NURS 502 Midterm Exam questions with 100% Correct Answers

NURS 502 Midterm Exam questions with 100% Correct Answers .A 13-year-old girl is brought by her mother to the clinic one day before the start of eighth grade because of a 3-day history of episodes of shortness of breath. When she gets the shortness of breath, she also notices tingling around her lips. She has no fever, cough, sputum production, or chest pain. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and extremity examinations show no abnormalities. Which of the following is the most likely diagnosis? Left-sided heart failure Pneumonia Asthma Aspiration of a foreign body Anxiety - ANSWER-Anxiety Tingling around lips = symptom of anxiety .A 14-year-old high school student comes to the clinic for a 3-month history of periodic dyspnea when playing basketball. It resolves shortly after resting. He has not had fever, chills, cough, sputum production, or chest pain. He has no history of serious illness. Based on the boy's history, asthma is suspected. Which of the following sounds heard on expiration during lung auscultation would be most suggestive of asthma? Rhonchi Stridor Pleural rub Wheezes Mediastinal crunch - ANSWER-Wheezes .A 14-year-old male presents to a new primary care provider after his family relocates to a state. The patient underwent treatment for sarcoma when he was age 11 years, including an above-the-knee amputation. He has learned to successfully navigate with a prosthetic leg and even engage in competitive athletics at school. He does not like to speak of his experience with cancer and often makes up humorous stories to tell new acquaintances about his amputation (such as, "I got bit by a squirrel and they had to amputate."). Although he is very well engaged in most of the visit with the new clinician, when the topic of cancer arises, he demurs to his father, who accompanies him to this appointment. Which of the following statements is most likely to be helpful in cementing the patient's trust in the new provider? 1. "You need to see a counselor since you have not adjusted well to your new condition." 2. "You have recovere - ANSWER-4. "That sounds like a frightening experience that you are recovering well from." .A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side. The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does he determine where the fourth intercostal space is? 1. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the fourth intercostal space. 2. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth intercostal space is just below the third rib. 3. He finds the clavicle. The second intercostal space is just below the clavicle. He then walks down to third rib, third intercostal space, fourth rib, and then the fourth intercostal space. 4. He finds the angle of Louis and then moves his finger laterally to the third rib. The fourth inte - ANSWER-5. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to the second intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space. .A 16-year-old girl presents to clinic with an earache. Which of the following is a useful maneuver to optimize visualization of the ear canal and ear drum? 1. Pull the tragus downward. 2. Hold the otoscope between your thumb and forefingers and brace your hand against the patient's face. 3. Brush against the ear canal with your speculum as you insert it, so that the patient suspects what is going on. 4. Have the patient lie down. 5. Insert the speculum rapidly in and out of the ear to minimize the time it is sitting in the ear canal. - ANSWER-2. Hold the otoscope between your thumb and forefingers and brace your hand against the patient's face. .A 16-year-old male high school student presents with a primary concern of acne. He relates a history of 2 years of moderate mild acne and closed comedones (whiteheads), which have recently worsened such that a classmate started calling him a pirate due to a large pustule that developed at the tip of his nose. He has increasing outbreaks of cyst-like acne as well as a generally poor complexion with pitting and scarring from prior outbreaks. Which of the following best describes this condition in the adolescent population? 1. Acne vulgaris affects 50% of the adolescent population. 2. The primary hormonal stimulus for acne vulgaris is estrogen, causing preferentially worse cases in females and males with lower testosterone levels. 3. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors. 4. Acne vulgaris is associated with an identifie - ANSWER-3. Acne vulgaris is associated with blockage of sebaceous glands, stress, humidity, and heavy sweating as well as other contributory factors. .A 16-year-old male presents for a sports physical. He is very talkative and tells you that sports are the best part of school. He has lots of friends. Other than sports and seeing his friends, he finds school boring. He hopes to play football, so that means he will probably go to college. He is managing to keep his grades up. He does not use drugs, but sometimes drinks alcohol on weekends with his friends—he knows he shouldn't. He quit his part-time job recently after the boss yelled at him for frequent lateness. His mother, in a separate interview, tells you that he is pretty impulsive, although he has always been very active and prone to making rash decisions. But, overall he is a good kid with lots of friends. The patient's history is most consistent with: Psychosis. Depression. Delirium. Adolescence. Anxiety. - ANSWER-Adolescence. .A 17-year-old male presents to a sexually transmitted disease clinic at the behest of his brother, who convinced the patient to attend the clinic after he disclosed that he prefers homosexual partners but is afraid that his last partner may have given him an infection. The patient expresses to the intake nurse that he is unashamed of his sexual orientation and will not stay through the visit if he feels that he is dismissed or discriminated against because of it. The nurse practitioner receives this communication prior to entering the examination room and decides to employ active listening to best connect with the patient at this critical juncture in his care with the clinic. Which of the following is an example of an active listening technique? 1. Ignoring visual cues to focus on the patient's exact words 2. Using nonverbal communication to encourage the patient to expand their narrative 3. Paring down the patient' - ANSWER-2. Using nonverbal communication to encourage the patient to expand their narrative .A 17-year-old woman presents with her parents to her primary care provider. She desires to utilize a tanning facility ahead of an upcoming event. Her parents have heard that this is a dangerous practice, although the tanning facility insists it is safe without risk of skin cancer in the future after tanning. Which of the following is true regarding ultraviolet (UV) light exposure and subsequent risk of skin cancer? 1. Sunscreen with a sun protective factor (SPF) of 15 blocks ~50% of UV-B light. 2. Water-resistant sunscreens confer no advantage over water-soluble products. 3. Chronic sun exposure confers greater risk for skin cancer than intermittent intensive exposure. 4. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors. 5. Tanning beds and sunlamps do not increase risks of skin cancer as they utilize UV wavelengths that are not carcinogenic. - ANSWER-4. Targeted messaging and practitioner reinforcement in primary care amplify sun-protective behaviors. .A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at work last week. He did not have it evaluated at that time and is now noticing purulent discharge and increasing pain from the wound along with fever and chills. Where would the clinician expect to find the first signs of lymphadenopathy? Central axillary nodes Lateral axillary nodes Infraclavicular nodes Cervical chain nodes Epitrochlear nodes - ANSWER-Epitrochlear nodes first nodes in the drainage region from the ulnar surface of the forearm and hand, little and ring fingers, and adjacent surface of the middle finger. .A 19-year-old student of art history presents to clinic after a syncopal (fainting) episode at school. He is notably thin; on a thorough review of his medical history, he admits that he eats only minimally to maintain a very low body weight that he feels is ideal. He is embarrassed that his issues were discussed by peers after this episode, especially because he believes that this is a problem that is only faced by girls and women. Concerning the two most common eating disorders (anorexia nervosa and bulimia nervosa), which of the following statements is true? 1. Men and women are both afflicted, but with a female:male prevalence ratio estimated at ~2:1. 2. The prognosis is similar regardless of whether individuals are diagnosed and treated in the early or late stage of these disorders. 3. Both of these eating disorders are associated with a real or imagined fear of appearing fat. 4. Both of these eating disorders a - ANSWER-3. Both of these eating disorders are associated with a real or imagined fear of appearing fat. .A 20-year-old college student is experiencing dyspnea on exertion and palpitations. On cardiac auscultation, the second heart sound is split and fixed on both inspiration and expiration. What is the most likely cardiac condition associated with this finding? Left bundle branch block Right bundle branch block Atrial septal defect Tricuspid stenosis Pulmonic stenosis - ANSWER-Atrial septal defect .A 21-year-old man complains of flashing lights in his right eye, and also moving shadows that cross his visual field he thinks also in his right eye. His eye examination is normal although he has some visual loss (myopia) in his right eye. What is the next best step in management? Refer to an optometrist for glasses. Refer to an ophthalmologist appointment immediately for potential newly detached vitreous or another urgent pathology. Make an appointment to see him again in a month. Schedule him for a mental health evaluation. Re-examine his eyes after giving him some time to calm down. - ANSWER-Refer to an ophthalmologist appointment immediately for potential newly detached vitreous or another urgent pathology. .A 22-year-old male patient presents to clinic with feelings of hopelessness and experiencing no pleasure in activities he formerly enjoyed. You suspect that the patient may have major depression. Which of the following is correct regarding suicide risk factors in such patients? 1. Women are less likely to make a suicide attempt than men. 2. Caucasians have a higher risk of suicide than American Indian or Alaska natives. 3. He is young and therefore at a low risk of making a suicide attempt. 4. Suicide is the third leading cause of death in young men aged 15-24 years. 5. He is unlikely to commit suicide if he does not have access to a gun. - ANSWER-4. Suicide is the third leading cause of death in young men aged 15-24 years. .A 23-year-old physician assistant (PA) student found that she felt nervous when called upon to examine men in her age group. On one occasion, she encountered a young male patient who appeared embarrassed to walk into the room. What should the PA do to minimize their mutual discomfort? Adjust lighting so it is tangential to the patient's body Provide ongoing interpretation of findings Ask the patient where he comes from Explain that she is a PA student Explain how the examination will proceed - ANSWER-Explain how the examination will proceed .A 24-year-old male returns to clinic for his sixth visit regarding headache, joint, and abdominal pain. His physical examination remains completely normal. You have been unable to identify a medical (organic) reason despite extensive evaluation. The patient recently found a new job as a janitor. You determine that he most likely has a somatization disorder. Which of the following is the best definition of a somatic symptom disorder? 1. Chronic preoccupation with the idea of having a serious illness and that is poorly amenable to reassurance. 2. Clinical syndrome characterized predominantly by pain in which psychological factors are judged to be of etiologic importance. 3. A chronic multisystem disorder characterized by complaints of pain that begins early in life especially in those with limited psychosocial and vocational achievement. 4. Syndrome of symptoms or deficits that mimic neurologic or medical illness in - ANSWER-3. A chronic multisystem disorder characterized by complaints of pain that begins early in life especially in those with limited psychosocial and vocational achievement. .A 24-year-old veteran returns from his second tour of duty in the Middle East. He was witness to a number of violent military encounters and experienced the death of several of his closest friends. He describes a number of problems including nightmares, poor sleep pattern, and mild panic attacks. In persons with trauma- and stress-related disorders as well as other disorders that may be associated with hallucinations and illusions, which of the following statements is true that distinguishes these two entities from each other? 1. Hallucinations by definition never include somatic perceptions, whereas illusions always involve at least some component of a somatic complaint. 2. Hallucinations may be visual or auditory, causing an alteration of the real external world, whereas illusions are entirely imaginary. 3. Illusions involve an irrational fear or perceptions, whereas hallucinations are a misinterpretation of real - ANSWER-4. Illusions are a misinterpretation of real stimuli, whereas hallucinations are subjective perceptions in the absence of real stimuli. .A 25-year-old construction worker is complaining of a swishing noise in both ears that never goes away and has occurred for about 6 months. He is otherwise healthy, is able to work on his job (operating large, vibrating machinery) without problems, and is not taking any medications. A complete examination reveals an abnormality. Which of the following abnormality is most often associated with tinnitus? Vertigo Bilateral earache Wax in both ears Headache Mild tremor - ANSWER-Vertigo Ménière disease: Vertigo and tinnitus .A 26-year-old homeless male presents for a new-patient evaluation at a community health center. He has a history of intravenous drug use, from which he contracted hepatitis C. He also suffers from uncontrolled asthma that he has had since childhood, with treatment including frequent doses of oral steroids when he cannot keep inhalers in his possession. Two years ago, he was diagnosed with bipolar disorder. On today's visit, his main concern is a small abscess in his right antecubital fossa at a heroin injection site. Which of the following is the best approach to the health history for this patient at his first visit? A clinician-centered health history A health history with only yes-no options A comprehensive health history A problem-focused health history A review of systems (ROS) only - ANSWER-A comprehensive health history .A 26-year-old man is brought to the emergency department by his friends, stating that they decided to bring him in after he suddenly became unresponsive and displayed shaking movements in his upper and lower extremities about 30 minutes previously. They deny knowledge of any substance abuse, head trauma, or significant past medical history. On examination, the patient is lying in bed with his eyes closed and does not respond to the physician calling his name, shaking him gently, or applying painful stimuli. Further examination shows that the patient is breathing at a normal rate and no cardiac abnormalities are noted. Which of the following is the most appropriate description of this patient's current level of consciousness? Lethargic Stuporous Asleep Comatose Obtunded - ANSWER-Comatose .A 28-year-old male business executive presents to a primary care provider with concerns about hair loss. He is otherwise healthy without chronic medical conditions or current medications. He has a chart history of allergy to sulfa medications, although this happened when he was a young child, and he does not recall the incident or the reaction. He is unsure at what age his father went bald, as he never remembers his father having hair. He remarks jokingly that he is losing more hair than his dogs at home, who shed frequently but are otherwise healthy. On examination, he has a single uniform oval patch of hair loss over the left temporal area without any scaling, inflammation, or other skin changes where the hair is missing. Which of the following is the most likely explanation for his hair loss? 1. Drug rash, as evidenced by his allergy to sulfa drugs 2. Male pattern baldness, as evidenced by his father's baldness a - ANSWER-3. Alopecia areata, as evidenced by patchy hair loss without associated skin changes .A 28-year-old male dishwasher presents with pain and swelling around his right middle fingernail that has worsened since onset one week ago. He has had no prior episodes and is concerned about what he might have been exposed to at work. On examination, the mediolateral nail fold is erythematous, swollen, and tender. He has no other symptoms (he specifically denies fever), and there are no other findings on examination. Which of the following statements regarding this condition is true? 1. Staphylococcus aureus - a normal skin flora species - is an uncommon pathogen in paronychia. 2. Acute paronychia is invariably due to Candida and other fungal species. 3. Risk factors for paronychia include nail biting, local trauma, and immersion in water. 4. Paronychia is a rare infection due to drug-resistant gram negative organisms. 5. Paronychia is an infection seen primarily in diabetics involving nails of the lower extremit - ANSWER-3. Risk factors for paronychia include nail biting, local trauma, and immersion in water. .A 28-year-old man presents to his physician with a chief complaint of persistent productive cough for the past three months. Which of the following is the best description of the duration of the cough? Acute. Fleeting. Subacute. Long term. Chronic. - ANSWER-Chronic. Chronic: More than 8 weeks Subacute: 3-8 weeks Acute: Less than 3 weeks .A 29-year-old electrician complains of persistent cough and wheezing, particularly when he exercises. He says he smokes "occasionally" but rarely so much that he needs to purchase cigarettes: "Mostly, I bum them," he says, chuckling. Upon hearing this information, what is the best next step on the part of the clinician? Conduct a mental status examination. Explain the relationship between smoking and cancer. Determine the patient's exercise regimen. Determine the number of pack-years the patient smokes. Determine the patient's immunization history. - ANSWER-Determine the number of pack-years the patient smokes.