NR 509 /NR509 Advanced Physical Assessment Midterm Exam Questions with Verified Answers (Latest 2024

NR 509/ NR509 Advanced Physical Assessment Midterm Exam Questions with Verified Answers (Latest 2024 / 2025)- Chamberlain Absence of red reflex ANSWER: an opacity of the lens (cataract) or, possibly, the vitreous (or even an artificial eye). Less commonly, a detached retina or, in children, a retinoblastoma may obscure this reflex.

Acanthosis nigricans ANSWER: deeply pigmented, velvety axillary skin in the axilla -associated with diabetes, obesity, PCOS, and rarely malignant paraneoplastic disorders Acromion ANSWER: Acromion ANSWER: tip of shoulder Acute RA ANSWER: Tender, painful, stiff joints in RA, usually with symmetric involvement on both sides of the body. The distal interphalangeal (DIP), metacarpophalangeal (MCP), and wrist joints are the most frequently affected. Note the fusiform or spindle-shaped swelling of the PIP joints in acute disease.

Adult Illnesses ANSWER: Medical: Illnesses such as diabetes, hypertension, hepatitis, asthma, and human immunodeficiency virus (HIV); hospitalizations; number and gender of sexual partners; and risk-taking sexual practices ■ Surgical: Dates, indications, and types of operations ■ Obstetric/Gynecologic: Obstetric history, menstrual history, methods of contraception, and sexual function ■ Psychiatric: Illness and time frame, diagnoses, hospitalizations, and treatments Angina pectoris ANSWER: Consider this as a differential diagnosis for chest pain Bronchial ANSWER: or louder, harsher and higher in pitch, with a short silence be-tween inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.

Bronchovesicular sounds ANSWER: with inspiratory and expiratory sounds about equal in length, at times separated by a silent interval. Detecting differences in pitch and intensity is often easier during expiration.

Bulging discs ANSWER: Vertebral bodies of the spin associated with bulging disc are cartilaginous C-section should be listed under surgeries ANSWER: Cause of falsely high BP ANSWER: -too small of a BP cuff - if the brachial artery is below heart level - loose cuff - bladder that balloons outside the cuff Cause of saddle numbness and urinary retention ANSWER: Cauda equina syndrome Check for nystagmus ANSWER: -involuntary jerking movement of the eyes with quick and slow components.

- It is named for the direction of the quick component - seen in cerebellar disease and vestibular disorders and in internuclear ophthalmoplegia Cherry angiomas ANSWER: Benign Chronic RA ANSWER: swelling and thickening of the MCP and PIP joints. Range of motion becomes limited, and fingers may deviate toward the ulnar side. The interosseous muscles atrophy. The fingers may show "swan neck" deformities (hyperextension of the PIP joints with fixed flexion of the distal interphalangeal [DIP] joints). Less common is a boutonnière deformity (persistent flexion of the PIP joint with hyperextension of the DIP joint). Rheumatoid nodules are seen in the acute or the chronic stage.

CN 1-6 ANSWER: 1) Olfactory- smell 2)Optic- visual acuity with eye chart & pupil response 3)Oculomotor- conjugate gaze with EOM

4)Trochlear- conjugate gaze with EOM 5) Trigeminal- palpate masseter & touch face and have pt identify where 6) Abducens- Conjugate gaze with EOM CN 7-12 ANSWER: 7)Facial- Blow cheeks out, smile, frown, pucker lips 8)Vestibulocochlear (Acoustic)- Whisper test 9) Glossopharyngeal- Gag reflex 10)Vagus- say "ahhh". soft palate and uvula rise symmetrically 11) Accessory- shrug shoulders 12) Hypoglossal- Stick out tongue and move left to right Condylar joints ANSWER: Knee & TMJ -Movement of two articulating surfaces not dissociable constitutional ROS ANSWER: fatigue, weakness, fever, chills, night sweats, weight changes, pain crackles ANSWER: -intermittent, nonmusical, brief - Come from abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart failure) or of the airways (bronchitis, bronchiectasis -can be indicative of heart failure Cranial nerve for lateral gaze ANSWER: CN6: Abducens Dim response of olfactory nerve in elderly ANSWER: Normal finding Dysfunction of the cerebellum ANSWER: Impaired speech and judgement with an otherwise normal exam epistaxis causes ANSWER: nosebleed - cause: trauma, inflammation, drying and crusting of the mucosa, tumors and foreign bodies

Glaucoma ANSWER: Increased cup-to-disc ratio Headache warning signs ANSWER: Progressively frequent or severe over a 3-month period ● Sudden onset like a "thunderclap" or "the worst headache of my life" ● New onset after age 50 years ● Aggravated or relieved by change in position ● Precipitated by Valsalva maneuver or exertion ● Associated symptoms of fever, night sweats, or weight loss ● Presence of cancer, HIV infection, or pregnancy ● Recent head trauma ● Change in pattern from past headaches ● Lack of a similar headache in the past ● Associated papilledema, neck stiffness, or focal neurologic deficits Health History ANSWER: ● Identifying data and source of the history; reliability ● Chief complaint(s) ● Present illness ● Past history ● Family history ● Personal and social history ● Review of systems Heroin overdose ANSWER: pinpoint pupils how do get a patient to open up when upset ANSWER: effective reassurance is simply identifying and acknowledging the patient's feelings.

-Partnering -Summarizing -Transitions - Empowering the pt How otosclerosis presents with Weber and Rinne test ANSWER: - Weber: Sound lateralizes to impaired ear. Room noise not well heard, so detection of vibrations improves - Rinne: BC longer than or equal to AC. While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.

if one patient comes from another country ANSWER: You still need to be selective in who you screen for malaria interpreter in the room ANSWER: you have eye contact with patient. Speak to pt. have interpreter sit close to the patient, or even behind you, so you don't have to turn your head back and forth Interpreting visual acuity test ANSWER: Vision of 20/200 means that at 20 feet the patient can read print that a person with normal vision could read at 200 feet. The larger the second number, the worse the vision. "20/40 corrected" means the patient could read the 20/40 line with glasses (a correction).

Jaundice ANSWER: yellow sclera Labs for vitiligo ANSWER: thyroid (hyperthyroidism) listening to the heart ANSWER: Patient must lay down to listen for S1, S2, and murmurs Lymph nodes ANSWER: Small, discrete, mobile mass Making a pelvic exam more comfortable ANSWER: Obtains permission; selects chaperone Explains each step of the examination in advance Drapes the patient from mid-abdomen to knees; depresses the drape between the knees to provide eye contact with patient Avoids unexpected or sudden movements Chooses a speculum that is the correct size Warms the speculum with tap water Monitors the comfort of the examination by watching the patient's face Uses excellent but gentle technique, especially when inserting the speculum objective information ANSWER: Vitals, info you detect during examination, physical exam findings

Obtunded ANSWER: patient opens the eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.

Patient consent ANSWER: you need consent to carry out a visit with someone in the room with them. pityriasis rosea ANSWER: Multiple round to oval scaling violaceous plaques on abdomen and back Present Illness ANSWER: chronologic description of the problems prompting the patient's visit, including the onset of the problem, the setting in which it developed, its manifestations, and any treatments to date.Each problem/symptom needs: (1) location; (2) quality; (3) quantity or severity; (4) timing, including onset, duration, and frequency; (5) the setting in which it occurs; (6) factors that have aggravated -meds, allergies, tobacco use, ETOH and drug use Presentation of optic neuritis ANSWER: Enlarged blind spot, vision loss in 1 eye, loss of color vision, hole in center of vision, trouble seeing to the side, eye pain Presentation of retinal detachment ANSWER: If sudden visual loss is unilateral and painless, prioritizing patient complaints ANSWER: Problem list - Most active and serious problems first - then, problems that need future observation and attention psoriasis presentation ANSWER: -Scattered erythematous round drop-like, flat-topped well-circumscribed scaling papules and plaques on trunk (guttate psoriasis) -Scattered erythematous to bright pink well-circumscribed flat-topped plaques on extensor knees and elbows, with overlying silvery scale; plaque psoriasis Rhonchi ANSWER: - Low pitched -sound from secretions in the large airways that may change with coughing

Risks for Melanoma ANSWER: Personal or family history of previous melanoma ● ≥50 common moles ● Atypical or large moles, especially if dysplastic ● Red or light hair ● Solar lentigines (acquired brown macules on sun-exposed areas) ● Freckles (inherited brown macules) ● Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths ● Light eye or skin color, especially skin that freckles or burns easily ● Severe blistering sunburns in childhood ●Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy ● Personal history of nonmelanoma skin cancer Rotator cuff injury ANSWER: Atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 2 to 3 weeks of a rotator cuff tear; infraspinatus atrophy has a positive likelihood ratio (LR) of 2 for rotator cuff disease. s/s of degenerative pain ANSWER: -Slowly progressive, with temporary exacerbations after periods of overuse -usually insidious - flexion and deviation deformities S/S of seasonal allergies ANSWER: Itching, watery eyes, sneezing, ear congestion, postnasal drainage Sequence of the interview ANSWER: Preparation. Then, Greeting the patient and establishing rapport.

Establishing the agenda for the interview. Inviting the patient's story. Exploring the patient's perspective. Identifying and responding to emotional cues. Expand-ing and clarifying the patient's story. Generating and testing diagnostic hypotheses. Sharing the treatment plan. Closing the interview and the visit. Taking time for self-reflection. signs of asthma ANSWER: wheezes absent breath sounds & abnormal retraction (severe asthma) hyperresonance

Signs of increased ICP ANSWER: Papilledema ( pink, hyperemic, loss of venous pulsations, disc more visible, disc swollen with blurred margins, physiologic cup not visible) signs of meningitis ANSWER: neck stiffness with resistance to flexion Signs of otitis externa ANSWER: -After swimming - inflammation of the ear canal -pain, itching, redness, swelling, hearing loss signs of respiratory distress ANSWER: Tachypnea, cyanosis or pallor, audible whistling during inspiration over neck or lungs, stridor, use of accessory muscles, Silent patient ANSWER: A patient who looks to her family member to answer a question sources of joint pain ANSWER: -If age <60 years, consider repetitive strain or overuse syndromes like tendinitis or bursitis, crystalline arthritis (gout; crystalline pyrophosphate deposition disease [CPPD]) (males), rheumatoid arthritis (RA), psoriatic arthritis and reactive (Reiter) arthritis (in inflammatory bowel disease [IBD]), and infectious arthritis from gonorrhea, Lyme disease, or viral or bacterial infections.

- If age >60 years, look for OA, gout and pseudogout, polymyalgia rheumatica (PMR), osteoporotic fracture, and septic bacterial arthritis.

- congenital, inflammatory or infectious, immunologic, neoplastic, metabolic, nutritional, degenerative, vascular, traumatic, and toxic?

Sternocleidomastoid lymph nodes ANSWER: Considered posterior cervical subconjunctival hemorrhage ANSWER: -no pain -vision not affected - no eye discharge -pupil not affected -clear cornea - benign, spontaneous, doesn't need treatment.

subjective data ANSWER: - Symptoms - What pt tells you -goes under ROS Symptoms of a SAH ANSWER: Headache with severe and sudden onset -thunderclap headache reaching maximal intensity over several minutes Symptoms of pneumonia ANSWER: - fever -may have normal VS - dim lung sounds or crackles - dull percussion -tachypnea -nasal flaring Talkative patient ANSWER: repeat what she said in the first 5 minutes and get her to focus on one aspect of what she told you Tension headache ANSWER: A headache located all over the head, is a tightness, and is noted after looking at a computer all day Tension Pneumo ANSWER: Use 2nd intercostal space for needle insertion tracheal sounds ANSWER: Loud, harsh sounds heard over the trachea in the neck vasovagal syncope ANSWER: -neurocardiogenic (also called neutrally mediated vasodepressor syncope or vasovagal syncope) and of cardiac origin from arrhythmias in only ∼20% of cases Vesicular lung sounds ANSWER: soft and low pitched. They are heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration.

What to do for + finding on physical exam, but - workup ANSWER: continue using test, but less lab and diagnostics Wheezes ANSWER: high pitched, shrill quality -means narrowed airway, COPD, bronchitis, asthma