Category: Nursing

NURS 6512 
Week 6 Midterm Exam: Advanced Health Assessment: Walden University

 

1. Before performing an abdominal examination, the examiner should:

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

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

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

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5. A fixed image of any group that rejects its potential for originality or individuality is known as a:

6. Peritonitis produces bowel sounds that are

7. Brittle nails are typical findings in:

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

9. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?

10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness you should palpate over the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

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

12. Unusual white areas on the skin may be due to

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

14. Mrs. Webb is a 38-year old patient who has been changing her lifestyle to eat in a healthy way and lose weight: during your health promotion education regarding her nutritional status, you explain the function of dietary protein as:

15. Mr. Akins is a 78-y/o 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.

16. The most superior part of the stomach is the

17. 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?

18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

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

20. Which technique is most likely to result in the patients understanding of questions?

21. 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 the history?

22. Nasal symptoms that imply an allergic response include:

23. Mr. Franklin is speaking with you the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more, that’s why I am here! You tell me what’s wrong.” Which caregiver response would be the most appropriate for enhancing communication?

24. When taking a history, you should:

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

26. 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:

27. Which question would be considered a leading question?

28. Mr. Black is a 44y/o 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?

29. The term denoting the caregiver’s need to do no harm to the patient is:

30. A tool used to screen adolescents for alcoholism is the:

31. Under normal circumstances, how much water is lost daily by the body?

32. You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish:

33. Mr. Mills is a 55/y/o patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of activities of daily living is part of a(n):

34. Sweat glands, hair, and nails are all formed from?

35. A brief statement of the reason the patient is seeking health care is called the?

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

37. Which cranial nerves innervate the face? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

38. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for?

39. When are open-ended questions generally most useful?

40. Knowledge of the culture or cultures represented by the patient should be used to?

41. 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?

42. A guideline for history taking is for caregivers to?

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

44. You are palpating a patient’s thyroid and find that its broadest dimension measures 4cm. the right lobe is 25% larger than the left. These data would indicate?

45. 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?

46. Before performing an abdominal examination, the examiner should?

47. 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?

48. 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?

49. When palpating the abdomen, you should note whether the liver is enlarged in the?

50. Expected normal percussion tones include?

51. 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 ate concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to?

52. Fluorescing lesions are best distinguished using a(n)?

53. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?

54. Underestimation of blood pressure will occur if the blood pressure cuff’s width covers?

55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

56. Penicillin is considered a?

57. Small, minute bruises are called?

58. After thorough inspection of the abdomen, the next assessment step is?

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

60. Regardless of the origin, discharge is described by noting?

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

62. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure?

63. Auscultation should be carried out last, except when examining the?

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

65. Which of the following is an “ABCD” characteristic of malignant melanoma?

66. Tracheal tug suggests the presence of a(n)?

67. 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?

68. The review of systems is a component of the:

69. Cherry angiomas are a common finding in:

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

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

72. The adult recommended dietary fat intake should be ____g/day.

73. 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?

74. A flat, nonplapable lesion is described as a macule if the diameter is:

75. 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?

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

77. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator?

78. To approximate vocal frequencies, which tuning fork should be used to assess hearing?

79. During percussion, a dull tone is expected to be heard over:

80. The attitudes of the health care professional:

81. When recording physical findings, which data are recorded first for all systems?

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

83. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?

84. Differential diagnoses belong in the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

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

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

87. Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:

88. Tympanic thermometers measure body temperature when a probe is placed:

89. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:

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

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

92. 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:

93. The infant should be placed in which position to have his or her height or length measured?

94. 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?

95. Which of the following is the most vital nutrient?

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

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

98. Mr. D. complains of a headache. During the history he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:

99. 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:

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

101
. 
Periods of silence during the interview can serve important purposes, such as: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

Pre Brief

Two days after a minor, low-speed car accident in which Tina was a passenger, she noticed daily bilateral headaches along with neck stiffness. She reports that it hurts to move her neck, and she believes her neck might be swollen. She did not lose consciousness in the accident and denies changes in level of consciousness since that time. She states that she gets a headache every day that lasts approximately 1-2 hours. She occasionally takes 650 mg of over the counter Tylenol with relief of the pain. This case study will allow you the opportunity to examine the patient’s optic nerve via use of the ophthalmoscope as well as assess her visual acuity. You will need to document your findings using appropriate medical terminology. Be sure to assess for foot neuropathy using the monofilament test. Reason for visit: Patient presents complaining of headache. NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment.

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ASSESSMENT

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Results: 
Transcript

Results: 
Subjective Data Collection

Results: 
Objective Data Collection

Results: 
Education & Empathy

Results: 
Documentation / Electronic Health Record

Results: 
Pre – Survey Lifespan

Results: 
Review Questions

Results: 
Self-Reflection

NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment

 

Objective Data Collection: 36.75 of 37 (99.32%)

 Correct

 Partially correct

 Incorrect

 Missed

Confirmed orientation

1 of 1 point

 

To Person (1/3 point)

 Oriented to person

 Not oriented to person

To Place (1/3 point)

 Oriented to place

 Not oriented to place

To Time (1/3 point)

 Oriented to time

 Not oriented to time

 Evaluated abstract thinking

1 of 1 point

 

Abstractness (1/2 point)

 Abstract

 Concrete

Relevance (1/2 point)

 Relevant

 Not relevant

 Evaluated attention span

1 of 1 point

 

Serial 7s Test (1/1 point)

 Accurate

 Not accurate

 Evaluated comprehension

1 of 1 point

 

Observations (1/1 point)

 Able to follow instructions

 Unable to follow instructions

 Evaluated general knowledge

1 of 1 point

 

Accuracy (1/1 point)

 Accurate

 Not accurate

 Evaluated judgment

1 of 1 point

 

Observations (1/1 point)

 Intact

 Not intact

 
Evaluated memory

1 of 1 point

 

Remote Memory (1/3 point)

 Intact

 Not intact

Immediate Memory (1/3 point)

 Intact

 Not intact

New Learning Ability (1/3 point)

 Accurate

 Not accurate

 Observed vocabulary

1 of 1 point

 

Complexity (1/1 point)

 Expected complex for patient’s age, education level, and general ability

 Not expected complexity

 Observed articulation

1 of 1 point

 

Observations (1/1 point)

 No observed problems with pronunciation or expression

 Imprecise pronunciation of consonants

 Slurring

 Hesitation

 Stutter

Tested olfactory nerve

1 of 1 point

 

Sense Of Smell (1/2 point)

 Able to discriminate

 Not able to discriminate

Symmetric (1/2 point)

 Symmetric bilaterally

 Asymmetric

Tested visual acuity (optic nerve)

1 of 1 point

 

Right (1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

Left (1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

Examined retina with ophthalmoscope (optic nerve)

0.75 of 1 point

 

Right: Fundus (No point)

 No visible abnormal findings

 Myelinated nerve fibers

 Papilledema

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Subjective Data Collection: 20 of 20 (100.0%)

Hover To Reveal…

Hover over the 
Patient Data
 items below to reveal important information, including 
Pro Tips
 and 
Example Questions
.

Found:

Indicates an item that you found.

Available:

Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Chief Complaint

Finding:

Established chief complaint

Finding:

Reports recent “fender bender”

(Found)

Pro Tip: Patients choose to seek treatment for a variety of reasons. Asking why Tina chose to seek treatment today might indicate primary concerns, the severity of her symptoms, or failure to manage symptoms herself.

Example Question:

Why are you seeking treatment today?

Finding:

Reports headaches

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had headaches specifies the way her individual symptoms and pain manifest.

Example Question:

Have you had any headaches?

Finding:

Reports neck symptoms

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had neck stiffness specifies the way her individual symptoms and pain manifest.

Example Question:

Have you had any neck stiffness?

History of Present Illness

Finding:

Asked about onset of symptoms

Finding:

Reports accident occurred 1 week ago

(Available)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

When did the accident happen?

Finding:

Reports symptoms began 2 days after accident

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina when the headaches begin specifies the way her individual symptoms and pain manifest.

Example Question:

When did the headaches begin?

Finding:

Followed up on details of car accident

Finding:

Denies loss of consciousness

(Found)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

Did you lose consciousness during the car accident?

Finding:

Reports low vehicle speed

(Found)

Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.

Example Question:

How fast was the car going?

Finding:

Reports wearing seatbelt

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Transcript

Started:
 Mar 18, 2020 | 
Total Time:
 219 min

All Lines (155)Interview Questions (94)Statements (3)Exam Actions (58)

Hello Tina. Welcome to our clinic. Am Pam, i will be interviewing you today, and later do a physical examination on you

Greet

Hey.

What brings you to the clinic today?

Question

Well, I got into a little fender bender a week ago and I’ve been getting these headaches ever since. And my neck is sore too.

Am sorry to hear that you are having headaches

Empathize

Thanks for saying that.

Have you had any neck stiffness?

Question

Yeah.

When did the neck stiffness begin?

Question

My neck started hurting about two days after the accident.

Am sorry that you got an accident (No matching questions found.)

Question

Am sorry that you got an accident

Empathize

Thanks.

And when did the headaches begin? (Clarified to When did the headache begin?.)

Question

 

.

.

.

 

Review Questions
Activity Time: 6 min

To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?

Correct:
 The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments L2, L3, and L4. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.

Achilles

Biceps

Patellar (Correct Response)

Triceps

Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?

Correct:
 Autonomic dysreflexia is the sudden increase in blood pressure caused by dysregulation of sympathetic and parasympathetic nervous systems reacting to a noxious stimulus below the site of spinal injury. Other symptoms include bradycardia, anxiety, blurred vision, headache, flushing, and sweating. The noxious stimulus (pulling of the Foley catheter) should be alleviated to resolve the condition.

Odynophagia

Febrile reaction

Idiopathic spinal reaction

Autonomic dysreflexia (Correct Response)

Which of the following is not a common symptom of Parkinson’s disease?

Correct:
 Parkinson’s disease is characterized by tremors at rest, bradykinesia, cogwheel rigidity, postural instability, festination, lack of facial expression, reduced arm swing, autonomic and neuroendocrine dysfunctions, and a variety of psychological issues such as depression, anxiety, and sleep disturbances.

Lack of facial expression

Festination

Cogwheel rigidity

Intention tremors (Correct Response)

Name at least three ways to assess cerebellar function during a physical exam.

Student Response:
Test cerebellar function by assessing gait and instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements

Model Note:
 The cerebellum is responsible for smooth and accurate coordination of voluntary movements. You can test cerebellar function by assessing gait and by instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements, and Romberg tests.

If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign.

 

 

Lifespan
Activity Time: 10 min

Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?

Student Response:
Rule out bacterial meningitis, there was no immunizations to increase meningitis risk.

Model Note:
 Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.

Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?

Student Response:
Differential diagnosis include stroke…

NR 602 Midterm Study Guide

Week 1: Early child development notes (chapter 6):

Toddler: 12-24 months

Preschoolers: 2-5 years old

WHO growth charts should be used to measure weight and length for children less than 24 months

CDC weight and length charts used for children older than 24 months

Average 24 month weighs 26 lbs, length 33.5 in and HC 18.5 in

Most have no palpable fontanelle by 12 months NR 602 Midterm Study Guide

Ant fontanelle closes by 18-19 months

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3-6 yrs weight gain expectation is 4.5-6.5 lbs/year

3-6 yrs height gain expectation is 2.5-3.5 inches/yr

4 yrs length at birth has doubled

4-5 years old legs grow faster than rest of the body

Use of dominant hand may appear as early as 8-12 months generally emerges 2-4 years old; handedness established at 5yrs

May develop bowel and bladder control by age 3, but many will not. Boys usually take longer than girls to maintain bedtime bladder control.

Articulation:

-24 months- 25% is understood by a stranger

-24m-36m- 66% is understood by a stranger

-3 years old- 90% should be understood by a stranger

3 and 4-year-old have a normal hesitance or show stuttering, considered abnormal if beyond 5 years of age

Speech problems often can be from lack of stimulation, hearing problems, ear infections, developmental delay. Early detection important. NR 602 Midterm Study Guide

Lexicon:

girls typically say their first word between 8-11 months; boys by 14 months

2 year olds: have more than 200 words in their vocabulary

3 years old: 900 words in vocabulary

3-4 yrs old: able to follow simple commands, talks incessantly

4-5 year olds: add at least 50 new words a month; 1500-2100 words in vocabulary (including names, coins, colors, knows days of the week) NR 602 Midterm Study Guide

5 year olds: should be able to define certain words with other words (cup: something you drink with)

Syntax:

8 months: develop receptive language- they understand what a word means before they are able to use it themselves

12-28 months: use holophrases (single words) to express whole ideas

18 months: use telegraphic speech (get milk, go bye-bye)

2 years old: short sentences

3 years old: add plurals, 3-4 word sentences

4 years old: past tense

5 years old: syntax is close to adult style, 5-6 word sentences NR 602 Midterm Study Guide

NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

Pre Brief

Three days ago, Ms. Jones injured “tweaked” her back lifting a box. The pain is in her low back and bilateral buttocks, is a constant aching with stiffness, and does not radiate. The pain is aggravated by sitting and decreased by rest and lying flat on her back. She presents today as the pain has continued and is interfering with her activities of daily living. This case study offers the opportunity to apply principles of body mechanics and range of motion to your critical thinking process. Be sure to incorporate this knowledge with your interview questions. Reason for visit: Patient presents complaining of lower back pain. NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

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Results Included:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education & Empathy

Documentation

Lifespan

Review Questions

Self – Reflection

NR 509 Week 3 Shadow Health Musculoskeletal Physical Assessment Assignment

NR 511 WEEK 1

Define diagnostic reasoning.

Identify subjective & objective data.

Identify the components of the HPI.

Develop an appropriate differential.

Describe the differences between medical billing and medical coding.

Compare and contrast the two coding classification systems that are currently used in the U.S. healthcare system.

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Discuss how specificity, sensitivity, and predictive value contribute to the usefulness of diagnostic data.

Discuss the elements that need to be considered when developing a plan.

Describe the components of medical decision making in E&M coding.

Correctly order the E&M office visit codes based on complexity from least to most complex

Define the components of a SOAP note.

Discuss a minimum of three purposes of the written history and physical in relation to the importance of documentation. NR 511 WEEK 1

Accurately document why every procedure code must have a corresponding diagnosis code.

Correctly identify a patient as new or established given the historical information.

Identify the three components required in determining an outpatient, office visit E&M code.

Describe the components of medical decision making in E&M coding.

Explain what a “well rounded” clinical experience means.

Discuss the maximum number of hours that time can … spent “rounding” in a facility.

Discuss nine things that must … documented when inputting data into clinical encounter logs.

Explain each part of the acronym the SNAPPS presentation. NR 511 WEEK 1

NR 509 Week 1 Shadow Health History Assignment

Pre-brief

Obtaining an accurate history is the critical first step in determining the etiology of a patient’s problem. A large percentage of the time, you will actually be able to make a diagnosis based on the history alone. The value of the history, of course, will depend on your ability to elicit relevant information. Your sense of what constitutes important data will grow exponentially as you practice your interviewing skills and through increased exposure to patients and illness NR 509 Week 1 Shadow Health History Assignment. However, you are already in possession of the tools that will enable you to obtain a good history. Specifically, you must listen and ask appropriate questions to define the nature of a particular problem. In fact, seasoned clinicians occasionally lose sight of this important point, placing more reliance on the use of diagnostic testing rather than taking the time to listen to their patients. Interviewing patients is an art and should remain an essential skill for successful practice.

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In this activity
, you will interview Tina Jones to collect data to assess Ms. Jones’ condition. NR 509 Week 1 Shadow Health History Assignment You will also have the opportunity to educate and empathize with Tina to engage in effective therapeutic  communication; create a problem listusing evidence from the data you collected; prioritize the identified problems to differentiate immediate from non-immediate care; plan how to best address the most important concern with further assessment, interventions, and patient education; and compare your documentation to model documentation.

Ms. Jones is a pleasant, 28-year-old obese African American single woman who presents to establish care and with a recent right foot injury. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Her speech is clear and coherent and she maintains eye contact throughout the interview. 
Reason for visit
: Patient presents for an initial primary care visit today complaining of a right foot wound. NR 509 Week 1 Shadow Health History Assignment

Results Included
:

Overview

Transcript

Subjective Data Collection

Objective Data Collection

Education and Empathy  

Documentation / Electronic Health Record

Information Processing

Certificate of Completion

NR 509 Week 1 Shadow Health History Assignment

NR 509 week 2

Even though your patient may have abnormal findings, you must document the expected normal exam findings for the system. If you would like to include the abnormal findings they should be noted in parenthesis next to the normal expected findings. The complete
 subjective and objective 
sections must be included.  You may include the assessment and plan portion of the SOAP note, but these sections will not be graded.

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You should devise a chief complaint so that you may document the OLDCART (HPI) data. 
You must use the chief complaint of sinus congestion, rash, and abdominal pain.
 You should also focus the ROS based on the patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format document in Course Resources as necessary. This will be the same format that faculty will follow during the immersion weekend.

* There are videos of the exams to be performed at immersion in Modules → Introduction and Resources→ Immersion section. Also the immersion evaluation forms are located in the Course Resources section. They should be reviewed and practiced often. NR 509 week 2

 

SOAP Note

Patient Information:

Initials
 T.K 
Age 30
. , 
Sex
 female. 
Race
 Jewish descent 
Insurance
United Health

 Chief Complain: 
Sinus Congestion, Abdominal pain and rash

Assessment: 
  

Onset of flare up:  3 days ago

Abdominal pain related to flare up from ulcerative colitis, fatigued, weight loss, chronic diarrhea with or without blood.

When percussed the abdomen had drum like sound due to inflammation and patient grimaced when palpated.

Vital Signs:  B/P 120/70, HR 85 RR, 26, T 98.3, height 5.7, weight 120 lb

Sinus Congestion, Abdominal pain and rash NR 509 week 2

Abdominal pain: Cramping, aching and bloating pain present

Aggravating Factors: bloating, diarrhea random cramping/aching bothersome pain.

Relieving Factors: Anti-diarrhea Motrin 200 mg with food as needed for pain.

Differential Diagnosis:
Ulcerative colitis, Sinusitis and urticaria

Current Medications
: Imodium AD

Ibuprofen 200 mg, take 1 caplet every 4 to 6 hours while symptoms persist

If pain does not respond to 1 caplet, 2 caplets may be used

Allergies: 
Hives when exposed to cold weather
(
Cold intolerance)

Patients Medical History:
 Sinusitis, Ulcerative colitis and headaches

Chronic diarrhea with or without blood, persistent desire to empty bowel, anorexia, nausea, vomiting present.

Last PCP visit and annual exam 2 weeks ago

Flu shot
: current

Family history
:

Father:
Suffers from mild Ulcerative Colitis

Mother:
Active healthy and owns cleaning business, had years of secondary infertility after client was born.

Siblings
: None

Psychosocial History
: Close relationship with both parents and Feels safe in home environment with parents.

Hobbies:
reading and watching movies

ROS
:

CONSTITUTIONAL
:  
No weight loss, sinusitis, abdominal pain and rash present

HEENT:

Head:
 Hair texture appears very soft and malnourished.

Eyes
: patient is using contact lens. Last eye exam 7 months ago & WNL.  No visual loss, blurred vision, double vision or yellow sclera noted. Conjunctival sac pale.

Ears:
 No hearing loss or drainage noted

Nose:
 Sinus congestion, runny nose, sneezing present, grimaced when sinus was palpated.

Throat:
 No abnormal findings noted

SKIN:  warm, dry, rash and mild itching noted.

 

CARDIOVASCULAR:  Breath sounds clear and equal bilaterally. Heart S1 S2, neither accentuated nor diminished. No murmur or extra heart sounds. No palpitations noted

 

RESPIRATORY:  Admits having shortness of breath with regular activities, such as climbing stairs, walking short distance sometimes and no coughing present.

 

GASTROINTESTINAL: Abdominal pain present, weight loss apparent. Drum like sound when percussed, frequent diarrhea from ulcerative colitis flare ups. Abdominal pain related to disease process present. TK grimaced when palpated

GENITOURINARY:  patient denies signs and symptoms of UTI, denies hesitancy, urgency, burning, no complaints reported.

NEUROLOGICAL:  Patient denies dizziness, vertigo, but fatigued and tingling, loss of sensation. No change in bowel or bladder control.

 

MUSCULOSKELETAL:  Extremities warm and equal bilaterally. All pulses present, 2+ and equal bilaterally. No lymphadenopathy present. Sensory modalities intact in legs and feet. No lesions noted.

HEMATOLOGIC:  Anemia noted, blood present in stool sometimes.

 

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

 

PSYCHIATRIC:  patient has no history of depression but needs social support and a lot of encouragement to deal with disease process. Strong family ties present.

 

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia. Lactose intolerance present

Differential Diagnosis for Rash

Urticaria

Urticaria (hives) is a pruritic, often immune-mediated skin eruption of well-circumscribed wheals on an erythematous base as cited by (Wanderer, 2000). Urticaria is the consequence of a mast cell release of mediators that increase vascular permeability, which leads to extravasation into the skin of protein-rich fluid from small blood vessels, usually post capillary venules. It is estimated that up to one fifth of the population will experience an urticarial episode and women are more likely to be affected than men however menstrual cycle can predispose a woman to urticarial or other erythematous rash especially, during the premenstrual time period. The condition could worsen three to 10 days prior to the onset of menses.  Most chronic urticaria resolves within 1 year, although persistent ones occurs in approximately 10% of cases. Many mechanisms have been implicated, and much remains incompletely understood, but mast cell activation is usually the final common pathway. Precipitants range from physical stimuli to autoimmune mechanisms. Heat, fever, emotional stress, alcohol, and premenstrual state. All of these stated precipitants can exacerbate urticaria, independent of the specific pathophysiology. Additional precipitants and mediators of the urticarial reaction are constantly being identified. The localized accumulation of fluid produces the characteristic edematous, erythematous, well-circumscribed itchy wheals, which blanch on pressure, range in size from a few millimeters to several centimeters, and manifests with serpiginous borders. Individual lesions may persist for 12 to 24 hours, but most resolve spontaneously much sooner. NR 509 week 2

Laboratory work
: history is the most useful component of the evaluation and yields clues to an underlying cause or precipitant far more often than does the physical examination or laboratory studies.

Treatment

Antihistamines provide excellent symptomatic control. The H1blockers, such as hydroxyzine (10 to 25 mg daily at bedtime) and diphenhydramine (25 to 50 mg daily at bedtime), have been the mainstay of antihistamine therapy depending on the severity. These medications are inexpensive and effective but have a sedating effect. The non-sedating H1 blockers (e.g., fexofenadine 60 mg or cetirizine 10 mg every morning) are also effective and are better tolerated for daytime use. It is often best to use a non-sedating antihistamine during the day and a more sedating agent at night. Chlorpheniramine and diphenhydramine are useful alternatives for nighttime use because they are available over the counter and are less expensive.

Ulcerative colitis
(UC) is an inflammatory bowel disease (IBD). Of the large intestine that affects the mucosal layer beginning in the rectum and colon and spreading into the adjacent tissue. Although the exact etiology of UC is unclear, it appears to be the result of an abnormal inflammatory response to intestinal microbes in genetically susceptible individuals. Predominant symptoms of UC are frequent and bloody diarrhea, cramping, abdominal tenderness, rectal bleeding, and intermittent tenesmus (i.e., straining or feeling urgency to defecate without a productive bowel movement). Severe disease is indicated by bloody or nocturnal diarrhea, weight loss, and low energy levels. Pallor, constipation, anorexia, severe weight loss, fever, vomiting, dehydration, tachycardia, and extra intestinal disease manifestations can be present. Ulcerative Colitis sufferer’s relapses or goes into remission sometimes. Mild UC is characterized by < 4 bowel movements per day with or without blood, no signs of toxicity, and normal erythrocyte sedimentation rate (ESR). Moderate UC is characterized by > 4 bowel movements per day and minimal signs of toxicity. In severe disease, bowel movements are more frequent (> 6/day) and there is evidence of toxicity, such as fever, tachycardia, anemia, and elevated ESR. NR 509 week 2. Extra intestinal disease affects 10–15% of patients with UC and can involve the joints, skin, mouth, and eyes, or manifest as liver disease, gallstones, kidney stones, peptic ulcer disease, osteoporosis, mal-absorption, amyloidosis, or thromboembolic disease. Possible complications include perforation, pseudo-polyps, toxic mega-colon, colorectal cancer (CRC), skin disorders, arthritis, lung disease, thromboembolism, and hemolytic anemia. UC is diagnosed based on patient history, physical examination, laboratory testing, radiography, and colonoscopy.  9–12 new cases per 100,000 persons diagnosed each year. Age at onset of UC shows a bimodal distribution with a large peak between 15 and 35 years of age Clinical management is focused on early recognition and resolution of severe attacks, achievement and maintenance of remission with medication, enhancement of patient quality of life, and reduction of CRC risk as cited by (Domagalski, 2017).

Laboratory Tests:
  CBC might show low hemoglobin and/or hematocrit levels, indicating anemia; WBC and platelet counts might be elevated; PT might be prolonged. Serum electrolytes and serum albumin levels will typically be decreased.  Inflammatory markers (e.g., ESR, C-reactive protein) might be elevated.  Peri-nuclear anti-neutrophil cytoplasmic antibodies with perinuclear staining (p-ANCA) are present in ~ 85% of patients with UC › Other Diagnostic Tests/Studies.  Abdominal x-ray will show the extent of disease and exclude toxic mega-colon. Endoscopic procedures (e.g., flexible sigmoidoscopy, colonoscopy) with biopsy confirm the diagnosis and define the extent and severity of disease; leukocyte scanning can be used when severe disease prohibits endoscopy.  Air-contrast barium enema in cases of mild to moderate UC show mucosal changes and complications. NR 509 week 2.

Treatment
: is individualized and commonly includes amino-salicylates, glucocorticoids, tumor necrosis factor (TNF) inhibitors, immune modulators, antibiotics, and antidiarrheal drugs. It is important to assess the severity of the disease. Bed rest or restrictive activity can be recommended. Medications like amino-salicylates (e.g., sulfaSALAzine, mesalamine), TNF inhibitors (e.g., inFLIXimab), immune modulators (e.g., azaTHIOprine), and/or I.V. corticosteroids (e.g., prednisone and antidiarrheal agents like loperamide can be helpful for client. Will continue to monitor number of stools in other to evaluate the effectiveness of treatment. It is important to closely monitor electrolyte imbalance and replace nutritional Losses and Provide Optimum Fluid Volume/Electrolyte Balance. Low residue and high calorie diet is recommended. Client will be encouraged to seek dietitian consult to individualize the diet according to tolerance, preference, meal frequency, and food presentation to minimize anorexia. Client will be encouraged to take supplemental vitamins, calcium, potassium, and iron, as ordered. Evaluation of treatment response through monitoring of intake and output, vital signs, weight, and laboratory values as well as antibiotics may be ordered whenever infectious complications develop. Client will benefit from counseling on strategies for coping with a chronic disease and to a social worker for identification of local support groups. Client will be encouraged to keep stool diary to identify irritating foods.  Health care provider will recommend nothing by mouth during exacerbation period.

Differential for Sinus Congestion

Sinusitis
is an inflammation of one or more of the four paired para-nasal sinuses surrounding the eyes. It is extremely common but likely an over diagnosed condition, with more than 30 million Americans treated for acute sinusitis annually. Many patients with nasal and sinus symptoms have self-limited viral infections or allergic conditions; the physician must distinguish these patients from the patient with a bacterial infection who may require antibiotics. Although acute sinusitis is often self-limited, there is significant morbidity associated with sinusitis. The extension of infection into the central nervous system and bone may be life threatening. The normal sinuses have sterile structures lined with ciliated epithelium. Mucus is cleared from the sinus in a directed manner toward the Ostia, or openings, which drain into the nasal cavity at the superior meatus and middle meatus. The superior meatus drains the posterior ethmoid and sphenoid sinuses, and the middle meatus drains the frontal, maxillary, and anterior ethmoid sinuses. Occlusion of these ostio-meatal complexes can lead to dysfunction of the normal sinus epithelium and bacterial infection. Although any sinus can become occluded through viral infection, anatomic abnormalities (including septal deviation, tumors, and polyps) or allergies can also predispose one to infection NR 509 week 2.

Acute Sinusitis

The common cold is actually a rhino-sinusitis that frequently involves the para-nasal sinuses. Computed tomographic study of patients with the common cold as cited by (Aring, 2011). According to (Goroll, 2014) more than n 85% have a self-limited para-nasal sinusitis which can resolve without treatment. The maxillary sinuses are the most common sites (87%), followed by ethmoidal (65%), sphenoidal (39%), and frontal (32%) involvement. Rhinorrhea and nasal stuffiness are the typical symptoms. Although symptoms may persist for well more than 10 days, those of uncomplicated viral rhino-sinusitis usually start to improve by 7 to 10 days as cited by (Chow, 2012).   Failure to improve suggests bacterial super infection. In about 0.5% to 2% of cases of the common cold, bacterial infection of the sinuses occurs, resulting in acute purulent bacterial sinusitis. It is characterized by nasal congestion, purulent nasal discharge, facial pain (which classically increases when the patient stoops forward), fever, fatigue, and other constitutional symptoms. Sinus pain or pressure and purulent nasal discharge are the defining clinical features of acute sinusitis. Maxillary sinusitis is the most common and produces pain and tenderness over the cheeks. The pain is referred to the teeth in some patients NR 509 week 2. Frontal sinusitis produces pain and tenderness over the lower forehead. Ethmoid sinusitis results in retro-orbital pain and may have tenderness over the upper lateral aspect of the nose. Isolated sphenoid sinusitis is uncommon but can present as retro-orbital, frontal, or facial pain. Purulent nasal discharge may be visualized in the middle meatus if the frontal, maxillary, or anterior ethmoid sinus is involved.

Laboratory work:
Elevated erythrocyte sedimentation rate or C-reactive protein is useful in diagnosing sinusitis; however, it is not common practice to obtain these tests.

Treatment: 
Patients with mild acute sinusitis may respond sufficiently well to the treatments listed and will not require antibiotics. In more severe cases of acute purulent sinusitis, antibiotics are commonly used. Meta-analyses of earlier studies indicate some small advantage for antibiotics in clinical improvement at 7 days, at the expense of antibiotic side effects.

Decongestants are available in both topical and systemic preparations. The mixed adrenergic agonist pseudoephedrine is reasonably effective and can be administered by mouth. Popular sympathomimetic nasal sprays include phenylephrine
(Neo-Synephrine)
and
oxymetazoline (Afrin
), which is the longest acting of the topical decongestants. Patients should be instructed to spray each nostril once and then wait a minute to allow the anterior nasal mucosa to shrink. A repeat spray will then reach the upper and posterior mucosa, including the nasal turbinate’s and sinus Ostia. This procedure can be repeated as needed every 4 hours with phenylephrine and every 12 hours with oxymetazoline for up to 3 days. Tachyphylaxis and irritation develop with prolonged topical use, but risk is minimal with short-term administration (1 to 3 days).    
Non-pharmacologic treatment:
Although large well-designed trials have not been conducted in acute sinusitis, the inhalation of steam or water and nasal irrigation with warm hypertonic saline appear to relieve symptoms of nasal congestion. Saline irrigation has improved airway patency, mucociliary clearance, and quality of life scores. A neti pot, which is a container designed for nasal irrigation, can be used several times a day NR 509 week 2.

 

Reference

Aring AM, Chan MM. Acute rhinosinusitis in adults. Am Fam Physician 2011;83:1057. (A concise review of diagnosis and treatment, advocating watchful waiting for seven days, followed by narrow-spectrum antibiotics if there is no improvement.)

 

Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012;54:e72. (IDSA guideline that advocates only using antibiotics for patients with symptoms lasting more than 10 days or with severe symptoms for 3 days. Amoxicillin– clavulanate is recommended as the first-line treatment based on epidemiology of causative agents. NR 509 week 2)

 

Domagalski, J. E. (2017). Ulcerative colitis. In F. J. Domino (Ed.), The 5-minute clinical consult standard 2017 (25th ed., pp. 1078-1079). Philadelphia, PA: Wolters Kluwer.

 

Wanderer AA, Bernstein IL, Goodman DL, et al. The diagnosis and management of urticaria: a practice parameter. Ann Allergy Asthma Immunol 2000;85:521. (A practice parameter paper.) NR 509 week 2

NR 509 APEA Test (HEENT) / NR 509 APEA Exam 2019 (HEENT): Advanced Physical Assessment: Chamberlain

Question 1:
 The function of the auditory ossicles is to:

Question 2:
 A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of:

3. A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with:

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4. Assessment of a patient’s visual acuity resulted in 20/200 using the Snellen eye chart. This means that:

5. Findings following assessment of a person’s left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with: a conjugate gaze.

6. Findings following assessment of a person’s eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: a conjugate gaze. NR 509 APEA Test (HEENT)

7. A patient was diagnosed as being farsighted. The term for this condition is:

8.  buildup of excess fluid around the periphery of the eye orbits is known as:

9. hat connects the middle ear to the nasopharynx?

10. The fleshly projection of the earlobe is known as the:

11.Then examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of:

12. A deposit of uric acid crystals appearing as hard nodules on the helix or antihelix is termed:

13. n the outer ear, anterior and parallel to the helix, is a curved prominence known as the:

14. On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of:

15. A six-year-old complains that something is in her left eye. There is a red raised area of the left lid. There is redness and tenderness of the eye and tearing. These findings are consistent with:

16. Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the: vein “winds” down on either side of the artery.

17.  A patient presents with complaints of burning, itching, tearing, and some pain in the eye. Findings reveal red, scaly, greasy flakes and thickened, crusted lid margins. This would be suggestive of:

18. Ophthalmoscopic examination of the fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with:

19. Redness, bleeding, pain, and swelling of the gums is most likely nr 509 apea exam

20. Ophthalmoscopic examination of the retina reveals a normal arteriovenous crossing. This appears as if the:

21. Otosclerosis is an example of a(n):

22.  Which of the following findings in a preschooler would indicate the need for further evaluation?

23. A 50- year-old patient complains of being unable to read the hymnal at church. This describes:

24. The gradual loss of vision with a change in color and size of the optic disc is referred to as:

25. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner’s right hand nr 509 apea exam NR 509 APEA Test (HEENT)

26. A 30-year-old patient presents with complaints of seeing double in the right eye. Examination reveals diplopia in the right eye when the left eye is …… This may be suggestive of a:

27. One cause of nasal septum perforation may be:

28. A 30-year-old patient presents with a moderate “aching” in his right eye. Findings reveal a small and irregular shaped right pupil.

29. Sudden bilateral and painless visual loss is rare but can be associated with all the following except:

30. On ophthalmoscopic examination, optic atrophy appears:

31. Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the: vein tapes down on either side of the artery.

32. Causes of sensorineural hearing loss include all of the following except nr 509 apea exam

33. What visual acuity constitutes legal blindness?

34. An example of a cause of conductive hearing loss in children would be:

35. Miosis is a term used to describe:

36.  If a patient complains of seeing flashing lights across the field of vision, this could be: NR 509 APEA Test (HEENT)

NR 509 APEA Exam – Women’s Health (Question and Answers with Explanation)

Question 1:
 When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of:

Question 2:
 In a female diagnosed with a first-degree uterine prolapse, the cervix:

3: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except:

4: A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with:

5: The most common causes of sexual problems in females are …..

6: Chronic pelvic pain refers to pain that does not respond to therapy and:

7: In female patients with dyspareunia, superficial pain is most likely related to all of the following except:

8: If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and:

9: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a: NR 509 APEA Exam – Women’s Health

10: When performing a bimanual vaginal exam, a solid, nodular-like lesion is palpated over the right ovary. This finding is most consistent with:

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11: Indications for performing a rectovaginal exam include all of the following except to:

12: Examination of a female patient’s right breast reveals a retraction of the nipple and areola. This finding is consistent with:

13: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for:

14: Upon examination of the vagina, a tense, hot, very tender abscess with labial swelling is noted. This finding is most consistent with a:

15: A female patient has a history of a retroverted uterus. This condition refers to:

16: Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a: NR 509 APEA Exam – Women’s Health

17: Urethritis in a female patient may arise from all of the following organisms except:

18: To palpate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen:

19: When do the ovaries become non-palpable after menopause?

20: When performing a rectal exam on a female, a hard nodular rectal “shelf” is palpable at the tip of the examiner’s finger. This finding is suggestive of:

21: A twenty-year-old female complains of a milky discharge bilaterally from her breasts. This suggests:

22: A woman complains of infrequent menses with intervals greater than 35 days. This condition is …..

23: The most common cause of acute pelvic pain in women is:

24: When performing a vaginal exam with a speculum, the use of the upper blade as a retractor could expose a:

25: When preparing to perform a pelvic exam in an older female, vaginal atrophy is noted. Due to this finding, the speculum:

26: Upon examination of the cervix, a yellow drainage is visible around the cervical os. This finding is most likely suggestive of:

27: When examining the cervix, a bright, red, soft and fragile lesion is noted on the cervical surface. This finding is consistent with:

28: During examination of the vagina, a bulge in the upper two-thirds of the anterior vaginal wall is noted. This symptom is most consistent with a:

29: The most common type of hernia in women is the:

30: A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with:

31: When performing a bimanual vaginal exam, a smooth and rather compressible non-tender lesion is palpated over the right ovary. This finding is most consistent with: NR 509 APEA Exam – Women’s Health

32: When performing the bimanual vaginal exam, a nodule on the anterior uterine surface could suggest a (an):

33: Cessation of the menses for 12 months is ….

34: A woman complains of experiencing uterine bleeding between expected menstrual cycles. This condition is …..

35: A 45-year old female presents to the nurse practitioner with complaints of postcoital bleeding (greater than spotting) unrelated to the menstrual cycle. What is the most likely cause?

36: When performing the bimanual vaginal exam, uterine enlargement is …… This enlargement could suggest:

37: In which of the following situations would it be difficult for the examiner to palpate an ovary during the bimanual vaginal exam?

38: Causes of post menopausal bleeding typically include all of the following except:

39: A 35-year-old female presents with complaints of swelling of her right breast. Findings reveal edema of the lower portion of her right breast. The skin appears thickened with enlarged pores. This condition is consistent with:

40: The shiny, pink area located around the cervical os is ….as nr 509 apea exam

41: During a speculum exam of the cervix the speculum is maintain in an open position by:

42: A female patient presents with a white and curd-like thin vaginal discharge. This discharge is most consistent with:

Question 43:
 Upon examination of the vagina, a bulge is …..in the lower posterior wall of the vagina. This finding is most consistent with a:

Question 44:
 Upon examination of the cervix, an irregular cauliflower-like growth was ….around the cervical os. This finding is most suggestive of:

45: Upon examination of the vagina, a small, red, benign tumor is …..at the posterior part of the urethral meatus. This finding is most consistent with a:

46: To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and:

47: An ulcerated vulvar lesion in an elderly woman may indicate nr 509 apea exam

48: Pelvic floor muscle weakness may be due to all of the following except:

49: In a female diagnosed with a third-degree uterine prolapse, the cervix:

50: A woman complains of abnormally heavy and prolonged menstrual periods that occur at regular intervals. This condition is most likely:

51: In a female diagnosed with a second-degree uterine prolapse, the cervix:

52: A woman complains of experiencing frequent menses with intervals of fewer than 21 days. This condition is …..

53: If performed correctly and in a timely fashion, which one of the following is most definitive for the diagnosis of breast cancer?

54: Retraction of the nipple and areola suggest:

55: The vaginal mucosa lies in transverse folds ……

56: The most important risk factor for cervical cancer is nr 509 apea exam

57: When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be ….into the vagina while exerting pressure primarily:

58: Fixed flattening of the nipple suggests:

59: Chronic pelvic pain may be secondary to all of the above except:

60: When discussing the female anatomy, the introitus is also ….as the nr 509 apea exam

61: When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is:

62: To palpate the right ovary when performing the bimanual vaginal exam, the abdominal hand should be on the right lower quadrant and the pelvic hand needs to be:

63: When performing an examination of the external genitalia of a female patient, a small, firm, round cystic nodule in the labia is …… This lesion is most consistent with: NR 509 APEA Exam – Women’s Health

64: Primary dysmenorrhea results from:

65: The deep red area located around the cervical os is ….as nr 509 apea exam

66: When examining the cervix, a translucent nodule is …..on the cervical surface. This finding is consistent with:

67: To palpate the left ovary when performing the bimanual vaginal exam, the abdominal hand should be on the left lower quadrant and the pelvic hand needs to be:

68: When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a: NR 509 APEA Exam – Women’s Health

NR 509 Week 1 Quiz (25 Points) – Question and Answers

A patient tells the FNP that he is very nervous, that he is nauseated, and that he “feels hot”. This type of data would be:

The patient’s record, laboratory studies, objective data, and subjective data combine to form the:

The FNP is reviewing information about evidence-based practice. Which statement best reflects evidence-based practice?

A 59-year-old patient tells the FNP that he has ulcerative colitis. He has been having black stools for the last 24 hours. How would the FNP best document his reason for seeking care?

A 29-year-old woman tells the FNP that she has excruciating pain in her back. Which would be an appropriate response by the FNP to the woman statement?

In recording the childhood illnesses of a patient who denies having had any, which note by the FNP would be most accurate?

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If a female patient tells the FNP that she has had six pregnancies, with four live births at term and two spontaneous abortions. Her four children are still living. How would the FNP record this information?

Which of these statements represents subjective data the FNP obtained from the patient regarding the patient’s skin?

The FNP is obtaining a history for a 30-year-old male patient and is concerned about health promotion activities. Which of these questions would be appropriate to use to assess health promotion activities for this patient? NR 509 WEEK 1-7 QUIZ

Which statement indicates that the FNP understands the pain experienced by an elderly person?

The FNP is performing a vision examination. Which of these charts is most widely used for visual examination?

During a complete health assessment, how would the FNP test the patients hearing? nr 509 week 1 quiz

The FNP has just completed an examination of a patient’s extra-ocular muscles. When documenting the findings, the FNP should document the assessment of which cranial nerves?

A patient’s uvula rises midline when she says “ahh” and she has a positive gag reflex. The FNP has just tested which cranial nerve?

During an examination the FNP notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with successful performance of this action?

A patient is unable to shrug her shoulders against the FNP‘s resistant hands. What cranial nerve is involved with successful shoulder shrugging?

During an examination, the patient has just successfully completed the finger to nose and rapid alternating movements test and is able to run each heel down the opposite shin. The FNP would conclude that the patient’s___ function is intact

A five-year-old child is in the clinic for checkup. The FNP would expect him to:

When the FNP performs the confrontation test the FNP has assessed: nr 509 week 1 quiz

Which of these statements is true regarding the complete physical assessment?

…. recording of data from the history and physical examination?

… in assessment of general appearance? nr 509 week 1 quiz

The FNP is performing a review of symptoms. Which of these questions are appropriate as Health promotion questions to ask during this time? NR 509 WEEK 1-7 QUIZ

The FNP is incorporating a person’s spiritual values into the health history. Which of these questions illustrates the community portion of the FICA questions?

The FNP is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins?

 

NR 509 Week 2 Quiz (25 Points) – Question and Answers

A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:

During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:

The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to:

When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____

When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:

The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland

A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:

The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:

The FNP is aware that the four areas in the body were lymph nodes accessible are the: nr 509 week 2 quiz

A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:

The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?

A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:

A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:

A patient’s vision is ……as 20/80 in each eye. The FNP interprets this finding to mean that nr 509 week 2 quiz

When performing the corneal light reflex assessment, the FNP notes that the light is …..at 2 o’clock in each eye. The FNP should

The FNP is performing the diagnostic positions test. Normal findings would be which of these results? nr 509 week 2 quiz

During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?

A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?

The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?

The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?

During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings

During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. These findings are reflective of:

The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?

The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy:

 

NR 509 Week 3 Quiz (25 Points) – Question and Answers

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the girl complains:

A patient has been diagnosed with osteoporosis and asked the FNP “what is osteoporosis?” The FNP explains to the patient that osteoporosis is defined as:

Patient states, “I can hear a crunching or grating sound when I kneel”. She also states “that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints”. The FNP should assess for signs of what problem?

When taking the history on a patient with a seizure disorder the FNP assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?

The FNP is teaching a class on osteoporosis prevention to a group of post menopausal women. A participant shows that she needs more instruction when she states I will:

The FNP is performing a neurological assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patella. Given this information what would the FNP suspect?

And 80-year-old woman is visiting the clinic for a check up. She states “I can’t walk as much as I used to”. The FNP is observing from motor dysfunction in her hip and should have her:

The FNP is testing the function of cranial nerve XI. Which of these best describes the response the FNP should expect if the nerve is intact? The patient:

A 50-year-old woman is in a clinic for weakness in her left arm and leg that she noticed for the past week. The FNP should perform which type of neurologic examination?

During the neurological assessment of a healthy 35-year-old patient the FNP asks him to relax his muscles completely. The FNP then moves each extremity through full range of motion. Which of these results would the FNP expect to find?

A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The FNP tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift and posture is known as

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasm’s. The FNP should suspect:

A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will assess for tenderness at the:

The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalens test. To perform this task the FNP should instruct the patient to:

During the history a patient tells the FNP that “it feels like the room is spinning around me”. The FNP would document this as: nr 509 week 3 quiz

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception the FNP decides to complete the test as quickly as possible. When the FNP applies the sharp point of a pin on his arm several times he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this?

An 85-year-old patient comments during his annual physical that “he seems to be getting shorter as he ages”. The FNP should explain that decrease height occurs with aging because:

A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The FNP should assess for other signs of what problem?

When the FNP asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this finding as:

During an assessment of the cranial nerves the FNP finds the following asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air when the FNP presses against the right path cheek. This would indicate dysfunction of which of these cranial nerves? nr 509 week 3 quiz

The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group?

In obtaining a history on a 74 year old patient the FNP notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold thing. With this information what should the FNP‘s response be?

During a history of a 78-year-old man his wife states that “he occasionally has problems with short-term memory loss and confusion. He can’t even remember how to button his shirt”. In doing the assessment of his sensory system which action of the FNP‘s is most appropriate?

While obtaining a history of a 3 month old infant from the mother the FNP asks about the infants ability to suck and grass the mothers finger. What is the FNP assessing? nr 509 week 3 quiz

The FNP is doing an assessment on a 29-year-old woman who visits the clinic complaining of always dropping things and falling down. While testing rapid alternating movements the FNP notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What should the FNP suspect?

 

NR 509 Week 4 Quiz (25 Points)

A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?

The direction of blood flow through the heart is best described by which of these

In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would

When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are

The sack that surrounds and protects the heart is called the

When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?

The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?

During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process?

The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?

In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?

The FNP is assessing the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a____pulse NR 509 WEEK 1-7 QUIZ

A patient complains of leg pain that wakes him at night. … states that he has been having problems with his legs. He has pain in his legs when they are … and disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing

During an assessment the FNP uses the profile sign to detect nr 509 week 4 quiz

 … these statements describes the closure of the valves in a normal cardiac cycle?

When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next

A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing

In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. nr 509 week 4 quiz  Which of these findings can … explained by expected hemodynamic changes related to age?

The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?

The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?

A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?

Findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is … 45°. The FNP knows that this finding indicate:

The component of the conduction system referred to as the pacemaker of the heart is the nr 509 week 4 quiz

The FNP is reviewing anatomy and physiology of the heart. Which statement best describes what is … by atrial kick?

A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be NR 509 WEEK 1-7 QUIZ

When assessing a patient the FNP notes that the left femoral pulse as diminished 1+/4+. What should the FNP do next?

 

NR 509 Week 5 Quiz (25 Points) – Question and Answers

An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to

The FNP is examining a patient who tells the FNP “I sure sweat a lot especially on my face and feet but it doesn’t have an odor”. The FNP knows that this could be related to

During an abdominal assessment the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder which of these structures?

An Inuit visiting Nevada from anchorage has come to the clinic in July during the hottest part of the day. It so happens that the clinics air conditioning is broken and the temperature is very hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?

The FNP notices that a patient has black, tarry stool and recalls that a possible cause would be

The FNP knows that during an abdominal assessment deep palpation is used to determine

The FNP is assessing the abdomen of an aging adult. Which of these statements regarding an aging adult and abdominal assessment is true?

During examination the FNP finds that a patient has excessive dryness of the skin. The best term to describe this condition is

A FNP notices that a patient has ascites, which indicates the presence of nr 509 week 5 quiz

The FNP is performing percussion during an abdominal assessment. Percussion notes during the abdominal assessment may include

The FNP is caring for a black child who has been diagnosed with marasmus. The FNP would expect to find the

The FNP just noted from a patient’s medical record that the patient has a lesion that is confluent in nature. On examination the FNP would expect to find

The FNP is assessing the abdomen of a pregnant woman who is complaining of having acid indigestion all the time. The FNP knows that esophageal reflux during pregnancy can cause

The patient has abdominal borborygmi. The FNP knows that this term refers to nr 509 week 5 quiz

A patient has a terrible itch for several months that he has been scratching continuously. On examination the FNP might expect to find NR 509 WEEK 1-7 QUIZ

During aging process, the hair can look gray or white and begin to feel thin and fine. The FNP knows that this occurs because of a decrease in number of functioning

The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding the FNP would report this as a

During an abdominal assessment the FNP would consider which of these findings as normal?

A 52 -year-old Woman has a papule on her nose that has a rounded pearly border and a central red ulcer. She said she first noticed it several months ago and that it is slowly growing larger. The FNP suspects which condition?

The FNP is listening to bowel sounds. Which of these statements is true about bowel sounds?

The FNP is watching a new graduate FNP perform auscultation of a patient abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation proceeds percussion and palpitation of the abdomen?

A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of

The patient is ….of having inflammation of the gallbladder or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?

A newborn infant is in the clinic for a well baby check. The FNP observes the infant for possibility of fluid loss because of which these factors?

During an assessment of a newborn infant, the FNP recalls that pyloric stenosis would be manifested by nr 509 week 5 quiz

 

NR 509 Week 6 Quiz (25 Points) – Question and Answers

A woman has come to the clinic to seek help with a substance-abuse problem. She admits to using cocaine just before arrival. Which of these assessment findings would the FNP expect to find when examining the woman?

A 63-year-old Chinese American man enters the office with complaints of chest pain, shortness of breath, and palpitations. Which statement most accurately reflect the FNPs best course of action?

The FNP is planning to assess new memory with the patient. The best way for the FNP to do this would be

During the health history the FNP asks a female patient “how many alcoholic drinks do you have a week?” Which answer by the patient would indicate at risk drinking?

Symptoms such as pain are often influenced by a person’s cultural heritage. Which of the following is a true statement regarding pain? NR 509 WEEK 1-7 QUIZ

The FNP suspect abuse when a 10-year-old child is taken to the urgent care center for leg injury. nr 509 week 6 quiz The best way to document the history and physical findings is to

During a mental status assessment, which question by the FNP would best assess a persons judgment?

The FNP is performing a mental status assessment on a five-year-old girl. Her parents are undergoing a bitter divorce and are worried about the effect it is having on their daughter. Which action or statement might leave FNP to be concerned about the girls mental status?

During mental status examination, the FNP wants to assess a patient’s affect. The FNP should ask the patient which question?

During an examination FNP notices a patterned injury on a patients back. Which of these would cause such an injury?

The FNP is aware that intimate partner violence screening should occur with which situation?

Which statement is best for the FNP to use when preparing to administer the abuse assessment screen?

The FNP is conducting a class on alcohol and the effects of alcohol on the body. How many standard drinks (each containing 12 g alcohol) Per day are associated with increased deaths from cirrhosis, cancers of the mouth, esophagus and injuries in men?

A woman who has just discovered that she is pregnant is in the clinic for her first obstetric visit. She asked the FNP how many drinks a day safe for my baby? The FNP‘s best response is

The FNP is performing the Denver II screen test on a 12 month old infant during a routine well child visit. The FNP should tell the infants parents that the Denver II

Which term refers to a one produced by tearing or splitting of body tissue usually from blunt impact of a bony surface NR 509 WEEK 1-7 QUIZ

When reviewing the use of alcohol by older adults the FNP notes that the older adults have several characteristics that can increase the risk of alcohol use which would increase the bioavailability of alcohol in the blood for longer periods of time in the older adult?

The FNP is reviewing concepts of cultural aspects of pain. Which statement is true regarding pain?

The FNP is planning to assess a child using behavioral checklist. This tool is most appropriate for a(an)

The FNP is … orientation in a 79-year-old patient. Which of these responses would leave the FNP to conclude that the patient is … ?

As a mandatory reporter of elder abuse, which of these must be present before an FNP notifies the authorities?

A 30-year-old female patient is describing feelings of hopelessness and depression. She has attempted self-mutilation and has a history of prior suicide attempts. She describes difficulty sleeping at night and has lost 10 pounds in the past month. Which of these statements or questions is the FNP‘s best response in this situation? nr 509 week 6 quiz

For persons age 12 years and older which of these illicit substances was one of the most commonly used?

Which of these individuals would the FNP consider at highest risk for suicide attempt?

The FNP is assessing a patient who has … admitted for cirrhosis of the liver secondary to chronic alcohol use. nr 509 week 6 quiz During the physical assessment the FNP looks for cardiac problems that are … with chronic heavy use of alcohol such as

NR 509 Week 7 Quiz – Question and Answers

During an examination of an aging male the FNP recognizes that normal changes to expect would be:

During a health history, a 22-year-old woman asks “can I get that vaccine for HPV? I have gentle warts and I’d like them to go away!” What is the FNP‘s best response?

During a speculum inspection of the vagina the FNP would expect to see what at the end of the vaginal canal?

A 62-year-old man is experiencing fever, chills, malaise, urinary frequency and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. The symptoms are most consistent with which of the following?

When performing a genital examination on a 25-year-old man the FNP notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information the FNP would:

The mother of a 10-year-old boy asks the FNP to discuss the recognition of puberty. The FNP should reply by saying:

The uterus is usually positioned tilting forward and superior to the bladder. This position is known as

A male patient with possible fertility problems asks the FNP where sperm is produced. The FNP knows that sperm production occurs in

A 15-year-old boy is seen in the clinic for complaints of dull pain and pulling in the scrotal area. On examination the FNP palpates a soft, irregular mass posterior to and above the testes on the left. This mass collapses when the patient is supine in refills when he is up right. This description is consistent with:

In performing an assessment of a woman’s axillary lymph system the FNP should assess which of these nodes?

A patient contacts the office and tells the FNP that she is … about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is … because the left breast is not enlarged. What would be the FNP‘s best response?

An 11-year-old girl is in the clinic for a sports physical. The FNP notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. … use which of these techniques to best assist the young girl in understanding the expected sequence for development? The FNP should: NR 509 WEEK 1-7 QUIZ

A 54-year-old woman who has just completed menopause is in the clinic today for yearly physical examination. Which of these statements should the FNP include in patient education? A post menopausal woman:

A 62-year-old man states that his doctor told him that he has an inguinal hernia. He asks the FNP to explain what a hernia is….. :

When performing a genital assessment on a middle-age man, the FNP notices multiple soft, moist, painless papules in the shape of cauliflower like patches scattered across the shaft of the penis. These lesions are characteristics of:

If a patient reports a recent breast infection, then the FNP should expect to find_____node enlargement

A 9-year-old girl is in the clinic for a sports physical. After some initial shyness she finally ….“am I normal? I don’t seem to need a bra yet, but I have some friends who do. What if I never get breasts?” The FNP‘s best response would be:

Which of these statements about the testes this true?

During an examination FNP observes a female patients vestibule and expect to see the

A 14-year-old girl is anxious about not having reached menarche. When taking history, the FNP should ascertain which of the following? The age:

A woman who is 22 weeks pregnant has a vaginal infection. She tells the FNP that she is afraid that the infection will hurt the fetus. The FNP knows that which of these statements is true?

In performing a breast examination the FNP knows that it is especially important to examine the upper outer quadrant of the breast. The reason for this is that the upper outer quadrant

An accessory glandular structure for the male genital organs is the

 …. true regarding the penis?

__ 8 weeks pregnant is in the clinic for a check up. The FNP reads on her chart that her cervix is … and looks cyanotic. The FNP knows that the woman is exhibiting____sign and _____sign NR 509 WEEK 1-7 QUIZ