NURS 6512 Advanced Health Assessment Midterm Exam Questions and Answers

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Question 1

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

		descending aorta.
		lower liver border.
		upper right kidney ridge.
		medial border of the spleen.

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Question 2

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

		PACES assessment.
		Miller Analogies Test.
		Glasgow Coma Scale.
		CAGE questionnaire.

Question 3

A brief statement of the reason the patient is seeking health care is called the:

		chief complaint.
		diagnosis.
		medical history.
		assessment.

Question 4

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

		sphenoid and frontal sinuses.
		maxillary and frontal sinuses.
		sphenoid sinuses only.
		maxillary sinuses only.

Question 5

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

		To be a member of a specific culture, an individual must have certain identifiable physical characteristics.
		Physical characteristics should be used to identify members of cultural groups.
		Gender and race are the two essential physical characteristics used to identify cultural groups.
		There is a difference between distinguishing cultural characteristics and distinguishing physical characteristics.

Question 6

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

		standing at the foot of the table.
		seated on the patient’s right.
		walking around the table.
		standing at the patient’s left.

Question 7

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

		Steroids
		Laxatives
		Oral hypoglycemics
		Diuretics

Question 8

During physical examination of a 30-year-old Chinese man, you notice slight asymmetry of his face. The cranial nerve examination is normal. Your best action is to:

		B. perform monofilament testing on the face.
		D. record the finding in the patient’s chart.
		A. ask the patient if this characteristic runs in his family.
		C. consult with the physician regarding laboratory tests needed.

Question 9

A fixed image of any group that rejects its potential for originality or individuality is known as a(n):

		norm.
		acculturation.
		stereotype.
		ethnos.

Question 10

Tangential lighting is best used for inspecting skin:

		exudates.
		color.
		contour.
		symmetry.

Question 11

Mrs. 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:

		B. patch.
		D. papule.
		C. macule.
		A. plaque.

Question 12

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

		ask the patient what he is upset about.
		ask him if he would like some time alone.
		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.

Question 13

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

		typical reluctance to talk.
		natural urge to communicate.
		need for verbal instructions.
		desire for adult companionship.

Question 14

Expected hair distribution changes in older adults include:

		increased terminal hair follicles to the tragus of men’s ears.
		more prominent axillary and pubic hair production.
		increased terminal hair follicles on the scalp.
		more prominent peripheral extremity hair production.

Question 15

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

		physical examination.
		review of systems.
		history of present illness.
		patient education.

Question 16

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

		D. overlap of cranial bones.
		A. closure of the anterior fontanel.
		C. ossification of all sutures.
		B. closure of the posterior fontanel.

Question 17

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

		astigmatism.
		strabismus.
		amblyopia.
		myopia.

Question 18

The most superior part of the stomach is the:

		pyloric orifice.
		body.
		pylorus.
		fundus.

Question 19

Brittle nails are typical findings in:

		D. older adults.
		C. pregnant women.
		A. adolescents.
		B. infants.

Older adults

Question 20

Which of the following is the most vital nutrient?

		Fat
		Protein
		Water
		Carbohydrate

Question 21

A tool used to screen adolescents for alcoholism is the:

		HITS.
		CAGE.
		CRAFFT.
		PACES.

Question 22

When taking a history, you should:

		use a holistic and eclectic structure.
		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.

Question 23

Ms. 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.

		past medical
		family
		personal and social
		present problem

Question 24

Mr. 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?

		Past medical data
		Age-specific data
		Social history
		Past surgical data

Question 25

Mr. 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?

		Vitamin K
		Vitamin E
		Vitamin A
		Vitamin D

Question 26

Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?

		B1
		B2
		B6
		B12

Question 27

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

		percussion.
		palpation.
		rectal examination.
		auscultation.

Question 28

You 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:

		A. telangiectasia.
		C. petechiae.
		B. spider angioma.
		D. purpura.

Question 29

Which of the following is the most accurate reflection of an individual’s food intake?

		Serum protein assays
		Food diary
		Twenty-four-hour diet recall
		Computerized nutrient analysis

Question 30

Mr. 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:

		ask a colleague from the same geographic area if this examination is acceptable.
		inform the patient of the reason for the examination and ask if it is acceptable to him.
		forego the examination for fear of violating cultural norms.
		refer the patient to a provider more knowledgeable about cultural differences.

Question 31

Tracheal tug suggests the presence of a(n):

		enlarged thyroid.
		thoracic carcinoma.
		swallowing disorder.
		aortic aneurysm.

Question 32

As 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:

		tell him that you understand his need to be alone.
		ask whether he would prefer to speak to the clinician.
		tell him that it is all right to be angry.
		ask whether he has any questions.

Question 33

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

		IV
		VIII
		III
		XII

Question 34

Nuchal rigidity is most commonly associated with:

		A. thyroiditis.
		C. Down syndrome.
		D. cranial nerve V damage.
		B. meningeal irritation.

Question 35

The attitudes of the health care professional:

		are difficult for the patient to sense.
		are largely irrelevant to the success of relationships with the patient.
		do not influence patient behavior.
		are culturally derived.

Question 36

Macronutrients are so named because they:

		form long chemical chains.
		have high molecular weights.
		are required in large amounts.
		tend to increase waist measurements.

Question 37

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

		aphthous ulcers.
		Fordyce spots.
		leukoedema.
		Stensen ducts.

Question 38

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

		The shortest speculum available
		The smallest speculum that will illuminate the ear
		Any speculum that will fit the otoscope head
		The largest speculum that will fit comfortably in the ear

Question 39

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

		5 minutes.
		1 minute.
		30 seconds.
		3 minutes.

Question 40

Which part of the information contained in the patient’s record may be used in court?

		Objective information only
		All information
		Diagnostic information only
		Subjective information only

Question 41

A flat, nonpalpable lesion is described as a macule if the diameter is:

		greater than 1 cm.
		less than 1 cm.
		3 cm exactly.
		too irregular to measure.

Question 42

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

		help make the interview questions more pertinent.
		draw conclusions regarding individual patient needs.
		form stereotypical categories.
		form a sense of the patient.

The review of systems is a component of the:

		health history.
		assessment.
		physical examination.
		past medical/surgical history.

Question 44

Mr. 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.

	a.	Progression is slow
	b.	Bone conduction heard longer than air conduction
	c.	Results from cranial nerve VII
	d.	Loss of high frequency
	e.	Sounds may be garbled and difficult to localize
	f.	Unable to hear in a crowded room

Question 45

Which of the following is an expected change in the assessment of the thyroid during pregnancy?

		A bruit is auscultated.
		Inspection reveals a goiter.
		The gland is tender upon palpation.
		Palpation of the gland becomes difficult.

Question 46

A 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:

		is cold intolerant.
		binges and vomits.
		has constipation frequently.
		has regular menstrual periods.

Question 47

Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:

		otoscope with pneumatic attachment.
		tympanometer.
		reflex hammer.
		tuning fork.

Question 48

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

		Ask whether the patient has considered self-harm.
		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.

Question 49

When are open-ended questions generally most useful?

		During the initial part of the interview
		While designing the genogram
		During the review of systems
		After several close-ended questions have been asked

Question 50

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

		history of interstate travel.
		food likes and dislikes.
		the first day of the last menstrual period.
		age at completion of toilet training.

Question 51

Regardless of the origin, discharge is described by noting:

		color and consistency.
		associated symptoms in alphabetic order.
		a grading scale of 0 to 4.
		demographic data and risk factors.

Question 52

Spasmodic muscular contractions of the head, face, or neck are called:

		D. webbing.
		B. tics.
		A. torticollis.
		C. dimpling.

Question 53

Before performing an abdominal examination, the examiner should:

		don double gloves.
		have the patient empty his or her bladder.
		ascertain the patient’s HIV status.
		completely disrobe the patient.

Question 54

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

14-20%

Question 55

Subjective and symptomatic data are:

		not mentioned in the legal chart.
		recorded with the examination technique.
		placed in the history section.
		documented with the examination findings.

Question 56

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):

		accident report.
		progress note.
		triage note.
		problem-oriented medical record.

Question 57

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

		Progress note
		Brief SOAP note
		Referral note
		Comprehensive health history

Question 58

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be:

		ignored while you address all questions to the parent.
		mailed a questionnaire in advance to avoid the need for her to talk.
		given the opportunity to be interviewed without the parent at some point during the interview.
		allowed to direct the flow of the interview.

Question 59

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

		use topical over-the-counter hemorrhoid treatment for 1 week.
		eat six small meals a day.
		exercise and eat more fiber.
		come to the laboratory for a stool guaiac test.

Question 60

Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?

		“What are your age, race, and educational level?”
		“What types of symptoms have you been having?”
		“Why do you think you are having these symptoms?”
		“How often do you have medical examinations?”

Question 61

Which cranial nerves innervate the face?

		A. II and V
		B. III and VI
		D. VIII and IX
		C. V and VII

Question 62

Peritonitis produces bowel sounds that are:

		absent.
		high pitched.
		hypoactive.
		hyperactive.

Question 63

Mrs. 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?

		Fat
		Calcium
		Iron
		Thiamin

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Question 64

Nasal symptoms that imply an allergic response include:

		small, atrophied nasal membranes.
		firm consistency of turbinates.
		purulent nasal drainage.
		bluish gray turbinates.

Question 65

Mr. 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:

		D. thyroglossal duct cyst.
		A. parotid gland tumor.
		B. branchial cleft cyst.
		C. Stensen duct stone.

Question 66

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

		C. sebaceous hyperplasia from eczema.
		D. seborrheic keratoses from actinic keratoses.
		B. furuncles from folliculitis.
		A. cutaneous tags from lentigines.

Question 67

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

		“I’m glad that you are a responsible drinker.”
		“If you only drink socially, you won t need to worry about always having a designated driver.”
		“Do the other people in your household consume alcohol?”
		“What amount and what kind of alcohol do you drink in a week?”

Question 68

Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning?

		Eustachian tube
		Triangular fossa
		Inner ear
		Pars flaccida

Question 69

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

		Thyroid position
		Prostate size
		Liver span
		Fontanel sizes

Question 70

A blood pressure cuff bladder should be long enough to:

		cover 75% to 80% of the arm circumference.
		completely encircle the arm.
		cover 20% to 25% of the arm circumference.
		cover 45% to 50% of the arm circumference.

Question 71

Mr. 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:

		hold the speculum in the canal.
		pull the auricle down and back.
		distract the infant.
		stabilize the chest.

Question 72

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

		preauricular area.
		mastoid bone.
		top of the head.
		forehead.

Question 73

Mrs. 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?

		C. Mandible and maxilla bones
		B. Hyoid and cricoid cartilages
		D. Nose and thyroid cartilages
		A. Coronal sutures

Question 74

Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted:

		B. under fluorescent lighting.
		D. using a Wood’s light.
		C. with illumination provided by daylight.
		A. using an episcope.

Question 75

Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?

		Realize that all members of a cultural group behave in the same way.
		Ignore one’s own cultural beliefs.
		Realize that cultural values are difficult to change and must be respected.
		Attempt to convince the patient to accept institutional mores.

Question 76

Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be:

		extremely obese.
		overweight.
		obese.
		normal body weight.

Question 77

The most common form of birth trauma of the scalp is:

		cranial bossing.
		torticollis.
		caput succedaneum.
		cephalhematoma.

Question 78

Mr. 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?

		“The stone must be sent to the lab for examination and therefore cannot be kept.”
		“We don’t know yet if your father has another kidney stone, so we must analyze this one.”
		“With your father’s permission, we will examine the stone and request that it be returned to him.”
		“We cannot let him keep his stone because it violates our infection control policy.”

Question 79

Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:

		inspect for ecchymosis of the flank.
		auscultate for abdominal bruits.
		assess for rebound tenderness.
		percuss for ascites.

Question 80

Mr. 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:

		B. C2 to C3.
		D. C4 to C5.
		A. C1 to C2.
		C. C3 to C4.

Question 81

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

		Gallbladder
		Pancreas
		Stomach
		Liver

Question 82

You 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:

		sit upright.
		hold his or her breath.
		flex his or her knees.
		raise his or her head off the pillow.

Question 83

Mrs. 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?

		Deep palpation
		Auscultation
		Percussion
		Light palpation

Question 84

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

		lateralization of sound.
		air conduction of sound.
		bone versus air conduction.
		mallear auditory ability.

Question 85

Before performing an abdominal examination, the examiner should:

		have the patient empty his or her bladder.
		completely disrobe the patient.
		don double gloves.
		ascertain the patient’s HIV status.

George 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?

		G. M. is a 22-year-old male here for “allergies.”
		G. M. came into the clinic complaining of green discharge for the past 72 hours.
		G. M., a 22-year-old male, states he has allergies and wants them checked.
		G.M. is a 22-year-old male here for having “green nasal discharge” for the past 72 hours.

Question 87

Your 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?

		Rebound tenderness
		Consistent right lower quadrant (RLQ pain)
		Positive McBurney sign
		Positive psoas sign

Question 88

Bulging of an amber tympanic membrane without mobility is most often associated with:

		repeated and prolonged crying cycles.
		middle ear effusion.
		healed tympanic membrane perforation.
		impacted cerumen in the canal.

Question 89

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

Question 90

Unusual white areas on the skin may be due to:

		B. polycythemia.
		A. adrenal disease.
		D. Down syndrome.
		C. vitiligo.

Question 91

Auscultation should be carried out last, except when examining the:

		lungs.
		abdomen.
		heart.
		neck area.

Question 92

Penicillin is considered a

		“cold” medicine.
		“hot” medicine.
		“lukewarm” oil.
		“cold” herb.

Bbb

Question 93

In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the:

		sternocleidomastoid.
		thyroid.
		hyoid.
		cricoid.

Question 94

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

		age at completion of toilet training.
		the first day of the last menstrual period.
		history of interstate travel.
		food likes and dislikes.

Question 95

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

		general patient information section.
		differential diagnosis.
		assessment.
		history of present illness.

Question 96

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

		providing time for reflection.
		increasing the length of the visit.
		promoting calmness.
		allowing the clinician to catch up on documentation.

Question 97

A guideline for history taking is for caregivers to:

		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.
		make notes sparingly so that patients can be observed during the history taking.
		write detailed information as stated by patients so that their priorities are reflected.

Question 98

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

		hearing range of normal speech.
		buzzing or tingling sensations.
		noise above the threshold level.
		buzzing from bone conduction.

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Question 99

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

		B. Flexed directly forward
		C. Flexed toward the side being examined
		A. Flexed away from the side being examined
		D. Hyperextended directly backward

Question 100

Which question would be considered a leading question?

		“You don’t get headaches often, do you?”
		“At what time of the day are your headaches the most severe?”
		“On a scale of 1 to 10, how would you rate the severity of your headaches?”
		“What do you think is causing your headaches?”