Download NR 509 Advanced Physical Assessment Final Exam Review: Weeks 5-8 and more Exams Nursing in PDF only on Docsity!
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NR 509 / NR509 Advanced Physical Assessment
Final Exam Week 5 to 8 Review
- Breast Exam Answer 5-7 days after the first day of menstruation -Inspect for symmetry, contours, and retractions -Palpitation with patient supine with arm above head -Palpate in ladder pattern, circular motion for each location
- Lactation Answer Physiological secretion with pregnancy, lactation, chest wall stimula- tion, sleep and stress.
- Montgomery glands:
2 / Answer sebaceous glands that secrete a protective lipid substance during lactation
- Galactorrhea : Answer a milky discharge from the nipple unrelated to normal breast feeding
- Mammary souffle: Answer "puff of air" heard during pregnancy and lactation (venous hum)
- Breast Cancer Answer Redness -Peau d'orange: thickening and prominent pores -Flattening instead of normal convexity -Asymmetry -Change in nipple direction -Paget disease: rash, scaling, ulceration of nipple and areola
- Breast cancer risk factors Answer
4 / -Sweating, pallor, nausea, vomiting, restlessness
- Abdominal Pain: Somatic/parietal: Answer Inflammation of the parietal peritoneum -localized or diffuse -Steady and aching pain, more severe than visceral -Aggravated by movement or coughing
- GERD Answer Rising retrosternal burning pain or discomfort -Aggravated by certain foods (alcohol, chocolate, citrus, coffee. onions, peppermint) and positional changes (supine or bending forward) -Coughing after eating or laying down
- Risk factor for Barretts's esophagus: Answer Esophageal cancer
- PUD: Answer Common causes: H.Pylori and NSAIDs Pain after meals (2-3 hr delay for
5 / duodenal) GERD Hematemesis Melena Treat with PPI, H2RA, antacids
- Appendicitis: Answer McBurney's point: tenderness on direct palpation Rovsing: rebound tenderness when palpating LLQ Psoas: raise thigh (flexion), contracts psoas muscle Obturator: flex the right thigh at the hip, bend knee, rotate leg internally, contracts obturator muscle Rectal exam: right side rectal tenderness Pelvic exam: palpable appendix through the pelvis May also presents with leukocytosis, high fever, nausea, vomiting, bowel changes
- Diverticulitis: Answer Diverticulosis: benign form (pockets only) LLQ pain, rebound tenderness Constipation (abdominal mass) Leukocytosis Hematochezia
7 / -Diagnosis of exclusion, intermittent pain for at least 12 weeks over a year, relief with defecation, changes in stool frequency and consistency -Commonly associated with food intolerances
- IBD (inflammatory bowel disease) Answer Mucous in stool -Bloating -Pain with defecation -Chronic diarrhea -Hematochezia -Anal fissures-Crohn's -Colonoscopy shows skip lesion or cobblestoning (Crohn), continuous inflammation (UC) -Strong family link
- Colon Cancer Answer Changes in stool -Palpable mass (late stage) -Pencil-thin stools -Hematochezia
8 / -(+) Cologuard/fecal tests=colonoscopy
- Risk factors for colon cancer Answer African American -Men -Elderly -IBD -Family history -Inactivity -Low fiber diet -Obesity -Alcohol -Cigarette smoking
- Rectal Exam Answer Side lying (preferred for elderly, obese) -Standing bent forward -Bear down to get past external sphincter -Asses glove for bleeding, discharge, or fecal matter -Masses: Moveable-fecal matter Immovable-prostate nodule, hemorrhoid, or fecal matter
10 / -Obesity -Cigarette smoking -Cadmium exposure
- What is the primary screening test for prostate cancer Answer PSA
- What is Proctitis cause by Answer IBD, STIs, trauma, bacterial infections, radiation therapy (especially for prostate cancer treatment)
- Proctitis Answer Anorectal pain
- Tenesmus -Discharge -Bleeding -Anal fissures
- Hernias: Protrusion of a loop of an organ or tissue through an abnormal opening
- Which hernias are at a higher risk for incarceration and strangulation?
11 / Answer Femoral hernias
- Incarcerate hernia: contents cannot be returned to abdominal cavity
- Stangulation: Blood supply is compromised
- Assessment for hernias is best with Answer Patient standing
- If fingers can go above the mass it is likely Answer A hydrocele
- Cryptorchidism: undescended testicles
- Occluded follicles / epidermoid cyst: dome-shaped white or yellow lesions
- Testicular torsion: Tender, painful, scrotal swelling
- Hydrocele: Fluid filled lesion, transilluminates
- Varicocele: Varicose vein of spermatic cord, thick rope-like texture
- Testicular Cancer Answer Painless nodule -Peak incidence 15-34 years old
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- Normal Discharge: clear, white, may have white clumps, not odorous
- Candidiasis: thick, white, and curdy discharge, not odorous, with pruritus, vagi- nal soreness, pain with urination, dyspareunia
- BV: gray, white, thin discharge, very odorous, worse after intercourse
- Uterine Tumors Answer Myomas: benign uterine tumors -Referred to as fibroids -Can be mistaken for ovarian mass if projecting laterally
- PID Answer most common cause of acute pelvic pain -secondary to most STD -ectopic pregnancy -recent IUD insertion
- Cervical cancer: extensive cauliflower like growth
- Risk factors for cervical cancer Answer immunosuppression -long term OC -chlamydia infection
14 / -precancerous lesions -in utero exposure to DES -more than 3 full term pregnancies
- Increased risk for cervical cancer Answer early age intercourse -frequent intercourse -multiple partners -smoking -HPV
- MS Assessment Answer IPROMS -Articular-altered active AND passive ROM -Nonarticular- altered active ROM
- Scapular winging: extend both arms, push against hand
- Crossover/crossed body abduction: AC joint, cross the arm straight over
- Apley scratch test: touch opposite scapula from above and below, tests exter- nal and internal rotation
- Painful arc test: abduct arm from down at side to straight up
- Neer Impingement sign: press on scapula, raise arm straight up, tests
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- External rotation resistance test: palms up bend at elbow, resistance on wrists and patient pushes arm out
- Empty can test: thumbs facing down, arms straight out, raise arms on resis- tance
- Midline back pain causes:: ligament injury, disc herniation, degenerative disc/faucet joints, vertebral fracture, spinal cord metastases or abscess
- Off midline: muscle strain, myofascial pain (trigger points), sacroiliitis, greater trochanteric pain syndrome, hip arthritis, renal pain and sciatica
- Low back pain + bowel/bladder incontinence + saddle seat anesthesia =: cauda equina syndrome
- Osetoarthritis Answer Age > 60 years -"Wear and tear" locations/degenerative -Heberden nodes (DIP) -Bouchard nodes (PIP) -Wide base stance -Pain worse with activity
- rheumatoid arthritis
17 / Answer Tender -Painful -Stiff -Symmetric -Ulnar deviation -Pain worse at rest -Morning stiffness
- Gout Answer Uric acid buildup -Crystal deposits in joints -Erythema -Deformities -Most common in big toe, distal locations
- Pseudogout: Calcium crystals NOT urate
- Muscle strength rating: 0: no contraction (flaccid) 1: barely detachable movement 2: movement, not against gravity, not against resistance 3: movement against gravity, not against resistance
19 / She has not had any vomiting or diarrhea. She had a normal bowel move- ment this morning. Her ²-human chorionic gonadotropin (²-hCG) is positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely diagnosis Answer Ruptured tubal (or ectopic) pregnancy
- A 63-year-old janitor with a history of adenomatous colonic polyps pre- sents for a well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, y-glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He presents for a follow-up appointment and the clinician performs on abdominal exam to assess his liver. Which of the following would be most consistent with hepatmegaly.: Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
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- A 63-year-old underweight administrative clerk with a 50-pack-year smok- ing history presents with a several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and temper- ature, 36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of the following is her most significant risk factor for an AAA Answer History of smoking
- A 76-year-old retired man with a history of prostate cancer and hyperten- sion has been screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for follow-up of his hypertension, during which the clinician scans his chart to ensure he is up to date with his preventative health care. He has a positive FOBT on on occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He has no first-degree rela- tives with a history
