NURS 612 Maryville Exam 4 MC question and answer with rated solutions

NURS 612 Maryville Exam 4 MC question and answer with rated solutions A patients inability to follow simple instructions could indicate with of the following findings? A. Dysphonia B. Amnesia C. Aphasia D. Depression D. Depression A patient scores a 3 on a mini-cog assessment instrument for dementia, What does this score indicate? A. Advanced dementia B. Early dementia C. Need for further evaluation D. Negative screen for dementia D. Negative screen for dementia The examiner asks the patient to complete this statement: "A bird is to air as a fish is to _________." This is an example of what type of testing? A Calculation B Analogies C Judgment D Mood and feelings B. Analogies Assume that the patients response to the examiner in question 3 is scales. What does this response likely reflect? A. Left cerebral hemisphere lesion B. Depression C. eating disorder D. Aphasia A. Left cerebral hemisphere lesion Which type of assessment should be used to evaluate the mental status of a patient with head trauma? A. PHQ B. Perceptual distortion assessment C. Glasgow Coma Scale D. Functional Assessment C. Glasgow Coma Scale Which of the following indicates possible cognitive impairment? A. ability to complete personal care without assistance B. Suspiciousness or inappropriate affect C. Articulate communication D. Prudent behavior and calm demeanor B. Suspiciousness or inappropriate affect A 65-year old woman is brought to the clinic by family. They report thieve have noticed a change in her mental abilities over the past 2 weeks. Normally they say she is independent, intelligent and very socially oriented. Medical history is unremarkable except for congestive heart failure, for which she takes digoxin. She has had no major changes in her health. What questions would be most important for the examiner to ask the woman's family? A. Is there a family hx of Alzheimers? B. How much alcohol does she drink in an average week? C. When was her digoxin level last checked? D. Did you know that the mental function begins to decline after the age of 60 ? C. When was her digoxin level last checked? A patient who has difficulty writing or drawing is most likely to have what condition? A. Temporal lobe damage B. Peripheral neuropathy C. Organic brain syndrome D. Psyciatric hallucinations B. Peripheral Neuropathy A mother brings her 18 month old to the clinic. The child rarely talks or smiles or makes eye contact. She has also notice he does not like to be held. She says his motor development seems to be normal. What are these symptoms consistent with? A. Dementia B. Autistic disorder C. ADHD D. Delirium B. Autistic disorder A patient with Alzheimers disease classically displays which of the following? A. alternating periods of mania and stupor B. Hallucinations and decorticate posturing C. Disintegration of personality D. Rapid onset of symptoms C. Disintegration of personality While examining a newborn male infant, the examiner palpates a testicle in the inguinal canal that cannot be pushed into the scrotum. this finding is consistent with what? A. A retractile testi B. Ambiguous genitalia C. Inguinal hernia D. undescended testicle D. Undescended testicle Genital self examination should be taught to patients who are at risk for? A. testicular cancer B. Peyronie disease C. STD D. prostate enlargement C. STD On exam of a patients scrotum you note the it is unusually thickened and it pits. What is one type of problem suggested by these findings? A. STD B. Squamous cell skin cancer C. Liver disease D. Autoimmune disease C. Liver disease While examining the genitalia of a 2 yr old boy the examiner should be aware. A. scrotum has edema until age 4 B. Foreskin of uncircumcised penis is not fully retractable until age 3-4yrs C. testicles typically do not descend into the scrotum until age 5 D. Cremasteric reflex does not become evident until age 6-7. B. Foreskin of uncircumcised penis is not fully retractable until age 3-4yrs. Which item in the patient history is considered a risk factor for cancer of the penis? A. circumcised at birth B. history of condyloma acuminatum infections C. Had congenital hydrocele D. History of untreated epispadius B. History of condyloma acuminatum infections In which of the following situations is transillumination of the scrotum indicated? A. presence of syphillis chancre is noted B. indirect hernia is palpated C. the examiner suspects a mass D. the examiners palpates the testes. C. the examiner suspects a mass The patient is asked to bear down while the examiner palpates the inguinal ring. The examiner feels a soft swelling sensation on the fingertip. the patient complains of pain while straining. These findings are consistent with which of the following? A. Indirect hernia B. Direct hernia C. Femoral hernia D. Rectal hernia A. Indirect hernia The examiner inspects the scrotum of 43 yr old man. Which of the following requires further evaluation? A. left teticle hangs lower than the right B. Scrotum is darker than general skin color C. Skin on scrotum is shiny and smooth D. Scrotum has a midline raphe. C. Skin on scrotum is shiny and smooth Which finding may indicate diabetes? A. the vas deferens feels lumpy or beaded B. The testicle feels hard with a lump C. Sebaceous cysts are present on the scrotal skin D. The urethra has a slit like orifice A. The vas deferens feels lumpy or beaded. During an examination for a hernia and adult male should: A. Be asked to stand B. be in a supine position C. sit on the table with heels together D. Assume a knee-chest position on the exam table. A. be asked to stand Which of the following testicular characteristics is associated with syphilis or diabetic neuropathy? A. Asymmetry or drooping B. Bilateral enlargement C. Insensitivity to pain D. Migration to abdomen C. Insensitivity to pain What type of hernia would you typically see in a 15 year old male? A. femoral B. umbilical C. direct inguinal D. indirect inguinal C. Direct inguinal hernia Which patient characteristics is associated with smegma as an expected finding? A. uncircumcised B. prepubertal C. sexually active D. transgender A. Uncircumcised A 24 year old male has scrotal pain and marked erythema. The examiner considers epidydimitis. Which other finding is most consistent with this finding? A. Absent cremasteric reflex B. Anorexia and nausea C. Acute onset of severe pain D. urethral discharge D. Urethral discharge Hypospadias is a congenital defect in which the urethra meatus is located on the ventral surface of the glans penis. This is thought to occur embryologically during urethral development during which stage of gestation? A. 4-6 weeks B. 8-20 weeks C. 15-25 weeks D. 20-30 weeks B. 8-20 weeks Which of the following hernias occur more often in females and is the least common of all hernias? A. Indirect B. Direct C. Femoral D. Ventral C. Femoral Which finding on exam of a scrotal mass which is neither a testicle or spermatic cord, suggests a problem with an incarcerated hernia? A. mass does not transilluminate or change in size when reduction is attempted. B. Mass doe not transilluminate but decreased in size when reduction is attempted. C. Mass does transilluminate but does not change in size when reduction is attempted D. Mass does transilluminate and change size when reduction is attempted. A. Mass does not transilluminate or change in size when reduction is attempted. You examine Mr. Lacosta 22 year old male. CC is penile pain and swelling. On exam you notice a constricting band of tissue directly behind the head of the penis. You diagnosis this as: A. paraphimosis B. hypospadius C. orchitis D. torsion A. paraphimosis You examine a patient and note pearly gray, smooth umbilicated lesions. The most common cause of these is: A. syphilis B. condyloma acuminata C. molluscum contagasioum D. lymphogranuloma venereum C. Molloscum contagious Which finding indicates a normal cremasteric reflex? A. penile erection in response to light touch B. descent of testicle into scrotum in response to pressure on abdominal wall C. Drop of urine appearing at urethral meatus in response to pressing glans D. Elevation of left testicle and scrotum in response to stroking left inner thigh. D. Elevation of left testicle and scrotum in response to stroking left inner thigh. Which characteristics suggests that a lesion on a patients breast is Paget disease and not eczema? A. Itchy predominantly at night B. Erythemtous and crusty C. Confined to nipple and areola of one breast D. Does not respond to steroids D. Does not response to steroids How should a breast examination on a patient who had a lumpectomy for breast cancer differ from a breast examination on one who has not had breast cancer? A. Supraclavicular and infraclavicular lymph nodes are palplated B. Lateral position with hands over head is used for palpation C. Area of scar is palpated using a circular motion D. fingertips are used to palpate for intercostal breast tissue C. Are of scar is palpated using a circular motion While palpating the axilla it is best to place the patient in a A. sitting position with arm flexed at elbow B. sitting position with arm at side C. supine position with arms on hips D. lateral position with arms at sides. A. sitting position with arm flexed at elbow Nipple compression should be included as part of the breast examination for which of the following patients? A. 23 year old concerned about lumps and tenderness B. 35 year old lactating with very sore nipples C. 48 year old reporting 2 episodes of bloody discharge from the right nipple D. 60 year old with gynecomastia C. 48 year old reporting 2 episodes of bloody discharge from the right nipple A supernumerary nipple is found on a white newborn infant girl. Which of the following may accompany this finding? A. Increased risk for breast cancer as adult B. increased lactation volume as adult C. congenital renal and cardiac anomolies D. mental retardation C. congenital renal and cardiac anomolies Which are typical of fibroadenomas? A. bilateral, stellate, rubber, nontender B. multiple, unilateral, tender, well defined C. Single, discoid, firm, nontender D. unilateral, hard, stellate, fixed C. Single, discoid, firm, nontender What is the correct position in which to place a patient for breast palpation? Supine, arm over head, and small pillow under shoulder of side being assessed Which statement made by a 37 year old would make the examiner suspect fibrocystic disease? A. lump in my breast that is nontender B. right breast is larger than left C. nipples are darker than before baby was born D. I feel a lump in my breast right before my period. D. I feel a lump in my breast right before my period. A patient 3 weeks postpartum reports sore nipples and is breastfeeding. The examiner observes dry, cracked nipples, Which question would be helpful? A. Do you pump? B. How do you clean your breasts? C. Have you been able to bond with your baby? D. what medications have you been taking? B. How do you clean your breasts? 68 year old man presents with gynecomastia which factor is a potential cause of the problem? A. decrease in physical activity B. increased lactiferous duct glans C. lymphatic engorgement D. a decrease in testosterone D. a decrease in testosterone Symptoms consistent with underlying ducats malignancy include: A. erythema, heat, pain around one nipple B. red, scaling, crusty patch on one nipple C. bilateral inflammation tenderness and sticky multicolored nipple discharge D. gynecomastia, deepening color of nipple. B. Red, scaling, crusty patch on one nipple While examining the breast of a 52 year old woman the examiner notes nipple discharge which of the following diagnostic tests would be appropriate? A. cytologic examination of discharge B. C&S C. WBC Count D. estrogen level A. cytologic examination of discharge while performing a breast examination on a 68year old woman, examiner expects to find what? A. breast tissue with multiple, firm large lumps B> breast tissue has granular feel C. the tail of spence is not longer observed D. Axillary lymph nodes are enlarged. B> breast tissue has granular feel which of the following represents the first sign of puberty in girls? A. thelarche B. menarche C. proliferation of lactiferous duct D. areolar elevation A. thelarche a benign tumor of the subareolar duct that produces nipple discharge is: A. pagets disease B. intraductal papilloma C. duct ectasia D. galactorrhea B. intraductal papilloma A 38 year old woman, is diagnosed with mastitis. what is likely causative agent? A. staph aureus B. strep C. Neissiera gonorhea D. E. coli A. staph aureus what finding on a female breast requires further investigation? A. wrinkled areolas B> prominent montgomery tubules C. one breast larger than the other D. unilateral venous network. D. unilateral venous network what finding on breast exam of a male can result from MJ use? A. galactorrhea B. subareolar mass C. gynecomastia D. dimpling C. gynecomastia Which finding is suggestive of PID ? A. enlargement of ovaries B. everted cervix C. pain resulting from movement of cervix D. unilateral labial swelling redness tenderness C. pain resulting from movement of cervix which finding would be of concern during an exam of older female? A. palpable ovaries B. small pale cervix C. constriction of vaginal introitus D. absence of vaginal rugation A. palpable ovaries while palpating Introitus of the vagina, the patient jumps, and complains os severe tenderness. a mass is palpated that is warm to touch. A. cancer of cervix B. inflammation of bartholin glands C. cystocele D. acute genital wart infection B. inflammation of bartholin glands which finding may be indicative of a pelvic mass. The cervix is: a. pale I color b. deviating to right c. protruding 2.5cm into vagina d. pointing anteriorly b. deviating to right A patient complains of dysmenorrhea pain, heavy prolonged menstrual flow, tender nodules are palpable along the uterosacral ligament. these suggest: endometriosis A practitioner collects samples for cytologic study during a vaginal exam. what type of lubricant on the speculum is least likely to interfere with specimen analysis? A. water soluble B. anesthizigin ointment C. warm water D. secretions C, water water symptoms associated with PMS area caused by: A> ovulation B> thickening of uterine lining C. elevations in body temp D. Fluctuations in hormone levels. D. Fluctuations in hormone levels. when examine a middle aged woman, with a history of endometrial cancer and hysterectomy the examiner should: A. avoid bimanual and palpation manuvers B. obtain Pap smear from suture line C. omit cultures and specimens from vagina D. palpate internal areas before inserting speculum B. obtain Pap smear from suture line a patient complains of urinary incontinence when she is active. which associated finding might explain this problem. A. hernias protrusion in posterior wall of vagina B. hernial protrusion through anterior wall of vagina C. PMS D. enlargement and protrusion of cervix into vaginal vault. B. hernial protrusion through anterior wall of vagina which finding is indicative of STD? A. ulcers and vesicles on vagina B. atrophy of labia majora C. dilation of urethral orifice D. bluish color to cervix. A. ulcers and vesicles on vagina the examiner observes a slit shaped cervical os in a multiparious woman. which data in her history explains this finding? A. earl onset peroid B. multiple sex partners C. infection with HPV D. had an abortion as teenager D. had an abortion as teenager a prominent labia minora in a newborn is: A. maternal infection B> Ambiguous genitalia C. consistent with preamaturity D. normal D. normal Softness of the cervix is an expected finding for: A. An adolescent B. A pregnant woman C. A nonpregnant woman D. An older adult B. A pregnant woman By which week of pregnancy would you expect to be able to palpate the uterus at the symphysis pubis? 12th week a cauliflower like mass is found on the labia of a female patient this is caused by A. syphilis B. condlyum latum C. condyloma acetinum D. herpes C. condyloma acetinum sexually active 22 year old, complains of gross vaginal discharge. Which question would help understand the symptom? A. Do you use condoms? B. What type of birth control do you use> C. at what age did you start your period D. DO you have a family history of ovarian or breast cancer? A. Do you use condoms? a 62 year old female went through menopause 14 years ago. Which statement by the patient indicates a need for follow up" A. I have not been sexually for about 4 years B. my pubic hair has become very thin C. I have small amounts of vaginal bleeding a few times a week D. I have been taking extra calcium since I reached menopause C. I have small amounts of vaginal bleeding a few times a week A patient reports that over the last year, the interval between periods has lengthened and her last 3 periods have been about 6 weeks apart. Which term describes this problem? oligomenorrhea what is an additional piece of info that you would include on lab requisition if a cervical Pap smear has been obtained from a transgender man? A. gender genotype B. years since change in gender identity C. use of testosterone D. number and gender of sexual partners. C. use of testosterone Phimosis foreskin cannot be retracted balanitis inflammation of the glans penis Balanoposthitis is ___ inflammation of the glans and foreskin Urethral discharge occurs with infection/STI TT rubbery, smooth free of nodules vas deferens beaded or lumpy diabetes or inflammation Well woman exam to decrease anxiety show instrument, explain what they do, instructing to let know if any discomfort, warm room ,ensure privacy, see to understand anxiety. ( hx assault? bad previous exp?) STI discharge foul smelling, thicker, STI symptoms pain/burning urination, pelvic pain, bleeding between periods, itchy rash, what questions do you ask patient with CC of mood disorder such as depression? Change of outlook on life? troubling thoughts? feeling hopeless, low energy, fatigue, agitation, thoughts of suicide what questions do you ask patient with CC of mood disorder such as anxiety? constant worry, fear, avoid certain situations or events, panic attacks, obsessive thoughts, compulsive behaviors What are the subjective data to collect in patients mental health? Alert: orientation to time place, person. Analogies, abstract reasoning, math facts, writing ability, motor skills, memory: recent or remote, attention span, judgement in hypothetical situation, voice: quality, pace, loudness, articulation. comprehension, coherence, What objective data do you collect in patients mental health exam? Grooming, body language, emotional status. coherence Delerium what disorder usually has an acute onset and is reversible? Delerium a state of sudden, temporary but acute mental confusion, signs; anxiety, tremors, hallucinations, delusions, attention problems, decline in level of conciousness, memory problems, errors in assessment tasks. rapid mood swing. rambling words. delirium caused by infections, meds, electorate imbalances, organ failure, brain injury, alcohol withdrawal Dementia a chronic or slowly persistent disorder of the mental processes marked by memory disorders, cognitive impairment, behavior changes, personality changes, and impaired reasoning increased activity age associated with dementia over 60 dementia speech incoherent, struggles to find words. hallucinations common. depressed. apathetic How to test a patient's memory? - Ask the patient to remember five items. wait 5 minutes After that, ask the patient to repeat the four words from before. This will test the patient's ability to learn new information. differential diagnosis for memory issues dementia, delirium, nutrition medication depression assess patient's orientation person place thing What is the mini mental status exam? 11 items measuring cognitive function change over time. checks orientation, registration, attention, calculation, recall and language.=4-10mins Mini-Mental State Examination (MMSE) Give you a quantifiable measureof cognitive functions of MSE - valid detector of organic disease - normal = 27 - 18-23 = mild cog dysfunction - 0-7 = severe cog dysfunction 1. orientation to time - what's the date? 2. registration - repeat back 3 words 3. naming - what is this object? 4. reading - please read this paper and do what it says 5. attention and calculation - spell this word backwards 6. langauge - repeat the following sentence.... Mini-Mental State Examination (MMSE) A test that is used to measure cognitive ability, especially in late adulthood. red rash on the breast is it eczema or Paget? unilateral is Paget breast exam post-mastectomy if malignancy occurs may be at scar site palpating axiallary position sitting position arms at sides 58 yr old woman how often mammogram 1-2 years if no symptoms benign tumor of subareolar ducts that has nipple discharge intraductal papilloma