NR509 ADVANCED PHYSICAL ASSESSMENT MIDTERM EXAM 2024 | ACTUAL EXAM MIDTERM EXAM QUESTIONS AND ANSWERS WITH A FINAL EXAM PRACTICE TEST BANK AND STUDY GUIDE | EXPERT VERIFIED FOR GUARANTEED PASS The following information is recorded in the health history: "The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is acc ompanied by nausea and vomiting. It is located in the mid-epigastric area." Which of these categories does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems B) Present illness This information describ es the problem of abdominal pain, which is the present illness. The interviewer has obtained the location, timing, severity, and associated manifestations of the pain. The interviewer will still need to obtain information concerning the quality of the pain, the setting in which it occurred, and the factors that aggravate and alleviate the pain. 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 car s 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 C) Personal and social history. Personal and social history inform ation 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 preferen ces and history). The following information is recorded in the health history: "I feel really tired." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems A) Chief complaint The chief complaint is an attempt to quote the patient's own words. It is brief, like a headline, and further details should be sought in the present illness section. The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to? A) Chief complaint B) Present illness C) Personal and social history D) Review of systems D) Review of systems Review of systems documents the presence or absen ce of common symptoms related to each major body system. The following information is best placed in which category? "The patient has had three cesarean sections." A) Adult illnesses B) Surgeries C) Obstetrics/gynecology D) Psychiatric B) Surgeries A cesarean section is a surgical procedure. Approximate dates or the age of the patient at the time of the surgery should also be recorded. 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 in flammation 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 m ay 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 an d 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 p rocesses 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 infe ction 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 meningoc occal 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?
