shadow health. shadow health., Exams of Nursing

Download shadow health. shadow health. and more Exams Nursing in PDF only on Docsity! shadow health A brief statement of the reason the patient is seeking health care is called the: - chief complaint Which of the following is an "ABCD" characteristic of malignant melanoma? - Irregular borders Which question would be considered a "leading question"? - "You don't get headaches often, do you?" A flat, nonpalpable lesion is described as a macule if the diameter is: - less than 1 cm. When you are questioning a patient regarding alcohol intake, she tells you that she is "only a social drinker." Which initial response is appropriate? - "What amount and what kind of alcohol do you drink in a week?" Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 3-cm, rough, elevated area of psoriasis. This is an example of a: - plaque Painful vesicles are associated with: - herpes zoster A 29-year-old white woman appears jaundiced. An etiology of liver disease has been excluded. What history questions should the nurse ask? - Whether she eats a lot of yellow and orange vegetables. Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the: - personal and social history. The thyroid gland is partially obscured by the: - sternocleidomastoid To perform the Rinne test, place the tuning fork on the: - mastoid bone. You observe pupillary response as the patient looks at a distant object and then at an object held 10 cm from the bridge of the nose. You are assessing for: - accommodation. Normal tympanic membrane color is: - pearly gray. Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the: - macula. According to the AUDIT scale , a person who receives a score of 14 is : - Is in the high risk category for alcohol abuse Bulging of an amber tympanic membrane without mobility is most often associated with: - middle ear effusion. You ask your patient to perform the DAST questionnaire, and note that he scored a "5". You understand this means: - the patient is at high risk for drug abuse After you have the patient complete the AUDIT questionnaire, your tally the score and realize the patient has scored a "9" . Your next communication with the patient should be: - I see that you completed the questionnaire, may I discuss the results with you? You are conducting a brief negotiated interview with your young male patient after you have reviewed his AUDIT questionnaire results. You discuss the safe drinking limits per day for his gender . You explain to him that this number is: - 4 You are discussing the amount of alcohol in different drinks with your patient. You explain to your patient what constitutes a standard drink. You review that 12 oz of regular beer is equal to: - 5 oz. of table wine With consolidation in the lung tissue, the breath sounds are louder and easier to hear, whereas healthy lung tissue produces softer sounds. This is because: - air-filled lung tissue is an insulator of sound The characteristic barrel chest of the older adult is due to a combination of factors including: - skeletal changes of aging. You would expect to document the presence of a pleural friction rub for a patient being treated for: - pleurisy. Both pleural effusion and lobar pneumonia are characterized by _____ percussion. - dullness heard on Mr. L. has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect he is having cardiac or pulmonary difficulty. What additional sign would support this impression? - Clubbing of the fingers Breath sounds normally auscultated over most of the lung fields are called: - vesicular. To begin counting the ribs and the intercostal spaces, you begin by palpating the reference point of the: - manubriosternal junction. Which bronchial structure(s) is(are) most susceptible to aspiration of foreign bodies? - Right mainstem bronchus The NP is examining a client with a history of rheumatic fever who is being followed for the development of endocarditis. During the cardiac auscultation, where on the chest wall is the stethoscope placed to determine the most common murmurs associated with this condition? - Fifth intercostal space, left side, at the midclavicular line. The NP notes that the patient has lymphadenopathy to the left axillary area. The expected lymph duct that is area will travel to is the: - Thoracic duct A third heart sound is created by: - diastolic filling. In assessing for potential appendicitis in your patient you perform the following exam. With the patient lying supine, you flex the patient's right leg by bending the knee, as you bring the knee in toward the chest and rotate it inward toward the navel, you stop because of the patient's increased pain. You would chart this as? - A positive Psoas sign. Visible intestinal peristalsis may indicate: - intestinal obstruction. After thorough inspection of the abdomen, the next assessment step is to: - ausculate. Percussion of the abdomen begins with establishing: - overall dullness and tympany in all four quadrants. When palpating the abdomen, you should note whether the liver is enlarged in the: - right upper quadrant. Auscultation of borborygmi is associated with: - gastroenteritis. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? - Venous hum In order to assess for liver enlargement in the obese person, you should: - ausculate using the scratch technique. The patient is complaining of abdominal pain, nausea with vomiting, malaise, and a low- grade fever attributed to eating some "bad food" 4 hours ago. The abdomen is soft and rounded, with hypoactive bowel sounds after 5 minutes of auscultation to each quadrant. Which assessment finding is inconsistent with gastroenteritis? - Hypoactive bowel sounds Percussion at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: - lower liver border. Inspection of the abdomen should begin with the patient supine and the examiner: - Standing at the foot of the table. An examiner can recognize a friction rub in the liver by a sound that is: - high pitched and associated with respirations. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: - decreased motility. In percussing the liver span, you know that in a patient with a normal sized liver, you would percuss dullness at the midsternal line of? - 4 to 8 cm Which organ(s) are located in the retroperitoneal space? - kidney. Before performing an abdominal examination, the examiner should: - have the patient empty his or her bladder. You ask the patient to raise the head and shoulders while lying in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): - diastasis recti. When palpating the aorta, a prominent lateral pulsation suggests: - aortic aneurysm. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course? - Obturator muscle test Which of the following is the most useful adjunct to the history of present illness when assessing the quantity and degree of a patient's abdominal pain? - Family comments about the patient You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive: - Romberg sign. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the: - fingertips. The musculoskeletal examination should begin when: - the patient enters the examination room. The physical assessment technique most frequently used to assess joint symmetry is: - inspection. You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient's neurologic status, you would: - test the six cardinal points of gaze. The finger-to-nose test allows assessment of: - coordination and fine motor function. The awareness of body position is known as: - proprioception. Bones around a joint are held together by: - ligaments. You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating: - stereognosis. When palpating joints, crepitus may be caused when: - irregular bony surfaces rub together. Environmental hazards and cognitive function are data needed for the personal and social history section of a neurologic assessment for: - every patient. Injuries to long bones and joints are more likely to result in fractures than in sprains until: - adolescence. In differentiating osteoarthritis from rheumatoid arthritis (RA), the osteoarthritis patient typically exhibits: - less weakness and fatigue. Light skin and thin body habitus are risk factors for: - osteoporosis. Bones are attached to muscles by: - Tendons As Mr. B. enters the room, you observe that his gait is wide based and he staggers from side to side while swaying his trunk. You would document Mr. B.'s pattern as: - cerebellar ataxia. To determine cerebellar functioning in the geriatric client, the nurse practitioner evaluates: - Ability to balance on one foot, then the other. A client is seen in the ER with complaints of foot pain after an injury. The X-ray revealed a foot fracture. Which reason explains why the foot is placed in a brace? - To act as a splint Which fracture is commonly seen in the upper extremities and is related to physical abuse? - spiral Osteomylitis most commonly results from trauma to a surrounding area such as a fish hook being removed from a foot ? (T/F) - True While examining the breasts of a 53-year-old woman, you detect a nontender, fixed, 2- cm hard mass beneath the left areola, associated with prominent veins. The mass should be further evaluated: - by a surgeon as soon as possible. In order to determine which heart sound is S1, which of the following should you assess? - Carotid upstroke The assessment of Jugular Venous Pressure (JVP) correlates with: - Central venous pressure Tina had brisk capillary refill (less than 3 seconds). What does this mean? - Arterial blood flow is sufficient Describe where on the body and when in the cardiac cycle you are most likely to auscultate a murmur caused by mitral valve prolapse. - mitral valve prolapse usually occur in late systole just after a mid systolic click They are best heard at the apex of the heart and the left lower sternal border when the patient is lying supine with legs raised or sitting up Imagine you had heard a murmur on Tina. Why would it have been important to ask Tina to change positions while auscultating the heart? - it is important to determine which body position the murmur is most loudly and clearly heard You decide to order an arterial blood gas on Tina. Which physical exam test should you perform before drawing blood from the radial artery? - a modified Allen test must be performed Which of the following physical exam tests could be used if you suspected cholecystitis in Tina? - Murphy's sign Suppose that you were concerned that Tina may have had an enlarged spleen. How would you have proceeded? - Percuss in the left anterior axillary line During a gastrointestinal exam, the purpose of light palpation of the abdomen is to: - Assess for tenderness If you had heard bowel sounds occurring about 15 times per minute in 1-2 quadrants while examining Tina, what would have been the significance of this finding? - Bowel sounds occurring irregularly between 5 to 30 times per minute is a normal finding Imagine that you had heard a swishing sound while auscultating Tina's epigastric region. Identify where this bruit would have been likely to originate. - turbulent blood flow in the abdominal aorta or a renal artery. Suppose that after examining Tina, you were concerned she may have peritonitis. How would you have assessed Tina to confirm your diagnosis? - a rebound tenderness test to look for a positive Blumberg's sign and a heel jar test to look for a positive Markle sign. If you were assessing range of motion (ROM) for a healthy 28-year-old woman with no known joint issues, which of the following would indicate limited ankle ROM? - 30 degrees plantar flexion When palpating joints in a musculoskeletal exam, crepitus indicates: - Roughened articular cartilages Imagine that Tina has hard painless bumps on the dorsolateral aspects of the distal interphalangeal joints that had limit flexion during a range of motion test. How would you have documented these abnormalities? - Heberden's node Describe the major differences in acute versus passive range of motion (ROM) when distinguishing between an articular and nonarticular joint issue. - joint (articular), there is pain and often swelling with limited passive and active ROM nonarticular, there is pain on active, but not passive, ROM Active ROM involves the use of structures (ligaments, tendons, muscles) outside of the joint, hence there is a limitation with active ROM and not passive ROM when a problem is outside of the joint. Explain the difference between a sprain and a strain - A sprain is a stretching or tearing of ligaments, and a strain is a stretching or tearing of muscle or tendon To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested? - Patellar Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening? - Autonomic dysreflexia Which of the following is not a common symptom of Parkinson's disease? - Intention tremors Describe how you would have tested for the Kernig's sign. - To perform the test, flex the leg at the knee and hip when the patient is supine, making a right angle with the flexed knee. Then attempt to straighten the leg at the knee. Resistance and pain in the lower back constitute a positive Kernig's sign, indicating meningeal irritation.