NGS6420 week 10 final exam guide

1. Question
: 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?

: Moist and smooth

Moist and rough

Dry and smooth

Dry and rough

Points Received: 1 of 1

Comments:

Question 2. Question
: You are assessing a patient
with joint pain and are trying to decide whether it is inflammatory or
noninflammatory in nature. Which one of the following symptoms is consistent
with an inflammatory process?

:
Tenderness

Cool temperature

Ecchymosis

Nodules

Points Received: 1 of 1

Comments:

Question 3. Question
: 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?

:
Actinic keratosis

Seborrheic keratosis

Basal cell carcinoma

Squamous cell carcinoma

Points Received: 0 of 1

Comments:

Question 4. Question
: A 28-year-old graduate student
comes to your clinic for evaluation of pain “all over.” With further
questioning, she is able to relate that the pain is worse in the neck,
shoulders, hands, low back, and knees. She denies swelling in her joints. She
states that the pain is worse in the morning. There is no limitation in her
range of motion. On physical examination, she has several points on the muscles
of the neck, shoulders, and back that are tender to palpation. Muscle strength
and range of motion are normal. Which one of the following is likely the cause
of her pain?

: Rheumatoid arthritis

Osteoarthritis

Fibromyalgia

Polymyalgia rheumatica

Points Received: 1 of 1

Comments:

Question 5. Question
: Heberden’s nodes are commonly
found in which one of the following diseases?

: Rheumatoid arthritis

Degenerative joint disease

Psoriatic arthritis

Septic arthritis

Points Received: 1 of 1

Comments:

Question 6. Question
: A new patient is complaining
of severe pruritus that is worse at night. Several family members also have the
same symptoms. Upon examination, areas of excoriated papules are noted on some
of the interdigital webs of both hands and on the axillae. This finding is most
consistent with:

: Contact dermatitis

Impetigo

Larva migrans

Scabies

Points Received: 1 of 1

Comments:

Question 7. Question
: An obese 55-year-old woman
went through menarche at age 16 and menopause 2 years ago. She is concerned
because an aunt had severe osteoporosis. Which one of the following is a risk
factor for osteoporosis?

: Obesity

Late menopause

Having an aunt with osteoporosis

Delayed menarche

Points Received: 0 of 1

Comments:

Question 8. Question
: Ms. Whiting is a 68-year-old
female 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?

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

Wait for her to mention them before asking
further questions.

Ask how she acquired them.

Conduct the visit as usual for the patient.

Points Received: 1 of 1

Comments:

Question 9. Question
: A 58-year-old man comes to
your office complaining of bilateral back pain that now awakens him at night.
This has been steadily increasing for the past 2 months. Which one of the
following is the most reassuring in this patient with back pain?

: Age over 50

Pain at night

Pain lasting more than 1 month or not
responding to therapy

Pain that is bilateral

Points Received: 1 of 1

Comments:

Question 10. Question
: The Phalen’s test is used to
evaluate:

:
Inflammation of the median nerve

Rheumatoid arthritis

Degenerative joint changes

Chronic tenosynovitis

1. Question
: Which of the following would
lead you to suspect a hydrocele versus other causes of scrotal swelling?

: The presence of bowel sounds in the scrotum

Being unable to palpate superior to the mass

A positive transillumination test

Normal thickness of the skin of the scrotum

Comments:

Question 2. Question
: You are examining a newborn
and note that the right testicle is not in the scrotum. What should you do
next?

: Refer to urology

Recheck in six months

Tell the parent the testicle is absent but
that this should not affect fertility

Attempt to bring down the testis from the
inguinal canal

Comments:

Question 3. Question
: A 50-year-old truck driver
comes to your clinic for a work physical. He has had no upper respiratory,
cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system
complaints. His past medical history 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 six beers a week, and denies using any illegal drugs. His mother has
high blood pressure and arthritis and his father died of lung cancer in his
sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His
cardiac, lung, and abdominal examinations are normal. He has no inguinal
hernia, but on his digital rectal examination you palpate a soft, smooth, and
nontender pedunculated mass on the posterior wall of the rectum. What anal,
rectal, or prostate disorder best fits his presentation?

: Internal hemorrhoid

Prostate cancer

Anorectal cancer

Rectal polyp

Comments:

Question 4. Question
: A 15-year-old high school
football player is brought to your office by his mother. He is complaining of
severe testicular pain since exactly 8:00 this morning. He denies any sexual
activity and states that he hurts so bad he can’t even urinate. He is nauseated
and is throwing up. He denies any recent illness or fever. His past medical
history is unremarkable. He denies any tobacco, alcohol, or drug use. His
parents are both in good health. On examination, you see a young teenager lying
on the bed with an emesis basin. He is very uncomfortable and keeps shifting
his position. His blood pressure is 150/100, his pulse is 110, and his
respirations are 24. On visualization of the penis, he is circumcised and there
are no lesions and no discharge from the meatus. His scrotal skin is tense and
red. Palpation of the left testicle causes severe pain and the patient begins
to cry. His prostate examination is unremarkable. His cremasteric reflex is
absent on the left but is normal on the right. By catheter you get a urine
sample and the analysis is unremarkable. You send the boy with his mother to
the emergency room for further workup.

: Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Comments:

Question 5. Question
: Which is true of prostate
cancer?

: It is commonly lethal.

It is one of the less common forms of cancer.

Family history does not appear to be a risk
factor.

Ethnicity is a risk factor.

Comments:

Question 6. Question
: Which of the following
conditions involves a tight prepuce which, once retracted, cannot be returned?

: Phimosis

Paraphimosis

Balanitis

Balanoposthitis

Comments:

Question 7. Question
: A 12-year-old is brought to
your clinic by his father. He was taught in his health class at school to do
monthly testicular self-examinations. Yesterday, when he felt his left
testicle, it was enlarged and tender. He isn’t sure if he has had burning with
urination and he says he has never had sexual intercourse. He has had a sore
throat, cough, and runny nose for the last three days. His past medical history
is significant for a tonsillectomy as a small child. His father has high blood
pressure and his mother is healthy. On examination, you see a child in no acute
distress. His temperature is 100.8 and his blood pressure and pulse are
unremarkable. On visualization of his penis, he is uncircumcised and has no
lesions or discharge. His scrotum is red and tense on the left and normal
appearing on the right. Palpating his left testicle reveals a mildly sore
swollen testicle. The right testicle is unremarkable. An examining finger is
put through both inguinal rings, and there are no bulges with bearing down. His
prostate examination is unremarkable. Urine analysis is also unremarkable.

What abnormality of the testes does this child most likely
have?

: Acute orchitis

Acute epididymitis

Torsion of the spermatic cord

Prostatitis

Comments:

Question 8. Question
: The most common cause of
cancer deaths in males is:

: Lung cancer

Prostate cancer

Colon cancer

Skin cancer

Comments:

Question 9. Question
: Important techniques in
performing the rectal examination include which of the following?

: Lubrication

Waiting for the sphincter to relax

Explaining what the patient should expect
with each step before it occurs

All of the above

Comments:

Question 10. Question
: Jim is a 47-year-old man who
is having difficulties with sexual function. He is recently separated from his
wife of 20 years. He notes that he has early morning erections but otherwise
cannot function. Which of the following is a likely cause for his problem?

: Decreased testosterone levels

Psychological issues

Abnormal hypogastric arterial circulation

Impaired neural innervation

Question : Which
of the following is true of human papilloma virus (HPV) infection?

: Pap smear is a relatively ineffective
screening method.

It commonly resolves spontaneously in one to
two years.

It is the second most common STI in the
United States.

HPV infections cause a small but important
number of cervical cancers.

Points Received: 1 of 1

Comments:

Question 2. Question
: Which of the following is the
most effective pattern of palpation for breast cancer?

:
Beginning at the nipple, make an
ever-enlarging spiral.

Divide the breast into quadrants and inspect
each systematically.

Examine in lines resembling the back and
forth pattern of mowing a lawn.

Beginning at the nipple, palpate vertically
in a stripe pattern.

Points Received: 0 of 1

Comments:

Question 3. Question
: A 14-year-old junior high
school student is brought in by his mother and father because he seems to be
developing breasts. The mother is upset because she read on the Internet that
smoking marijuana leads to breast enlargement in males. The young man adamantly
denies using any tobacco, alcohol, or drugs. He has recently noticed changes in
his penis, testicles, and pubic hair pattern. Otherwise, his past medical
history is unremarkable. His parents are both in good health. He has two older
brothers who never had this problem. On examination, you see a mildly
overweight teenager with enlarged breast tissue that is slightly tender on both
sides. Otherwise, his examination is normal. He is agreeable to taking a drug
test. What is the most likely cause of his gynecomastia?

: Breast cancer

Imbalance of hormones of puberty

Drug use

Points Received: 1 of 1

Comments:

Question 4. Question
: Which of the following
represents metrorrhagia?

: Fewer than 21 days between menses

Excessive flow

Infrequent bleeding

Bleeding between periods

Points Received: 1 of 1

Comments:

Question 5. Question
: What does a KOH (potassium
hydroxide) prep help the nurse practitioner diagnose?

: Herpes zoster infections

Yeast infections

Herpes simplex infections

Viral infections

Points Received: 1 of 1

Comments:

Question 6. Question
: Abby is a newly married woman
who is unable to have intercourse because of vaginismus. Which of the following
is true?

: This is most likely due to lack of
lubrication.

This is most likely due to atrophic
vaginitis.

This is most likely due to pressure on an
ovary.

Psychosocial reasons may cause this
condition.

Points Received: 1 of 1

Comments:

Question 7. Question
: A 30-year-old man notices a
firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of
breast cancer in his first-degree relatives. What is the most likely diagnosis?

:
Breast tissue

Fibrocystic disease

Breast cancer

Lymph node

Points Received: 0 of 1

Comments:

Question 8. Question
: Which of the following is true
regarding breast self-examination?

: It has been shown to reduce mortality from
breast cancer.

It is recommended unanimously by
organizations making screening recommendations.

A high proportion of breast masses are
detected by breast self-examination.

The undue fear caused by finding a mass
justifies omitting instruction in breast self-examination.

Points Received: 0 of 1

Comments:

Question 9. Question
: A 23-year-old computer
programmer comes to your office for an annual examination. She has recently
become sexually active and wants to be placed on birth control. Her only
complaint is that the skin in her armpits has become darker. She states it
looks like dirt, and she scrubs her skin nightly with soap and water but the
color stays. Her past medical symptoms consist of acne and mild obesity. Her
periods have been irregular for 3 years. Her mother has type 2 diabetes, and
her father has high blood pressure. The patient denies using tobacco but has
four to five drinks on Friday and Saturday nights. She denies any illegal drug
use. On examination, you see a mildly obese female who is breathing
comfortably. Her vital signs are unremarkable. Looking under her axilla, you
see dark, velvet-like skin. Her annual examination is otherwise unremarkable.

What disorder of the breast or axilla is she most likely to
have?

: Peau d’orange

Acanthosis nigricans

Hidradenitis suppurativa

Points Received: 1 of 1

Comments:

Question 10. Question
: Which of the following is true
of women who have had a unilateral mastectomy?

: They no longer require breast examination.

They should be examined carefully along the
surgical scar for masses.

Lymphedema of the ipsilateral arm usually
suggests recurrence of breast cancer.

Women with breast reconstruction over their
mastectomy site no longer require examination.

Question : A
76-year-old retired farmer comes to your office complaining of abdominal pain,
constipation, and a low-grade fever for about three days. He denies any nausea,
vomiting, or diarrhea. The only unusual thing he remembers eating is two bags
of popcorn at the movies with his grandson, three days before his symptoms
began. He denies any other recent illnesses. His past medical history is
significant for coronary artery disease and high blood pressure. He has been
married for over fifty years. He denies any tobacco, alcohol, or drug use. His
mother died of colon cancer and his father had a stroke. On examination, he
appears his stated age and is in no acute distress. His temperature is 100.9
degrees and his other vital signs are unremarkable. His head, cardiac, and
pulmonary examinations are normal. He has normal bowel sounds and is tender
over the left lower quadrant. He has no rebound or guarding. His rectal
examination is unremarkable and his fecal occult blood test is negative. His
prostate is slightly enlarged but his testicular, penile, and inguinal
examinations are all normal. Blood work is pending.

What diagnosis for abdominal pain best describes his
symptoms and signs?

:
Acute diverticulitis

Acute cholecystitis

Acute appendicitis

Mesenteric ischemia

Points Received: 1 of 1

Comments:

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

: Bleeding from a diverticulum

Bleeding from a peptic ulcer

Bleeding from a colon cancer

Bleeding from cholecystitis

Points Received: 1 of 1

Comments:

Question 3. Question
: A 26-year-old sports store
manager comes to your clinic, complaining of severe right-sided abdominal pain
for twelve hours. He began having a stomachache yesterday, with a decreased
appetite, but today the pain seems to be just on the lower right side. He has
had some nausea and vomiting but no constipation or diarrhea. His last bowel
movement was the night before and was normal. He has had no fever or chills. He
denies any recent illnesses or injuries. His past medical history is unremarkable.
He is engaged. He denies any tobacco or drug use and drinks four to six beers
per week. His mother has breast cancer and his father has coronary artery
disease. On examination, he appears ill and is lying on his right side. His
temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are
decreased and he has rebound and involuntary guarding, one-third of the way
between the anterior superior iliac spine and the umbilicus in the right lower
quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular
examinations are normal.

What is the most likely cause of his pain?

:
Acute appendicitis

Acute mechanical intestinal obstruction

Acute cholecystitis

Mesenteric ischemia

Points Received: 1 of 1

Comments:

Question 4. Question
: Josh is a 14-year-old boy who
presents with a sore throat. On examination, you notice dullness in the last
intercostal space in the anterior axillary line on his left side with a deep
breath. What does this indicate?

: His spleen is definitely enlarged and further
workup is warranted.

His spleen is possibly enlarged and close
attention should be paid to further examination.

His spleen is possibly enlarged and further
workup is warranted.

His spleen is definitely normal.

Points Received: 0 of 1

Comments:

Question 5. Question
: Diminished radial pulses may
be seen in patients with which of the following?

: Aortic insufficiency

Hyperthyroidism

Arterial emboli

Early “warm” septic shock

Points Received: 0 of 1

Comments:

Question 6. Question
: A 42-year-old florist comes to
your office, complaining of chronic constipation for the last six months. She
has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping.
She denies any recent illnesses or injuries. She denies any changes to her diet
or exercise program. She is on no new medications. During the review of systems
(ROS), you note that she has felt fatigued, had some weight gain, has irregular
periods, and has cold intolerance. Her past medical history is significant for
one vaginal delivery and two cesarean sections. She is married, has three
children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her
mother has type 2 diabetes and her father has coronary artery disease. There is
no family history of cancers. On examination, she appears her stated age. Her
vital signs are normal. Her head, eyes, ears, nose, throat, and neck
examinations are normal. Her cardiac, lung, and abdominal examinations are also
unremarkable. Her rectal occult blood test is negative. Her deep tendon
reflexes are delayed in response to a blow with the hammer, especially the
Achilles tendons.

What is the best choice for the cause of her constipation?

: Large bowel obstruction

Irritable bowel syndrome

Rectal cancer

Hypothyroidism

Points Received: 1 of 1

Comments:

Question 7. Question
: 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 sixteen, but 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?

:
Intermittent claudication

Chest pressure with exertion

Shortness of breath

Knee pain

Points Received: 1 of 1

Comments:

Question 8. Question
: You are assessing a
59-year-old gas station owner for atherosclerosis in the lower extremities. In
which of the following locations would the patient’s pain make you concerned
for this disease process?

: Thigh

Knee

Calf

Ankle

Points Received: 1 of 1

Comments:

Question 9. Question
: A 55-year-old secretary with a
recent history of breast cancer, for which she underwent surgery and radiation
therapy, and a history of hypertension comes to your office for a routine
checkup. Which of the following aspects of the physical are important to note
when assessing the patient for peripheral vascular disease in the arms?

: Femoral pulse, popliteal pulse

Dorsalis pedis pulse, posterior tibial pulse

Carotid pulse

Radial pulse, brachial pulse

Points Received: 1 of 1

Comments:

Question 10. Question
: Cody is a teenager with a
history of leukemia and an enlarged spleen. Today he presents with fairly
significant left upper quadrant (LUQ) pain. On examination of this area, a rough
grating noise is heard. What is this sound?

:
It is a splenic rub.

It is a variant of bowel noise.

It represents borborygmi.

It is a vascular noise.

Question : A
30-year-old woman with a history of mitral valve problems states that she has
been “very tired.” She has started waking up at night and feels like her “heart
is pounding.” During the assessment, the nurse practitioner palpates a thrill
and lift at the fifth left intercostal space midclavicular line. In the same
area the nurse practitioner also auscultates a blowing, swishing sound right
after S1. These findings would be most consistent with:

: heart failure.

aortic stenosis.

pulmonary edema.

mitral regurgitation.

Instructor Explanation: Mitral regurgitation subjective findings
include fatigue, palpitation, and orthopnea. Objective findings are (1) a
thrill in systole at apex, (2) lift at apex, (3) apical impulse displaced down
and to the left, (4) S1 diminished, S2 accentuated, S3 at apex often present,
and (5) murmur: pansystolic, often loud, blowing, best heard at apex, radiating
well to the left axilla.

Points Received: 4 of 4

Comments:

Question 2. Question
: A patient presents with
excruciating headache pain on one side of his head, especially around his eye,
forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice
each day. The nurse practitioner suspects:

: hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Instructor Explanation: Cluster headaches produce pain around the eye,
temple, forehead, and cheek and are unilateral and always on the same side of
the head. They are excruciating and occur once or twice per day and last 1/2 to
2 hours each.

Points Received: 4 of 4

Comments:

Question 3. Question
: A patient complains that while
studying for an examination he began to notice a severe headache in the
frontotemporal area of his head that is throbbing and is somewhat relieved when
he lies down. He tells the nurse practitioner that his mother also had these
headaches. The nurse practitioner suspects that he may be suffering from:

: hypertension.

cluster headaches.

tension headaches.

migraine headaches.

Instructor Explanation: Migraine headaches tend to be supraorbital,
retro-orbital, or frontotemporal with a throbbing quality. They are of a severe
quality and are relieved by lying down. Migraines are associated with family
history of migraine.

Points Received: 4 of 4

Comments:

Question 4. Question
: A patient tells the nurse
practitioner that he is very nervous, that he is nauseated, and that he “feels
hot.” This type of data would be:

: objective.

reflective.

subjective.

introspective

Instructor Explanation: Subjective data are what the person says about
himself or herself during history taking.

Points Received: 4 of 4

Comments:

Question 5. Question
: The most important reason to
share information and offer brief teaching while performing the physical
examination is to help:

: the examiner feel more comfortable and gain
control of the situation.

build rapport and increase the patient’s
confidence in the examiner.

the patient understand his or her disease
process and treatment modalities.

the patient identify questions about his or
her disease and potential areas of patient education.

Instructor Explanation: Sharing of information builds rapport and
increases the patient’s confidence in you as an examiner. It also gives the
patient a little more control in a situation in which it’s easy to feel
completely helpless.

Points Received: 4 of 4

Comments:

Question 6. Question
: A patient says that she has
recently noticed a lump in the front of her neck below her “Adam’s apple” that
seems to be getting bigger. During the assessment, the finding that reassures
the nurse practitioner that this may not be a cancerous thyroid nodule is that
the lump (nodule):

: is tender.

is mobile and not hard.

disappears when the patient smiles.

is hard and fixed to the surrounding
structures.

Instructor Explanation: Suspect any painless, rapidly growing nodule,
especially the appearance of a single nodule in a young person. Cancerous
nodules tend to be hard and are fixed to surrounding structures.

Points Received: 4 of 4

Comments:

Question 7. Question
: A patient visits the clinic
because he has recently noticed that the left side of his mouth is paralyzed.
He states that he cannot raise his eyebrow or whistle. The nurse practitioner
suspects that he has:

: Cushing’s syndrome.

Parkinson’s syndrome.

Bell’s palsy.

had a cerebrovascular accident (stroke).

Instructor Explanation: With an upper motor neuron lesion (as with
CVA) the patient will have paralysis of lower facial muscles, but the upper
half of the face is not affected owing to the intact nerve from the unaffected
hemisphere. The person is still able to wrinkle the forehead and close the
eyes.

Points Received: 4 of 4

Comments:

Question 8. Question
: The temporomandibular joint is
just below the temporal artery and anterior to the:

: hyoid.

vagus.

tragus.

mandible.

Instructor Explanation: The temporomandibular joint is just below the
temporal artery and anterior to the tragus.

Points Received: 4 of 4

Comments:

Question 9. Question
: During an examination of a
patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and
firm to the touch. During percussion, the nurse practitioner notes a drum-like
quality of the sound across the quadrants. This type of sound indicates:

: constipation.

air-filled areas.

the presence of a tumor.

the presence of dense organs.

Instructor Explanation: A musical or drum-like sound (tympany) is the
sound heard when percussion occurs over air-filled viscus, such as the stomach
or intestines.

Points Received: 4 of 4

Comments:

Question 10. Question
: A patient tells the nurse that
he is allergic to penicillin. What would be the nurse practitioner’s best
response to this information?

: “Are you allergic to any other drugs?”

“How often have you received penicillin?”

“I’ll write your allergy on your chart so you
won’t receive any.”

“Please describe what happens to you when you
take penicillin.”

Instructor Explanation: Note both the allergen (medication, food, or
contact agent, such as fabric or environmental agent) and the reaction (rash,
itching, runny nose, watery eyes, difficulty breathing). With a drug, this
symptom should not be a side effect but a true allergic reaction.

Points Received: 4 of 4

Comments:

Question 11. Question
: A patient’s thyroid is
enlarged, and the nurse practitioner is preparing to auscultate the thyroid for
the presence of a bruit. A bruit is a:

: low gurgling sound best heard with the
diaphragm of the stethoscope.

loud, whooshing, blowing sound best heard
with the bell of the stethoscope.

soft, whooshing, pulsatile sound best heard
with the bell of the stethoscope.

high-pitched tinkling sound best heard with
the diaphragm of the stethoscope.

Instructor Explanation: If the thyroid gland is enlarged, auscultate
it for the presence of a bruit, which is a soft, pulsatile, whooshing, blowing
sound heard best with the

Explanation & Answer

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