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South University, Savannah NSG 6020 week 2 qeustions and answers tested and verified with latest updates ,answers have a detailed explanation
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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. The components of the health history include all of the following except which one? E) Review of systems F) Thorax and lungs G) Present illness H) 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. 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. I) Subjective J) Objective PERSONAL SOCIAL REVEW 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 demonstrates the “tension” in clinical reasoning between making sure all possibilities are covered, while still being able to pick the most likely cause. A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? A) Infectious B) Inflammatory C) Hematologic D) Traumatic Ans: B
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 yes/no answer B) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer 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: 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?
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 D) Parkinson's disease Ans: D Feedback: This is a typical description for a patient with Parkinson's disease. Facial mobility is decreased, which results in a blunt expression—a “masked” appearance. The patient also has decreased blinking and a characteristic stare with an upward gaze. In combination with the findings of slow movements and a shuffling gait, the diagnosis of Parkinson's is almost clinched. Which of the following is a “red flag” regarding patients presenting with headache? A) Unilateral headache B) Pain over the sinuses C) Age over 50 D) Phonophobia and photophobia Ans: C
G) Cotton wool spots H) 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 B) Consensual reaction C) Near reaction D) Accommodation Ans: B Feedback: The constriction of the contralateral pupil is called the consensual reaction. The response of the ipsilateral eye is the direct response. The dilation of the pupil when focusing on a close object is the near reaction. Accommodation is the changing of the shape of the lens to sharply focus on an object.
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.