Thomas Jefferson University NU673 Comprehensive Assessment for Advanced Nursing Practice
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Free Thomas Jefferson University NU673 Comprehensive Assessment for Advanced Nursing Practice Questions
The advanced practice registered nurse (APRN) is assessing an 86 year-old patient. The APRN notes a blowing diastolic murmur (grade III out of VI), heard best at the left 2nd through 4th intercostal spaces. What is the most likely cause of the diastolic murmur in this patient?
- Pulmonary hypertension
- Right sided heart failure
- Left sided heart failure
- Aortic regurgitation
Explanation
Correct Answer: D) Aortic regurgitation
A blowing diastolic murmur heard best at the left 2nd through 4th intercostal spaces is characteristic of aortic regurgitation (AR). In AR, the aortic valve fails to close completely during diastole, allowing blood to flow back from the aorta into the left ventricle, producing a high-pitched, blowing decrescendo diastolic murmur heard best along the left sternal border.
Pulmonary hypertension can produce a diastolic murmur (Graham Steell murmur) but it is typically softer and associated with other signs of right heart strain. Right-sided and left-sided heart failure are consequences of valve pathology rather than direct causes of this specific murmur pattern. Therefore, aortic regurgitation is the most likely cause of this diastolic murmur.
The advanced practice registered nurse (APRN) is documenting their physical exam findings for a patient with acute otitis media. Which of the following statements most accurately describes otoscope findings of acute otitis media?
- Bilateral tympanic membranes erythematous, flat, with a good cone of light.
- Left tympanic membrane erythematous, bulging and non-mobile, with loss of landmarks.
- Bilateral tympanic membranes intact and mobile, with a good cone of light.
- Right tympanic membrane erythematous and flat, with blood tinged discharge.
Explanation
Correct Answer: B) Left tympanic membrane erythematous, bulging and non-mobile, with loss of landmarks.
Acute otitis media (AOM) classically presents with a erythematous, bulging, and non-mobile tympanic membrane with loss of normal landmarks such as the cone of light and the bony landmarks of the malleus. The bulging occurs due to accumulation of purulent fluid in the middle ear space.
Option A describes bilateral erythema which may suggest viral illness but the presence of a good cone of light argues against AOM. Option C describes a completely normal tympanic membrane. Option D describes a flat membrane with discharge, which may suggest a perforated eardrum rather than classic AOM findings.
A sudden, painless, unilateral vision loss may be caused by which of the following?
- Retinal detachment
- Corneal ulcer
- Acute glaucoma
- Uveitis
Explanation
Correct answer: A) Retinal detachment
Retinal detachment is a medical emergency that leads to sudden, painless, unilateral vision loss. It occurs when the retina separates from the underlying tissue, often caused by trauma or age-related changes.
The loss of vision is typically painless, but it can present with symptoms such as flashes of light, floaters, or a shadow in the visual field. Immediate treatment is required to prevent permanent vision loss. The other conditions listed are associated with vision loss but typically involve pain or different mechanisms of injury.
Which of the following are objective findings?
- Chest pain
- Palpitations
- Shortness of breath
- Tenderness on palpation of anterior chest
Explanation
Correct answer: D) Tenderness on palpation of anterior chest
Objective findings refer to signs that can be observed, measured, or verified by a healthcare provider. "Tenderness on palpation of the anterior chest" is an objective finding because it can be physically assessed by a healthcare provider. On the other hand, chest pain, palpitations, and shortness of breath are subjective findings, as they are reported by the patient.
The advanced practice registered nurse (APRN) is examining a 70-year-old patient with pulmonary hypertension. On cardiac exam, they auscultate a grade II/VI pansystolic (holosystolic) murmur of medium pitch at the left lower sternal border, which radiates to the right of the sternum (xiphoid area). The APRN asks the patient to inspire and notes an increase in the intensity of the murmur. Which is the most likely physiological cause of the murmur?
- Tricuspid valve regurgitation
- Pulmonic valve regurgitation
- Mitral valve regurgitation
- Aortic valve regurgitation
Explanation
Correct answer: A) Tricuspid valve regurgitation
The murmur described in this case is likely caused by tricuspid valve regurgitation, a condition in which blood flows backward through the tricuspid valve into the right atrium during systole. This type of murmur is often heard best at the left lower sternal border and can radiate to the xiphoid area.
The intensity of the murmur increases with inspiration, a characteristic feature of tricuspid valve regurgitation due to the increased venous return to the right side of the heart during inhalation, which amplifies the regurgitant flow. Pulmonary hypertension is a common underlying condition contributing to tricuspid valve regurgitation.
The advanced practice registered nurse (APRN) recognizes that extraocular movements are assessed by testing which cranial nerves?
- II, III, IV
- III, IV, VI
- V and VII
- IX and X
Explanation
Correct answer: B) III, IV, VI
Extraocular movements (EOMs) are movements of the eye that are controlled by the muscles around the eye. These movements are tested by assessing the function of cranial nerves III (oculomotor), IV (trochlear), and VI (abducens).
- Cranial nerve III (Oculomotor) controls most of the eye’s movements, including the medial, superior, and inferior rectus muscles, and the inferior oblique muscle. It also controls pupil constriction and eyelid elevation.
- Cranial nerve IV (Trochlear) controls the superior oblique muscle, which is responsible for moving the eye downward and laterally.
- Cranial nerve VI (Abducens) controls the lateral rectus muscle, which allows the eye to move laterally (outward).
The coordinated action of these three nerves is essential for smooth, coordinated eye movements in all directions. Dysfunction of any of these cranial nerves can lead to problems such as double vision or difficulty with certain eye movements.
The other cranial nerves listed in the options (II, V, VII, IX, and X) do not primarily control extraocular movements.
Which is an example of non-stigmatizing, person-first language?
- Drug addict
- Schizophrenic
- Person with disabilities
- AIDS victim
Explanation
Correct answer: C) Person with disabilities
Person-first language emphasizes the individual before their condition, which helps reduce stigma and highlights their humanity. "Person with disabilities" focuses on the individual rather than labeling them by their condition.
This approach fosters respect and dignity, avoiding the negative implications often associated with terms like "drug addict," "schizophrenic," or "AIDS victim," which can define the person by their condition rather than seeing them as a person first.
The Certified Registered Nurse Anesthetist (CRNA) is examining a patient after surgery with general anesthesia in the post-anesthesia care unit (PACU). The CRNA notes an audible high pitched inspiratory whistling, and is concerned for upper airway obstruction. How is this abnormal physical exam finding best described?
- Rhonchi
- Crackles
- Wheezing
- Stridor
Explanation
Correct Answer: D) Stridor
Stridor is a high-pitched, harsh inspiratory sound caused by turbulent airflow through a partially obstructed upper airway. It is a critical finding in the post-anesthesia setting as it may indicate laryngospasm, airway edema, or vocal cord dysfunction following extubation.
Rhonchi are low-pitched, rumbling sounds caused by secretions in the larger airways and are typically heard on expiration. Crackles are discontinuous, popping sounds associated with fluid in the alveoli or small airways, commonly heard in pneumonia or heart failure.
Wheezing is a high-pitched sound but is typically expiratory and associated with lower airway obstruction such as asthma or bronchospasm. Therefore, the high-pitched inspiratory whistling consistent with upper airway obstruction is best described as stridor.
During an examination of the abdomen in a patient with right lower quadrant pain the advanced practice registered nurse (APRN) checks for a positive psoas sign. How is this test performed?
- Press on the right lower quadrant and ask the patient to say where the pain is worse.
- Press on the left lower quadrant and ask the patient to say where the pain is worse.
- Ask the patient to raise their thigh against resistance from the APRN's hand.
- Flex the patient's right thigh and with the knee bent rotate the leg internally at the hip.
Explanation
Correct Answer: C) Ask the patient to raise their thigh against resistance from the APRN's hand.
The psoas sign is assessed by asking the patient to raise their right thigh against the resistance of the examiner's hand while lying supine, or alternatively by extending the hip while the patient lies on their left side.
Either maneuver stretches the iliopsoas muscle, and if an inflamed appendix is in contact with the psoas muscle, it will elicit right lower quadrant pain, indicating a positive psoas sign. Option A describes Rovsing's sign.
Option B also relates to Rovsing's sign where pressure on the left side causes pain on the right. Option D describes the obturator sign, which involves internal rotation of the flexed hip.
An advanced practice registered nurse (APRN) assesses chest expansion (also known as lung excursion). Which technique by the APRN is correct?
- Palpate vibrations transmitted through the chest wall with the patient saying "ninety-nine"
- Assess the distance between the examiner's thumbs on the thorax during inspiration
- Determine the distance between the diaphragm on expiration and inspiration
- Percuss the anterior and posterior thorax using a ladder pattern
Explanation
Correct answer: B) Assess the distance between the examiner's thumbs on the thorax during inspiration
To assess chest expansion (lung excursion), the APRN can place their thumbs along the ribs, making sure they are in a symmetrical position on either side of the patient's chest.
As the patient inhales deeply, the APRN can watch and feel the distance between their thumbs to evaluate the range of chest expansion. This technique helps to detect any asymmetry in the chest wall movement, which could indicate underlying lung conditions.
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