Exam (elaborations)
NUR 634 MIDTERM EXAM LATEST 2024 VERIFIED EXAM WITH ANSWERS GRADED A+
- Course
- NUR 634
- Institution
- Ball State University
NUR 634 MIDTERM EXAM LATEST 2024 VERIFIED EXAM WITH ANSWERS GRADED A+
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NUR 634 MIDTERM EXAM LATEST 2024 VERIFIED EXAM WITH A NSWERS GRADED A+ NUR 634 Advanced Health Assessment 2024/2025 BALL STATE UNIVERSIT Y A 77 -year -old retired bus driver comes to your clinic for a physical examination at his wife's request. He has recently been losing weight and has felt very fatigued. He has had no chest pain, shortn ess of breath, nausea, vomiting, or fever. His past medical history includes colon cancer, for which he had surgery, and arthritis. He has been married for over 40 years. He denies any tobacco or drug use and has not drunk alcohol in over 40 years. His par ents both died of cancer in their 60s. On examination his vital signs are normal. His head, cardiac, and pulmonary examinations are unremarkable. On abdominal examination you hear normal bowel sounds, but when you palpate his liver it is abnormal. His rect al examination is positive for occult blood. What further abnormality of the liver was likely found on examination? A. Smooth, large, nontender liver B. Irregular, large liver C. Smooth, large, tender liver D. Irregular, small, nontender ANS: B Feedback: With his past history of colon cancer and with recent weight loss and fatigue, a relapse of his colon cancer would be expected. Colon cancer usually metastasizes to the liver, creating hard, irregular nodules, which can sometimes be palpated on examinatio n. A smooth, large liver which is tender is often seen in hepatitis. A 21 -year -old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any oth er upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She ha s had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local un iversity and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high -pitched whistling on expiration in all lobes. Percussion reveals resonant lu ngs. Which disorder of the thorax or lung does this best describe? A. Spontaneous pneumothorax B. Chronic obstructive pulmonary disease (COPD) C. Asthma D. Pneumonia ANS: C Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often as sociated with a history of allergies and can be made worse by exercise or irritants such as smoke in a bar. On auscultation there can be normal to decreased air movement. Wheezing is heard on expiration and sometimes inspiration. The duration of wheezing i n expiration usually correlates with severity of illness, so it is important to document this length (e.g., wheezes heard halfway through exhalation). Realize that in severe asthma, wheezes may not be heard because of the lack of air movement. Paradoxicall y, these patients may have more wheezes after treatment, which actually indicates an improvement in condition. Peak flow measurements help to discern this. . A 17 -year -old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right -sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medi cal history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He d enies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the ri ght side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe. What disorder of the thorax or lung best describes his symptoms? A. Spontaneous pneumothorax B. Chronic obstructive pulmonary disease (COPD) C. Asthma D. Pneumonia ANS: A Feedback: In left -sided heart failure, fluid starts “backing up” into the lungs because the heart is unable to handle the volume. The excess fluid collects in the dependent are as, causing crackles in the bases of the lower lobes. Sitting up allows patients to breathe easier. The two main causes are chronic high blood pressure and coronary artery disease, which lead to myocardial ischemia and decreased contractility of the heart. . A 60 -year -old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can't do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. Sh e had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination she is in no acute distress. Her blood pressure is 160/100 and her pulse is 100. She is afebrile and her respiratory rate is 16. With auscultation she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination the S1 and S2 are distant and an S3 is heard over the apex. What disorder of the chest best describes her symptoms? A. Pneumonia B. Chronic obstructive pulmonary disease (COPD) C. Pleural pain D. Left -sided heart failure ANS: DThe benefits of buying summaries with Stuvia:
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