CHAPTER 03- Health Assessment

Question 1

Open-ended questions are more pertinent to:

1. Review of systems.
2. Past illness.
3. Present illness.
4. Family history.

Answer 1

3. Present illness.

Open-ended questions are especially pertinent to eliciting the patient’s chief concerns and the History of the Present Illness.

Question 2

Mary is a 62-year-old female established patient who presents to the clinic with complaints of intermittent diarrhea and nausea for the past week. The type of history taking most appropriate will be:

1. Clinician-centered.
2. A comprehensive health history.
3. A detailed review of systems.
4. Focused or problem-centered.

Answer 2

4. Focused or problem-centered.

For patients who seek care for specific complaints—for example, coughs or painful urination—a more limited interview tailored to that specific problem may be indicated. This is sometimes known as a focused or problem-oriented history.

Question 3

Jennifer is a 16-year-old female who comes to the clinic with complaints of a headache and stomachache for 4 days. To elicit the most information, it is best to ask as many questions as possible.

1. Open-ended
2. Closed-ended
3. Guided
4. Direct

Answer 3

1. Open-ended

Open-ended questions are best for getting information about chief complaints, but they are especially important when working with adolescent patients. Adolescents tend to be very brief with their answers and asking as many open-ended questions as possible will yield more details about their symptoms.

Question 4

The patient is a 68-year-old Asian American female seeing the FNP for the first time. The female provider starts the interview by asking some basic questions like “What brings you here today?” Her responses are very brief and she nods frequently during the conversation. Understanding about Asian culture, the FNP knows that:

1. The patient may expect you to already know what is wrong with them.
2. Nodding reflects her full understanding of what is being said.
3. The patient would prefer to see a male provider.
4. Nodding reflects her agreement with the provider.

Answer 4

1. The patient may expect you to already know what is wrong with them.

Some Asian Americans may expect providers to already know what is wrong with them. Nodding is not a reflection of agreement or understanding but their cultural value for interpersonal harmony.

Question 5

When interviewing a patient, it is best to be:

1. Standing above the patient.
2. Sitting below the patient.
3. At eye-level with the patient.
4. 2 to 3 feet from the patient.

Answer 5

3. At eye-level with the patient.

Ideally, the FNP should be at eye level, with the patient four to five feet from the patient. Avoid facing a patient across a desk.

Question 6

Note-taking during an interview:

1. Can be threatening to patients when discussing sensitive issues.
2. Should never be done and is always avoidable.
3. Makes the patient feel you are paying attention to them and you are carefully noting their comments.
4. Shifts the attention to the patient and gives them a sense of importance.

Answer 6

1. Can be threatening to patients when discussing sensitive issues.

Note-taking should be avoided whenever possible, but is sometimes necessary. It can, however, be threatening to a patient, especially when discussing sensitive issues. It can shift the attention away from the patient and make them feel unimportant.

Question 7

When using an interpreter, it is important to note that:

1. The same or similar age is often preferred.
2. The same gender is often preferred.
3. A summary of the conversation is often relayed.
4. Using children of the patient is best.

Answer 7

2. The same gender is often preferred.

An interpreter of the same gender is often preferred. Older interpreters are often preferred by patients. Avoid using children of the patient when at all possible. An interpreter should provide a line-by-line verbatim account of the conversation.

Question 8

Johnny is a 2-year-old male who was diagnosed with sickle cell anemia shortly after birth. Prior to conducting a physical assessment, it is important to note which of the following can be a chronic manifestation of sickle cell anemia?

1. Stroke
2. Sepsis
3. Priapism
4. Jaundice

Answer 8

4. Jaundice

Jaundice can be a chronic manifestation of sickle cell anemia, whereas the other conditions may be an acute manifestation that can lead to chronic issues.

Question 9

Mrs. Adam’s note says that she has a lesion that is confluent in nature. On examination, the FNP would expect to find:

1. Lesions that run together.
2. Annual lesions that have grown together.
3. Lesions arranged in a line along a nerve route.
4. Lesions that are grouped or clustered together.

Answer 9

1. Lesions that run together.

Confluent is defined as flowing together, blending as one, or merging together.

Question 10

Assessing a patient’s ability to think abstractly can be done in one of two ways:

1. Asking them who the president of the United States is or five previous presidents.
2. Ask the patient to count backward or give them a proverb and ask them to explain it.
3. Give them a proverb and ask them to explain it, or ask them to explain how two words are alike.
4. Give them two words and ask them to explain how they are different, or ask them to calculate several numbers.

Answer 10

3. Give them a proverb and ask them to explain it, or ask them to explain how two words are alike.

Interpreting proverbs measures one’s ability to think abstractly, as does interpreting similarities and differences between words.

Question 11

It is important for clinicians to understand the terminology when assessing for alcohol and drug usage and possible addiction. A state of adaption in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time is the definition of:

1. Alcoholism.
2. Tolerance.
3. Physical dependence.
4. Addiction.

Answer 11

2. Tolerance.

This is the definition for tolerance.

Question 12

When assessing for domestic violence, a statement such as, “I routinely ask all my patients about domestic violence” should come:

1. Prior to asking probing questions.
2. Prior to asking in-depth questions.
3. After asking in-depth questions.
4. At the end of the overall interview.

Answer 12

1. Prior to asking probing questions.

A normalizing statement should be at the beginning of the interview. First ask probing questions, then follow with more in-depth questions.

Question 13

Which statement is true about dying patients?

1. Dying patients often want to talk about their illness at each encounter.
2. Dying patients may experience Kübler-Ross’s stages for death and dying in any sequence, and stages may overlap.
3. Dying patients often want to discuss their condition with multiple people.
4. Media often gives the dying patients a realistic view of the effectiveness of resuscitation.

Answer 13

2. Dying patients may experience Kübler-Ross’s stages for death and dying in any sequence, and stages may overlap.

The patient may experience the stages of death and dying in any stage or sequence or combination thereof.

Question 14

When interviewing a patient, he says he doesn’t have any energy. What are some general statements about the fatigue that will assist in asking further appropriate questions?

1. Fatigue is a specific symptom with few causes.
2. Fatigue is an abnormal response to stress.
3. Fatigue can be a normal response to grief.
4. Fatigue related to stress or hard work requires further investigation.

Answer 14

3. Fatigue can be a normal response to grief.

Fatigue can be a normal response to hard work, stress, or grief. If it is not related to such situations, it requires further investigation.

Question 15

The PQRSTU or PQRST mnemonic is a way to:

1. Assess a patient’s pain level or presenting symptom.
2. Assess a patient’s skin.
3. Determine a patient’s level of understanding of instructions.
4. Assess a patient’s family history.

Answer 15

1. Assess a patient’s pain level or presenting symptom.

The PQRST method of assessing pain is a valuable tool to accurately describe, assess, and document a patient’s pain (or other presenting symptoms).

Question 16

A family tree can also be described as a:

1. Family map.
2. Web.
3. Network.
4. Genogram and Pedigree.

Answer 16

4. Genogram and Pedigree.

A family tree may be referred to as a genogram or pedigree.

Question 17

The FNP is doing an interview of a 21-year-old male. In the assessment, the FNP asks the patient, “You don’t smoke, do you?” This type of question is:

1. An appropriate open-ended question.
2. An appropriate close-ended question.
3. An inappropriate leading question.
4. An inappropriate open-ended question.

Answer 17

3. An inappropriate leading question.

This type of question is leading, and leading questions imply that there is a right or wrong response, and if the person wants to please you, they will respond how they think you want them to respond.

Question 18

A 39-year-old female presents to the clinic for her annual GYN visit. During her interview, she uses unusual frequent and long pauses with speech that is slow and monotone. The patient is most likely:

1. Distracted.
2. Depressed.
3. Anxious.
4. Angry.

Answer 18

2. Depressed.

Depressed: Unusually frequent and long pauses in speech that are slow and monotone are usually a sign of depression and need further investigation.

Question 19

When assessing the patient for strabismus, an eye muscle problem such as esotropia or exotropia, the practitioner should select which of the following eye tests?

1. An ophthalmoscope exam
2. The cover-uncover test
3. The confrontation visual field test
4. The eye test for distance vision

Answer 19

2. The cover-uncover test

A cover test or cover-uncover test is an objective determination of the presence and amount of ocular deviation.

Question 20

A 37-year-old male arrives at the clinic for a work physical. The FNP places both hands on the patient’s shoulders and asks him to shrug his shoulders. This tests which cranial nerve?

1. IX
2. XI
3. IV
4. VI

Answer 20

2. XI

You are testing cranial nerve 11 (cranial nerve XI).

Question 21

A 43-year-old female presents to the clinic with complaints of frequent headaches. While attempting to test her cranial nerve function, she is requested to: puff out her checks, close her eyes tightly, and clench her teeth. Which of the following cranial nerves was tested?

1. V and VII
2. III, IV, and VI
3. III and V
4. IV, V, and VI

Answer 21

1. V and VII

To test cranial nerve V, ask the patient to clinch their teeth. To test cranial nerve VII, have the patient puff out their cheeks and close their eyes tightly.

Question 22

Mr. Davis is a 42-year-old construction worker. He has come to the clinic complaining of decreased hearing over the last few months. Upon examination, the FNP notes that both his ear canals are occluded with dark brown cerumen. Hearing loss due to impacted cerumen is an example of:

1. Otitis media.
2. A conductive hearing loss.
3. A sensorineural hearing loss.
4. Otitis externa.

Answer 22

2. A conductive hearing loss.

Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). This can be caused by obstruction.

Question 23

Boggy turbinates is usually associated with which condition?

1. Allergic rhinitis
2. Nasal polyps
3. A deviated septum
4. A foreign body in the nose

Answer 23

1. Allergic rhinitis

Nasal turbinates that are swollen, pale, boggy, or bluish are a sign of allergic rhinitis.

Question 24

A 27-year-old patient is 27 weeks pregnant and has come to the clinic for her prenatal exam. The fundal height measures 21 centimeters. This may be a sign of:

1. Too much amniotic fluid.
2. Twin gestation.
3. Slow fetal growth.
4. An expected finding for gestational age.

Answer 24

3. Slow fetal growth.

After 16 weeks of gestation fundal height measurement often matches the number of weeks gestation. A smaller than expected measurement can be a sign of slow fetal growth.

Question 25

While performing a 24-year-old female’s GYN exam, it is observed that the cervix is friable. This condition is most commonly associated with what?

1. Cervical cancer
2. Pelvic Inflammatory Disease (PID)
3. Trichomoniasis
4. Cervical cancer and Pelvic Inflammatory Disease (PID)

Answer 25

2. Pelvic Inflammatory Disease (PID)

In rare cases, a friable cervix is an early sign of cervical cancer. The most likely cause is HPV or chlamydia. Commonly, it is a sign associated with PID. It may also be due to trichomoniasis, but is more likely a result of chlamydia or PID.

Question 26

A patient is being assessed for range of motion. He is asked to move his arms in toward the center of his body. This movement is called what?

1. Adduction
2. Abduction
3. Flexion
4. Extension

Answer 26

1. Adduction

Adduction is movement toward the mid-line of the body.

Question 27

A 57-year-old bank teller comes to the office complaining of fever, shortness of breath, and a productive cough with slightly brown sputum. She says she had a cold the last two weeks and her symptoms continue to get worse. She has been taking over-the-counter cold and flu medications without any improvement. She mentions a slight chest pain upon breathing deeply, and has a history of HTN and a grade II murmur. She denies alcohol or drug use. She smokes half a pack of cigarettes a day. Both her parents are living. Both have HTN and elevated cholesterol. She looks ill and her temperature is elevated (100.7). Her blood pressure is 140/87 and pulse 85. On auscultation, she has decreased air movement, and fine crackles are heard over the right lower lobe. There is dullness on percussion, and increased fremitus during palpation. What disorder of the thorax or lung best describes her symptoms?

1. COPD
2. Upper respiratory infection
3. Pneumothorax
4. Pneumonia

Answer 27

4. Pneumonia

Pneumonia is usually associated with dyspnea, cough, and fever. On auscultation, there can be coarse or fine crackles heard over the affected lobe. Percussion over the affected area is dull and there is often an increase in fremitus.

Question 28

A 36-year-old man comes to the ER for examination after a motorcycle accident. It was reported that he landed on his left side on the handlebars. It is suspected that he may have some internal injuries. Which of the following is the best response regarding assessment of the spleen in this situation?

1. It is normal for the spleen to be palpable.
2. The spleen can be enlarged as a result of trauma.
3. If an enlarged spleen is noted, palpate thoroughly to determine size.
4. An enlarged spleen should not be palpated because it can rupture easily.

Answer 28

4. An enlarged spleen should not be palpated because it can rupture easily.

If an enlarged spleen is palpated, do not continue to palpate and order an immediate ultrasound. An enlarged spleen is friable and can rupture easily with overpalpation.

Question 29

While assessing the carotid pulse of a 57-year-old male, the FNP notices that the pulse is bounding. This would be documented as what?

1. A normal carotid pulse
2. 2+
3. WNL
4. 3+

Answer 29

4. 3+

A forceful pulse might be described as 3+ or even 4+ and is also described as bounding.

Question 30

The finding in the previous question may be due to:

1. A normal physiological reaction.
2. Fluid overload.
3. Dehydration.
4. Hypotension.

Answer 30

2. Fluid overload.

Increased carotid-pulse amplitude may be associated with fluid-volume overload or hypertension.

Question 31

When assessing heart sounds, auscultate in _____ areas. These include:

1. 4; apical, pulmonic, tricuspid, mitral.
2. 5; aortic, pulmonic, Erb’s point, tricuspid, mitral.
3. 5; apical, pulmonic, Erb’s point, tricuspid, mitral.
4. 3; pulmonic, tricuspid, apical.

Answer 31

2. 5; aortic, pulmonic, Erb’s point, tricuspid, mitral.

The clinician should listen in five locations, both with the bell and the diaphragm of the stethoscope. These are the aortic, pulmonic, Erb’s point, tricuspid, and mitral areas.

Question 32

It is not unusual for patients with GERD to have atypical respiratory symptoms. These may include all of the following except:

1. Aspiration pneumonia.
2. Wheezing.
3. Rhonchi.
4. Cough.

Answer 32

3. Rhonchi.

Some patients with GERD may present with aspiration pneumonia, wheezing, or coughing.

Question 33

Jarrod is a 62-year-old male who presents to the ER with complaints of chest pain across the anterior chest that sometimes radiates to the shoulders, arms, and lower jaw. On a scale of 1–10 he reports the pain at a 9. He describes the pain as pressing, tight, and sharp. He states the pain may last 10–15 minutes and then subsides. Based on his presenting symptoms, which diagnosis would you immediately rule out?

1. Dissecting aortic aneurysm
2. Angina pectoris
3. Myocardial infarction
4. Pericarditis

Answer 33

1. Dissecting aortic aneurysm

All but dissecting. An aortic aneurysm may present with shoulder pain and is often described as a ripping or tearing pain. The pain is persistent.

Question 34

When auscultating over a patient’s left femoral arteries, the presence of a bruit is noted on the left side. The initial assessment is that it indicates:

1. Venous disease.
2. A history of MI.
3. An aortic aneurysm.
4. Partial occlusion of the left femoral artery.

Answer 34

4. Partial occlusion of the left femoral artery.

A bruit occurs with turbulent blood flow, indicating partial occlusion of the artery.

Question 35

Mark is a 73-year-old male who was diagnosed with COPD 4 years ago. While doing the exam, it is observed that he has a barrel chest. In the note, the documentation is that the AP ratio is:

1. 2:1
2. 1:2
3. 1:1
4. normal.

Answer 35

3. 1:1

In patients with COPD, it is common for them to present with a barrel chest. In a barrel chest, the AP ratio is usually 1:1.

Question 36

Which is true of a fourth heart sound (S4)?

1. It is caused by rapid deceleration of blood against the ventricular wall.
2. It is abnormal or rare in trained athletes.
3. It is heard in atrial fibrillation.
4. It marks atrial contraction.

Answer 36

4. It marks atrial contraction.

The S3 gallop is caused by rapid deceleration of blood against the ventricular wall. S4 is heard with atrial contractions and is absent in atrial fibrillations for this reason. This is occasionally normal in trained athletes.

Question 37

Abby is an 11-year-old girl who presents to the ER after having had a seizure at school. She has a history of epilepsy, and is currently awake but drowsy. She begins to complain of a headache. The FNP knows that this is:

1. Common.
2. Slightly unusual.
3. Abnormal and requires follow up within the next 24 hours.
4. Highly unusual and requires immediate intervention.

Answer 37

1. Common.

Peri-ictal headaches are common in children who have epilepsy.

Question 38

The next step in Abby’s care would be to:

1. Provide analgesics and continue to monitor her postictally.
2. Provide analgesics and consider an MRI.
3. Provide analgesics and refer her to a neurologist within 24 hours.
4. Obtain an MRI immediately.

Answer 38

1. Provide analgesics and continue to monitor her postictally.

Because peri-ictal headaches are common in children with epilepsy, no further diagnostic measures are necessary.

Question 39

When assessing a patient with complaints of headaches, what is the single most important factor?

1. Neuro exam
2. Their history
3. Prior treatment
4. Location of pain

Answer 39

2. Their history

The patient’s history is the single most important factor in the evaluation of a headache.

Question 40

Parity is documented in terms of mnemonic TPAL, which stands for:

1. term pregnancies, premature births, abortions (therapeutic), and live births.
2. term deliveries, premature births, abortions (therapeutic), and living children.
3. term pregnancies, premature births, abortions (spontaneous), and live births.
4. term deliveries, preterm deliveries, abortions (spontaneous and therapeutic), and living children.

Answer 40

4. term deliveries, preterm deliveries, abortions (spontaneous and therapeutic), and living children.

TPAL is the mnemonic for term deliveries, preterm deliveries, abortions (spontaneous and therapeutic), and living children.

Question 41

While assessing the neurologic status of a 63-year-old male who has a late-stage brain tumor, the FNP strokes up the lateral side of the sole of the foot and inward with a reflex hammer. The patient fans out his toes, and the big toe shows dorsiflexion. This would be documented as:

1. A negative Babinski’s reflex, which is normal for adults.
2. A positive Babinski’s reflex, which is abnormal for adults.
3. A positive Babinski’s reflex, which is normal for adults.
4. A negative Babinski’s reflex, which is abnormal for adults.

Answer 41

2. A positive Babinski’s reflex, which is abnormal for adults.

The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. This appears in infants up to 2 years old but is seen as abnormal after that.

Question 42

The FNP is assessing Tanner staging of the breast in a young woman. It is observed that projection of the areola and nipple forms a secondary mound above the level of the breast. Which Tanner stage would this be?

1. IV
2. III
3. I
4. II

Answer 42

1. IV

This would be a Tanner stage IV because there is elevation of the nipple and areola above the level of the surrounding breast tissue, as well as formation of a secondary mound.

Question 43

Ellen is a 40-year-old woman with three children who presents to the clinic with complaints of painful periods. She is diagnosed with secondary dysmenorrhea. What assessment data is the best indicator that she has secondary dysmenorrhea versus primary dysmenorrhea?

1. It occurs at the onset of menses.
2. She has no signs or symptoms of uterine problems, such as uterine fibroids or PID.
3. She has had a history of normal periods until one year ago.
4. She has had three normal pregnancies.

Answer 43

3. She has had a history of normal periods until one year ago.

Secondary dysmenorrhea is menstrual pain that develops later in women who have had normal periods. It is often related to problems in the uterus or other pelvic organs.

Question 44

Abraham is a 54-year-old male who presents to the office with a complaint of joint pain. Certain symptoms will help determine whether it is inflammatory or non-inflammatory in nature. Which one of the following factors is consistent with an inflammatory process?

1. Tenderness
2. Cool to the touch
3. History of injury
4. Redness

Answer 44

1. Tenderness

Tenderness implies an inflammatory process, along with increased temperature and tenderness.

Question 45

Trina is a 22-year-old woman who is 28 weeks pregnant. She presents to the clinic for her prenatal visit. She has complaints of occasional nosebleeds, some hair loss, a rash on her face, and she thinks her face has really gotten fat over the past two weeks. Which symptom is of the greatest concern?

1. Nosebleeds
2. Facial edema
3. Generalized hair loss
4. Rash on her face

Answer 45

2. Facial edema

Generalized hair loss, a hyperpigmented maxillary rash (chloasma), and nosebleeds are usually benign and common in pregnancy. Facial edema after the 24th week of gestation may indicate gestational hypertension.

Question 46

A lesion that is a change in color, flat circumscribed, and less than 1 cm is generally a:

1. Café au lait spot.
2. Freckle.
3. Mole.
4. Mongolian spot.

Answer 46

2. Freckle.

A macule is a flat, discolored, circumscribed area of skin that is less than 1 cm in size. Examples of this include freckles, petechia, and flat nevi.

Question 47

A lesion that is encapsulated-fluid filled in a dermis or subcutaneous layer, elevating the skin, is what?

1. Pustule
2. Nodule
3. Wheal
4. Cyst

Answer 47

4. Cyst

A cyst is a fluid-filled lesion that involves the dermis or subcutaneous layer of the skin and is encapsulated. None of the other lesions have all these characteristics.

Question 48

A fissure can be described as:

1. Scooped out but shallow.
2. A self-inflicted abrasion.
3. An irregular shaped deep depression in the dermis.
4. A linear crack with abrupt edges.

Answer 48

4. A linear crack with abrupt edges.

A fissure is a linear crack that extends into the dermis with abrupt edges.