NURS 634 MIDTERM ACTUAL EXAM UPDATED

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NURS 634 MIDTERM ACTUAL EXAM UPDATED

QUESTIONS AND ANSWERS VERIFIED 100%

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42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. TheFre is no family history of cancers. On examination she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation?

• Large bowel obstruction
• Irritable bowel syndrome
• Rectal cancer
• Hypothyroidism

ANS: D

COPD is associated with what on physical exam?

2 increase in A/P diameter A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D

ANS: A

Feedback: The lack of contact with blood and body fluids makes

hepatitis B, C, and D unlikely. She regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is recommended for daycare workers A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings?

• Eczema
• Pityriasis rosea
• Psoriasis
• Tinea infection

ANS: C

Feedback: This is a classic presentation of plaque psoriasis. Eczema is

usually over the flexor surfaces and does not scale, whereas psoriasis

3 affects the extensor surfaces. Pityriasis usually is limited to the trunk and proximal extremities. Tinea has a much finer scale associated with it, almost like powder, and is found in dark and moist areas Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against resistance when her palms face the floor. What condition does she have?

• Medial epicondylitis (golfer's elbow)
• Olecranon bursitis
• Lateral epicondylitis (tennis elbow)
• Supracondylar fracture

ANS: C

Feedback: Mary’s injury probably occurred by lifting heavy buckets

with her palms down (toward the bucket). This caused her chronic overuse injury at the lateral epicondyle. Medial epicondylitis has reproducible pain when palmar flexion against resistance is performed and also features tenderness over the involved epicondyle. Olecranon bursitis produces erythema and swelling over the olecranon process. A supracondylar fracture of the humerus is a major injury and would present more acutely.Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation, and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?

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• Allow the patient to speak uninterrupted for the duration of the

appointment.

• Briefly summarize what you heard from the patient in the first 5

minutes and then try to have her focus on one aspect of what she told you.

• Set the time limit at the beginning of the interview and stick with it,

no matter what occurs in the course of the interview.

• Allow your impatience to show so that the patient picks up on your

nonverbal cue that the appointment needs to end.

ANS: B

Feedback: You can also say, “I want to make sure I take good care of

this problem because it is very important. We may need to talk about the others at the next appointment. Is that okay with you?” This is a technique that can help you to change the subject but, at the same time, validate the patient's concerns; it also can provide more structure to the interview You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. Which of the following is most likely?

• Cancer
• Lymph node
• Deep scar
• Muscle

ANS: B

Feedback: A useful maneuver for discerning lymph nodes from other

masses in the neck is to check for their mobility in all directions. Many