N522PE Advanced Physical Assessment midterm exam july 2021

A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to 10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the-counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?

 

a.

Tension

 

b.

Analgesic rebound

 

c.

Cluster

 

d.

Migraine

Question 2

Incorrect

0.00 points out of 1.00

 Flag question

Question text

When you encourage your patient to elaborate or say more about the condition, you are using the communication technique of:

 

a.

Confrontation

 

b.

Facilitation

 

c.

Clarification

 

d.

Reflection

Question 3

Correct

1.00 points out of 1.00

 Flag question

Question text

Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?

 

a.

Wait for her to mention them before asking further questions.

 

b.

Conclude that these are lesions she has had for a long time.

 

c.

Ask how she acquired them.

 

d.

Conduct the visit as usual for the patient.

Question 4

Correct

1.00 points out of 1.00

 Flag question

Question text

A 75-year-old 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 has never had pain like this before. Nothing seems to make the pain better or worse. Her medical history consists of difficult-to-control hypertension and coronary artery disease requiring two stents in the past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother died of a stroke and her father died of a heart attack. She has one younger brother who has had bypass surgery. On examination 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 blood pressure 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 examination is unremarkable. You call EMS and have her taken to the hospital’s ER for further evaluation.

What disorder of the chest best describes her symptoms?

 

 

a.

Angina pectoris

 

b.

Pleural pain

 

c.

Pericarditis

 

d.

Dissecting aortic aneurysm

Feedback

Your answer is correct.

Question 5

Correct

1.00 points out of 1.00

 Flag question

Question text

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?

 

a.

Psoriasis

 

b.

Eczema

 

c.

Pityriasis rosea

 

d.

Tinea infection

Question 6

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Mary is a 55-yr-old female patient who presents with abdominal pain for about 2 weeks. She reports she has noticed a change in her bowel habits & occasionally her stool looks dark.  What do you suspect?

 

a.

Cholecystitis

 

b.

Colon cancer

 

c.

Peptic ulcer

 

d.

Diverticulitis

Question 7

Correct

1.00 points out of 1.00

 Flag question

Question text

The older adult may have plaque buildup in the walls of the arteries causing stiffness and leading to loss of elasticity of the arterial walls. This may lead to increased peripheral vascular resistance and:

 

a.

Increased diastolic blood pressure

 

b.

Decreased systolic blood pressure

 

c.

Decreased diastolic blood pressure

 

d.

Increased systolic blood pressure

Question 8

Incorrect

0.00 points out of 1.00

 Flag question

Question text

How should you determine whether a murmur is systolic or diastolic?

 

a.

Palpate the carotid pulse.

 

b.

Correlate the murmur with a bedside heart monitor.

 

c.

Palpate the radial pulse.

 

d.

Judge the relative length of systole and diastole by auscultation.

Question 9

Correct

1.00 points out of 1.00

 Flag question

Question text

A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom?

 

a.

Cardiac

 

b.

Reproductive

 

c.

Urinary

 

d.

Hematologic

Question 10

Correct

1.00 points out of 1.00

 Flag question

Question text

The following information should be included in which part of the health history: “I live with my husband and three children. I work as a teller at the local bank.”

 

a.

Present illness

 

b.

Family history

 

c.

Past medical history

 

d.

Personal and social history

Question 11

Correct

1.00 points out of 1.00

 Flag question

Question text

The following information is recorded in the health history: “I feel really tired.” Which category does it belong to?

 

a.

Present illness

 

b.

Chief concern

 

c.

Review of systems

 

d.

Personal and social history

Question 12

Correct

1.00 points out of 1.00

 Flag question

Question text

A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, 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?

 

a.

Mitral

 

b.

Tricuspid

 

c.

Pulmonic

 

d.

Aortic

Question 13

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Which of the following is most likely benign on breast examination?

 

a.

One nipple inverted

 

b.

One breast with dimple when the patient leans forward

 

c.

One breast larger than the other

 

d.

Dimpling of the skin resembling that of an orange

Question 14

Correct

1.00 points out of 1.00

 Flag question

Question text

A light is pointed at a patient’s pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?

 

a.

Consensual reaction

 

b.

Near reaction

 

c.

Accommodation

 

d.

Direct reaction

Question 15

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Your patient is noted to have some swelling in the right lower extremity. As you assess the edema, you note a noticeably deep pit lasting more than one minute to palpation and the extremity is visibly fuller than the left extremity. You would document this edema as:

 

a.

1+ pitting edema

 

b.

2+ pitting edema

 

c.

3+ pitting edema

 

d.

4+ pitting edema

Question 16

Correct

1.00 points out of 1.00

 Flag question

Question text

A 35-year old female patient describes losing about 10 pounds over the past 6 months. She indicates she seems to be tired all the time, feels her heart “skip a beat” occasionally, and just can’t stay outside in the summer heat like she used to do. She mentions that her mom has had some type of disease for the past 30 years where her immune system just wasn’t working right. Which one of the following disorders would you consider in your initial differential diagnoses list for this patient?

 

a.

Myxedema

 

b.

Type 1 diabetes

 

c.

Grave’s Disease

 

d.

Hashimoto Disease

Question 17

Correct

1.00 points out of 1.00

 Flag question

Question text

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?

 

a.

6 months

 

b.

8 months

 

c.

10 months

 

d.

12 months

Question 18

Correct

1.00 points out of 1.00

 Flag question

Question text

Which of the following statements is false about conditions related to location of abdominal pain?

 

a.

Pancreatitis may present as excruciating pain in the LUQ.

 

b.

Cholecystitis may present as severe pain in the RUQ.

 

c.

Biliary stones may present as episodic LUQ pain.

 

d.

Appendicitis may present as epigastric colicky pain initially.

Question 19

Incorrect

0.00 points out of 1.00

 Flag question

Question text

You are assessing a 2-yr-old with a recent history of productive cough for the past month. The parent shares that the child has been having some unusually large stools. You review the previous well child visit six months ago and note the child has not gained any weight over the period. What health history question would be most appropriate at this time to determine the diagnosis?

 

a.

Has your child had any nausea or vomiting?

 

b.

Tell me about any family history of genetic disorders.

 

c.

Has the child’s diet changed any in the past 6 months?

 

d.

What color is the sputum from the cough?

Question 20

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Sudden, painful unilateral loss of vision may be caused by which of the following conditions?

 

a.

Optic neuritis

 

b.

Vitreous hemorrhage

 

c.

Central retinal artery occlusion

 

d.

Macular degeneration

Question 21

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Which statement about lymph nodes is true?

 

a.

Soft, movable painful bilateral nodes suggest a malignant process.

 

b.

A hard, fixed painless node suggests a malignant process.

 

c.

Rapid nodal enlargement indicates a benign process.

 

d.

The more tender a node, the less likely it is an inflammatory process.

Question 22

Correct

1.00 points out of 1.00

 Flag question

Question text

A 55-year-old patient visits your clinic reporting feeling very tired, short of breath, and difficulty sleeping noting the need for use of several pillows. The patient indicates this has occurred for the past month or so. You realize these symptoms may indicate left-sided congestive heart failure (CHF). What specific assessment finding is the most helpful in making this diagnosis?

 

a.

Displaced PMI

 

b.

Hypertension

 

c.

Tachycardia

 

d.

Hypotension

Question 23

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Which hearing screening test below can be performed by the nurse initially with good sensitivity & specificity in adults from 50 to 70 years of age?

 

a.

Audiometric testing

 

b.

The whisper test

 

c.

The finger rub test

 

d.

The tuning fork test

Question 24

Correct

1.00 points out of 1.00

 Flag question

Question text

Which statement about the skin is false?

 

a.

Infants have smoother skin than adults.

 

b.

Older adults have less sebaceous and sweat gland activity.

 

c.

Apocrine glands enlarge in adolescence leading to sweating.

 

d.

Pregnant women have decreased blood flow to the skin.

Question 25

Correct

1.00 points out of 1.00

 Flag question

Question text

A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

 

a.

Intermittent claudication

 

b.

Knee pain

 

c.

Chest pressure with exertion

 

d.

Shortness of breath

Question 26

Correct

1.00 points out of 1.00

 Flag question

Question text

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.

Surgeries

 

b.

Obstetrics/gynecology

 

c.

Adult illnesses

 

d.

Psychiatric

Question 27

Correct

1.00 points out of 1.00

 Flag question

Question text

Which statement is true about auscultation of S3:

 

a.

It is best assessed with the patient in the left lateral recumbent position, at the apex of the heart, with the bell of the stethoscope.

 

b.

It is best assessed with the patient supine, at the apex of the heart, with the diaphragm of the stethoscope.

 

c.

It is best assessed with the patient sitting, at the base of the heart, with the bell of the stethoscope.

 

d.

It is best assessed with patient in any position, at the base of the heart, with the diaphragm of the stethoscope.

Question 28

Correct

1.00 points out of 1.00

 Flag question

Question text

The components of the health history include all the following except:

 

a.

Review of systems

 

b.

Past medical history

 

c.

General inspection

 

d.

Family history

Question 29

Correct

1.00 points out of 1.00

 Flag question

Question text

The mother of a newborn infant is holding her newborn and states “My baby has blue hands & feet. What’s wrong?” You note the baby has blue hands & feet. The mucous membranes & skin of the upper body is pink. The best response to this mother is:

 

a.

Blue hands & feet indicate your baby is in shock & will need intensive care.

 

b.

Blue hands & feet occur with a congenital heart defect, so I’ll notify the doctor.

 

c.

Blue hands & feet indicate a pathologic heart murmur to be treated immediately.

 

d.

Blue hands & feet occur frequently in the newborn & usually resolve within a few days.

Question 30

Correct

1.00 points out of 1.00

 Flag question

Question text

A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition?

 

a.

PET scan

 

b.

Venogram

 

c.

CT scan of the lower legs

 

d.

Ankle–brachial index (ABI)

Question 31

Correct

1.00 points out of 1.00

 Flag question

Question text

For which of the following patients would a comprehensive health history be appropriate?

 

a.

A new patient with the chief complaint of “I cut my hand”

 

b.

A new patient with the chief complaint of “I sprained my ankle”

 

c.

A new patient with the chief complaint of “I am here to establish care”

 

d.

An established patient with the chief complaint of “I have an upper respiratory infection”

Question 32

Correct

1.00 points out of 1.00

 Flag question

Question text

A 68-year-old retired waiter comes to your clinic for evaluation of fatigue. You perform a cardiac examination and find that his pulse rate is less than 60. Which of the following conditions could be responsible for this heart rate?

 

a.

Atrial fibrillation

 

b.

Second-degree A-V block

 

c.

Atrial flutter

 

d.

Sinus arrhythmia

Question 33

Correct

1.00 points out of 1.00

 Flag question

Question text

Which of the following is consistent with good percussion technique?

 

a.

Allow all of the fingers to touch the chest while performing percussion.

 

b.

Maintain a stiff wrist and hand.

 

c.

Strike the pleximeter over the distal interphalangeal joint.

 

d.

Leave the plexor finger on the pleximeter after each strike.

Question 34

Correct

1.00 points out of 1.00

 Flag question

Question text

A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

 

a.

Orthopnea

 

b.

Tenesmus

 

c.

Abdominal pain

 

d.

Hematochezia

Question 35

Correct

1.00 points out of 1.00

 Flag question

Question text

You are performing a routine check-up on an 81 year old retired cotton farmer in the vascular surgery clinic. You note that he has a history of chronic arterial insufficiency. Which of the following physical examination findings in the lower extremities would be expected with this disease?

 

a.

Marked edema

 

b.

Normal temperature

 

c.

Thin, shiny, atrophic skin

 

d.

Normal pulsation

Question 36

Correct

1.00 points out of 1.00

 Flag question

Question text

Is the following information subjective or objective? Mr. M. has a respiratory rate of 32 and a pulse rate of 120.

 

a.

Subjective

 

b.

Objective

Question 37

Correct

1.00 points out of 1.00

 Flag question

Question text

Which of the following percussion notes would you obtain over the gastric bubble?

 

a.

Resonance

 

b.

Hyperresonance

 

c.

Flatness

 

d.

Tympany

Question 38

Correct

1.00 points out of 1.00

 Flag question

Question text

An 89-yr-old patient visits the clinic and indicates some lower leg pain that is noticeably worse with activities such as walking or climbing the steps to her home. It seems to subside with rest. The most likely diagnosis for this patient is:

 

a.

Peripheral arterial disease

 

b.

Venous thrombosis

 

c.

Arterial aneurysm

 

d.

Peripheral venous disease

Question 39

Correct

1.00 points out of 1.00

 Flag question

Question text

Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration?

 

a.

Vesicular

 

b.

Bronchovesicular

 

c.

Bronchial

 

d.

Tracheal

Question 40

Incorrect

0.00 points out of 1.00

 Flag question

Question text

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?

 

a.

Explain that even small amounts of weight gain can classify you as obese.

 

b.

Measure his waist.

 

c.

Place him on a high-protein, low-fat diet.

 

d.

Advise him to increase his aerobic exercise for calorie burning.

Question 41

Correct

1.00 points out of 1.00

 Flag question

Question text

A 78 year old retired seamstress comes to the office for a routine check-up. You obtain an ECG (electrocardiogram) because of her history of hypertension. You diagnose a previous myocardial infarction and ask her if she had any symptoms related to this. Which of the following symptoms would be more common in this patient’s age group for an acute yocardial infarction?

 

a.

Pain radiating into the left arm

 

b.

Syncope

 

c.

Chest pain

 

d.

Pain radiating into the jaw

Question 42

Correct

1.00 points out of 1.00

 Flag question

Question text

For which of the following patients would a complete health history be appropriate?

 

a.

An established patient with the chief concern of “I’m here for my follow up visit”.

 

b.

A new patient with the chief concern of “I fell and now I can’t move my right arm”.

 

c.

A new patient with the chief concern of “I just moved here & need to establish care”.

 

d.

An established patient with the chief concern of “I’ve had a cough for 5 days now”

Question 43

Correct

1.00 points out of 1.00

 Flag question

Question text

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?

 

a.

Pityriasis rosea

 

b.

Tinea infection

 

c.

Psoriasis

 

d.

Eczema

Question 44

Incorrect

0.00 points out of 1.00

 Flag question

Question text

Which of the following statements is true about the vision of a newborn?

 

a.

Peripheral vision is fully developed at birth.

 

b.

The newborn infant can differentiate colors.

 

c.

Central vision is fully developed at birth.

 

d.

The lacrimal gland produces a full volume of tears at birth.

Question 45

Correct

1.00 points out of 1.00

 Flag question

Question text

Which statement is true about heart murmurs found in the newborn infant?

 

a.

A murmur heard two or three days after birth is apt to be less significant than one heard immediately at birth.

 

b.

A murmur that occupies diastole only does not need investigation.

 

c.

A murmur heard immediately at birth is apt to be less significant than one heard two or three days after birth.

 

d.

A murmur noted with 48 hours of birth is usually pathologic.

Question 46

Correct

1.00 points out of 1.00

 Flag question

Question text

Which of the following events occurs at the start of diastole?

 

a.

Production of the first heart sound (S1)

 

b.

Closure of the tricuspid valve

 

c.

Closure of the aortic valve

 

d.

Opening of the pulmonic valve

Question 47

Incorrect

0.00 points out of 1.00

 Flag question

Question text

You work in an urgent care center. A 45-year-old patient visits the clinic with a history of a wasp sting on the upper thigh about 3 days ago. The patient indicates severe pain and swelling began yesterday and you notice the area is red, hot, and tender to touch with some streaking. The most likely diagnosis for this patient is:

 

a.

Tinea

 

b.

Folliculitis

 

c.

Cellulitis

 

d.

Furuncle

Question 48

Not answered

Points out of 1.00

 Flag question

Question text

Jim is a 60-yr-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

 

a.

Bleeding from a peptic ulcer

 

b.

Bleeding from cholecystitis

 

c.

Bleeding from a colon cancer

 

d.

Bleeding from a diverticulum

Question 49

Not answered

Points out of 1.00

 Flag question

Question text

You’re assessing a newborn infant. As you inspect the infant’s hands, you notice a single transverse crease on the palms. You suspect:

 

a.

The infant may have neurofibromatosis.

 

b.

The infant may have spina bifida occulta.

 

c.

The infant may have Down syndrome.

 

d.

The infant may have a neural tube defect.

Question 50

Not answered

Points out of 1.00

 Flag question

Question text

A 27-yr-old patient visits the clinic with a report of fever, productive cough, weight loss, and night sweats for the past week or so. You notice the patient coughs frequently during the visit and note some blood tinged sputum is produced with the coughing. As you complete a health history, which of the following questions would be a priority?

 

a.

When did you begin to notice blood in the sputum?

 

b.

How many pounds have you lost?

 

c.

How high has your fever been?

 

d.

Have you recently traveled overseas?

 

Explanation & Answer

Our website has a team of professional writers who can help you write any of your homework. They will write your papers from scratch. We also have a team of editors just to make sure all papers are of HIGH QUALITY & PLAGIARISM FREE. To make an Order you only need to click Order Now and we will direct you to our Order Page at Litessays. Then fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.