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 condition produces a hyperresonant percussion note?
- Pneumothorax
- Lobar pneumonia
- Pleural effusion
- Empyema
Explanation
Correct Answer: A) Pneumothorax
A hyperresonant percussion note is produced when there is an abnormal increase in air within a body cavity. In pneumothorax, air accumulates in the pleural space, causing an exaggerated resonance upon percussion.
Lobar pneumonia produces a dull percussion note due to consolidation of lung tissue with fluid and inflammatory exudate. Pleural effusion and empyema both produce dull or flat percussion notes because fluid accumulation in the pleural space dampens the sound.
Therefore, pneumothorax is the only condition among the choices that produces a hyperresonant note.
A patient presents to the advanced practice registered nurse and reports new onset abdominal pain. Which of the following is the best initial response by the nurse practitioner?
- "We will talk more about this in the interview."
- "Have you ever had any children?"
- "What have you eaten in the last four hours?"
- "When did this abdominal pain start?"
Explanation
Correct answer: D) "When did this abdominal pain start?"
The best initial response is to ask about the onset of the pain. Understanding when the pain started helps the nurse practitioner assess the nature of the problem, determine whether it is acute or chronic, and guide further questioning. The onset of pain is critical in forming an early diagnosis and should be the first area of inquiry in any assessment of abdominal pain.
The advanced practice registered nurse (APRN) examines a 92 year-old patient. The APRN notes a systolic ejection murmur (grade III out of VI), heard in the right upper sternal border and the right side of the neck. What is the most likely cause of the systolic murmur in this patient?
- Aortic stenosis
- Right sided heart failure
- Tricuspid valve prolapse
- Mitral valve stenosis
Explanation
Correct Answer: A) Aortic stenosis
A systolic ejection murmur heard best at the right upper sternal border (aortic area) that radiates to the neck is the classic presentation of aortic stenosis. In aortic stenosis, the narrowed aortic valve obstructs blood flow from the left ventricle into the aorta during systole, creating turbulent flow that produces a harsh, crescendo-decrescendo systolic murmur.
The radiation to the neck occurs because turbulent flow travels in the direction of blood flow through the carotid arteries. Right-sided heart failure is a consequence of various conditions and does not itself produce this specific murmur pattern.
Tricuspid valve prolapse produces a murmur heard best at the left lower sternal border. Mitral valve stenosis produces a diastolic, not systolic, murmur heard best at the apex.
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 assessing a patient's thyroid gland. The APRN places their hands below which anatomical landmark?
- Lower mandible
- Cricoid cartilage
- Vocal cords
- Suprasternal notch
Explanation
Correct Answer: B) Cricoid cartilage
When assessing the thyroid gland, the APRN places their hands below the cricoid cartilage, as the thyroid gland is located in the anterior neck just inferior to the cricoid cartilage and superior to the suprasternal notch.
The thyroid isthmus lies directly below the cricoid cartilage, connecting the two thyroid lobes. The lower mandible is too superior and is not a relevant landmark for thyroid assessment. The vocal cords are internal structures not used as an external palpation landmark.
The suprasternal notch is inferior to the thyroid and is used as a lower boundary reference rather than the starting point for thyroid palpation.
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.
A patient presents with a sore throat, fever, and fatigue for several days. An advanced practice registered nurse (APRN) notes exudate on the patient's enlarged tonsils. The APRN does a careful lymphatic examination and notes some scattered small, mobile lymph nodes just behind the sternocleidomastoid muscles bilaterally. Which group of nodes is this?
- Submandibular
- Tonsillar
- Occipital
- Posterior cervical
Explanation
Correct answer: D) Posterior cervical
The posterior cervical lymph nodes are located just behind the sternocleidomastoid muscles on either side of the neck. These lymph nodes play a key role in filtering lymph fluid and trapping pathogens such as bacteria and viruses. When the body is fighting an infection, like the one described in this patient with a sore throat and fever, the lymphatic system responds by swelling the nearby lymph nodes. In this case, the posterior cervical lymph nodes are palpated as enlarged, which is a common finding during infections such as tonsillitis or pharyngitis.
The patient's symptoms, including fever, fatigue, and exudate on the tonsils, indicate a possible throat infection that could trigger the immune response in the lymph nodes. As the tonsils are enlarged with infection, lymph nodes in the surrounding area, including the posterior cervical group, are likely to swell.
This swelling is an expected finding as the lymphatic system works to filter out infectious agents. Other lymph nodes such as submandibular, tonsillar, and occipital, while relevant, are less likely to be the focus in this scenario, as the posterior cervical nodes are most directly affected by throat infections.
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?
- Whisper pectoriloquy
- Egophony
- Fremitus
- 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.
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.
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