Midterm Exam for NURS 6512, Advanced Health Assessment
1. 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: Answer. Thyroglossal duct cyst. 2. To perform the Rinne test, place the tuning fork on the: Answer: Mastoid bone. 3. 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: Answer. Inform the patient of the reason for the examination and if it is acceptable to him. 4. When communicating with older children and teenagers, you should be sensitive to their: Answer. Typical reluctance to talk 5. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure: Answer. Hearing range of normal speech 6. During percussion, a dull tone is expected to be heard over: Answer. The liver. Midterm Exam for NURS 6512, Advanced Health Assessment. 7. 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: Answer: Lean meat and fish. Midterm Exam for NURS 6512, Advanced Health Assessment.
8. A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness, you should palpate over the: Answer: Maxillary sinuses only.
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9. The most superior part of the stomach is the: Answer: Fundus. 10. 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: Answer. Flex his or her knees. 11. Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be: Answer. Obese 12. 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: Answer. Inspect for ecchymosis of the flank. 13. Before performing an abdominal examination, the examiner should: Answer. Have the patient empty his or her bladder 14. 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: Answer. Inspect for ecchymosis of the flank. Midterm Exam for NURS 6512, Advanced Health Assessment. 15. Before performing an abdominal examination, the examiner should: Answer. have the patient empty his or her bladder. 16. 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(n): Answer: Progress note. 17. A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: Answer. Come to the laboratory for a stool guaiac test. 18. 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: Answer. Binges and vomits. 19. 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? Answer. With your father's permission, we will examine the stone and request that it be returned to him. 20. Recommended carbohydrate content of total dietary intake (% total calories) is %. Answer. 45-65 21. Tympanic thermometers measure body temperature when a probe is placed: Answer: In the auditory canal. Midterm Exam for NURS 6512, Advanced Health Assessment. 22. Mr. Donald is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted: Answer. With illumination provided by daylight. 23. Which of the following is an "ABCD" characteristic of malignant melanoma? Answer. Asymmetric borders 24. The position on a clock, topographic notations, and anatomic landmarks: Answer. Are methods for recording locations of findings. 25. 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? Answer. Vitamin D 26. 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: Answer. Fluid-filled from solid cysts or masses
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27. What finding is unique to the documentation of a physical examination of an infant? Answer. Fontanel sizes 28. Peritonitis produces bowel sounds that are: Answer: Hypoactive. Midterm Exam for NURS 6512, Advanced Health Assessment. 29. 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?Answer. Fat 30. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4' 3-cm, rough, elevated area of psoriasis. This is an example of a: Answer. Plaque 31. In issues surrounding ethical decision making, beneficence refers to the: Answer. Need to do good for the patient. 32. Which of the following organs is part of the alimentary tract? Answer. Stomach 33. When taking a history, you should: Answer. Use a chronologic and sequential framework. Midterm Exam for NURS 6512, Advanced Health Assessment. 34. When examining the skull of a 4-month-old baby, you should normally find: Answer. Closure of the posterior fontanel. 35. When assessing abdominal pain in a college-age woman, one must include: Answer. The first day of the last menstrual period. 36. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the: Answer. Peritoneum 37. Which of the following occurs when firm pressure is used to apply the stethoscope's bell end-piece to the skin? Answer: It functionally converts to a diaphragm end-piece. 38. You are planning to palpate the abdomen of your patient. Which part of the examiner's hand is best for palpating vibration? Answer. Ulnar surface. 39. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for: Answer. Normal growth and development 40. 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? Answer. Vitamin B12 41. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: Answer. Lower liver border.
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42. 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?Answer. G.M. is a 22-year-old male here for having “green nasal discharge” for the past 72 hours 43. 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'm here. You tell me what's wrong!" Which caregiver response would be most appropriate for enhancing communication? Answer: After 3 days, you're tired of coughing. Have you had a fever? Midterm Exam for NURS 6512, Advanced Health Assessment. 44. 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? Answer: Why do you think you are having these symptoms? 45. 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: Answer. Spider angioma. 46. 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 daily living (ADLs) is part of a(an): Answer. Functional assessment. Midterm Exam for NURS 6512, Advanced Health Assessment. 47. 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? Answer. Are you uncomfortable talking with me? 48. 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: Answer. Building and maintaining tissues.
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49. 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? Answer. Matrix. Midterm Exam for NURS 6512, Advanced Health Assessment. 50. 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. Answer. Personal and social 51. 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? Answer. Eustachian tube 52. 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? Answer. Nose and thyroid cartilages 53. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: Answer. CAGE questionnaire. 54. 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: Answer. Pull the auricle down and back. 55. Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)? Answer. Brief SOAP note 56. 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? Answer. Auscultation 57. In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: Answer. Cricoid.
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58. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: Answer. Seborrheic keratoses from actinic keratoses. Midterm Exam for NURS 6512, Advanced Health Assessment. 59. 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: Answer. A poorly developed subcutaneous fat layer. 60. 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? Answer. Race 61. You are using an ophthalmoscope to examine a patient's inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for: Answer. Myopia. Midterm Exam for NURS 6512, Advanced Health Assessment. 62. 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? Answer. Vitamin D 63. Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first? Answer. Inspection 64. 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? Answer. Obturator muscle test 65. As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include: Answer. Repeated trauma or irritation to skin
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66. You are palpating a patient's thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate: Answer. A normal thyroid gland. 67. 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: Answer. Given the opportunity to be interviewed without the parent at some point during the interview. Midterm Exam for NURS 6512, Advanced Health Assessment. 68. 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: Answer. Hyperthyroidism. 69. 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: Answer. Record the finding in the patient’s chart. 70. 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 his history? Answer. Past medical data 71. When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate? Answer. What amount and what kind of alcohol do you drink in a week? 72. Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence? Answer. Realize that cultural values are difficult to change and must be respected. 73. 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: Answer. Given the opportunity to be interviewed without the parent at some point during the interview. 74. Which statement is true regarding the relationship of physical characteristics and culture? Answer. There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics. 75. 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: Answer. Personal and social history. Midterm Exam for NURS 6512, Advanced Health Assessment. 76. 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: Answer. Ask whether he has any questions
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77. 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? Answer. Vitamin D 78. During an interview, tears appear in the patient's eyes and his voice becomes shaky. Initially, you should: Answer. Offer a tissue and let him know it is all right to cry. 79. 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? Answer. Nose and thyroid cartilages 80. Mr. Walters, a 32-year-old patient, tells you that his ears are "stopped up." An objective assessment of this complaint is achieved by using the: Answer. Tympanometer 81. Which of the following is an expected change in the assessment of the thyroid during pregnancy? Answer. A bruit may be heard because of increased vascularity.