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NR 509 / NR509 Advanced Physical Assessment
Midterm Exam
Questions with Verified Answers - Chamberlain
Consist of 100 multiple choices Questions with Answers
1. 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 sleep- ing 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? a. Perform a pelvic examination. b. Obtain a urine sample for testing. c. Obtain a more complete description of problems. d. Obtain blood for testing.
e. Ask about recent travel destinations ANS: c. Obtain a more complete description of problems.
2. A 29-year-old female professional athlete presents to a new primary care provider with chronic menstrual complaints. She remarks to the nursing staff that, in the past, she has experienced a dismissal of her complaints because of her high level of physical fitness and conditioning. She is seeking a care provider who will explore the issue in more detail and work with her particular concerns. Which of the following is the description of the patient-centered care this individual seeks? a. Structured and clinician-centered with open-ended questions b. Validating and empathetic with open-ended questions c. Dismissive and concrete with open-ended questions d. Affirming and reassuring with close-ended questions e. Factual and structured with active listening ANS: b. Validating and empathetic with open-ended questions 3. A 36-year-old female air traffic controller presents to her primary
4. A 63-year-old male presents to establish care at a new primary care clinic to discuss issues with pain and fatigue. The clinician conducting the visit begins with general historical questions but quickly becomes suspicious that the patient is suffering from decompensated heart failure. When the patient mentions that he has had vague chest pain since last night, the clinician feels that the focus must be redirected to this potentially emergent condition. Which of the following interview techniques is the most appropriate to effectively manage this visit? a. Providing serial reassurances such as, "Don't worry, you're going to be fine." b. Asking a series of negative questions such as, "You don't have any swelling in your feet, do you?" c. Nonverbally cuing the patient to focus on his narrative regarding a motor vehicle accident d. (MVA) that led to back pain e. Asking leading questions that focus on the presumed diagnosis of chest pain f. Moving from open-ended to focused questions: f. Moving from open- ended to focused questions
5. A 59-year-old patient presents to his primary care provider with a history of several episodes of sharp epigastric pain. His father died of pancreatic cancer at age 52 years, and the patient recalls to the clinician that, "His pain was just like mine is now ..." The patient then pauses several seconds. The clinician replies, "Just like?" after which the patient restarts his narrative. Which of the following is an example of the interviewing techniques employed by the clinician? a. Clarifying b. Echoing c. Encouraging with continuers d. d. Eliciting a graded response e. Asking a leading question ANS: b. Echoing 6. A 14-year-old male presents to a new primary care provider after his family relocates to a state. The patient underwent treatment for sarcoma when he was age 11 years, including an above-the-knee amputation. He has learned to successfully navigate with a prosthetic leg and even engage in competitive athletics at school. He does not like to speak of his experience with cancer and often makes up humorous
"Mostly, I bum them," he says, chuckling. Upon hearing this information, what is the best next step on the part of the clinician? a. Determine the patient's exercise regimen. b. Determine the number of pack-years the patient smokes. c. Conduct a mental status examination. d. Explain the relationship between smoking and cancer. e. Determine the patient's immunization history. ANS: b. Determine the number of pack-years the patient smokes.
8. A 47-year-old fitness trainer visits the physician assistant (PA) because of skin dryness, night sweats, and irregular menstrual periods. It is the PA's first contact with this patient. The patient notes that "My sex life has really gone downhill lately" and says that she is considering divorcing her husband of 20 years, stating that "He's not a bad guy. I just think that I can do better." In which of the following ways should the clinician proceed? a. Obtain a menstrual history for the previous 6 months. b. Help the patient review the pros and cons of divorce. c. Inform the patient that menopause is a normal part of aging. d. Conduct a breast examination.
e. Determine the patient's out-of-country travel history. ANS: a. Obtain a menstrual history for the previous 6 months.
9. One important examination technique involves using the third fingers of each hand to determine the health of internal organs. What is the name of this technique? a. Auscultation b. Percussion c. Inspection d. Palpation e. Listening ANS: b. Percussion 10. A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. What should the PA do to minimize their mutual discomfort? a. Adjust lighting so it is tangential to the patient's body. b. Explain how the examination will proceed.
concerns, and requests d. Deferring respect, empathy, humility, and sensitivity in favor of the acquisi- tion of concrete details about the patient's condition e. Taking a symptom-focused approach to reduce the involvement of the patient's emotional difficulties ANS: c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests
12. A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is afraid that his last partner may have given him an infection. The patient expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is dismissed or discriminated against because of it. The nurse practitioner receives this communication prior to entering the
11 / examination room and decides to employ active listening to best connect with the patient at this critical juncture in his care with the clinic. Which of the following is an example of an active listening technique? a. Ignoring visual cues to focus on the patient's exact words b. Setting aside the patient's emotional state to focus on his medical needs c. Paring down the patient's concerns to concrete medical needs d. Using nonverbal communication to encourage the patient to expand their narrative e. Considering a differential diagnosis while the patient is speaking to maxi- mize the patient's time with the provider ANS: d. Using nonverbal communication to encourage the patient to expand their narrative
13. A 42-year-old female mathematician presents for follow-up care regarding a new diagnosis of systemic lupus erythematosus 6 months ago after a lengthy diagnostic process during which she was debilitated with fatigue and joint pain. Since her diagnosis, she has been minimally
13 / c. Likelihood that the patient complaints are "psychosomatic" d. Major depressive disorder e. Bipolar disorder ANS: a. Alcohol misuse
15. A 53-year-old caterer comes to the clinic for a routine examination. She has type 2 diabetes mellitus, which is well controlled on medication. Her history from her last visit reveals that she smoked one pack of cigarettes a day at that time. The 5 As Model is a useful approach to take with trying to help patients to quit smoking. What is the 5 As Model? a. Admonish, action, available, assess, alleviating factors b. Agitate, assist, alleviating factors, able, action c. Affable, associated manifestations, ask, admonish, available d. Ask, advise, assess, assist, arrange e. Arrange, aggravating factors, action, attitude, able ANS: d. Ask, advise, assess, assist, arrange 16. A 21-year-old college student experiences tachycardia following a night of heavy drinking. She is advised to undergo a stress electrocardiogram (ECG). As she exercises, the recently calibrated pulse oximeter records a heart rate ranging from 25 beats per minute (bpm) at rest to 50 bpm while jogging. The test is stopped and re-started
14 / twice, and each time the pulse oximeter yields a resting heart rate of 25 and a jogging heart rate of 50. Which aspect of this instrument does the ECG technician question? a. Prevalence b. Validity c. Sensitivity d. Specificity e. Predictive value ANS: b. Validity
16 / strips from Container A show abnormally low pH levels in the urine. However, three test strips from Container B, purchased more recently, consistently indicate that the pH of this patient's urine is normal. Which of the following is a true statement about the test strips? a. The test strips demonstrate high interobserver reliability. b. The test strips demonstrate low intraobserver reliability. c. The test strips demonstrate high intraobserver reliability. d. The test strips demonstrate high sensitivity. e. The test strips demonstrate high specificity. ANS: c. The test strips demonstrate high intraobserver reliability.
19. A 45-year-old forklift driver presents to the clinic at 4 o'clock in the after- noon complaining of intense substernal chest pain and nausea. He appears pale and sweaty. At work that day, he filled in for an absent co-worker and was asked to perform heavy lifting not normally a part of his job. The physician assistant (PA) questions the patient in detail about his nausea, eating habits, and digestive history. Which of the following steps of clinical reasoning has the PA failed to follow?
17 / a. Elicit information about the patient's gastrointestinal (GI) system b. Localize findings anatomically c. Match findings against conditions that could cause them d. Give special consideration to potential life-threatening problems e. Elicit information about the patient's family history of digestive disorders ANS: d. Give special consideration to potential life-threatening problems
20. The positive predictive value of a test is calculated as the number of true positives identified by the test divided by the total positives found by the test. If a novel test for strep throat yields 150 true-positive results and 150 false-positive results, what is the positive predictive value of this test? a. 10% b. 25% c. 50% d. 75% e. 100% ANS: c. 50%
- OLDCARTS: Onset Location
19 / examination. The physician assistant notes a systolic murmur on auscultation of the aorta. How- ever, she does not immediately conclude that this patient has aortic stenosis. Which of the following is the reason that she seeks additional information?
20 / a. Systolic murmurs have high sensitivity and high specificity for aortic steno- sis. b. Systolic murmurs have low sensitivity and low specificity for aortic steno- sis. c. Systolic murmurs have low sensitivity but high specificity for aortic steno- sis. d. Systolic murmurs have high sensitivity but low specificity for aortic steno- sis. e. Systolic murmurs are unrelated to aortic stenosis. ANS: d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis.
24. A mother brings her 8-year-old daughter to the clinic because she found a tick in the girl's hair and would like her daughter to be tested for Lyme disease. The nurse practitioner (NP) explains that the enzyme- linked immunosorbent assay (ELISA), an early test for Lyme disease, is effective in finding early cases of Lyme disease but can also give positive results in some people who do not have the disease, making additional testing necessary. This means that the ELISA test has which of the following? a. Low sensitivity, high specificity
