Reasoning Practice Questions with Correct Detailed Answers

1 NURS550 Advanced Health Assessment and Diagnostic Reasoning Practice Questions with Correct Detailed Answers/ Updated .

An 8-year-old patient presents with their mother to the clinic. The client's chief complaint is a "very sore throat". The vital signs for the patient are: temperature 101.6F, pulse 102 bpm, blood pressure 92/54 mmHg, respirations 12/min. Which diagnostic test should the provider order first? – ✓ Rapid streptococcal testing Rapid screening tests (rapid antigen detection testing [RADT]) for streptococcal antigens are useful in patients with signs and symptoms of acute pharyngitis. Because of improvements with RADT, a throat culture is not necessary unless the RADT is negative, symptoms do not improve or the patient shows no response to appropriate antibiotics. Streptococcal pharyngitis is most common among those under 25 years of age, especially 5 - 15 years.

A 36-year-old female presents to the office complaining of headache since she started a new position at work. When completing the HPI, the clinician notes that the client's previous position involved walking through the industrial plant, however the new job has her sitting at a desk, looking at a computer most of the day. The client describes the headaches as dull, non-throbbing and rates the pain 4/10. The provider would make which likely diagnosis?✓ Tension Headache Tension headaches are often the result of emotional or physical stress and can also occur as a result of abnormal neck positions (especially neck tension) and prolonged mental concentration. Tension HA is the most common cause of headache at any age and occurs more commonly in females.

Your client is complaining of fatigue, weight loss, loss of body hair and has palmar erythema. They have been taking a multivitamin with iron to see if this would help with symptoms for the last month, but they have increased. Lab values show microcytic anemia and normal ferritin levels. This is indicative of – ✓ Thalassemia See anemia slide 36 symptoms along with microcytic anemia and normal ferritin levels indicative of thalassemia

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2 Which is a plasma protein synthesized by the liver?✓ Albumin Albumin is a plasma protein synthesized by the liver. Progesterone and Estrogen are Lipoproteins synthesized by the liver. Vitamin K stored in the liver-

Primary Prevention – ✓ aimed at preventing the onset of disease and typically involves managing risk factors in healthy people that may lead to disease

Secondary Prevention – ✓ aimed at treating disease after its onset but before serious complications occur

Tertiary prevention – ✓ used in the later or final states of a disease with the aim of minimizing the degree of disability caused by the disease

The most sensitive and specific test for iron deficiency is: -

✓ Ferritin level See anemia slide 24 Iron level not indicative of iron stores or true deficiency TIBC nonspecific and Reticulocyte count compensatory

You are evaluating a 24-year-old female in her 3rd trimester of pregnancy. You order a hemoglobin and hematocrit due to complaints of fatigue. She denies spotting or bleeding and her hemoglobin is 13mg/dl and her hematocrit is 30%. Her current hemoglobin and hematocrit most likely represents – ✓ Hemodilution

Hgb⁄Hct ratio is usually 1:3 when greater usually hemodilution

You are evaluating a client with a history of fever. The Complete Blood Count reveals the following: WBC 16,000mm3, Neutrophils 40% Lymphocytes 55% Monocytes 3% Eosinophils: 1%, Basophils 1%. Based on

these findings you suspect: -

✓ Viral Infection WBC and differential slides slide 13 Lymphocytes 20-40% total WBC -increase with viral infection 2 / 4

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Using glomerular filtration rate testing to estimate to monitor the severity of chronic kidney disease is an

example of:-

✓ Tertiary Prevention

Screening tests are utilized to: -

✓ Assess the likelihood of the presence of a disease or condition in asymptomatic individuals predictive values are dependent on the prevalence of disease among the population of interest. The same diagnostic test will have varying predictive values in different population

A negative predictive value predicts the probablity of a client: -

✓ Being free of disease after a negative test result.Predictive values the positive predictive value (PPV) is the probability of a patient actually being free of the disease if the test result is negative

Using "Murtagh's Red Flag" system for reviewing differential diagnoses, what diagnoses would you focus on for a client you are seeing with abdominal pain? – ✓ Abdominal Aortic Aneurysm

Your client is concerned because she has found an article on the internet that says the test you utilized to check for a disease has a low sensitivity but high specificity. You correctly explain that this means that: - ✓ If the test is negative, she can know she doesn't have the disease.Specificity high is good for rule in disease

A 45 year old female patient presents with right upper quadrant abdominal pain and nausea after eating for the last 2 weeks. She had a physical 6 months ago and labwork was all within normal limits. Of note today, her physical exam is positive for Murphys sign and abnormal labs are listed below: •AST=25 U/L(0- 31) •ALT=45 U/L(0-31) •ALK PHOS=355 U/L(0-125) •GGT=245 U/L(0-45) •UA=+ bilirubin You suspect: - ✓ Choleycystitis Alcoholic Liver Disease AST⁄ALT usually at least 2:1, if chronic Hep B most likely would not have had normal labs 6 months ago and usually ALP and GGT not as elevated. Paget's Disease would have isolated elevated ALP 3 / 4

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microcytic - ANS - MCV <80

iron deficiency thalassemia sideroblastic

macrocytic - ANS - MCV > 100

Megaloblastic -B12 deficiency -Folate deficiency Non-Megaloblastic -pregnancy -alcoholism -liver disease -reticulocytosis

Red Cell Distribution Width (RDW) - ANS - One of the most reliable markers of deficient erythropoiesis in evolving macro/microcytic anemia

Your client is complaining of "blurriness" in the center of their visual field. They deny pain, drainage or itching; you know these symptoms are consistent with: - ANS - Macular Degeneration

Age-related macular degeneration (AMD) is a disease that blurs the sharp, central vision you need for "straight-ahead" activities such as reading, sewing, and driving .AMD affects the macula, the part of the eye that allows you to see fine detail. AMD causes no pain.

Acute Cough - ANS - < 3 weeks

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