Exam (elaborations)
NR509 Bates Test Bank – Midterm Exam/251 Questions & Answers
NR509 Bates Test Bank – Midterm Exam/251 Questions & Answers
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NR509 Bates Test Bank – Midterm Exam/251Questions & Answers
A patient presents for evaluation of a sharp, aching chest pain which
increases with breathing. Which anatomic area would you localize the
symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine - -A) Musculoskeletal
Chest pain may be due to a musculoskeletal condition, such as
costochondritis or
intercostal muscle cramp. This would be worsened by motion of the chest
wall. Pleuritic chest pain is also a sharp chest pain which increases with a
deep breath. This type of pain can
occur with inflammation of the pleura from pneumonia or other conditions
and pulmonary
embolus.
-A patient comes to the emergency room for evaluation of shortness of
breath. To which anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic - -C) Cardiac
Cardiac disorders such as congestive heart failure are the most likely on this
list to result in shortness of breath. There are cases within the other
categories which may also result
in shortness of breath, such as anemia in the hematologic category,
pregnancy in the reproductive
category, or sepsis with UTI in the urinary category.
-A patient presents for evaluation of a cough. Which of the following
anatomic regions can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine - -C) Cardiac
,The cardiac system can cause a cough if the patient has congestive heart
failure. This results in fluid buildup in the lungs, which in turn can cause a
cough that produces pink,
frothy sputum. A foreign body in the ear may also cause a cough by
stimulating Arnold's branch of the vagus nerve, but this is less likely to be
seen clinically than heart failure.
-A 22-year-old advertising copywriter presents for evaluation of joint pain.
The pain is new,
located in the wrists and fingers bilaterally, with some subjective fever. The
patient denies a
rash; she also denies recent travel or camping activities. She has a family
history significant for
rheumatoid arthritis. Based on this information, which of the following
pathologic processes
would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic - -B) Inflammatory
The description is most consistent with an inflammatory process, although all
the other etiologies should be considered. Lyme disease is an infection which
commonly causes
arthritis, hemophilia is a hematologic condition which can cause bleeding in
the joints, and trauma can obviously cause joint pain.
-A 47-year-old contractor presents for evaluation of neck pain, which has
been intermittent for several years. He normally takes over-the-counter
medications to ease the pain, but this time they haven't worked as well and
he still has discomfort. He recently wallpapered the entire second floor in his
house, which caused him great discomfort. The pain resolved with rest. He
denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to
the neck. Based on this description, what is the most likely pathologic
process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic - -C) Degenerative
The description is most consistent with degenerative arthritis in the neck.
The
patient has had intermittent symptoms and the questions asked to elicit
pertinent negative and
,positive findings are negative for infectious, traumatic, or neoplastic disease.
-A 15-year-old high school sophomore comes to the clinic for evaluation of a
3-week history
of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and
nonproductive cough. Which
is the most likely pathologic process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular - -C) Allergic
This description is most consistent with allergic rhinitis.
-A 19-year old-college student presents to the emergency room with fever,
headache, and
neck pain/stiffness. She is concerned about the possibility of meningococcal
meningitis.
Several of her dorm mates have been vaccinated, but she hasn't been.
Which of the following
physical examination descriptions is most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck
supple with full range
of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with
paraspinous
muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins,
neck tender to
palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins,
neck supple with
full range of motion - -C) Head is normocephalic and atraumatic, fundi with
blurred disc margins, neck tender to
palpation, unable to perform range of motion
Blurred disc margins are consistent with papilledema, and neck tenderness
and lack of range of motion are consistent with neck stiffness, which in this
scenario is likely to be caused
by meningeal inflammation. Kernig's and Brudzinski's signs are also helpful
in testing for meningeal irritation on exam.
-A 37-year-old nurse comes for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and occurs
, 1 to 2 hours after eating greasy foods. Which one of the following physical
examination descriptions would be most consistent with the diagnosis of
cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without
hepatosplenomegaly or masses.
B) Abdomen is soft and tender to palpation in the right lower quadrant,
without rebound or
guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with
inspiration, to the
point of stopping inspiration, and there is no rebound or guarding.
D) Abdomen is soft and tender to palpation in the mid-epigastric area,
without rebound or
guarding. - -C) Abdomen is soft and tender to palpation in the right upper
quadrant with inspiration, to the
point of stopping inspiration, and there is no rebound or guarding.
In cholecystitis, the pain, which originates from the gallbladder, is located in
the
right upper quadrant. Severity of pain with inspiration that is sufficient to
stop further inhalation
is also known as Murphy's sign, which, if present, is further indicative of
inflammation of the
gallbladder.
-A 55-year-old data entry operator comes to the clinic to establish care. She
has the following
symptoms: headache, neck pain, sinus congestion, sore throat, ringing in
ears, sharp brief chest
pains at rest, burning abdominal pain with spicy foods, constipation, urinary
frequency that is worse with coughing and sneezing, and swelling in legs.
This cluster of symptoms is explained
by:
A) One disease process
B) More than one disease process - -B) More than one disease process
The patient appears to have several possible conditions: allergic rhinitis,
arthritis,
conductive hearing loss, pleuritic chest pains, heartburn, stress urinary
incontinence, and venous stasis, among other conditions. Although we
always try, it is very difficult to assign all of these
symptoms to one cohesive diagnosis.
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