NR 509 Week 4 Midterm Review with Rationale

(NR 509 Week 4 Midterm Review)

1. Question: Which of the following statements best describes a differential diagnosis list?
2. Question: A 66-year-old female presents to the primary care office with complaints of jaw pain, fatigue, and nausea for the last 48 What course of action is appropriate in the treatment of this patient?
3. Question: In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may … indicative of what? Select all that
4. Question: A 72-year-old male is … to intensive care from the Emergency Room for the initial complaint of chest After the history and physical examination, the NP documents the following cardiovascular findings: JVP is 5 cm above the sternal angle with the head of the … to 50°. Carotid upstrokes are brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the anterior axillary line in the fifth and sixth intercostal spaces. S1 and S2 are soft. S3 is present at the apex. High-pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla. Which of the following possible diagnoses is based on the accurate interpretation of the assessment findings?
5. Question: A 76-year-old male presents to the office for a routine physical The NP documents the following skin findings: Decreased elasticity with multiple lentiginous macules on habitually sun-exposed skin. Multiple, discrete, brown, stuck-on, non-indurated, verrucous plaques on the back and abdomen varying from 1-2 centimeters. Which of the following is the most accurate interpretation of these findings?
6. Question: A 14-year-old male presents to the clinic with his grandmother for a complaint of a sore The patient is afebrile and denies cough. After completing the history and physical examination, the NP … the following partial assessment findings: Throat—Oral mucosa pink, dental caries in lower molars, tongue midline, uvula, and pharynx erythematous, bilateral tonsils enlarged, no exudates. Neck—Trachea midline. Neck supple; thyroid isthmus midline, lobes palpable but not enlarged. Lymph Nodes—Submandibular and anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery and mobile; no posterior cervical, epitrochlear, axillary, or inguinal lymphadenopathy. Which of the following is the most accurate interpretation of the findings?
7. Question: The NP is assuming care for a 56-year-old female resident of a long-term … living The woman is seated in a wheelchair next to a window in her private room. After completing the history and physical examination, the NP …d the following mental status findings: The patient appears sad and fatigued; clothes are wrinkled. Speech is slow and words are mumbled. Thought processes are coherent, but insight into current life reverses is limited. The patient is … to person, place, and time. Digit span, serial 7s, and calculations accurate, but responses delayed. Clock drawing is good. Which of the following is the most accurate interpretation of the findings?
8. Question: The NP … a physical assessment on a 74-year-old male with a complaint of shortness of His history is significant for a 20 pack-year history of smoking. He uses 2 inhalers daily (medication unknown) but did not bring them with him to his appointment. The documentation for the respiratory findings is as follows: Which of the following is the most accurate interpretation of the findings?
9. Question: A 28-year-old female presents to the office for an annual physical The NP is evaluating the cranial nerves (CNs) while assessing the eyes. The findings are … in this image. Damage or inflammation of which of the following cranial nerve(s) is … in this image? ADA Description: Eyes looking right and looking left.
10. Question: Otoscopic examination of the patient’s left ear reveals the assessment findings … in this image. What is the best documentation for the assessment findings of the tympanic membrane and external auditory canal? ADA Description: Left ear, tympanic membrane, and external
11. Question: A 44-year-old female presents with a painful skin rash on her neck for several days (see image). How would you best document the integumentary findings? ADA Description: Rash on the
12. Question: An NP is caring for a patient with depression. The patient reports not feeling suicidal although still … on their current regimen of Documenting the lack of suicidal ideation is an example of what important aspect of clinical documentation?
13. Question: The NP is establishing rapport with a patient during an initial encounter and prepares to ask the patient how they would like to … What additional consideration should the NP acknowledge when asking patients about their pronouns?
14. Question: Orthopnea and paroxysmal nocturnal dyspnea (PND) generally occur in the following conditions? Select all that
15. Question: A 19-year-old male … a laceration to the ulnar aspect of his mid-forearm. He did not have his injury … at that time and is now noticing purulent discharge and increasing pain from the wound along with fever and Where would the NP expect to find the first signs of lymphadenopathy?
16. Question: An NP is evaluating a 74-year-old female for an open wound on the right lower leg (see image). She denies injury and reports the wound is very painful. On examination, the NP does not note any odor from the wound or … warmth with palpation. Based on history and physical examination, which of the following most likely explains her signs and symptoms? ADA Description: Right, lower leg with open wound above the lateral ankle
17. Question: A 42-year-old male complains of pain in his left leg. He does not remember injuring his leg; however, he notes that there is a small wound on the lateral aspect of his mid-shin. Upon examination, some mild erythema surrounding the wound and flat, nonpalpable red streaks progressing up his leg are What do these streaks likely represent?
18. Question: A 61-year-old female was recently … with ovarian She has not been feeling well lately and presents to the clinic with a cough and some mild shortness of breath for the past couple of days as well as worsening pain and swelling in her right groin and leg for about a week. On physical examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant erythema are noted. Based on the history and symptomatology, the NP should consider which high-risk differential diagnosis?
19. Question: When assessing for the femoral pulse, between which anatomical landmarks should the NP begin deeply palpating?
20. Question: A 73-year-old male presents to the Emergency Department complaining of chest pain that … about 2 hours ago. Electrocardiogram, cardiac enzymes, and chest x-ray are normal. The NP notes that his blood pressures in the right arm are significantly lower than of blood pressures in his left Based on the history and physical examination, which of the following will most likely explain his signs and symptoms?
21. Question: A 68-year-old female complains of a 3-month history of recurring pain after ambulating that radiates from her back in the upper lumbar region into both buttocks, bilateral thighs, and mid-calf regions. Her pain is typically … by sitting or by leaning forward. The origin of her pain is likely secondary to which of the following?
22. Question: A 70-year-old male presents with progressive shortness of breath and two-pillow orthopnea. On physical examination, the blood pressure is 145/90 mm Hg, there is jugular venous distension, lower extremity pitting edema to the knee, and a blowing holosystolic murmur heard best at the lower left sternal border. No other murmurs or thrills are … on the physical Which of the following interventions is most likely to improve the patient’s symptoms?
23. Question: A 21-year-old male is experiencing dyspnea on exertion and On cardiac auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding?
24. Question: An NP student is examining a patient with a structurally normal heart. The student is having difficulty auscultating the splitting of the second heart At what area on the patient’s chest would the student have the best opportunity of hearing this sound?
25. Question: A 77-year-old male is experiencing progressive shortness of breath and dizziness. The patient undergoes cardiac catheterization, and the systolic blood pressure … in the left ventricle is 180 mm Hg, while the systolic blood pressure … in the aorta is 140 mm Hg. The patient is most likely experiencing symptoms related to what valve condition?
26. Question: An 89-year-old female with a history of smoking two packs of cigarettes a day for 50 years complains to her NP of progressive shortness of On cardiac examination, the NP finds the most prominent palpable impulse to … in the xiphoid area. This is most likely a result of what condition?
27. Question: A 16-year-old male arrives at the Emergency Department (ED) for shortness of breath following a motor vehicle A chest x-ray shows a rib fracture and a pneumothorax on the right side. The acute care NP decides that a chest tube needs to … in the fourth intercostal space. What steps are necessary to determine the accurate location of the fourth intercostal space?
28. Question: After examining a patient who is in the hospital for shortness of breath, the NP records the following for lung examination: “There is dullness to percussion over the right lung Breath sounds are absent at the right lung base. There are no crackles, wheezes, or rhonchi. There are no … voice sounds.” Which of the following is the most likely etiology?
29. Question: A 29-year-old male presents to the clinic with a cough for 2 When he lowers his gown so the NP can listen to his lungs, the NP notices a depression of the lower part of his sternum. Which of the following best describes the appearance of his chest?
30. Question: An NP is percussing the lungs of a patient with chronic obstructive pulmonary disease (COPD) for Which of the following is an example of good percussion technique?
31. Question: An 18-year-old male presents to the clinic for a 3-month history of periodic dyspnea when playing It resolves shortly after resting. He has not had a fever, chills, cough, sputum production, or chest pain. He has no history of serious illness. Based on the history, asthma is suspected. Which of the following sounds heard on expiration during lung auscultation would … most suggestive of asthma?
32. Question: A 74-year-old female patient presents with a complaint of palpitations. While checking her pulse, you notice an irregular During auscultation, you note every fourth beat sounds different. It sounds like a triplet rather than the usual “lub dub.” How would you document your examination findings?
33. Question: Regarding the eyes, which of the following physical assessment findings are NR 509 Week 4 Midterm Review as part of the normal aging process?
34. Question: An 81-year-old male presents to the vascular clinic with a painful sore on his right leg. On examination, the NP notes an ulcerative lesion near the medial malleolus with accompanying Which of the following etiologies is most likely … with these assessment findings?
35. Question: A 61-year-old female presents with the complaint of cough for 1 She is a smoker. The pulmonary examination revealed positive egophony with E-to-A change in the left lower lobe and crackles on auscultation. These assessment findings are strongly indicative of what etiology?
36. Question: A 37-year-old female presents with left lower extremity swelling and redness that extends from the foot to the mid-calf. Her posterior calf is tender with palpation during knee extension and dorsiflexion of the left The right lower extremity is unremarkable. She denies fever or injury. Which of the following history findings would … most significant given the presenting complaint?
37. Question: You are examining a 60-year-old male with a long-standing history of chronic obstructive pulmonary disease (COPD). The patient reports smoking since he was a teenager. Which of the following physical examination finding(s) are NR 509 Week 4 Midterm Reviewwith the patient presentation? Select all that
38. Question: A 25-year-old female comes to your clinic for evaluation of As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to … , based on the location of the murmur?
39. Question: Proper positioning of the patient is critically important during the physical assessment. During the physical examination, which is the best position to place the patient when assessing for the murmur of aortic regurgitation?
40. Question: Proper positioning of the patient during the physical examination is fundamental to conducting an effective and efficient cardiovascular During the physical examination, which is the best position to place the patient when auscultating for S1, S2, and murmurs?
41. Question: A 40-year-old male presents with daily headaches that have worsened over the past several The headaches are worse with lying down and persist throughout the day. On funduscopic examination of the right eye, you note that the disk edge is indistinct, and the veins do not pulsate. What medical condition is most closely associated with these physical assessment findings?
42. Question: A 45-year-old male has … multiple small, blood-red, raised lesions over his chest and abdomen for the past several months. They are not painful, and he has not noted any bleeding or bruising. On physical examination, the NP notes more than 75 discrete, raised, red papules of varying size between 1-0.4 cm as represented in this image. Which of the following actions if taken by the NP is an appropriate next step? ADA Description: Bare chest with multiple scattered, discrete, red, papules.
43. Question: A 15-year-old male presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, 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 the history and physical examination findings, what is the most likely diagnosis?
44. Question: A 32-year-old female presents with ear pain. She is an avid swimmer. The history includes pain and drainage from the left ear for about a week. On examination, she has pain when the ear is manipulated, including manipulation of the The canal is narrowed and erythematous, with some white debris in the canal. The rest of the examination is unremarkable. What diagnosis would you assign this patient based on physical assessment findings?
45. Question: A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the tuning fork better on the left. Which of the following is most likely?
46. Question: A 21-year-old female presents with a sore throat, fever, and fatigue for several You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. Which group of lymph nodes is this?
47. Question: When testing for nystagmus, the NP instructs the patient to:
48. Question: Identify the anatomical landmark on the neck between the examiner’s fingers in this ADA Description: Examiner’s hands bilaterally on the anterior neck
49. Question: A 57-year-old male complains of a tender growth under his tongue. He reports a history of cigarette use, but not for 20 years. He also reports a non-productive cough and general malaise. Upon inspection, you note the lesion cannot … and bleeds slightly when touched with a tongue What medical condition is most likely associated with the history and physical exam findings?
50. Question: Identify the letter that corresponds with the handle of the malleus in this image of the right tympanic membrane of the
51. Question: Examination of the nose of a 27-year-old male during a routine appointment reveals the following (see red oval in the image). The patient denies pain, injury, or difficulty What medical condition is associated with this physical examination finding?
52. Question: A 25-year-old male complains of a swishing noise in both ears that never goes away for about 6 months. He is otherwise healthy, can work on his job (operating large, vibrating machinery) without problems, and is not taking any A complete examination reveals an abnormality. Which abnormality is most often associated with tinnitus in this patient demographic?
53. Question: An 82-year-old male is speaking loudly during an examination, suggesting that he may not … hearing What is a good question to ask him to help identify whether he has hearing loss?
54. Question: A 70-year-old male complains of double vision. Which of the following associated symptoms or signs discovered during the history and physical examination would … worrying about an underlying neurological problem (as opposed to pathology in the eye)?
55. Question: Which of the following statements is true regarding aphasia?
56. Question: Abstract thinking is an important component of the human thought process. A person’s ability to understand questions that test his or her ability to answer appropriately is dependent upon several factors. Which one of the following answers is true in identifying a patient with concrete thinking and a reduced ability to think abstractly?
57. Question: Which complaints/findings are considered patient identifiers for mental health screening? Select all that
58. Question: A 42-year-old male presents with widespread pain. He reports almost daily headaches, pain in his back from an old motor vehicle accident, and generalized achiness and hypersensitivity throughout the He recounts ongoing pain since his early 20s and has sought treatment from several providers. Which of the following statements is true regarding chronic pain?
59. Question: A 19-year-old male presents to the clinic after a syncopal During your general survey, you note that he is very thin for his height. He admits that he eats only minimally to maintain a very low body weight that he feels is ideal. You suspect that he may have an eating disorder. Concerning the two most common eating disorders (anorexia nervosa and bulimia nervosa), which of the following statements is true?
60. Question: A 58-year-old male presents for his annual physical The NP notes a systolic murmur on auscultation of the aorta. However, the NP does not immediately conclude that this patient has aortic stenosis. Which of the following is the accurate rationale for seeking additional information?
61. Question: A 45-year-old male presents to the clinic complaining of intense substernal chest pain and nausea. He appears pale and sweaty. At work that day, he filled in for an absent co-worker and was asked to perform heavy lifting not normally a part of his job. The NP questions the patient in detail about his nausea, eating habits, and digestive Which of the following steps of clinical reasoning has the NP failed to follow?
62. Question: An NP student is interviewing an 80-year-old new patient brought to the office by her As part of the patient’s history, the NP student obtains information about childhood illnesses and adult illnesses and then moves on to inquire about the family history. Which important area of the past medical history (PMH) was omitted?
63. Question: A 65-year-old male presents to the office for an unscheduled He complains of recurrent headaches. The patient reports gradual onset of dizziness and occasional numbness on the left side. Which of the following body systems or regions should … a priority focus during the physical assessment?
64. Question: A 59-year-old man presents to the office for a scheduled He complains of feeling tired and hungry, despite getting sufficient rest and having a good appetite and access to food. The patient is obese and is wearing thermal socks with his sandals despite the warm weather outside. He says this is because his feet are always cold and “feel funny.” With which body system should the NP begin the examination?
65. Question: A 26-year-old male presents to the free He reports having active hepatitis C from intravenous drug use. He also suffers from uncontrolled asthma since childhood and bipolar disorder. On today’s visit, his main concern is an abscess in his right arm at a heroin injection site. Which of the following is the best approach to the health history for this patient at his first visit?
66. Question: A 29-year-old male complains of persistent cough and wheezing, particularly when he exercises. He says he smokes cigarettes “occasionally” and vapes e-cigarettes 3 times Upon hearing this information, what is the best next step for the NP to proceed?
67. Question: A 16-year-old female presents to the office with his mother to establish care. The patient underwent treatment for sarcoma including an above-the-knee amputation 3 years ago. Since then, she has learned to ambulate with a prosthetic leg and recently began talking about sports The patient is very engaged in most of the visit, but when the topic of cancer arises, she becomes quiet. Which of the following statements would help to build trust between the provider and the patient?
68. Question: A 59-year-old male complains of several episodes of epigastric His father died of pancreatic cancer at age 52 years. He recalls, “My father’s pain was just like mine is now . . .” The NP replies, “Just like?” after which the patient restarts his narrative. Which of the following is an example of the interviewing techniques employed by the NP?
69. Question: A 65-year-old male presents as a new He wishes to discuss issues with erectile dysfunction and fatigue. As the interview continues, the NP becomes suspicious that the patient is suffering from decompensated heart failure. When the patient mentions that he has had vague chest pain since last night, the NP feels that the focus must … to this potentially emergent condition. Which of the following interview techniques is the most appropriate to effectively manage this visit?
70. Question: A 38-year-old female is a well-established She complains of irregular menstrual periods and pelvic pain. She says that she is having trouble sleeping and asks whether she could … a “sleeping pill.” The patient also says she is thinking of leaving her job. What is the best “next step” in caring for this patient?
71. Question: A 44-year-old female presents for follow-up She was diagnosed with systemic lupus erythematosus 6 months ago. Since her diagnosis, she has been minimally compliant with medications. The NP elects to explore the issues using the FIFE model to guide the encounter. Which of the following best defines the elements of the FIFE model?
72. Question: A 17-year-old male presents to a sexually transmitted disease clinic. He prefers same-sex partners and is afraid that he contracted an infection from his last partner. The patient expresses that he is nervous and embarrassed by the situation. The nurse practitioner wishes to best connect with the patient at this critical juncture in his care with the clinic and ease his Which of the following is an example of an active listening technique?
73. Question: A 34-year-old male presents to the clinic to establish The patient has experienced several adversarial relationships with prior providers. He voluntarily left two practices within the previous year and was discharged from a third clinic due to misbehavior. The NP desires to utilize an approach to this patient that will most likely lead to comprehensive care and patient compliance. Which of the following is the most appropriate interview style for the NP to use?
74. Question: A 23-year-old nurse practitioner (NP) student found that she felt nervous when called upon to examine men in her age On one occasion, she encountered a young male patient who appeared embarrassed to see her walk into the room. Which action if taken by the student would help to minimize their mutual discomfort?
75. Question: A 62-year-old male presents to the urgent care clinic with complaints of pain, numbness, and tingling in the foot and lower leg for 3 On physical examination, the NP notes the affected foot is cold, pale, and pulseless. Which action, if taken by the NP, is an appropriate next step?
76. Question: The usual starting position for the head of the bed or examining table when assessing jugular venous pressure (JVP) is?
77. Question: A newborn has an embryologic defect affecting the aortic What additional valve is most likely to … affected?
78. Question: A 13-year-old female is brought by her mother to the clinic one day before the start of eighth grade because of a 3-day history of episodes of shortness of When symptomatic, she also notices tingling around her lips. Her history and physical examination are unremarkable. Which of the following is the most likely etiology?
79. Question: What assessment technique is being … in this image? ADA Description: Examiner’s hands on patient’s bilateral thoracic back 
80. Question: The NP is performing a cardiac assessment on a 64-year-old male with a history of congestive heart failure (CHF) with left ventricular hypertrophy (LVH). Which of the following assessment findings is indicative of displacement of the point of maximal impulse (PMI)?
81. Question: A 12-year-old female complains of fullness as well as “popping sensations” in the ear and sometimes pain. During the physical assessment you note mild conduction hearing Identify the abnormal assessment findings in this image. What medical condition is associated with these findings? ADA Description: External auditory canal and tympanic membrane
82. Question: A 74-year-old male complains of non-traumatic right eye pain for 1 He suspects something accidentally got into his eye but does recall this happening. After flushing out his eye, the pain and … vision remains and is getting worse. His visual acuity is 20/20 OS and 20/100 OD. Which action if … by the NP is the best next step?
83. Question: A 42-year-old fair-skinned woman presents with an abnormal skin growth that was first noted 7 years On examination, the NP notes a 2 × 3-cm lesion over her left bicep. Which of the following historical elements should raise the NP’s suspicion for malignancy?
84. Question: Concerning hallucinations, an abnormal perception experienced by a patient, which of the following statements are true about this abnormality? Select all that apply.
85. Question: Of the following statements, which are true concerning mental health disorders in primary care? Select all that apply.
86. Question: Weight change may indicate the presence of important underlying pathology requiring further Which of the following patient scenarios best describes a significant weight change that requires further evaluation?
87. Question: A 32-year-old female reports excessive stress at work and pain in the right lower She states that last night she vomited twice. Her blood pressure is 120/75, heart rate is 93 bpm. The patient looks pale and is sweating lightly. Which of these assessment findings are objective? Select all that apply.