NSG 6020 Midterm Exam Study Guide
NSG 6020 Midterm Study Guide
1.
For which of the following patients would a comprehensive health history be appropriate?
A)
A new patient with the chief complaint of “I sprained my ankle”
B)
An established patient with the chief complaint of “I have an upper respiratory infection”
C)
A new patient with the chief complaint of “I am here to establish care”
D)
A new patient with the chief complaint of “I cut my hand” NSG 6020 Midterm Exam Study Guide
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2.
Is the following information subjective or objective?
Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest.
A)
Subjective
B)
Objective
3.
Is the following information subjective or objective?
Mr. M. has a respiratory rate of 32 and a pulse rate of 120.
A)
Subjective
B)
Objective
4.
The following information is recorded in the health history: “Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.”
Which category does it belong to?
A)
Chief complaint
B)
Present illness
C)
Personal and social history
D)
Review of systems
5.
A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to?
A)
Musculoskeletal
B)
Reproductive
C)
Urinary
D)
Endocrine
6.
A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct?
A)
Infectious
B)
Inflammatory
C)
Hematologic
D)
Traumatic
7.
A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process?
A)
Infection
B)
Inflammation
C)
Allergic
D)
Vascular
8.
You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list?
A)
Arthritis, war injury pain, headaches, chest pain
B)
War injury pain, arthritis, headaches, chest pain
C)
Headaches, arthritis, war injury pain, chest pain
D)
Chest pain, headaches, arthritis, war injury pain
9.
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient–provider interview?
A)
Establish the agenda, negotiate a plan, establish rapport, and invite the patient’s story.
B)
Invite the patient’s story, negotiate a plan, establish the agenda, and establish rapport.
C)
Greet the patient, establish rapport, invite the patient’s story, establish the agenda, expand and clarify the patient’s story, and negotiate a plan.
D)
Negotiate a plan, establish an agenda, invite the patient’s story, and establish rapport.
10.
Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?
A)
Setting in which the symptom occurs
B)
Associated manifestations
C)
Quality
D)
Timing
11.
A 23-year-old graduate student comes to your clinic for evaluation of a urethral discharge. As the provider, you need to get a sexual history. Which one of the following questions is inappropriate for eliciting the information?
A)
Are you sexually active?
B)
When was the last time you had intimate physical contact with someone, and did that contact include sexual intercourse?
C)
Do you have sex with men, women, or both?
D)
How many sexual partners have you had in the last 6 months?
12.
On a very busy day in the office, Mrs. Donelan, who is 81 years old, comes for her usual visit for her blood pressure. She is on a low-dose diuretic chronically and denies any side effects. Her blood pressure is 118/78 today, which is well-controlled. As you are writing her script, she mentions that it is hard not having her husband Bill around anymore. What would you do next?
A)
Hand her the script and make sure she has a 3-month follow-up appointment.
B)
Make sure she understands the script.
C)
Ask why Bill is not there.
D)
Explain that you will have more time at the next visit to discuss this.
13.
When you enter your patient’s examination room, his wife is waiting there with him. Which of the following is most appropriate?
A)
Ask if it’s okay to carry out the visit with both people in the room.
B)
Carry on as you would ordinarily. The permission is implied because his wife is in the room with him.
C)
Ask his wife to leave the room for reasons of confidentiality.
D)
First ask his wife what she thinks is going on.
14.
You are performing a young woman’s first pelvic examination. You make sure to tell her verbally what is coming next and what to expect. Then you carry out each maneuver of the examination. You let her know at the outset that if she needs a break or wants to stop, this is possible. You ask several times during the examination, “How are you doing, Brittney?” What are you accomplishing with these techniques?
A)
Increasing the patient’s sense of control
B)
Increasing the patient’s trust in you as a caregiver
C)
Decreasing her sense of vulnerability
D)
All of the above
15.
A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter’s weight. You measure her daughter’s height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?
A)
Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B)
Reassure the mother that this is a normal body weight.
C)
Give the patient information about exercise because the patient is obese.
D)
Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese.
16.
A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit?
A)
Refer the patient to a nutritionist because he is anorexic.
B)
Reassure the patient that he has a normal body weight.
C)
Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
D)
Give the patient information about reduction of fat and cholesterol because he is obese.
17.
Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except:
A)
Changes in weight
B)
Fatigue and weakness
C)
Cough
D)
Fever and chills
18.
You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except:
A)
Level of consciousness
B)
Signs of distress
C)
Dress, grooming, and personal hygiene
D)
Blood pressure
19.
Mrs. Lenzo weighs herself every day with a very accurate balance-type scale. She has noticed that over the past 2 days she has gained 4 pounds. How would you best explain this?
A)
Attribute this to some overeating at the holidays.
B)
Attribute this to wearing different clothing.
C)
Attribute this to body fluid.
D)
Attribute this to instrument inaccuracy.
20.
You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn’t correlate with the other findings?
A)
It is caused by an “auscultatory gap.”
B)
It is caused by a cuff size error.
C)
It is caused by the patient’s emotional state.
D)
It is caused by resolution of the process which caused her retinopathy and kidney problems.
21.
Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this?
A)
Idiopathic pain
B)
Neuropathic pain
C)
Nociceptive or somatic pain
D)
Psychogenic pain
22.
A 50-year-old body builder is upset by a letter of denial from his life insurance company. He is very lean but has gained 2 pounds over the past 6 months. You personally performed his health assessment and found no problems whatsoever. He says he is classified as “high risk” because of obesity. What should you do next?
A)
Explain that even small amounts of weight gain can classify you as obese.
B)
Place him on a high-protein, low-fat diet.
C)
Advise him to increase his aerobic exercise for calorie burning.
D)
Measure his waist.
23.
A 32-year-old white female comes to your clinic, complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination you see a woman appearing her stated age who seems quite sad. Her facial expression does not change while you talk to her and she makes little eye contact. She speaks so softly you cannot always understand her. Her thought processes and content seem unremarkable.
What type of mood disorder do you think she has?
A)
Dysthymic disorder
B)
Manic (bipolar) disorder
C)
Major depressive episode
24.
A 23-year-old ticket agent is brought in by her husband because he is concerned about her recent behavior. He states that for the last 2 weeks she has been completely out of control. He says that she hasn’t showered in days, stays awake most of the night cleaning their apartment, and has run up over $1,000 on their credit cards. While he is talking, the patient interrupts him frequently and declares this is all untrue and she has never been so happy and fulfilled in her whole life. She speaks very quickly, changing the subject often. After a longer than normal interview you find out she has had no recent illnesses or injuries. Her past medical history is unremarkable. Both her parents are healthy but the husband has heard rumors about an aunt with similar symptoms. She and her husband have no children. She smokes one pack of cigarettes a day (although she has been chain-smoking in the last 2 weeks), drinks four to six drinks a week, and smokes marijuana occasionally. On examination she is very loud and outspoken. Her physical examination is unremarkable.
Which mood disorder does she most likely have?
A)
Major depressive episode
B)
Manic episode
C)
Dysthymic disorder
25.
Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it “would be better if he were not here.” What would you do next?
A)
Tell him that he has a very promising career in anything he chooses and soon he will feel better.
B)
Tell him that he needs an antidepressant and it will take about 4 weeks to work.
C)
Speak with his mother about getting him together more with his friends.
D)
Assess his suicide risk.
26.
You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A)
A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B)
A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
C)
A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D)
A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution
27.
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism?
A)
Moist and smooth
B)
Moist and rough
C)
Dry and smooth
D)
Dry and rough
28.
A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related?
A)
Diet
B)
Family history of liver diseases
C)
Family history of blood diseases
D)
Ethnicity of the child
29.
You are examining an unconscious patient from another region and notice Beau’s lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next?
A)
Conclude this is caused by a cultural practice.
B)
Conclude this finding is most likely secondary to trauma.
C)
Look for information from family and records regarding any problems which occurred 3 months ago.
D)
Ask about dietary intake.
30.
Jacob, a 33-year-old construction worker, complains of a “lump on his back” over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely?
A)
An enlarged lymph node
B)
A sebaceous cyst
C)
An actinic keratosis
D)
A malignant lesion
31.
A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small “pits” in his nails. What would account for these findings?
A)
Eczema
B)
Pityriasis rosea
C)
Psoriasis
D)
Tinea infection
32.
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?
A)
Insect bites
B)
Urticaria, or hives
C)
Psoriasis
D)
Purpura
33.
Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn’t mention them. They are tender when you examine them. What should you do?
A)
Conclude that these are lesions she has had for a long time.
B)
Wait for her to mention them before asking further questions.
C)
Ask how she acquired them.
D)
Conduct the visit as usual for the patient.
34.
Which of the following is a symptom involving the eye?
A)
Scotomas
B)
Tinnitus
C)
Dysphagia
D)
Rhinorrhea
35.
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis?
A)
Ptosis
B)
Exophthalmos
C)
Ectropion
D)
Epicanthus
36.
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?
A)
Dacryocystitis
B)
Chalazion
C)
Hordeolum
D)
Xanthelasma
37.
A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis?
A)
Conjunctivitis
B)
Acute iritis
C)
Corneal abrasion
D)
Subconjunctival hemorrhage
38.
A sudden, painless unilateral vision loss may be caused by which of the following?
A)
Retinal detachment
B)
Corneal ulcer
C)
Acute glaucoma
D)
Uveitis
39.
Sudden, painful unilateral loss of vision may be caused by which of the following conditions?
A)
Vitreous hemorrhage
B)
Central retinal artery occlusion
C)
Macular degeneration
D)
Optic neuritis
40.
A light is pointed at a patient’s pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which of the following terms describes this latter phenomenon?
A)
Direct reaction
B)
Consensual reaction
C)
Near reaction
D)
Accommodation
41.
A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?
A)
She obtains a 20% correct score at 100 feet.
B)
She can accurately name 20% of the letters at 20 feet.
C)
She can see at 20 feet what a normal person could see at 100 feet.
D)
She can see at 100 feet what a normal person could see at 20 feet.
42.
A patient presents with ear pain. She is an avid swimmer. The history includes pain and drainage from the left ear. On examination, she has pain when the ear is manipulated, including manipulation of the tragus. The canal is narrowed and erythematous, with some white debris in the canal. The rest of the examination is normal. What diagnosis would you assign this patient?
A)
Otitis media
B)
External otitis
C)
Perforation of the tympanum
D)
Cholesteatoma
43.
A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely?
A)
Otosclerosis of the left ear
B)
Exposure to chronic loud noise of the right ear
C)
Otitis media of the right ear
D)
Perforation of the right eardrum
44.
A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this?
A)
Submandibular
B)
Tonsillar
C)
Occipital
D)
Posterior cervical
45.
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her temperature is 98.6. Her blood pressure is 120/80, her pulse is 80, and her respirations are 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and a high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs.
Which disorder of the thorax or lung does this best describe?
A)
Spontaneous pneumothorax
B)
Chronic obstructive pulmonary disease (COPD)
C)
Asthma
D)
Pneumonia
46.
A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. Although he has had worsening of symptoms occasionally with a cold, his symptoms have stayed about the same. The cough has occasional mucous drainage but never any blood. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married and has two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer’s disease. On examination you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. He is breathing comfortably with respirations of 12. His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung fields. There is no area of dullness and no increased or decreased fremitus.
What thorax or lung disorder is most likely causing his symptoms?
A)
Spontaneous pneumothorax
B)
Chronic obstructive pulmonary disease (COPD)
C)
Asthma
D)
Pneumonia
47.
A 68-year-old retired postman presents to your clinic, complaining of dull, intermittent left-sided chest pain over the last few weeks. The pain occurs after he mows his lawn or chops wood. He says that the pain radiates to the left side of his jaw but nowhere else. He has felt light-headed and nauseated with the pain but has had no other symptoms. He states when he sits down for several minutes the pain goes away. Ibuprofen, Tylenol, and antacids have not improved his symptoms. He reports no recent weight gain, weight loss, fever, or night sweats. He has a past medical history of high blood pressure and arthritis. He quit smoking 10 years ago after smoking one pack a day for 40 years. He denies any recent alcohol use and reports no drug use. He is married and has two healthy children. His mother died of breast cancer and his father died of a stroke. His younger brother has had bypass surgery. On examination you find him healthy-appearing and breathing comfortably. His blood pressure is 140/90 and he has a pulse of 80. His head, eyes, ears, nose, and throat examinations are unremarkable. His lungs have normal breath sounds and there are no abnormalities with percussion and palpation of the chest. His heart has a normal S1 and S2 and no S3 or S4. Further workup is pending.
Which disorder of the chest best describes these symptoms?
A)
Angina pectoris
B)
Pericarditis
C)
Dissecting aortic aneurysm
D)
Pleural pain
48.
A 36-year-old teacher presents to your clinic, complaining of sharp, knifelike pain on the left side of her chest for the last 2 days. Breathing and lying down make the pain worse, while sitting forward helps her pain. Tylenol and ibuprofen have not helped. Her pain does not radiate to any other area. She denies any upper respiratory or gastrointestinal symptoms. Her past medical history consists of systemic lupus. She is divorced and has one child. She denies any tobacco, alcohol, or drug use. Her mother has hypothyroidism and her father has high blood pressure. On examination you find her to be distressed, leaning over and holding her left arm and hand to her left chest. Her blood pressure is 130/70, her respirations are 12, and her pulse is 90. On auscultation her lung fields have normal breath sounds with no rhonchi, wheezes, or crackles. Percussion and palpation are unremarkable. Auscultation of the heart has an S1 and S2 with no S3 or S4. A scratching noise is heard at the lower left sternal border, coincident with systole; leaning forward relieves some of her pain. She is nontender with palpation of the chest wall.
What disorder of the chest best describes this disorder?
A)
Angina pectoris
B)
Pericarditis
C)
Dissecting aortic aneurysm
D)
Pleural pain
49.
A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last week when he took off his shirt that his breastbone seemed collapsed. He seems embarrassed and tells you that it has been that way for quite awhile. He states he has no symptoms from it and he just tries not to take off his shirt in front of anyone. He denies any shortness of breath, chest pain, or lightheadedness on exertion. His past medical history is unremarkable. He is in sixth grade and just moved in with his grandmother after his father was deployed to the Middle East. His mother died several years ago in a car accident. He states that he does not smoke and has never touched alcohol. On examination you see a teenage boy appearing his stated age. On visual examination of his chest you see that the lower portion of the sternum is depressed. Auscultation of the lungs and heart are unremarkable.
What disorder of the thorax best describes your findings?
A)
Barrel chest
B)
Funnel chest (pectus excavatum)
C)
Pigeon chest (pectus carinatum)
D)
Thoracic kyphoscoliosis
50.
A 55–year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?
A)
Bronchitis
B)
Costochondritis
C)
Pericarditis
D)
Angina pectoris
51.
Which of the following percussion notes would you obtain over the gastric bubble?
A)
Resonance
B)
Tympany
C)
Hyperresonance
D)
Flatness
52.
Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration?
A)
Bronchovesicular
B)
Vesicular
C)
Bronchial
D)
Tracheal
53.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology?
A)
Bronchitis
B)
Simple asthma
C)
Cystic fibrosis
D)
Heart failure
54.
What is responsible for the inspiratory splitting of S2?
A)
Closure of aortic, then pulmonic valves
B)
Closure of mitral, then tricuspid valves
C)
Closure of aortic, then tricuspid valves
D)
Closure of mitral, then pulmonic valves
55.
A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?
A)
Mitral
B)
Tricuspid
C)
Aortic
D)
Pulmonic
56.
You are screening people at the mall as part of a health fair. The first person who comes for screening has a blood pressure of 132/85. How would you categorize this?
A)
Normal
B)
Prehypertension
C)
Stage 1 hypertension
D)
Stage 2 hypertension
57.
You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse?
A)
Palpable
B)
Soft, rapid, undulating quality
C)
Pulsation eliminated by light pressure on the vessel
D)
Level of pulsation changes with changes in position
58.
You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse?
A)
Hypothyroidism
B)
Aortic stenosis, with pressure overload of the left ventricle
C)
Mitral stenosis, with volume overload of the left atrium
D)
Cardiomyopathy
59.
You are performing a cardiac examination on a patient with shortness of breath and palpitations. You listen to the heart with the patient sitting upright, then have him change to a supine position, and finally have him turn onto his left side in the left lateral decubitus position. Which of the following valvular defects is best heard in this position?
A)
Aortic
B)
Pulmonic
C)
Mitral
D)
Tricuspid
NSG 6020 Midterm Exam Study Guide
60.
You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?
A)
Upright
B)
Upright, but leaning forward
C)
Supine
D)
Left lateral decubitus
61.
Which of the following events occurs at the start of diastole?
A)
Closure of the tricuspid valve
B)
Opening of the pulmonic valve
C)
Closure of the aortic valve
D)
Production of the first heart sound (S1)
62.
Which is true of splitting of the second heart sound?
A)
It is best heard over the pulmonic area with the bell of the stethoscope.
B)
It normally increases with exhalation.
C)
It is best heard over the apex.
D)
It does not vary with respiration.
63.
Which of the following is true of jugular venous pressure (JVP) measurement?
A)
It is measured with the patient at a 45-degree angle.
B)
The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
C)
A JVP below 9 cm is abnormal.
D)
It is measured above the sternal notch.
64.
How much does cardiovascular risk increase for each increment of 20 mm Hg systolic and 10 mm Hg diastolic in blood pressure?
A)
25%
B)
50%
C)
75%
D)
100%
65.
In measuring the jugular venous pressure (JVP), which of the following is important?
A)
Keep the patient’s torso at a 45-degree angle.
B)
Measure the highest visible pressure, usually at end expiration.
C)
Add the vertical height over the sternal notch to a 5-cm constant.
D)
Realize that a total value of over 12 cm is abnormal.
