NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 1 Discussion
Chlamydia Diagnosis
Respond to the following in a minimum of 175 words:
Explain how you would diagnose chlamydia based on a patient's history and exam.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Discussion
Differentiate Prostatitis from BPH
Respond to the following in a minimum of 175 words:
Explain how you would differentiate prostatitis from benign prostatic hyperplasia (BPH) in a 50-year-old male patient.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 3 Discussion
Examining Infants and Children
Respond to the following in a minimum of 175 words:
Explain what part of the physical exam is usually better to perform last on an infant or child and explain why. Incorporate Bates' Guide to Physical Examination and History Taking; Well-Baby Guidelines.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Discussion
Parental Consent/Patient Request
Respond to the following in a minimum of 175 words:
How do you balance parental consent with an adolescent patient requesting birth control?
Does the patient's age affect your response?
How might your principles affect your answer?
What nonverbal cues might the patient exhibit suggesting the presence of family distress?
Incorporate Bates' Guide to Physical Examination and History Taking; Adolescent Guidelines.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 5 Discussion
ECG
Respond to the following in a minimum of 175 words:
What history and physical findings might you elicit indicating the need for an ECG?
What ECG rhythms seen in an office setting require urgent action on the part of the FNP? Incorporate AccessMedicine ECG Practice Guidelines.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 6 Discussion
Biopsies
Respond to the following in a minimum of 175 words:
Give an example of a clinical situation where it would be appropriate to use each of the following types of biopsies:
Shave
Punch
Incisional
Incorporate practice guidelines from Procedures for the Primary Care Provider to support your answer.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 7 Discussion
Diagnostics
Respond to the following in a minimum of 175 words:
Part 1:
Recommend a type of diagnostic image, with or without contrast, for the following patients:
patient with persistent lower back pain resistant to conservative interventions
A 74-year-old male with dyspnea, productive green phlegm, fever and chills, and malaise
A 48-year-old female who is 48-hours postoperative complaining of right-calf pain
Part 2:
When are computed tomography (CT) scans indicated?
When are magnetic resonance imaging (MRIs) indicated?
What helps the FNP decided whether to use contrast or not when ordering a CT scan or MRI?
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 8 Discussion
You can use this space to talk about residency. Ask any questions about the rest of the program. Or ask any questions about material we covered throughout this course.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 1 Assignment
Reflection: i-Human Patients – Carolyn Cross
Assignment Content
Read one of the recommended evidence-based practice academic articles provided at the end of the Carolyn Cross case or locate an academic article from the University Library that relates to the conditions presented in the Carolyn Cross case to improve your clinical skills.
Write a 500-word summary of the article as it relates to your patient encounter with Carolyn Cross.
Include the following in your summary:
Rationale for the questions you asked during the history examination
Rationale for the physical exam that was conducted on the patient
Summary of what the article was trying to validate
Critique of your overall case evaluation (now that the diagnosis has been revealed) and examination of areas of opportunity identified in the article to improve your clinical skills
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Assignment 1
Signature Assignment Episodic SOAP Note Pt. 1 Craig Harris
Assignment Content
This week focused on the male genitourinary system and how to collect a proper history. It is time to practice your documentation skills by completing an episodic SOAP note for Craig Harris.
Review the Craig Harris Scenario.
Use the SOAP Note Template and the SOAP Note Structure Guide to develop your documentation needed to complete your SOAP note.
The assessment and plan sections will not be graded but should be completed to ensure documentation of a complete SOAP note. You will also use this information to complete your E&M coding for the visit. Make sure to:
Document all relevant information using appropriate terminology.
List the appropriate ICD-10 codes and E&M codes using the diagnoses provided.
Submit your assignment.
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Assignment
Wk 2 - Signature Assignment: Episodic SOAP Note Pt. 2: Craig Harris
Assignment Content
Now that you have completed your SOAP note for Craig Harris, it is time for reflection. This reflection is your opportunity to review what you learned about the patient, the process, and the outcomes in preparation for future patient encounters. The reflection must include a discussion about an evidence-based practice to improve the quality of care the patient receives.
Write a 700-word reflection providing rationale for your completed SOAP note. Consider the interview information provided in the patient scenario as you:
List 5 open-ended questions you would ask using descriptive language familiar to the patient during the HPI exam relevant to the chief complaint, including all pertinent and positive negatives. Provide a rationale for each question you ask by explaining why it is appropriate and how it aligns to the chief complaint.
Provide a minimum of 3 rationales for the physical exam components performed.
Locate and review a current evidence-based article that discusses evidence-based guidelines or new research relating to each diagnosis. Provide a brief summary of the article(s) in your reflection.
Identify a minimum of 2 barriers to quality health care the patient can potentially experience per the information provided in the interview (e.g., cultural, linguistic, economic, previous conditions, etc.).
As the FNP, explain how you can address these barriers to improve the quality of care the patient receives. Use a minimum of 2 peer reviewed articles to support your answers.
Cite your references according to APA guidelines.
Submit your assignment.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 3 Assignment
Reflection: i-Human Patients: Buddy Theodore Jr.
Read one of the recommended evidence-based practice academic articles provided at the end of the Buddy Theodore Jr. case or locate an academic article from the University Library that relates to the conditions presented in the Buddy Theodore Jr. case to improve your clinical skills.
Write a 500-word summary of the article as it relates to your patient encounter with Buddy Theodore Jr.
Include the following in your summary:
Rationale for the questions you asked during the history examination
Rationale for the physical exam that was conducted on the patient
Summary of what the article was trying to validate
Critique of your overall case evaluation (now that the diagnosis has been revealed) and examination of areas of opportunity identified in the article to improve your clinical skills
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Assignment 1
Signature Assignment: Pediatric Comprehensive SOAP Note Pt. 1: B.P.
Assignment Content
This week you have gained insight about the pediatric assessment, as you have compared the head to toe examination of the infant, child, and adult.
Now it is time to apply your documentation skills by writing a comprehensive SOAP note focused on a 7-year-old well child check with parental concerns of short stature.
Review the B.P Scenario.
Use the SOAP Note Template and the SOAP Note Structure Guide to develop your documentation needed to complete your SOAP note. Make sure to review the The 10 charts in Set 2: Clinical charts with 3rd and 97th percentiles from the National Center for Health Statistics and reference the appropriate chart within the SOAP note.
The assessment and plan sections will not be graded but should be completed to ensure documentation of a complete SOAP note. You will also use this information to complete your E&M coding for the visit. Make sure to:
Document all relevant information using appropriate terminology.
List the appropriate ICD-10 codes and E&M codes using the diagnoses provided.
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Assignment 2
Assignment Content
Now that you have completed your SOAP note for B.P., it is time for reflection. This reflection is your opportunity to review what you learned about the patient, the process, and the outcomes in preparation for future patient encounters. The reflection must include a discussion about an evidence-based practice to improve the quality of care the patient receives.
Write a 700-word reflection providing rationale for your completed SOAP note. Consider the interview information provided in the patient scenario as you:
List 5 open-ended questions you would ask using descriptive language familiar to the patient during the HPI exam relevant to the chief complaint, including all pertinent and positive negatives. Provide a rationale for each question you ask by explaining why it is appropriate and how it aligns to the chief complaint.
Provide a minimum of 3 rationales for the physical exam components performed.
Locate and review a current evidence-based article that discusses evidence-based guidelines or new research relating to each diagnosis. Provide a brief summary of the article(s) in your reflection.
Identify a minimum of 2 barriers to quality health care the patient can potentially experience per the information provided in the interview (e.g., cultural, linguistic, economic, previous conditions, etc.).
As the FNP, explain how you can address these barriers to improve the quality of care the patient receives. Use a minimum of 2 peer reviewed articles to support your answers.
Format?your references according to APA guidelines.
Submit your assignment.
Resources
Center for Writing Excellence
Reference and Citation Generator
Grammar and Writing Guides
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 6 Assignment 1
Clinical Procedures Case Studies
Complete the case studies by answering the questions beneath each scenario.
Case Study 1
A 35-year-old Hispanic female presents to the office. She complains of severe pain in her left 1st metatarsal (big toe) on the medial corner of her nail bed. She reports that the pain has gradually worsened over the last week and she can now barely walk. She has tried soaking her foot in Epsom salts and putting antibiotic cream on her toe, none of which have helped. On physical exam her toe is swollen and erythematous with tenderness. She also has purulent drainage present.
PMHx: none
SHx: married with two children
Allergies: none
1. What is your diagnosis (include staging)?
2. What is the treatment plan?
3. What post-procedure instruction should she receive?
Case Study 2
A 47-year-old male presents to the clinic. He has a 3-inch laceration on his right forearm and reports that he was replacing a bedroom window when the window broke, cutting his right arm. He reports that “it bled quite a bit.” He wrapped it in a shirt and came directly to the clinic. He does not know when he had his last Td shot, but he thinks it was at least 12 years ago.
On physical examination you observe a 3-inch laceration extending through the dermis layer of skin not affecting tendons or ligaments and determine if sutures are warranted.
PMHx: asthma
SHx: married with no children
Allergies: none
VS: T 98 BP 134/60 HR 78 R 18 02 sat 98%
1. What sequence of steps would you take to treat this patient?
2. What would be your post-procedure instructions to the patient?
3. Should he receive a Td immunization today?
Case Study 3
A 45-year-old male was in his garage grinding a piece of metal when he experienced sudden pain in his right eye. He went inside and flushed his eye with water, but he still felt like there was something in the eye.
On physical examination, his visual acuity in both eyes is 20/20. There is no obvious foreign body seen in the eye; however, the conjunctiva is injected. You consider that he may have a corneal abrasion.
PMHx: none
SHx: divorced with no children
Allergies: sulfa
VS: T 98 BP 136/60 HR 70 R 12 02 sat 97%
1. Describe the process involved with assessing a patient for a corneal abrasion.
2. What would your treatment be if this patient was positive for a corneal abrasion?
3. How would your treatment differ if there was a change in visual acuity?
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 7 Assignment
Diagnostic Testing Case Studies
Complete the case studies by answering the questions associated with each scenario.
Case Study 1
A 25-year-old male experienced a FOOSH (fall on outstretched hand – see images below) while riding his bicycle. He comes in for evaluation of the wrist injury. Initial X-ray suggests that there are no visible fractures. You note on physical exam that he has tenderness at the scaphoid fossa.
PMHx: None
Medications: Advil 200mg q8h PRN pain
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 145/60 HR 55 R 12 o2 sats 95%
Gen: Well developed male in no acute distress. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right wrist with mild edema and slight decreased ROM due to pain. Tenderness noted at the scaphoid fossa.
1. What diagnosis must you always consider with this assessment finding?
2. What will be your treatment at this time? Is there further testing to be ordered?
3. Are there any potential consequences of not treating this? If so, what?
Case Study 2
A 24-year-old female runner just returned three days ago from traveling in Guatemala. She is finishing medication for a UTI. She was running and felt a pop in her right calf but was able to continue her run and iced her leg when she got home. This morning, she woke up with ecchymosis, slight swelling to the upper right ankle, and slight pain with some positions like squatting and climbing stairs.
PMHx: None
Medications: Ciprofloxin 250 mg TID x 3 days, Chloroquine
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 154/90 HR 78 R 14 o2 sats 99%
Pain scale 6/10
Gen: Well developed female in pain. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right posterior ankle with purple ecchymosis, mild edema, and decreased ROM due to pain. Tenderness noted at the Achilles tendon insertion site. Slight positive Thompson's test and knee flexion sign appears negative.
1. What diagnosis should you consider?
2. What imaging studies should you order?
3. What treatment will you start now?
Case Study 3
A 32-year-old white female is concerned with increasing migraines and vision disturbances with vertigo over the past three months. She denies any head injuries or LOC, has never had migraines before, and usually headaches resolve with just rest. For current headaches, she needs to go to sleep and take OTC analgesics which sometimes help. She does not have a headache at this visit. She reports having a similar incident that lasted 5 weeks 2 years ago while in Colorado visiting family. No test was done then, and she never found out what caused it.
PMHx: None
Medications: Excedrin Migraine
SH: Single, non-smoker, denies alcohol or drug use
VS: T: 98.6 BP 118/72 HR 90 R 16 o2 sats 100%
Pain scale 1/10
Gen: Pleasant WF NAD
HEENT:PERRLA, Fundoscopy no papilladema, cup:disc ratio 2:1 no AV nicking.
Neuro: CN II-XII grossly intact, Romberg was positive.
MS: FROM all extremities, DTR's 2 + with positive Babinski right foot.
You are referring to a neurologist and they have requested imagining before seeing her.
1. What imaging is appropriate for this patient?
2. What questions do you need to ask before ordering MRI with contrast?
3. How would you describe an MRI during patient education?
Case Study 4
A 44-year-old well-known Caucasian female patient presents to the clinic. She has experienced increased shortness of breath over the past 3 days. She has a well-documented history of asthma which is normally controlled by her asthma medications. The patient tells you she recently had a cold and this has triggered her shortness of breath.
PMHx: asthma, hypothyroidism
Meds: synthroid 137mcg qd, proventil inhaler 2 puffs qid prn
SHx: single
Allergies: NKDA
VS: T 97.7 BP 122/60 HR 88 R 12 02 sat 90%
Gen: well-developed female in NAD
Lungs: clear BS throughout with diminished in both bases with expiratory wheezes heard in both lungs
1. What is the likely diagnosis?
2. What test would be appropriate for this patient?
3. How might the information obtained from testing be helpful to the practitioner?
Case Study 5
A 50-year-old Hispanic male presents to the clinic as a new patient with a concern about increased shortness of breath over the last 6 months when climbing stairs. He also reports a productive cough. He has just relocated to southern California and “thinks this may be allergies.”
PMHx: previous health care minimal in Mexico
Meds: no Rx; his wife gave him some OTC Claritin
SHx: married, smokes 2 packs/day x 30 years
Allergies: NKDA
VS: T 98 BP 126/80 HR 84 RR 24 O2 Sat 90%
Gen: well-developed male in NAD
Lungs: clear bilaterally, but diminished BS throughout, no rales, rhonchi, or wheezing, however, slightly increased expiratory phase (I:E ratio 1:3)
1. What is in your differential diagnosis?
2. What test would be appropriate in this patient?
3. How might the information obtained from testing be helpful to the nurse practitioner?
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 1 Quiz
Question 1 A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 4.5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells).
What type of vaginitis best describes her findings?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 2A 34-year-old married daycare worker comes to your office, complaining of severe pelvic pain for the last 6 hours. She states that the pain was at first cramp-like but is now sharp. Nothing makes the pain better or worse. She has had no vaginal bleeding or discharge. She has had no pain with urination. She has had some nausea for the last few days but denies vomiting, constipation, or diarrhea. She states she feels so bad that when she stands up she has fainted. Her past medical history consists of two prior cesarean sections and an appendectomy. She is married and has two children. She denies any tobacco, alcohol, or drug use. Her parents are both healthy. On examination you find a pale young woman who is obviously in a great deal of pain. She is lying on her right side with her eyes closed. Her blood pressure is 9060 and her pulse is 110. She is afebrile. She has bowel sounds and her abdomen is soft. The speculum examination reveals a bluish cervix but no blood or purulent discharge at the os. There is a mild amount of tenderness with palpation of the cervix. The uterus is nongravid but the right adnexal area is swollen and very tender. Urine analysis is normal and the urine pregnancy test is pending.
What type of adnexal disorder is causing her pain?
Ovarian cysts
Tubal pregnancy
Pelvic inflammatory disease
Question 3A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer and her father has coronary artery disease, high blood pressure, and Alzheimer's disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep.
What form of vaginitis is this patient most likely to have?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 4Which of the following represents metrorrhagia?
Fewer than 1 days between menses
Excessive flow
Infrequent bleeding
Bleeding between periods
Question 5 Posteriorly, the labia minora meet as two ridges that fuse to form the:
fourchette
vulva
clitoris
perineum
Question 6The vaginal discharge of a woman with a typical Trichomonas vaginalis infection is:
moderate, gray, with low pH.
scant, curdy, with high pH.
profuse, frothy, with high pH.
profuse, curdy, with low pH.
Question 7
A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 13080 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae.
What vaginitis does this patient most likely have?
Trichomonas vaginitis
Candida vaginitis
Bacterial vaginosis
Atrophic vaginitis
Question 8Which is the most effective pattern of palpation for breast cancer?
Beginning at the nipple, make an ever-enlarging spiral.
Divide the breast into quadrants and inspect each systematically.
Examine in lines resembling the back and forth pattern of mowing a lawn.
Beginning at the nipple, palpate outward in a stripe pattern.
Question 9What structures are located at the five-o’clock and the seven-o’clock positions of the vaginal orifice?
Skene glands
Bartholin glands
Nabothean glands
Hymenal glands
Question 10For purposes of examination and communication of physical findings, the breast is divided into:
halves (upper and lower).
thirds (left, middle, and right).
four quadrants plus a tail.
circles (six consecutive rings, each 1 inch farther away from nipple).
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 2 Quiz
Question 1 An 18 year old high school student presents to the office for evaluation of acute sudden onset of pain in his left testicle. It is intermittent, sharp, and radiates into his left groin. What test should be done to help in the evaluation process?
Cremasteric reflex
Testicular reflex
Prostate exam
Murphy’s test
Question 2Which is a sign of benign prostatic hyperplasia?
Weight loss
Bone pain
Fever
Nocturia
Question 3A young man feels something in his scrotum and comes to you for clarification. On your examination, you note what feels like a “bag of worms” in the left scrotum, superior to the testicles. Which of the following is most likely?
Hydrocele of the spermatic cord
Varicocele
Testicular carcinoma
A normal vas deferens
Question 4You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next?
Refer to urology
Recheck in 6 months
Tell the parent the testicle is absent but that this should not affect fertility
Attempt to bring down the testis from the inguinal canal
Question 5Frank is a 24-year-old man who presents with multiple burning erosions on the shaft of his penis and some tender inguinal adenopathy. Which of the following is most likely?
Primary syphilis
Herpes simplex
Chancroid
Gonorrhea
Question 6Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?
The presence of bowel sounds in the scrotum
Being unable to palpate superior to the mass
A positive transillumination test
Normal thickness of the skin of the scrotum
Question 7The most common cancer in young men aged 15-30 years old is:
Testicular
Penile
Prostate
Anus
Question 8Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned?
Phimosis
Paraphimosis
Balanitis
Balanoposthitis
Question 9In males, which surface of the prostate gland is accessible by the DRE (digital rectal exam)?
median lobe
posterior
superior
anterior
Question 10What is the definition for Hypospadias?
Imflammation of the glans
Low hanging testicles
Tight prepuce that cannot be retraced over the glans
Ventral displacement of the urethra meatus on the penis
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 4 Quiz
Question 1 A young Hispanic mother brings in her 2-month-old son. She is upset because her neighbors have threatened to call the Child Protective Agency because they think his birthmark is a bruise. Her son was the product of an uneventful pregnancy and spontaneous vaginal delivery. On examination you see a large, smooth-bordered bluish mark on his buttock and lower back. Otherwise his examination is unremarkable.
What form of birthmark is this likely to be?
Café-au-lait spot
Salmon patch
Mongolian spot
Question 2In newborn infants, closure of the ductus arteriosus usually occurs:
After 7 days of life
12 – 48 hours after birth
During the toddler period
Between the second and third months
Question 3Developmental changes of puberty are caused mainly by the interaction of the pituitary gland, the gonads, and the:
Hypothalamus
Islet cells
Thymus
Thalamus
Question 4You are assessing an infant and notice that his nares flare, he has a soft grunt with each breath, and the skin between his ribs is pulled inward with inhalation. What is the significance of these findings?
These are indicative of a CNS process.
These are indicative of respiratory distress.
These are indicative of muscular dystrophy.
These are frequently accompanied by stridor.
Question 5You note that a child has a positive Gower Sign. This indicates generalized:
Bursitis
Arthropathy
Muscle weakness
Muscle hypertrophy
Question 6The ability for abstract thinking normally develops during:
Infancy
Early childhood
Adolescence
Adulthood
Question 7In infants and small children, a capillary refill time of 4 seconds:
Is normal
Indicates hpovolemia
Indicates hypervolemia
Indicates renal artery stenosis
Question 8A mother brings her 15-month-old daughter to your office for evaluation of a rash and fever. She says the rash started one day and the fever developed the next day. Her daughter has had all of her vaccinations up to 10 months. The mother sheepishly admits that she hasn't had time to bring her daughter in since her 10-month check-up. On examination you see a mildly sick-appearing toddler with a 102-degree temperature. Looking at her skin you see at least 100 of a variety of papules, vesicles, and ulcers in different stages of development.
What illness prevented by proper vaccination does this toddler have?
Varicella (chickenpox)
Measles
Smallpox
Question 9You are examining a 5-year-old before he begins school. You notice a systolic, grade II/VI vibratory murmur over the LLSB and apex with normal S2 splitting. He has normal pulses as well. Which of the following is most likely?
Tricuspid stenosis
Mitral stenosis
Still's murmur
Venous hum
Question 10One way that a health history for an infant differs from that of an adult is the inclusion of:
Nutritional history
Chief Complaint
Prenatal information
personal social information
Question 11When the Goodenough-Harris Drawing Test is administered to a child, the evaluator principally observes the:
Presence and form of body parts
Gender and race of the person drawn
Length of time needed to draw a stick man
Approximate age and posture of the person drawn
Question 12A quiet 3-year-old is brought in for a routine check-up when you notice a fresh bruise in the axilla and bilateral bruises over the upper back that appear slightly older. There are brown bruises over his shins as well. His mother said this happened when he fell off of a couch. What diagnosis should be considered?
Von Willebrand's disease
Normal childhood bruises from activity
Abuse
Seizure disorder
Question 13A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The ear examination is as follows: external ear, normal appearance and no tenderness with manipulation; canal, normal diameter without evidence of inflammation; tympanic membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain. What is your diagnosis?
Otitis externa
Cholesteatoma
Ruptured tympanic membrane
Otitis media
Question 14You diagnose an infant in the clinic with Seborrheic Dermatitis. What physical exam findings are most consistent with this diagnosis?
Erythema of the scalp
Pustules on the scalp
Dry, flaking areas on the scalp
Ecchymosis on the scalp
Question 15You are assessing Tanner staging of the breast in a young woman. You notice projection of the areola and nipple to form a secondary mound above the level of the breast. Which Tanner stage would this be?
I
II
III
IV
Question 16When measuring the length of an infant, the measurement should extend from:
Forehead to feet
Crown to tip of toes in prone position
Head to toes in upright position
Crown to heel in supine position
Question 17When examining the skull of a 4-month old baby, you should normally find:
Closure of the anterior fontanel
Closure of the posterior fontanel
Closure of both the anterior and posterior fontanel
Overlap of the cranial bones
Question 18A 17 year old girl presents to the clinic for a sports physical for cheerleading. Physical examination findings reveal BMI of 15, bradycardia, multiple erosions of tooth enamel, and scabs and scars on her knuckles. You should ask her if she:
Is heat intolerant
If she binges and vomits
If she is constipated
Falls a lot
Question 19A toddler is able to jump in place and balance on one foot as well. She can also speak in full sentences and feed herself. What is the approximate developmental age of this child?
2 years
3 years
4 years
5 years
Question 20You are assessing an ill toddler in your office. He responds when spoken loudly to or physically stimulated but then appears to fall back to sleep. This level of consciousness is:
Alert
Lethargic
Comatose
Unconscious
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 5 Quiz
Question 1Atrial fibrillation is characterized by _____.
an erratic, wavy baseline and irregular ventricular rhythm
"saw-tooth"- or "picket-fence"-shaped waveforms preceding each QRS
one P wave before each QRS and a regular ventricular rate of 60 to 100 beats/min
P waves occurring before, during, or after the QRS complex; when seen, they are inverted
Question 2Which of the following are possible causes of sinus bradycardia?
Elevated temperature, pain
Increased intracranial pressure, beta-blocker overdose
Hypoxia, fright, caffeine-containing beverages
Hypovolemia, administration of sympathomimetics
Question 3An ECG rhythm strip shows a regular ventricular rhythm at a rate of 30 beats/min, more P waves than QRS complexes (the P waves occur regularly), a variable PR interval, and a QRS duration of 0.14 seconds. This rhythm is _____.
2:1 AV block
third-degree AV block
second-degree AV block type I
second-degree AV block type II
Question 4How are frequent PACs usually managed?
Defibrillation
Synchronized cardioversion
Correcting the underlying cause
Administration of medications such as atropine or epinephrine
Question 5What is meant by the term pulseless electrical activity (PEA)?
A chaotic rhythm that is likely to degenerate into cardiac arrest
An organized rhythm on the cardiac monitor (other than VT), although a pulse is not present
A slow rhythm with a wide QRS complex
A flat line on the cardiac monitor
Question 6Which of the following are possible causes of sinus tachycardia?
Hypothermia, hypovolemia
Hypoxia, calcium channel blocker overdose
Fever, pain, anxiety
Vomiting, vagal maneuvers
Question 7A delta wave is an ECG characteristic associated with which of the following dysrhythmias?
Junctional rhythm
AV nodal reentrant tachycardia (AVNRT)
Wolff-Parkinson-White (WPW) syndrome
Accelerated idioventricular rhythm (AIVR)
Question 8 Tall, peaked T waves observed on the ECG are most commonly seen in patients with _____.
hypokalemia
hyponatremia
hyperkalemia
hypernatremia
Question 9An ECG rhythm strip shows a ventricular rate of 46 bpm, a regular rhythm, a PR interval of 0.14 seconds, a QRS duration of 0.06 seconds, and one upright P wave before each QRS. This rhythm is _____.
sinus rhythm
sinus bradycardia
sinus arrest
sinoatrial block
Question 10To determine whether the ventricular rhythm on an ECG tracing is regular or irregular, compare _____ intervals.
PR
R to R
TP
P to
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 6 Quiz
Assignment Content
Question 1 Because hypothalamic-pituitary-adrenal axis suppression can occur up to four days after an injection,
1.Inject only one large joint at a time
2. chances are high that an infection is likely to occur
3. inject as many joints as necessary
4. prophylactic oral antibiotics are recommended 24 hours prior to injection
Question 2The application of phenol during partial toenail removal does which of the following?
1.Prevents infection
2. Provides pain relief up to 12 hours
3. Prevents nail regrowth
4. Aids in the regrowth of the nail
Question 3Joint aspirations are contraindicated in patients who are
1. anticoagulated or have a major clotting disorder
2.pregnant
3. diabetics
4. vascularly compromised
Question 4 When doing an intra-articular injection,
1. inject the medication into the jointdespite resistance
2. use a 3 cc syringe and a 25 gaugeneedle to draw up 2.5 cc of 1% lidocaine and 0.5 cc of corticosteroid
3. do not mix the syringe prior to injecting
4. keep the joint immobile to preventextravasation after the injection
Question 5 What is the correct sequence for wound or laceration treatment?
1. Obtain informed written consent, assess the wound for more serious underlying disorders, assess the neuro function, cleanse the wound with aseptic solution, provide the patient with appropriate anesthesia, and explore, irrigate, debride, and prepare the wound for suturing.
2.Cleanse the wound with aseptic solution, obtain informed written consent, assess the wound for more serious underlying disorders, provide the patient with appropriate anesthesia, and explore, irrigate, debride, and prepare the wound for suturing.
3.Provide the patient with appropriate anesthesia; explore, irrigate, debride, and prepare the wound for suturing; obtain informed written consent; and assess the wound for more serious underlying disorders.
4. Assess the wound for more serious underlying disorders, cleanse the wound with aseptic solution, provide the patient with appropriate anesthesia, and explore, irrigate, debride, and prepare wound for suturing.
Question 6 A 40-year-old male presents to your clinic and has a suspicious lesion on his back. You believe the lesion may be a basal cell carcinoma. After obtaining consent from your patient, you remove the lesion with an elliptical incision and send the specimen to the lab. The lesion has left a 2.5 cm long laceration that is wide and shallow. Which of the following is the most appropriate type of suture technique?
1. Horizontal mattress
2. Dermabond
3. Running interrupted sutures
4. Duct tape
Question 7One of the critical steps when performing an intra-articular injection is to pull back on the syringe prior to injecting the corticosteroid solution. The purpose of this is to? Edmunds and Mayhew page 320.
1. remove any excess fluid
2. check the plunger movement prior to injection
3. aspirate to make sure you are not injecting into the vascular bed
4. remove any air which may be in the intra-articular space
Question 8 What is the correct sequence for a toenail removal procedure?
1.Position the patient comfortably in a supine position. Clean the toe with an aseptic solution. Administer a bilateral digital nerve block with 2% lidocaine. Use a nail elevator to free the nail sulcus and eponychium from the nail plate.
2.The patient may soak the foot the night before the procedure by wrapping the toe or foot in a wet cloth. Position the patient comfortably in a supine position. Administer a bilateral digital nerve block with 2% lidocaine. Clean the toe with an aseptic solution. Use a nail elevator to free the nail sulcus and eponychium from the nail plate.
3.The patient may soak the foot the night before the procedure by wrapping the toe or foot in a wet cloth. Position the patient comfortably in a supine position. Use a nail elevator to free the nail sulcus and eponychium from the nail plate. Clean the toe with an aseptic solution. Administer a bilateral digital nerve block with 2% lidocaine. Clean the toe with an aseptic solution.
Question 9Which of the following patients has an increased risk of infection following toenail removal?
1. A type I labile Diabetic
2. Immune-competent patient
3. A 78-year-old male
4. Patient just recovering from a viral upper respiratory infection
Question 10Suturing a laceration or a wound prior to aseptic cleansing and debridement may result in?
1. lower chance of infection
2. increased scarring
3. less pain
4. dermatological pigmentation changes
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 7 Quiz
Question 1The severity of obstruction is indicated by what?
1. the value of FVC
2. the value of FEV1/FVC
3. the value of FEV1
4. the value of SPo2
Question 2Which of the following are the Ottawa rules for obtaining x-rays for ankle injuries?
1. Bone tenderness along the distal 6 cm posterior edge of tibia or the tip of the medial malleolus
2. Bone tenderness along the distal 6 cm posterior edge of fibula or the tip of the lateral malleolus
3. Inability to bear weight at time of injury and unable to bear weight with four steps during exam
4. All of the above
Question 3What is the primary indication for an abdominal plain film (KUB)?
1. Rule out Helicobacter pylori infection
2. Evaluate abdominal hernia
3. Check for suspected intraperitoneal free air
4. Evaluation of postoperative abdominal infection
Question 4A patient with a Permanent Pacemaker cannot undergo which of the following imaging studies?
1. X-ray
2.MRI
3. CT scan with contrast
4. CT scan without contrast
Question 5A patient’s FEV1 and absolute FEV1/FVC ratio are both decreased. This indicates a what?
1. restrictive ventilatory pattern
2. obstructive ventilatory pattern
3. thermid-expiratory pattern
4. maximal voluntary ventilation pattern
Question 6The FEV1/FVC value varies according to?
1. BMI and FEV of the patient
2. age and height of the patient
3.BMI and TLV of the patient
4. age and PEF of the patient
Question 7Obstruction is reversible if there is a ____% or greater increase on the FVC or FEV1 after a bronchodilator challenge.
1.3%
2.5%
3. 7%
4. 12%
Question 8What is your diagnosis on the basis of this X-ray?
1.Pulmonary fibrosis
2. Pneumonia
3. Pneumothorax
4. Congestive Heart Failure
Question 9Why is a pediatric patient younger than three years not a candidate for spirometry testing?
1.Lung volumes are to low
2. Too young to follow directions
3. Prone to vomiting and may aspirate
4. Testing in pediatric patients may precipitate respiratory failure
Question 10A patient’s spirometry results are as follows: FVC normal, FEV1 decreased, Absolute FEV1/FVC <70%. What is your diagnosis?
1. Restrictive impairment
2.Obstructive impairment
3. Normal
4. Reversible impairment
NRP571 Advanced Health Assessment IIand Clinical Procedures
Week 8 Quiz
Question 1Regardless of the origin, discharge is described by noting:
1. grading scale of 0 to 4.
2.color and consistency.
3.demographic data and risk factors.
4.associated symptoms in alphabetic order.
Question 2Spaces between the cranial bones accommodate:
1.brain growth.
2.cartilage formation.
3.muscular expansion.
4. nerve regeneration.
Question 3The quality of a symptom, such as pain, is subjective information that should be:
1. deferred until the cause is determined.
2. described in the history.
3. placed in the past medical history section.
4. placed in the history with objective data.
Question 4The QRS complex is the electrocardiographic expression of:
1. the electrical activation of the ventricular myocardium
2. the electrical activation of the atrial myocardium
3. the electrical activation of the left ventricular wall
4. the electrical activation of the AV node
Question 5Lidocaine has a longer time to onset of action and longer duration than Marcaine.
1. True
2.False
Question 6If information is purposefully omitted from the record, you should:
1. erase the notes that are not pertinent.
2. accept that sometimes data are omitted.
3. state in the record why the information was omitted.
4. use correction fluid to cover the information.
Question 7The position on a clock, topographic notations, and anatomic landmarks:
1.are methods for recording locations of findings.
2. are used for noting disease progression.
3. are ways for recording laboratory study results.
4. should not be used in the legal record.
Question 8The presence of cervical motion tenderness may indicate:
1. pregnancy
2. nulliparity
3. pelvic inflammatory disease
4. vulvovaginitis
Question 9Itchy, painful, small red vesicles are typical of:
1. condyloma acuminatum.
2.condyloma latum.
3. herpes simplex lesions.
4.syphilitic chancre.
Question 10 6-month-old who can hear well can be expected to:
1. exhibit the Moro reflex.
2. stop breathing in response to sudden noise.
3. turn his or her head toward the source of sound.
4. imitate simple words.
Question 11Montgomery tubercles are most prominent in the breasts of:
1. adult males.
2. patients with lung disease.
3. pregnant women.
4. pubertal females.
Question 12A patient has received suturing of the left upper arm after a simple three-inch long laceration. What is the recommended follow up for suture removal?
1. 7–10 days
2. 2 weeks
3. The next day
4. 3–5 days
Question 13Which of the following findings, when seen in the infant, is ominous?
1.Difficulty tracking objects with the eyes
2. Appearing to have better peripheral than central vision
3.Blinking when bright light is directed at the face
4.White pupils on photographs
Question 14Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies?
1. Left mainstem bronchus
2.Terminal bronchioles
3. Right mainstem bronchus
4. Respiratory bronchioles
Question 15What is the primary indication for an abdominal plain film (KUB)?
1. Rule out Helicobacter pylori infection
2. valuate abdominal hernia
3.Check for suspected intraperitoneal free air
4. Evaluation of postoperative abdominal infection
Question 16Long bones in children have growth plates known as:
1. epiphyses
2. epicondyles
3.synovium
4. fossae
Question 17The mother of an 8-year-old child reports that she has recently noticed a discharge stain on her daughter’s underwear. Both the mother and daughter appear nervous and concerned. You would need to ask questions to assess the child’s:
1.drug ingestion.
2.fluid intake.
3. risk for sexual abuse.
4. hormone responsiveness.
Question 18The most emergent cause of testicular pain in a young male is:
1. testicular torsion
2. epididymitis
3.tumor
4.hydrocele
Question 19In an uncircumcised male, retraction of the foreskin may reveal cheesy white material. This is usually:
1. evidence of a fungal infection.
2.a collection of sebaceous material.
3.indicative of penile carcinoma.
4.suggestive of diabetes.
Question 20A 65-year-old male patient presents to your clinic for his annual physical, a routine ECG is obtained which shows atrial fibrillation with a rate of 177. His BP is 80. He is diaphoretic and complains of feeling dizzy. The patient
1. requires no intervention
2. should be told to make an appointment with a cardiologist with no further intervention
3.requires immediate intervention as he is considered unstable
4.needs to be scheduled for a treadmill test
Question 21Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:
1.the presence of coarse terminal hair.
2.desquamation of the stratum corneum.
3.their covering of vernix caseosa.
4.a poorly developed subcutaneous fat layer.
Question 22When collecting specimens, which sample should be obtained first?
1.Chlamydial swab
2.Gonococcal culture
3.Pap smear
4.Wet mount
Question 23Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:
1.pull the auricle down and back.
2.hold the speculum in the canal.
3.distract the infant.
4.stabilize the chest.
Question 24The presence of a fishy odor after dropping potassium hydroxide on a wet mount slide containing vaginal mucus suggests:
1.bacterial vaginosis.
2.yeast infection.
3.chlamydial infection.
4.pregnancy.
Question 25Which of the following are the Ottawa rules for obtaining x-rays for ankle injuries?
1.Bone tenderness along the distal 6 cm posterior edge of tibia or the tip of the medial malleolus
2.Bone tenderness along the distal 6 cm posterior edge of fibula or the tip of the lateral malleolus
3.Inability to bear weight at time of injury and unable to bear weight with four steps during exam
4.All of the above
Question 26A cremasteric reflex should result in:
1.testicular and scrotal rise on the stroked side.
2.penile deviation to the left side.
3.bilateral elevation of the scrotum.
4.immediate erection of the penis.
Question 27Developmental changes of puberty are caused mainly by the interaction of the pituitary gland, gonads, and:
1.hypothalamus.
2.islet cells.
3.thalamus.
4.thymus.
Question 28The brown or tan pigmentation on the forehead, nose, and malar prominence of some pregnant women is called:
1.hormonal acne.
2.erythema.
3.alopecia.
4.chloasma
Question 29To prevent personal appearance from becoming an obstacle in patient care, the health professional should:
1.wear a uniform.
2.avoid wearing white.
3.avoid extremes in dress.
4.avoid wearing any jewelry.
Question 30Which rhythm abnormality requires emergent intervention?
1.Sinus rhythm with first-degree AV block
2.Sinus arrhythmia
3.Ventricular fibrillation
4.Stable sinus tachycardia
Question 31Mrs. Simmler brings in her adolescent daughter for a routine physical examination. As you are explaining the health promotion activities, you remind the patient that approximately 75% of females are menstruating by which Tanner stage of breast development?
1.Stage 1
2.Stage 2
3.Stage 3
4.Stage 4
Question 32Which of the following is a relatively benign condition that may occur during pregnancy or labor?
1.Macular degeneration
2.Papilledema
3.Subconjunctival hemorrhage
4.Cupping of the optic disc
Question 33Mr. Johnson is a 43-year-old patient who presents for a routine physical examination. On examination, you note that the urethral meatus opens on the ventral surface of his penis. You determine that he has which condition?
1.Epispadias
2.Hydrocele
3.Hypospadias
4.Normal variation
Question 34A patient with a standard Permanent Pacemaker cannot undergo which of the following imaging studies?
1.X-ray
2.MRI
3.CT scan with contrast
4.CT scan without contrast
Question 35“3-0” suture material is thicker or thinner than “9-0” suture material?
1.Thicker
2.Thinner
Question 36Verbal consent is as good as written consent for office procedures:
1. True
2. False
Question 37When examining the skull of a 4-month-old baby, you should normally find:
1.closure of the anterior fontanel.
2.closure of the posterior fontanel.
3.ossification of all sutures.
4.overlap of cranial bones.
Question 38While examining an 18-year-old man, you note that the penis and testicles are more darkly pigmented than the body skin. You should consider this finding to be:
1.within normal limits.
2.suggestiveof a skin fungus.
3.suggestive of psoriasis.
4.due to excessive progesterone.
Question 39Pearly gray, smooth, dome-shaped, often umbilicated lesions of the glans penis are probably:
1.herpetic lesions
2.condylomata
3.molluscum contagiosum
4.chancres
Question 40The goals of preparticipation sports evaluation include:
1.Screening for steroid use or abuse.
2.Determining the best fit for positions in each sport.
3.Identifying risk of injury or death during sports
4.Securing a legal contract before recommending limiting participation
Question 41 Which of the following techniques is part of the proper procedure for cleansing a wound or laceration?
1.Start from the outer edges and swab in a circular pattern toward the center.
2.Start from the center and swab in a circular pattern toward the periphery.
Question 42The male with Peyronie disease will usually complain of:
1.painful, inflamed testicles.
2.deviation of the penis during erection.
3.lack of sexual interest.
4.painful lesions of the penis.
Question 43On palpation, a normal vas deferens should feel:
1.beaded
2.smooth
3.ridged
4.spongy
Question 44To spread the breast tissue evenly over the chest wall, you should ask the woman to lie supine with:
1.her arms straight alongside of her body.
2.both arms overhead with palms upward.
3.her hands clasped just above the umbilicus.
4.one arm overhead and a pillow under her shoulder.
Question 45Male gynecomastia associated with illicit or prescription drug use can be expected to:
1.lessen when the body becomes accustomed to the drug.
2.resolve after the drug is discontinued.
3.leave permanent breast enlargement when the drug is discontinued.
4.cause purulent drainage if left untreated.
Question 46The visualization of a large proportion of “clue cells” on your wet mount slide examination suggests:
1.trichomonal infection.
2.bacterial vaginosis.
3.candidiasis.
4.gonorrhea.
Question 47Which technique is appropriate for detecting an inguinal hernia?
1.Conduct percussion while the patient coughs.
2.Have the patient strain as you pinch the testes.
3.Inspect rectal areas as the patient bears down.
4.Move your finger upward along the vas deferens.
Question 48Mrs. Jones, a 45-year-old patient, comes into the office today with a complaint of a breast lump. In a woman complaining of a breast lump, it is most important to ask about:
1.its relationship to menses.
2.weight gain.
3.sleep patterns.
4.immunization status.
Question 49 A cervical polyp usually appears as a:
1.grainy area at the ectocervical junction.
2.bright-red soft protrusion from the endocervical canal.
3.transverse or stellate scar.
4.hard granular surface at or near the os.
Question 50While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding:
1.history of medication allergies.
2.alcohol, tobacco, and caffeine use.
3.level of personal education.
4.amount of personal income.
