GCU NUR643E Week 5 Midterm

GCU NUR643E Week 5 Midterm

GCU NUR643E Week 5 Midterm

Question

NUR643E Advanced Health Assessment for Nurse Educators

Week 5 Midterm Quiz

• Adam is a very successful
15-year-old student and athlete. His mother brings him in today because he no
longer studies, works out, or sees his friends. This has gone on for a month
and a half. When you speak with him alone in the room, he states it “would be
better if I was not here.” What would you do next?

•Tell him
that he has a very promising career in anything he chooses and soon he will
feel better.

•Tell him
that he needs an antidepressant and it will take about 4 weeks to work.

•Speak with
his mother about getting him together more with his friends.

•Assess his
suicide risk.

•Mr. Chin
is an 82-year-old man who presents to your office for a routine check. On
examination, you notice a somewhat high-pitched murmur in the second right
intercostal space during systole. It does not radiate and the rest of his
examination is normal for his age. Which is true of the most likely cause of
this murmur?

•It often
increases carotid upstroke.

•It carries
with it increased risk for cardiovascular disease.

•It is
usually accompanied by an S3 gallop.

•It is
found in 10% of otherwise normal elderly patients.

•Mrs.
Fletcher complains of numbness of her right hand. On examination, sensation of
the volar aspect of the web of the thumb and index finger and the pulp of the
middle finger are normal. The pulp of the index finger has decreased sensation.
Which of the following is affected?

•Median
nerve

•Ulnar
nerve

•Radial nerve

•You are
assessing a patient for peripheral vascular disease in the arms, secondary to a
complaint of increased weakness and a history of coronary artery disease and
diabetes. You assess the brachial and radial pulses and note that they are
bounding. What does that translate to on a scale of 0 to 3?

•0

•3+

•2+

•1+

•A
70-year-old retired auto mechanic presents to your office because his neighbor
is concerned about his memory. The patient himself admits to misplacing his
keys more often and forgets what he is supposed to buy from the grocery store
and where he has parked the car. He denies getting lost in familiar places.
Upon further questioning, he states that his wife of 40 years died 8 months
ago; his three children live in three different states; and he has limited his
activities because the people he interacted with were “his wife’s friends, not
his.” He drinks a six-pack of beer daily; he does not smoke or use illicit
drugs. You perform a mini-mental state examination and obtain a total score of
24 out of 28. Based on this information, what is the most likely condition?

•Benign
forgetfulness

•Dementia

•Meningitis

•Depression

•You are
screening people at the mall as part of a health fair. The first person who
presents for screening has a blood pressure of 132/85. How would you categorize
this?

•Normal

•Prehypertension

•Stage 1
hypertension

•Stage 2
hypertension

•A
17-year-old high school senior presents to your clinic in acute respiratory
distress. Between shallow breaths, he states he was at home finishing his
homework when he suddenly began having right-sided chest pain and severe
shortness of breath. He denies any recent traumas or illnesses. His past
medical history is unremarkable. He doesn’t smoke but drinks several beers on
the weekend. He has tried marijuana several times but denies any other illegal
drugs. He is an honors student and is on the basketball team. His parents are
both in good health. He denies any recent weight gain, weight loss, fever, or
night sweats. On examination you see a tall, thin young man in obvious
distress. He is diaphoretic and is breathing at a rate of 35 breaths per
minute. On auscultation, you hear no breath sounds on the right side of his
superior chest wall. On percussion, he is hyperresonant over the right upper
lobe. With palpation, he has absent fremitus over the right upper lobe.

What
disorder of the thorax or lung best describes his symptoms?

•Spontaneous
pneumothorax

•Chronic
obstructive pulmonary disease (COPD)

•Asthma

•Pneumonia

•When
assessing the lung fields, what does the technique of percussion look for?

•Consolidation

•Rales

•Wheezing

•Rhonchi

•Which of
the following events occurs at the start of diastole?

•Closure of
the tricuspid valve

•Opening of
the pulmonic valve

•Closure of
the aortic valve

•Production
of the first heart sound (S1)

•A pregnant
woman finally presents in for her prenatal checkup. She complains today of
headache and abdominal pain of several months’ duration. She appears somewhat
hurried or nervous. What question would you ask next?

•Do you
have a family history of thyroid disease?

•Have you
been eating properly and taking a prenatal vitamin?

•Do you
feel safe at home?

•How much
activity have you been able to fit into your schedule?

•You are a
student in the vascular surgery clinic. You are asked to perform a physical
examination on a patient with known peripheral vascular disease in the legs.
Which of the following aspects is important to note when you perform your
examination?

•Size,
symmetry, and skin color

•Muscle
bulk and tone

•Nodules in
joints

•Lower
extremity strength

•Mrs.
Fletcher presents to your office with unilateral pain during chewing, which is
chronic. She does not have facial tenderness or tenderness of the scalp. Which
of the following is the most likely cause of her pain?

•Trigeminal
neuralgia

•Temporomandibular
joint syndrome

•Temporal
arteritis

•Tumor of
the mandible

•On the way
to see your next patient, you glance at the calendar and make a mental note to
buy a Mother’s Day card. Your patient is Ms. Hernandez, a 76-year-old widow who
lost her husband in May, 2 years ago. She presents today with complaints
including headaches, abdominal pain, and general malaise. This happened once
before, about a year ago, according to your detailed office notes. You have
done a thorough evaluation but are unable to arrive at a consistent picture to
tie these symptoms together.

This is an
example of a:

•Pathophysiologic
problem

•Psychopathologic
problem

•Which of
the following is most likely benign on breast examination?

•Dimpling
of the skin resembling that of an orange

•One breast
larger than the other

•One nipple
inverted

•One breast
with dimple when the patient leans forward

•A
55-year-old secretary with a recent history of breast cancer, for which she
underwent surgery and radiation therapy, and a history of hypertension presents
to your office for a routine checkup. Which of the following aspects of the
physical are important to note when assessing the patient for peripheral
vascular disease in the arms?

•Femoral
pulse, popliteal pulse

•Dorsalis
pedis pulse, posterior tibial pulse

•Carotid
pulse

•Radial
pulse, brachial pulse

•A
58-year-old teacher presents to your clinic with a complaint of breathlessness
with activity. The patient has no chronic conditions and does not take any
medications, herbs, or supplements. Which of the following symptoms is
appropriate to ask about in the cardiovascular review of systems?

•Abdominal
pain

•Orthopnea

•Hematochezia

•Tenesmus

•You are
obtaining an arterial blood gas in the radial artery on a retired cab driver
who has been hospitalized in the intensive care unit for a stroke. You are
concerned about the possibility of arterial insufficiency. You perform the
Allen test. This means that you:

•Checked
for patency of the popliteal artery

•Checked
for patency of the brachial artery

•Checked
for patency of the ulnar artery

•Checked
for patency of the femoral artery

•Ray works
a physical job and notes pain when he attempts to lift his arm over his head.
When you move the shoulder passively, he has full range of motion without pain
and there is no gross swelling or tenderness. What type of joint disease does
this most likely represent?

•Articular

•Extra-articular

•Neither

•Both

•A
62-year-old construction worker presents to your clinic complaining of almost a
year of chronic cough and occasional shortness of breath. Although he has had
worsening of symptoms occasionally with a cold, his symptoms have stayed about
the same. The cough has occasional mucous drainage but never any blood. He
denies any chest pain. He has had no weight gain, weight loss, fever, or night
sweats. His past medical history is significant for high blood pressure and
arthritis. He has smoked two packs a day for the past 45 years. He drinks
occasionally but denies any illegal drug use. He is married and has two
children. He denies any foreign travel. His father died of a heart attack and
his mother died of Alzheimer’s disease. On examination you see a man looking
slightly older than his stated age. His blood pressure is 130/80 and his pulse
is 88. He is breathing comfortably with respirations of 12. His head, eyes,
ears, nose, and throat examinations are unremarkable. His cardiac examination
is normal. On examination of his chest, the diameter seems enlarged. Breath
sounds are decreased throughout all lobes. Rhonchi are heard over all lung
fields. There is no area of dullness and no increased or decreased fremitus.

What thorax
or lung disorder is most likely causing his symptoms?

•Spontaneous
pneumothorax

•Chronic
obstructive pulmonary disease (COPD)

•Asthma

•Pneumonia

•You are
going to obtain a social history on an early adolescent boy. How should you
proceed to obtain the best information?

•Ask his
mother to leave the room.

•Ask if he
would prefer his mother to leave the room.

•Ask your
questions with his mother in the room.

•Ask his
mother how she would like to proceed.

•A patient
presents with claudication symptoms and diminished pulses. Which of the
following is consistent with chronic arterial insufficiency?

•Pallor of
the foot when raised to 90 degrees for up to two minutes

•Return of
color to the skin within 5 seconds of allowing legs to dangle

•Filling of
the veins of the ankles within 10 seconds of allowing the legs to dangle

•Hyperpigmentation
of the skin

•A patient
presents with claudication symptoms and diminished pulses. Which of the
following is consistent with chronic arterial insufficiency?

•Pallor of
the foot when raised to 90 degrees for up to two minutes

•Return of
color to the skin within 5 seconds of allowing legs to dangle

•Filling of
the veins of the ankles within 10 seconds of allowing the legs to dangle

•Hyperpigmentation
of the skin

•A
75-year-old retired teacher presents to your clinic complaining of severe,
unrelenting anterior chest pain radiating to her back. She describes it as if
someone is “ripping out her heart.” It began less than an hour ago. She states
she is feeling very nauseated and may pass out. She denies any trauma or recent
illnesses. She states she has never had pain like this before. Nothing seems to
make the pain better or worse. Her medical history consists of difficult-to-control
hypertension and coronary artery disease requiring two stents in the past. She
is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother
died of a stroke, and her father died of a heart attack. She has one younger brother
who has had bypass surgery. On examination, you see an elderly female in a
great deal of distress. She is lying on the table, curled up, holding her left
and right arms against her chest and is restless, trying to find a comfortable
position. Her blood pressure is 180/110 in the right arm and 130/60 in the left
arm, and her pulse is 120. Her right carotid pulse is bounding, but the left
carotid pulse is weak. She is afebrile but her respirations are 24 times a
minute. On auscultation, her lungs are clear and her cardiac examination is
unremarkable. You call EMS and have her taken to the hospital’s ER for further
evaluation.

What
disorder of the chest best describes her symptoms?

•Angina
pectoris

•Pericarditis

•Possible
Dissecting aortic aneurysm

•Pleural
pain

•You note a
painful ulcerative lesion near the medial malleolus, with accompanying
hyperpigmentation. Which of the following etiologies is most likely?

•Arterial
insufficiency

•Neuropathic
ulcer

•Venous
insufficiency

•Trauma

•You notice
a patient has a strong pulse and then a weak pulse. This pattern continues.
Which of the following is likely?

•Emphysema

•Asthma
exacerbation

•Severe
left heart failure

•Cardiac
tamponade

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