Advanced Health Assessment Exam
A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse
is aware that which of these findings would be consistent with an acute
infection?
A) Tonsils 3+/1-4+ with large white spots
B) Tonsils 1+/1-4+ with pale coloring
C) Tonsils 1+/1-4+ and pink, same color as oral mucosa
D) Tonsils 2+/1-4+ and pink with white particles inside deep crypts -
Answ✔✔A) Tonsils 3+/1-4+ with large white spots
With an acute infection, tonsils are bright red and swollen and may
have exudate or large white spots. Tonsils are enlarged to 2+, 3+, or 4+
with an acute infection.
A 15 month old is brought to you for a fever of 101 F and fussiness. The
ear examination is as follows: external ear - normal appearance and no
tenderness with manipulation; canal - normal diameter without
evidence of inflammation; tympanic membrane - bulging,
erythematous, and the light reflex is dull. Insufflation is deferred due to
pain. What is your diagnosis?
A) ruptured tympanic membrane
B) cholesteatoma
C) otitis media
D) otitis externa - Answ✔✔C) otitis media
,Acute otitis media in a symptomatic child typically has a red, bulging
tympanic membrane, with a dull or absent light reflex.
A 15-year-old high school sophomore presents to the emergency room
with his mother for evaluation of an area of blood in the left eye. He
denies trauma or injury but has been coughing forcefully with a recent
cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to
light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally.
There is a homogeneous, sharply demarcated area at the lateral aspect
of the base of the left eye. The cornea is clear. Based on this
description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage - Answ✔✔D) Subconjunctival
hemorrhage
Leakage of blood outside of the vessels, producing a homogenous,
sharply demarcated, red area. The pupil is not affected, vision is not
affected and the cornea is clear. May result from trauma, bleeding
disorders, or sudden increase in venous pressure, as from a cough.
A 27 year old female patient has three furuncles connected around a
hair follicle. You use the following term in your charting:
,A) nodules
B) carbuncle
C) macules
D) bulla - Answ✔✔B) carbuncle
Multiple furuncles around a hair follicle form a carbuncle.
A 29-year-old physical therapist presents for evaluation of an eyelid
problem. On observation, the right eyeball appears to be protruding
forward. Based on this description, what is the most likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion - Answ✔✔C) Exophthalmos
Eye protrusion (proptosis or exophthalmos)
A 29-year-old woman tells the nurse that she has "excruciating pain" in
her back. Which of the following would be an appropriate response by
the nurse to her statement?
A) "How does your family react to your pain?"
B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating."
, D) "How would you say the pain affects your ability to do your daily
activities?" - Answ✔✔D) "How would you say the pain affects your
ability to do your daily activities?"
Inquire about the effects of pain on the patient's daily activities, mood,
sleep, work, and sexual activity.
A 45-year-old man is in the clinic for a routine physical. During history
the patient states he has been having difficulty sleeping. "I'll be sleeping
great and then I wake up and feel like I can't catch my breath." His
symptoms indicates sleep related symptoms of a certain type of
disease, so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - Answ✔✔B) Do you
have any history of problems with your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down
increases volume of intrathoracic blood, and the weakened heart
cannot accommodate the increased load. Classically, the person
awakens after 2 hours of sleep, arises, and flings open a window with
the perception of needing fresh air. (Bates, p357)
A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse
is aware that which of these findings would be consistent with an acute
infection?
A) Tonsils 3+/1-4+ with large white spots
B) Tonsils 1+/1-4+ with pale coloring
C) Tonsils 1+/1-4+ and pink, same color as oral mucosa
D) Tonsils 2+/1-4+ and pink with white particles inside deep crypts -
Answ✔✔A) Tonsils 3+/1-4+ with large white spots
With an acute infection, tonsils are bright red and swollen and may
have exudate or large white spots. Tonsils are enlarged to 2+, 3+, or 4+
with an acute infection.
A 15 month old is brought to you for a fever of 101 F and fussiness. The
ear examination is as follows: external ear - normal appearance and no
tenderness with manipulation; canal - normal diameter without
evidence of inflammation; tympanic membrane - bulging,
erythematous, and the light reflex is dull. Insufflation is deferred due to
pain. What is your diagnosis?
A) ruptured tympanic membrane
B) cholesteatoma
C) otitis media
D) otitis externa - Answ✔✔C) otitis media
,Acute otitis media in a symptomatic child typically has a red, bulging
tympanic membrane, with a dull or absent light reflex.
A 15-year-old high school sophomore presents to the emergency room
with his mother for evaluation of an area of blood in the left eye. He
denies trauma or injury but has been coughing forcefully with a recent
cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to
light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally.
There is a homogeneous, sharply demarcated area at the lateral aspect
of the base of the left eye. The cornea is clear. Based on this
description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage - Answ✔✔D) Subconjunctival
hemorrhage
Leakage of blood outside of the vessels, producing a homogenous,
sharply demarcated, red area. The pupil is not affected, vision is not
affected and the cornea is clear. May result from trauma, bleeding
disorders, or sudden increase in venous pressure, as from a cough.
A 27 year old female patient has three furuncles connected around a
hair follicle. You use the following term in your charting:
,A) nodules
B) carbuncle
C) macules
D) bulla - Answ✔✔B) carbuncle
Multiple furuncles around a hair follicle form a carbuncle.
A 29-year-old physical therapist presents for evaluation of an eyelid
problem. On observation, the right eyeball appears to be protruding
forward. Based on this description, what is the most likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion - Answ✔✔C) Exophthalmos
Eye protrusion (proptosis or exophthalmos)
A 29-year-old woman tells the nurse that she has "excruciating pain" in
her back. Which of the following would be an appropriate response by
the nurse to her statement?
A) "How does your family react to your pain?"
B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating."
, D) "How would you say the pain affects your ability to do your daily
activities?" - Answ✔✔D) "How would you say the pain affects your
ability to do your daily activities?"
Inquire about the effects of pain on the patient's daily activities, mood,
sleep, work, and sexual activity.
A 45-year-old man is in the clinic for a routine physical. During history
the patient states he has been having difficulty sleeping. "I'll be sleeping
great and then I wake up and feel like I can't catch my breath." His
symptoms indicates sleep related symptoms of a certain type of
disease, so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - Answ✔✔B) Do you
have any history of problems with your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down
increases volume of intrathoracic blood, and the weakened heart
cannot accommodate the increased load. Classically, the person
awakens after 2 hours of sleep, arises, and flings open a window with
the perception of needing fresh air. (Bates, p357)
