Walden NURS6512 Week 6 Exam

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Walden NURS6512 Week 6 Exam

NURS6512 Advanced Health Assessment and Diagnostic Reasoning

Week 6 Exam

Question 1You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:

Answers:

B. a multinodular goiter.

D. thyroiditis.

A. a congenital anomaly.

C. a normal thyroid gland.

Question 2Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?

Answers:

A. Coronal sutures

D. Nose and thyroid cartilages

C. Mandible and maxilla bones

B. Hyoid and cricoid cartilages

Question 3Peritonitis produces bowel sounds that are:

Answers:

hyperactive.

absent.

high pitched.

hypoactive.

Question 4When communicating with older children and teenagers, you should be sensitive to their:

Answers:

desire for adult companionship.

natural urge to communicate.

need for verbal instructions.

typical reluctance to talk.

Question 5The review of systems is a component of the:

Answers:

assessment.

physical examination.

health history.

past medical/surgical history.

Question 6You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:

Answers:

D. purpura.

A. telangiectasia.

B. spider angioma.

C. petechiae.

Question 7Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.

 

Answers:

a. Loss of high frequency

b. Progression is slow

c. Bone conduction heard longer than air conduction

d. Sounds may be garbled and difficult to localize

e. Results from cranial nerve VII

f. Unable to hear in a crowded room

Question 8A guideline for history taking is for caregivers to:

Answers:

write detailed information as stated by patients so that their priorities are reflected.

make notes sparingly so that patients can be observed during the history taking.

ask direct questions before open-ended questions so that data move from simple to complex.

ask for a complete history at once so that data are not forgotten between meetings.

Question 9Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a:

Answers:

A. parotid gland tumor.

B. branchial cleft cyst.

C. Stensen duct stone.

D. thyroglossal duct cyst.

Question 10A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

Answers:

use topical over-the-counter hemorrhoid treatment for 1 week.

eat six small meals a day.

come to the laboratory for a stool guaiac test.

exercise and eat more fiber.

Question 11

Which cranial nerves innervate the face?

Answers:

D. VIII and IX

B. III and VI

A. II and V

C. V and VII

Question 12Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at:

Answers:

D. C4 to C5.

B. C2 to C3.

C. C3 to C4.

A. C1 to C2.

Question 13Expected hair distribution changes in older adults include:

Answers:

increased terminal hair follicles on the scalp.

more prominent peripheral extremity hair production.

more prominent axillary and pubic hair production.

increased terminal hair follicles to the tragus of men’s ears.

Question 14The attitudes of the health care professional:

Answers:

do not influence patient behavior.

are culturally derived.

are largely irrelevant to the success of relationships with the patient.

are difficult for the patient to sense.

Question 15Which of the following is the most vital nutrient?

Answers:

Protein

Carbohydrate

Water

Fat

Question 16The recommended minimum daily protein requirement for the normal adult is ______.

Answer:

Evaluation Method          Answer  Case Sensitivity

Match  10% to 35% of total calories

Contains              10 to 35 percent

Pattern Match    It is recommended that protein content of the diet be 10% to 35% of total calories, or 46 g in adults.

Contains              10% to 35%

Question 17Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an):

Answers:

ethnic assessment.

functional assessment.

social history.

genetic examination.

Question 18When examining the skull of a 4-month-old baby, you should normally find:

Answers:

D. overlap of cranial bones.

A. closure of the anterior fontanel.

C. ossification of all sutures.

B. closure of the posterior fontanel.

Question 19Periods of silence during the interview can serve important purposes, such as:

Answers:

allowing the clinician to catch up on documentation.

increasing the length of the visit.

providing time for reflection.

promoting calmness.

Question 20After thorough inspection of the abdomen, the next assessment step is:

Answers:

palpation.

percussion.

rectal examination.

auscultation.

Question 21The term denoting the caregiver’s need to do no harm to the patient is:

Answers:

utilitarianism.

nonmaleficence.

beneficence.

autonomy.

Question 22When taking a history, you should:

Answers:

start the interview with the patient’s family history.

ask the patient to give you any information they can recall about their health.

use a chronologic and sequential framework.

use a holistic and eclectic structure.

Question 23The position on a clock, topographic notations, and anatomic landmarks:

Answers:

are used for noting disease progression.

are ways for recording laboratory study results.

should not be used in the legal record.

are methods for recording locations of findings.

Question 24Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:

Answers:

buzzing from bone conduction.

noise above the threshold level.

hearing range of normal speech.

buzzing or tingling sensations.

Question 25Which type of speculum should be used to examine a patient’s tympanic membrane?

Answers:

The largest speculum that will fit comfortably in the ear

The shortest speculum available

The smallest speculum that will illuminate the ear

Any speculum that will fit the otoscope head

Question 26A blood pressure cuff bladder should be long enough to:

Answers:

cover 75% to 80% of the arm circumference.

cover 45% to 50% of the arm circumference.

completely encircle the arm.

cover 20% to 25% of the arm circumference.

Question 27Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?

Answers:

Ascorbic acid

Folate

Fiber

Vitamin B12

Question 28Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight. In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient?

Answers:

Calcium

Iron

Thiamin

Fat

Question 29Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:

Answers:

D. seborrheic keratoses from actinic keratoses.

A. cutaneous tags from lentigines.

B. furuncles from folliculitis.

C. sebaceous hyperplasia from eczema.

Question 30A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the:

Answers:

maxillary sinuses only.

sphenoid sinuses only.

sphenoid and frontal sinuses.

maxillary and frontal sinuses.

Question 31Underestimation of blood pressure will occur if the blood pressure cuff’s width covers:

Answers:

more than 4 inches of the lower arm.

less than one-half of the upper arm.

less than 5 inches of the lower arm.

more than two-thirds of the upper arm.

Question 32A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she:

Answers:

binges and vomits.

is cold intolerant.

has constipation frequently.

has regular menstrual periods.

Question 33George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care?

Answers:

G. M., a 22-year-old male, states he has allergies and wants them checked.

G. M. came into the clinic complaining of green discharge for the past 72 hours.

G.M. is a 22-year-old male here for having “green nasal discharge” for the past 72 hours.

G. M. is a 22-year-old male here for “allergies.”

Question 34Which question would be considered a leading question?

Answers:

“You don’t get headaches often, do you?”

“At what time of the day are your headaches the most severe?”

“What do you think is causing your headaches?”

“On a scale of 1 to 10, how would you rate the severity of your headaches?”

Question 35Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the technique for locating the:

Answers:

medial border of the spleen.

upper right kidney ridge.

descending aorta.

lower liver border.

Question 36Unusual white areas on the skin may be due to:

Answers:

D. Down syndrome.

C. vitiligo.

B. polycythemia.

A. adrenal disease.

Question 37White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:

Answers:

leukoedema.

Stensen ducts.

Fordyce spots.

aphthous ulcers.

Question 38Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:

Answers:

stabilize the chest.

hold the speculum in the canal.

pull the auricle down and back.

distract the infant.

Question 39In issues surrounding ethical decision making, beneficence refers to the:

Answers:

care provider acting as a father or mother figure.

care provider knowing what is best for the patient.

need to do good for the patient.

need to avoid harming the patient.

Question 40Under normal circumstances, how much water is lost daily by the body?

Answers:

3 to 4 L

1 to 1.5 L

5 to 6 L

2 to 2.5 L

Question 41During percussion, a dull tone is expected to be heard over:

Answers:

emphysemic lungs.

most of the abdomen.

the liver.

healthy lung tissue.

Question 42Knowledge of the culture or cultures represented by the patient should be used to:

Answers:

form stereotypical categories.

help make the interview questions more pertinent.

draw conclusions regarding individual patient needs.

form a sense of the patient.

Question 43

A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly:

Answers:

lean meat and fish.

pasta and chicken.

sandwiches and diet drinks.

fruit and vegetables.

Question 44Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for:

Answers:

air conduction of sound.

bone versus air conduction.

lateralization of sound.

mallear auditory ability.

Question 45Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of his history?

Answers:

Social history

Age-specific data

Past medical data

Past surgical data

Question 46You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:

Answers:

amblyopia.

strabismus.

myopia.

astigmatism.

Question 47Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.

Answers:

personal and social

present problem

family

past medical

Question 48Your 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?

Answers:

Rebound tenderness

Positive McBurney sign

Consistent right lower quadrant (RLQ pain)

Positive psoas sign

Question 49The examiner’s evaluation of a patient’s mental status belongs in the:

Answers:

physical examination.

patient education.

history of present illness.

review of systems.

Question 50Before performing an abdominal examination, the examiner should:

Answers:

don double gloves.

ascertain the patient’s HIV status.

completely disrobe the patient.

have the patient empty his or her bladder.

Question 51To perform the Rinne test, place the tuning fork on the:

Answers:

forehead.

preauricular area.

mastoid bone.

top of the head.

Question 52Which is the best way to position a patient’s neck for palpation of the thyroid?

Answers:

A. Flexed away from the side being examined

C. Flexed toward the side being examined

B. Flexed directly forward

D. Hyperextended directly backward

Question 53Inspection of the abdomen should begin with the patient supine and the examiner:

Answers:

standing at the patient’s left.

standing at the foot of the table.

seated on the patient’s right.

walking around the table.

Question 54Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first?

Answers:

Light palpation

Deep palpation

Inspection

Percussion

Question 55During an interview, you have the impression that a patient may be considering suicide. Which action is essential?

Answers:

Avoid directly confronting the patient regarding your impression.

Record the impression in the patient’s chart and refer the patient for hospitalization.

Ask whether the patient would like to visit a psychiatrist.

Ask whether the patient has considered self-harm.

Question 56Recommended carbohydrate content of total dietary intake (% total calories) is ____%.

Answer:

Evaluation Method          Answer  Case Sensitivity

Contains              45-65

Pattern Match    Forty five to sixty five percent of total calories intake should be from carbohydrates.

Contains              Forty five to sixty five

Question 57As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to:

Answers:

tell him that it is all right to be angry.

ask whether he has any questions.

tell him that you understand his need to be alone.

ask whether he would prefer to speak to the clinician.

Question 58You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

Answers:

hold his or her breath.

flex his or her knees.

sit upright.

raise his or her head off the pillow.

Question 59Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

Answers:

Referral note

Comprehensive health history

Brief SOAP note

Progress note

Question 60Differential diagnoses belong in the:

Answers:

physical examination.

assessment.

plan.

history.

Question 61Which of the following organs is part of the alimentary tract?

Answers:

Stomach

Pancreas

Liver

Gallbladder

Question 62When assessing abdominal pain in a college-age woman, one must include:

Answers:

food likes and dislikes.

age at completion of toilet training.

history of interstate travel.

the first day of the last menstrual period.

Question 63The infant should be placed in which position to have his or her height or length measured?

Answers:

Supine on a measuring board

Prone on a measuring board

Vertical, with the examiner’s hands under the infant’s axilla

In the lateral position with the toes against a measuring board

Question 64In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for:

Answers:

glycogen storage in the liver.

building and maintaining tissues.

normal growth and development.

myocardial cell function.

Question 65Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?

Answers:

“We don’t know yet if your father has another kidney stone, so we must analyze this one.”

“We cannot let him keep his stone because it violates our infection control policy.”

“The stone must be sent to the lab for examination and therefore cannot be kept.”

“With your father’s permission, we will examine the stone and request that it be returned to him.”

Question 66Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?

Answers:

Vitamin D

Vitamin  K

Vitamin E

Vitamin A

Question 67Tangential lighting is best used for inspecting skin:

Selected Answer:

Answers:

color.

exudates.

symmetry.

contour.

Question 68When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?

Answers:

“What amount and what kind of alcohol do you drink in a week?”

“Do the other people in your household consume alcohol?”

“If you only drink socially, you won t need to worry about always having a designated driver.”

“I’m glad that you are a responsible drinker.”

Question 69Coarse, dry, and brittle hair is associated with which metabolic disorder?

Answers:

Cushing syndrome

Hypothyroidism

Diabetes mellitus

Addison disease

Question 70A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask?

Answers:

We will be able to communicate better if you will look at me.

Does your religion make it hard for you to answer my questions?

Are you uncomfortable talking with me?

It s hard for me to gather useful information because your answers are so short.

Question 71Mr. 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:

Answers:

review of systems.

personal and social history.

past medical history.

chief complaint.

Question 72Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication?

Answers:

I’d like to hear more about your experiences. Where were you born?

After 3 days, you’re tired of coughing. Have you had a fever?

I don’t know what’s wrong. You could have almost any disease.

I’ll examine you and figure out later what the problem is.

Question 73A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:

Answers:

hilum.

periosteum.

peritoneum.

mediastinum.

Question 74Sweat glands, hair, and nails are all formed from:

Answers:

D. papillae that penetrate the epidermis.

A. basement membranes under cellular strata.

C. invaginations of epidermis into dermis.

B. closely packed squamous cells.

Question 75Which statement is true regarding the relationship of physical characteristics and culture?

Answers:

To be a member of a specific culture, an individual must have certain identifiable physical characteristics.

Gender and race are the two essential physical characteristics used to identify cultural groups.

Physical characteristics should be used to identify members of cultural groups.

There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics.

Question 76You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish:

Answers:

D. herpes zoster from varicella.

A. vascular from nonvascular lesions.

B. furuncles from folliculitis lesions.

C. fluid-filled from solid cysts or masses.

Question 77Nuchal rigidity is most commonly associated with:

Answers:

D. cranial nerve V damage.

B. meningeal irritation.

A. thyroiditis.

C. Down syndrome.

Question 78When palpating the abdomen, you should note whether the liver is enlarged in the:

Answers:

midepigastric region.

periumbilical area.

left lower quadrant.

right upper quadrant.

Question 79Fluorescing lesions are best distinguished using a(n):

Answers:

incandescent lamp.

transilluminator.

magnifying glass.

Wood’s lamp.

Question 80Which of the following is an “ABCD” characteristic of malignant melanoma?

Answers:

Asymmetric borders

Borders well demarcated

Color of lesion is uniform

Diameter less than 6 mm

Question 81What finding is unique to the documentation of a physical examination of an infant?

Answers:

Thyroid position

Prostate size

Liver span

Fontanel sizes

Question 82Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

Answers:

ask a colleague from the same geographic area if this examination is acceptable.

refer the patient to a provider more knowledgeable about cultural differences.

forego the examination for fear of violating cultural norms.

inform the patient of the reason for the examination and ask if it is acceptable to him.

Question 83Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator?

Answers:

Race

Norm

Ritual

Rite

Question 84Small, minute bruises are called:

Answers:

ecchymoses.

spider veins.

petechiae.

telangiectasias.

Question 85When recording physical findings, which data are recorded first for all systems?

Answers:

Palpation

Inspection

Auscultation

Percussion

Question 86Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4′ 3-cm, rough, elevated area of psoriasis. This is an example of a:

Answers:

B. patch.

D. papule.

A. plaque.

C. macule.

Question 87Tympanic thermometers measure body temperature when a probe is placed:

Answers:

under the ear.

in the auditory canal.

posterior to the ear.

anterior to the ear.

Question 88When assessing abdominal pain in a college-age woman, one must include:

Answers:

history of interstate travel.

the first day of the last menstrual period.

age at completion of toilet training.

food likes and dislikes.

Question 89During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:

Answers:

offer a tissue and let him know it is all right to cry.

explain to the patient that you will be able to help him more if he can control his emotions.

ask him if he would like some time alone.

ask the patient what he is upset about.

Question 90Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain?

Answers:

Steroids

Laxatives

Diuretics

Oral hypoglycemics

 

Question 91To correctly document absent bowel sounds, one must listen continuously for:

Answers:

30 seconds.

1 minute.

3 minutes.

5 minutes.

Question 92A detailed description of the symptoms related to the chief complaint is presented in the:

Answers:

differential diagnosis.

history of present illness.

assessment.

general patient information section.

Question 93When are open-ended questions generally most useful?

Answers:

After several close-ended questions have been asked

During the initial part of the interview

During the review of systems

While designing the genogram

Question 94Expected normal percussion tones include:

Answers:

tympany over an empty stomach.

dullness over the lungs.

hyperresonance over the lungs.

flatness over an empty stomach.

Question 95Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?

Answers:

Most sounds are occluded.

Assessment findings are more accurate.

It transmits low-pitched sounds.

It functionally converts to a diaphragm end-piece.

Question 96

Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating a(n):

Answers:

problem-oriented medical record.

accident report.

triage note.

progress note.

Question 97

Before performing an abdominal examination, the examiner should:

Answers:

have the patient empty his or her bladder.

ascertain the patient’s HIV status.

completely disrobe the patient.

don double gloves.

Question 98Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process?

Answers:

Light palpation

Deep palpation

Auscultation

Percussion

Question 99

When hearing is evaluated, which cranial nerve is being tested?

Answers:

XII

III

VIII

IV

Question 100

Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:

Answers:

PACES assessment.

Glasgow Coma Scale.

Miller Analogies Test.

CAGE questionnaire.

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