Download NURS 612 Maryville Exam 4 |Latest Version 2025-2026| Questions and Correct Answers | Ver and more Exams Nursing in PDF only on Docsity!
NURS 612 Maryville Exam 4 |Latest
Version 2025-2026| Questions and
Correct Answers | Verified Answers
A patients inability to follow simple instructions could indicate with of the following findings? A. Dysphonia B. Amnesia C. Aphasia D. Depression D. Depression A patient scores a 3 on a mini-cog assessment instrument for dementia, What does this score indicate? A. Advanced dementia B. Early dementia C. Need for further evaluation D. Negative screen for dementia D. Negative screen for dementia The examiner asks the patient to complete this statement: "A bird is to air as a fish is to _________." This is an example of what type of testing? A Calculation B Analogies C Judgment D Mood and feelings B. Analogies Assume that the patients response to the examiner in question 3 is scales. What does this response likely reflect? A. Left cerebral hemisphere lesion B. Depression C. eating disorder D. Aphasia A. Left cerebral hemisphere lesion
Which type of assessment should be used to evaluate the mental status of a patient with head trauma? A. PHQ B. Perceptual distortion assessment C. Glasgow Coma Scale D. Functional Assessment C. Glasgow Coma Scale Which of the following indicates possible cognitive impairment? A. ability to complete personal care without assistance B. Suspiciousness or inappropriate affect C. Articulate communication D. Prudent behavior and calm demeanor B. Suspiciousness or inappropriate affect A 65-year old woman is brought to the clinic by family. They report thieve have noticed a change in her mental abilities over the past 2 weeks. Normally they say she is independent, intelligent and very socially oriented. Medical history is unremarkable except for congestive heart failure, for which she takes digoxin. She has had no major changes in her health. What questions would be most important for the examiner to ask the woman's family? A. Is there a family hx of Alzheimers? B. How much alcohol does she drink in an average week? C. When was her digoxin level last checked? D. Did you know that the mental function begins to decline after the age of 60? C. When was her digoxin level last checked? A patient who has difficulty writing or drawing is most likely to have what condition? A. Temporal lobe damage B. Peripheral neuropathy C. Organic brain syndrome D. Psyciatric hallucinations B. Peripheral Neuropathy A mother brings her 18 month old to the clinic. The child rarely talks or smiles or makes eye contact. She has also notice he does not like to be held. She says his motor development seems to be normal. What are these symptoms consistent with? A. Dementia B. Autistic disorder C. ADHD D. Delirium B. Autistic disorder A patient with Alzheimers disease classically displays which of the following? A. alternating periods of mania and stupor
B. indirect hernia is palpated C. the examiner suspects a mass D. the examiners palpates the testes. C. the examiner suspects a mass The patient is asked to bear down while the examiner palpates the inguinal ring. The examiner feels a soft swelling sensation on the fingertip. the patient complains of pain while straining. These findings are consistent with which of the following? A. Indirect hernia B. Direct hernia C. Femoral hernia D. Rectal hernia A. Indirect hernia The examiner inspects the scrotum of 43 yr old man. Which of the following requires further evaluation? A. left teticle hangs lower than the right B. Scrotum is darker than general skin color C. Skin on scrotum is shiny and smooth D. Scrotum has a midline raphe. C. Skin on scrotum is shiny and smooth Which finding may indicate diabetes? A. the vas deferens feels lumpy or beaded B. The testicle feels hard with a lump C. Sebaceous cysts are present on the scrotal skin D. The urethra has a slit like orifice A. The vas deferens feels lumpy or beaded. During an examination for a hernia and adult male should: A. Be asked to stand B. be in a supine position C. sit on the table with heels together D. Assume a knee-chest position on the exam table. A. be asked to stand Which of the following testicular characteristics is associated with syphilis or diabetic neuropathy? A. Asymmetry or drooping B. Bilateral enlargement C. Insensitivity to pain D. Migration to abdomen C. Insensitivity to pain
What type of hernia would you typically see in a 15 year old male? A. femoral B. umbilical C. direct inguinal D. indirect inguinal C. Direct inguinal hernia Which patient characteristics is associated with smegma as an expected finding? A. uncircumcised B. prepubertal C. sexually active D. transgender A. Uncircumcised A 24 year old male has scrotal pain and marked erythema. The examiner considers epidydimitis. Which other finding is most consistent with this finding? A. Absent cremasteric reflex B. Anorexia and nausea C. Acute onset of severe pain D. urethral discharge D. Urethral discharge Hypospadias is a congenital defect in which the urethra meatus is located on the ventral surface of the glans penis. This is thought to occur embryologically during urethral development during which stage of gestation? A. 4-6 weeks B. 8-20 weeks C. 15-25 weeks D. 20-30 weeks B. 8-20 weeks Which of the following hernias occur more often in females and is the least common of all hernias? A. Indirect B. Direct C. Femoral D. Ventral C. Femoral Which finding on exam of a scrotal mass which is neither a testicle or spermatic cord, suggests a problem with an incarcerated hernia? A. mass does not transilluminate or change in size when reduction is attempted. B. Mass doe not transilluminate but decreased in size when reduction is attempted. C. Mass does transilluminate but does not change in size when reduction is attempted D. Mass does transilluminate and change size when reduction is attempted.
C. supine position with arms on hips D. lateral position with arms at sides. A. sitting position with arm flexed at elbow Nipple compression should be included as part of the breast examination for which of the following patients? A. 23 year old concerned about lumps and tenderness B. 35 year old lactating with very sore nipples C. 48 year old reporting 2 episodes of bloody discharge from the right nipple D. 60 year old with gynecomastia C. 48 year old reporting 2 episodes of bloody discharge from the right nipple A supernumerary nipple is found on a white newborn infant girl. Which of the following may accompany this finding? A. Increased risk for breast cancer as adult B. increased lactation volume as adult C. congenital renal and cardiac anomolies D. mental retardation C. congenital renal and cardiac anomolies Which are typical of fibroadenomas? A. bilateral, stellate, rubber, nontender B. multiple, unilateral, tender, well defined C. Single, discoid, firm, nontender D. unilateral, hard, stellate, fixed C. Single, discoid, firm, nontender What is the correct position in which to place a patient for breast palpation? Supine, arm over head, and small pillow under shoulder of side being assessed Which statement made by a 37 year old would make the examiner suspect fibrocystic disease? A. lump in my breast that is nontender B. right breast is larger than left C. nipples are darker than before baby was born D. I feel a lump in my breast right before my period. D. I feel a lump in my breast right before my period. A patient 3 weeks postpartum reports sore nipples and is breastfeeding. The examiner observes dry, cracked nipples, Which question would be helpful? A. Do you pump? B. How do you clean your breasts? C. Have you been able to bond with your baby? D. what medications have you been taking?
B. How do you clean your breasts? 68 year old man presents with gynecomastia which factor is a potential cause of the problem? A. decrease in physical activity B. increased lactiferous duct glans C. lymphatic engorgement D. a decrease in testosterone D. a decrease in testosterone Symptoms consistent with underlying ducats malignancy include: A. erythema, heat, pain around one nipple B. red, scaling, crusty patch on one nipple C. bilateral inflammation tenderness and sticky multicolored nipple discharge D. gynecomastia, deepening color of nipple. B. Red, scaling, crusty patch on one nipple While examining the breast of a 52 year old woman the examiner notes nipple discharge which of the following diagnostic tests would be appropriate? A. cytologic examination of discharge B. C&S C. WBC Count D. estrogen level A. cytologic examination of discharge while performing a breast examination on a 68year old woman, examiner expects to find what? A. breast tissue with multiple, firm large lumps B> breast tissue has granular feel C. the tail of spence is not longer observed D. Axillary lymph nodes are enlarged. B> breast tissue has granular feel which of the following represents the first sign of puberty in girls? A. thelarche B. menarche C. proliferation of lactiferous duct D. areolar elevation A. thelarche a benign tumor of the subareolar duct that produces nipple discharge is: A. pagets disease B. intraductal papilloma C. duct ectasia D. galactorrhea B. intraductal papilloma
which finding may be indicative of a pelvic mass. The cervix is: a. pale I color b. deviating to right c. protruding 2.5cm into vagina d. pointing anteriorly b. deviating to right A patient complains of dysmenorrhea pain, heavy prolonged menstrual flow, tender nodules are palpable along the uterosacral ligament. these suggest: endometriosis A practitioner collects samples for cytologic study during a vaginal exam. what type of lubricant on the speculum is least likely to interfere with specimen analysis? A. water soluble B. anesthizigin ointment C. warm water D. secretions C, water water symptoms associated with PMS area caused by: A> ovulation B> thickening of uterine lining C. elevations in body temp D. Fluctuations in hormone levels. D. Fluctuations in hormone levels. when examine a middle aged woman, with a history of endometrial cancer and hysterectomy the examiner should: A. avoid bimanual and palpation manuvers B. obtain Pap smear from suture line C. omit cultures and specimens from vagina D. palpate internal areas before inserting speculum B. obtain Pap smear from suture line a patient complains of urinary incontinence when she is active. which associated finding might explain this problem. A. hernias protrusion in posterior wall of vagina B. hernial protrusion through anterior wall of vagina C. PMS D. enlargement and protrusion of cervix into vaginal vault. B. hernial protrusion through anterior wall of vagina which finding is indicative of STD? A. ulcers and vesicles on vagina
B. atrophy of labia majora C. dilation of urethral orifice D. bluish color to cervix. A. ulcers and vesicles on vagina the examiner observes a slit shaped cervical os in a multiparious woman. which data in her history explains this finding? A. earl onset peroid B. multiple sex partners C. infection with HPV D. had an abortion as teenager D. had an abortion as teenager a prominent labia minora in a newborn is: A. maternal infection B> Ambiguous genitalia C. consistent with preamaturity D. normal D. normal Softness of the cervix is an expected finding for: A. An adolescent B. A pregnant woman C. A nonpregnant woman D. An older adult B. A pregnant woman By which week of pregnancy would you expect to be able to palpate the uterus at the symphysis pubis? 12th week a cauliflower like mass is found on the labia of a female patient this is caused by A. syphilis B. condlyum latum C. condyloma acetinum D. herpes C. condyloma acetinum sexually active 22 year old, complains of gross vaginal discharge. Which question would help understand the symptom? A. Do you use condoms? B. What type of birth control do you use> C. at what age did you start your period D. DO you have a family history of ovarian or breast cancer?
STI discharge foul smelling, thicker, STI symptoms pain/burning urination, pelvic pain, bleeding between periods, itchy rash, what questions do you ask patient with CC of mood disorder such as depression? Change of outlook on life? troubling thoughts? feeling hopeless, low energy, fatigue, agitation, thoughts of suicide what questions do you ask patient with CC of mood disorder such as anxiety? constant worry, fear, avoid certain situations or events, panic attacks, obsessive thoughts, compulsive behaviors What are the subjective data to collect in patients mental health? Alert: orientation to time place, person. Analogies, abstract reasoning, math facts, writing ability, motor skills, memory: recent or remote, attention span, judgement in hypothetical situation, voice: quality, pace, loudness, articulation. comprehension, coherence, What objective data do you collect in patients mental health exam? Grooming, body language, emotional status. coherence Delerium what disorder usually has an acute onset and is reversible? Delerium a state of sudden, temporary but acute mental confusion, signs; anxiety, tremors, hallucinations, delusions, attention problems, decline in level of conciousness, memory problems, errors in assessment tasks. rapid mood swing. rambling words. delirium caused by infections, meds, electorate imbalances, organ failure, brain injury, alcohol withdrawal Dementia a chronic or slowly persistent disorder of the mental processes marked by memory disorders, cognitive impairment, behavior changes, personality changes, and impaired reasoning increased activity age associated with dementia over 60 dementia speech incoherent, struggles to find words. hallucinations common. depressed. apathetic
How to test a patient's memory?
- Ask the patient to remember five items. wait 5 minutes After that, ask the patient to repeat the four words from before. This will test the patient's ability to learn new information. differential diagnosis for memory issues dementia, delirium, nutrition medication depression assess patient's orientation person place thing What is the mini mental status exam? 11 items measuring cognitive function change over time. checks orientation, registration, attention, calculation, recall and language.=4-10mins Mini-Mental State Examination (MMSE) Give you a quantifiable measureof cognitive functions of MSE
- valid detector of organic disease
- normal = 27
- 18 - 23 = mild cog dysfunction
- 0 - 7 = severe cog dysfunction
- orientation to time - what's the date?
- registration - repeat back 3 words
- naming - what is this object?
- reading - please read this paper and do what it says
- attention and calculation - spell this word backwards
- langauge - repeat the following sentence.... Mini-Mental State Examination (MMSE) A test that is used to measure cognitive ability, especially in late adulthood. red rash on the breast is it eczema or Paget? unilateral is Paget breast exam post-mastectomy if malignancy occurs may be at scar site palpating axiallary position sitting position arms at sides 58 yr old woman how often mammogram 1 - 2 years if no symptoms
Screening done with DRE GUIAC TEST what means possible hirshprungs disease consistently empty rectum with hx of constipation how is anal ring assessed rotation of finger within anal sphincter normal feel of prostate pencil eraser anal patency is assessed at birth by meconium stool passing in first 24-48hrs Prostate enlargement is determined by the: protrusion of the prostate into the rectum. which patient has risk factor of colorectal cancer 56 year old man that diets high in red meat odd bright bulge coming out of anus that looks like donut rectal prolapse prostate is hard and irregular on palpation. median sulcus is not palpable. prostate cancer rectal prolapse in young child seen in cystic fibrosis patient scores 22 out of 24 on Isaac set test. what does this score indicate? need for further eval Differential for enlarged scrotum that is painful epididimytis, versus torsion differential for enlarged scrotum that is painless hydrocele, speratocele possibly indirect hernia transillumination of scrotum mass that DOES transilluminate and no change in size when with reduction attempt probably hydrocele
mass that DOES NOT transilluminate but DOES change in size hernia Mass that does NOT transilluminate and does NOT change in size incarcerated hernia ( emergency) or testicular cancer palpating scrotum Before you palpate the scrotum, place the thumb and index finger of one hand over the inguinal canals at the upper part of the scrotal sac. This maneuver helps prevent retraction of the testes into the inguinal canal or abdomen. Palpate each side of the scrotum to detect the presence of the testes or other masses. What does cermasteri reflex test for? cremasteric reflex can be performed in assessing scrotal pain. While some studies report a high correlation of loss of cremasteric reflex and testicular torsion. How to inspect breasts arms at sides hanging loosely. symmetry, contour, color and texture, venous pattern lesions Abnormal Breast Inspection unequal nipple axis, dimpling, retraction of skin, nipple discharge or orange peel appearance Montgomery tubercles The sebaceous glands on the areola, which enlarge and produce a secretion that protects and lubricates the nipples what does unilateral nipple inversion mean malignancy normals breast charting symmetrical, smooth, bilateral venous pattern, no lesions, areola round, equal bilaterally, nipples and areola match in color. smooth texture of areola. no nipple eversion or retraction. no extra nipples. 3 positions to inspect breasts extend arms overhead press palms together lean forward while seated How to palpate the breast ( seated, supine, bimanual) seated; bimanual palpation. lymph nodes palpated. Help the woman into a supine position and took a small pad under the side to be palpated and raise her arm over the head. Use the pads of your first three fingers make dental circular motion on the breast
- Age over 50
- gender
- genetic risk factors
- Family history, mother, grandmother, sister
- Personal history
- First pregnancy after the age of 30
- race- white higher risk
- previous breast biopsies
- radiation to chest
- periods before age 12 or menopause after 55
- breast density
- DES therapy ( infertility)
- hormone therpay
- alcohol use
- obesity
- high fat diet
- lack of physical activity PHQ- 9 little interest or pleasure in doing things feeling down depressed or hopeless trouble falling asleep, staying asleep or too much poor appetite or overeating moving to slow or restless poor concentration feeling like a failure thoughts of hurting yourself Differential for positive PHQ 9 anxiety, depression, PPD, Columbia Suicide Severity Rating Scale have you ever wished your were dead or just goto sleep and not wake up? have you actually had any thoughts of hurting yourself? Risk factors for suicide Social isolation, older men or women, divorced, widowed, living alone. mental health concerns, depression, hopelessness, chronic or terminal health condition, family history of suicide or significant losses or challenges. access to firearms. Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. Women try more often. Men succeed more often.
Mini-Cog Test minimize■ Quick method for assessing dementia. If abnormal, screen further with MMSE. ■ Use these two methods: the clock drawing test with word recall test (three unrelated words). ■ Instruct patient to draw a clock and mark it with the hands showing a certain time. ■ Example: Instruct patient to "Draw a clock that shows 20 minutes past 4."
- Scoring clock test: Hands point to the correct time and numbers on clock are in correct sequence. 0 is positive screen, 1-2 abnormal, 3 normal/negative Bacterial Vaginosis (BV) a condition caused by an overgrowth of certain bacteria inhabiting the vagina potassium hydroxide test obtain vaginal discharge specimen, place specimen on glass, add drop of 10% potassium hydroxide. a fishy odor suggests BV, with a microscope check for budding yeast cells. Pap smear uses cervical broom to obtain cells.
