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NSG 6020 / NSG6020 study guide week
1 _3 Q & A
Week 1 Exam (25/25) (100%)
1 - Which of the following accurately describe a client’s chief complaint?
a. Duration of Symptoms
b. Prior Medical Hystory
c. Reason for Visit
d. Family History
2 - What elements are documented in the History of Present Illness (HPI) Select all that apply.
a. Social History
b. Reason for visit
c. Prior Medical History
d. Onset of Symtoms
3 - Which of the following would be considerated a component of the Subjetive Data?
a. Assessment
b. Social History
c. Differential diagnoses
d. Treatment Plan
4 - Which of the following statements belong in the Objetive Data?
a. Chief Complaint
b. History of Present Illness
c. Prior Medical History
d. Vital Signs
5 - Which of the following is documented in the Objetive Data?
a. Differential diagnoses
b. Current medications
c. Lab Results
d. Allergies
6 - Which category should this information be placed in the SOAP note? “Abdominal pain x 3 days, intermittent with a pain score of 7/10; accompanied by nausea and vomiting”.
a. Chief Complaint
b. Personal History
c. History of Present Illness
d. Review of System
7 - Where is the differential diagnoses located?
a. Objetive Data
b. Subjetive Data
c. Assesstment
d. Plan
8 - Which of the following statements regarding the differential diagnoses is true?
a. A group of at least 3 evidence-based diagnoses including the
primary diagnosis that a clinician must be aware of if the client does not improve
b. Evidence-based diagnoses, at least 2 plus primary diagnoses all of
which need to be considered during the treatment options
c. A group of 3 evidence-based diagnoses which by the process of
elimination, can be ruled out of potential diagnoses
d. A group of 3 evidence-based diagnoses that do not include the
primary diagnoses as one of the differential diagnoses in which a clinician must be aware of if the client does not improve. 9 - Which of the following would not be identified as a portion of the History of Present Illness?
d. Non-verbal Communication
14 - Which of the negative traits would a clinician need to work on in order to apply Cultural Humility to individual of all athnicities and cultural and cultural beliefs?
a. Reflect on Self-Awareness: learn about your own biases
b. Respectful Communication: Active listening non-verbal communication
c. Collaborative Partnerships: Empower the patient to be a portion of the
treatment plan
d. Allow an interpreter if needed in the clinical room; all other family members
must wait in the lobby if the lobby if the patient is an adult to protect privacy 15 - When inquiring about a patient’s sexual history which of the of the following questions may be considered vague?
a. “Do you have any concerns about HIV infection or AIDs?”
b. “Do you consider yourself sexually active?”
c. “How many sexual partners have you had in the last 6 months?’
d. “Do you have sex with men, women, or both?”
16 - Which of the following is not the most appropriate way to initiate and format
questions regarding alcohol use?
a. “I see in your chart that you wrote “occacionallya” alcohol, so it’s not a
problem, right?
b. Do you feel annoyed when family or friends talk to you about your alcohol
intake?
c. Do you feel the you need to cut back on your use of alcohol the following
day?
d. Do you feel guilty about how much alcohol you drank the following day?
17 - Which of the following is considered Subjective Data?
a. Ms. G reports pressure over her left chest and pain down her left are;
sensation of an elephant sitting on her chest and difficult to breathe
b. Ms. G is an older, Caucasian female who is pleasant and cooperative. BP
Oxygen Sat 97% via nasal cannula
c. Ms. G’s EKG is noted to be abnormal; referral placed to in-house
Cardiologist
d. Ms. G’s oxygen has now returnrd to 100% on RA
18 - Identify the following information that should not be in the SOAP note
a. Document the date and time when patient was evaluated
b. Document Chief Complain in clinician’s words
c. Document allergies with the reactions and place on the front of the chart
d. Document both prescription, OTC, and herbal supplements under
medications 19 - Which of the following is considerate Objective Data?
a. Complains of pain in the right side of the abdomen
b. Denies fever o chills
c. Denies changes in appetite
d. WBC: 15,
20 - As a new clinician documenting a note, which of the following will ensure that you have documented all information in a succinct format?
a. Documenting “Omitted” by a system that was not assessed
b. Documenting “WNL” or “Within Normal Limits” in a system assessed
c. Documenting positive rebound tenderness, guarding along RLQ
d. Documenting “Deferred” by a system that was not assessed
21 - Which of the following would be an appropriate differencial diagnosis for a patient diagnosed with Mononucleosis?
a. Pityriasis Rosea
b. Appendicitis
c. Mastoiditis
d. Epiglotitis
22 - Which of the following statements is not part of objective data?
WEEK TWO _ 2
1. For which of the following patients would a comprehensive health
history be appropriate?
A) A new patient with the chief complaint of “I sprained my ankle”
B) An established patient with the chief complaint of “I have an
upper respiratory infection”
C) A new patient with the chief complaint of “I am here to
establish care”
D) A new patient with the chief complaint of “I cut my hand”
Ans: C Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health history is appropriate.
2. The components of the health history include all of the following
except which one?
A) Review of systems
B) Thorax and lungs
C) Present illness
D) Personal and social items
Ans: B Feedback: The thorax and lungs are part of the physical examination, not part of the health history. The other answers are all part of a complete health history.
3. Is the following information subjective or objective?
Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest.
A) Subjective
B) Objective PERSONAL SOCIAL
REVE
W OF
SYSTEMS
Ans: A Feedback: This is information given by the patient about the circumstances of his chief complaint. It does not represent an objective observation by the examiner.
- The following information is best placed in which category? “The patient has had three cesarean sections.”
A) Adult illnesses
B) Surgeries
C) Obstetrics/gynecology
D) Psychiatric
Ans: B Feedback: A cesarean section is a surgical procedure. Approximate dates or the age of the patient at the time of the surgery should also be recorded.
- A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic
Ans: C Feedback: Cardiac disorders such as congestive heart failure are the most likely on this list to result in shortness of breath. There are cases within the other categories which may also result in shortness of breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis with UTI in the urinary category. This
- A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without
hepatosplenomegaly or masses.
B) Abdomen is soft and tender to palpation in the right lower
quadrant, without rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper
quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
D) Abdomen is soft and tender to palpation in the mid-epigastric
area, without rebound or guarding. Ans: C Feedback: In cholecystitis, the pain, which originates from the gallbladder, is located in the right upper quadrant. Severity of pain with inspiration that is sufficient to stop further inhalation is also known as Murphy's sign, which, if present, is further indicative of inflammation of the gallbladder.
- You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning? A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a y e s/no answer B)
C) Offering the patient multiple choices in order to clarify the
character of the urinary symptoms that she is experiencing
D) Asking her to tell you exactly what she means when she
states that she has a urinary tract infection Ans: B Feedback: Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer
Reassurance is not part of clarifying the patient's story; it is part of establishing rapport and empathizing with the patient.
- A 19-year-old male college student presents to the clinic of a cloudy urethral discharge which off the following questions is inappropriate for eliciting the information?
- Do you experience pain when you urinate
- \When did you symptoms begin
- When was your last prostate exam
- Are you sexually active
- Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea
Ans: A Feedback: Scotomas are specks in the vision or areas where the patient cannot see; therefore, this is a common/concerning symptom of the eye.
- A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is not on any medications and does not take herbs or supplements. She has no chronic medical conditions. She does not smoke or drink alcohol. She walks into the examination room with slow movements and shuffling steps. She has decreased facial mobility and a blunt expression, without any changes in hair distribution on her face. Based on this description, what is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
Corneal ulcer, acute glaucoma, and uveitis are almost always accompanied by pain. Retinal detachment is generally painless, as is chronic glaucoma.
- A patient complains of epistaxis. Which other cause should be considered?
A) Intracranial hemorrhage
B) Hematemesis
C) Intestinal hemorrhage
D) Hematoma of the nasal CAVITY
Ans: B Feedback: Although the source of epistaxis may seem obvious, other bleeding locations should be on the differential. Hematemesis can mimic this and cause delay in life-saving therapies if not considered. Intracranial hemorrhage and septal hematoma are instances of contained bleeding. Intestinal hemorrhage may cause hematemesis if there is obstruction distal to the bleeding, but this is unlikely. 16.Glaucoma is the leading cause of blindness in African-Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination?
A) Increased cup-to-disc ratio
B) AV nicking
C) Cotton wool spots
D) Microaneurysms
Ans: A Feedback: It is important to screen for glaucoma on funduscopic examination. The cup and disc are among the easiest features to find. AV nicking and cotton wool spots are seen in hypertension. Microaneurysms are seen in diabetes.
- A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?
A) Direct reaction
- A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this?
A) Submandibular
B) Tonsillar
C) Occipital
D) Posterior cervical
Ans: D Feedback: The group of nodes posterior to the sternocleidomastoid muscle is the posterior cervical chain. These are common in mononucleosis.
- WHICH OF THE FOLLOWING ARE USED TO SCREEN FOR COLOR BLINDNESS IN A 7 YEAR OLD BOY? 2) SNELLING
- Ishihara test
- COVER UNCOVER TEST
- RED REFLEX Ishihara Color test A 49-year-old female presents to the clinic for evaluation of dizziness for the past 12 hourse , symptoms include vertigo tinnitus nausea vomiting x 1
. prior medical history unremarkable. based on her clinical presentation what is the most likely diagnosis? A) miner’s disease
WEEK THREE _ 3 A condition associated with a chronic cough that produces copious amounts of purulent sputum is most likely: bronchiectasis When performing a respiratory assessment on a 4-year-old child, further evaluation is warranted in the presence of: supraclavicular retractions When percussing the chest in a patient who has left sided heart failure, the sound emanated would be: resonant Stridor heard louder in the neck than over the chest wall indicates: a partial obstruction in the larynx The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the: mediastinum An acute viral illness that presents with a burning retrosternal discomfort and a dry cough is suggestive of: tracheobronchitis On auscultation of the chest, if the patient says “ninety-nine” and it is clearly heard, this is indicative of: lung density in the area When percussing the right upper posterior area of the chest, a dullness replaces the resonance sound usually heard in the lung. This sound would be suggestive of: lobar pneumonia When percussing the posterior chest, which one of the following techniques would be omitted? Percuss the areas over the scapular. Then angle of Louis is a useful place to start counting ribs. This landmark is located: on the manubrium and body of the sternum. When auscultating breath sounds, use the diaphragm of the stethoscope by placing it initially on the: posterior chest at the cervical 7 level. Orthopnea is typically associated with hall of the following conditions except: pulmonary embolus. When percussing the lower posterior chest, begin by: standing on the side rather than directly behind the patient. Breath sounds heard over the periphery of the lung fields are: vesicular When inspecting the chest for respiratory effort, which one of the following is not part of the inspection? Assessment for tactile fremitus.
Breath sounds heard on chest over the hilar region are: bronchovesicular. A patient who presents with a long history of cigarette smoking exhibits a cry to productive cough with dyspnea and weight loss. These symptoms could be consistent with: a neoplasm of the lung. To document chest findings located at the lowest most portion of the lungs, which one of the following terms would be used. Bases of the lungs To document chest findings located below the scapular, which on of the following terms would be used? Intrascapular A patient who walked into the examination room, may be observed to be sitting and leaning forward in his chair. Lips were pursed during exhalation and arms are supported on the table. This position could be consistent with patients who have: chronic obstructive pulmonary disease Diminished breath sounds should be interpreted as: an abnormal finding warranting further evaluation. A 65-year old obese man with past medical history of hypertension complains of increased fatigue during the day. The practitioner orders a polysomnogram to test for: obstructive sleep apnea (OSA). When trying to differentiate between hemoptysis or blood streaked material, which one of the following observations is correct? Hemoptysis is common in children with cystic fibrosis To document chest findings located between the scapular, which one of the following terms would be used? Interscapular The anterior surface landmark on the thorax that is denoted by a hollow u-shaped depression just above the sternum and between the clavicles is termed the: suprasternal notch. The lower tip of the scapula is located: around the seventh or eighth rib. Breath sounds consisting of a full inspiratory and expiratory phase with the inspiratory phased usually being louder and normally heard over the trachea and larynx are considered: bronchial Retractions are observed in all the following areas except the: hilar area The midaxillary line: runs down from the apex of the axilla and lies between and parallel to the anterior and posterior lines A 37- year-old female has audible stridor. This type of stridor is consistent with: a foreign object lodged in the upper trachea.
One of the anterior thoracic landmarks is the costal angle. It is located: where the right and left costal margins form an angle where they meet at the xiphoid process Which one of the following infants should be seen immediately by the nurse practitioner? A two- week old infant with nasal congestion and a respiratory rate of 64 breaths/minutes A 3-year- old presents with a history of fever and cough over the past 24 hours. Finding on exam reveal: temperature of 102 degrees F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute. Tachypnea in this child is most likely related to: the child’s febrile state. When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are: vesicular with late inspiratory crackles in the dependent portions of the lungs and resonant on percussion. The palpation technique used to assess respiratory expansion of the chest is placing the hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and grasping a small fold of skin between the thumbs. Then: ask the patient to take a deep breathe and note any delay in expansion during inhalation.
