N522PE Advanced Physical Assessment Mid Term Exam

N522PE-22A_22Sep Advanced Physical Assessment Mid Term Exam 2022

Question 1

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

Objective

Subjective

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Question 2

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Which of the following is consistent with good percussion technique?

Leave the plexor finger on the pleximeter after each strike.

Maintain a stiff wrist and hand.

Strike the pleximeter over the distal interphalangeal joint.

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

Question 3 N522PE Advanced Physical Assessment Mid Term Exam

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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?

12 months

10 months

6 months

8 months

Question 4

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

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

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

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

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

Question 5

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

Chief concern

Review of systems

Personal and social history

Present illness

Question 6

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

Cardiac

Urinary

Reproductive

Hematologic

Question 7

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The following information is recorded in the health history: “The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric area.” Which of these categories does it belong to?

Personal and social history

Present illness

Review of systems

Chief complaint

Question 8

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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.”

Obstetrics/gynecology

Psychiatric

Adult illnesses

Surgeries

Question 9 N522PE Advanced Physical Assessment Mid Term Exam

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You ask your patient the following question: “What brought you here today?” The patient’s answer would be placed in which part of the health history?

Chief concern

Review of systems

Family history

Present illness

Question 10

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The components of the health history include all of the following except which one?

Present illness

Personal and social history

Thorax and lungs

Review of systems

Question 11

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Which statement about the skin is false?

Pregnant women have decreased blood flow to the skin.

Older adults have less sebaceous and sweat gland activity.

Apocrine glands enlarge in adolescence leading to sweating.

Infants have smoother skin than adults.

Question 12

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A 6-year old child and the parent come to the clinic and report ear pain for the past 2 or 3 days. The parent shares that the child has had a runny nose along with the ear pain and the drainage is yellow & thick. You perform an otoscopic exam and notice a bulging red eardrum without any bony landmarks visible. Which of the following is the most likely diagnosis?

Serous otitis media

Perforated tympanic membrane

Acute otitis media

Otitis externa

Question 13

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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:

Folliculitis

Furuncle

Tinea

Cellulitis

Question 14

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Which statement about lymph nodes is true?

Soft, movable painful bilateral nodes suggest a malignant process.

A hard, fixed painless node suggests a malignant process.

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

Rapid nodal enlargement indicates a benign process.

Question 15

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You are speaking to a group of pregnant patients during an educational presentation about skin changes in pregnancy. Which of the following statements accurately presents what skin changes women can expect during pregnancy?

Stretch marks may appear but will disappear completely after delivery.

Increased pigmentation may occur, and you may see a line running up & down your abdomen.

Redness may cover the palms of your hands, but it usually disappears after delivery.

a, b, & c

b & c

a & b

Question 16

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You feel a small mass as you palpate the area behind your patient’s left ear. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely?

Cancer

Muscle

Lymph node

Deep scar

Question 17

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Which hearing screening test below helps to identify unilateral hearing loss?

Audiometric testing

The Weber test

The whisper test

The Rinne test

Question 18

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You note that a patient has anisocoria on examination. Pathologic causes of this include which of the following?

Horner’s syndrome

Eye prosthesis

Differing light intensities for each eye

Benign anisocoria

Question 19

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As you assess your adult patient’s feet, you notice some small red to purple discolorations that don’t blanch. You measure them and they are all less than 0.5 cm in diameter. The best term to document them is:

Petechiae

Hemangioma

Ecchymoses

Purpura

Question 20

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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?

Cluster

Analgesic rebound

Tension

Migraine

Question 21 N522PE Advanced Physical Assessment Mid Term Exam

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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?

Near reaction

Consensual reaction

Accommodation

Direct reaction

Question 22

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You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?

A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution

A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution

A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

Question 23

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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?

Displaced PMI

Tachycardia

Hypertension

Hypotension

Question 24

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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?

Normal temperature

Thin, shiny, atrophic skin

Normal pulsation

Marked edema

Question 25

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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?

PET scan

Ankle–brachial index (ABI)

CT scan of the lower legs

Venogram

Question 26

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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?

Sinus arrhythmia

Atrial flutter

Second-degree A-V block

Atrial fibrillation

Question 27

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You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?

Arterial insufficiency

Trauma

Neuropathic ulcer

Venous insufficiency

Question 28

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Assessment of the heart of a 72-year-old patient reveals S4 to auscultation. This may indicate:

Decreased right ventricular compliance

Increased right ventricular compliance

Decreased left ventricular compliance

Increased left ventricular compliance

Question 29

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A 55–year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?

Bronchitis

Pericarditis

Costochondritis

Angina pectoris

Question 30

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A 68 year old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP?

Constrictive pericarditis

Left sided heart failure

Aortic aneurysm

Mitral stenosis

Question 31

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

Judge the relative length of systole and diastole by auscultation.

Palpate the radial pulse.

Palpate the carotid pulse.

Correlate the murmur with a bedside heart monitor.

Question 32

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You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Upright, but leaning forward

Supine

Upright

Left lateral decubitus

Question 33

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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?

Chest pressure with exertion

Shortness of breath

Intermittent claudication

Knee pain

Question 34

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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?

Has your child had any nausea or vomiting?

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

What color is the sputum from the cough?

Tell me about any family history of genetic disorders.

Question 35

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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?

Chest pain

Pain radiating into the jaw

Pain radiating into the left arm

Syncope

Question 36

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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?

Hematochezia

Abdominal pain

Orthopnea

Tenesmus

Question 37

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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:

Increased diastolic blood pressure

Decreased systolic blood pressure

Increased systolic blood pressure

Decreased diastolic blood pressure

Question 38

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All the following signs are expected in pregnancy except:

Decreased diastolic blood pressure

Palmar erythema

Increased systolic blood pressure

Dependent edema

Question 39

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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?

Pleural pain

Angina pectoris

Pericarditis

Dissecting aortic aneurysm

Question 40

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Which statement is true about auscultation of S3:

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

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

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.

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

Question 41 N522PE Advanced Physical Assessment Mid Term Exam

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The correct order of physical assessment technique when assessing the abdomen is:

Auscultation, Inspection, Percussion, Palpation

Inspection, Auscultation, Percussion, Palpation

Inspection, Palpation, Percussion, Auscultation

Inspection, Percussion, Palpation, Auscultation

Question 42

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A 92-yr-old patient comes to the clinic reporting several days of diarrhea. With your knowledge about assessment of the GI system in the older adult, you know:

The tendency for older adults to have increased gas in the GI tract may lead to diarrhea.

Older adults commonly have increased motility of the GI tract leading to diarrhea.

Many older adults have sensory deficits that lead to confusion about what diarrhea is.

A fecal impaction due to constipation in the older adult may present as diarrhea.

Question 43

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A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?

Hepatitis C

Hepatitis D

Hepatitis A

Hepatitis B

Question 44

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A 33-yr-old patient who is 6 weeks pregnant comes to the clinic for a prenatal visit. During the assessment she asks what changes she may expect to occur with her gastrointestinal system while she’s pregnant. All the following statements are correct except:

You may notice a problem with constipation due to slower motility of the GI tract.

You may experience heartburn due to the relaxation of the lower esophageal sphincter.

Due to an extended gall bladder & decreased emptying time, you may develop gall stones more easily.

You may notice increased muscle tone of the abdominal muscles as they stretch during pregnancy.

Question 45

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Which of the following is a modifiable risk factor for breast cancer?

Gender

Genetics

Age

Obesity

Question 46

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All the following are expected changes of the GI tract in the older adult except:

The liver decreases in size.

Motility of the GI tract is decreased.

The pancreas decreases in size.

New food intolerances may appear.

Question 47

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Which of the following statements about mammography from the U.S. Preventive Services Task Force in 2016 is correct?

Most of the benefit of screening mammography occurs for women between the ages of 50 and 74.

Head-to-head trials of screening intervals show annual mammography screenings are best.

The evidence shows that mammography used with clinical breast exams has a strong impact on breast cancer mortality.

Mammography screening shows large statistical significance for all ages to reduce breast cancer mortality.

Question 48

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The best technique to assess for kidney tenderness is:

Indirect percussion of the costovertebral angles with patient in sitting position

Deep palpation with patient in supine position

Direct percussion of the costovertebral angles with patient in supine position

Light palpation with patient in prone position

Question 49

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Your assessment of a 57-yr-old female patient reveals a red, scaly, & crusty patch on the left nipple area of the breast. You identify this as Paget’s Disease which is a surface manifestation of which of the following diseases:

Duct ectasia

Ductal carcinoma

Lobular carcinoma

Intraductal papilloma

Question 50

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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?

Colon cancer

Cholecystitis

Peptic ulcer

Diverticulitis