Advanced Health Assessment Exam
A 59 year old patients tells the nurse practitioner that he thinks he must have
ulcerative colitis. He has been having "black stools" for the last 24 hours. How
would the nurse practitioner best document THE FACTS for his reason for seeking
care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. -
(correct Answer) - A) JM is a 59 year old male here for having "black stools" for
the past 24 hours.
Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek
care. Make every effort to quote the patient's own words.
A patient tells the nurse practitioner that she has had abdominal pain for the past
week. What would be the best response by the nurse practitioner?
A) We'll talk more about that later in the interview."
B) "Have you ever had any children?"
C) "What have you had to eat in the last 4 hours?"
D) "Can you point to where it hurts?" - (correct Answer) - D) "Can you point to
where it hurts?"
Each principle symptom should be well-characterized, with descriptions of location;
along with the other seven attributes. Location: Ask the patient to point to the
pain because lay terms may not be specific enough to localize the site of origin.
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?" -
(correct Answer) - 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.
In recording the childhood illnesses of a patient who denies having had any, which
of the following notes by the nurse would be most accurate?
A) Patient denies usual childhood illnesses.
B) Patient states he was a "very healthy" child.
C) Patient states sister had measles, but he didn't.
D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever,
and polio. - (correct Answer) - D) Patient denies measles, mumps, rubella,
chickenpox, pertussis, rheumatic fever, and polio.
Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic
fever, scarlet fever, and polio. They are included in the past history.
A patient tells the nurse that he is allergic to penicillin. What would be the
nurse's best response to this information?
A) "Are you allergic to any other drugs?"
B) "How often have you received penicillin?"
C) "I'll write your allergy on your chart so you won't receive any."
D) "Please describe what happens to you when you take penicillin." - (correct
Answer) - D) "Please describe what happens to you when you take penicillin."
Allergies, including specific reactions to each medication, such as rash or nausea,
,must be recorded.
The nurse is taking a family history. Important diseases or problems to ask the
patient about include:
A) emphysema.
B) head trauma.
C) mental illness.
D) fractured bones. - (correct Answer) - C) mental illness.
Specifically ask for any family history of heart disease, high blood pressure,
stroke, diabetes, obesity, blood disorders, ovarian cancer, colon cancer, sickle
cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness,
suicide, seizure disorder, kidney disease, and tuberculosis. The other answers are
acquired.
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 - (correct Answer) - D) Review of systems
Most review of systems questions pertain to systems. You may also draw on Review of
Systems questions related to the Chief Complaint to establish positives and
negatives that help clarify the diagnosis.
Which of the following statements represents subjective data obtained from the
patient regarding his skin?
A) Skin appears dry.
B) No obvious lesions
C) Denies color change
D) Lesion noted lateral aspect right arm - (correct Answer) - C) Denies color
change
Remember that the history (from the chief complaint through review of systems)
should be limited to patient statements or subjective data�factors that the person
says were or were not present.
Subjective data is what the patient tells you.
The following information is best placed in which category? "The patient had a
stent placed in the left anterior descending artery (LAD) in 1999."
A) Medical
B) Surgical
C) Obstetrics/gynecology
D) Psychiatric - (correct Answer) - B) Surgical
Provide information relative to Adult Illnesses in each of four areas: Medical,
Surgical, Obstetric/Gynecologic, and Psychiatric.
During the aging process, the hair can look gray or white and begin to feel thin
and fine. The nurse practitioner knows that this occurs because of a decrease in:
A) pigmentation
B) thyroid stimulating hormone
C) phagocytes
D) fungacytes - (correct Answer) - A) pigmentation
Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of
melanocytes) so the hair looks gray or white and feels thin and fine. The other
options are not correct.
You are speaking to an 8th grade class about health prevention and are preparing to
discuss the ABCDEs of melanoma. Which of the following descriptions correctly
defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6
, mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D =
diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E =
evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D =
diameter >6 mm; E = evolution - (correct Answer) - B) A = asymmetry; B = irregular
borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
You are examining the skin on a 22 year old female when you notice a circumscribed
superficial lesion that is elevated approximately 0.5cm in diameter, filled with
serous fluid. What type of lesion is this?
A) macule
B) papule
C) vesicle
D) spider angioma - (correct Answer) - C) vesicle
Vesicle - up to 1.0 cm filled with serous fluid
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after
being in the hospital for 6 weeks. She was treated for sepsis and respiratory
failure and had to be on a ventilator for 3 weeks. The nurse is completing an
initial assessment and evaluating the client's skin condition. On her sacrum there
is full-thickness skin loss that is 5 cm in diameter with damage to the
subcutaneous tissue. The underlying muscle is not affected. What is the stage of
this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4 - (correct Answer) - C) Stage 3
A crater appears in the skin, with full-thickness skin loss and damage to or
necrosis of subcutaneous tissue that may extend to, but not through underlying
muscle.
Mrs. Anderson presents with an itchy rash which is raised and appears and
disappears in various locations. Each lesion lasts for many minutes. What most
likely accounts for this rash?
A) Insect bites
B) Wheals, urticaria, or hives
C) Psoriasis
D) Purpura - (correct Answer) - B) Wheals, urticaria, or hives
Wheals/urticaria - a somewhat irregular, relatively transient, superficial area of
localized skin edema.
Ethel is a 68 year old Caucasian female who is new to your area. She shows you
multiple brown colored, flat lesions on her face, chest, and hands that have been
present for years. You respond that these are likely:
A) solar lentigos
B) melanomas
C) keloids
D) fissures - (correct Answer) - A) solar lentigos
solar lentigos are from sun damage, are more common on the face, shoulders, and
hands.
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 - (correct Answer) - B) carbuncle
A 59 year old patients tells the nurse practitioner that he thinks he must have
ulcerative colitis. He has been having "black stools" for the last 24 hours. How
would the nurse practitioner best document THE FACTS for his reason for seeking
care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. -
(correct Answer) - A) JM is a 59 year old male here for having "black stools" for
the past 24 hours.
Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek
care. Make every effort to quote the patient's own words.
A patient tells the nurse practitioner that she has had abdominal pain for the past
week. What would be the best response by the nurse practitioner?
A) We'll talk more about that later in the interview."
B) "Have you ever had any children?"
C) "What have you had to eat in the last 4 hours?"
D) "Can you point to where it hurts?" - (correct Answer) - D) "Can you point to
where it hurts?"
Each principle symptom should be well-characterized, with descriptions of location;
along with the other seven attributes. Location: Ask the patient to point to the
pain because lay terms may not be specific enough to localize the site of origin.
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?" -
(correct Answer) - 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.
In recording the childhood illnesses of a patient who denies having had any, which
of the following notes by the nurse would be most accurate?
A) Patient denies usual childhood illnesses.
B) Patient states he was a "very healthy" child.
C) Patient states sister had measles, but he didn't.
D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever,
and polio. - (correct Answer) - D) Patient denies measles, mumps, rubella,
chickenpox, pertussis, rheumatic fever, and polio.
Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic
fever, scarlet fever, and polio. They are included in the past history.
A patient tells the nurse that he is allergic to penicillin. What would be the
nurse's best response to this information?
A) "Are you allergic to any other drugs?"
B) "How often have you received penicillin?"
C) "I'll write your allergy on your chart so you won't receive any."
D) "Please describe what happens to you when you take penicillin." - (correct
Answer) - D) "Please describe what happens to you when you take penicillin."
Allergies, including specific reactions to each medication, such as rash or nausea,
,must be recorded.
The nurse is taking a family history. Important diseases or problems to ask the
patient about include:
A) emphysema.
B) head trauma.
C) mental illness.
D) fractured bones. - (correct Answer) - C) mental illness.
Specifically ask for any family history of heart disease, high blood pressure,
stroke, diabetes, obesity, blood disorders, ovarian cancer, colon cancer, sickle
cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness,
suicide, seizure disorder, kidney disease, and tuberculosis. The other answers are
acquired.
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 - (correct Answer) - D) Review of systems
Most review of systems questions pertain to systems. You may also draw on Review of
Systems questions related to the Chief Complaint to establish positives and
negatives that help clarify the diagnosis.
Which of the following statements represents subjective data obtained from the
patient regarding his skin?
A) Skin appears dry.
B) No obvious lesions
C) Denies color change
D) Lesion noted lateral aspect right arm - (correct Answer) - C) Denies color
change
Remember that the history (from the chief complaint through review of systems)
should be limited to patient statements or subjective data�factors that the person
says were or were not present.
Subjective data is what the patient tells you.
The following information is best placed in which category? "The patient had a
stent placed in the left anterior descending artery (LAD) in 1999."
A) Medical
B) Surgical
C) Obstetrics/gynecology
D) Psychiatric - (correct Answer) - B) Surgical
Provide information relative to Adult Illnesses in each of four areas: Medical,
Surgical, Obstetric/Gynecologic, and Psychiatric.
During the aging process, the hair can look gray or white and begin to feel thin
and fine. The nurse practitioner knows that this occurs because of a decrease in:
A) pigmentation
B) thyroid stimulating hormone
C) phagocytes
D) fungacytes - (correct Answer) - A) pigmentation
Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of
melanocytes) so the hair looks gray or white and feels thin and fine. The other
options are not correct.
You are speaking to an 8th grade class about health prevention and are preparing to
discuss the ABCDEs of melanoma. Which of the following descriptions correctly
defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6
, mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D =
diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E =
evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D =
diameter >6 mm; E = evolution - (correct Answer) - B) A = asymmetry; B = irregular
borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
You are examining the skin on a 22 year old female when you notice a circumscribed
superficial lesion that is elevated approximately 0.5cm in diameter, filled with
serous fluid. What type of lesion is this?
A) macule
B) papule
C) vesicle
D) spider angioma - (correct Answer) - C) vesicle
Vesicle - up to 1.0 cm filled with serous fluid
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after
being in the hospital for 6 weeks. She was treated for sepsis and respiratory
failure and had to be on a ventilator for 3 weeks. The nurse is completing an
initial assessment and evaluating the client's skin condition. On her sacrum there
is full-thickness skin loss that is 5 cm in diameter with damage to the
subcutaneous tissue. The underlying muscle is not affected. What is the stage of
this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4 - (correct Answer) - C) Stage 3
A crater appears in the skin, with full-thickness skin loss and damage to or
necrosis of subcutaneous tissue that may extend to, but not through underlying
muscle.
Mrs. Anderson presents with an itchy rash which is raised and appears and
disappears in various locations. Each lesion lasts for many minutes. What most
likely accounts for this rash?
A) Insect bites
B) Wheals, urticaria, or hives
C) Psoriasis
D) Purpura - (correct Answer) - B) Wheals, urticaria, or hives
Wheals/urticaria - a somewhat irregular, relatively transient, superficial area of
localized skin edema.
Ethel is a 68 year old Caucasian female who is new to your area. She shows you
multiple brown colored, flat lesions on her face, chest, and hands that have been
present for years. You respond that these are likely:
A) solar lentigos
B) melanomas
C) keloids
D) fissures - (correct Answer) - A) solar lentigos
solar lentigos are from sun damage, are more common on the face, shoulders, and
hands.
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 - (correct Answer) - B) carbuncle
