Midterm Exam Flashcards
A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?
Enlarged and tender inguinal nodes
The direction of blood flow through the heart is best described by which of these
Right atrium > right ventricle > pulmonary artery > lungs > pulmonary vein > left atrium > left ventricle
In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would
Listen with the bell of the stethoscope to assess for bruit
When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are
Aortic and pulmonic
The sack that surrounds and protects the heart is called the
Pericardium
When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?
There is an opening in the atrial septum were blood can flow into the left side of the heart
The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?
Consider this a delayed capillary refill time investigate further
During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process?
Peripheral blood vessels growing more rigid with age producing a rise in systolic blood pressure
The mother of a three-month-old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?
Presence of dyspnea or diaphoresis one sucking
In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?
Smoking, hypertension, obesity, diabetes, high cholesterol
A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when
she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the
girl complains:
Of sharp pain that increases with movement
A patient has been diagnosed with osteoporosis and asked the FNP “what is osteoporosis?” The
FNP explains to the patient that osteoporosis is defined as:
Loss of bone density
Patient states, “I can hear a crunching or grating sound when I kneel”. She also states “that it is
very difficult to get out of bed in the morning because of stiffness and pain in my joints”. The FNP
should assess for signs of what problem?
Crepitation
When taking the history on a patient with a seizure disorder the FNP assesses whether the
patient has an aura. Which of these would be the best question for obtaining this information?
Do you have any warning signs before you receive your starts?
The FNP is teaching a class on osteoporosis prevention to a group of post-menopausal women. A participant shows that she needs more instruction when she states I will:
“Start swimming to increase my weight bearing exercise”
The FNP is performing a neurological assessment on a 41-year-old woman with a history of
diabetes. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the
patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel
vibrations on both patellae. Given this information what would the FNP suspect?
Peripheral neuropathy
An 80-year-old woman is visiting the clinic for a checkup. She states “I can’t walk as much as I
used to”. The FNP is observing from motor dysfunction in her hip and should have her:
Abduct her hip while she is lying on her back
The FNP is testing the function of cranial nerve XI. Which of these best describes the response
the FNP should expect if the nerve is intact? The patient
Moves the head and shoulders against resistance with equal strength
A 50-year-old woman is in a clinic for weakness in her left arm and leg that she noticed for the
past week. The FNP should perform which type of neurologic examination?
Complete neurologic examination
During the neurological assessment of a healthy 35-year-old patient the FNP asks him to relax his
muscles completely. The FNP then moves each extremity through full range of motion. Which of
these results would the FNP expect to find?
Mild, even resistance to movement
A woman who is 8 months pregnant comments that she has noticed a change in posture and is
having lower back pain. The FNP tells her that during pregnancy women have a posture shift to
compensate for the enlarging fetus. This shift and posture are known as:
Lordosis
A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his
arm because of pain and muscle spasms. The FNP should suspect
Rotator cuff lesions
A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will
assess for tenderness at the:
Medial and lateral epicondyle
The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalen’s
test. To perform this task the FNP should instruct the patient to:
Hold both hands back-to-back while flexing the wrists 90 degrees for 60 seconds
During the history a patient tells the FNP that “it feels like the room is spinning around me”. The
FNP would document this as:
Vertigo
The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain
perception the FNP decides to complete the test as quickly as possible. When the FNP applies
the sharp point of a pin on his arm several times he is only able to identify these as one very
sharp prick. What would be the most accurate explanation for this?
This is most likely the result of the summation effect
An 85-year-old patient comments during his annual physical that “he seems to be getting shorter
as he ages”. The FNP should explain that decrease height occurs with aging because:
Of the shortening of the vertebral column
A patient is complaining of pain in his joints that is worse in the morning, is better after he has
moved around for a while, and then gets worse again if he sits for long periods of time. The FNP
should assess for other signs of what problem?
Rheumatoid arthritis
When the FNP asks a 68-year-old patient to stand with feet together and arms at his side with
his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this
finding as:
Positive Romberg sign
During an assessment of the cranial nerves the FNP finds the following asymmetry when the
patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air
when the FNP presses against the right path cheek. This would indicate dysfunction of which of
these cranial nerves?
Motor component of VII
The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group?
Taking calcium and Vitamin D supplements
In obtaining a history on a 74-year-old patient the FNP notes that he drinks alcohol daily and that
he has noticed a tremor in his hands that affects his ability to hold thing. With this information
what should the FNP’s response be?
Does the tremor change when you drink the alcohol?
During a history of a 78-year-old man his wife states that “he occasionally has problems with
short-term memory loss and confusion. He can’t even remember how to button his shirt”. In
doing the assessment of his sensory system which action of the FNP’s is most appropriate?
Before testing, the FNP would assess the patient’s mental status and ability to follow directions at this time
While obtaining a history of a 3-month-old infant from the mother the FNP asks about the infants
ability to suck and grass the mother’s finger. What is the FNP assessing?
Reflexes
The FNP is doing an assessment on a 29-year-old woman who visits the clinic complaining of
always dropping things and falling down. While testing rapid alternating movements the FNP
notices that the woman is unable to pat both her knees. Her response is very slow and she
misses frequently. What should the FNP suspect?
Dysfunction of the cerebellum
A mother brings her two-month-old daughter in for an examination says “my daughter rolled over
against the wall and now I have noticed that she has the spot soft on the top of her head, is there
something terribly wrong?” The FNP’s best response would be:
“That soft spot actually allows for growth of the brain during the first year of your baby’s life”
During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most
likely results from:
Increased density of lung tissue
The patient is unable to differentiate between sharp and dull stimulation to both sides of her face.
The FNP suspects damage to:
The trigeminal nerve
When examining the face, the FNP is aware that the two pairs of salivary glands that are
accessible to examination are the _____ glands
Parotid and submandibular
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her
head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination
by____
XI; asking the patient you should have her shoulders against resistance
When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the
neck that are innervated by CN XI are the:
Sternomastoid and trapezius
The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an
examination of the _____ gland
Thyroid
A patient says that she has recently noticed a lump in the front of her neck below her “Adams
apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to
suspect that this may not be a cancerous thyroid nodule is that the lump:
Is mobile and not hard
The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify
the cause of the node enlargement, the FNP would assess the patient’s:
Area proximal to the enlarged node
The FNP is aware that the four areas in the body were lymph nodes accessible are the:
Head and neck, arms, inguinal area, and axillae
A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his
eyes. The FNP should know that floaters are usually not significant and are caused
by:
Condensed vitreous fibers
The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP
proceed?
Use the Snellen chart position 20 feet away from the patient
A patient’s vision is recorded as 20/30 when the Snellen eyechart is used. The FNP interprets
these results to indicate that:
The patient can read at 20 feet would a person with normal vision can read it at 30 feet
A patient is unable to read even the largest letters on the Snellen chart. The FNP should take
which action next
Shorten the distance between the patient and the chart until it is seen and record that distance
A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that
The patient has poor vision
When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2
o’clock in each eye. The FNP should
Consider this a normal finding
The FNP is performing the diagnostic positions test. Normal findings would be which of these
results?
Parallel movement of both eyes
During an assessment of the sclera of an African-American patient, the FNP would consider
which of these an expected finding?
The presence of small brown macules on the sclera
A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one
eye. How should the FNP check for this?
Observe the distance between the palpebral fissures
The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa
appears pale gray and swollen. What would be the most appropriate question to ask the patient?
Are you aware of having any allergies?
The FNP is palpating the sinus areas. If the findings are normal, then the patient should report
which sensation?
Firm pressure
During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips
and a dark line along the gingival margin. What would the FNP do in response to these findings
Proceed with assessment knowing that this is a normal finding
During an assessment of a 20-year-old patient with a three-day history of nausea and vomiting
the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are
reflective of:
Dehydration
The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which
statement by the graduate FNP reflects a correct understanding of tactile fremitus?
Tactile fremitus:
It’s caused by sounds generated from the larynx
The FNP student is reviewing physical assessment findings of the HEENT system associated
with pregnancy. Which statement by the graduate FNP reflects a correct understanding of
expected HEENT changes associated with pregnancy? During pregnancy:
Nasal stuffiness may occur as a result of decreased vascularity in upper respiratory tract
A patient tells the FNP that he is very nervous, that he is nauseated, and that he “feels hot”. This type
of data would be:
Subjective
The patient’s record, laboratory studies, objective data, and subjective data combine to form the
Data base
The FNP is reviewing information about evidence-based practice. Which statement best reflects evidence-based practice?
EBP emphasizes the use of best evidence with the clinician’s experience
A 59-year-old patient tells the FNP that he has ulcerative colitis. He has been having black stools for the last 24 hours. How would the FNP best document his reason for seeking care?
J.M. is a 59-year-old male here for having black stools for the past 24 hours
A 29-year-old woman tells the FNP that she has excruciating pain in her back. Which would be an appropriate response by the FNP to the woman’s statement?
How would you say the pain affects your ability to do your daily activities?
In recording the childhood illnesses of a patient who denies having had any, which note by the FNP would be most accurate?
Patient denies measles, mumps, rubella, chickenpox, pertussis and strep throat
If a female patient tells the FNP that she has had six pregnancies, with four live births at term and two spontaneous abortions. Her four children are still living. How would the FNP record this information?
Gravida 6, Para 4, (S) AB 2, Living 4
Which of these statements represents subjective data the FNP obtained from the patient regarding the patient’s skin:
Denies color change
The FNP is obtaining a history for a 30-year-old male patient and is concerned about health promotion activities. Which of these questions would be appropriate to use to assess health promotion activities for this patient?
Do you perform testicular self-examinations?
Which statement indicates that the FNP understands the pain experienced by an elderly person?
Pain indicates pathology or injury and is not normal process of aging
The FNP is performing a vision examination. What chart is most widely used for visual examination?
Snellen
During a complete health assessment, how would the FNP test the patients hearing?
Using the Whisper Voice Test
The FNP has completed an examination of a patient’s extra-ocular muscles. When documenting the findings, the FNP should document the assessment of which cranial nerves?
III, IV, VI
A patient’s uvula rises midline when she says”ahh” and she has a positive gag reflex. The FNP has just tested which cranial nerves?
IX, X
During an examination the FNP notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with successful performance of this action?
XII
A patient is unable to shrug her shoulders against the FNP’s resistant hands. What cranial nerve is involved with successful shoulder shrugging?
XI
During an examination, the patient has just successfully completed the finger to nose and rapid alternating movements test and is able to run each heel down the opposite shin. The FNP would conclude that the patient’s______ function is intact
Cerebellar
A five-year-old child is in the clinic for checkup. The FNP would expect him to:
Be able to sit on the examination table
When the FNP performs the confrontation test the FNP has assessed
Visual fields
Which of these statements is true regarding the complete physical assessment?
The patient should be in sitting position or examination of the head and neck
Which of these statements is true regarding recording of data from the history and physical examination?
Record the data as soon as possible after the interview and physical examination
Which of these is included in the assessment of general appearance?
Skin color
The FNP is performing a review of symptoms. Which of these questions are appropriate as health promotion questions to ask during this time?
Do you wear sunscreen while outside?
The FNP is incorporating a person’s spiritual values into the health history. Which of these questions illustrates the community portion of the FICA questions?
Are you part of any religious or spiritual congregation?
The FNP is preparing to complete a health assessment on a 1-year-old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins?
While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires
