NR 509 Midterm Exam / NR509 Midterm Exam: Advanced Physical Assessment: Chamberlain College of Nursing (Verified Correct Answers) While obtaining a history of a 3 month old infant from the mother the FNP asks abo ut the infants’ ability to suck and grass the mothers’ finger. What is the FNP assessing? CORRECT ANSWER: Reflexes A 23 -year -old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. What should the PA do to minimize their mutual discomfort? a. Adjust lighting so it is tangential to the patient's body. b. Explain how the examination will proceed. c. Ask the patient where he comes from. d. Explain that she is a PA student. e. Provide ongoing interpretation of findings. CORRECT ANSWER: b. Explain how the examination will proceed. A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the girl complains: CORRECT ANSWER: Of sharp pain that increases with movement A patient has been diagnosed with osteoporosis and asked the FNP "what is osteoporosis?" The FNP explains to the patient that osteoporosis is defined as: CORRECT ANSWER: Loss of b one density A 34 -year -old male with a history of complex social and medical needs (including current substance abuse) presents to a primary care teaching clinic. The patient has experienced a number of adversarial relationships with prior clinicians, including voluntarily leaving two practices within the previous year and being asked to leave care at a third clinic due to misbehavior. The attending physician desires to utilize the approaches to this patient that are most likely lead to comprehensive care and patient compliance. Which of the following is the most appropriate interview style for the attending physician to use? a. Focusing on the need for immediate diagnostic certainty over person al connection b. Taking charge of the interaction to meet the clinician's desire to acquire diagnostic information c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests d. Deferring respect, empathy, CORRECT ANSWER: c. Following the patient's lead to understand their thoughts, ideas, concerns, and requests Patient states, "I can hear a crunching or grating sound when I kneel". She also states "that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints". The FNP should assess for signs of what problem? CORRECT ANSWER: Crepitation When taking the history on a patient with a seizure disorder the FNP assesses whether the patient has an aura. Which of these would be the best question for obtaining this information? CORRECT ANSWER: Do you have any warning sign before you receive your starts? The FNP is teaching a class on osteoporosis prevention to a group of post menopausa l women. A participant shows that she needs more instruction when she states I will: CORRECT ANSWER: "Start swimming to increase my weight bearing exercise" The FNP is performing a neurological assessment on a 41 -year -old woman with a history of diabete s. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patella. Given this information what would the FNP suspect? CORRECT ANSWER: Peripheral neuropathy And 80 -year -old woman is visiting the clinic for a check up. She states "I can't walk as much as I used to". The FNP is observing from motor dysfunction in her hip and should have her: CORRECT ANSWER: Abduct her hip while she is lying on her back The FNP is testing the function of cranial nerve XI. Which of these best describes the response the FNP should expect if the nerve is intact? The patient : CORRECT ANSWER: Moves the head and shoulders against resistance with equal strength A 50 -year -old woman is in a clinic for weakness in her left arm and leg that she noticed for the past week. The FNP should perform which type of neurologic examination? CORRECT ANSWER: Complete neurologic examination Duri ng the neurological assessment of a healthy 35 -year -old patient the FNP asks him to relax his muscles completely. The FNP then moves each extremity through full range of motion. Which of these results would the FNP expect to find? CORRECT ANSWER: Mild, ev en resistance to movement A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The FNP tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This sh ift and posture is known as: CORREC T ANSWER: Lordosis A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasm's. The FNP should suspect: CORRECT ANSWER: Rotator cuff lesions A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will assess for tenderness at the: CORRECT ANSWER: Medial and lat eral epicondyle The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalens test. To perform this task the FNP should instruct the patient to: CORRECT ANSWER: Hold both hands back to back while flexing the wrists 90° for 60 seconds During the history a patient tells the FNP that "it feels like the room is spinning around me". The FNP would document this as: CORRECT ANSWER: Vertigo The assessment of a 60 -year -old patient has taken longer than anticipated. In testing his pa in perception the FNP decides to complete the test as quickly as possible. When the FNP applies the sharp point of a pin on his arm several times he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this? CORRECT ANSWER: This is most likely the result of the summation effect An 85 -year -old patient comments during his annual physical that "he seems to be getting shorter as he ages". The FNP should explain that decrease height occurs with aging because : CORRECT ANSWER: Of the shortening of the vertebral column A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The F NP should assess for other signs of what problem? CORRECT ANSWER: Rheumatoid arthritis When the FNP asks a 68 -year -old patient to stand with feet together and arms at his side with his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this finding as: CORRECT ANSWER: Positive Romberg sign During an assessment of the cranial nerves the FNP finds the following asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air when the FNP presses against the right path cheek. This would indicate dysfunction of which of these cranial nerves? CORRECT ANSWER: Motor component of VII The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group? CORRECT ANSWER: Taking calcium and vitamin D supplements In obtaining a history on a 74 year old patient the FNP notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold thing. With this information what should the FNP's response be? CORRECT ANSWER: Does the tremor change when you drink the alcohol? During a history of a 78 -year -old man his wife states that "he occasionally has problems with short -term memory loss and confusion. He can't even remember how to button his shirt". In doing the assessment of his sensory system wh ich action of the FNP's is most appropriate? CORRECT ANSWER: Before testing, the FNP would assess the patient's mental status and ability to follow directions at this time The FNP is doing an assessment on a 29 -year -old woman who visits the clinic complaining of always dropping things and falling down. While tes ting rapid alternating movements the FNP notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What should the FNP suspect? CORRECT ANSWER: Dysfunction of the cerebellum A mother brings her two mont h old daughter in for an examination says "my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?" The FNP's best response would be: CORRECT ANSWER: " That sof t spot is normal and actually allows for growth of the brain during the first year of your baby's life" During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from: CORRECT ANSWER: Increased density of lung tissue The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to: CORREC T ANSWER: The trigeminal nerve When examining th e face, the FNP is aware that the two pairs of salivary gland's that are accessible to examination are the _____ glands CORRECT ANSWER: Parotid and submandibular A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn he r head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____ CORRECT ANSWER: XI; asking the patient you should have her shoulders against resistance When examining a patient's cranial nerve function, the FNP remembers t hat the muscles in the neck that are innervated by CN XI are the: CORRECT ANSWER: Sternomastoid and trapezius The patient's laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland CORRECT ANSWER: Thyroid A patient says that she has recently noticed a lump in the front of her neck below her "Adams apple" that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodu le is that the lump: CORRECT ANSWER: Is mobile and not hard The FNP notices that the patient's submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient's: CORRECT ANSWER: Area proxim al to the enlarged node The FNP is aware that the four areas in the body were lymph nodes accessible are the: CORRECT ANSWER: Head and neck, arms, inguinal area, and axillae
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