CURRENTLY TESTING SOLUTIONS OF NUR 634 MIDTERM EXAM
QUESTIONS WITH ACTUAL CORRECT DETAILED ANSWERS
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand"
ANS: C
Feedback: This patient is here to establish care, and because she is new to you, a comprehensive health
history is appropriate.
The following information is recorded in the health history: "The patient completed 8th grade. He
currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass
factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems
ANS: C
Feedback: Personal and social history information includes educational level, family of origin, current
household status, personal interests, employment, religious beliefs, military history, and lifestyle
(including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and
history). All of this information is documented in this example
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Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has
noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would
you tell her regarding her rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
D. It should not cause any problems.
ANS: A
Feedback: A “palpable purpura” is usually associated with a vasculitis. This is an inflammatory condition
of the blood vessels often associated with systemic rheumatic disease. It can cut off circulation to any
portion of the body and can mimic many other diseases in this manner. While allergic and chemical
exposures may be a possible cause of the rash, this patient's SLE should make you consider vasculitis
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow
pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance
when her palms face the floor. What condition does she have?
A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture
ANS: C
Feedback: Mary’s injury probably occurred by lifting heavy buckets with her palms down (toward the
bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has
reproducible pain when palmar flexion against resistance is performed and also features tenderness over
,the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process.
A supracondylar fracture of the humerus is a major injury and would present more acutely.
Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on
vacation, and she wanted to be seen. You have heard about her many times from your colleague and are
aware that she is a very talkative person. Which of the following is a helpful technique to improve the
quality of the interview for both the provider and the patient?
A. Allow the patient to speak uninterrupted for the duration of the appointment.
B. Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her
focus on one aspect of what she told you.
C. Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the
course of the interview.
D. Allow your impatience to show so that the patient picks up on your nonverbal cue that the
appointment needs to end.
ANS: B
Feedback: You can also say, “I want to make sure I take good care of this problem because it is very
important. We may need to talk about the others at the next appointment. Is that okay with you?” This is
a technique that can help you to change the subject but, at the same time, validate the patient's
concerns; it also can provide more structure to the interview
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-
side directions. Which of the following is most likely?
A. Cancer
B. Lymph node
C. Deep scar
D. Muscle
ANS: B
Feedback: A useful maneuver for discerning lymph nodes from other masses in the neck is to check for
their mobility in all directions. Many other masses are mobile in only two directions. Cancerous masses
may also be “fixed,” or immobile
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, shortness 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 parents 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 rectal 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. Irregula
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 examination. 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 other 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 has 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 university 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
ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough. It is often associated 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 in 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. Paradoxically, 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 medical
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 denies 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 right side of his superior chest wall. On percussion he is hyperresonant over the right
upper lobe. With palpation he h
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 areas, causing crackles in the bases of
