NSG6020 MIDTERM Exam Questions and answers best rated A+ guaranteed success latest update, Exams of Nursing

Download NSG6020 MIDTERM Exam Questions and answers best rated A+ guaranteed success latest update and more Exams Nursing in PDF only on Docsity! NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Chapter 1: Foundations for Clinical Proficiency  The following information is recorded in the health history: “Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.”Which category does it belong to? . A) Chief complaint . B) Present illness . C) Personal and social history D) Review of systems Ans: D Chapter: 01 Feedback: Review of systems documents the presence or absence of common symptoms related to each major body system. The absence of cardiac symptoms is listed in the above example.  The following information is best placed in which category? “The patient has had three cesarean sections.” A) Adult illnesses B) Surgeries C) Obstetrics/gynecology NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ D) Psychiatric Ans: B Chapter: 01 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.  The following information is best placed in which category?“The patient had a stent placed in the left anterior descending artery (LAD) in 1999.” A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric Ans: A Chapter: 01 Feedback: The adult illnesses category is reserved for chronic illnesses, significant hospitalizations, significant injuries, and significant procedures. A stent is a major procedure but does not involve a surgeon.  The following information is best placed in which category? “The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated.” A) Adult illnesses NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ this example.  The following information is recorded in the health history: “I feel really tired.” Which category does it belong to? . A) Chief complaint . B) Present illness . C) Personal and social history . D) Review of systems Ans: A Chapter: 01 Feedback: The chief complaint is an attempt to quote the patient's own words, as long as they are suitable to print. It is brief, like a headline, and further details should be sought in the present illness section. The above information is a chief complaint.  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 NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ establish care” d- A new patient with the chief complaint of “I cut my hand” Ans: CChapter: 01Page and Header: 4, Patient Assessment: Comprehensive or FocusedFeedback: 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? A-Review of systems B-Thorax and lungs C- Present illness D- Personal and social items Ans: B Chapter: 01 Feedback: The thorax and lungs are part of the physical examination, not part of the health history. The others answers are all part of a complete health history. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ . B) Present illness . C) Personal and social history . D) Review of systems Ans: B Chapter: 01 Feedback: This information describes the problem of abdominal pain, which is the present illness. The interviewer has obtained the location, timing, severity, and associated manifestations of the pain. The interviewer will still need to obtain information concerning the quality of the pain, the setting in which it occurred, and the factors that aggravate and alleviate the pain. You will notice that it does include portions of the pertinent review of systems, but because it relates directly to the complaint, it is included in the history of present illness. Chapter 2 1) Which anatomic area would you localize the symptom to? A) Musculoskeletal B) Reproductive NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ C) Urinary D) Endocrine Ans: A Chapter: 02 Feedback: Chest pain may be due to a musculoskeletal condition, such as costochondritis or intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic chest pain is also a sharp chest pain which increases with a deep breath. This type of pain can occur with inflammation of the pleura from pneumonia or other conditions and pulmonary embolus.  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 NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ D) Hematologic Ans: C Chapter: 02 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 patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough? A) Ophthalmologic B) Auditory C) Cardiac D) Endocrine Ans: C Chapter: 02 Feedback: The cardiac system can cause a cough if the patient has congestive NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process? A) Infectious B) Neoplastic C) Degenerative D) Traumatic Ans: C Chapter: 02 NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Feedback: The description is most consistent with degenerative arthritis in the neck. The patient has had intermittent symptoms and the questions asked to elicit pertinent negative and positive findings are negative for infectious, traumatic, or neoplastic disease.  A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process? A) Infection B) Inflammation C) Allergic D) Vascular Ans: C Chapter: 02 Feedback: This description is most consistent with allergic rhinitis.  You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list? . A) Arthritis, war injury pain, headaches, chest pain . B) War injury pain, arthritis, headaches, chest pain . C) Headaches, arthritis, war injury pain, chest pain . D) Chest pain, headaches, arthritis, war injury pain Ans: D Chapter: 02 Feedback: The problem list should have the most active and serious problem first. This new complaint of chest pain is almost certainly a higher priority than his other, more chronic problems.  You are excited about a positive test finding you have just noticed on physical examination of your patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that there is no sign of the disease you thought would correlate with the finding. This same experience happens several times. What should you NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ and diagnostics. . D) Continue performing it on all future examinations. Ans: A Chapter: 02 Feedback: This is an example of a specific test that lacks sensitivity. With this scenario, when you finally find a positive, you might be very certain that a given condition is present.We generally develop our examinations to fit our clinical experiences. Sensitive tests are performed routinely on the screening examination, while specific tests are usually saved for the detailed or “branched” examinations. Branched examinations are further maneuvers we can perform to investigate positive findings on our screening examinations. Save this type of maneuver to confirm your hypothesis. All of this information also applies to history questions.  You have recently returned from a medical missions trip to sub- Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers? NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ . A) Continue asking these questions in a more selective way. . B) Stop asking these questions, because they are low yield. . C) Question the validity of the questions. . D) Ask these questions of all your patients. Ans: A Chapter: 02 Feedback: The predictive value of a positive finding depends upon the NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ prevalence of a given disease in a population. The prevalence of malaria in the Midwest is almost zero, except in people immigrating from areas of high prevalence. You will waste time and resources applying these questions and maneuvers to all patients. It would be wise to continue applying what you learned to those who are from areas of high prevalence of a given disease. Likewise, physicians from Ghana should not ask about signs or symptoms of multiple sclerosis, as it is found almost exclusively in northern latitudes. You will learn to tailor your examination to the population you are serving.  A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right C) Head is normocephalic and atraumatic, fundi with blurred disc NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ no rebound or guarding. D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding. Ans: C Chapter: 02 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. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+  A 55-year-old data entry operator comes to the clinic to establish care. She has the following symptoms: headache, neck pain, sinus congestion, sore throat, ringing in ears, sharp brief chest pains at rest, burning abdominal pain with spicy foods, constipation, urinary frequency that is worse with coughing and sneezing, and swelling in legs. This cluster of symptoms is explained by: . A) One disease process . B) More than one disease process Ans: B Chapter: 02 Feedback: The patient appears to have several possible conditions: allergic rhinitis, arthritis, conductive hearing loss, pleuritic chest pains, heartburn, stress urinary incontinence, and venous stasis, among other conditions. Although we always try, it is very difficult to assign all of these symptoms to one cohesive diagnosis.  A 62-year-old teacher presents to the clinic for evaluation of the following symptoms: fever, headache, sinus congestion, sore throat, green nasal discharge, and cough. This cluster of symptoms is best explained by: . A) One disease process . B) More than one disease process NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Ans: A Chapter: 02 Feedback: This cluster of symptoms is most consistent with sinusitis. The chance that all of these symptoms are caused by multiple synchronous conditions in the same patient is much less than the possibility of having one problem which accounts for all of them.  Steve has just seen a 5-year-old girl who wheezes when exposed to cats. The patient's family history is positive for asthma. You think the child most likely has asthma. What have you just accomplished? NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ congestive heart failure.  On the way to see your next patient, you glance at the calendar and make a mental note to buy a Mother's Day card. Your patient is Ms. Hernandez, a 76-year-old widow who lost her husband in May, two years ago. She comes in today with a headaches, abdominal pain, and general malaise. This happened once before, about a year ago, according to your detailed office notes. You have done a thorough evaluation but are unable to arrive at a consistent picture to tie these symptoms together. This is an example of a: . A) Pathophysiologic problem . B) Psychopathologic problem Ans: B Chapter: 02 Feedback: It is not uncommon for patients to experience psychopathologic symptoms around the anniversary of a traumatic event. The time of year and the lack of an obvious connection between Ms. Hernandez's symptoms would make you consider this as a possibility. You will note that although this might have been an early consideration in your hypothesis generation, it is key to convince yourself that there is not a physiologic explanation for these symptoms, by performing a careful history and examination.  Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He works in a sales office to support his family. Recently he has injured NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ his back and you are thinking he would benefit from physical therapy, three times a week, for an hour per session. What would be your next step? A) Write the physical therapy prescription. B) Have your office staff explain directions to the physical therapy center. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ C) Discuss the plan with Mr. Larson. D) Tell Mr. Larson that he will be going to physical therapy three times a week. Ans: C Chapter: 02 Feedback: You should discuss your proposed plan with the patient before implementing it. In this case, you and Mr. Larson will need to weigh the benefit of physical therapy against the ability to provide for his family. You may need to consider other ways of helping the patient, perhaps through prescribed back exercises he can do at home. It is a common mistake to implement a plan without coming to an agreement with the patient first. Chapter 3: Interviewing and the Health History Multiple Choice 1. You are running late after your quarterly quality improvement meeting at the hospital and have just gotten paged from the nurses' station because a family member of one of your patients wants to talk with you about that NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 3. Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ omitted? . A) Setting in which the symptom occurs . B) Associated manifestations C) Quality D) Timing Ans: B Chapter: 03 Feedback: The interviewer has not recorded whether or not the pain has been accompanied by nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional symptoms that may accompany the initial chief complaint and that help the examiner to start refining his or her differential diagnosis. 4. Jason is a 41-year-old electrician who presents to the clinic for evaluation of shortness of breath. The shortness of breath occurs with exertion and improves with rest. It has been going on for several months and initially occurred only a couple of times a day with strenuous exertion; however, it has started to occur with minimal exertion and is happening more than a dozen times per day. The shortness of breath lasts for less than 5 minutes at a time. He has no cough, chest pressure, chest pain, swelling in his feet, palpitations, NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ orthopnea, or paroxysmal nocturnal dyspnea.Which of the following symptom attributes was not addressed in this description? A) Severity B) Setting in which the symptom occurs C) Timing D) Associated manifestations Ans: A NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ B) Nonverbal communication C) Facilitation D) Empathic response Ans: C Chapter: 03 Feedback: This is an example of facilitation. Facilitation can be posture, actions, or words that encourage the patient to say more. 7. Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient? . A) Talkative patient . B) Angry patient . C) Silent patient . D) Hearing-impaired patient Ans: C Chapter: 03 Feedback: This is one example of a silent patient. There are many NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ possibilities for this patient's silence: depression, dementia, the manner in which you asked the question, and so on. 8. Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient? NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ A) Allow the patient to speak uninterrupted for the duration of the appointment. B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you. C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview. D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end. Ans: B Chapter: 03 Feedback: You can also say, “I want to make sure I take good care of this problem because it is very important. We may need to talk about the others at the next appointment. Is that okay with you?” This is a technique that can help you to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the interview. 9. Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Feedback: This is inappropriate because it is too vague. Given the complaint, you should probably assume that he is sexually active. Sometimes patients may respond to this question with the phrase “No, I just lie there.” A specific sexual history will help you to assess this patient's risk for other sexually transmitted infections. 11. Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ alcohol. Which one of the following questions will be most helpful in diagnosing this problem? . A) You are an alcoholic, aren't you? . B) When was your last drink? C) Do you drink 2 to 3 beers every weekend? D) Do you drink alcohol when you are supposed to be working? Ans: B Chapter: 03 Feedback: This is a good opening question that is general and neutral in tone; depending on the timing, you will be able to ask for more specific information related to the patient's last drink. The others will tend to stifle the conversation because they are closed-ended questions. Answer D implies negative behavior and may also keep the person from sharing freely with you. 12. On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her script, she mentions that it is hard not having her husband Bill around anymore. What would you do next? A) Hand her the script and make sure she has a 3-month follow-up NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ appointment. B) Make sure she understands the script. C) Ask why Bill is not there. D) Explain that you will have more time at the next visit to discuss this. Ans: C Chapter: 03 Feedback: Sometimes, the patient's greatest need is for support and NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 14. You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next? A) Carry out your examination, focusing on the neurologic portion, and then cover her properly. . B) Carry out your examination and let the nurse assigned to her “put her back together.” . C) Put her socks back on and cover her completely before beginning the evaluation. . D) Apologize for the last examiner but let the next examiner dress and cover her. Ans: C Chapter: 03 Feedback: It is crucial to make an effort to make a patient comfortable. In this scenario, the patient can neither speak nor move well. Take a moment to imagine yourself in her situation. As a matter of respect as well as comfort, you should cover the patient appropriately and consider returning a little later to do your examination if you feel she is cold. While it is her nurse's job to keep her comfortable, it is also your NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ responsibility, and you should do what you can. It is unacceptable to leave the patient in the same state in which you found her. 15. When you enter your patient's examination room, his wife is waiting there with him. Which of the following is most appropriate? . A) Ask if it's okay to carry out the visit with both people in the room. . B) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ C) Ask his wife to leave the room for reasons of confidentiality. D) First ask his wife what she thinks is going on. Ans: A Chapter: 03 Feedback: Even in situations involving people very familiar with each other, it is important to respect individual privacy. There is no implicit consent merely because he has allowed his wife to be in the room with him. On the other hand, it is inappropriate to assume that his wife should leave the room. Remember, the patient is the focus of the visit, so it would be appropriate to allow him to control who is in the room with him and inappropriate to address his wife first. Although your duty is to the patient, you may get optimal information by offering to speak to both people confidentially. This situation is analogous to an adolescent's visit. 16. A patient complains of knee pain on your arrival in the room. sentence be after greeting the patient? . A) How much pain are you having? . B) Have you injured this knee in the past? . C) When did this first occur? . D) Could you please describe what happened? Ans: D Chapter: 03 NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Ans: D Chapter: 03 What is this an example of? Feedback: This is an example of validation to legitimize her emotional experience. “Now that you have had your treatment, you should not have any further troubles” is an example of reassurance. “I understand what you went through because I am a cancer survivor myself” is an example of empathy. “So, you have had a lumpectomy and multiple radiation treatments” is an example of summarization as applied to this vignette. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 19. You are performing a young woman's first pelvic examination. You make sure to tell her verbally what is coming next and what to expect. Then you carry out each maneuver of the examination. You let her know at the outset that if she needs a break or wants to stop, this is possible. You ask several times during the examination, “How are you doing, Brittney?” What are you accomplishing with these techniques? . A) Increasing the patient's sense of control . B) Increasing the patient's trust in you as a caregiver . C) Decreasing her sense of vulnerability . D) All of the above Ans: D Chapter: 03 Feedback: These techniques minimize the effects of transitions during an examination and empower the patient. Especially during a sensitive examination, it is important to give the patient as much control as possible. 20. When using an interpreter to facilitate an interview, where should the interpreter be positioned? A) Behind you, the examiner, so that the lips of the patient and the patient's nonverbal cues can be seen NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ B) Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient C) Between you and the patient so all parties can make the necessary observations D) In a corner of the room so as to provide minimal distraction to the interview Ans: B NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ examination. His BMI is 26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit? . A) Refer the patient to a nutritionist because he is anorexic. . B) Reassure the patient that he has a normal body weight. . C) Give the patient information about reduction of fat, cholesterol, and calories because he is overweight. . D) Give the patient information about reduction of fat and cholesterol because he is obese. Ans: C Chapter: 04 Feedback: The patient has a BMI in the overweight range, which is 25.0 to 29.9 kg/m2. It is prudent to give him information about reducing calories, fat, and cholesterol in his diet to help prevent further weight gain. 3. A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m2. What is the most appropriate amount for a weekly weight reduction goal? . A) .5 to 1 pound per week NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ . B) 1 to 2.5 pounds per week . C) 2.5 to 3.5 pounds per week . D) 3.5 to 4.5 pounds per week Ans: A Chapter: 04 Feedback: Based on the NIH Obesity Guidelines, this is the weekly weight loss goal to strive for to maintain long-term control of weight. More rapid weight loss than this does not result in a better outcome at NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ one year. 4. A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer? . A) Have you tried to force yourself to vomit after eating a meal? . B) Do you have heartburn/indigestion and diarrhea? . C) Do you have enough food to eat? . D) Have you tried to lose weight? Ans: D Chapter: 04 Feedback: This is important: If the patient hasn't tried to lose weight, then this weight loss is inadvertent and poses concern for a neoplastic process, especially given his smoking history. 5. Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except: NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ . C) Blood pressure is measured on a bare arm. . D) Patient's arm is resting, supported by your arm at her mid-chest level as you stand to measure the blood pressure. Ans: A Chapter: 04 Feedback: A blood pressure cuff that is too tightly fitted can result in a false high reading. The other answers are important to observe to obtain an accurate blood pressure reading. JNC-7 also mentions the importance of having the back supported when obtaining blood pressure in the NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ sitting position. 8. A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel? . A) Large amplitude, forceful . B) Small amplitude, weak . C) Normal . D) Bigeminal Ans: B Chapter: 04 Feedback: Congestive heart failure is characterized by decreased stroke volume or increased peripheral vascular resistance, which would result in a small-amplitude, weak pulse. Subtle differences in amplitude are usually best detected in large arteries close to the heart, like the carotid pulse. You may not be able to notice these in other locations. 9. An 18-year-old college freshman presents to the clinic for evaluation of gastroenteritis. You measure the patient's temperature and it is 104 degrees Fahrenheit. What type of pulse would you expect to feel during his initial NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ examination? . A) Large amplitude, forceful . B) Small amplitude, weak . C) Normal . D) Bigeminal Ans: A Chapter: 04 Feedback: Fever results in an increased stroke volume, which results in a NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Feedback: This amount of weight over a short period should make one think of body fluid changes. You may consider a kidney problem or heart failure in your differential. The other reasons should be considered as well, but this amount of weight gain over a short period usually indicates causes other than excessive caloric intake. A rule of thumb for dieters is that an energy excess of 3500 calories will cause a 1-pound weight gain, if the increase is to be attributed to food intake. 12. Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him? . A) “When you get down to your goal weight, you will feel so much better.” . B) “Some people seem to be able to lose weight and others just can't, no matter how hard they try.” C) “We are coming up with new medicines and methods to treat your conditions every day.” D) “Even a weight loss of 10% can make a noticeable improvement in the problems you mention.” Ans: D NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ WWW.TESTBANKTANK.COM Chapter: 04 Feedback: Many patients trying to change a habit are overwhelmed by how far they are from their goal. As the proverb says: “A journey of a thousand miles begins with one step.” Many patients find it empowering to know that they can achieve a small goal, such as a loss of 1 pound per week. They must be reminded that this process will take time and that slow weight loss is more successful long-term. Research has shown that significant benefits often come with even a 10% weight loss. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 13. Jenny is one of your favorite patients who usually shares a joke with you and is nattily dressed. Today she is dressed in old jeans, lacks makeup, and avoids eye contact. To what do you attribute these changes? . A) She is lacking sleep. . B) She is fatigued from work. . C) She is running into financial difficulty. . D) She is depressed. Ans: D Chapter: 04 Feedback: It is important to use all of your skills and memory of an individual patient to guide your thought process. She is not described as sleepy. Work fatigue would most likely not cause avoidance of eye contact. Financial difficulties would not necessarily deplete a nice wardrobe. It is most likely that she is depressed or in another type of difficulty. 14. You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn't correlate with the other findings? NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ C) You question the accuracy of his measurements. D) You question the accuracy of your measurements. Ans: C Chapter: 04 Feedback: It is not uncommon to see differences in a patient's home measurements and your own in the office. Presuming that this is “white coat hypertension” can be dangerous because this condition is not usually treated. This allows for the effects of a missed diagnosis of hypertension to go unchecked. It is also very difficult to judge if a patient is outwardly nervous. You should always consider that your NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ measurements are not accurate as well, but the fact that you and your staff are well-trained and perform this procedure on hundreds of patients a week makes this less likely. Ideally, you would ask the patient to bring in his BP equipment and take a simultaneous reading with you to make sure that he is getting an accurate reading. 16. You are observing a patient with heart failure and notice that there are pauses in his breathing. On closer examination, you notice that after the pauses the patient takes progressively deeper breaths and then progressively shallower breaths, which are followed by another apneic spell. The patient is not in any distress. You make the diagnosis of: . A) Ataxic (Biot's) breathing . B) Cheyne-Stokes respiration . C) Kussmaul's respiration . D) COPD with prolonged expiration Ans: B Chapter: 04 Feedback: Cheyne-Stokes respiration can be seen in patients with heart failure and is usually not a sign of an immediate problem. Ataxic breathing is very irregular in rhythm and depth and is seen with brain injury. Kussmaul's respiration is seen in patients with a metabolic acidosis, as they are trying to rid their bodies of carbon dioxide to compensate. Respirations in COPD are NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ usually regular and are not usually associated with apneic episodes. 17. Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. on his right side. What type of pain is this? A) Idiopathic pain NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ muscle mass. In this situation, it is important to measure his waist. It is most likely under 40 inches, which makes obesity unlikely (even to an insurance company). It is important that you personally contact the company and explain your reasoning. Be prepared to back your argument with data. A special diet is unlikely to be of much use, and more aerobic exercise, while probably a good idea for most, is redundant for this individual. 19. Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual “lub dup.” How would you document your examination? . A) Regular rate and rhythm . B) Irregularly irregular rhythm . C) Regularly irregular rhythm D) Bradycardia Ans: C Chapter: 04 Feedback: Because this unusual beat occurs every fourth set of heart sounds, it is regularly irregular. This is most consistent with ventricular premature contractions (or VPCs). This is generally a common and benign rhythm. An irregularly irregular rhythm is a classic finding in atrial fibrillation. The rhythm is very random in character. Bradycardia refers to the rate, not the NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ rhythm. Chapter 6: The Skin, Hair, and Nails Multiple Choice 1. A 35-year-old archaeologist comes to your office (located in Phoenix, NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age . B) Hair color . C) Actinic lentigines . D) Heavy sun exposure Ans: A Chapter: 06 Feedback: The risk for melanoma is increased in people over the age of 50; our patient is 35 years old. The other answers represent known risk factors for melanoma. Especially with a family history of melanoma, she should be instructed to keep her skin covered when in the sun and use strong sunscreen on exposed areas. 2. You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ this description, what is the most likely diagnosis? . A) Pityriasis rosea . B) Tinea versicolor C) Psoriasis D) Atopic eczema Ans: A Chapter: 06 NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ Feedback: This is a classic description of pityriasis rosea. The description of a large single or “herald” patch preceding the eruption is a good way to distinguish this rash from other conditions. 5. A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? . A) Pityriasis rosea . B) Tinea versicolor . C) Psoriasis . D) Atopic eczema Ans: B Chapter: 06 Feedback: This is a typical description of tinea versicolor. The information that the patient is sweating more also helps support this diagnosis, because tinea is a fungal infection and is promoted by moisture. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 6. A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? . A) Actinic keratosis . B) Seborrheic keratosis NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? . A) Stage 1 . B) Stage 2 . C) Stage 3 . D) Stage 4 Ans: C Chapter: 06 Feedback: A stage 3 ulcer is a full-thickness skin loss with damage to or necrosis of subcutaneous tissue that may extend to, but not through, the underlying muscle. 9. An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia Ans: A Chapter: 06 Feedback: This is a typical description for alopecia areata. There are no risk factors for trichotillomania or for traction alopecia. The physical examination is not consistent with tinea capitis because the skin is intact. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ 10. A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related? . A) Diet . B) Family history of liver diseases . C) Family history of blood diseases . D) Ethnicity of the child Ans: A Chapter: 06 Feedback: The lack of jaundice in the sclerae is an important clue. Typically, this is the first place where one sees jaundice. This examination should also be carried out in natural light (sunlight) as opposed to fluorescent lighting, which can alter perceived colors. Many infants this age have a large proportion of carrots, tomatoes, and yellow squash, which are rich in carotene. Liver and blood diseases can cause jaundice, but this should involve the sclerae. The ethnicity of the child should not cause a perceived change from her usual skin tone. 11. A new mother is concerned that her child occasionally “turns blue.” On further questioning, she mentions that this is at her hands and feet. She does NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ hospitalized for endocarditis or may have had another significant illness which should be sought. Trauma to all 10 nails in the same location is unlikely. Dietary intake at this time would not be related to this finding. Do not assume a finding is necessarily related to a patient's culture unless you have good knowledge of that culture. 13. Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ What should you do? . A) Prescribe a steroid cream to decrease inflammation. . B) Consider admitting the patient to the hospital. . C) Reassure the parents and the patient that this should resolve within a week. . D) Tell him not to scratch them, and follow up in 3 days. Ans: B Chapter: 06 Feedback: Although this may not be an impressive rash, the fact that they do not “blanch” with pressure is very concerning. This generally means that there is pinpoint bleeding under the skin, and while this can be benign, it can be associated with life-threatening illnesses like meningococcemia and low platelet counts (thrombocytopenia) associated with serious blood disorders like leukemia. You should always report this feature of a rash immediately to a supervisor or teacher. 14. Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? . A) It is likely to be related to her lupus. NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+ . B) It is likely to be related to an exposure to a chemical. . C) It is likely to be related to an allergic reaction. . D) It should not cause any problems. Ans: A Chapter: 06 Feedback: A “palpable purpura” is usually associated with a vasculitis. This is an inflammatory condition of the blood vessels often associated NURS 208A Midterm Advanced Heath Assessment exam questions and answers attained grade A+ new update 2022/2023 RATEDA+