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
What is the proper sequence when performing an abdominal examination?
- Auscultation, inspection, percussion, palpation
- Inspection, percussion, palpation, auscultation
- Inspection, auscultation, percussion, palpation
- Auscultation, inspection, palpation, percussion
Explanation
Correct answer: C) Inspection, auscultation, percussion, palpation
The correct sequence for an abdominal examination is:
• Inspection – Begin by visually examining the abdomen for any abnormalities, such as swelling, discoloration, or visible movement.
• Auscultation – Next, auscultate the abdomen to listen for bowel sounds and vascular sounds. Auscultation should be done before palpation to avoid altering bowel sounds with pressure.
• Percussion – Percussion helps assess the presence of fluid or gas and can identify organ size or areas of dullness.
• Palpation – Finally, palpation is performed to assess tenderness, organ size, and any masses, and should be done last to avoid causing discomfort or altering findings.
This sequence ensures a thorough and non-invasive examination process.
The advanced practice registered nurse (APRN) is assessing a patient with Bell palsy and finds paralysis of the entire right side of the face. The APRN knows that Bell palsy is caused by a peripheral lesion of which cranial nerve?
- CN VII - Facial
- CN IX - Glossopharyngeal
- CN X - Vagus
- CN V - Trigeminal
Explanation
Correct Answer: A) CN VII - Facial
Bell palsy is caused by inflammation and dysfunction of the CN VII (facial nerve), which controls the muscles of facial expression on both the upper and lower face. A peripheral lesion of CN VII results in complete unilateral facial paralysis, affecting both the upper and lower portions of the face on the affected side, including the forehead.
This is a key distinguishing feature from a central lesion such as a stroke, which typically spares the forehead due to bilateral cortical representation of the upper face. CN IX (glossopharyngeal) controls swallowing and taste.
CN X (vagus) controls autonomic functions and swallowing. CN V (trigeminal) is responsible for facial sensation and mastication, not facial movement. Therefore, Bell palsy is specifically a peripheral lesion of CN VII.
For which of the following patients would a comprehensive health history be appropriate?
- An established patient with the chief complaint of "I sprained my ankle".
- An established patient with the chief complaint of "I have a bad cold".
- A new patient with the chief complaint of "I am here to establish care".
- An established patient with the chief complaint of "I cut my left hand".
Explanation
Correct Answer: C) A new patient with the chief complaint of "I am here to establish care".
A comprehensive health history is indicated for new patients or patients presenting for a complete physical examination, as it involves a thorough review of all aspects of a patient's health including past medical history, family history, social history, and review of systems.
Established patients presenting with acute, focused complaints such as a sprained ankle, a cold, or a cut hand require a focused or problem-oriented history rather than a comprehensive one, as the clinical encounter is directed at addressing a specific issue.
- A new patient establishing care has no prior documented history in the system, making a comprehensive health history the most appropriate and necessary approach.
The advanced practice nurse (APRN) is assessing a patient who presents with right upper quadrant pain. On exam the APRN deeply palpates the right upper quadrant and asks the patient to take a deep breath. The patient abruptly stops inspiration and reports increased pain. The APRN notes that this positive sign likely indicates what disease process?
- Appendicitis
- Pancreatitis
- Cholecystitis
- Gastroenteritis
Explanation
Correct Answer: C) Cholecystitis
The clinical maneuver described is Murphy's sign, which is performed by deeply palpating the right upper quadrant at the location of the gallbladder while asking the patient to inhale. A positive Murphy's sign occurs when the patient abruptly halts inspiration due to pain as the inflamed gallbladder descends and contacts the examiner's hand.
This is the hallmark physical examination finding of acute cholecystitis. Appendicitis presents with right lower quadrant pain and rebound tenderness at McBurney's point. Pancreatitis typically presents with epigastric pain radiating to the back.
Gastroenteritis presents with diffuse abdominal cramping, nausea, vomiting, and diarrhea without this specific localized finding.
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.
When examining a patient the advanced practice registered nurse (APRN) notices a 3 cm x 2 cm indurated erythematous mass in the right axilla. In which area of the SOAP note should this information be documented?
- Subjective
- Objective
- Assessment
- Plan
Explanation
Correct Answer: B) Objective
The Objective section of the SOAP note contains measurable, observable, and verifiable data collected by the clinician during the physical examination. A 3 cm x 2 cm indurated erythematous mass noted upon examination is a physical finding directly observed and measured by the APRN, making it objective data.
The Subjective section contains information reported by the patient, such as symptoms and complaints. The Assessment section contains the clinician's clinical impression or diagnosis based on the subjective and objective findings.
The Plan section outlines the management strategy, including diagnostics, treatments, and follow-up. Therefore, this physical examination finding belongs in the Objective section.
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category would include this information?
- Chief Complaint/Concern
- Past Medical History
- Social History
- Review of Systems
Explanation
Correct Answer: D) Review of Systems
The Review of Systems (ROS) is a systematic collection of subjective symptoms reported by the patient, including both positive and negative findings related to each body system.
The statement documents that the patient denies specific cardiovascular symptoms such as chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea, which are all symptom-based questions pertaining to the cardiovascular system.
Chief Complaint refers to the primary reason the patient seeks care. Past Medical History includes previous diagnoses, surgeries, and hospitalizations. Social History covers lifestyle factors such as smoking, alcohol use, and occupation. Therefore, this documentation belongs in the Review of Systems.
Which of the following is consistent with a positive obturator sign?
- Pain distant from the site used to check rebound tenderness
- Right hypogastric pain with the right hip flexed and the hip internally rotated
- Pain with extension of the right thigh while the patient is on their left side
- Pain that stops inhalation in the right upper quadrant
Explanation
Correct Answer: B) Right hypogastric pain with the right hip flexed and the hip internally rotated
The obturator sign is a clinical test used to assess for irritation of the obturator internus muscle, commonly associated with appendicitis or other pelvic inflammatory conditions. A positive obturator sign occurs when the patient experiences right hypogastric (lower abdominal) pain upon flexion and internal rotation of the right hip while lying supine.
This maneuver stretches the obturator internus muscle, and if an inflamed appendix or other inflamed structure is in contact with this muscle, it will elicit pain. The other options describe different clinical signs: pain distant from the rebound site describes Rovsing's sign, pain with extension of the thigh while on the left side describes the psoas sign, and pain that stops inhalation in the right upper quadrant describes Murphy's sign.
Note that the image highlights option C, however this describes the psoas sign, not the obturator sign.
The advanced practice registered nurse (APRN) is performing a cardiovascular exam on a 75 year-old patient. The APRN auscultates a carotid bruit. Which condition is least likely to cause a carotid bruit?
- Atherosclerosis
- Carotid artery stenosis
- Aortic stenosis
- Tricuspid valve regurgitation
Explanation
Correct Answer: D) Tricuspid valve regurgitation
A carotid bruit is an abnormal swooshing sound heard over the carotid artery caused by turbulent blood flow. Atherosclerosis and carotid artery stenosis are the most common causes, as plaque buildup narrows the vessel lumen and disrupts laminar flow.
Aortic stenosis can also transmit turbulent flow sounds up to the carotid arteries due to its proximity and the direction of blood flow through the aorta. Tricuspid valve regurgitation, however, is a right-sided heart valve disorder where blood flows back into the right atrium during systole.
Because it involves the right side of the heart and the flow does not travel toward the carotid arteries, it is the least likely condition to produce a carotid bruit.
Where should the advanced practice registered nurse (APRN) examine for kidney tenderness?
- Suprapubic area
- Perumbilical area
- Costovertebral angle
- 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.
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