NURS 6512 Final Exam (2) / NURS6512 Final Exam (2) Latest Version (75 Q & A, 100% Correct)
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
1.	A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child's diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a:
A. fixed mass palpated in the hypogastric area.
B. tender, midline abdominal mass.
C. olive-sized mass of the right upper quadrant.
D. nontender, slightly moveable, flank mass.
A Wilms tumor (nephroblastoma) is the most common intra-abdominal tumor of childhood. It presents with hypertension, fever, malaise, and a firm nontender mass deep within the flank that is only slightly movable and is usually unilateral.
2.	Mr. Sprat is a 21-year-old patient who complains of nasal congestion. He admits to using recreational drugs. On examination, you have noted a septal perforation. Which of the following recreational drugs is commonly associated with nasal septum perforation?
Long-term cocaine snorting causes ischemic necrosis of the septal cartilage and leads to perforation of the nasal septum.
3.	Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of his history?
A. Age-specific data
B. Past medical data
C. Past surgical data
D. Social history
4.	Ms. Rudman, age 74, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?
A. Barrel chest
B. Cor pulmonale
C. Funnel chest
D. Malodorous breath
5.	Ms. Sharpe is a 22-year-old secretary. She presents with fatigue, malaise, and a rash. On auscultation of her heart, you note murmurs of mitral regurgitation and aortic stenosis. She reports a recent severe sore throat. You suspect:
B. acute rheumatic fever.
C. cardiac amyloidosis.
D. aortic sclerosis.
6.	In the fetus, the right ventricle pumps blood through the:
A. left atrium.
B. ductus arteriosus.
D. foramen ovale.
7.	In the most effective percussion technique for the posterior lung fields, the patient cooperates by:
A. folding the arms in front.
B. bending the head back.
C. standing and bending forward.
D. lying on the side and extending the top arm.
8.	In the presence of otitis externa, tympanic membrane perforation, or myringotomy tubes, you should:
A. avoid performing otoscopic examinations.
B. clean the inner ear with soap.
C. instill alcohol into the ear.
D. avoid instilling fluids.
9.	In what age-group are the right and left ventricles equal in weight and muscle mass?
B. School-age children
D. Older adults
10.	In what position can the mediastinal crunch (Hamman sign) best be heard?
A. A supine position
B. Lying on the left side
C. Sitting completely upright
D. With the head elevated 30 degrees
11.	In which patient situation would you expect to assess tachypnea?
A. Patient who is depressed
B. Patient who abuses narcotics
C. Patient with metabolic acidosis
D. Patient with myasthenia gravis
12.	Laryngeal obstructions would elicit which breath sound?
13.	A lift along the left sternal border is most likely the result of:
A. aortic stenosis.
B. atrial septal defect.
C. pulmonary hypertension.
D. right ventricular hypertrophy.
14.	Loud, harsh bronchovesicular breath sounds in young children are an indication of:
A. the accumulation of fluid.
B. malignant tumors or solid masses.
C. normal, thin chest wall structures.
D. pus-filled abscesses and tumors.
15.	The lung begins its gestational development from the:
16.	The major function of the large intestine is:
A. water absorption.
B. food digestion.
C. carbohydrate absorption.
D. glucose storage.
17.	Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.
A. Results from cranial nerve VII
B. Progression is slow
C. Loss of high frequency
D. Bone conduction heard longer than air conduction
E. Sounds may be garbled and difficult to localize
F. Unable to hear in a crowded room
18.	Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant's middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:
A. pull the auricle down and back.
B. hold the speculum in the canal.
C. distract the infant.
D. stabilize the chest.
19.	Mr. Curtis is a 44-year-old patient who has presented to the emergency department with shortness of breath. During the history, the patient describes shortness of breath that gets worse when he sits up. To document this, you will use the term:
20.	Mr. Jones and his wife have brought in their infant daughter for a routine visit. A holosystolic murmur in an infant that is best heard along the left sternal border, is in the third to fifth intercostal spaces, and does not radiate to the neck is indicative of:
A. ventricular septal defect.
B. patent ductus arteriosus.
C. pulmonary stenosis.
21.	The major heart sounds are normally created by:
A. valves opening.
B. valves closing.
C. the rapid movement of blood.
D. rubbing together of the cardiac walls.
22.	The majority of nutrient absorption takes place in the:
B. small intestine.
D. transverse colon.
23.	The major occupant of the retroperitoneal space is the:
24.	The middle ear contains the:
A. cerumen and sebaceous glands.
B. umbo and malleus.
C. vestibule and cochlea.
D. pars tensa and semicircular canals.
25.	The middle ear is normally filled with:
C. serous fluid.
D. cerebrospinal fluid.
26.	The middle lobe of the right lung is best auscultated in the:
A. anterior chest.
B. posterior chest.
D. midclavicular line.
27.	The most common congenital anomaly of the gastrointestinal tract is:
A. biliary atresia.
B. pyloric stenosis.
D. Meckel diverticulum.
28.	The most helpful finding in determining left-sided heart failure is:
C. jugular vein distention.
D. S3 heart sound.
29.	The most pronounced functional change of the gastrointestinal (GI) tract in older adults is:
A. decreased hydrochloric acid production.
B. increased saliva secretion.
C. decreased bile absorption.
D. decreased motility.
30.	The most superior part of the stomach is the:
D. pyloric orifice.
31.	Mr. L. has cyanotic lips and nail beds. His lips are pursed, and he has nasal flaring. You suspect he is having cardiac or pulmonary difficulty. What additional sign would support this impression?
A. Callus formation on the heels
B. Clubbing of the fingers
C. Graying hair
D. Swollen toes and ankles
32.	Mr. O., age 50, comes for his yearly health assessment, which is provided by his employer. During your initial history-taking interview, Mr. O. mentions that he routinely engages in light exercise. At this time, you should:
A. ask if he makes his own bed daily.
B. have the patient describe his exercise.
C. make a note that he walks each day.
D. record "light exercise" in the history.
33.	Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint of constipation. During auscultation, you note borborygmi sounds. This is associated with:
D. paralytic ileus.
34.	Mrs. Donaldson is a 31-year-old patient who is pregnant. In providing Mrs. Donaldson with health care information, you will explain she can expect to experience:
A. more nasal stuffiness.
B. a sensitive sense of smell.
D. enhanced hearing.
35.	Mrs. James is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy due to changes in the colorectal areas, such as:
A. decreased movement through the colon and increased water absorption from stool.
B. increased movement through the colon and increased salt taken from foods.
C. looser anal sphincter and fewer nutrients taken from foods.
D. tighter anal sphincter and less iron eliminated in the stool.
36.	Mrs. Kinder is a 39-year-old patient who presents to the office with complaints of an earache. In explaining to the patient about the function of her ears, which ear structure would you tell her is responsible for equalizing atmospheric pressure when swallowing, sneezing, or yawning?
A. Eustachian tube
B. Inner ear
C. Pars flaccida
D. Triangular fossa
37.	Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your examination, you ask the patient to raise her head and shoulders while lying in a prone position. A midline abdominal ridge rises. You chart this observation as a(n):
A. small inguinal hernia.
B. large epigastric hernia.
C. abdominal lipoma.
D. diastasis recti.
38.	Mr. Spencer presents with the complaint of hearing loss. You specifically inquire about current medications. Which medications, if listed, are likely to contribute to his hearing loss?
39.	A musical squeaking noise heard on auscultation of the lungs is called:
A. friction rub.
40.	Nancy Walker is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that, apart from occasional colds, Nancy is not prone to respiratory problems. What potential risk factor is most important to assess with regard to Nancy's current problem?
A. Anorexia symptoms
B. Cocaine use
C. Last menses
D. Signs of rheumatic fever
41.	Nasal symptoms that imply an allergic response include:
A. purulent nasal drainage.
B. bluish-gray turbinates.
C. small, atrophied nasal membranes.
D. firm consistency of turbinates.
42.	A newborn whose serum bilirubin is greater than 20 mg/100 mL has a risk of later:
A. hearing loss.
C. tooth decay.
43.	Normal cardiac changes that occur during pregnancy include:
A. decreased cardiac output.
B. increased thickness and mass of the left ventricle.
C. decreased heart rate.
D. dilation of the ventricles.
44.	Normal heart sounds are best heard:
A. directly over the semilunar and bicuspid heart valves.
B. over areas where blood flows after it passes through a valve.
C. near the carotid vessels.
D. over the central sternum.
45.	Normal tympanic membrane color is:
B. chalky white.
D. pearly gray.
46.	One major function of the liver is to:
A. secrete pepsin.
B. emulsify fats.
C. store glycogen.
D. absorb bile.
47.	The organ of Corti is a coiled structure located inside the:
A. cochlea in the inner ear.
B. pars flaccida in the tympanic membrane.
C. eustachian tube.
D. lateral aspect of the pinna.
48.	The "pacing" structure of the heart's electrical activity is the:
A. AV node.
B. bundle of His.
C. Purkinje fibers.
D. sinoatrial (SA) node.
49.	A palpable rushing vibration over the base of the heart at the second intercostal space is called a:
50.	A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured?
51.	The patient tells you that she uses herbal and other alternative therapies to maintain her health. This information is recorded in the:
A. past medical history.
B. chief complaint.
C. social history.
D. family history.
52.	A patient you are seeing in the emergency department for chest pain is believed to be having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of "heart trouble." The most important follow-up question you should pose is which of the following?
A. "Did your father have coronary bypass surgery?"
B. "Did your father's father have heart trouble also?"
C. "What were your father's usual dietary habits?"
D. "What age was your father at the time of his death?"
53.	Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the:
A. descending aorta.
B. lower liver border.
C. medial border of the spleen.
D. upper right kidney ridge.
54.	Percussion of the abdomen begins with establishing:
A. liver dullness.
B. spleen dullness.
C. gastric bubble tympany.
D. overall dullness and tympany in all quadrants.
55.	Peristalsis of intestinal contents is under the control of:
A. cognitive processes.
C. the autonomic nervous system.
D. the fluid content of the stomach.
56.	Peritonitis produces bowel sounds that are:
C. high pitched.
57.	Placing the base of a vibrating tuning fork on the midline vertex of the patient's head is a test for:
A. air conduction of sound.
B. bone versus air conduction.
C. lateralization of sound.
D. mallear auditory ability.
58.	Pleural pain differs from chest discomfort caused by other conditions in that it is:
A. precipitated by coughing.
B. eased with deep breathing.
C. usually described as dull in nature.
D. related to time of day.
59.	A pregnant woman is expected to develop:
A. tachypnea and decreased tidal volume.
B. deep breathing but not more frequent breathing.
C. dyspnea and increased functional residual capacity.
D. bradypnea and increased tidal volume.
60.	Purkinje fibers are located in the:
A. sinoatrial node.
B. atrioventricular node.
D. aortic arch.
61.	Respiratory effort usually exhibited by a patient with cerebral brain damage is called:
A. Cheyne-Stokes respiration.
B. paroxysmal nocturnal dyspnea.
C. Kussmaul breathing.
D. Biot respiration.
62.	The respiratory rate of a sleeping newborn is expected to be _____ breaths per minute.
63.	A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:
64.	Severe vertigo, tinnitus, and progressive hearing loss are characteristic of:
B. Ménière disease.
D. cocaine abuse.
65.	A smooth red tongue with a slick appearance may indicate:
A. niacin or vitamin B12 deficiency.
B. oral cancer.
C. recent use of antibiotics.
D. fungal infection.
66.	Speech with a monotonous tone and erratic volume may indicate:
A. otitis externa.
B. hearing loss.
C. serous otitis media.
67.	A split-second heart sound is:
B. greatest at the peak of inspiration.
C. heard best after forceful expiration.
D. supposed to disappear with deep inspiration.
68.	The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:
A. P wave.
B. QRS complex.
C. PR interval.
D. T wave.
69.	The structures that lie along the lateral wall of the nasal cavity near the facial cheek are the _____ sinuses.
70.	Tactile fremitus is best felt:
A. along the costal margin and xiphoid process.
B. in the suprasternal notch along the clavicle.
C. parasternally at the second intercostal space.
D. posterolaterally beneath the scapula.
71.	Thin-walled reservoirs of the heart are the:
72.	A third heart sound is created by:
A. atrial contraction.
B. ventricular contraction.
C. diastolic filling.
D. regurgitation between the right and left ventricles.
73.	To accommodate the enlarging uterus of pregnancy, chest changes result in:
A. intercostal muscle atrophy.
B. lowering of the resting diaphragm.
C. a decrease in alveoli expansion.
D. an increase in the subcostal angle.
74.	To approximate vocal frequencies, which tuning fork should be used to assess hearing?
A. 100 to 300 Hz
B. 200 to 400 Hz
C. 500 to 1000 Hz
D. 1500 to 2000 Hz
75.	To assess for liver enlargement in the obese person, you should:
A. use the hook method.
B. have the patient lean over at the waist.
C. auscultate using the scratch technique.
D. attempt palpation during deep exhalation.