NUR 634 Review/Midterm Exam: NUR634/ NUR 634 (Latest 2023/ 2024 Update) Advanced Health Assessment and Diagnostic Reasoning Study Guide | Questions and Verified Answers| 100% Correct – GCU
Midterm Exam: NUR634/ NUR 634 (Latest
2023/ 2024 Update) Advanced Health
Assessment and Diagnostic Reasoning Study
Guide | Questions and Verified Answers|
100% Correct – GCU
Q: Patient with asthma complains of
Answer:
SOB, wheezing, tightness to the chest, coughing with exertion or nocturnal cough that is
nonproductive, sounds like high pitched whistling on expiration auscultation, decreased air
motion.
Q: Asthma Atopy TRIAD:
Answer:
Any family hx of allergies, asthma, or eczema.
Q: Decreased air movement and a high-pitched whistling on expiration in all fields is associated
with?
Answer:
Asthma: problems with expiration (getting air out, it is trapped).
Q: Acute cough vs chronic cough
Answer:
Acute cough < 3 weeks, chronic cough > 8 weeks.
Q: Normal sound over lungs:
Answer:
Resonance
Q: Sound heard over hyperinflated lungs:
Answer:
hyper-resonance.
Q: What is the sequence of doing a lung exam
Answer:
inspect, palpate, percuss, and auscultate.
Q: COPD: What is the patient going to complain about prior to diagnosis?
Answer:
Productive chronic cough in the morning, occasional SOB
Q: COPD Diagnosis
Answer:
Look for smoking hx or exposure to noxious environment. No chest pain. Barrel chest on
physical exam, assess AP diameter (increased), decreased breath sounds (rhonchi), tactile
phremitis with increased vibration.
Q: PNA presents as
Answer:
chest pain, fever (maybe), cough, sputum production, crackles in lower bases, dullness on
percussion, egophony on auscultation.
Q: What does dull percussion of the lungs indicate?
Answer:
Consolidations, PNA
Q: A patient presents with with symptoms of fever, SOB, productive cough, and hemoptysis.
What ddx do you consider?
Answer:
PNA
Q: Acid Reflux S/S
Answer:
reflux described as heart burn, sore throat, abdominal discomfort (upper epigastric).
Q: Risk factors for acid reflux
Answer:
laying flat, eating before bed, age, stress, ETOH, high BMI, spicy foods, caffeine, anything
citrus, chocolate, diary, carbonated beverages.
Q: GERD education
Answer:
Limit spicy food, tomato/acidic, caffeine, carbonated beverages, don’t eat before bed.
Q: Old fat guy complains of hoarse/forced voice, ddx?
Answer:
GERD
Q: Order of abdomen examination:
Answer:
inspection > auscultation > percussion > palpation.
Q: Abnormal sound over abdomen:
Answer:
tympany
abdominal auscultatio requires listening with the bell in all four quadrants at least 2 places in
each quadrant.
Q: Where would you listen for bruits in the abdominal aorta?
Answer:
above the umbilicus below xiphoid process just left of the midline.
Q: What does CVA tenderness assess for?
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When do you complete a comprehensive visit?
Comprehensive visit occurs at NEW patient encounters or if the last visit was >3 years ago.
Sequence of Interview
- introduce self
- gather supplies/wash hands
- establish rapport
- what brings you in, CC: listen for 5 minutes
- summarize (establish agenda)
- ask focused questions 7. collaborate/share decision making in plan.
How much time do you allow for the patient to tell you their complaint?
3-5 minutes
What to do if your patient is a talker?
give them 3-5 minutes, summarize what you heard within those 5 minutes, then direct them to the complaint.
Your patient presents with a long erratic rant introducing themselves, what do you do?
Summarize what they are here for.
What is echoing?
interviewing technique of repeating back what pt says.
What type of questions do you ask in the interview?
Start with open ended questions and go to focused questions.
What does FIFE stand for and what is it used for?
Feelings, Ideas, Function, Expectation. Assesses a patients illness experience.
What part of a history is it when asking about education, work, and ETOH intake?
Social Hx
What is the ROS?
your pertinent positives and negatives based on body systems.
Subjective Data
Things a person tells you about that you cannot observe through your own senses; symptoms.
Objective Data
Information that is seen, heard, felt of smelled by an observer; signs.
Nonmaleficence
duty to do no harm
Beneficence
Doing good or causing good to be done; kindly action
The elements that constitute decisional capacity:
Patient must have the ability to understand the relevant information about proposed diagnostic tests or treatments, appreciate their situation (including their underlying values and current clinical situation), use reason to make a decision, and communicate their choice.
Aid to Capacity Evaluation (ACE):
conducted to determine a person’s ability to make informed decisions regarding his/her treatment and/or authorization to release confidential information.
Active or attentive listening:
Carefully attending to what the patient is communicating, connected to the patient’s emotional state, using verbal and nonverbal skills. Nonverbal communication technique that you use to encourage patient to tell you more.
What is therapeutic communication?
Encouraging them, expanding on a statement they are presenting, acknowledging if something that makes them uncomfortable.
Patient presents with a sharply demarcated area of blood in eye and a history of coughing a lot or vomiting, what do you want to know, and what is your ddx?
Any recent trauma
subconjunctival hemorrhage
Normal disc to cup ratio
1:3
Patient presents with a disc to cup ratio of 1:2, what do you suspect?
Glaucoma
presbyopia
Normal vision change in the elderly. A gradual, age-related loss of the eyes’ ability to focus actively on nearby objects.
When someone comes in with sudden painless loss of vision in one eye, what do you consider?
Retinal Detachment
Retinal detachment
Sudden loss of vision without pain, unilateral, flashes of light, can be traumatic.
What is the disease process called for sudden, painful, unilateral loss of vision?
Optic Neuritis
Optic Neuritis
Sudden PAINFUL, unilateral loss of vision. Early sign of MS, associated with autoimmune disease.
Patient has red raised area to eyelid margin, tender to palpation, what is it? NO discharge, no tearing, no change in vision, no trauma.
Hordeolum (stye)
Chalazion
A nodule or cyst usually on the upper eyelid caused by obstruction in the meibomian gland.
What is a pterygium?
Fleshy or triangular thickening of the bulbar conjunctiva outer surface of the cornea seen in individuals who are outside a lot- lots of UV light exposure. Does NOT effect pupil response.
Penlight pupil assessment, you shine on one eye and the other reacts. What is this called?
Consensual reaction
Macular degeneration
slow loss of central vision in both eyes.
Blurred vision/double vision, which CN?
CN III- Oculomotor
Hx of R eye blurred vision, metal shaving in eye, what do you do?
refer to ophthalmologist.
Are cataracts a normal part of aging? Glaucoma?
Common, but not expected.
CN III, IV, VI, what do they assess? What if something is wrong?
Ocular movement.
Neuro problem.
Lack of red reflex in eye exam, what are you concerned for?
retinoblastoma.
When do you do vision testing?
Anyone with new eye complaint, new patients, sports exam, and annual exam gets vision testing.
How to assess cranial nerve VII- facial?
Puff cheeks, raise eyebrows, smile, close eyes, wrinkle forehead.
What condition is associated with partial facial paralysis, asymmetry, and flatting of the NLF?
Bell’s palsy
What eye condition are people with bell’s palsy at risk for?
Dry eye
A patient’s tympanic membrane is erythematous, bulging, opaque/cloudy, and presents with ear pain, and possible fever, what do you suspect?
Otitis Media
Otitis media s/s in kids
In kids pulling at ear, crying/fussy, not eating well.
Otitis Externa
erythema in canal, narrowed canal space, possible discharge, pain with ear manipulation/tragus palpation or pressure.
What is ‘Swimmers Ear’? S/S?
Otitis Externa
Redness, pain, pus in canal.
Patient comes in with sudden hearing loss, what do you do?
Look in ear, visualize TM, perform Rhinne and Weber, refer to audiology for further workup.
Webber test abnormal finding, next step?
Examine ear canal, refer to specialist.
Normal air conduction : bone conduction
2:1
A kid is putting things in their ear, damaging what CN:
CN IX
Pain from ear, which CN:
CN IX
Tinnitus is most commonly associated with?
Vertigo
Benign Positional Vertigo
Sudden onset of spinning sensation when lying flat. room is spinning, worse with moving their head. No ringing in ears, no loss of hearing, no nystagmus. Lasts only a few minutes and can be accompanied by nausea.
Strep throat (strep pharyngitis):
white exudates on tonsils, enlarged tonsils (grade + behind tonsillar pillars), sore throat, no cough, fever (>100.5), enlarged tonsillar, submandibular, posterior cervical (behind sternocleidomastoid muscle) lymph nodes
While assessing a patients mouth, you ask them to say ‘ahh’ and notice their uvula is deviating to the right side. What CN is affected and what are you concerned for?
CN X- Vagus
If there is deviation, be suspicious for tumor/lesion on opposite side.
RIGHT deviation = LEFT lesion
What is dysphagia?
difficulty swallowing
Nasal exam show growth that is inflamed, obstructing nasal cavity, what is it?
Nasal polyp
Pain with chewing gum, Ddx?
TMJ
patient complains of pain with chewing, usually starts unilateral.
If CN 5 affected: lateral headache, pain into jaw/radiating into teeth, sensation difference.
Patient who is older adult, complains of bilateral temporal headache/temple pain, blurred vision. What are you concerned for? What physical exam will you perform?
Concern for giant arteritis.
Palpate temporal arteries for bounding temporal pulses.
Normal lymph node finding
small, soft, and mobile.
If they are hard = BAD
Flexion of the neck is assessing which muscle group?
Sternocleidomastoid
Posterior Cervical Lymph nodes:
Lymph nodes behind the sternocleidomastoid
Patient with asthma complains of
SOB, wheezing, tightness to the chest, coughing with exertion or nocturnal cough that is nonproductive, sounds like high pitched whistling on expiration auscultation, decreased air motion.
Asthma Atopy TRIAD:
Any family hx of allergies, asthma, or eczema.
Decreased air movement and a high-pitched whistling on expiration in all fields is associated with?
Asthma: problems with expiration (getting air out, it is trapped).
Acute cough vs chronic cough
Acute cough < 3 weeks, chronic cough > 8 weeks.
Normal sound over lungs:
Resonance
Sound heard over hyperinflated lungs:
hyper-resonance.
What is the sequence of doing a lung exam
inspect, palpate, percuss, and auscultate.
COPD: What is the patient going to complain about prior to diagnosis?
Productive chronic cough in the morning, occasional SOB
COPD Diagnosis
Look for smoking hx or exposure to noxious environment. No chest pain. Barrel chest on physical exam, assess AP diameter (increased), decreased breath sounds (rhonchi), tactile phremitis with increased vibration.
PNA presents as
chest pain, fever (maybe), cough, sputum production, crackles in lower bases, dullness on percussion, egophony on auscultation.
What does dull percussion of the lungs indicate?
Consolidations, PNA
A patient presents with with symptoms of fever, SOB, productive cough, and hemoptysis. What ddx do you consider?
PNA
Acid Reflux S/S
reflux described as heart burn, sore throat, abdominal discomfort (upper epigastric).
Risk factors for acid reflux
laying flat, eating before bed, age, stress, ETOH, high BMI, spicy foods, caffeine, anything citrus, chocolate, diary, carbonated beverages.
GERD education
Limit spicy food, tomato/acidic, caffeine, carbonated beverages, don’t eat before bed.
Old fat guy complains of hoarse/forced voice, ddx?
GERD
Order of abdomen examination:
inspection > auscultation > percussion > palpation.
Abnormal sound over abdomen:
tympany
abdominal auscultatio requires listening with the bell in all four quadrants at least 2 places in each quadrant.
Where would you listen for bruits in the abdominal aorta?
above the umbilicus below xiphoid process just left of the midline.
What does CVA tenderness assess for?
pyelonephritis.
Findings of cirrhosis:
enlarged liver with irregular border, jaundice, ascites, N/V, unintentional weight loss, fatigue.
Patient presents with cc of losing weight, fatigue, night sweats, low grade fever, enlarged liver, what are you concerned for?
Liver Cancer
Normal sound over liver:
Dullness
In splenomegaly, percussion of the L side of the abdomen would reveal:
Dullness
Findings of biliary colic:
Right shoulder pain.
Patient presents with a + Murphy’s sign, pain that radiates from RUQ to shoulder, ddx?
Cholecystitis
Patients with cholecystitis should avoid
spicy, fatty, dairy, and anything in the cabbage family.
Cholecystitis
Inflammation of the gallbladder
Patient complains of right upper quadrant pain that can radiate to right shoulder into right back. Complains of nausea/vomiting 1-2hrs after eating fatty/greasy foods. ddx?
cholecystitis
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