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
A systolic click is auscultated during cardiac examination. What is the likely cause of this extra heart sound?
- Heart failure
- Ventricular volume overload
- Decreased myocardial contractility
- Mitral valve prolapse
Explanation
Correct Answer: D) Mitral valve prolapse
A systolic click is a high-pitched, brief extra heart sound heard during systole and is the hallmark auscultatory finding of mitral valve prolapse (MVP). In MVP, one or both mitral valve leaflets bulge backward into the left atrium during systole, producing this characteristic clicking sound.
Heart failure, ventricular volume overload, and decreased myocardial contractility are associated with extra heart sounds such as S3 or S4 gallops, not a systolic click. Therefore, a midsystolic click is most classically associated with mitral valve prolapse.
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.
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.
A patient tells the advanced practice registered nurse (APRN) about their experience with prolonged therapy for their breast cancer. The APRN comments, "That must have been a very trying time for you". What is this statement an example of?
- Reassurance
- Clarification
- Validation
- Summarization
Explanation
Correct Answer: C) Validation
Validation is a therapeutic communication technique in which the healthcare provider acknowledges and affirms the patient's feelings and experiences. By saying "That must have been a very trying time for you," the APRN is recognizing and empathizing with the patient's emotional experience, which is the essence of validation.
Reassurance would involve providing comfort or reducing fear about a specific concern. Clarification involves seeking to better understand the patient's message by asking for more detail. Summarization involves restating the key points of what the patient has shared to confirm understanding. Therefore, the APRN's statement best reflects validation of the patient's emotional experience.
The advanced practice registered nurse (APRN) is seeing a 6 year old in the urgent care with complaints of a sore throat. The APRN is concerned for streptococcal tonsillitis. What physical exam findings suggest streptococcal tonsillitis? Select All That Apply.
- Beefy-red uvula
- White or yellow exudates on the tonsils
- Palatal petechiae
- Asymmetric protrusion of one tonsil
Explanation
Correct Answer: A) Beefy-red uvula, B) White or yellow exudates on the tonsils, and C) Palatal petechiae
Streptococcal tonsillitis (strep throat) classically presents with a beefy-red uvula, white or yellow exudates on the tonsils, palatal petechiae (small red spots on the soft palate), tonsillar enlargement, and anterior cervical lymphadenopathy.
These findings are captured in the Centor criteria used to assess likelihood of streptococcal infection. Asymmetric protrusion of one tonsil is a concerning finding that suggests peritonsillar abscess, a complication of tonsillitis, rather than uncomplicated streptococcal tonsillitis itself.
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 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.
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.
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.
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.
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