Case Studies in Clinical Medicine, Exams of Nursing

Download Case Studies in Clinical Medicine and more Exams Nursing in PDF only on Docsity! NUR-682 ASSESSMENT FINAL EXAM QUESTIONS AND VERIFIED ANSWERS 2024 UPDATE 1. The components of the health history include all of the following except: • Thorax and lungs 2. The following information is best placed in which category: “The patient had a stent placed in the left anterior descending artery (LAD) in 1999” • Surgeries 3. The following information is recorded in the health history: “I feel really tired.” Which category does it belong to? • Chief complaint 4. The following information is recorded in the health history: “The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric area.” Which of these categories does it belong to? • Present illness 5. 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? • You have created a hypothesis 6. You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list? • Chest pain, headaches, arthritis, war injury pain 7. 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? • Inflammatory 8. Ms. Washington is a 67 year old who had a heart attack last month. Now she complains of shortness of breath and not being able to sleep in a flat position (orthopnea). On examination you note increased jugular venous pressure, a S3 gallop, crackles low in the lung fields, and swollen ankles (edema). This is an example of a: • Pathophysiologic problem 9. 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? • Even a weight loss of 10% can make a noticeable improvement in the problems you mention 10. A 50 year old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as “high risk” because of obesity. What should you do next: • Measure his waist 11. 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? • It is caused by a cuff size error 12. 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: • Cheyne-Stokes respiration 20. You are conducting a mental status examination and note impairment of speech and judgment, but the rest of your examination is intact. Where is the most likely location of the problem • Cerebrum 21. Steve has had a stroke and comes to you for a follow-up today. On examination you find that he has increased muscle tone, some involuntary movements, an abnormal gait, and a slowness of response in movements. He most likely has involvement of which of the following • The basil ganglia 22. You are beginning the examination of the skin on a 25 year old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism • dry and rough 23. 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? • Asymmetry, irregular borders, color changes (especially blue), diameter > 6 mm, evolution 24. 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 most likely your diagnosis • Tinea Versicolor 25. A 28 year old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? • Pityriasis rosea 26. A 22 year old nurse comes to your clinic, complaining of severe constipation and pain during defecation. She has also seen blood on the toilet paper. She states that she eats a healthy diet and does some light exercising. She is currently at the beginning of her third trimester of an unremarkable pregnancy. Her past medical history is unremarkable. Her mother has high cholesterol but her father is in good health. She does not smoke, drink alcohol or use illegal drugs. She is married and expecting her first child. On examination she appears healthy and is afebrile, with a blood pressure of 110/60. Her abdominal examination reveals a gravid uterus but is otherwise unremarkable. On visualization of the anus there is a slight red, moist-appearing protrusion from the anus. As you have her bear down, the protrusion grows larger. On digital rectal examination you can feel an enlarged tender area on the posterior side. There is some blood on the glove after the examination. What disorder of the anus or rectum best fits this presentation? • Internal hemorrhoids 27. A 24 year old graduate student comes to your clinic, complaining of burning during urination and increased urinary frequency. He has had a low grade fever (100.5) and does not feel very well. He is very worried about STDs because he had a drunken encounter 2 weeks ago and did not use a condom. He has had no recent weight loss, weight gain, or night sweats. His past medical history includes knee surgery in HS and genital warts in college. He does not smoke but drinks six beers every Friday and Saturday night. He denies using any IV drugs but has tried marijuana in the past. His father has high cholesterol but his mother is healthy. On examination he appears tired. His temperature is 99.5 degrees and his BP is 110/70. His abdominal examination is normal. Visualization of the anus shows no masses, inflammation, or fissures. DRE reveals a warm, boggy, tender prostate. No discrete masses are felt and there is no blood on the glove. The scrotum and penis appear normal. Urinalysis shows moderate amounts of WBCs and bacteria. What d/o of the anus, prostate, or rectum best describes this situation? • Prostatitis 28. A 55 y/o retired property manager comes to your clinic, concerned that she may have a tumor in her rectum. When asked why, she stakes that after straining at a bowel movement she felt a mass around her rectum. She denies any blood in her stool, black stools, or pain with defecation. She admits to having had chronic constipation for 30 years. She often uses laxatives to be able to have a VM. She denies any recent weight gain, weight loss, fever, or night sweats. Her PMhx consists of hypothyroidism, and she has had 2 spontaneous vaginal deliveries. Her mother died recently of colon CA and her father has HTN but is otherwise healthy. She denies any smoking and only occasionally drinks ETOH. On examination she seems nervous. Her BP is 140/90 and her HR is 100. Her cardiac, lung, and abdominal examinations are normal. On visualization of her anus, no inflammation, masses, or fissures noted. When she is asked to bare down, you see a rosette of red mucosa prolapsing from the anus. On DRE there are no masses and no blood is found on the glove. What disorder of the anus or rectum is this likely to be? • Prolapse of the rectum 29. A 50 year old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, GI, UI, or musculoskeletal system complaints. His past medical hx is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than 6 beers a week, and denies using any illegal drugs. His mother has HTN and arthritis and his father died of lung CA in his 60’s. on examination, his BP is 130.80 and his HR is 80. His cardiac, lung, and abdominal examinations, are normal. He has no inguinal hernia, but on his DRE you palpate a soft, smooth, nontender peduculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation? • Rectal Polyp 30. A 75 year old retired construction worker comes to your clinic, complaining of bright red blood in the toilet for the last several months. He has no pain with • Term, normal birth weight 40. A mother brings her 16 month old son in for an evaluation. She is afraid he is not meeting his developmental milestones and wants to know if he should be sent to therapy. He was the product of an uneventful pregnancy and a spontaneous vaginal delivery. His apgar scores were 7 and 9. Until reaching a year old the mother believes he was hitting his milestones appropriately. You decide to administer the Denver Developmental Screening Test. You find that he is using a spoon to eat with and can take off his own shoes and shirt. He can build a tower of two cubes and dump raisins. His vocabulary consists of at least 10 words. He can stand-alone and stoop and recover, but he is unable to walk without holding onto someones hand. What type of developmental delay does he have? • Gross Motor 41. A quiet 3 year old is brought in for a routine check-up when you notice a fresh bruise in the axilla and bilateral bruises over the upper back that appear slightly older. There are brown bruises over his shins as well. His mother said this happened when he fell off a couch. What dx should be considered? • Abuse 42. A toddler is able to jump in place and balance on one foot as well. She can also speak in full sentences and feed herself. What is the approximate developmental age of this child? • 3 43. You are observing an infant who is able to pull to a stand, uses “mama” and “dada” specifically, and indicates his wants by vocalization and pointing. Where would you place this child’s developmental age? • 8 months 44. A 19 y/o childcare worker comes to you for her first prenatal visit. She cannot remember when her last period was but thinks it was between 2 to 5 months ago. When she began gaining weight and felling something move down there, she did a home pregnancy test and it was positive. She states she felt the movement about a week ago. She has had no n/v, fatigue, or fevers. Her past medical hx is remarkable only for irregular periods. She has been dating the same young man for a year. She says they were not using condoms. On examination you see an overweight young lady appearing her stated age. Her head, eyes, ears, nose, throat, neck, thyroid, cardiac, and pulmonary exams are unremarkable. Her abdomen is nontender with normal bowel sounds, and the gravid uterus is palpated to the level of the umbilicus. Fetal heart tones are easily found with doptone, and with the bimanual exam the cervix is soft. Results of pap smear, cultures, and blood work are pending. You give the pt her due date and how far along she is, based on your clinical findings. An OB ultrasound to confirm her dates is ordered. With only the clinical exam, how many weeks pregnant did you tell the pt she is? • 18-20 wks 45. A pregnant woman finally comes in for her prenatal check up. She complains today of a headache and abdominal pain for several months’ duration. She appears somewhat hurried or nervous. What question do u ask next? • Do you feel safe at home 46. A woman in her 30th week has a cervical length estimated at 1 cm. should you be concerned? • Yes; she may be at risk for preterm labor 47. During cardiac examination you notice a new parasternal systolic murmur of 2/6 intensity. On palpation the PMI is slightly higher than usual. What do you suspect? • Mammary soufflé 48. Which of the following is a major effect of placental hormones? • Insulin resistance 49. You are examining for fetal heart tones with a fetoscope and are unable to hear any. Using a doptone, you measure the rate at 164. Which gestational age is most likely? • 20 wks 50. A 70 year old retired auto mechanic comes to your office because his neighbor is concerned about his memory. The patient himself admits to misplacing his keys more often and forgets what he is supposed to buy from the grocery store and where he has parked the car. He denies getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8 months ago; his three children live in three different states; and he has limited his activities because the people he interacted with were “his wife’s friends, not his.” He drinks a six-pack of beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination and obtain a total score of 24 out of 28. Based on this information what is your most likely diagnosis? • Depression 51. A 79 year old retired banker comes to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go oat least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is you expected physical examination finding, based on this description? • Enlarged size, smooth 52. An 89 year old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test? • Time interval until benefit from screening accrues 53. Mr. Chin is an 82 y/o man who comes to your office for a routine check. On examination, you notice a somewhat high-pitched murmur in the second right intercostal space during systole. It does not radiate and the rest of his examination is normal for his age. Which is true of the most likely cause of this murmur? • It carries with it increased risk for cardiovascular disease 54. Mrs. Stanton is a 79 y/o widow who presents to your office for a routine BP visit. You note a new pulsatile mass in the right neck at the carotid artery. Which of the following is the most likely cause for this? • Kinking of the artery His parents and siblings are in good health. He has recently married, and his wife has a baby due in 2 months. He denies any smoking or illegal drug use. He drinks two to three beers once a month. He states that he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, GI, or musculoskeletal symptoms. On examination he is lying on his right side but appears quite comfortable. His temperature, BP, pulse, and respirations are unremarkable. During palpation the ribs are nontender. What d/o of the chest best describes his symptoms? • Pleural pain 67. A 47 y/o receptionist comes to your office, complaining of fever, SOB, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using OTC cold remedies. She denies any weight gain, weight loss, or cardiac or GI symptoms. Her past medical hx includes type 2 DM for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother had DM and HTN. Her father passed away from colon CA. on exam you see a middle aged woman appearing her stated age. She looks ill and her temperature is elevated at 101. Her BP and pulse are unremarkable. Her head, eyes, ears, nose, and throat exam are unremarkable except for edema of the nasal turbinates. On auscultation she has decreased air movement, and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during plapation, and egophony and whispered pectoriloquy on ausculataion. What d/o of the thorax or lung best describes her symptoms? • Pneumonia 68. A 75 y/o retired teacher presents to your clinic, complaining of severe, unrelenting anterior chest pain radiating to her back. She describes it as if someone is “ripping out her heart”. It began less than an hour ago. She states she is feeling very nauseated and may pass out. She denies any trauma or recent illnesses. She states she is never had pain like this before. Nothing seems to make the pain better or worse. Her medical hx consists of difficult to control htn and CAD requiring two stents in the past. She is a widow. She denies any ETOH, tobacco, or illegal drug use. Her mother died of a CVA and her father died of a MI. she has one younger brother who has had bypass surgery. On exam you see an elderly female in a great deal of distress. She is lying on the table, curled up, holding her left and right arms against her chest and is restless, trying to find a comfortable position. Her BP is 180/110 in the right arm and 130/60 in the left arm, and her pulse is 120. Her right carotid pulse is bounding but the left carotid pulse is weak. She is afebrile but her respirations are 24 times a minute. On auscultation her lungs are clear and her cardiac exam is unremarkable. You call ems and have her taken to the hospitals ER for further evaluation. What d/o of the chest best describes her symptoms? • Dissecting aortic aneurysm 69. When crackles, wheezes, or rhonchi clear with a cough, which of the following is likely etiology? • Bronchitis 70. A 25 y/o optical tech comes to your clinic for eval of fatigue. As part of your physical exam, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur? • Mitral 71. Suzanne is a 20 y/o college student who complains of chest pain. This is intermittent and is located to the left of her sternum. There are no associated symptoms. On exam, you hear a short, high pitched sound in systole, followed by a murmur which increased in intensity until S2. This is heard over the apex. When she squats, this noise moves later in systole along with the murmur. Which of the following is the most likely dx? • Mitral valve prolapse 72. Which is true of a third hear sound (S3)? • It is caused by rapid deceleration of blood against the ventricular wall 73. Which of the following correlates with a sustained, high amplitude PMI? • HTN 74. Which of the following regarding jugular venous pulsation is a systolic phenomenon? • The downstroke of the “v” wave 75. You are examining a pt with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good exam? • Listen in the epigastrium 76. You are performing a cardiac exam on a pt with SOB and palpitations. You listen to the heart with the pt sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position, which of the following valvular defects is best heard in this position? • Mitral 77. You find a bounding carotid pulse on a 62 y/o pt. which murmur should you search out. • Aortic insufficiency 78. You notice a pt has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely? • Severe left HF 79. A 77 y/o retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition? • HTN 80. When assessing temperature of the skin, which portion of your hand should be used? • Backs of fingers 81. You are assessing a pt for peripheral vascular dz in the arms, secondary to the complaint of increased weakness and a hx of CAD and DM. you assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3? • 3+ 82. You are performing a routine check-up on a 81 y/o retired cotton farmer in the vascular surgery clinic. You note that he has a hx of chronic arterial insufficiency. period last week. She denies any upper respiratory, GI, cardiac, or pulmonary symptoms. Her PMH consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has HTN and her father died from heart dz. On examination she appears healthy and has unremarkable VS. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thing gray-white d/c is seen in the vault. The pH of the d/c is over 4.5 and there is a fishy odor when potassium hydroxide is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders. What type of vaginitis best describes her findings? • Bacterial vaginosis 91. Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true? • Psychosocial reasons may cause this condition 92. An 18 year old college freshman comes to your clinic, complaining of severe left sided lower abdominal pain and a foul yellow discharge. The pain began last night while she was having intercourse with her b/f. Afterward the pain became more severe and the discharge started. By this morning she had a fever of 101 degrees and walking was making the pain worse. Only lying very still makes the pain better. She has tried ibuprofen and acetaminophen without any improvement. She denies any n/v/d or constipation. Her past medical hx is unremarkable. She has had two past sexual partners. She uses the birth control patch instead of condoms. She smokes a half pack of cigarettes a day and drinks four to five beers per weekend night. She denies any illegal drug use. Her parents both are healthy. On examination you find a young woman who appears ill. Her temperature is 102 degrees and her pulse is elevated at 110. She is tender in the LLQ but has no guarding or rebound. Speculum examination reveals yellow purulent drainage from the os. On palpation there is cervical motion tenderness and the left adnexa is swollen and tender. A urine analysis is unremarkable and the UPT is pending. What is the best choice of dx for this adnexal swelling? • Pelvic inflammatory disease 93. Which of the following is true of HPV? • It commonly resolves spontaneously in 1-2 years 94. A pt tells you about her experience with prolonged therapy for her breast cancer. You comment, “that must have been a very trying time for you.” What is this an example of? • Empathy 95. Jason is a 41 y/o electrician who presents to the clinic for evaluation of SOB. The SOB 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 SOB lasts for less than 5 minutes at a time. He has no cough chest pressure, chest pain, swelling in his feet, palpitations, orthopnea, or paroxysmal nocturnal dyspnea. Which of the following symptom attributes was not addressed in this description? • Severity 96. Mrs. R. is a 92 y/o 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 pt? • Silent pt 97. When using an interpreter to facilitate an interview, where should the interpreter be positioned? • Next to the pt, so the examiner can maintain eye contact and observe the nonverbal cues of the pt 98. You are performing a young woman’s first pelvic exam. You make sure to tell her verbally what is coming next and what to expect. Then you carry out each maneuver of the exam. 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 exam, “how are you doing, Brittney?” What are you accomplishing with these techniques? • Increasing the pt’s sense of control • Increasing the pt’s trust in you as a caregiver • All of the above 99. Cody is a teenager with a hx of leukemia and an enlarged spleen. Today he presents with fairly significant LUQ pain. On exam of this area a rough grating noise is heard. What is this sound? • It is a splenic rub 100. Which is the proper sequence of exam for the abdomen? • Inspection, auscultation, percussion, palpation