Midterm Exam: NUR634/ NUR 634 (Latest 2023/ 2024 Update) Advanced Health Assessment and Diagnostic Reasoning Exam | Questions and Verified Answers| 100% Correct| Grade A- GCU

Midterm Exam: NUR634/ NUR 634 (Latest

2023/ 2024 Update) Advanced Health

Assessment and Diagnostic Reasoning Exam |

Questions and Verified Answers| 100%

Correct| Grade A- GCU

Q: A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath

and nonproductive cough over the last month. She feels like she can't do as much activity as she

used to do without becoming tired. She even has to sleep upright in her recliner at night to be

able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical

history is significant for high blood pressure and coronary artery disease. She had a hysterectomy

in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon.

She denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died

from prostate cancer. She denies any recent upper respiratory illness, and she has had no other

symptoms. On examination she is in no acute distress. Her blood pressure is

160/100 and her pulse is 100.She is afebrile and her respiratory rate is 16.With auscultation she

has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac

examination the S1 and S2 are distant and

an S3 is heard over the apex. What disorder of the chest best describes her symptoms?

A. Pneumonia

B. Chronic obstructive pulmonary disease (COPD)

C. Pleural pain

D. Left-sided heart failure

Answer:

D

Q: When a patient is suspected of having medial epicondylitis (pitcher's, golfer's, or Little

League elbow) where would they experience pain?

Answer:

Wrist flexion against resistance increases the pain.

Q: A differential to consider if a patient is having fever, shortness of breath, productive cough,

and hemoptysis?

A. COPD

B. Raynaud Syndrome

C. Pneumonia

D. Spontaneous Pneumothorax

Answer:

C

With a "fever" think infection

Q: Exam findings of a patient with pneumonia (Select all that Apply)

A. Dullness with percussion

B. Dull, diminished lung sounds

C. Coarse crackles on auscultation

D. Decreased fremitus during palpation

Answer:

A, B, C

Q: You are speaking to an 8th grade class about health prevention and are preparing to discuss

the ABCDEs of melanoma. Which of the following de- scriptions correctly defines the

ABCDEs?

A. A = actinic; B = basal cell; C = color changes, especially blue; D = diameter

>6 mm; E = evolution

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

mm; E = evolution

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

evolution

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

mm; E = evolution

Answer:

B

Feedback: This is the correct description for the mnemonic

Q: If a patient has splenomegaly, what sound would be heard when per- cussing the left side of

the abdomen?

A. Dullness

B. Tympany

C. Fremitus

D. Hyperactive bowel sounds

Answer:

A

Q: Which of the following percussion notes would you obtain over the gastric bubble?

A. Resonance

B. Tympany

C. Hyperresonance

D. Flatness

Answer:

B

Feedback: The gastric bubble produces one of the longest percussion notes. A patient with COPD

may have hyperresonance over his chest, while a normal person would have resonance. Dullness

is heard over a normal liver, and flatness is heard if one percusses a large muscle

Q: Where is the point of maximal impulse (PMI) normally located?

A. In the left 5th intercostal space, 7 to 9 cm lateral to the sternum

B. In the left 5th intercostal space, 10 to 12 cm lateral to the sternum

C. In the left 5th intercostal space, in the anterior axillary line

D. In the left 5th intercostal space, in the midaxillary line

Answer:

A

Feedback: The PMI is usually located in the left 5th intercostal space, 7 to 9 centimeters lateral

to the sternal border. If it is located more laterally, it usually represents cardiac enlargement. Its

size should not be greater than the size of a US quarter, or about an inch. Left ventricular

enlargement should be suspected if it is larger. The PMI is often the best place to listen for mitral

valve murmurs as well as S3 and S4.The PMI is often difficult to feel in normal patients.

Q: A 62-year-old smoker complains of "coughing up small amounts of blood," so you consider

hemoptysis. Which of the following should you also consid- er?

A. Intestinal bleeding

B. Hematoma of the nasal septum

C. Epistaxis

D. Bruising of the tongue

Answer:

C

Q: A patient complaining of hemoptysis what may warrant consideration?

A. Upper GI Beed

B. Oral Bruising

C. Hematoma of nasal septum

D. Periungual infection

Answer:

A

**Exam HENT, GI, and lungs**

Q: A 46-year-old executive who is obese and otherwise healthy presents to a family medicine

clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on its own

after a few hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she

has had to leave

or miss work on three separate occasions. She would like a diagnosis and the problem fixed.

Which symptoms or signs would be most suggestive of a diagnosis of biliary colic?

A. Vomiting of bile

B. Poorly localized periumbilical pain

C. Associated right shoulder pain

D. Positive McBurney point tenderness

E. Exacerbating factor includes alcohol intake

Answer:

C

Pain with biliary colic can produce referred pain to the right shoulder or scapula due to irritation

of the right hemidiaphragm. Alcohol is not an exacerbating factor for bil- iary colic. Positive

McBurney point tenderness is associated with acute appendicitis. The Murphy sign is associated

with acute cholecystitis. Vomiting bile is associated with small bowel obstruction

Q: A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain.

The pain is associated with nausea and vomiting and occurs

1 to 2 hours after eating greasy foods. Which one of the following physical examination

descriptions would be most consistent with the diagnosis of cholecystitis?

A. Abdomen is soft, nontender, and nondistended, without he- patosplenomegaly or masses.

B. Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or

guarding.

C. Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the

point of stopping inspiration, and there is no rebound or guarding.

D. Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or

guarding.