GCU NUR643E Week 8 Final Quiz Latest 2019 September

NUR643E Advanced Health Assessment for Nurse Educators

Week 8 Final Quiz

• A 62-year-old woman, who has been coming to you for 3 years, has a recent onset of hypertension. She is still not at goal despite three antihypertensive medicines, and you strongly doubt nonadherence. Her father died of a heart attack at age 58. Today her pressure is 168/94 and pressure on the other arm is similar. What would you do next?

•Add a fourth medicine

•Refer to nephrology

•Get a CT scan

•Listen closely to her abdomen

• Mrs. Jaeger is a 67–year-old who went through menopause at age 55. She has now had some vaginal bleeding. Which of the following should be considered?

•Endometrial cancer

•Hormone replacement therapy

•Uterine or cervical polyps

•All of these

• A 73-year-old retired accountant presents to your office for her annual examination. She has incontinence of urine when she coughs or sneezes. She takes several medications for control of hypertension and diabetes. You use the DIAPERS mnemonic to assess the cause of her incontinence. All of the following are items represented by the mnemonic except for:

•Atrophic vaginitis

•Depression

•Pharmaceuticals

•Restricted mobility

• A 58-year-old gardener presents to your office for evaluation of a new lesion on her upper chest. The lesion appears to be “stuck on” and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?

•Actinic keratosis

•Seborrheic keratosis

•Basal cell carcinoma

•Squamous cell carcinoma

• A patient presents to you because she is experiencing a tremor only when she reaches for things. This becomes worse as she nears the “target.” When you ask her to hold out her hands, no tremor is apparent. What type of tremor does this most likely represent?

•Intention tremor

•Postural tremor

•Resting tremor

•Intention tremor

• A 77-year-old retired bus driver presents to your clinic for a physical examination at his wife's request. He has recently been losing weight and has felt very fatigued. He has had no chest pain, shortness of breath, nausea, vomiting, or fever. His past medical history includes arthritis and colon cancer, for which he had surgery. He has been married for more than 40 years. He denies any tobacco or drug use and has not had alcohol in more than 40 years. His parents both died of cancer in their 60s. On examination, his vital signs are normal. His head, cardiac, and pulmonary examinations are unremarkable. On abdominal examination, you hear normal bowel sounds, but when you palpate his liver it is abnormal. His rectal examination is positive for occult blood.

What further abnormality of the liver was likely found on examination?

•Smooth, large, non-tender liver

•Soft, sharp, liver edge

•Elongated right lobe

•Irregular, large liver

• A 32-year-old attorney presents to your office for her second prenatal visit. She has had two previous pregnancies with uneventful prenatal care and vaginal deliveries. Her only problem was that with each pregnancy she gained 50 lbs (23 kg) and had difficulty losing the weight afterward. She has no complaints today. Looking at her chart, you see she is currently 10 weeks pregnant and that her prenatal weight was 130 lbs (59 kg). Her weight today is 134 lbs (60.9 kg). Her height is 5'4”, giving her a BMI of 22. Her blood pressure, pulse, and urine tests are unremarkable. The fetal heart tone is difficult to find but is located and is 150. While you give her first trimester education, you tell her how much weight you expect her to gain.

How much weight should this patient gain during pregnancy?

•Less than 15 pounds (less than 7 kg)

•15 to 25 pounds (7 to 11.5 kg)

•25 to 35 pounds (11.5 to 16 kg)

•30 to 40 pounds (12.5 to 18 kg)

• Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?

•This is most likely due to lack of lubrication.

•This is most likely due to atrophic vaginitis.

•This is most likely due to pressure on an ovary.

•Psychosocial reasons may cause this condition.

• You are speaking to an eighth-grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?

•A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution

•A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

•A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution

•A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

• You are examining an elderly man and notice the following: decreased vibration sense in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and diminished abdominal reflexes. Which of these is abnormal?

•Decreased vibration sense

•Diminished gag reflex

•Diminished right patellar reflex compared to the left

•Diminished abdominal reflexes

• You 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.

• Jacob, a 33-year-old presents with fluid filled lesions on neck. On examination multiple small pustules and vesicles grouped together are seen on erythematous base.

What is most likely?

•Herpes Simplex Virus

•Contact dermatitis

•Actinic keratosis

•Sebaceous hyperplasia

• A 76-year-old retired farmer presents to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for more than 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer, and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees, and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable, and his fecal occult blood test is negative. His prostate is slightly enlarged, but his testicular, penile, and inguinal examinations are all normal. Blood work is pending.

What condition that typically causes abdominal pain best describes his symptoms and signs

•Acute diverticulitis

•Acute cholecystitis

•Acute appendicitis

•Mesenteric ischemia

• Which of the following booster immunizations is recommended in the older adult population?

•Tdap

•Diphtheria

•Measles

•Mumps

• A 72-year-old teacher presents to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum, there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?

•Stage 1

•Stage 2

•Stage 3

•Stage 4

• A 21-year-old receptionist presents to your clinic complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally, she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.

What is most likely the etiology of her diarrhea?

•An infection

•Trauma

•Irritable bowel syndrome

•An endocrine disorder

• A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?

•A palpable “notch” along its edge

•The inability to push your fingers between the mass and the costal margin

•The presence of normal tympany over this area

•The ability to push your fingers medial and deep to the mass

• Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash?

•It is likely to be related to her lupus.

•It is likely to be related to an exposure to a chemical.

•It is likely to be related to an allergic reaction.

•It should not cause any problems.

• An elderly woman with a history of coronary bypass presents in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

•Malingering

•Neuropathy

•Ischemia

•Physical abuse

• A 26-year-old sports store manager presents to your clinic complaining of severe right-sided abdominal pain for 12 hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant. His rectal, inguinal, prostate, penile, and testicular examinations are normal.

What is the most likely cause of his pain?

•Acute appendicitis

•Acute mechanical intestinal obstruction

•Acute cholecystitis

•Mesenteric ischemia

• A 30-year-old paralegal analyst presents 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

• Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline that is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?

•Sigmoid mass

•Tumor in the abdominal wall

•Hernia

•Enlarged bladder

• Which of the following brief screening measures is useful in assessing memory?

•Three-item recall

•Serial 7s

•Spelling “world” backward

•Copying intersecting pentagrams

• A 36-year-old security officer presents to your clinic complaining of a painless mass in his scrotum. He found it 3 days ago during a testicular self-examination. He has had no burning with urination and no pain during sexual intercourse. He denies any weight loss, weight gain, fever, or night sweats. His past medical history is notable for high blood pressure. He is married and has three healthy children. He denies using illegal drugs, smokes two to three cigars a week, and drinks six to eight alcoholic beverages per week. His mother is in good health and his father had high blood pressure and coronary artery disease. On physical examination, he appears anxious but in no pain. His vital signs are unremarkable. On visualization of his penis, he is circumcised and has no lesions. His inguinal region has no lymphadenopathy. Palpation of his scrotum shows a soft cystic-like lesion measuring 2 cm over his right testicle. There is no difficulty getting a gloved finger through either inguinal ring. With weight bearing there are no bulges. His prostate examination is unremarkable.

•Hydrocele

•Scrotal hernia

•Testicular tumor

•Varicocele

• Claire's daughter brings her in today after Claire fell at her home. Which assessments are indicated at this time?

•Orthostatic vital signs

•Review of her medications

•Assessment of gait and balance

•All of these

• Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely causing pain in this region?

•Peptic ulcer

•Cholecystitis

•Pancreatitis

•Appendicitis

• Which is a sign of benign prostatic hyperplasia?

•Weight loss

•Bone pain

•Fever

•Nocturia

• Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered?

•Peptic ulcer

•Pancreatitis

•Myocardial ischemia

•All of these should be considered

• Mr. Martin is a 72-year-old smoker who presents to you for his hypertension visit. You note that with deep palpation you feel a pulsatile abdominal mass which is about 4 centimeters in diameter. What should be done next?

•Obtain abdominal ultrasound

•Reassess by examination in 6 months

•Reassess by examination in 3 months

•Refer to a vascular surgeon.

• Mrs. LaFarge is a 60-year-old who presents with urinary incontinence. She is unable to get to the bathroom quickly enough when she senses the need to urinate. She has normal mobility. Which of the following is most likely?

•Stress incontinence

•Urge incontinence

•Overflow incontinence

•Functional incontinence

• Important techniques in performing the rectal examination include which of the following?

•Lubrication

•Waiting for the sphincter to relax

•Explaining what the patient should expect with each step before it occurs

•All of these

• A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely?

•CN IX lesion on the left

•CN IX lesion on the right

•CN X lesion on the left

•CN X lesion on the right

• Which of the following is consistent with obturator sign?

•Pain distant from the site used to check rebound tenderness

•Right hypogastric pain with the right hip and knee flexed and the hip internally rotated

•Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexion

•Pain that stops inhalation in the right upper quadrant

• Which 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.

• A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

•Actinic keratosis

•Seborrheic keratosis

•Basal cell carcinoma

•Keratotic Scale

• A 37-year-old nurse presents for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?

•Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.

•Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.

•Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.

•Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.

• An elderly woman with dementia is brought in by her daughter for a “rectal mass.” On examination you notice a moist pink mass protruding from the anus, which is nontender. It is soft and does not have any associated bleeding. Which of the following is most likely?

•Rectal prolapse

•External hemorrhoid

•Perianal fistula

•Prolapsed internal hemorrhoid

• A young woman presents with brief, rapid, jerky, irregular movements. They can occur at rest or during other intentional movements and involve mostly her face, head, lower arms, and hands. How would you describe these movements?

•Tics

•Dystonia

•Athetosis

•Chorea

• Which is the proper sequence of examination for the abdomen?

•Auscultation, inspection, palpation, percussion

•Inspection, percussion, palpation, auscultation

•Inspection, auscultation, percussion, palpation

•Auscultation, percussion, inspection, palpation

• A middle-aged man presents because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?

•Reassure him, keep monitoring and return with any changes.

•Do laboratory work to check for platelet problems.

•Obtain an extensive history regarding blood problems and bleeding disorders.

•Do a skin biopsy in the office.

• Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling coffee grounds. What do you suspect?

•Bleeding from a diverticulum

•Bleeding from a peptic ulcer

•Bleeding from a colon cancer

•Bleeding from cholecystitis

•Bleeding from a diverticulum

•Which of the following percussion notes would you obtain over the gastric bubble?

•Resonance

•Tympany

•Hyperresonance

•Flatness

• A 46-year-old former salesman presents to the ER complaining of black stools for the past few weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has had approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He denies any recent use. He is currently unemployed and has never been married. On examination, you find a man appearing older than his stated age. His skin has a yellowish tint, and he is thin, with a prominent abdomen. You note multiple “spider angiomas” at the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection, he has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is more severe in the epigastric area. His liver is small and hard to palpation, and he has a positive fluid wave. He is positive for occult blood on his rectal examination.

What cause of black stools most likely describes his symptoms and signs?

•Infectious diarrhea

• Mallory-Weiss tear

•Upper GI bleed

•Lower GI bleed

• A 32-year-old white male presents to your clinic complaining of aching on the right side of his testicle. He has felt this aching for several months. He states that as the day progresses the aching increases, but when he wakes up in the morning he is pain-free. He denies any pain with urination and states that the pain doesn't change with sexual activity. He denies any fatigue, weight gain, weight loss, fever, or night sweats. His past medical history is unremarkable. He is a married hospital administrator with two children. He notes that he and his wife have been trying to have another baby this year but have so far been unsuccessful despite frequent intercourse. He denies using tobacco, alcohol, or illegal drugs. His father has high blood pressure but his mother is healthy. On examination, you see a young man appearing his stated age with unremarkable vital signs. On visualization of his penis, he is circumcised with no lesions. He has no scars along his inguinal area, and palpation of the area shows no lymphadenopathy. On palpation of his scrotum, you feel testes with no discrete masses. Upon placing your finger through the right inguinal ring you feel what seems like a bunch of spaghetti. Asking him to bear down, you feel no bulges. The left inguinal ring is unremarkable, with no bulges on bearing down. His prostate examination is unremarkable.

What abnormality of the scrotum does he most likely have?

•Hydrocele

•Scrotal hernia

•Scrotal edema

•Varicocele

• A 27-year-old policewoman presents to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate, but she has no burning on the outside. She has had no frequency or urgency with urination, but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure, and her father is healthy. On examination, she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells.

What type of urinary tract pain is she most likely to have?

•Kidney pain (from pyelonephritis)

•Ureteral pain (from a kidney stone)

•Musculoskeletal pain

•Ischemic bowel pain

• Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?

•Bilateral flank tympany

•Dullness which remains despite change in position

•Dullness centrally when the patient is supine

•Tympany which changes location with patient position

•Mr. Jackson is a 50-year-old African-American who has had discomfort between his scrotum and anus. He also has had some fevers and dysuria. Your rectal examination is halted by tenderness anteriorly, but no frank mass is palpable. What is your most likely diagnosis?

•Prostate cancer

•Colon cancer

•Prostatitis

•Colonic polyp

• A 22-year-old law student presents to your office complaining of severe abdominal pain radiating to his back. He states it began last night after hours of heavy drinking. He has had abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep any food or water down, and these symptoms have been going on for almost 12 hours. He has had no recent illnesses or injuries. His past medical history is unremarkable. He denies smoking or using illegal drugs but admits to drinking 6 to 10 beers per weekend night. He admits that last night he drank something like 14 drinks. On examination you find a young male appearing his stated age in some distress. He is leaning over on the examination table and holding his abdomen with his arms. His blood pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination reveals normal bowel sounds, but he is very tender in the left upper quadrant and epigastric area. He has no Murphy's sign or tenderness in the right lower quadrant. The remainder of his abdominal examination is normal. His rectal, prostate, penile, and testicular examinations are normal. He has no inguinal hernias or tenderness with that examination. Blood work is pending.

What etiology of abdominal pain is most likely causing his symptoms?

•Peptic ulcer disease

•Biliary colic

•Acute cholecystitis

•Acute pancreatitis

• Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely?

•Colon cancer

•Cholecystitis

•Inflammatory bowel disease

•Irritable bowel syndrome

• A 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 the most likely condition here?

•Otitis externa

•Cholesteatoma

•Ruptured tympanic membrane

•Otitis media