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ADVANCED HEALTH ASSESSMENT FINAL
EXAM | ALL QUESTIONS AND CORRECT
ANSWERS | ALREADY GRADED A+ |
VERIFIED ANSWERS | LATEST VERSION
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem? A) You are an alcoholic, aren't you? B) When was your last drink? C) Do you drink 2 to 3 beers every weekend? D) Do you drink alcohol when you are supposed to be working? --------- CORRECT ANSWER-----------------B) When was your last drink? Positive answers to two additional questions are highly suspicious for problem drinking: "Have you every had a drinking problem?" and "When was your last drink?" especially if the night before (Bates, p 96 - 97) A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that: A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. B) at 30 feet the patient can read the entire chart. C) the patient can read the 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 from 20 feet. ---------CORRECT ANSWER-----------------A) the patient can read at 20 feet what a person with normal vision can read at 30 feet. Visual acuity is expressed as 2 numbers (e.g. 20/30): the first indicates the distance of the patient from the chart, and the second the distance at which a normal eye can read the line of letters (Bates, p 231).
Which of the following enables optimal examination of the adult's tympanic membrane? A) Grasp the auricle firmly and pull it downward, backward, and pressed close to the head. B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. C) Pull the ear lobe toward the chin and keep the auricle pulled away from the head. D) Grasp the auricle keeping it in normal position and pressed close to the head. ---------CORRECT ANSWER-----------------B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head. To straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head (Bates, p 245). In using the ophthalmoscope to assess a patient's eyes, the nurse notices a red glow in the patient's pupils. On the basis of this finding, the nurse would: A) check the light source of the ophthalmoscope to verify that it is functioning. B) consider this a normal reflection of the ophthalmoscope light off the inner retina. C) continue with the ophthalmoscopic examination and refer the patient for further evaluation. D) suspect that there is an opacity in the lens or cornea. ---------CORRECT ANSWER-----------------B) consider this a normal reflection of the ophthalmoscope light off the inner retina. Shine the light beam on the pupil and look for the orange glow in the pupil - the red reflex. (Bates, p239). The other responses are not correct.
If a child is fearful or sensitive because she can't see the ear exam, you might need to restrain her so wait until the end of the exam. Use the largest speculum for the best view. For best visualization, pull the auricle downward, outward, and backward (Bates 867-869). The nurse practitioner might see which of the following physical findings in a patient with otitis externa? A) a bulging, red tympanic membrane B) an unusually prominent short process and prominent handle. C) a chalky, white patch with irregular margins on the inferior part of the tympanic membrane. D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal. ---------CORRECT ANSWER--- --------------D) Pain with the movement of the auricle and tragus (tug test): a swollen, narrowed, moist, pale and tender ear canal. Frank blood or clear watery drainage (cerebrospinal leak) after trauma suggest a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. (Bates, 245- 246) An Annual Low Dose Computed Tomography (LDCT) screening would be recommended for which patient? A) Tammy, age 57, who smokes a half pack of cigarettes a day for the last 20 years. B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. C) Angela, age 43, and started smoking when she was 15 years old. D) George, age 80, who lives with his wife and is a smoker. --------- CORRECT ANSWER-----------------B) Bob, age 72, who quit smoking 10 years ago after a 30-pack year history. LDCT screenings are recommended to patients 55-74 years, a 30-pack year smoking history or current smoking or have quit in the last 15 years (Bates, p315-316).
NP is preparing to perform an otoscopic examination of a newborn infant. Which statement is true regarding this examination? A) Immobility of the drum is a normal finding. B) The light reflex is cone shaped in the first few days of life. C) The appearance of the membrane is identical to that of an adult. D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life. ---------CORRECT ANSWER-----------------D) The normal membrane may appear thick and opaque because of the vernix caseosa obscuring the tympanic membrane for the first few days of life. During the first few days, the tympanic membrane often looks thickened and opaque because there is vernix caseosa obscuring the tympanic membrane (Bates, p825). The nurse practitioner is doing an assessment on a 21 year old patient and notices that his nasal mucosa appears pale and bluish. What would be the most appropriate question to ask the patient? A) Have you had any symptoms of a cold? B) Don't ask any questions. This is a normal finding. C) Are you aware of having any allergies? D) Have you been having frequent nosebleeds? ---------CORRECT ANSWER-----------------C) Are you aware of having any allergies? With chronic allergy, mucosa looks swollen, boggy, pale, and gray. Colds and nosebleeds do not cause these mucosal changes. A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse is aware that which of these findings would be consistent with an acute infection? A) Tonsils 3+/1-4+ with large white spots B) Tonsils 1+/1-4+ with pale coloring C) Tonsils 1+/1-4+ and pink, same color as oral mucosa
breath sounds per auscultation, decreased tactile fremitus, and no crackles, wheezes, or rhonchi. COPD is characterized by diffusely hyper-resonant sounds with percussion, decreased or absent breath sounds per auscultation, decreased tactile fremitus, and no crackles, wheezes, or rhonchi. (Bates, p340) Which of the following is true about auscultating the heart? A) the diaphragm is better for picking up the sounds of S1 and S2 and the bell is better for picking up the sounds of S3 and S4. B) The bell is better for picking up the sounds of S1 and S2 and the diaphragm is better for picking up the sounds of S3 and S4. C) The diaphragm is not necessary for accurate auscultation during the cardiac exam. D) The bell is not necessary for the cardiac exam, but it is necessary for accurate auscultation during the abdominal exam. ---------CORRECT ANSWER-----------------A) the diaphragm is better for picking up the sounds of S1 and S2 and the bell is better for picking up the sounds of S3 and S4. (Bates, p390) The nurse practitioner aucultates the heart and hears a murmur which she documents as 4/6 at its loudest point. She means the murmur is: A) moderately loud B) very loud, with thrill. May be heard when the stethoscope is partly off the chest. C) loud with a palpable thrill. D) quiet, but heard immediately after placing the stethoscope on the chest. ---------CORRECT ANSWER-----------------C) loud with a palpable thrill. Grade 4 is loud with a palpable thrill (Bates, p396). Physiologic splitting of the S2 in the 2nd and 3rd interspace, which is usually accentuated by inspiration, is caused by:
A) the closing of the aortic and pulmonic valves B) the addition of the S4 sound C) the addition of the S3 sound D) the closing of the tricuspid and mitral valves ---------CORRECT ANSWER-----------------A) the closing of the aortic and pulmonic valves Physiologic splitting of the S2 = closing of the aortic and pulmonic valves. Usually, the pulmonic valve closure is too faint to be heart but at the apex. The split is accentuated upon inspiration and disappears on expiration (Bates, p405). When assessing a patient's lungs, the nurse recalls that the left lung: A) is shorter than the right lung because of the underlying stomach. B) is divided by the horizontal fissure. C) consists of 2 lobes. D) consists primarily of an upper lobe on the posterior chest. --------- CORRECT ANSWER-----------------C) consists of 2 lobes. The left lung has 2 lobes, and the right lung has 3 lobes. The right lung is shorter than the left lung because of the underlying LIVER. The left lung is narrower than the right lung because the heart bulges to the left. The posterior chest is almost all lower lobe (Bates, p307). The primary muscles of respiration include the : A) trapezius and rectus abdominis. B) sternomastoids and scaleni. C) diaphragm and intercostals. D) external obliques and pectoralis major. ---------CORRECT ANSWER------ -----------C) diaphragm and intercostals. The major muscle of respiration is the diaphragm. The intercostal muscles life the sternum and elevate the ribs during inspiration, increasing the anteroposterior diameter. Expiration is primarily passive. Forced inspiration involves the use of other muscles, such as the accessory neck muscles (sternomastoids, scalene, trapazii). Forced expiration involves the abdominal muscles (Bates, p309).
B) very loud and relatively high pitch of the sounds heard over the trachea in the neck C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae D) crepitus palpated at the costochrondral junctions ---------CORRECT ANSWER-----------------C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae Bronchovesicular breath sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae. They are intermediate in intensity. Inspiration to expiration periods are equal. Inspiration and expiration are equal. (Bates, p324) The NP knows that normal newborn lung sounds: A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the sounds B) are vesicular C) are easily auscultated without the stethoscope D) are quiet in the infant compared to the adult ---------CORRECT ANSWER-----------------A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the sounds Fine crackles are commonly heard in the immediate newborn period as a result of the opening of the airways and learning of fluid. Persistent fine crackles would be noticed with pneumonia, bronchiolitis, or atelectasis. (Bates, p 831) During an assessment of an adult, the nurse practitioner has noted abnormally located bronchovesicular breath sounds and asks the patient to say "ee" which sounds like "a." Which of the following is true? A) The NP suspects the patient has had a pneumothorax. B) The NP suspects the patient is in the early phases of COPD. C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia.
D) The NP concludes that there is only a low likelihood that the patient has pneumonia. ---------CORRECT ANSWER-----------------C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia. If "ee" sounds like "a" then egophony is present and it could be a sign of pneumonia. (Bates, p327). A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with: A) acute pneumonia B) an asthmatic attack C) a pneumothorax D) bronchitis ---------CORRECT ANSWER-----------------C) a pneumothorax With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax is large then tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus, tracheal deviation to the unaffected side, decreased chest expansion, hyperresonnant percussion tones, and decreased or absent breath sounds are found with the presence of a pneumothorax. (Bates, p
The diameter of the PMI is approximately: A) 1-2.5 cm in diameter and any larger is evidence of mitral valve prolapse B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy C) .5-1 cm in diameter and any larger is evidence supporting left ventricular hypertrophy D) .5-1 cm in diameter and any larger is evidence of mitral valve prolapse -- -------CORRECT ANSWER-----------------B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy
and then I wake up and feel like I can't catch my breath." His symptoms indicates sleep related symptoms of a certain type of disease, so which question would the NP want to ask? A) Have you had a recent sinus infection or URI? B) Do you have any history of problems with your heart? C) Do you think it is because it's been so hot at night? D) When was your last electroencephalogram? ---------CORRECT ANSWER-----------------B) Do you have any history of problems with your heart? Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air. (Bates, p357) In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a history? A) Personality type, high cholesterol, diabetes, smoking B) Family history, hypertension, stress, age C) Alcohol consumption, obesity, diabetes, stress, high cholesterol D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history ---------CORRECT ANSWER-----------------D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history For major risk factors for coronary artery disease, collect data regarding elevated serum cholesterol, elevated blood pressure, blood glucose levels above 130 mg/dL or known diabetes mellitus, obesity, cigarette smoking, low activity level (Bates, p358) In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would: A) palpate the artery in the upper one third of the neck. B) listen with the bell of the stethoscope to assess for bruits. C) palpate both arteries simultaneously to compare amplitude.
D) instruct the patient to take slow deep breaths during inspiration. --------- CORRECT ANSWER-----------------B) listen with the bell of the stethoscope to assess for bruits. If cardiovascular disease is suspected, the nurse should auscultate each carotid artery for the presence of a bruit. The NP should avoid compressing the artery because this could create an artificial bruit, and it could compromise circulation if the carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the carotid sinus area higher in the neck; excessive vagal stimulation here could slow down the heart rate, especially in older adults. Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain. The bell of the stethoscope is best for picking up bruits. The diaphragm is more attuned to relatively high-pitched sounds; the bell is more sensitive to low-pitched sounds like bruits. (Bates, 381) All of the following are true about assessing the jugular venous pressure EXCEPT: A) The jugular venous pressure is affected by changes in the right atrial filling. B) The pulsation from the internal jugular vein reflects the left ventricle pressure. C) The jugular venous pressure is determined by the highest point of oscillation in the internal jugular vein. D) The jugular venous pressure is considered abnormal if it is greater than 4 cm above the sternal angle or greater than 9 cm above the right atrium. -- -------CORRECT ANSWER-----------------B) The pulsation from the internal jugular vein reflects the left ventricle pressure. The jugular venous pressure is affected by changes in R atrial filling. The JVP is abnormal at a height greater than 4 cm and is determined by the highest point of oscillation. The pulsation from the internal jugular vein is not palpable. (Bates, p354-355) During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?
A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care? A) JM is a 59 year old male here for having "black stools" for the past 24 hours. B) JM came into the clinic complaining of black stools for the past 24 hours. C) JM is a 59 year old male here for "ulcerative colitis." D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. ---------CORRECT ANSWER-----------------A) JM is a 59 year old male here for having "black stools" for the past 24 hours. Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care. Make every effort to quote the patient's own words. A patient tells the nurse practitioner that she has had abdominal pain for the past week. What would be the best response by the nurse practitioner? A) We'll talk more about that later in the interview." B) "Have you ever had any children?" C) "What have you had to eat in the last 4 hours?" D) "Can you point to where it hurts?" ---------CORRECT ANSWER------------- ----D) "Can you point to where it hurts?" Each principle symptom should be well-characterized, with descriptions of location; along with the other seven attributes. Location: Ask the patient to point to the pain because lay terms may not be specific enough to localize the site of origin. A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the following would be an appropriate response by the nurse to her statement? A) "How does your family react to your pain?" B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating." D) "How would you say the pain affects your ability to do your daily activities?" ---------CORRECT ANSWER-----------------D) "How would you say the pain affects your ability to do your daily activities?" Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity. In recording the childhood illnesses of a patient who denies having had any, which of the following notes by the nurse would be most accurate? A) Patient denies usual childhood illnesses. B) Patient states he was a "very healthy" child. C) Patient states sister had measles, but he didn't. D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio. ---------CORRECT ANSWER-----------------D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio. Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic fever, scarlet fever, and polio. They are included in the past history. A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information? A) "Are you allergic to any other drugs?" B) "How often have you received penicillin?" C) "I'll write your allergy on your chart so you won't receive any." D) "Please describe what happens to you when you take penicillin." --------- CORRECT ANSWER-----------------D) "Please describe what happens to you when you take penicillin." Allergies, including specific reactions to each medication, such as rash or nausea, must be recorded.
Remember that the history (from the chief complaint through review of systems) should be limited to patient statements or subjective data— factors that the person says were or were not present. Subjective data is what the patient tells you. The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." A) Medical B) Surgical C) Obstetrics/gynecology D) Psychiatric ---------CORRECT ANSWER-----------------B) Surgical Provide information relative to Adult Illnesses in each of four areas: Medical, Surgical, Obstetric/Gynecologic, and Psychiatric. During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse practitioner knows that this occurs because of a decrease in: A) pigmentation B) thyroid stimulating hormone C) phagocytes D) fungacytes ---------CORRECT ANSWER-----------------A) pigmentation Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of melanocytes) so the hair looks gray or white and feels thin and fine. The other options are not correct. You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution ---------CORRECT ANSWER---- -------------B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this? A) macule B) papule C) vesicle D) spider angioma ---------CORRECT ANSWER-----------------C) vesicle Vesicle - up to 1.0 cm filled with serous fluid A 72-year-old teacher comes 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 a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's 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. What is the stage of this pressure ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 ---------CORRECT ANSWER-----------------C) Stage 3 A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through underlying muscle.
