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 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.
Which of the following is a normal finding when performing an examination with the otoscope?
- Macula
- Cone of light
- Optic disc
- Red reflex
Explanation
Correct Answer: B) Cone of light
The cone of light, also known as the light reflex, is a normal finding seen when examining the tympanic membrane with an otoscope. It appears as a triangular reflection of light in the anterior inferior portion of the tympanic membrane, indicating a healthy, intact, and properly positioned eardrum.
The macula and optic disc are structures of the eye visualized with an ophthalmoscope, not an otoscope. The red reflex is also an eye examination finding assessed with an ophthalmoscope or otoscope light directed through the pupil, not a finding of the tympanic membrane.
Which of the following are Review of Systems (ROS) questions? SELECT ALL THAT APPLY.
- No cough, wheezing, shortness of breath
- Bilateral inspiratory wheeze with mild intercostal retractions
- Reports increased inhaler use following exercise
- No hemoptysis or change in sputum color or consistency
- Chest radiograph findings show loculated pleural effusion
Explanation
Correct Answer: A) No cough, wheezing, shortness of breath, C) Reports increased inhaler use following exercise, and D) No hemoptysis or change in sputum color or consistency
Review of Systems (ROS) questions are subjective symptoms reported by the patient. Options A, C, and D reflect symptoms or experiences the patient reports themselves. Option B describes an objective physical examination finding (bilateral inspiratory wheeze with mild intercostal retractions) observed by the clinician, making it part of the physical exam rather than ROS.
Option E describes a diagnostic imaging result, which is an objective finding and belongs to diagnostic data, not the ROS.
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) 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?
- Flashlight
- Cotton swab
- Snellen chart
- 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.
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?
- Pneumonia
- Asthma exacerbation
- Spontaneous pneumothorax
- 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.
During assessment of the Jugular Venous Pressure (JVP), the advanced practice registered nurse (APRN) measures a JVP >5 cm above the sternal angle. How will this finding be described?
- Normal: indicating normal left atrial pressure
- Normal: indicating normal right atrial pressure
- Abnormal: indicating elevated right atrial pressure (central venous pressure)
- Abnormal: indicating decreased right atrial pressure (central venous pressure)
Explanation
Correct answer: C) Abnormal: indicating elevated right atrial pressure (central venous pressure)
A JVP greater than 5 cm above the sternal angle is considered abnormal and indicates elevated right atrial pressure, which reflects increased central venous pressure. This can be a sign of heart failure, tricuspid valve disease, or fluid overload, where the right side of the heart is not pumping effectively, leading to increased pressure in the veins. This is often seen in conditions such as congestive heart failure.
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?
- Sound will lateralize to the patient's ears equally.
- Sound will lateralize to the patient's unaffected ear.
- Sound will lateralize to the patient's affected ear.
- 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.
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.
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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