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NUR 604 Exam 2 2024/2025 Questions With Completed & Verified Solutions.
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NUR 604 Exam 2 2024/2025 Questions With Completed & Verified Solutions.
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NUR 604 Exam 2A 37-year-old insurance agent comes to your office complaining of trembling hands. She says
that for the past 3 months when she tries to use her hands to fix her hair or cook they shake
badly. She says she doesn't feel particularly nervous when this occurs but she worries that other
people will think she has an anxiety disorder or that she's a drinker. She admits to having some
recent fatigue, trouble with vision, and difficulty maintaining bladder control. Her past medical
history is remarkable for hypothyroidism. Her mother has lupus and her father is healthy. She
has an older brother with type1 diabetes. She is married with three children. She denies
tobacco, alcohol, or drug use. On exam, when she tries to reach for a pencil to fill out the health
form she has obvious tremors in her dominant hand.What type of tremor is she most likely to
have? - ANS Intention tremor
This is seen in cerebellar disease (stroke or alcohol use) or in multiple sclerosis. This patient's
tremor, fatigue, bladder problems, and visual problems are suggestive of multiple sclerosis.
A 77-year-old retired school superintendent comes to your office complaining of unsteady
hands. He says that for the past 6 months when his hands are resting in his lap they shake
uncontrollably. He says when he holds them out in front of his body the shaking improves and
when he uses his hands the shaking is also better. He also complains of some difficulty getting
up out of his chair and walking around. His past medical history is significant for high blood
pressure and coronary artery disease, requiring a stent in the past. He has been married for
over 50 years and has five children and twelve grandchildren. He denies any tobacco, alcohol,
or drug use. On exam you see a fine pill-rolling tremor of his left hand. His right shows less
movement. His cranial nerve exam is normal. He has some difficulty rising from his chair, his
gait is slow, and it takes him time to turn around to walk back towards you. What type of - ANS
Resting tremor
Resting tremors occur when the hands are literally at rest, such as sitting in the lap. These are
slow, fine tremors, such as the pill rolling seen in Parkinson's disease, which this patient most
likely has.
A 41-year-old real estate agent comes to your office complaining that he feels like his face is
paralyzed on the left. He states that last week he felt his left eyelid was drowsy and as the day
progressed he was unable to close his eyelid all the way. Later he felt like his smile became
affected also. He denies any recent injuries but had an upper respiratory viral infection last
month. His past medical history is unremarkable. He is divorced with one child. He smokes one
pack of cigarettes a day, occasionally drinks alcohol, and denies any illegal drug use. His
mother has high blood pressure and his father has sarcoidosis. On exam you see ask him to
close his eyes. He is unable to close his left eye. You ask him to open his eyes and raise his
eyebrows. His right forehead furrows but his left remains flat. You then ask him to give you a big
,smile. The right corner of his mouth raises but the left side of his mouth re - ANS Peripheral CN
VII paralysis
In a peripheral lesion the entire side of the face will be involved. This causes the inability to
close the eye, raise the eyebrow, wrinkle the forehead, and smile on the affected side. Bell's
palsy is an example of this type of paralysis and is probably what is affecting this patient.
A 60-year-old retired seamstress comes to your office complaining of decreased sensation in
her hands and feet. She states that she began to have the problems in her feet a year ago but
now it has started in her hands also. She also complains of some weakness in her grip. She has
had no recent illnesses or injuries. Her past medical history consists of having type 2 diabetes
for 20 years. She now takes insulin and oral medications for her diabetes. She has been
married for 40 years. She has two healthy children. Her mother has Alzheimer's disease and
coronary artery disease. Her father died of a stroke and also had diabetes. She denies any
tobacco, alcohol, or drug use. On exam she has decreased deep tendon reflexes in the patellar
and Achilles tendons. She has decreased sensation of fine touch, pressure, and vibration on
both feet. She has decreased two-point discrimination on her hands. Her grip strength is
decreas - ANS Peripheral polyneuropathy
With peripheral polyneuropathy there will be distal extremity symptoms before proximal
symptoms. There will be weakness and atrophy and decreased sensory sensations. There is
often the classic glove-stocking distribution pattern of the lower legs and hands. Causes include
diabetic neuropathy, as in this case, and alcoholism and vitamin deficiencies.
A 17-year-old high school student is brought in to your emergency room in a comatose state.
His friends have accompanied him and tell you that they have been shooting up heroin tonight
and they think their friend may have had too much. The patient is unconscious and cannot
protect his airway so he is intubated. His heart rate is 60 and he is breathing through the
ventilator. He is not posturing and he does not respond to a sternal rub. Preparing to finish the
neurological exam you get a penlight. What size pupils do you expect to see in this comatose
patient? - ANS pinpoint pupils
A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned
about his memory. The patient himself admits to misplacing his keys more often and forgets
what he is supposed to buy from the grocery store and where he has parked the car. He denies
getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died 8
months ago; his three children live in three different states; and he has limited his activities
because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of
beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination
and obtain a total score of 24 out of 28. Based on this information, what is your most likely
diagnosis? - ANS Depression
, The patient has symptoms of depression: His wife died; he has no real social support system,
and he has isolated himself from his usual activities. He also drinks a considerable amount of
alcohol on a daily basis, which can further depress his mood.
Which of the following brief screening measures is useful in assessing memory?
three-item recall
serial 7s
spell "world" backwards
copy intersecting pentagrams - ANS Three-item recall
Which of the following is associated with tension headache?
Bilateral, mild to moderate, pressing headache lasting 30 minutes to days
Uni lateral, moderate to severe, throbbing, lasting 4-72 hours, aggravated by routine physical
activity, with nausea, vomitting, or both, headache preceeded by flashing lights
Pounding , dull frontal or occipital pain present when upright and relieved by lying down
More prevalent in men, occuring in attacks of severe unilateral orbital, supraorbital or temporal
pain, lasting 15-180 minutes, with miosis. - ANS Bilateral, mild to moderate, pressing headache
lasting 30 minutes to days
A 15-year-old high school football player is brought to your office by his mother. He is
complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual
activity and states that he hurts so bad he can't even urinate. He is nauseated and is throwing
up. He denies any recent illness or fever. His past medical history is unremarkable. He denies
any tobacco, alcohol, or drug use. His parents are both in good health. On examination you see
a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps
shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24.
On visualization of the penis he is circumcised and there are no lesions and no discharge from
the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain
and the patient begins to cry. His prostate exam is unremarkable. By catheter y - ANS Testicular
torsion
A 29-year-old married computer programmer comes to your clinic complaining of "something
strange" going on in his scrotum. Last month while he was doing his self-testicular exam he felt
a lump in his left testis. He waited a month and felt the area again but the lump was still there.
He has had some aching in his left testis but denies any pain with urination or sexual
intercourse. He denies any fever, malaise, or night sweats. His past medical history consists of
groin surgery when he was a baby and a tonsillectomy as a teenager. He eats a healthy diet
and works out at the gym five times a week. He denies any tobacco or illegal drugs and drinks
alcohol occasionally. His parents are both healthy. On exam you see a muscular healthy young
man appearing with unremarkable vital signs. On visualization the penis is circumcised with no
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