Quizes Flashcards by lori williams

The provider is preparing to perform a physical assessment. The correct action by the provider is reflected by which statement? The provider:
A. performs the examination from the left side of the bed.
B. examines tender or painful areas first to help relieve the patient’s anxiety.
C. follows the same examination sequence regardless of the patient’s age or condition.
D. organizes the assessment so that the patient does not change positions too often.

Answer Key: D
Feedback: The steps of the assessment should be organized so that the patient does not change positions to often. The sequence of the steps of the assessment may differ depending on the age of the person and the examiner’s preference. Tender or painful areas should be assessed last.

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The provider is performing a general survey. Which action is a component of the general survey?
A. Observing the patient’s body stature and nutritional status.
B. Interpreting the subjective information the patient has reported.
C. Measuring the patient’s temperature, pulse, respirations, and blood pressure.
D. Observing specific body systems while performing the physical assessment.

Answer Key: A
Feedback: The general survey is a study of the whole person that includes observation of physical appearance, body structure, mobility and behavior.

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When assessing an older adult, the provider keeps in mind which vital sign changes occur with aging?
  A.  Increase in pulse rate. 
    B.  Widened pulse pressure. 
  C.  Increase in temperature. 
  D.  Decrease in diastolic pressure.

Answer Key: B
Feedback: With aging the systolic blood pressure increases, leading to widened pulse pressure. With many older people, both the systolic and diastolic pressures increase. The pulse rate and temperature do not increase.

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Question 4 of 10 5.0 Points
The provider is taking an initial blood pressure on a 72-year-old patient with documented hypertension. How should the provider proceed?
A. Place the cuff on the patient’s arm and inflate it to 30 mm Hg above the patient’s pulse rate.
B. Inflate the cuff to 200 mg Hg in an attempt to obtain the most accurate systolic reading.
C. Inflate the cuff 30 mm Hg above the point at which the palpated pulse disappears.
D. Look at the patient’s past blood pressure readings and inflate the cuff 30 mm Hg above the highest systolic reading recorded.

Answer Key: C
Feedback: An auscultatory gap occurs in about 5% of the people, most often in those with hypertension. To check for the presence of an auscultatory gap, inflate the cuff 20-30 mm Hg beyond the point at which the palpated pulse disappeared.

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Question 5 of 105.0 Points
A 70-year-old man has a blood pressure of 150/90 mm Hg in a lying position, 130/80 mm Hg in a sitting position, and 100/60 in a standing position. How should the provider evaluate these findings?
A. This is a normal response due to changes in the patient’s position.
B. The change in blood pressure readings is called orthostatic hypotension.
C. The blood pressure reading in the lying position is within normal limits.
D. The change in blood pressure readings is considered within normal limits for the patient’s age.

Answer Key: B
Feedback: Orthostatic hypotension is a drop in systolic pressure of more than 20 mm Hg, which occurs with a quick change to a standing position. Aging people have the greatest risk of this problem.

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Which statement indicates the provider understands the pain experienced by an elderly patient?
A. “Older patients must learn to tolerate pain.”
B. “Pain is a normal process of aging and is to be expected.”
C. “Pain indicates pathology or injury and is not a normal process of aging.”
D. “Older individuals perceive pain to a lesser degree than do younger individuals.”

Answer Key: C
Feedback: Pain indicates pathology or injury and should never be considered something an elderly person should expect or tolerate. Pain is not a normal process of aging, and there is no evidence that pain perception is reduced with aging.

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When assessing a patient's pain, the provider knows an example of visceral pain would be:
  A.  hip fracture. 
    B.  cholecystitis. 
  C.  second degree burns. 
  D.  pain after leg amputation.

Answer Key: B

Feedback: Visceral pain originates from the larger interior organs, such as the gallbladder, liver, or kidneys.

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What will the provider use to assess a patient's attention? (Select all that apply.)
 A. Number list 	
 B. Calculations 	
 C. Serial 7s 	
 D. Proverbs 	
 E. Spelling backward

Answer Key: C, E

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While conducting a mental status history the provider notes that the patient is articulate, makes spontaneous comments, and speaks at a normal rate. Which section of the history is this information important?
  A.  Appearance and behavior 
  B.  Mood 
  C.  Thoughts and perceptions 
    D.  Speech and language

Answer Key: D

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Question 10 of 10 5.0 Points
When conducting a mental health examination, what should the provider carefully assess as signs of depression in an older, recently widowed patient? (Select all that apply.)
 A. Sleep disorder 	
 B. Difficulty making decisions 	
 C. Anhedonia 	
 D. Family violence 	
 E. Firearms in the house

Answer Key: A, B, C

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Question 1 of 105.0 Points
The nurse practitioner is preparing to conduct a health history. Which of these statements best describes the purpose of a health history?
A. To provide an opportunity for interaction between patient and provider.
B. To provide a form for obtaining the patient’s biographic information.
C. To document the normal and abnormal findings of a physical assessment.
D. To provide a database of subjective information about the patient’s past and current health.

Answer Key: D
Feedback: The purpose of the health history is to collect subjective data - what the person says about himself or herself.

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During an assessment of a patient’s family history, the provider constructs a genogram. Which statement best describes a genogram?
A. A list of diseases present in a person’s near relatives.
B. A graphic family tree that uses symbols to depict the gender, relationship, and age of immediate family members.
C. A drawing that depicts the patient’s family members up to five generations back.
D. A description of the health of a person’s children and grandchildren.

Answer Key: B
Feedback: A genogram (or pedigree) is a graphic family tree that uses symbols to depict the gender, relationship, and age of immediate blood relatives in at least three generations (parents, grandparents, and siblings).
Question 3 of 10 5.0 Points

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The provider is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins?
A. “Please stay during the interview; you can answer for her if she does not know the answer.”
B. “It would be helpful to interview the three of you together.”
C. “While I interview your daughter, will you please stay in the room and complete these family health history questionnaires?”
D. “While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires?”

Answer Key: D

Feedback: Interview the girl alone. The parents can wait outside and fill out family health history questionnaires.

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Question 4 of 105.0 Points
The provider makes which adjustment in the physical environment in order to promote the success of an interview?
A. Reduces noise by turning off televisions and radios.
B. Reduces the distance between the interviewer and the patient to 2 feet or less.
C. Provides a dim light that makes a room cozier and will help the patient relax.
D. Arranges seating across a desk or table to allow the patient some personal space.

Answer Key: A
Feedback: The provider should reduce noise by turning off the television, radio and other unnecessary equipment because multiple stimuli are confusing. The interviewer and patient should be about 4 to 5 feet apart; the room should be well-lit so that the interviewer and patient can see each other clearly. Having a table or desk in between the two people creates the idea of a barrier; having a table or desk in between the two people creates the idea of a barrier; equal-status seating, at eye-level, is better.

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Question 5 of 10 5.0 Points
During an interview, the provider states, "You mentioned shortness of breath. Tell me more about that." Which verbal skill is used with this statement?
  A.  Reflection 
  B.  Facilitation 
  C.  Direct Question 
    D.  Open-ended Question

Answer Key: D
Feedback: The open-ended question asks for narrative information. It states that topic to be discussed but only in general terms. The provider should use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic.

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A provider is taking complete health histories on all of the patients attending a wellness workshop. On this history form, one of the questions asked, “You don’t smoke, drink, or take drugs, do you?” This question is an example of:
A. talking too much.
B. using confrontation.
C. using biased or leading questions.
D. using blunt language to deal with distasteful topics.

Answer Key: C
Feedback: This is an example of using leading or biased questions. Asking, “You don’t smoke do you?” implies that one answer is “better” than another. If the person wants to please someone, he or she is either forced to answer in a way corresponding to their implied values or is made to feel guilty when admitting the other answer.

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Question 7 of 10 5.0 Points
The provider is conducting an interview in an outpatient clinic and is using a computer to record data. Which is the best use of the computer in this situation?
A. Collect the patients data in a direct, face-to-face manner.
B. Enter all the data as the patient states it.
C. Ask the patient to wait as the provider enters the data.
D. Type the data into the computer after the narrative has been explored.
E. Allow the patient to see the monitor during typing.

Answer Key: A, E
Feedback: The use of a computer can become a barrier. The provider should begin the interview as usual by greeting the patient, establishing rapport, and collecting the patient’s narrative story in a direct face-to-face manner. Only after the narrative is fully explored should the provider type data into the computer. When typing the provider should position the monitor so that the patient can see it.

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Question 8 of 10 5.0 Points
Which situation is most appropriate for the provider to perform a focused or problem-centered history?
A. A patient’s admission to a long-term care facility.
B. A patient has sudden, severe shortness of breath.
C. A patient’s admission to the hospital for surgery the following day.
D. A patient in an outpatient clinic has cold and flu-like symptoms.

Answer Key: D
Feedback: In a focused or problem centered data base, the provider collects a “mini” data base, smaller in scope than the completed data base. It concerns mainly one problem, one cue complex, or one body system.

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The provider recognizes that the concept of prevention in describing health is essential because:
A. disease can be prevented by treating the external environment.
B. the majority of deaths among Americans under age 65 years are not preventable.
C. prevention places emphasis on the link between health and personal behavior.
D. the means to prevention is through treatment provided by primary health care.

Answer Key: C
Feedback: A natural progression to prevention now rounds out our concept of health. Guidelines to prevention place emphasis on the link between health and personal behavior.

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Question 10 of 10 5.0 Points
A man has been admitted to the observation unit for observation after being treated for a large cut on his forehead. As the provider works through the interview, one of the standard questions has to do with alcohol, tobacco, and drug use. When the provider asks him about tobacco use, he states, “I quit smoking after my wife died 7 years ago.” However, the provider notices an open package of cigarettes in his shirt pocket. Using confrontation, the provider could say:
A. “I know that you are lying.”
B. “Come on, tell me how much you smoke.”
C. “I didn’t realize your wife had died. It must be difficult for you at this time. Please tell me more about that.”
D. “You have said that you don’t smoke, but I see you have an open package of cigarettes in your pocket.”

Answer Key: D
Feedback: In the case of confrontation, a certain action, feeling, or statement, has been observed, and the provider now focuses the patient’s attention on it. The provider should give honest feedback about what is seen or felt. This may focus on a discrepancy. Or the provider may confront the patient when parts of the story are inconsistent.

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A patient tells the provider that he has noticed that one of his moles has started to burn and bleed. When assessing his skin, the provider would pay special attention to the danger signs for pigmented lesions and would be concerned with which additional finding?
    A.  color variation 
  B.  border regularity 
  C.  symmetry of lesions 
  D.  diameter less than 6 mm

Answer Key: A
Feedback: Abnormal characteristics of pigmented lesions are summarized in the mnemonic ABCD: asymmetry of pigmented lesion, border irregularity, color variation, and diameter greater than 6 mm.

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Question 2 of 20 5.0 Points
A patient has come to the clinic for a skin assessment because he is afraid he might have skin cancer. During the assessment the provider notices several areas of pigmentation that look greasy, dark, and “stuck” on his skin. Which is the best prediction? He probably has:
A. senile lentigines, which do not become cancerous.
B. atinic keratoses, which are precursors to basal cell carcinoma.
C. acrochordons, which are precursors to squamous cell carcinoma.
D. seborrheic keratoses, which do not become cancerous.

Answer Key: D

seborrheic keratoses, which do not become cancerous.

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Question 3
The provider just noted from a patient’s medical record that the patient has a lesion that is confluent in nature. On examination, the provider would expect to find this:
A. lesions that run together.
B. annular lesions that have grown together.
C. lesions arranged in a line along a nerve route.
D. lesions that are grouped or clustered together.

Answer Key: A
Feedback: Confluent lesions (as with urticaria [hives]) run together. Grouped lesions are clustered together. Annular lesions are circular in nature. Zosteriform lesions are arranged along a nerve route.

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Question 4 
When examining the face, the provider is aware that the two pairs of salivary glands that are accessible to examination are the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ glands.
  A.  occipital and submental 
  B.  parotid and jugulodigastric 
    C.  parotid and submandibular 
  D.  submandibular and occipital

Answer Key: C

parotid and submandibular

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Question 5 A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The provider suspects damage to cranial nerve ___ and proceeds with the examination by _____________. A. XI: palpating the anterior and posterior triangles. B. XI: asking the patient to shrug her shoulders against resistance. C. XII: percussing the sternomastoid and submandibular neck muscles. D. XII: assessing for a positive Romberg sign.

Answer Key: B

``` Question 6 During an examination of a patient, the provider notes lymphadenopathy and suspects an acute infection. Acutely infected lymph nodes would be: A. clumped. B. unilateral. C. firm but freely movable. D. firm and nontender. ```

Answer Key: C Feedback: Acutely infected lymph nodes are bilateral, enlarged, warm, tender, and firm but freely movable. Unilaterally enlarged nodes that are firm and non tender may indicate cancer.

During ocular examinations, the provider keeps in mind that movement of the extraocular muscles is: A. decreased in the elderly. B. impaired in a patient with cataracts. C. stimulated by cranial nerves I and II. D. stimulated by cranial nerves III, IV, and VI.

Answer Key: D | Feedback: Movement of the extraocular muscles is stimulated by three cranial nerves: III, IV, and VI.

Question 8 The provider is testing a patient's visual accommodation, which refers to which action? A. Pupillary constriction when looking at a near object. B. Pupillary dilation when looking at a far object. C. Changes in peripheral vision in response to light. D. Involuntary blinking in the presence of bright light.

Answer Key: A Feedback: The muscle fibers of the iris contract the pupil in bright light and accommodate for near vision, which also results in pupil constriction.

A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The provider interprets these results to indicate that: A. at 30 feet the patient can read the entire chart. B. the patient can read at 20 feet what a person with normal vision can read at 30 feet. C. the patient can read that chart from 20 feet in the left eye and 30 feet in the right eye. D. the patient can read from 30 feet what a person with normal vision can read at 20 feet.

Answer Key: B Feedback: The top number indicates the distance the person is standing from the chart; the denominator gives the distance at which a normal eye can see.

Question 10 The provider is performing the diagnostic positions test. Normal findings would be which of these results? A. Convergence of the eyes. B. Parallel movement of both eyes. C. Nystagmus in extreme superior gaze. D. A slight amount of lid lag when moving the eyes from a superior to inferior position.

Answer key B

Question 11 The provider is examining a patient's retina with an opthalmoscope. Which finding is considered normal? A. An optic disc that is a yellow-orange color. B. Optic disc margins that are blurred around the edges. C. The presence of pigmented crescents in the macular area. D. The presence of the macula located on the nasal side of the retina.

Answer Key: A

``` Question 12 During an opthalmoscopic examination of the eye, the provider notices areas of exudate that look like "cotton wool" or fluffy gray-white cumulus clouds. This finding indicates which possible problem? A. Diabetes B. Hyperthyroidism C. Glaucoma D. Hypotension ```

Answer Key: A

Question 13 When examining the ear with an otoscope, the provider notes that the tympanic membrane should appear: A. light pink with a slight bulge. B. pearly gray and slightly concave. C. pulled in at the base of the cone of light. D. whitish with a small fleck of light in the superior portion.

Answer Key: B Feedback: The tympanic membrane is a translucent membrane with a pearly gray color and a prominent cone of light in the anteroinferior quadrant, which is the reflection of the otoscope light.

Question 14 A patient has been shown to have a sensorineural hearing loss. During the assessment, it would be important for the provider to: A. speak loudly so he can hear the questions. B. assess for middle ear infection as a possible cause. C. ask the patient what medications he is taking. D. look for the source of the obstruction in the external ear.

Answer Key: C Feedback: A simple increase in amplitude may not enable the person to understand words. Sensorineural hearing loss may be caused by prebycusis, which is a gradual nerve degeneration that occurs with aging and by ototoxic drugs, which affect the hair cells in the cochlea.

Question 15 The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the provider? A. It is unusual for a small child to have frequent ear infections unless there is something else wrong. B. We need to check the immune system of your son to see why he is having so many ear infections. C. Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear. D. Your son's eustachian tube is relatively short and wider than yours because of his age which allows for infections to develop more easily.

Answer Key: D

``` Question 16 A 31-year-old patient tells the provider that he has noticed a progressive loss in his hearing. He says that it does not seem to help when people speak louder or if he turns up the volume. The most likely cause of his hearing loss is: A. otosclerosis. B. presbycusis. C. trauma to the bones. D. frequent ear infections. ```

Answer Key: A

Question 17 A 70-year-old patient tells the provider that he is having trouble hearing, especially in large groups. He says he "can't always tell where the sound is coming from" and "the words often sound mixed up". What might the nurse suspect as the cause for the change? A. Atrophy of the apocrine gland. B. Cilia becoming coarse and stiff. C. Nerve degeneration in the inner ear. D. Scarring of the tympanic membrane.

Answer Key: C

Question 18 In assessing the tonsils of a 30-year-old, the provider notices that they are involuted, granular in appearance, and appear to have deep crypts. What is the correct response to these findings? A. Refer the patient to ENT. B. Nothing, this is the appearance of normal tonsils. C. Continue with the assessment looking for any other abnormal findings. D. Obtain a throat culture on the patient for possible strep infection.

Answer Key: B Feedback: The tonsils are the same color as the surrounding mucous membrane, although they look more granular and their surface shows deep crypts.

``` Question 19 The provider is palpating the sinus areas. If the findings are normal, then the patient should report which sensation? A. No sensation B. Firm pressure C. Pain during palpation D. Pain sensation behind the eyes ```

Answer key B

Question 20 The provider is performing an otoscopic examination on an adult. Which of these actions is correct? A. Tilt the person's head forward during the exam. B. Once the speculum is in the ear release the traction. C. Pull the pinna up and back before inserting the speculum. D. Use the smallest speculum to decrease the amount of discomfort.

Answer Key C

``` When listening to heart sounds, the provider knows that the valve closure that can be heard best at the base of the heart are: A. mitral and tricuspid. B. tricuspid and aortic. C. aortic and pulmonic. D. mitral and pulmonic. ```

Answer Key: C Feedback: The second heart sound (S2) occurs with closure of the semilunar (aortic and pulmonic) valves and signals the end of systole. Although it is heard over all the precordium, S2 is louder at the base of the heart.

Question 2 Which of these statements describes the closure of valves in a normal cardiac cycle? A. The aortic valve closes slightly before the tricuspid valve. B. The pulmonic valve closes slightly before the aortic valve. C. The tricuspid valve closes slightly later than the mitral valve. D. Both the tricuspid and pulmonic valve closes at the same time.

Answer Key: C Feedback: Events occur just slightly later in the right side of the heart because of the route of myocardial depolarization. As a result, two distinct components to each of the heart sounds exist, and sometimes they can be heard separately. In the first heart sound, the mitral component (M1) closes just before the tricuspid component (T1).

Question 3 The findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations 5 cm above the sternal angle when his head is elevated 45 degrees. The provider knows that this finding indicates: A. decreased fluid volume. B. increased cardiac output. C. narrowing of jugular veins. D. elevated pressure related to heart failure.

Answer Key: D Feedback: Because no cardiac valve exists to separate the superior vena cava from the right atrium, the jugular veins give information about activity on the right side of the heart. They reflect filling pressures and volume changes.

Question 4 During an assessment of a healthy adult, where would the provider expect to palpate the apical impulse? A. Third left intercostal space at the midclavicular line. B. Fourth left intercostal space at the sternal border. C. Fourth left intercostal space at the anterior axillary line. D. Fifth left intercostal space at the midclavicluar line.

Answer Key: D Feedback: The apical impulse should occupy only one intercostal space, the fourth or fifith and it should be at or medial to the midclavicular line.

Question 5 Which statement about the apices of the lungs is true? The apices of the lungs: A. are at the level of the second rib anteriorly. B. extend 3 to 4 cm above the inner third of the clavicles. C. are located at the sixth rib anteriorly and the eighth rib laterally. D. rest on the diaphragm at the fifth intercostal space in the midclavicular line.

Answer Key: B | Feedback: The apex of the lung on the anterior chest is 3 to 4 cm above the inner third of the clavicles.

Question 6 During an assessment, the provider knows that expected assessment findings in the normal adult lung include the presence of: A. adventitious sounds and limited chest expansion. B. increased tactile fremitus and dull percussion tones. C. muffled voice tones and symmetrical tactile fremitus. D. absent voice tones and hyperresonant percussion tones.

Answer Key: C Feedback: Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds.

Question 7 During percussion, the provider knows that a dull percussion note elicited over a lung lobe most likely results from: A. shallow breathing. B. normal lung tissue. C. decreased adipose tissue. D. increased density of lung tissue.

Answer Key: D Feedback: A dull percussion note indicates an abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor. Resonance is

Question 8 When assessing tactile fremitus the provider recalls that it is normal to feel tactile fremitus most intensely over which location? A. Between the scapula. B. Third intercostal space, MCL. C. Fifth intercostal space, MAL. D. Over the lower lobes, posterior side.

Answer Key: A Feedback: A dull percussion note indicates an abnormal density in the lungs, as with pneumonia, pleural effusion, atelectasis, or tumor. Resonance is the expected finding in normal lung tissue.

Question 9 The provider notes hyperresonant percussion tones when percussing the thorax of an infant. The best action would be to: A. suspect a pneumothorax. B. consider this a normal finding. C. monitor the infants respiratory rate and rhythm.

Answer Key: B Feedback: The percussion note of hyperresonance occurs normally in the infant and young child, owing to the relatively thin chest wall.

Question 10 A patient has a history of COPD. During the assessment the provider is most likely to observe which of these? A. Unequal chest expansion. B. Increased tactile fremitus. C. Atrophied neck and trapezius muscles. D. An anteroposterior to transverse diameter ratio of 1:1.

Answer Key: D

Question 11 A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the provider most likely to observe? A. Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, ankle edema. B. Rasping cough, thick mucoid sputum, wheezing, bronchitis. C. Productive cough, dyspnea, weight loss, anorexia, tuberculosis. D. Fever, dry non-productive cough, diminished breath sounds.

Answer Key: A

``` Question 12 The correct method to use when progressing from one ausculatory site on the thorax to another is __________________ comparison. A. side-to-side B. top-to-bottom C. posterior-to-anterior D. interspace-to-interspace ```

Answer Key: A Feedback: Side to side comparison is most important when auscultating the chest. The provider should listen to at least one full respiration in each location. Other techniques are incorrect.

Question 1 In performing a breast examination, the provider knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant is: A. the largest quadrant of the breast. B. the location of most breast tumors. C. where most of the suspensory ligaments attach. D. more prone to injury and calcification than other locations in the breast.

Answer Key: B | Feedback: The upper outer quadrant is the site of most breast tumors.

Question 2 A 14-year-old girl is anxious about not having reached menarche. When taking the history, the provider should ascertain which of the following? The age: A. she began to develop breasts. B. her mother developed breasts. C. she began to develop pubic hair. D. she began to develop axillary hair.

Answer Key: A | Feedback: Full development from stage 2 to stage 5 takes an average of 3 years, although the range is 1.5 to 6 years.

Question 3 A woman has just learned she is pregnant. What are some things the provider should teach her about her breasts? A. She can expect her aerolae to become larger and darker in color. B. Breasts may begin secreting milk after the fourth month of pregnancy. C. She should inspect her breasts for visible veins and report this immediately. D. During pregnancy, breast changes are fairly uncommon; most of the changes occur after birth.

Answer Key: A Feedback: The aerolae become larger and darker and grow a darker brown as pregnancy progressess, and the tubercles become more prominent.

Question 4 of 25 4.0 Points A patient is newly diagnosed with benign breast disease. The provider recognizes that which statement about benign breast disease is true? The presence of the benign breast disease: A. makes it harder to examine the breasts. B. frequently turns into cancer in woman's later years. C. is easily reduced with hormone replacement therapy. D. is usually diagnosed before a woman reaches childbearing age.

Answer Key: A Feedback: The presence of benign breast disease (formerly fibrocystic breast disease) makes it harder to examine the breasts; the general lumpiness of the breast conceals a new lump. Other statements are not true.

Question 5 During the physical examination, the provider notices that a female patient has an inverted left nipple. Which statement regarding this is most accurate? A. Normal nipple inversion is usually bilateral. B. A unilateral inversion is usually abnormal. C. It should be determined whether the inversion is a recent change. D. Nipple inversion is not significant unless accompanied by an underlying palpable mass.

Answer Key: C Feedback: The provider should distinguish a recently retracted nipple from one that has been inverted for many years or since puberty. Normal nipple inversion may be unilateral or bilateral and usually can be pulled out. Recent nipple retraction signifies acquired disease.

Question 6 The provider has palpated a lump in a female patient's right breast. The provider documents this a small, round, firm, distinct, lump located at 2 o'clock, 2 cm from the nipple. It is non-tender and fixed. There is no associated reaction of skin or nipple, no erythema, and no axillary lympadenopathy. Which of these statements reveals the information that is missing from the documentation? It is missing information about: A. the shape of the lump. B. the lump's consistency. C. the size of the lump. D. whether the lump is solitary or multiple.

Answer Key: C Feedback: If the provider feels a lump or mass, he or she should note these characteristics: location, size - judge in centimeters in three dimensions: width X length X thickness, shape, consistency, motility, distinctness, nipple, the skin over the lump, tenderness, and lymphadenopathy.

7 The provider is conducting a class about breast self-examination (BSE). Which of these statements indicates proper BSE technique? A. The best time to perform BSE is in the middle of the menstrual cycle. B. The woman needs to do BSE only bimonthly unless she has fibrocystic breast tissue. C. The best time to perform BSE is 4 to 7 days after the first day of the menstrual period. D. If she suspects that she is pregnant, the woman should not perform BSE until her baby is born.

Answer Key: C Feedback: The provider should help each woman establish a regular schedule of self-care. The best time to conduct breast self-examination is right after the menstrual period, or the 4th-7th day of the menstrual cycle.

Question 8 The provider is discussing breast self-examination with a postmenopausal woman. The best time for postmenopausal women to perform BSE is: A. the same day every month. B. daily, during the shower or bath. C. 1 week after her menstrual period. D. every year with her annual gynecologic examination.

Answer: A

Question 9 A patient is being seen at the clinic for gastrointestinal complaints and weight loss. The provider determines that many of her complaints may be related to erratic eating patterns, eating predominantly fast foods, and high caffeine intake. In this situation, which is most appropriate when collecting current dietary intake information? A. Schedule a time for direct observation of the patient during meals. B. Ask the patient for a 24 hour diet recall and assume this is reflective of a typical day for her. C. Have the patient complete a food diary for 3 days, including 2 weekdays and 1 weekend day. D. Use the food frequency questionnaire to identify the amount of intake of specific foods.

Answer Key: C Feedback: Food diaries require the individual to write down everything consumed for a certain time period. Because of the erratic eating patterns of this individual, assessing dietary intake over a few days would produce more accurate information regarding eating patterns.

The provider is precepting a nurse practitioner student and is watching them perform auscultation of a patient's abdomen. Which statement made by the student shows correct understanding of the reason ausculation precedes percussion and palpation of the abdomen. A. "We need to determine areas of tenderness before using percussion and palpation." B. "It prevents distortion of bowel sounds that might occur after percussion and palpation." C. "It allows the patient more time to relax and therefore be more comfortable with the physical examination." D. "This prevents distortion of vascular sounds such as bruits and hums that might occur after percussion and palpation."

Answer Key: B Feedback: Auscultation is performed first (after inspection) because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.

Question 11 The provider is auscultating bowel sounds. Which of these statements is true of bowel sounds? A. They are usually loud, high-pitched, rushing, tinkling sounds. B. They are usually high-pitched, gurgling, irregular sounds. C. They sound like two pieces of leather being rubbed together. D. They originate from the movement of air and fluid through the large intestine.

Answer Key: B Feedback: Bowel sounds are high-pitched, gurgling, cascading sounds that occur irregularly from 5 to 30 times per minute. They originate from movement of air and fluid through the small intestine.

Question 12 During an abdominal assessment, the provider would consider which of these findings as normal? A. The presence of a bruit in the femoral area. B. A tympanic percussion note in the umbilical region. C. A palpable spleen between the ninth and eleventh ribs in the left midaxillary line. D. A dull percussion note in the left upper quadrant at the midclavicular line.

Answer Key: B Feedback: Tympany should predominate in all four quadrants of the abdomen because the air in the intestines rises to the surface when the person is supine. Vascular bruits are not usually present. Normally the spleen is not palpable. Dullness would not be found in the area of lung resonance (left upper quadrant in the MCL)

``` Question 13 A patient is complaining of a sharp pain along the costovertebral angles. The provider knows that this symptom is most often indicative of: A. ovary infection. B. liver enlargement. C. kidney inflammation. D. spleen enlargement. ```

Answer Key: C Feedback: Sharp pain along the costovertebral angles occurs with inflammation of the kidney or paranephric area. The other options are not correct.

``` Question 14 During an abdominal assessment, the provider is unable to hear bowel sounds. Before documenting this finding as "absent bowel sounds" the provider should listen for at least: A. 1 minute. B. 5 minutes. C. 10 minutes. D. 2 minutes in each quadrant. ```

Answer Key: B | Feedback: Absent bowel sounds are rare. The provider must listen for 5 minutes before deciding bowel sounds are absent.

Question 15 The provider knows that during an abdominal assessment, deep palpation is used to determine: A. bowel motility. B. enlarged organs. C. superficial tenderness. D. overall impression of skin surface and superficial musculature.

Answer Key: B Feedback: With deep palpation, the nurse should notice the location, size, consistency, and mobility of any palpable organs and the presence of any abnormal enlargement, tenderness, or masses.

``` Question 16 A patient is suspected of having cholecystitis. The provider should conduct which of these techniques to assess for this condition? A. Obturator test. B. Test for Murphy's sign. C. Assess for rebound tenderness. D. Iliopsoas muscle test. ```

Answer Key: B Feedback: Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder, pain occurs as the descending liver pushes on the inflamed gallbladder onto the examining hand during inspiration (Murphy's test). The person feels sharp pain and abruptly stops inspiration midway.

``` Question 17 The provider suspects that a patient has appendicitis. Which of these procedures are appropriate for use when assessing for appendicitis or a perforated appendix? Select all that apply. A. Test for Murphy's sign. B. Test for Blumberg's sign. C. Test for shifting dullness. D. Perform iliopsoas muscle test. E. Test for fluid wave. ```

Answer Key: B, D Feedback: Testing for Blumberg's sign (rebound tenderness) and performing the iliopsoas muscle test should be used to assess for appendicitis. Murphy's sign is used to assess for an inflamed gallbladder. Testing for a fluid wave and shifting dullness is done to assess for ascites.

Question 18 The mother of a 10-year-old boy asks the provider to discuss the recognition of puberty. The provider should replay by saying: A. "Puberty usually begins about age fifteen." B. "The first sign of puberty is enlargement of the testes." C. "Penis size does not increase until about the age of sixteen." D. "The development of pubic hair precedes testicular or penis enlargement."

Answer Key: B Feedback: Puberty begins sometime between ages 9 1/2 and 13 1/2 years. The first sign is enlargement of the testes. Next, pubic hair appears and then penis size increases.

Question 19 The provider is aware that which of these statements is true regarding the incidence of testicular cancer? A. Testicular cancer is the most common cancer in men aged 30 to 50 years. B. The early symptoms of testicular cancer are pain and induration. C. Men with a history of cryptorchidism are at greatest risk for development of testicular cancer. D. The cure rate for testicular cancer is low.

Answer Key: C Feedback: Men with undescended testicles (cryptorchidism) are at greatest risk for development of testicular cancer. The overall incidence of testicular cancer is rare. Testicular cancer has no early symptoms. When detected early and treated before metastasis, the cure rate is almost 100%.

Question 20 During an examination of an aging male, the provider recognizes that normal changes to expect would be: A. a change in scrotal color. B. a decrease in the size of the penis. C. enlargement of the testes and scrotum. D. an increase in the number of rugae over the scrotal sac.

Answer Key: B Feedback: When assessing the genitals of an older man, the nurse may notice thinner, graying pubic hair and a decrease in the size of the penis. The size of the testes may be decreased, they may feel less firm, and the scrotal sac is pendulous with less rugae. There is no change in scrotal color.

Question 21 After completing an assessment of a 60-year-old man with a family history of colon cancer, the provider discusses with him early detection measures for colon cancer. The provider should mention the need for a(n): A. annual proctoscopy. B. colonoscopy every 10 years. C. fecal test for blood every 6 months. D. digital rectal examination every 2 years.

Answer Key: B Feedback: Early detection measures for colon cancer include a digital rectal examination performed annually after age 50 years, a fecal occult blood test annually after age 50 years, sigmoidoscopy every 5 years or colonoscopy every 10 years after age 50 years; and a PSA blood test annually for men over 50 years old, except black men beginning at age 45 years (American Cancer Society, 2006).

Question 23 A woman is in the clinic for an annual gynecologic examination. The provider should plan to begin the interview with the: A. menstrual history because it is generally non-threatening. B. obstetric history because it is the most important information. C. urinary system history because there may be problems in this area as well. D. sexual history because it will build rapport to discuss this first.

Answer Key: A Feedback: Menstrual history is usually nonthreatening; thus it is a good place to start. Obstetric, urinary, and sexual histories are also part of the interview but not necessarily the best topics with which to start.

``` Question 24 When performing an external genitalia examination of a 10-year-old girl, the provider notices that this is no pubic hair, and the mons and the labia are covered with fine vellus hair. These findings are consistent with stage __________ of sexual maturity, according to the Sexual Maturity Rating Scale. A. 1 B. 2 C. 3 D. 4 ```

Answer Key: A Feedback: Sexual Maturity Rating stage 1 is the preadolescent stage. There is no pubic hair. The mons and labia are covered with fine, vellus hair as on the abdomen.

Question 25 A 54-year-old woman who has just completed menopause is in the clinic today for a yearly physical examination. Which Of these statements should the provider include in patient education? A postmenopausal women: A. is not at any great risk for heart disease than a younger woman." B. should be aware that she is at increased risk for dyspareunia because of decreased vaginal secretions." C. has only stopped menstruating; there are no other significant changes with which she should be concerned." D. is likely to have difficulty with sexual pleasure as a result of drastic changes in the female sexual response cycle."

Answer Key: B Feedback: Decreased vaginal secretions leave the vagina dry and at risk for irritation and pain with intercourse (dyspareunia). The other statements are incorrect.

Question 22 When testing stool for occult blood, the provider is aware that a false-positive result may occur with: A. absent bile pigment. B. increased fat content. C. increased ingestion for iron medication. D. a large amount of red meat within the last 3 days.

Answer Key: D Feedback: When testing for occult blood, a false-positive finding may occur if the person has ingested significant amounts of red meat within 3 days of the test. Absent bile pigment causes the stools to be gray or tan in color. Increased fat content causes the stool to be pale, yellow, and greasy. Increased ingestion of iron medication causes the stool to be black in color.

. A 65-year-old is experiencing pain in his left calf when he exercises that disappears after resting for a few minutes. The provider recognizes that this description is most consistent with ____________. A. venous obstruction. B. claudication due to venous abnormalities. C. ischemia caused by partial blockage of an artery. D. ischemia caused by complete blockage of an artery.

Answer Key: C Feedback: Ischemia is deficient supply of oxygenated arterial blood to a tissue. A partial blockage creates an insufficient supply, and the ischemia may be apparent only during exercise when oxygen needs increase.

``` Question 2 of 10 5.0 Points A 67-year-old patient states he recently began to have pain in his left calf when climbing the stairs to his apartment. This pain is relieved for about 2 minutes then he is able to resume his activities. The provider interprets that this patient is most likely experiencing: A. claudication. B. sore muscles. C. muscle cramps. D. venous insufficiency. ```

Answer Key: A Feedback: Intermittent claudication feels like a "cramp" and is usually relieved by rest within 2 minutes. The other responses are not correct.

A patient complains of leg pain that wakes him at night. He states that he "has been having problems" with his legs. He has pain in his legs when they are elevated that disappears when he dangles them. He recently noticed a "sore" on the inner aspect of the right ankle. On the basis of this history information, the provider interprets that the patient is most likely experiencing: A. pain related to lymphatic abnormalities. B. problems related to arterial insufficiency. C. problems related to venous insufficiency. D. pain related to musculoskeletal abnormalities.

Answer Key: B Feedback: Night leg pain is common in aging adults. It may indicate the ischemic rest pain of peripheral vascular disease. Alterations in arterial circulation cause pain that becomes worse with leg elevation and is eased when the extremity is dangled.

Question 4 of 10 5.0 Points The provider is preparing to perform an Allen test. Which is an appropriate reason for this test? A. To measure the rate of lymphatic drainage. B. To evaluate the adequacy of capillary patency before venous blood draws. C. To evaluate the adequacy of collateral circulation before cannulating the radial artery. D. To evaluate the venous refill rate that occurs after the ulnar and radial arteries are temporarily occluded.

Answer Key: C Feedback: An Allen test is used to evaluate the adequacy of collateral circulation before the radial artery is cannulated. The other responses are not reasons for an Allen test.

A patient has been diagnosed with venous stasis. Which of these findings would the provider most likely observe? A. A unilateral cool foot. B. Thin, shiny, atrophic skin. C. Pallor of the toes and cyanosis of the nail beds. D. A brownish discoloration to the skin of the lower leg.

Answer Key: D Feedback: A brown discoloration occurs with chronic venous stasis as a result of hemosiderin deposits (a by-product of red blood cell degradation). Pallor, cyanosis, atrophic skin, and unilateral coolness are all signs associated with arterial problems.

Question 6 of 10 5.0 Points A patient has hard, non-pitting edema of the left lower leg and ankle. The right leg has no edema. Based on these findings the provider recalls that: A. non-pitting, hard edema occurs with lymphatic obstruction. B. alterations in arterial function will cause this edema. C. phlebitis of a superficial vein will cause bilateral edema. D. long-standing arterial obstruction will cause pitting edema.

Answer Key: A Feedback: Unilateral edema occurs with occlusion of a deep vein and with unilateral lymphatic obstruction. With these factors, the edema is non-pitting and feels hard to the touch (brawny edema)

Question 7 of 10 5.0 Points A teenage girl arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The provider examines her hand would expect a fracture if the girl complains: A. of a dull ache. B. that the pain in her wrist is deep. C. of sharp pain that increases with movement. D. of dull throbbing pain that increases with rest.

Answer Key: C | Feedback: A fracture causes sharp pain that increases with movement. The other pains do not occur with a fracture.

``` Question 8 of 10 5.0 Points A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for awhile, and then gets worse again if he sits for long periods of time. The provider should assess for other signs of what problem? A. Tendinitiis B. Osteoarthritis C. Rheumatoid arthritis D. Intermittent claudication ```

Answer Key: C Feedback: Rheumatoid arthritis is worse in the morning when arising. Movement increases most joint pain, except in rheumatoid arthritis, in which movement decreases pain. The other options are not correct.

Question 9 of 10 5.0 Points The provider suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen's test. To perform this test, the provider should instruct the patient to: A. dorsiflex the foot. B. plantarflex the foot. C. hold both hands back to back while flexing wrists 90 degrees for 60 seconds. D. hyperextend the wrists with the palmar surface of both hands touching and wait for 60 seconds.

Answer Key: C Feedback: For the Phalen's test, the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand. The Phalen's test reproduces numbness and burning in a person with carpal tunnel syndrome. The other actions are not correct for testing for carpal tunnel syndrome.

``` Question 10 of 10 5.0 Points When assessing muscle strength, the provider observes that a patient has complete range of motion against gravity with full resistance. What grade should the provider record using a 0 to 5 point scale? A. 2 B. 3 C. 4 D. 5 ```

Answer Key: D | Feedback: Complete range of motion against gravity is normal muscle strength and is recorded as Grade 5 muscle strength.

``` A 50-year-old woman is in clinic for weakness in her left leg that she has noticed for the past week. The provider should perform which type of neurologic examination? A. Glasgow Coma Scale B. Neurologic re-check examination C. Screening neurologic examination D. Complete neurologic examination ```

Answer Key: D Feedback: The provider should perform a complete neurologic examination on persons who have neurologic concerns (e.g., headache, weakness, loss of coordination) or who have shown signs of neurologic dysfunction. The Glasgow Coma scale is used to define a person’s level of consciousness. The neurologic recheck examination is appropriate for persons with demonstrated neurologic deficits. The screening neurologic examination is performed on seemingly well persons who have no significant subjective findings from the history.

Question 2 of 7 5.0 Points During an assessment of the cranial nerves, the provider finds the following: asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of the lower eyelids, and escape of air when the provider presses against the right puffed cheek. This would indicate dysfunction of which of these cranial nerves? A. Motor component of IV B. Motor component of VII C. Motor and sensory component of XI D. Motor component of X and sensory component of VII

Answer Key: B | Feedback: The findings listed reflect a dysfunction of the motor component of cranial nerve VII, the facial nerve.

Question 3 of 7 5.0 Points The provider is testing the function of cranial nerve XI. Which of these best describes the response the provider should expect if the nerve is intact? The patient: A. demonstrates ability to hear normal conversation. B. sticks tongue out midline without tremors or deviation. C. follows an object with eyes without nystagmus or strabismus. D. moves the head and shoulders against resistance with equal strength.

Answer Key: D Feedback: These are the expected normal findings when testing cranial nerve XI (spinal accessory nerve): The patient’s sternomastoid and trapezius muscles are of equal size; the person can rotate the head both ways forcibly against resistance applied to the side of the chin with equal strength; the patient can shrug the shoulders against resistance with equal strength on both sides. Checking the patient’s ability to hear normal conversation checks the function of CN VIII. Having the patient stick out the tongue checks the function of CN XII. Testing the eyes for nystagmus or strabismus is done to check CN III, IV, and VI.

``` Question 4 of 7 5.0 Points When the provider 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 provider would document this finding as a(n): A. negative Homan's sign. B. lack of coordination. C. positive Romberg sign. D. ataxia. ```

Answer Key: C Feedback: Abnormal findings for Romberg test include swaying, falling, and widening base of feet to avoid falling. Positive Romberg sign is loss of balance that is increased by closing of the eyes. Ataxia is uncoordinated or unsteady gait. Homans’ sign is used to test the legs for deep vein thrombosis.

``` Question 5 of 7 5.0 Points The provider places a key in the hand of a patient and he identifies it as a penny. What term would the provider use to describe this finding? A. extinction B. stereognosis C. graphesthesia D. tactile discrimination ```

Answer Key: B Feedback: Stereognosis is the person’s ability to recognize objects by feeling their forms, sizes, and weights. Astereognosis is an inability to identify objects correctly, and it occurs in sensory cortex lesions. Tactile discrimination tests fine touch. Extinction tests the person’s ability to feel sensations on both sides of the body at the same point.

Question 6 of 7 5.0 Points The provider is testing the deep tendon reflexes of a 30-year-old woman who is in the clinic for an annual physical examination. When striking the Achilles and quadriceps, the provider is unable to elicit the reflex. The provider's next response should be to: A. ask the patient to lock her fingers and "pull". B. complete the examination and then test these reflexes again. C. refer the patient to a specialist for further testing. D. document these reflexes as "0" on a scale of 0 to 4+

Answer Key: A Feedback: Sometimes the reflex response fails to appear. It is too soon to document this as “absent” reflexes. Try further encouragement of relaxation, varying the person’s position or increasing the strength of the blow. Reinforcement is another technique to relax the muscles and enhance the response. Ask the person to perform an isometric exercise in a muscle group somewhat away from the one being tested. For example, to enhance a patellar reflex, ask the person to lock the fingers together and “pull.”

``` Question 7 of 7 5.0 Points The provider knows that testing kinesthesia is a test of a person's: A. fine touch. B. position sense. C. motor coordination. D. perception of vibration. ```

Answer Key: B Feedback: Kinesthesia, or position sense, is the person’s ability to perceive passive movements of the extremities. The other options are inc