Download Clinical Case Studies: Diagnostic Reasoning in Healthcare and more Exams Nursing in PDF only on Docsity!
NR 509 Final Exam With Well Verified
Questions and Model Answers Your Key To
Success(Score A)-Hazard community and
Technical college
A 34-year-old female presents to the office with left elbow pain following rigorous training for a tennis match. Tenderness is noted with palpation in the area on the image marked by the red circle. What correlative diagnosis does this assessment finding indicate? ADA Description: Left elbow with emphasis on the small, tuberculated eminence, curved a little forward, about 1 cm from the joint. lateral epicondylitis A 35-year-old male presents to the clinic for a routine physical examination. His only complaint is a feeling of heaviness in his scrotum. He denies injury or trauma. After conducting a history and physical, the NP documents the following genitourinary (GU) findings: Uncircumcised penis; prepuce easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally; right testicle smooth; 1 × 1 cm firm, fixed, nontender, nodule on the left lateral testicle. Epididymis nontender. No inguinal or femoral hernias. Negative CVA tenderness. Which of the following is the most accurate interpretation of these findings? These findings suggest testicular cancer Created with OfficeSuite
A 26-year-old female presents to the Emergency Department with intense abdominal pain for 6 hours, light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a history of gallstones and is concerned that she is having another gallbladder attack. She denies nausea and vomiting, and her last normal bowel movement was this morning. She reports that her LMP was 10 weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. A β-human chorionic gonadotropin (β-hCG) blood test is pending. The NP performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. Which of the following is the most likely etiology for these assessment findings? Ruptured ectopic pregnancy A 42-year-old female presents to the office for her annual well-woman examination. She has a history of fibrocystic breast changes since her mid-20s, so she did not report any new issues except that her right breast feels "heavier" than usual. After a careful history and physical examination, the NP documents the following breast findings: Breasts pendulous with diffuse fibrocystic changes. Single firm 1 × 1 cm mass, mobile, and nontender, with overlying peau d'orange appearance in the right breast, upper outer quadrant at 11 o'clock, 2 cm from the nipple. Which of the following is the most accurate interpretation of these findings? These findings suggest a cyst An NP student conducted a clinical breast examination on a 27-year-old female with a history of fibroadenomas. The NP palpated a rubbery, mobile, nontender mass in the right breast. The mass was located 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most appropriate way to document the physical assessment findings? rubbery, mobile, nontender mass located in the right breast, in the 10: position from the nipple Created with OfficeSuite
A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to find on examination that is most consistent with the diagnosis? Flexed forward posture with lower extremity weakness What is the action(s) of the erector spinae muscle group? Extension of the spine A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8 weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle wasting as the etiology for the winged scapula. Which of the following physical assessment maneuvers should the NP perform to confirm the suspension? Compare the strength of the trapezius muscles A 31-year-old female presents to the clinic with a worsening stiff, painful neck. On inspection, the patient's head is laterally deviated toward the shoulder and rotated. Given this specific physical assessment finding, what condition should the NP suspect as a differential diagnosis? Torticollis During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion evaluation at the neck. All of the following muscles are being assessed when the patient is asked to extend, flex, and rotate the neck, EXCEPT? Created with OfficeSuite
Sacro spinalis A 58-year-old male complains of lower back pain for many years. He denies a recent injury. On examination, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of the following conditions is most consistent with this physical sign? ankylosing spondylitis Which of the following statements is true regarding prostate cancer screening? Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing A 53-year-old African American male presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer risk for this patient and subsequent screening? This patient is at an elevated risk of prostate cancer due to his family history; thus, screening modalities should be discussed between the patient and provider. A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of pain. In addition, today she reports that she has developed episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find? Inflammatory bowel disease Created with OfficeSuite
These findings suggest no abdnormalities Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description: Examiner's hands placed on anterior shoulders while patient shrugs both shoulders upward against hands. CNXI What assessment test is being performed in this image? ADA Description: Tuning fork on top of the head. Weber test A 74-year-old man presents to the clinic for a scheduled annual examination. He has a history of hypertension and diabetes, both controlled with medication. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal assessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina. Cotton wool spots A 66-year-old female presents to the office for a focused visit to discuss hypertension management strategies. During the interview, the patient asks the NP if she could be screened today for cervical cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no abnormal findings, and no history of cancer. What is the best action the NP should take regarding the patient's request for screening? Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no longer requires screening, and focus on the reason for the visit. Created with OfficeSuite
Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine? The vaccine can protect against anogenital lesions A 21-year-old female presents for her first annual exam. She reports concern because her female partner was recently diagnosed with condyloma acuminata and wonders if she could also be infected. If true, what physical assessment findings would the NP expect to find during the speculum examination? Raised friable or lobed lesions An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID). During the speculum examination, the NP would expect to find purulent discharge in the following area(s) which is consistent with the diagnosis of PID? Cervical os A 23-year-old female presents to the clinic. She has decided to discontinue using condoms and would like a different birth control option. Her last pelvic exam was 2 years ago when she had a negative Pap smear and STI screening. Her LMP was 2 days ago, and she is still spotting. She last had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her speculum exam during this office encounter. What is the best evidence-based rationale for the decision to postpone her exam? She is on her menses A 24-year-old female presents to the clinic for an annual exam. The NP proceeds to perform a Pap smear and understands that the most important area on the cervix to obtain cells for the Pap smear is where? Transformation zone Created with OfficeSuite
A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She also reports that the smell increased after intercourse and during her period last week. After a careful history and physical assessment, the NP documents the following pelvic and anorectal examination findings: Bilateral shotty inguinal adenopathy. External genitalia without erythema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings? These findings suggest bacterial vaginosis The NP knows it is possible to palpate multiple structures in relation to the inguinal canal and related hernias while performing a physical examination on male patients. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region? Internal inguinal rings What are the most predominant risk factors for prostate cancer? Age Ethnicity Family history A patient presents with right-upper quadrant (RUQ) pain but does not have any tenderness on palpation in the RUQ. The NP is suspicious of acute cholecystitis. The NP knows to perform which assessment test next? Murphy Sign Created with OfficeSuite
Pain in the right-lower quadrant (RLQ) during deep, even palpation of the left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what positive assessment finding? Blumberg sign The NP suspects a patient has appendicitis. Identify the physical examination maneuver done by applying pressure halfway between the umbilicus and the anterior spine of the ilium? McBurney Sign Which assessment finding would be most suggestive of a diagnosis of biliary colic? Associated right shoulder pain Which of the following physical assessment finding is most suggestive of peritonitis secondary to a ruptured appendix? Pressing down onto the abdomen firmly and quickly withdrawals the hand produces pain A 76-year-old female presents to the office for an annual physical. Upon reviewing her history, she had a positive FOBT on one occasion at age 66 years. Subsequent colonoscopy revealed internal hemorrhoids and sigmoid diverticuli only. She has no first degree relatives with a history of colorectal cancer or adenomatous polyps. What is the U.S. Preventive Services Task Force (USPSTF) screening recommendation for this particular patient? Do not screen routinely Created with OfficeSuite
The staff NP in a nursing home is conducting a physical assessment on an 84-year-old male resident who is pleasant, active, and cooperative. The skin findings in this image are observed during the examination. The staff and patient deny any known injury or trauma. The NP should document these findings as consistent with which of the following? ADA Description: Extensor surface of the right forearm with emphasis on well-demarcated vividly purple macules and patches Actinic purpura An 80-year-old woman who lives alone at home presents with concerns about maintaining her independent living status. She continues to drive and care for herself and her pet dog but reports two falls over the past 4 months. During one fall, she struck her head, causing a contusion over the right eye. She attributes these episodes to environmental factors. Once she tripped over a rug, and once she misjudged the depth of the curb while crossing the street. Which of the following would be the best approach to this patient? Perform a comprehensive assessment of fall risk and plan preventive interventions Concerning alcohol consumption in older adults, which of the following is true? The CAGE screening for alcohol abuse retains the same sensitivity and specificity it has for younger populations Which of the following statements are true about the presentation of pain and pain assessment in the older adult? Select all that apply Older patients are less likely to report pain symptoms than younger patients Created with OfficeSuite
The American Geriatrics Society (AGS) prefers the term "persistent pain" over the term "chronic pain". Which of the following physical assessment findings regarding blood pressure is consistent with the normal aging process and not a sign of cardiovascular disease? A net increase in pulse pressure with an increase in systolic pressure and a decrease in diastolic pressure Which of the following statements best demonstrates that the NP understands their role in caring for the aging population? I will evaluate geriatric conditions in terms of functionality and quality of life rather than via traditional disease models. Which of the following physiologic and psychologic changes are expected assessment findings with the normal aging process? Select all that apply A 25-year-old female presents to the clinic after a positive home pregnancy test. She confides in you that her live-in, male partner has been verbally threatening her. She denies interest in involving law enforcement. Additionally, she reports that she has a 3- year-old daughter who lives in the home. What is the appropriate next step by the NP? Ask open-ended questions, allow her to make decisions that she feels are best for herself given the circumstance, and provide immediate or long-term referrals to domestic violence resources Created with OfficeSuite
The NP is conducting a physical assessment on a woman in her 26 th week of pregnancy. Which of the examination finding is worrisome for a potential, emergent condition? Facial edema The NP is documenting the obstetric history of a patient. Her history includes two spontaneous miscarriages at 16- and 24-weeks' gestation, four living children (one set of twins) who were delivered at term, and a current pregnancy. How would this be documented? G 6 P 3024 An 11-month-old infant male is accompanied to the clinic by his father. The father is concerned about the skin rash on this son's arms represented in this image. Family history is significant for a 4-year-old sibling with atopic dermatitis and asthma. Which of the following is the best documentation of the integument findings? Erythematous, patches and plaques involving the extensor surfaces of the bilateral antecubital fossa. Mild, secondary excoriations present with serous exudate. No streaking. Scant purulent drainage A mother brings her 15-day-old female infant to the outpatient clinic for evaluation of a rash that appeared suddenly after visiting family in Florida. It is August and the house did not have air conditioning. The infant is afebrile, eating and drinking well, and does not appear to be in distress. The physical assessment findings are represented in this image. Based on the history and examination findings, what is the likely etiology? ADA Description: Infant with a red, facial rash. miliaria rubra Created with OfficeSuite
The NP assesses for the Moro Reflex as part of an infant routine physical examination. The NP should suspect a neurologic disease if the reflex has not disappeared by what specific timeframe? 16 weeks A 2-month-old female is accompanied by her parents for her first visit to the practice. When reviewing the hospital medical records of her birth, the NP notes documentation regarding significantly edematous hands and feet present at birth. Upon physical examination of the infant, the NP finds skin folds that run along the sides of the neck down to the shoulders. Which of the following should be assessed and monitored by the NP and parents related to these findings? Select all that apply. The infant's growth chart with concern for height and length. The infant's ability to properly latch during breastfeeding. The infant's fluid gain or loss. The NP is observing a female pediatric patient during a routine physical. She can jump in place and balance on one foot. She speaks in full sentences and her mother states that she can feed herself. Based on your observations and the history, determine her developmental age 4 years The NP is observing a full-term infant male. He can pull to a stand, use "mama" and "dada" specifically, and indicates his wants by vocalization and pointing. Based on your observations, determine his developmental age. Created with OfficeSuite
A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step? Take a further history and perform a very careful neurological exam A grandmother is accompanying her 9-year-old granddaughter during a routine physical examination. She asks you privately if her granddaughter has started puberty yet. During the examination, the NP notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound above the level of the breast. The left breast is underdeveloped. These assessment findings are consistent with which Tanner Stage of development? IV Primary prevention is defined as which of the following? Interventions designed to prevent disease Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the following statements is true about screening for breast cancer in average-risk women? Mammography is recommended every 2 years for women aged 50-74 with insufficient evidence for screening women over the age of 75. Which of the following statements is true regarding recommendations by the eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all that apply. Created with OfficeSuite
Target blood pressure should be </= 150/90 mmHg but notes that if treatment results in SBP <140 and is "well tolerated and without adverse effects to health or quality of live, treatment does not need to be adjusted." In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear optimal for notable reductions in stroke, cardiovascular events, and all-cause mortality. Which of the following is a useful strategy when examining young children between the ages of 1 and 4? Have the parent facilitate the exam (e.g., removing clothes, holding the child on lap). The NP is completing the review of systems on a 4-month-old female during a routine encounter. Which statement from the parent may indicate a cardiac problem in the infant and require a more thorough subjective history? "It often takes the baby more than 30 minutes to finish a bottle." A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition? Patient with eyelid drooping CNIII Created with OfficeSuite
