Nursing 507- Exam 3 Q's

Question 1

David a 36 y/o male presents with c/o low back pain. The 1st question you need to ask should consist of?

A. onset, location, precipitating factors

B. location & aggravating factors

C. previous history of back injury

D. medication & pain relief

Answer 1

A. onset, location, precipitating factors

Question 2

Your exam for David (low back pain) will consist of which of the following?

A. gait, ROM for back, straight leg raises

B. complete musculoskeletal exam

C. straight leg raises & achilles reflex only

D. ROM neck, back, lower extremities

Answer 2

A. gait, ROM for back, straight leg raises

Question 3

Amy a 18 year old presents to your clinic with complaints of bilateral tenderness & small pea sized lumps in her breast. She denies any other complaints & states she is otherwise healthy & feels fine. To accurately dx Amy what other data do you require?

A. tobacco use & diet

B. LNPM, onset, complaints, performs SBE & when, where is she in her menstrual cycle, caffeine use

C. LNP onset of complaints, ETOY use, caffeine intake, SBE

D. PMH, LNMP, tobacco use, diet

Answer 3

B. LNPM, onset, complaints, performs SBE & when, where is she in her menstrual cycle, caffeine use

Question 4

You discover that Amy’s LNMP was 2 weeks ago & the lumps were discovered 2-3 days ago. You have diagnosed this as a fibrocycstic breast changes. To have this dx, the exam needed to reveal which of the following?

A. small , non-mobile masses tender to palpation

B. small, mobile masses, nontender to palpation

C. small, mobile masses, tender to palpation, which change with the menstrual cycle

D. small non-mobile masses fixed to the chest wall

Answer 4

C. small, mobile masses, tender to palpation, which change with the menstrual cycle

Question 5

Jamie a 24 y/o presents to your clinic with c.o N&V X 24 hrs, She also states she has abd pain. Her LNPM was 1 week ago. She denies a h/o GI disorders. The 1st set of questions to ask Jamie would be? (use Jamie’s scenario for the next 2 Q’s)

A. onset & duration of sx’s?

B. previous meds?

C. onset, duration, amount of vomitus, fever, & malaise?

D. exposure to recent illness?

Answer 5

C. onset, duration, amount of vomitus, fever, & malaise?

Question 6

What exam would you perform on Jamie?

A. abd exam to include auscultation of the BS, palpation for tenderness, palpation of organs for masses, check hydration status

B. light abd palpation only

C. palpation for enlarged gallbladder, liver, or spleen

D. auscultation of the BS, palpation for tenderness, femoral pulses, auscultation for bruits

Answer 6

A. abd exam to include auscultation of the BS, palpation for tenderness, palpation of organs for masses, check hydration status

Question 7

During the physical exam, you notice Jamie’s abd is nontender & soft. She also has dry mucous membranes & decreased skin turgor. Jamie has hyperactive BS. What is the likely dx?

A. PUD

B. acute gastroenteritis

C. pregnancy

D. drug overdose

Answer 7

B. acute gastroenteritis

Question 8

Sophie Klinger is a 50 y/o woman brought to the ER after an episodic loss of consciousness. Her body began making jerking movements. The jerking movements lasted about 3 minutes . . . did not respond to verbal stimuli for 10 mins. Brought to the ER confused NO problems. Med history neg for acute or chronic diseases.

She feels well
-smokes 1 pack.day for 30 years
-2-3 alcoholic bevrages per night
-banged head on cabinet 1 week ago

A. head trauma- banged head on cabinet

B. idiopathic epilepsy- body had jerking movements

C. malignancy- she has no acute or chronic diseases

D. alcohol withdrawal- has 2-3 drinks a night

Answer 8

C. malignancy

Question 9

Based on the clinical features described by her husband. Sophie’s seizure can be described as?

A. partial complex seizure

B. Absent seizure

C. status epilepticus seizure

D. generalized tonic clonic seizure

Answer 9

D. generalized tonic clonic seizure

Question 10

Rachel Jacobs is a 20 year old college student who presents to student health services with a severe right sided headache. She is nauseous, has not vomited & was unable to attend class today.

-throbbing knife stabbing her behind her right eye.
-feels sick from her period

Answer 10

migraine headache?

Question 11

In completing a h/o Rachel what other info do you require?

A. family history, current meds, PMH (Rachel)

B. family history, PMH, current meds, alleviating/aggravating sx’s

C. family history, ETOH use

D. family history, history of psychological disturbances

Answer 11

B. family history, PMH, current meds, alleviating/aggravating sx’s

Question 12

What exam would you complete for Rachel?

A. ophtalmoscopic, palpation of head & neck, Brudzinski sign, Kernigs sign

B. a complete head to toe physcial

C. HEENT, cardiac, resp

D. palpation of head & neck, EOMS, palpation of lymph nodes

Answer 12

A. ophtalmoscopic, palpation of head & neck, Brudzinski sign, Kernigs sign

Question 13

Which of the following exam dose NOT evaluate peripheral circulation?

A. Allen test

B. Retrograde filling test

C. skin inspection of dependent places on bed-bound pt’s

D. test for shifting dullness

Answer 13

D. test for shifting dullness

Question 14

Which is the best time of the month to examine the female breasts?

A. during menstruation

B. about 7-10 days after menstruation

C. just prior to menstruation

D. anytime of the month is fine

Answer 14

B. about 7-10 days after menstruation

Question 15

A 45 yr old woman has multiple hand injuries from a car accident. On nspection of each hand, what areas will you assess?

A. symmetry, condition of surrounding tissues, hand grip, edema

B. condition of surrounding tissue, limitation of movement, redness, & lacerations

C. symmetry, signs of inflamed joints from arthritis, & hand grip

D. condition of surrounding tissues, paraspinal tenderness, edema, & redness

Answer 15

B. condition of surrounding tissue, limitation of movement, redness, & lacerations

Question 16

When the breasts are palpated for consistency of tissues which of the following is a positive clinical finding on the breast exam?

A. there is an increased nodularity in both breasts premenstrually

B. there is a firm ridge of tissue along the lower edge of both breasts

C. There is a hard, irregular, fixed nodule in 1 breast

D. There are multiple soft, mobile nodules in both breasts

Answer 16

C. There is a hard, irregular, fixed nodule in 1 breast

Question 17

on palpation which lymph nodes would be important to assess if a pt. has cellultitis from a spider bit on the left lateral forearm?

A. epitrochlear nodes

B. infraclavicular nodes

C. axillary nodes

D. horizontal nodes

Answer 17

A. epitrochlear nodes

Question 18

Will Johnson, a 67 y/o white male, presents with c/o leg pain. He states that when he walks from his apartment to the store (which is a block away) his leg “cramps up”. He finds it difficult to continue walking without resting. The pain is described as aching in the left calf & thigh. His med history reveals smoked 1 ppd X 50 years (quit 1 yr ago). NIDDM X 8 yrs & HTN X 10 years. He denies chest pain, SOB, renal disease, & known cardiac disease. His family reveals father deceased MI age 50 & mother deceased lung CA age 70/ The kind of pain he is experiencing is symptomatic of?

A. Deep vein thrombosis

B. Intermittent claudication

C. peripheral neuropathy

D. musculofascial pain

Answer 18

B. Intermittent claudication

Question 19

Which 2 exam techniques are the most important during the musculoskeletal exam?

A. inspection & percussion

B. inspection & palpation

C. palpation & auscultation

D. percussion & palpation

Answer 19

B. inspection & palpation

Question 20

A 55 yr old construction worker presents for eval of swelling in his feet. He has smoked cigs 2 ppd since the age of 15. He has noticed pain in both legs when walking. which is relieved with resting for 10 mins. On physical exam hhis dorsalis pedis pulses are decreased bilaterally in comparison with his femoral pulses. His feet are cool to the touch when compared to his upper legs. He has no pedal edema. What is your most likely dx?

A. DVT

B arterial insufficiency

C. venous insufficiency

D. peripheral neuropathy

Answer 20

B arterial insufficiency

Question 21

Generalized lympadenopathy can be distinguished from local lymphadenopathy by which of the following criteria?

A. enlarged nodes in 1 area

B. widespread tenderness

C. enlarged nodes in 2 different areas

D. absence of lesions

Answer 21

C. enlarged nodes in 2 different areas

Question 22

Although a pt. is very upset as he relates his feelings about difficulty eating, this is a good sign. U notice he has smiled, frowned, closed his eyes, & in general has expected facial movements of emotion. Which cranial nerve is intact?

A. CN-IV

B. CN-VIII

C. CN-VII

D. CN-V

Answer 22

C. CN-VII

Question 23

If the 36 yr old with c/o low back pain has disc involvement which is the following is most significant?

Answer 23

positive cross straight leg raise

Question 24

An obese 55 yr old female went through menarche at age 16 & menopause 2 years ago. She is concerned because her aunt has severe osteoporosis. Which of the following is a risk factor for osteoporosis?

A. obesity

B. postmenopausal status

C. having an aunt with osteoporosis

D. delayed menarche

Answer 24

B. postmenopausal status

Question 25

The physical assessment of the peripheral vascular system relies on which of the following?

A. auscultation of all peripheral pulses & a search for edema

B. inspection of extremities, palpation of pulses & a search for edema

C. a search for edema & auscultation of prominent vessels in that area

D. inspection of extremities, eval of cap refill, & auscultation of all peripheral pulses

Answer 25

B. inspection of extremities, palpation of pulses & a search for edema

Question 26

A 13 y/o junior HS student is brough into your office by her mother for eval of the students unequal shoulder height. Her mother 1st noticed this 2 weeks ago. There is no h/o birth trauma or recent injury. On physical exam, there is a lateral curvature to the spine. The curvature is more pronounced with forward flexion. Based on this info what is your most likely dx?

A. normal spine curvature

B. kyphosis

C. scoliosis

D. lumbar lordosis

Answer 26

C. scoliosis

Question 27

A pt. is asked if he ever had his appendix out or had any prior hospitlizations for abd pain. These q’s would come under what part of the history?

a. chief complaint

B. history of present illness

C. past medical history

D. pt. profile

Answer 27

C. past medical history

Question 28

A 68 y/o retired kindergarten teacher presents to your office for evaluation of swelling in her right arm. On questioning her further, you discover she had a recent mastectomy for right-sided ductal carcinoma in situ. What is your most likely dx?

A. orthostatic edema

B. lymphedema

C. lipedema

D. chronic venous insufficiency

Answer 28

B. lymphedema

Question 29

Which of the following is important to ask when taking a history on the older adult, under the musculoskeletal review of systems?

A. how do you feel about getting older?

B. are you increasingly aware of your personal aging?

C. What would you like to change in your life?

D. What ordinary activities of daily living are difficult for your to perform?

Answer 29

D. What ordinary activities of daily living are difficult for your to perform?

Question 30

When palpating the femoral pulses, which lymph are in the same region & should be palpated ay the same time?

A. deep posterior chain

B. superficial inguinal nodes

C. anterior chain

D. epitrochlear nodes

Answer 30

B. superficial inguinal nodes

Question 31

A 62 y/o accountant presents for eval of a rash for several months. He denies fever & chills. The skin itches & has tried OTC creams without success. He has smoked 1/2 ppd of cigs for the past 20 yrs. On physical exam, the skin of his lower legs are hyperpigmented & bluish-red. He has a shallow ulcer on his right medial calf. His dorsalis pedis pulses are 2+/2+ bilaterally & he has expected hair distribution on his lower legs. These findings are most compatible with which of the following dx’s?

A. DVT

B. Tinea pedis

C. arterial insufficiency

D. venous insufficiency

Answer 31

D. venous insufficiency

Question 32

Deep vein thrombosis often presents first as:

Answer 32

throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, when walking or standing up.
swelling in 1 leg (rarely both legs)
warm skin around the painful area.
red or darkened skin around the painful area – this may be harder to see on brown or black skin.

	A. tender calf with swelling & possible pitting edema

Question 33

A 27 yr old software specialist presents to your office for eval of numbness & pain his fingers. He has noticed that the numbness increases as the day continues; at first, he noticed it only at the end of the day but now it is present upon awakening. It is present in both hands. The pain started several months ago & is not relieved with OTC med. His family history is significant for HTN & cerebrovascular disease. On physical exam his blood pressure is 110/70 & is atropic. Which test would you perform to confirm your initial hypothesis of carpal tunnel syndrome?

A. tinels test

B. anterior drawer test

C. McMurray’s test

D. allen test

Answer 33

A. tinels test

Question 34

An 18 yr old college freshman presents to the ER for eval of fever, h/a, & neck stiffness. On physical exam the pt. is resting quietly & has a flushed face. His vital signs are temp 104 F, HR 110, BP 105/70. There are no rashes noted. During the physical exam, you flex the pt’s neck & his hips & knees flex in response indicating meningeal irritation. The name of this positive sign is?

A. Kernig’s sign

B. Brudzinski sign

C. Babinski sign

D. Lachman’s sign

Answer 34

B. Brudzinski sign

Question 35

A 15 yr old girl is assessed as a stage 3 Tanner’ sex maturity rating. Which of the following is a rating of stage 3 breast developement?

A. enlargement & elevation of the breast & areola with on sepation of their contours

B. elevation of the breast & nipple as a small mound with enlargement of the areolar diameter

C. Projection of nipple only with areola receded to general contour of the breast

D. Projection of teh areola & nipple to form a secondary mound above the level of the breast

COME BACK TO!!

Answer 35

D.

Question 36

Exam of an extremity affected by intermittent claudication focuses on?

A. observing for inflammation, erythema, & pitting edema

B. palpating for pulses, comparing one leg to the the other

C. noting color change, affected leg looks brownish

D. checking for Homan’s sign & evaluating deep tendon reflexes

Answer 36

B. palpating for pulses, comparing one leg to the the other

Question 37

Your health 32 year old pt. presents with C/O edema in lower legs after driving from California to TN last week. Your explanation of this occurrence is based on the following?

A. obstructed lymph channels

B. increased capillary permeability

C. insufficient muscular activity to promote venous flow

D. None of the above

Answer 37

C. insufficient muscular activity to promote venous flow

Question 38

Which of the following is the expected aging process in the peripheral vascular system?

A. Loss if arterial pulsations

B. arterial & venous disorders

C. an atherosclerotic process

D. Thin, dry skin on legs

Answer 38

D. Thin, dry skin on legs

Question 39

You are obtaining an arterial blood gas on the rt wrist of a pt in the ICU setting. You perform a physical exam maneuver to assess the patency of the ulnar artery. What is the name of this test?

A. Murphy’s test

B. Phelan’s test

C. Allen test

D. Obturator test

Answer 39

C. Allen test

Question 40

A 35 yr old postal worker presents to your office for eval of pain in her joints. She states that the pain is worse in her fingers & wrists with both hands being affected. She notices that it takes her longer than 1 hr to get moving in the morning b/c she is so stiff. For the past few wks, she has been having fevers; some as high as 100.5 degrees. You notice that she has fusiform swelling in her fingers & wrists bilaterally & that the PIP & MCP joints are tender to palpation. Based on the history & physical exam findings, what is your most likely dx?

A. osteoarthritis

B. RA

C. Gouty arthritis

D. Ankylosing spondylitis

Answer 40

B. RA

Question 41

What exam technique could reveal Osgood-Schlatter disease of the knees in a teenager with knee pain that awakens her at night?

A. palpate for tenderness over the lateral collateral ligaments

B. Palpate for a fluid wave in the suprapatellar pouch

C. Palpate on the tibial tuberosity & note swelling or tenderness

D. Palpate for tenderness as the knee is pressed flat

Answer 41

C. Palpate on the tibial tuberosity & note swelling or tenderness

Question 42

You have a pt. whom you have decided will benefit from PT. This would be documented under which of the following?

A. plan/education

B. plan/treatment

C. analysis

D. short-term goal

Answer 42

B. plan/treatment

Question 43

You are assessing a 65 yr old lawyer who has been brought into the office by his family memory loss. You perform a mini-mental status exam to assess his cognitive function. Which of the following is considered a higher cognitive function?

A. calculating ability

B. orientation

C. remote memory

D. recent memory

Answer 43

A. calculating ability

Question 44

Which of the following is an important principle when performing sensory testing?

Answer 44

compare 2 sides of the body

compare proximal & distal areas of the arms legs for pain, temperature, & touch sensation

proprioception (joint position sense)- move toe up and down

graphesthesia- drawing on the hand

Question 45

A 65 yr old interior decorator presents for an annual exam. In order to examine her breasts, you ask her first place her arms over her head & then to place her arms against her hips, & then to lean forward. You notice that her left nipple & areola is retracted while she is in the leaning forward position. The appearance of the skin is as expected. This finding makes you suspicious for which clinical condition?

A. Breast Ca+

B. Mastitis

C. Fibrocystic breast disease

D. Acanthosis nigricans

Answer 45

A. Breast Ca+

Question 46

You are in the ER assessing a pt. with abd pain & fever. You are performing an abd exam to assess for peritoneal signs. Which of the following is NOT a peritoneal sign?

A. rebound tenderness

B. involuntary guarding

C. rigity of the abd

D. voluntary guarding

Answer 46

D.voluntary guarding

Question 47

A 15 yr old high school student presents to the office with a 1 day history of nausea & anorexia. He describes the pain as generalized yesterday, but today it has localized to the right lower quadrant. You palpate the left lower quadrant & the pt. experiences pain in the right lower quadrant. What is the name of this sign?

A. Psoas sign

B. Obturator sign

C. Rovsings sign

D. Cutaneous hyperesthesia

Answer 47

C. Rovsings sign

Question 48

If a pt. is unaware that she is unable to remain focused on tasks, you assess that she has a deficient in which of the following functions?

A. Insight

B. Judgement

C. Thought content

D. Attention

Answer 48

D attention

Question 49

For which chronic problem is Phalen’s test used to assess numbness & tingling in the hand?

A. rotator cuff tear

B. carpal tunnel syndrome

C. RA

D. effusion of the elbow

Answer 49

B. carpal tunnel syndrome

Question 50

A man is found lying in the garden, conscious but incoherent with one side much weaker than the other. What history question is MOST important to ask first?

A. Has the pt. been on any meds for his heart?

B. has a similar episode in the past?

C. was he weaker on one side prior to this time?

D. what has he eaten in the past 24 hrs?

COME BACK TO!

Answer 50

C? weaker on 1 side prior to this time?

Question 51

What is the name given to a band of skin that aids in localizing neurologic lesions & is innervated by the sensory root of a single spinal nerve?

A. corticospinal tract

B. ipsilateral

C. dermatome

D. reflex

Answer 51

C. dermatome

Question 52

Which nodes are examined by grasping the anterior axillary fold between the thumb & fingers & palpating the fingers inside the border of the pectoral muscle?

A. subscapular nodes

B. pectoral nodes

C. central nodes

D. lateral nodes

Answer 52

B. pectoral nodes