaints of shortness of breath for 1 months, 15-pound weight gain and lower extremity edema. Vitals are as follows: HR: 120, Respirations 30, Blood Pressure: 138/90, BMI: 40; Oxygen saturation of 90%. On examination patient is noted to have jugular venous distention, enlarged liver, and crackles are noted on examination. A chest x-ray is completed and shows findings consistent with which diagnosis? Based on this scenario and imaging what is the most likely diagnosis? Selected Answer: Right Sided Congestive Heart Failure Question 60 For purposes of examination and communication of physical findings, the breast is divided into: Selected Answer: four quadrants plus a tail. Question 61 Palpation of a normal prostate in an older adult is likely to feel: Selected Answer: rubbery. Question 62 When you attempt to move a 10-month-old child from his mother's lap to the examination table, he screams loudly. Your best action is to: Selected Answer: perform the examination while the child is in the mother's lap. Question 63 The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg. Selected Answer: 10 Question 64 Breath sounds normally heard over the trachea are called: Selected Answer: bronchial. Question 65 You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should: Selected Answer: inquire about previous penile infections. Question 66 The Mini-Mental State Examination should be administered for the patient who: Selected Answer: gets lost in her neighborhood. Question 67 A red, hot swollen joint in a 40-year-old man should lead you to suspect: Selected Answer: gout. Question 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: Selected Answer: note the finding in the patient's record. Question 69 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: Selected Answer: test the six cardinal points of gaze. Question 70 Postural hypotension is defined as a _____ when the patient stands, compared with sitting or supine readings. Selected Answer: systolic pressure drop of more than 15 mm Hg with a pulse rate increase Question 71 You are assessing Mr. Z.'s fluid volume status as a result of heart failure. If your finger depresses a patient's edematous ankle to a depth of 6 mm, you should record this pitting as: Selected Answer: 3+. Question 72 When conducting a geriatric assessment, basic activities of daily living (ADLs) include: Selected Answer: bathing. Question 73 To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested? Selected Answer: Patellar Question 74 During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings: Selected Answer: are usual conditions during pregnancy. Question 75 When palpating breast tissue, the examiner should use the _____ at each site. Selected Answer: finger pads, gliding Question 76 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: Selected Answer: fingertips. Question 77 Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the: Selected Answer: P wave. Question 78 During chest assessment, you note the patient's voice quality while auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and the e's sound like a s. This sound is indicative of: Selected Answer: lung consolidation. Question 79 Inspection of the scrotum should reveal: Selected Answer: left scrotal sac lower than the right. Question 80 The family history for a patient with joint pain should include information about siblings with: Selected Answer: genetic disorders. Question 81 Which condition is considered progressive rather than reversible? Selected Answer: Dementia Question 82 When palpating joints, crepitus may occur when: Selected Answer: irregular bony surfaces rub together. Question 83 You are examining Mr. S., a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial occlusion? Selected Answer: Loss of hair over the extremity Question 84 An elderly female was recently diagnosed with osteoporosis 2 weeks ago. What is the hallmark appearance of a patient with this diagnosis? Selected Answer: Dowager hump Question 85 A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarction. 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? Selected Answer: "What age was your father at the time of his death?" Question 86 The goals of preparticipation sports evaluation include: Selected Answer: identifying risk of injury or death during sports participation. Question 87 Temporalis and masseter muscles are evaluated by: Selected Answer: having the patient clench his or her teeth. Question 88 Normal changes of the aging brain include: Selected Answer: diminished perception of touch. Question 89 In the adult, the apical impulse should be most visible when the patient is in what position? Selected Answer: Upright Question 90 Nerves that arise from the brain rather than the spinal cord are called: Selected Answer: cranial. Question 91 To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with: Selected Answer: one arm overhead and a pillow under her shoulder. Question 92 A finding that is indicative of osteoarthritis is: Selected Answer: Heberden nodes. Question 93 Diabetic peripheral neuropathy will likely produce: Selected Answer: diminished pain sensation. Question 94 Your patient's chief complaint is repeated pencil-like stools. Further examination should include: Selected Answer: digital rectal examination (DRE). Question 95 To hear diastolic heart sounds, you should ask patients to: Selected Answer: lie on their left sides. Question 96 The reliability of health-related findings and observations is the responsibility of the: Selected Answer: professional and the patient. Question 97 A pulsation that is diminished to the point of being barely palpable would be graded as: Selected Answer: 1 Question 98 A grade IV mitral regurgitation murmur would: Selected Answer: radiate to the axilla. Question 99 Which portion of the physical examination is best done with the patient standing? Selected Answer: Spinal Question 100 Anterior cruciate ligament integrity is assessed via the _____ test. Selected Answer: Lachman Question 101 When completing this exam, did you comply with Walden University's Code of Conduct including the expectations for academic integrity? Selected Answer: Yes Thursday, November 11, 2021 1:09:38 PM EST ...
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