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NURS 511 – Midterm Questions With Complete Solutions
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NURS 511 – Midterm Questions With Complete Solutions
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NURS 511 – Midterm Questions With Complete Solutions45 year old patient presents with a cough. Upon auscultation,
you hear rhonchi unilaterally. If you are following the normal
order of lung assessment, what would be the next step of your
assessment in order to best establish a differential diagnosis?
Correct Answer Ask the patient to cough to evaluate whether
the rhonchi clears with cough.
58 y.o. patient with a history of hypertension and coronary
artery disease presents with symptoms suggestive of intermittent
claudication (pain in legs comes on rapidly during exercise,
quickly relieved by rest). Which of the following is most
accurate? Correct Answer You suspect arterial insufficiency, so
you will palpate the dorsalis pedis and posterior tibial pulses
which are likely to be diminished.
A 14 year old male presents to the ED with his mother for
evaluation of an area of blood in the left eye. He states there has
been no recent trauma or injury but has been coughing forcefully
with a recent cold. He has no visual disturbances, no eye pain, or
discharge from the eye. On physical examination, the pupils are
equal, round, and reactive to light, with a visual acuity of 20/20
in each eye and 20/20 bilaterally. There is a homogeneous,
sharply demarcated area at the lateral aspect of the base of the
left eye. The cornea is clear. Based on this description, what is
the most likely diagnosis? Correct Answer subconjunctival
hemorrhage
A 22-y-o student comes to your office, complaining of severe
abdominal pain radiating to his back. He states it began last
,night after hours of heavy drinking. He has had abdominal pain
and vomiting in the past after drinking but never as bad as this.
He cannot keep any food or water down, and these symptoms
have been going on for almost 12 hours. He has had no recent
illnesses or injuries. His past medical history is unremarkable.
He denies smoking or using illegal drugs but admits to drinking
6 to 10 beers per weekend night. He admits that last night he
drank something like 14 drinks. On examination you find a
young male appearing his stated age in some distress. He is
leaning over on the examination table and holding his abdomen
with his arms. His blood pressure is 90/60 and his pulse is 120.
He is afebrile. His abdominal examination reveals normal bowel
sounds, but he is very tender in the left upper quadrant and
Correct Answer Acute pancreatitis
A 23-y.o. graduate student comes to your clinic for evaluation of
a urethral discharge. Due to the nature of the complaint you need
to get a sexual history. Which one of the following question
provides the least amount of useful information? Correct
Answer Are you sexually active:
A 24 y.o. comes to your clinic for evaluation of fatigue. During
your physical examination, you listen to her heart and notice a
murmur at the cardiac apex only. Based upon the location of the
murmur, you suspect that which valve is most likely involved?
Correct Answer Mitral
A 25 y.o. radio announcer comes to the clinic for an annual
examination. His BMI is 26.0 kg/m2. He states he is concerned
about his weight. What is appropriate counsel for the patient
during the visit? Correct Answer Give the patient information
,about reduction of fat, cholesterol, and calories because he is
overweight.
A 25-y.o. patient presents to the clinic with complaints of off-
and-on chest pain for several days. He describes it as knifelike in
the lower right side of his chest and states it only lasts for 3 to 5
seconds, taking his breath away. He states he feels like he has to
breathe shallowly to keep it from recurring. The only thing that
makes it better is lying quietly on his right side. It is much worse
when he takes a deep breath. He has taken some Tylenol and put
a heating pad on his side but neither has helped. He remembers
that 2 weeks ago he had an upper respiratory infection with a
severe hacking cough. He denies any recent trauma. His past
medical history is unremarkable. His parents and siblings are in
good health. He has recently married, and his wife has a baby
due in 2 months. He denies any smoking or illegal drug use. He
drinks two to three beers once a month. He states that he eats a
healthy diet and runs re Correct Answer Pleural Pain
A 27 y.o. female has had headaches, muscle aches, and fatigue
for the last 2 months. She was seen last week by another
provider in your clinic who ordered a complete laboratory
workup; all of the lab tests were normal. She is seeing you today
to follow-up. Although the previous provider documented that a
complete history and physical exam was performed last week,
you would be sure to include the following during your visit
today: Correct Answer A screening for depression
A 27 year old male comes to your clinic to establish care. You
are preparing to go into the examination room to interview him.
Which of the following is the most logical sequence for the
, patient-provider interview? Correct Answer Greet the patient,
establish rapport, invite the patient's story, establish the agenda,
expand and clarify the patient's story, and negotiate a plan
A 28 y.o. female patient presents to your clinic with abdominal
pain, worst in the right upper quadrant. She rates the pain as
ranging from 3-8. The pain comes and goes for 2-3 hours at a
time and is particularly worsened after eating. She thinks the
pain started about 3 weeks ago. Greasy foods seem to make the
pain worse, so she reports decreasing intake of these. Initially
the pain only happened weekly but now she notices it almost
daily and nothing seems to relieve the pain. What other key
attribute of a symptom assessment does the NP need to next ask
questions about to the patient in order to fully understand this
symptom? Correct Answer Quality of the pain
A 28 year old patient complains of a "very itchy" rash on his
knees and elbows; he reports the rash has come and gone for
several years, better with some sun exposure in the summer but
worse in the winter. He has tried some over-the-counter lotions
but none seem to help. On exam, you see scabbing and crusting
with some silvery scale, and you notice small pits in his nails.
What would be a reasonable primary differential diagnosis?
Correct Answer Psoriasis
A 29-y.o. patient comes to your office for evaluation of a
headache. He spends several hours each day at a computer
monitor/keyboard. He describes his headache as a tightening
sensation is located all over the head and is of moderate
intensity. It usually only last minutes, but this time it has lasted
for 5 days. He has no photophobia and nausea. He has not tried
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