NR 509 Final Exam 2023 questions and answers
10 minute geriatric screener - (correct answer)1.vision a. difficulty driving/watching TV/reading
-->snellen chart with corrective lenses (normal: <20/40)
2. hearing: audioscope at 40dB (1,000 and 2,000) (+= inability to hear one in both or one ear)
3. leg mobility: Get up and Go test: rise, walk 10 ft, turn, walk back, sit down (+= greater than 10
seconds)
4. urinary incontinence: Ask: a. lose urine and gotten wet in last year? b. 6 times? (+= yes to both)
5. nutrition/weight loss: a. lost 10 lbs in 6 mos? b. check weight (+= <100lbs)
6. memory: three-item recall (+= unable to remember all 3 after 1 min)
7. depression: Ask: do you feel sad/depressed (+= yes)
8. physical disability (6 questions: 1. strenious activity? 2. Heavy work? 3. Shopping? 4. Go to places out
of walking distance? 5. Bath/shower? 6. Dress?) (+= no to any)
Abdomen palpation - (correct answer)gently palpate over 4 quadrants:
abnormal: involuntary rigidity=peritoneal inflammation
Deep palpation to feel for masses: physiologic (pregnancy), inflammatory (diverticulitis), vascular (AAA),
neoplastic (colon cancer), or obstructive (distended bladder or dilated loop of bowel)
Abdomen percussion - (correct answer)--Tympany dominates d/t gas
--Dull areas: fluid, feces, mass, enlarged organ
--Protuberant abdomen: note where tympany changes to dullness (solid posterior structures)
--Percuss lower anterior chest above costal margins: normal= right dullness over liver, left tympany over
gastric air bubble and spelnic flexure of colon.
Abdominal Auscultation - (correct answer)1. Bowel sounds
2. Bruits: hepatic (Cirrhosis), Arterial with systolic and diastolic component (occlusion of aorta or large
artery (ex. epigastric--renal artery stenosis/renovascular hypertension)
3. Venous Hum: rare soft humming w/ sys/dias.= increase collateral circ btwn portal and systemic
systems (hepatic cirrhosis)
4. Friction Rub over liver or spleen: Rare grating sounds w/ respiratory variation=inflammation (liver
cancer, chlamydial/gonococcal perihepatitis, liver bx, splenic infarct)
Abdominal insepction - (correct answer)Abnormal:
purple striae: cushing syndrome
Dilated veins: portal HTN from cirrhosis or ICV obstruction
Ecchymosis: intraperitoneal or retroperitoneal hemorrhage
,NR 509 Final Exam 2023 questions and answers
Protuberant abdomen: 1. Hernia (umbilica, incisional, epigastric, 2. Diastasis Recti, 3. Lipoma, 4. Fat, 5.
Gas, 6. Tumor, 7. Pregnancy, 8. Ascites
Acrocyanosis - (correct answer)Blue cast to hands and feet when exposed to cold. Common for first few
days into early infancy.
--should disappear within 8 hrs of birth or warming.
Acute Cholecystits - (correct answer)RUQ pain
Murphy Sign
Acute Pancreatitis Aggrevating Factors - (correct answer)Lying supine; dyspnea if pleural effusions from
capillary leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Associated Symptoms and Setting - (correct answer)Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol abuse or gallstones
Acute Pancreatitis Location - (correct answer)Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Process - (correct answer)Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of the pancreas
Acute Pancreatitis Quality - (correct answer)Usually steady
Acute Pancreatitis Relieving factors - (correct answer)Leaning forward with trunk flexed
Acute PancreatitisTiming - (correct answer)Acute onset, persistent pain
Adult immunizations - (correct answer)Influenza: >50 yrs, disorders present, immunosuppressed,
nursing homes residents, household contacts of children <5 yrs.
Pneumococcal: >65 yrs, adults 19-64 with immunosuppression or other problems.
Tdap: All adults no previously immunized and every 10 years.
Zoster: >60 years (except with history of immunodeficiency)
Anxiety disorders - (correct answer)excessive worry persisting over a 6 month period suggests anxiety
disorder.
--3 % prevalence
1. Panic disorder
2. OCD
3. PTSD
4. Social anxiety disorder
5. Phobias
, NR 509 Final Exam 2023 questions and answers
Aorta abnormalities - (correct answer)A periumbilical or upper abdominal mass with expansile
pulsations that is ≥3 cm in diameter suggests an AAA. Sensitivity of palpation increases as AAAs enlarge.
Aorta assessment - (correct answer)Press firmly deep in the epigastrium, slightly to the left of the
midline, and identify the aortic pulsations
Adults over age 50 years, assess the width of the aorta by pressing deeply in the upper abdomen with
one hand on each side of the aorta (normally no more than 3cm wide).
Aphasia - (correct answer)Disorder in producing or understanding language.
Aphonia - (correct answer)loss of the voice as a result of disease or injury to the larynx or nerve supply
Appendicitis - (correct answer)1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing sign, and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates to the RLQ. Older adults
are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests appendicitis.
Ascites assessment - (correct answer)A protuberant abdomen with bulging flanks is suspicious for
ascites
dullness appears in the dependent areas of the abdomen.
Test for shifting dullness: site of dullness shifts when pt turns to one side.
Test for fluid wave: have someone hold both sides of abdomen and sharply tap top part of abdomen and
feel for fluid to shift to lower part.
A positive fluid wave, shifting dullness, and peripheral edema makes the presence of ascites to three to
six times more likely
Axilla Exam - (correct answer)Enlarged axillary nodes may result from infection of the hand or arm,
recent immunizations or skin tests, or generalized lymphadenopathy. Check the epitrochlear nodes
medial to the elbow and other groups of lymph nodes.
Nodes that are large (≥1 to 2 cm) and firm or hard, matted together, or fixed to the skin or underlying
tissues sug-gest malignancy.
bacterial vaginosis - (correct answer)1. Bacterial overgrowth: often transmitted sexually
2. Gray or white, thin, homogeneous, malodorous discharge
3. Unpleasant fishy or musty genital odor reported after intercourse
10 minute geriatric screener - (correct answer)1.vision a. difficulty driving/watching TV/reading
-->snellen chart with corrective lenses (normal: <20/40)
2. hearing: audioscope at 40dB (1,000 and 2,000) (+= inability to hear one in both or one ear)
3. leg mobility: Get up and Go test: rise, walk 10 ft, turn, walk back, sit down (+= greater than 10
seconds)
4. urinary incontinence: Ask: a. lose urine and gotten wet in last year? b. 6 times? (+= yes to both)
5. nutrition/weight loss: a. lost 10 lbs in 6 mos? b. check weight (+= <100lbs)
6. memory: three-item recall (+= unable to remember all 3 after 1 min)
7. depression: Ask: do you feel sad/depressed (+= yes)
8. physical disability (6 questions: 1. strenious activity? 2. Heavy work? 3. Shopping? 4. Go to places out
of walking distance? 5. Bath/shower? 6. Dress?) (+= no to any)
Abdomen palpation - (correct answer)gently palpate over 4 quadrants:
abnormal: involuntary rigidity=peritoneal inflammation
Deep palpation to feel for masses: physiologic (pregnancy), inflammatory (diverticulitis), vascular (AAA),
neoplastic (colon cancer), or obstructive (distended bladder or dilated loop of bowel)
Abdomen percussion - (correct answer)--Tympany dominates d/t gas
--Dull areas: fluid, feces, mass, enlarged organ
--Protuberant abdomen: note where tympany changes to dullness (solid posterior structures)
--Percuss lower anterior chest above costal margins: normal= right dullness over liver, left tympany over
gastric air bubble and spelnic flexure of colon.
Abdominal Auscultation - (correct answer)1. Bowel sounds
2. Bruits: hepatic (Cirrhosis), Arterial with systolic and diastolic component (occlusion of aorta or large
artery (ex. epigastric--renal artery stenosis/renovascular hypertension)
3. Venous Hum: rare soft humming w/ sys/dias.= increase collateral circ btwn portal and systemic
systems (hepatic cirrhosis)
4. Friction Rub over liver or spleen: Rare grating sounds w/ respiratory variation=inflammation (liver
cancer, chlamydial/gonococcal perihepatitis, liver bx, splenic infarct)
Abdominal insepction - (correct answer)Abnormal:
purple striae: cushing syndrome
Dilated veins: portal HTN from cirrhosis or ICV obstruction
Ecchymosis: intraperitoneal or retroperitoneal hemorrhage
,NR 509 Final Exam 2023 questions and answers
Protuberant abdomen: 1. Hernia (umbilica, incisional, epigastric, 2. Diastasis Recti, 3. Lipoma, 4. Fat, 5.
Gas, 6. Tumor, 7. Pregnancy, 8. Ascites
Acrocyanosis - (correct answer)Blue cast to hands and feet when exposed to cold. Common for first few
days into early infancy.
--should disappear within 8 hrs of birth or warming.
Acute Cholecystits - (correct answer)RUQ pain
Murphy Sign
Acute Pancreatitis Aggrevating Factors - (correct answer)Lying supine; dyspnea if pleural effusions from
capillary leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Associated Symptoms and Setting - (correct answer)Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol abuse or gallstones
Acute Pancreatitis Location - (correct answer)Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Process - (correct answer)Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of the pancreas
Acute Pancreatitis Quality - (correct answer)Usually steady
Acute Pancreatitis Relieving factors - (correct answer)Leaning forward with trunk flexed
Acute PancreatitisTiming - (correct answer)Acute onset, persistent pain
Adult immunizations - (correct answer)Influenza: >50 yrs, disorders present, immunosuppressed,
nursing homes residents, household contacts of children <5 yrs.
Pneumococcal: >65 yrs, adults 19-64 with immunosuppression or other problems.
Tdap: All adults no previously immunized and every 10 years.
Zoster: >60 years (except with history of immunodeficiency)
Anxiety disorders - (correct answer)excessive worry persisting over a 6 month period suggests anxiety
disorder.
--3 % prevalence
1. Panic disorder
2. OCD
3. PTSD
4. Social anxiety disorder
5. Phobias
, NR 509 Final Exam 2023 questions and answers
Aorta abnormalities - (correct answer)A periumbilical or upper abdominal mass with expansile
pulsations that is ≥3 cm in diameter suggests an AAA. Sensitivity of palpation increases as AAAs enlarge.
Aorta assessment - (correct answer)Press firmly deep in the epigastrium, slightly to the left of the
midline, and identify the aortic pulsations
Adults over age 50 years, assess the width of the aorta by pressing deeply in the upper abdomen with
one hand on each side of the aorta (normally no more than 3cm wide).
Aphasia - (correct answer)Disorder in producing or understanding language.
Aphonia - (correct answer)loss of the voice as a result of disease or injury to the larynx or nerve supply
Appendicitis - (correct answer)1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing sign, and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates to the RLQ. Older adults
are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests appendicitis.
Ascites assessment - (correct answer)A protuberant abdomen with bulging flanks is suspicious for
ascites
dullness appears in the dependent areas of the abdomen.
Test for shifting dullness: site of dullness shifts when pt turns to one side.
Test for fluid wave: have someone hold both sides of abdomen and sharply tap top part of abdomen and
feel for fluid to shift to lower part.
A positive fluid wave, shifting dullness, and peripheral edema makes the presence of ascites to three to
six times more likely
Axilla Exam - (correct answer)Enlarged axillary nodes may result from infection of the hand or arm,
recent immunizations or skin tests, or generalized lymphadenopathy. Check the epitrochlear nodes
medial to the elbow and other groups of lymph nodes.
Nodes that are large (≥1 to 2 cm) and firm or hard, matted together, or fixed to the skin or underlying
tissues sug-gest malignancy.
bacterial vaginosis - (correct answer)1. Bacterial overgrowth: often transmitted sexually
2. Gray or white, thin, homogeneous, malodorous discharge
3. Unpleasant fishy or musty genital odor reported after intercourse
