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
After examining a patient who is in the hospital for shortness of breath, the advanced practice registered nurse (APRN) records the following respiratory examination: "There is dullness to percussion over the right lung base. Breath sounds are decreased at the right lung base with rhonchi, +egophony, +bronchophony, +cough." Which of the following is the most likely diagnosis?
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Left-sided heart failure
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Atelectasis
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Pneumothorax
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Pneumonia
Explanation
Correct Answer: D) Pneumonia
The combination of dullness to percussion, decreased breath sounds, rhonchi, positive egophony, and positive bronchophony over the right lung base is classic for pneumonia. Egophony (E to A change) and bronchophony (increased transmission of spoken words) occur when lung tissue is consolidated, as sound transmits more efficiently through fluid-filled or consolidated lung than through air-filled lung.
Rhonchi indicate secretions in the airways, consistent with an infectious process. Left-sided heart failure typically produces bilateral basilar crackles rather than these consolidation signs. Atelectasis presents with decreased breath sounds but typically without egophony or bronchophony. Pneumothorax produces hyperresonance on percussion and absent breath sounds, which is the opposite of what is described here.
The advanced practice registered nurse (APRN) suspects a trigeminal nerve (cranial nerve V) injury in a patient presenting with difficulty chewing. What tool will the APRN choose to complete the assessment?
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Flashlight
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Cotton swab
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Snellen chart
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Tuning fork
Explanation
Correct answer: B) Cotton swab
The trigeminal nerve (cranial nerve V) is responsible for sensation in the face and motor functions such as chewing. To assess the function of this nerve, the APRN would use a cotton swab to lightly touch different areas of the patient's face (the ophthalmic, maxillary, and mandibular branches) to evaluate sensation. If the patient has difficulty identifying or responding to the touch, it may indicate trigeminal nerve dysfunction.
The other tools listed are used for different purposes:
- Flashlight is used to examine the eyes.
- Snellen chart assesses visual acuity.
- Tuning fork is used to test for hearing and vibratory sensation, not nerve function related to the face.
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?
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Press on the right lower quadrant and ask the patient to say where the pain is worse.
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Press on the left lower quadrant and ask the patient to say where the pain is worse.
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Ask the patient to raise their thigh against resistance from the APRN's hand.
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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?
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Palpate vibrations transmitted through the chest wall with the patient saying "ninety-nine"
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Assess the distance between the examiner's thumbs on the thorax during inspiration
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Determine the distance between the diaphragm on expiration and inspiration
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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.
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?
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Tricuspid valve regurgitation
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Pulmonic valve regurgitation
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Mitral valve regurgitation
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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) is performing the Weber test on an 80 year-old patient with known cochlear nerve damage. The APRN expects what findings?
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Sound will lateralize to the patient's ears equally.
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Sound will lateralize to the patient's unaffected ear.
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Sound will lateralize to the patient's affected ear.
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The patient will not hear the tuning fork at all.
Explanation
Correct Answer: B) Sound will lateralize to the patient's unaffected ear.
The Weber test is performed by placing a vibrating tuning fork on the midline of the skull and asking the patient where they hear the sound. In sensorineural (cochlear nerve) hearing loss, sound lateralizes to the unaffected ear because the damaged ear has reduced ability to perceive sound through the cochlear nerve.
This is in contrast to conductive hearing loss, where sound would lateralize to the affected ear. Equal lateralization to both ears would indicate normal hearing. The patient not hearing the tuning fork at all is not a typical expected finding in this test, as even patients with sensorineural loss can usually perceive some sound in the unaffected ear. Therefore, in a patient with known cochlear nerve damage, the sound is expected to lateralize to the unaffected ear.
Where should the advanced practice registered nurse (APRN) examine for kidney tenderness?
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Suprapubic area
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Perumbilical area
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Costovertebral angle
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Epigastric area
Explanation
Correct answer: C) Costovertebral angle
The costovertebral angle (CVA), located where the lower ribs meet the spine, is the proper area to assess for kidney tenderness. To check for kidney tenderness, the nurse taps gently on the CVA, which can cause discomfort if there is inflammation or infection in the kidneys, such as in conditions like pyelonephritis or kidney stones.
The advanced practice registered nurse (APRN) suspects a diagnosis of pneumonia in a 13-year-old patient presenting with cough, dyspnea, and fever. The APRN auscultates the lungs while asking the patient to say "E" and the APRN hears "A". What is the name of this test?
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Whisper pectoriloquy
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Egophony
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Fremitus
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Bronchophony
Explanation
Correct answer: B) Egophony
Egophony is a clinical test used to assess for lung consolidation, commonly seen in pneumonia. When a patient with pneumonia says the letter "E," and the examiner hears a distorted "A" sound instead, it is considered positive for egophony. This happens because the consolidation in the lung tissue amplifies high-frequency sounds, resulting in the change in the sound of the patient's voice.
A tall, thin teenager with no past medical history presents to an urgent care clinic in acute respiratory distress. They report playing video games when they suddenly experienced right-sided chest pain and shortness of breath. Physical exam is notable for respiratory rate 35 breaths per minute, absent breath sounds on the right upper side of the chest wall on auscultation, and hyperresonance on percussion over the right upper lobe. With palpation, there is absent fremitus over the right upper lobe. What diagnosis best describes these findings?
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Pneumonia
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Asthma exacerbation
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Spontaneous pneumothorax
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Pericarditis
Explanation
Correct Answer: C) Spontaneous pneumothorax
Spontaneous pneumothorax most commonly occurs in tall, thin young individuals with no prior lung disease. The classic presentation includes sudden onset of unilateral chest pain and shortness of breath.
The triad of absent breath sounds, hyperresonance on percussion, and absent tactile fremitus on the affected side are hallmark physical examination findings of pneumothorax, as air in the pleural space prevents normal sound transmission. Pneumonia would present with dullness on percussion, increased fremitus, and bronchial breath sounds.
Asthma exacerbation typically presents with bilateral wheezing and does not cause unilateral absent breath sounds. Pericarditis presents with chest pain that worsens with lying down and improves leaning forward, without these unilateral pulmonary findings.
A sudden, painless, unilateral vision loss may be caused by which of the following?
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Retinal detachment
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Corneal ulcer
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Acute glaucoma
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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.
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