Download GCU NUR 634 Midterm EXAM LATEST 2025/2026 ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A and more Exams Nursing in PDF only on Docsity!
GCU NUR 634 Midterm EXAM LATEST 2025/
ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A
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 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? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4 ANS: C A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You elicit the information that the dizziness is a spinning sensation of sudden onset, worse with head position changes. The episodes last a few seconds and then go away, and they are accompanied by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical examination of the head and neck and note that the patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the most likely diagnosis? A. Benign positional vertigo B. Vestibular neuronitis
C. Mé niè re's disease D. Acoustic neuroma ANS: A Feedback: This is a classic description of benign positional vertigo. The vertigo is episodic, lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is no tinnitus or sensorineural hearing loss as occurs in Mé niè re's disease and acoustic neuroma. You may choose to learn about Hallpike maneuvers, which are also helpful in the evaluation of vertigo. A young woman comes to you with a cut on her finger caused by the lid of a can she was opening. She is pacing about the room, crying loudly, and through her sobs she says, "My career as a pianist is finished!" Which personality type exhibits these features? A. Narcissistic B. Paranoid C. Histrionic D. Avoidant ANS: C Feedback: The theatrical nature of her behavior as well as her overreaction leads to a diagnosis of histrionic character disorder.
You order an EKG on your patient in bay #1, patient is a 25 year old male who appears healthy except his complaint today of a runny nose and cough. The nurse brings the EKG and it shows a HR of 25, what is your next step? Have the nurse re-do the EKG A 6 1 - year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a cough and some mild shortness of breath for the past couple of days. She now presents to the clinic complaining of pain and swelling in her right groin and leg, which she says has been there for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant erythema are noted. What is the chief concern with this patient? A. Acute arterial occlusion B. Ovarian metastasis C. Pulmonary embolism (PE) D. Acute Lymphangitis ANS: C Cancer patient are at high risk of deep venous thrombosis (DVT) and, with the presenting symptoms of swelling and pain in her groin, along with recent history of cough and shortness of breath, this patient’s presentation is suspicious for PE. Patients with DVT in the proximal leg veins are at high risk of thromboembolism. if an ultrasound of the leg does NOT reveal a clot the next place to check is the lungs
When assessing for the femoral pulse, where should the clinician begin deeply palpating? A. Above the inguinal ligament, just lateral to the symphysis pubis B. Below the inguinal ligament, just medial to the anterior superior iliac spine C. Below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis. D. Above the inguinal ligament, just medial to the anterior superior iliac spine. ANS: C The clinician would begin deeply palpating below the inguinal ligament, midway between the anterior superior iliac spine in the symphysis pubis. A 55-year-old actress sustains a heart attack and the follow-up electrocardiogram demonstrates a left bundle branch block. What would be the likely duration of the QRS complex? A. 125 milliseconds B. 95 milliseconds C. 90 milliseconds D. 75 milliseconds E. 100 milliseconds ANS: A
ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current household status, personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in this example 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? A. It is likely to be related to her lupus. B. It is likely to be related to an exposure to a chemical. C. It is likely to be related to an allergic reaction. D. It should not cause any problems. ANS: A Feedback: A “palpable purpura” is usually associated with a vasculitis. This is an inflammatory condition of the blood vessels often associated with systemic rheumatic disease. It can cut off circulation to any portion of the body and can mimic many other diseases in this manner. While allergic and chemical exposures may be a possible cause of the rash, this patient's SLE should make you consider vasculitis
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have? A. Medial epicondylitis (golfer's elbow) B. Olecranon bursitis C. Lateral epicondylitis (tennis elbow) D. Supracondylar fracture ANS: C Feedback: Mary’s injury probably occurred by lifting heavy buckets with her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely. Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation, and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? A. Allow the patient to speak uninterrupted for the duration of the appointment. B. Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
A 77-year-old retired bus driver comes 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 colon cancer, for which he had surgery, and arthritis. He has been married for over 40 years. He denies any tobacco or drug use and has not drunk alcohol in over 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? A. Smooth, large, nontender liver B. Irregular, large liver C. Smooth, large, tender liver D. Irregula ANS: B Feedback: With his past history of colon cancer and with recent weight loss and fatigue, a relapse of his colon cancer would be expected. Colon cancer usually metastasizes to the liver, creating hard, irregular nodules, which can sometimes be palpated on examination. A smooth, large liver which is tender is often seen in hepatitis. A 62-year-old smoker complains of "coughing up small amounts of blood," so you consider hemoptysis. Which of the following should you also consider? A. Intestinal bleeding B. Hematoma of the nasal septum C. Epistaxis
D. Bruising of the tongue ANS: C A patient complaining of hemoptysis what may warrant consideration? A. Upper GI Beed B. Oral Bruising C. Hematoma of nasal septum D. Periungual infection ANS: A Exam HENT, GI, and lungs A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on its own after a few hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave or miss work on three separate occasions. She would like a diagnosis and the problem fixed. Which symptoms or signs would be most suggestive of a diagnosis of biliary colic? A. Vomiting of bile B. Poorly localized periumbilical pain C. Associated right shoulder pain D. Positive McBurney point tenderness
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis? A. Dacryocystitis B. Chalazion C. Hordeolum D. Xanthelasma ANS: C Feedback: A hordeolum, or sty, is a painful, tender, erythematous infection in a gland at the margin of the eyelid. A 55-year-old woman with a headache explains to the clinician that she has had headaches before, but this one is unusual because of some new symptoms. Which of the following symptoms would prompt an immediate investigation? A. The headache comes and goes B. The patient had a car accident and minor head trauma about 3 months ago C. The patient lost her glasses D. The patient also has developed fever and night sweats and thinks she lost some weight.
E. The headache is similar in nature to prior ones she has had for decades but more severe. ANS: D Concomitant fever, night sweats, and weight loss are concerning systemic symptoms and suggest a serious underlying cause of the headaches. A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is ANS: C Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated with a history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On auscultation there can be normal to decreased air movement. Wheezing is heard on expiration and sometimes inspiration. The duration of wheezing in expiration usually correlates with severity of illness, so it is important to document this length (e.g., wheezes heard halfway through exhalation). Realize that in severe asthma, wheezes may not be heard because of the lack of air movement. Paradoxically, these patients may have more wheezes after treatment, which actually indicates an improvement in condition. Peak flow measurements help to discern this.
When a patient is suspected of having medial epicondylitis (pitcher's, golfer's, or Little League elbow) where would they experience pain? Wrist flexion against resistance increases the pain. A differential to consider if a patient is having fever, shortness of breath, productive cough, and hemoptysis? A. COPD B. Raynaud Syndrome C. Pneumonia D. Spontaneous Pneumothorax ANS: C With a "fever" think infection Exam findings of a patient with pneumonia (Select all that Apply) A. Dullness with percussion B. Dull, diminished lung sounds C. Coarse crackles on auscultation D. Decreased fremitus during palpation
ANS: A, B, C
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 > 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 > mm; E = evolution ANS: B Feedback: This is the correct description for the mnemonic If a patient has splenomegaly, what sound would be heard when percussing the left side of the abdomen? A. Dullness B. Tympany C. Fremitus
ANS: A
Feedback: The PMI is usually located in the left 5th intercostal space, 7 to 9 centimeters lateral to the sternal border. If it is located more laterally, it usually represents cardiac enlargement. Its size should not be greater than the size of a US quarter, or about an inch. Left ventricular enlargement should be suspected if it is larger. The PMI is often the best place to listen for mitral valve murmurs as well as S3 and S4. The PMI is often difficult to feel in normal patients. A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10 months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lbs. over 4 months. What is the mechanism of his most likely diagnosis? A. Helicobacter pylori infection B. Reduced blood supply to the bowel C. Inflammation of the gallbladder D. Fibrosis of the pancreas E. Inflammation of colonic diverticulum ANS: D Fibrosis of the pancreas is associated with chronic pancreatitis. Chronic pancreatitis leads to fibrosis and decreased pancreatic function, which causes diarrhea from pancreatic enzymes insufficiency and diabetes mellitus. H.Pylori infection may cause peptic ulcer disease and dyspepsia, which is not usually associated with diarrhea
A 19-year-old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? A. Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion B. Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right C. Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion D. Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion ANS: C Feedback: Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of motion are consistent with neck stiffness, which in this scenario is likely to be caused by meningeal inflammation. Later, you will learn about Kernig's and Brudzinski's signs, which are helpful in testing for meningeal irritation on examination During an evaluation of an athletic 30-year-old patient, the clinician conducts an active ROM evaluation at the neck. Which muscle is being assessed when the patient is asked to flex the neck?
