NUR643E Advanced Health Assessment for Nurse Educators Midterm Exam August 2021

•             Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it “would be better if I was not here.” What would you do next?

•Tell him that he has a very promising career in anything he chooses and soon he will feel better.

•Tell him that he needs an antidepressant and it will take about 4 weeks to work.

•Speak with his mother about getting him together more with his friends.

•Assess his suicide risk.

•             Mr. Chin is an 82-year-old man who presents to your office for a routine check. On examination, you notice a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate and the rest of his examination is normal for his age. Which is true of the most likely cause of this murmur?

•             It often increases carotid upstroke.

•It carries with it increased risk for cardiovascular disease.

•             It is usually accompanied by an S3 gallop.

•             It is found in 10% of otherwise normal elderly patients.

•             Mrs. Fletcher complains of numbness of her right hand. On examination, sensation of the volar aspect of the web of the thumb and index finger and the pulp of the middle finger are normal. The pulp of the index finger has decreased sensation. Which of the following is affected?

•             Median nerve

•             Ulnar nerve

•             Radial nerve

•             You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and diabetes. You assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3?

•             0

•             3+

•             2+

•             1+

•             A 70-year-old retired auto mechanic presents to your office because his neighbor is concerned about his memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different states; and he has limited his activities because the people he interacted with were “his wife's friends, not his.” He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this information, what is the most likely condition?

•             Benign forgetfulness

•             Dementia

•             Meningitis

•             Depression

•             You are screening people at the mall as part of a health fair. The first person who presents for screening has a blood pressure of 132/85. How would you categorize this?

•             Normal

•             Prehypertension

•             Stage 1 hypertension

•             Stage 2 hypertension

•             A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths, he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation, you hear no breath sounds on the right side of his superior chest wall. On percussion, he is hyperresonant over the right upper lobe. With palpation, he has absent fremitus over the right upper lobe.

What disorder of the thorax or lung best describes his symptoms?

•             Spontaneous pneumothorax

•             Chronic obstructive pulmonary disease (COPD)

•             Asthma

•             Pneumonia

•             When assessing the lung fields, what does the technique of percussion look for?

•             Consolidation

• Rales

•             Wheezing

•             Rhonchi

•             Which of the following events occurs at the start of diastole?

•Closure of the tricuspid valve

•             Opening of the pulmonic valve

•             Closure of the aortic valve

•             Production of the first heart sound (S1)

•             A pregnant woman finally presents in for her prenatal checkup. She complains today of headache and abdominal pain of several months' duration. She appears somewhat hurried or nervous. What question would you ask next?

•             Do you have a family history of thyroid disease?

•             Have you been eating properly and taking a prenatal vitamin?

•             Do you feel safe at home?

•             How much activity have you been able to fit into your schedule?

•             You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?

•             Size, symmetry, and skin color

•             Muscle bulk and tone

•             Nodules in joints

•             Lower extremity strength

•             Mrs. Fletcher presents to your office with unilateral pain during chewing, which is chronic. She does not have facial tenderness or tenderness of the scalp. Which of the following is the most likely cause of her pain?

•             Trigeminal neuralgia

•             Temporomandibular joint syndrome

•             Temporal arteritis

•             Tumor of the mandible

•             On the way to see your next patient, you glance at the calendar and make a mental note to buy a Mother's Day card. Your patient is Ms. Hernandez, a 76-year-old widow who lost her husband in May, 2 years ago. She presents today with complaints including headaches, abdominal pain, and general malaise. This happened once before, about a year ago, according to your detailed office notes. You have done a thorough evaluation but are unable to arrive at a consistent picture to tie these symptoms together.

This is an example of a:

•             Pathophysiologic problem

•             Psychopathologic problem

•             Which of the following is most likely benign on breast examination?

•             Dimpling of the skin resembling that of an orange

•             One breast larger than the other

•             One nipple inverted

•             One breast with dimple when the patient leans forward

•             A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension presents to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

•             Femoral pulse, popliteal pulse

•             Dorsalis pedis pulse, posterior tibial pulse

•             Carotid pulse

•             Radial pulse, brachial pulse

•             A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

•             Abdominal pain

•             Orthopnea

•             Hematochezia

•             Tenesmus

•             You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:

•             Checked for patency of the popliteal artery

•             Checked for patency of the brachial artery

•             Checked for patency of the ulnar artery

•             Checked for patency of the femoral artery

A 29-year-old electrician complains of persistent cough and wheezing, particularly when he exercises. He says he smokes "occasionally" but rarely so much that he needs to purchase cigarettes: "mostly, I bum them," he says, chuckling. Upon hearing this information, what is the best next step on the part of the clinician?

Determine the number of pack-years the patient smokes

•             You are going to obtain a social history on an early adolescent boy. How should you proceed to obtain the best information?

•             Ask his mother to leave the room.

•             Ask if he would prefer his mother to leave the room.

•             Ask your questions with his mother in the room.

•             Ask his mother how she would like to proceed.

•             A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency?

•             Pallor of the foot when raised to 90 degrees for up to two minutes

•             Return of color to the skin within 5 seconds of allowing legs to dangle

•             Filling of the veins of the ankles within 10 seconds of allowing the legs to dangle

•             Hyperpigmentation of the skin

•             You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent?

•             Gastroesophageal reflux disease

•             Peripheral arterial disease

•             Systemic lupus erythematosus

•             Chronic obstructive pulmonary disease (COPD)

A 39-year-old nurse who is a well-established patient complains of irregular menstrual periods and pelvic pain. She says that she is having trouble sleeping and asks whether she could be given a "sleeping pill." The patient also says she is thinking of leaving her job. What is the best "next step" in caring for this patient?

•             You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?

•Arterial insufficiency

•Neuropathic ulcer

•Venous insufficiency

•Trauma

•             You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?

•Emphysema

•Asthma exacerbation

•Severe left heart failure

•Cardiac tamponade