Download Health Care Examiner's Guide: Identifying and Diagnosing Various Eye and Ear Conditions and more Exams Nursing in PDF only on Docsity!
Maryville NURS 612 Exam 1
A 51-year-old patient tells the examiner, "My mother had glaucoma. What can I do to prevent myself from getting it?" Which of the following responses is most appropriate? - ans"Although it can't be prevented, regular screening and testing assist in early detection." A cobblestone appearance of the conjunctiva is most likely related to - ansallergic or infectious conjunctivitis A common mistake made by health care professionals is to? - ansstereotype individuals based on color or ethnic group A patient has xanthelasma on their eyes what is this caused by? - ansabnormality of lipid metabolism A patient presents with multiple raised lesions on her skin. Which instrument should be used to examine these lesions - ansruler A patient tells the examiner, "I have a loss of vision in the outer half of each eye." Which of the following underlying problems should the examiner consider? - ansglaucoma A young mother brings her infant to the emergency department with a high temperature and dehydration. Which of the following questions asked by an examiner demonstrates cultural awareness? - ansWhat do you think is causing the illness? Abnormal findings in elderly mouth/pharynx - ansGingivitis, periodontal disease, dental caries, teeth may appear longer, Dental malocclusion Abnormal findings with elderly Conjunctiva - ansCataracts Age related macular degeneration Diabetic retinopathy Glaucoma According to the Centers for Disease Control and Prevention, the health care provider should apply infection control measures when caring for which group of patients? - ansAll patients regardless of their infectious status After an examiner has identified and confirmed a problem, the next step is to - ansdetermine the managment plan
All of the following are cultural considerations that affect health care except - anseye color, temperature, and visual acuity An integral part of the overall effort to respond adequately to a person in need is - anscultural awareness An ophthalmoscope has positive and negative magnification in order to - anscompensate for myopia or hyperopia in the examiner's or the patient's eyes. As a component of palpation, which surface is most sensitive to vibration - ansulnar surface of the hand Before instilling a mydriatic eyedrop, the examiner should - ansobserve the eye with focused light tangentially characterized by a progressive series of abnormal changes in the retinal microvasculature, proliferative retinopathy, dilated fundoscopy - ansDiabetic retinopathy Chronic sniffling, nasal congestion, nosebleeds, mucosal scabs, and septum perforation are signs of - anscocaine abuse Despite repeated instruction over a period of 3 years, the mother of three young children has still not had her children immunized. Which of the following questions would help the health care provider understand this situation? - ansWhat are your beliefs about immunizations Developing a knowledge base about cultural groups allows the practitioner to - ansunderstand the behaviors, practices, and problems observed Developing cultural sensitivity is vital in order for the examiner to be successful in - ansrecognizing and accepting health beliefs that differ from his or her own beliefs. Differential diagnosis of thickened white patch on the lateral or ventral surface of the tongue in a pt with HIV? - anssarcoma Direct questions are designed to - ansobtain or clarify specific details about an answer During a history, the patient indicates he has an uncle and a brother with sickle cell disease. Which of the following is an appropriate method to document this information? - ansInclude it in the family history.
How do you check for glaucoma? - ansCheck intraocular pressure (tonometry); optic disc assessment, peripherial vision exam, whether intraocular drainage system is "open" or "closed" (gonioscopy) How is the Rinne test performed? - ansPlace the base of the tuning fork against patients mastoid bone, ask patient to tell you when sound is no longer heard (bone conduction) Place the still vibrating tines (1-2 cm) in from the auditory canal and ask patient to tell you when sound is no longer heard (air conduction) how to identify bacterial conjunctivitis vs allergic conjunctivitis - ansBacterial- starts in one eye and spreads to the other, yellow/ crusty drainage Allergic- both eyes, puffy and/ or runny How would you diagnose a patient with an allergy? - ansClear rhinorrhea as opposed to purulent, throat irritation, POST NASAL DRIP How would you like to be addressed?; How are you feeling today?; What would you like for us to do today?; What do you think is causing your symptoms?; What is your understanding of your diagnosis? - ansexamples of patient-centered questions Ideally, auscultation should be carried out last, except when examining the - ansabdomen If a patient comes in with a herpes lesion or shingles on face close to eyes, what is the number one thing that you would think of and send this patient to the emergency department? - ansoptic neuritis if a patient comes in with any complaints of mouth problems whats an important question to ask? - ansif they are a smoker or not If language is a barrier how should it be handled - ansprofessional interpreter, rather than a family member, should be used If patient is hyperoptic (farsighted) or aphakic (lacks a lens) what lens will be used with ophthalmascope? - ansplus (green) lens if someone of a different culture comes in with pain how would you address that? - ansask if they any cultural beliefs that will affect how you need to treat the pain, does the pain frighten you, how do you cope with pain, what ways do you usually treat pain If the eye is very firm when palpated what disease should be considered - ansGlaucoma
If the patient presents with sudden vision disturbances, "curtains", floaters, or flashing lights with a wrinkled and grey retina following a trauma what would you suspect? - ansretinal detachment If you do not see a red reflex what could that indicate - ansRetinoblastoma If you look at the outside of the ear and you see drainage, is this normal or abnormal? - ansAbnormal If you see white flakes, or dense plaques in the ear what could that indicate? - anshealed inflammation If your patient is myopic (nearsighted) what lens will be used with ophthalmascope - ansminus (red) len In an outpatient setting such as a clinic, how should infection control practice differ from that in the acute care setting? - ansInfection control practice is applicable in all healthcare settings. In which of the following situations is transillumination an appropriate examination technique - ansDetection of fluid within the sinuses In which of the following situations is use of a Doppler indicated - ansAuscultation of a nonpalpable pulse in a patient with peripheral vascular disease Initial symptoms are cracking sound when yawning or swallowing, discomfort, feeling of fullness (no drainage) - ansOtitis media with effusion Initial symptoms of Abrupt onset, fever, feels blocked, anorexia, irritability, deep-seated ear ache, if TM ruptured foul-smelling discharge - ansAcute Otitis Media Interviewers should identify and assess their own feelings, such as hostility and prejudice, in order to - ansreduce communication barriers Jerry, a 26-year-old homosexual man, is having a health history taken. Which question regarding sexual activity would most likely hamper trust between Jerry and the interviewer? - ansAre you married or do you have a girlfriend Know some red flags of the eye (send to ED or eye doctor) - ansuneven pupils with HA, sudden loss of vision, floaters/flashers Laboratory tests should be used to - ansdevelop a list of potential problems markedly asymmetric cupping between the 2 eyes can indicate? - ansGlaucoma
The examiner notes that a patient's tonsils are enlarged and that they touch the uvula. This is documented as - ans3+ The examiner observes a blackish lesion on the top surface of the tongue of an adult patient. The patient indicates that his tongue is painful. Which question by the examiner would be helpful in explaining this finding? - ans"Have you been taking antibiotics lately?" The examiner screens a 5-year-old child for nystagmus by - ansinspecting movement of the eyes to the six cardinal fields of gaze The most important clinical signs for sinusitis in adults includes which of the following? - ansMaxillary toothache, purulent nasal drainage, poor response to decongestants The term intensity, when used in relation to percussion tones, refers to - ansthe loudness of the tone. The use of a computer could potentially be detrimental to the examiner because - ansit may become a substitute for critical thinking. To identify problems based on clinical examination, the examiner should organize the data - ansby body systems To visualize the macula, the examiner should ask the patient to - anslook directly into the light of the ophthalmoscope. Unless a life-threatening situation exists, the best guide to determining the priority for the patient's condition should be based on - ansintuition What are some tests that you would run if you see a patient with oral ulcers that are not resolving - ansCheck for HIV, syphilis, imunosuppression What causes peripheral cataracts? - anshypoparathyroidism What differential diagnoses would you think of if the uvula is deviated? - ansPeritonsillar abscess What diseases are associated with periodontal disease? - ansDM, PVD and CV disease What do direct questions allow? - ansto seeks specific information What do open-ended questions allow? - ansgives the patient discretion about the extent of an answer
What does a chalky white TM or redness mean? - ansmiddle ear infection (Acute otitis media) What does a Herpes lesion look like? - ansvesicular lesion What else would you want to know on a history of a patient that comes in with lesions or mouth sores? - anstobacco use, if immunocompromised, stress levels What if the uvula is not midline? - ansSuspect a problem on the opposite side that the uvula deviates What is being looked at with ophthalmoscope - ansRed reflex, vascular supply of the retina, optic disc and macula What is disease that progressively destroys the macula, impairing central vision - ansAge related macular degeneration (AMD): What is first thing visualized with ophthalmascope 12 inchs away? - ansred reflex What is Glaucoma? - ansprogressive, chronic optic neuropathy in which intraocular pressure (IOP), disease of optic nerve where the nerve cells die what is palpated while examining external ear? - ansthe preauricular and post auricular lymph nodes and mastoid area What is the number one thing that you should document on a sinusitis patient? - ansLength of symptoms (to know whether to treat viral or bacterial) What is the number one virus that causes oral ulcers with fever? - ansHerpes Simplex What is the worst differential diagnosis for a patient that comes in with an ear infection?
- ansMastoid infection or meningitis What is usually observed before visual field losses appear in Glaucoma? - ansoptic disc cupping What is your differential diagnoses if you see drainage outside of the ear? - ansOtitis Externa, Otitis Media, Ear effusion, or foreign body in the ear What kind of patients get Otitis Externa? - ansSwimmers, breast/ bottle fed children What placement should the uvula have? - ansmidline What tests are done to test hearing? - ansWhisper, Weber, & Rinne
Which examination finding may be indicative of a retro-orbital tumor? - ansUnilateral exophthalmos Which mode of communication may be offensive to a patient whose cultural perspective differs from that of the practitioner - ansmaintaining firm and direct eye contact Which of the following correctly describes the method to assess accommodation? - ansConstriction should be noted as gaze shifts from across the room to an object 6 inches away. Which of the following cranial nerves innervate the six muscles that control eye movement? - ansIII, IV, VI Which of the following examples illustrates a vague or nondescriptive term - ans"skin color is normal" Which of the following infection control guidelines are currently recommended by the Centers for Disease Control and Prevention (CDC)? - ansstandard precautions Which of the following instruments is used in conjunction with a simple nasal speculum to visualize the lower and middle turbines of the nose? - anspenlight Which of the following is an example of a cultural characteristic? - ansshared belief Which of the following is an example of a physical, as opposed to a cultural, characteristic? - ansSkin color Which of the following is the correct technique while performing an ophthalmoscopic examination? - ansExamine the patient's right eye with your right eye and the pt's left eye with your left eye Which of the following is true regarding the correct use of a stethoscope? - ansThe bell is pressed lightly against the skin to detect low-frequency sounds Which of the following questions may lead to an inaccurate patient response? - ans"That was a horrible experience, wasn't it?" Which of the following should be used to test for near vision? - ansRosenbaum chart
Which of the following situations is an indication for transillumination? - ansThe patient complains of pain over sinuses with palpation. Which of the following statements is true regarding use of abbreviations? - ansUse only universally accepted abbreviations for documentation Which of the following statements made by a 72-year-old patient would indicate a normal process of aging? - ans"Food does not taste the same as it used to." Which of the following techniques is incorrect and affects the accuracy of auscultation? - ansAuscultating through clothing Which of the following will best facilitate the interview when obtaining a history for a deaf patient who can read lips? - ansspeaking slowly Which of the following would be applicable to a family history? - ansRetinoblastoma Which statement best characterizes a belief that supports a sound decision-making process? - ansCommon problems occur commonly, and rare ones occur rarely Which technique is applied throughout the entire examination and interview process - ansinspection While performing an internal eye examination, the examiner observes a fundal lesion. What feature on the ophthalmoscope permits the examiner to estimate the size and location of the lesion? - ansgrid light You are taking a health history on your patient. When you are asking about problems in other body systems, your patient reports constipation over the past 5 or 6 months. This would be documented in - ansReview of symptoms You have a 42 y/o female that comes in to you saying "I have dizziness" what differential diagnoses could be and what test can you do to check if it is vertigo? - ansEar infection, Meniere's disease, vertigo; Dix Hallpike maneuver (Head tilt and lay back maneuver) Your patient presents to the office with a chief complaint of shoulder pain that he reports as stabbing. In using the mnemonic OLDCARTS, this is noted as - anscharacteristic
