NRNP 6540 MIDTERM EXAM-WITH 100% VERIFIED
SOLUTIONS
1. Mrs. M. W. comes into the primary care office for her regular yearly checkup.
The nurse practitioner begins the assessment by asking if there are concerns
Mrs. M. W. has that need to be addressed. The patient says that she has been
experiencing periodic episodes of abdominal cramps and diarrhea that just
comes and goes. The nurse practitioner continues the assessment with which of
the following?
1. Asking about the sequence of events and events that triggered each episode.
2. Conducting a complete neurological examination.
3. Collecting a urine specimen.
4. Evaluating abdominal pain.
1. Answer: 1
Page: 225
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1.
Determining the sequence of events that triggered each symptom and inquiring about
precipitating factors such as a meal, position of the body, use of caffeine, or alcohol and
smoking will lead to a differential diagnosis.
2.
Information regarding episodes of anorexia, dyspepsia, dysphagia, heartburn, nausea,
regurgitation, vomiting, painful or difficult defecation, diarrhea, tenesmus, or constipation
can be clustered to form a differential diagnosis.
3.
The physical examination is often unremarkable, and laboratory findings may not
provide diagnostic information because the presentation of illness in an older adult is
usually subdued.
4.
Ask about the severity of pain by having the patient rate her pain on a scale of 1 to 10.
Realize, however, that in older adults, pain may be blunted despite the underlying
pathology.
2. Part of the abdominal examination the nurse practitioner will conduct is the
assessment of skin color. As the nurse practitioner assesses the abdominal skin,
the findings include which of these signs that are concerning?
1. Generalized pinkness.
2. Bluish discoloration on the flanks.
3. Yellow tint around the lower left quadrant.
4. Blue in the upper left quadrant.
2. Answer: 2
Page: 226
, Feedback
1.
Pinkness is normal for a Caucasian patient.
2.
If the bluish discoloration is on the flanks, this is known as Grey Turner's sign and is
often indicative of retroperitoneal bleeding, as with pancreatitis.
3.
Jaundice in the area of the umbilicus is known as Ransohoff's sign and is a result of a
ruptured common bile duct.
4.
If a bluish discoloration is detected around the umbilicus, this is known as Cullen's sign,
which is often found in patients with bleeding in the peritoneum.
3. Mrs. M.W. asks the nurse practitioner what she is listening to in her belly and
what it means. The nurse practitioner tells her that she is listening to determine:
1. That her bowels are moving properly.
2. If the blood vessels are not circulating blood.
3. Circulation and bowel function.
4. A diagnosis of her symptoms.
3. Answer: 3
Page: 226
Feedback
1.
Studies have refuted the usefulness of auscultation when differentiating between
patients with normal bowel sounds versus those with pathological bowel sounds.
2.
Other sites to auscultate for bruits during an abdominal examination include the iliac
arteries and the femoral arteries.
3.
To auscultate for bruits during an abdominal examination, include the iliac arteries and
the femoral arteries. When auscultating bowel sounds, take the time to listen for the
presence of bowel sounds.
4.
Nurse practitioners should not rely on auscultation alone for diagnostic purposes.
4. Mr. Person comes to the health-care clinic with a presenting symptom of not
urinating as much as usual. The nurse practitioner assesses Mr. Person by
asking which of the following?
1. How much do you drink per day?
2. Is your urine a clear yellow color?
3. Do you experience urgency and frequency of urination?
4. What medications have you taken recently or are you currently taking?
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