Download NR509 Final Exam Questions With Correct Answers and more Exams Medicine in PDF only on Docsity!
NR509 Final Exam Questions With Correct Answers
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. c. Ask the patient where he comes from. d. Explain that she is a PA student. e. Provide ongoing interpretation of findings. - accurate answers-b. Explain how the examination will proceed. A 34-year-old male with a history of complex social and medical needs (including current substance abuse) presents to a primary care teaching clinic. The patient has experienced a number of adversarial relationships with prior clinicians, including voluntarily leaving two practices within the previous year and being asked to leave care at a third clinic due to misbehavior. The attending physician desires to utilize the approaches to this patient that are most likely lead to comprehensive care and patient compliance. Which of the following is the most appropriate interview style for the attending physician to use? a. Focusing on the need for immediate diagnostic certainty over personal connection b. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic information c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests d. Deferring respect, empathy, - accurate answers-c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests 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 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 conce - accurate answers-d. Using nonverbal communication to encourage the patient to expand their narrative 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 compliant with medications and has switched her rheumatology provider twice. She continues to feel ill, and, in explanation for her lack of adherence to the prescribed treatment, she simply says, "I don't like it." At this initial visit with her third rheumatology provider, the clinician elects to explore the issues behind her noncompliance before engaging in diagnostics and treatment using the FIFE model. Which of the following best defines the elements of the FIFE model? a. Focus, intensity, function, and evaluation b. Facts, intensity, focus, and evidence c. Feelings, ideas, function, and expectations d. Feelings, impression, fantasy, and em - accurate answers-c. Feelings, ideas, function, and expectations 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 sleeping 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. - accurate answers-c. Obtain a more complete description of problems. 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
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 diag - accurate answers-f. Moving from open-ended to focused questions 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. Eliciting a graded response e. Asking a leading question - accurate answers-b. Echoing 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 stories to tell new acquaintances about his amputation (such as, "I got bit by a squirrel and they had to amputate."). Although he is very well engaged in most of the visit with the new clinician, when the topic of cancer arises, he demurs to his father, who accompanies him to this appointment. Which of the following statements is most likely to be helpful in cementing the patient's trust in the new provider a. "That sounds like a frightening experience that you are recovering well from." b. "You are becoming an adult - accurate answers-a. "That sounds like a frightening experience that you are recovering well from." A 29-year-old electrician complains of persistent cough and wheezing, particularly when he exercises. He says he smokes "occasionally" but rarely so much that he needs to purchase cigarettes: "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. - accurate answers-b. Determine the number of pack-years the patient smokes. 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. - accurate answers-a. Obtain a menstrual history for the previous 6 months. 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 - accurate answers-b. Percussion The CAGE questionnaire is a short screening examination administered in the office to evaluate for which of the following? a. Alcohol misuse b. Risk for illicit substance abuse c. Likelihood that the patient complaints are "psychosomatic" d. Major depressive disorder e. Bipolar disorder - accurate answers-a. Alcohol misuse
c. Negative predictive value of an observation is lower in a group with a higher prevalence of disease. d. Negative predictive value of an observation is higher in a group - accurate answers-a. Positive predictive value of an observation is higher in a group with a higher prevalence of disease. A 23-year-old farm worker submits urine for testing. Three test 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. - accurate answers-c. The test strips demonstrate high intraobserver reliability. A 45-year-old forklift driver presents to the clinic at 4 o'clock in the afternoon 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? 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 - accurate answers-d. Give special consideration to potential life-threatening problems 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% - accurate answers-c. 50% OLDCARTS - accurate answers-Onset Location Duration Character Aggravating or alleviating factors Radiation Timing Setting The negative predictive value of a test is calculated as the number of true negatives identified by the test divided by the total negatives found by the test. If a novel test for strep throat yields 85 true-negative results and 15 false-negative results, what is the negative predictive value of this test? a. 10% b. 15% c. 75% d. 85% e. 99% - accurate answers-d. 85% A 58-year-old carpenter presents for his annual physical examination. The physician assistant notes a systolic murmur on auscultation of the aorta. However, she does not immediately conclude that this patient has aortic stenosis. Which of the following is the reason that she seeks additional information? a. Systolic murmurs have high sensitivity and high specificity for aortic stenosis. b. Systolic murmurs have low sensitivity and low specificity for aortic stenosis. c. Systolic murmurs have low sensitivity but high specificity for aortic stenosis. d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis. e. Systolic murmurs are unrelated to aortic stenosis. - accurate answers-d. Systolic murmurs have high sensitivity but low specificity for aortic stenosis. 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
b. A 32-year-old female with a baseline weight of 175 lb who checks her weight irregularly but reports a 5-lb unintended weight loss over 3 months c. A 45-year-old recently menopausal female who gains 5% beyond her baseline weight of 140 lb in 6 months d. A 26-year-old female with a baseline body mass index (BMI) of 25 who loses 5% of her body weight with 6 months of diet and exercise modification e. A 31-year-old male with a baseline body mass index (BMI) of 20 who loses 3 lb after a prolonged bout of infectious gastroenteritis - accurate answers-a. A 45- year-old male with baseline weight of 280 lb who decides to undertake a light exercise regimen and loses 15% of A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode at school. He is notably thin; on a thorough review of his medical history, he admits that he eats only minimally to maintain a very low body weight that he feels is ideal. He is embarrassed that his issues were discussed by peers after this episode, especially because he believes that this is a problem that is only faced by girls and women. Concerning the two most common eating disorders (anorexia nervosa and bulimia nervosa), which of the following statements is true? a. Men and women are both afflicted, but with a female:male prevalence ratio estimated at ~2:1. b. Both of these eating disorders are associated with a body mass index (BMI) of <17.5. c. Both of these eating disorders are associated with a real or imagined fear of appearing fat. d. Persons with eating disorders are generally easily identified by their appeara - accurate answers-c. Both of these eating disorders are associated with a real or imagined fear of appearing fat. A 55-year-old air traffic control agent reports his home blood pressure log to clinic after he was diagnosed with hypertension at a prior visit. He notes that he consistently measures within the normal range at home, but seems to fall outside the normal range every time he comes to the clinic. Which of the following blood pressure measurements is considered to be most accurate (i.e., reflecting the patient's "true" blood pressure)? a. Blood pressure recorded in three positions in the health practitioner's office b. Three separate blood pressure measurements recorded by a medical technician within 90 minutes of awakening in the morning in an office setting using an automated device
c. Blood pressure recorded in three positions in the health practitioner's office after resting for a 10-minute period in a supine position d. Regular ambulatory monitoring recorded outside of the office setting e. A total of six blood pre - accurate answers-d. Regular ambulatory monitoring recorded outside of the office setting A 68-year-old retired college professor presents for routine physical examination. After the patient has been reading a novel in the waiting room for ~20 minutes, the technician records his blood pressure in both arms using an automated device. The technician notes a 20-mm Hg difference in systolic blood pressure between the right and left arms; he repeats the readings 10 minutes later and records the same asymmetrical systolic blood pressure. Which of the following is true regarding this physical finding? a. An arm-to-arm difference of up to 20 mm Hg in systolic blood pressure is considered the upper limits of normal. b. The difference is likely secondary to white coat hypertension and should be followed up with three subsequent monthly readings to confirm. c. The patient should undergo ambulatory blood pressure monitoring in both arms for 24 hours to confirm conflicting measurements in the office. d. This finding - accurate answers-d. This finding is clearly abnormal and requires immediate evaluation for possible cardiovascular emergency. Position of listening to heart sounds - accurate answers-https://medizzy.com/feed/ Aortic regurgitation -What position the patient should be in to auscultate -What sound will you hear - accurate answers--Leaning forward -Soft diastolic decrescendo murmur Olfactory nerve: - accurate answers-1 Sense of smell. Optic nerve - accurate answers-2 : Ability to see. Oculomotor nerve: - accurate answers-3 Ability to move and blink your eyes. Trochlear nerve: - accurate answers-4 Ability to move your eyes up and down or back and forth
month beyond the course of an acute illness or injury, or pain recurring at intervals of months or years. Chronic pain is the leading cause of disability and impaired performance at work. Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity. Depressive, somatoform, and anxiety disorders affect the patient's coping strategies and have to be identified in order to effectively treat acute pain, in particular, chronic pain. Visual acuity 20/100 - accurate answers-Means that at 20 feet the patient can read a print that a person with normal vision could read at 100 ft, the larger the second number the worse the vision. First # indicates the distance from the chart. Funduscopic exam - accurate answers-The use of an ophthalmoscope to look through the pupil and examine the interior surface of the posterior eye Signs of increased intracranial pressure - accurate answers-•Papilledema of the optic disc leads to elevated ICP causes intraaxonal edema along the optic nerve leading to engorgement and swelling on the optic disc -Pink, hyperemic, loss of venous pulsations, disc more visible, disc swollen with blurred margins, physiologic cup not visible •Headache, blurred vision, feeling less alert than usual, vomiting, changes in behavior, weakness or problems with moving or talking, lack of energy or sleepiness Edema scale - accurate answers-• 1+ Mild pitting, slight indentation, no perceptible swelling of the leg
- 2+ Moderate pitting, indentation, subsides rapidly
- 3+ Deep pitting, indentation remains for a short time, leg looks swollen
- 4+ Very deep pitting, indentation lasts a long time, leg is very swollen Macular degeneration - accurate answers-Macular degeneration is an important cause of poor central vision in older adults.
Types include dry atrophic (more common but less severe) and wet exudative, or neovascular. Cellular debris, called drusen, may be "hard" and sharply defined or "soft" and confluent with altered pigmentation 6 EOMs - accurate answers-Ask the patient to follow your finger or pencil as you sweep through the six cardinal directions of gaze. Making a wide H in the air, lead the patient's gaze Where is the malleus located - accurate answers-Middle ear / oval shaped thing A 62-year-old former tennis pro obtained a home blood pressure cuff after an office measurement revealed that his blood pressure fell in the hypertensive range. At a follow-up visit, he questions the accuracy of the clinician's blood pressure cuff and the veracity of his diagnosis of hypertension. Which of the following is true regarding blood pressures recorded in a practitioner's office versus values obtained in the ambulatory setting? a. The accepted normal values for blood pressure are lower for ambulatory measurements compared with office measurements. b. Masked hypertension is a phenomenon whereby ambulatory blood pressure is measured in the normal range but measurement in the office is elevated. c. The accepted normal values for blood pressure are the same for ambulatory measurements compared with office measurements. d. Both systolic and diastolic measurements must be in the hypertensive range to confer card - accurate answers-a. The accepted normal values for blood pressure are lower for ambulatory measurements compared with office A first-semester physician assistant student reports to his supervisor that he has trouble determining the diastolic blood pressure. On manual blood pressure, which of the following provides the best estimate of the true diastolic blood pressure? a. The point at which Korotkoff sounds first muffle after systolic blood pressure is discerned. b. The average between the highest and lowest points of the auscultatory gap. c. The recommencement of Korotkoff sounds following the lower point of the auscultatory gap.
e. Pain th - accurate answers-b. Chronic pain is defined as pain not due to cancer or a recognized medical condition that persists for >3-6 months. Disparities in pain treatment have been well described in numerous studies comparing Caucasian patients to those of African American and Hispanic origin. Which of the following statements is true concerning this issue? a. Racial and ethnic biases are only relevant in geographic areas that have a history of racial and ethnic discrimination. b. Racial and ethnic biases never involve two persons of the same race or ethnic group. c. Language barriers do not contribute to the problem of racial and ethnic biases. d. Biases of the treating clinician are associated with overtreatment of pain in minority patients and non-English speakers. e. Biases of the treating clinician are associated with under-treatment of pain in minority patients and non-English speakers. - accurate answers-e. Biases of the treating clinician are associated with under-treatment of pain in minority patients and non-English speakers. Which of the following statements is true concerning mental health disorders in primary care? a. The prevalence for mental disorders is estimated to be ~10%, of which only 25% are not diagnosed. b. Anxiety disorders are the most prevalent of all diagnoses in this setting. c. Somatic symptom disorder (DSM-5) is distinctly uncommon in this setting and constitutes less than 5% of these disorders. d. Mood disorders make up ~25% of all diagnoses. e. Alcohol and substance abuse are not considered mental health disorders.d. Mood disorders make up ~25% of all diagnoses. - accurate answers-d. Mood disorders make up ~25% of all diagnoses. Which of the following complaints/findings is considered to be a patient identifier for mental health screening? a. High use of health services due to chronic unstable medical diagnoses b. Symptoms lasting for >2 weeks c. Acute pain syndromes of 10 days' duration that require opiates for relief d. Substance abuse
e. A patient with type I diabetes and neuropathic pain - accurate answers-d. Substance abuse The focused cardiovascular assessment includes - accurate answers-Inspection, palpation, and auscultation of the chest, neck, and extremities. Percussion is used to determine the borders of the heart. A 38-year-old accountant presents to the office with a series of generalized complaints. He relates that he feels a loss of pleasure in daily activities, has difficulty sleeping, and is experiencing problems making decisions. Which of the following best explains the patient's presentation? a. Substance abuse with anhedonia b. Bipolar disorder in the early pre-excitatory phase c. Histrionic personality d. Depression e. Antisocial personality - accurate answers-d. Depression Concerning hallucinations, an abnormal perception experienced by a patient, which of the following statements is true about this abnormality? a. They include false perceptions associated with dreaming and occurring with falling asleep and awakening. b. Objective testing can be performed by a trained neuropsychologist to ascertain the correct diagnosis associated with this complaint. c. Although alcoholism may be associated with abnormalities of perception, it is not considered a cause of hallucinations as this finding is due to its direct toxic effects. d. It may occur in association with a number of conditions including delirium and dementia, posttraumatic stress disorder (PTSD), and schizophrenia. e. By definition, hallucinations are confined to those abnormal perceptions that are either auditory or visual in nature. - accurate answers-d. It may occur in association with a number of conditions including delirium and dementia, posttraumatic stress disorder (PTSD), and schizophrenia. A 24-year-old veteran returns from his second tour of duty in the Middle East. He was witness to a number of violent military encounters and experienced the death of several of his closest friends. He describes a number of problems
b. It is best characterized by slurred speech with an associated defect in language control. c. It is best characterized by involuntary, rhythmic, repetitive movements involving the tongue and jaws making speech difficult to comprehend. d. The ability to write a full correct sentence does not rule out the presence of aphasia in a patient. e. It is defined as an inability to produce or understand language. - accurate answers-e. It is defined as an inability to produce or understand language. A 42-year-old fair-skinned woman of Irish origin presents with an abnormal skin growth that was first noted 7 years ago. On examination, a 2 × 3-cm lesion is noted over her left bicep. Which of the following historical elements most increases the suspicion that the lesion is malignant? a. No evolution in size since onset, but mild intermittent pruritus over the last 2 yearsb. No evolution in size since onset, but uniformly darkly pigmented color c. Minimal but discernible increase in size over the past 6 months d. Presence of similar pinkish tan lesions on the sun-exposed areas including the face and hands e. Proximal location, that is, over the bicep rather than the distal arm - accurate answers-c. Minimal but discernible increase in size over the past 6 months A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice, although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer? a. Chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure. b. Tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that are not carcinogenic. c. Water-resistant sunscreens confer no advantage over water-soluble products. d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors. e. Sunscreen with a sun protective factor (SPF) of 15 blocks ~50% of UV-B light. - accurate answers-d. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors.
A 52-year-old male presents for an annual examination. He discloses on review of family history that his father has died of skin cancer since his last visit. He personally has had two actinic keratoses frozen and has further lesions that require evaluation today. He is very concerned about his personal and family history and would like to know more about the potential for skin cancer to spread and become a dangerous condition. Which of the following skin lesions is the least likely to metastasize? a. Squamous cell carcinoma (SCC) b. Actinic keratosis c. Melanoma d. Seborrheic keratosis e. Basal cell carcinoma (BCC) - accurate answers-d. Seborrheic keratosis A 62-year-old manual laborer presents to an annual physical examination with concerns about skin cancer screening. He does not have any lesions of concern but was recently told by a friend that he should have his skin checked by a doctor yearly. What is the best advice for this patient according to the U.S. Preventive Services Task Force (USPSTF) recommendations on skin cancer screening from 2015? a. The USPSTF recommends that all individual age >50 years be screened yearly for skin cancer regardless of risk factors. b. The USPSTF recommendations mirror those of the American Cancer Society (ACS) and American Academy of Dermatologists (AAD) in recommending and annual skin cancer screening for patients age >50 years. c. The USPSTF recommends skin cancer screening only in sun-exposed areas of fair-skinned individuals every 6 months. d. The USPSTF recommends focused screening of individuals with a history of dysplasti - accurate answers-e. The USPSTF recommends against routine screening for skin cancer due to lack of evidence for this intervention across the general population. A 72-year-old retired woman presents to a primary care provider for evaluation of a suspicious mole. She noticed this lesion 3 weeks ago on her right flank in an area where she had previously seen no abnormality. She is very concerned about melanoma and asks if this could be a possible diagnosis and also wonders if this should have been noticed at her annual examination 7 months ago. Concerning the initial recognition of melanoma, which of the following is true?
