NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat
NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat – Episodic/Focused SOAP Note Example
Patient Information:
CL, 28, Female, White American
S.
CC: Runny nose, itchy eyes, itchy throat, fullness of ears, and sneezing
HPI: Mrs C.L., a 28-year-old female, came to the hospital and was well until nine days ago when she developed a runny nose, itchy eyes, and her ears felt full. The nasal drainage is clear mucus, and she sneezes all day. The patient reports that the symptoms are seasonal and last about six to eight weeks every spring. She also sneezes all day, her eyes have severe itch, and her throat is usually itchy during these attacks. The ears also pop sometimes, which is quite uncomfortable. The symptoms are often self-limiting, do disappear without intervention, and are recurrent during spring, and she decided to seek treatment this time. The patient claims that colds during the morning and evenings worsen the symptoms. Chlorpheniramine taken provides temporary symptom relief.
Current Medications:
Chlorpheniramine 12mg twice daily for two days
Green tea 300ml twice daily
Vitamin C supplement 50 ml daily
Allergies: She is allergic to dust and cold and develops a runny nose, nasal congestion, and sneezes. Allergic to penicillin and develops itchiness and hives. No other known drug or food allergies
PMHx: Diagnosed with severe pneumonia in 8th grade and was admitted for treatment for a week. No surgery or intubation history was performed during the admission. Diagnosed with nephritis five years ago and was admitted for four days during the treatment period. She denies a history of surgery or blood transfusion. Childhood immunizations are up to date. The last tetanus dose was two years ago. Covid-19 vaccine booster was given one year ago. Last flu vaccine seven years ago she was in college.
Soc Hx: Mrs C. L. is a teacher who teaches fourth-grade students at a local school. She loves playing with the children and doubles up as the hockey coach in the school. She also loves bible study and fellowship services. She is married with one 3-year-old child. She lives with her husband and child, with whom they have a good relationship. She denies smoking or alcohol use. She reports using seatbelts when driving, denies participating in extreme sports, and has safety measures at home, such as smoke detectors and a home phone for emergency calls.
Fam Hx: Her paternal grandparents died in a road accident. Her maternal grandfather is an alcoholic, hypertensive, and was recently diagnosed with BPH. Her maternal grandmother is asthmatic. Her maternal uncle is asthmatic. She has three brothers. The eldest brother, Tim, is obese and hypertensive. The other siblings are alive and well
ROS:
GENERAL: Patient denies weight loss, malaise, fever, or fatigue.
HEENT: Eyes: Reports eye itchiness and denies eye discharge or changes in vision acuity. Ears: Reports popping and fullness of ears. Denies pain, discharge or hearing acuity changes. Nose: Reports a runny nose with clear discharge and occasional sneezing. Throat: Reports an occasionally itchy throat.
SKIN: Denies rash or itching.
CARDIOVASCULAR: Denies chest pain, pressure, discomfort, palpitations, or edema.
RESPIRATORY: Reports mild difficulty in breathing due to nasal congestion. Denies cough or sputum production.
GASTROINTESTINAL: Denies nausea or vomiting, diarrhea, blood in stool, or diarrhea.
GENITOURINARY: Denies urine retention, burning on urination, urine odor or color change, or lower abdominal pain. LMP: 12/18/2023
NEUROLOGICAL: Reports mild headache and denies dizziness, numbness or tingling sensation in limbs. Reports adequate bowel and bladder control.
MUSCULOSKELETAL: Denies muscle, pain, or joint injury, stiffness, pain
HEMATOLOGIC: Denies easy bruising or uncontrollable bleeding
LYMPHATICS: Denies lymph node enlargement or history of splenectomy.
PSYCHIATRIC: Denies depression or anxiety
ENDOCRINOLOGIC: Denies profuse sweating, cold or heat intolerance, polyuria, polyphagia, or polyuria.
ALLERGIES: Reports runny nose, nasal congestion, and sneezing on exposure to dust. Reports hives and skin rashes on exposure to penicillin.
O.
Physical exam:
HEENT: Head: Normocephalic, hair evenly distributed, no receding hairline, scalp moist and shiny. Eyes: Erythematous and teary. Ears: No drainage, pain or changes in hearing acuity. Nose: Clear, thin nasal discharge, nasal mucosa boggy, enlarged nasal turbinates, obstructed airway. Throat: Mildly erythematous
Neck: No enlarged lymph nodes, trachea midline, and tonsils non-palpable
Chest: symmetrical rising with breathing in and out. No accessory muscle use in breathing., no rashes or lesions. Lungs clear to auscultation, no crackles or wheezes. Apical pulse 74bpm, S1 and S2 auscultated. No murmurs or gallops
Abdomen: Globular in shape, well hydrated, no scars, lesions or rashes. No organomegaly. Moderate bowel sounds in all abdomen quadrants. No tenderness on light and deep palpation.
Neurological: All cranial nerves intact. Good plantar and knee-jerk reflexes. Good muscle tone on all extremities.
Vitals
Temp: 37.1oC, Blood pressure 132/77, Pulse Rate- 74, RR- 19, SpO2 94%
Diagnostic results:
The strep test is an ideal test for this patient. The strep test is a simple procedure that will help rule out or confirm streptococci infection (Ball et al., 2023). Nasal allergen challenge is a test that can be used to identify the offending allergens and help differentiate between allergic and non-allergic conditions, as Eguiluz-Gracia et al. (2019) support.
A.
Differential Diagnoses
Seasonal Allergic Rhinitis: Allergic rhinitis, a condition caused by a reaction to environmental allergens, is the most presumptive diagnosis; the duration of illness, history of allergic attacks, and recurrence of the condition in early spring support the diagnosis. Unlike most upper respiratory tract infections, allergic rhinitis can persist long without management and easily recur. Allergic rhinitis symptoms include a runny nose, nasal stuffiness, itchy nose, watery and itchy eyes, headache, coughing, and an itchy palate, coinciding with the patient’s symptoms (Eguiluz-Gracia et al., 2019).
Non-Allergic Rhinitis: In non-allergic rhinitis, the nasal mucosa is inflamed by not from an allergen cause. The symptoms include nasal congestion, sneezing, runny nose, and a post-nasal drip. A post-nasal drip can precipitate a cough or sore throat. Eguiluz-Gracia et al. (2019) note that non-allergic rhinitis is often chronic and not seasonal. Non-allergic rhinitis causes are unknown and primarily affects individuals above 20 years. Non-allergic rhinitis is often challenging to manage because it lacks a cause and thus can persist for longer than most upper respiratory tract infections (Patel et al., 2020)
Acute nasopharyngitis (Common Cold). The condition is a self-limiting infection lasting 7-10 days. However, a cough that follows untreated cases may last up to four weeks. Common cold often occurs in the colder seasons, and transmissions are higher in winter. Common cold presents with symptoms of nasal stuffiness, cough, mild headache, malaise, fever, sore throat and a runny nose, as Jaume et al. (2020) state. However, common cold symptoms do not last beyond ten days, ruling it out as the primary diagnosis.
Seasonal Hemophilus Influenza (Flu). Hemophilus influenza is a viral whose symptoms last 3-7 days and are severe, warranting medical treatment. Uyeki et al. (2019) note that flu symptoms develop rapidly and are often severe, especially in children, making it difficult to persevere without seeking treatment. An individual can contract the flu anytime, but seasonal transmission is often high in the fall. However, Mrs C.L. has had her symptoms for about nine days. She also reports that these symptoms can last six to eight weeks, ruling out the flu. More so, the flu is also more common in the fall than spring and spring is associated with many environmental changes, including treas blossoming in preparation for spring. These differential diagnoses can help diagnose and treat the client promptly and eliminate recurrences.
NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby. https://www.amazon.com/Seidels-Guide-Physical-Examination-Interprofessional/dp/0323481957
Eguiluz-Gracia, I., Pérez-Sánchez, N., Bogas, G., Campo, P., & Rondón, C. (2019). How to diagnose and treat local allergic rhinitis: a challenge for clinicians. Journal of Clinical Medicine, 8(7), 1062. https://doi.org/10.3390/jcm8071062
Jaume, F., Valls-Mateus, M., & Mullol, J. (2020). Common cold and acute rhinosinusitis: up-to-date management in 2020. Current allergy and asthma reports, 20, 1-10. https://doi.org/10.1007/s11882-020-00917-5
Patel, G. B., Kern, R. C., Bernstein, J. A., Hae-Sim, P., & Peters, A. T. (2020). Current and future treatments of rhinitis and sinusitis. The Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1522-1531. https://doi.org/10.1016/j.jaip.2020.01.031
Uyeki, T. M., Bernstein, H. H., Bradley, J. S., Englund, J. A., File, T. M., Fry, A. M., Gravenstein, S., Hayden, F. G., Harper, S. A., Hirshon, J. M ., Ison, M. G., Johnston, B. L., Knight, S. L., McGeer, A., Riley, L. E., Wolfe, C. R., Alexander, P. E., & Pavia, A. T. (2019). Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68(6), e1-e47. https://doi.org/10.1093/cid/ciy866
Also Read:
NURS 6512 Week 11 The Ethics Behind Assessment Sample
NURS 6512 Digital Clinical Experience
NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children Case
NURS 6512 Discussion: Assessing Musculoskeletal Pain Discussion Paper
NURS 6512 Lab Assignment: Assessing the Abdomen Sample Paper
NURS6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.
Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer.
With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare for NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
- Review this week’s Learning Resources and consider the insights they provide.
- Consider what history would be necessary to collect from the patient.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat: The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
By Day 6 of Week 5 of NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat
Submit your Assignment.
NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat Case Study Example Solution 2
The patient is a 28-year-old woman who has been experiencing a runny nose and itchy eyes for about nine days. These symptoms typically last for six to eight weeks and occur every spring. Besides the runny nose, she reports having itchy eyes that she feels the urge to scratch, a tickling sensation in her throat, and a feeling of fullness in her ears that sometimes causes them to pop. Last year, she took Claritin with relief. Upon examination, the patient is alert and oriented and has pale nasal mucosa with clear thin secretions and enlarged nasal turbinates that obstruct airway flow, but her lungs are clear. Her tonsils are not enlarged, but her throat is mildly red.
Diagnostic Tests Justification
Based on the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full, a few possible diagnostic tests that could be appropriate for this case are listed and justified below.
- Allergy testing: The patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens such as pollen, mold, or pet dander (McCance & Huether, 2019). Allergy testing can help confirm whether the patient has an allergy and identify the specific allergens causing the patient’s symptoms.
- Nasal endoscopy: A nasal endoscopy involves inserting a thin, flexible tube with a camera into the patient’s nose to visualize the inside of the nasal passages and sinuses. This test can help identify any structural abnormalities or inflammation in the nasal passages that may contribute to the patient’s symptoms.
- Sinus imaging: Sinus imaging tests such as CT scans or MRIs provide detailed images of the patient’s sinuses and help identify any blockages or infections that may be causing the patient’s symptoms.
- Throat culture: A throat culture involves taking a sample of the patient’s throat secretions and growing them in a laboratory to identify any bacterial or viral infections that may be causing the patient’s symptoms.
- Complete blood count (CBC): A CBC would give a depiction of the white blood cells and their differentials and show whether there is an excess of or any deficiency of the cells. Elevated eosinophils upon doing a CBC may be suggestive of an allergic condition.
Differential Diagnoses
Based on the patient’s symptoms and the diagnostic tests described above, the following five conditions should be considered in the differential diagnosis:
- Allergic rhinitis: As mentioned above, the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens (Emeryk et al., 2019). Allergy testing can help confirm this diagnosis.
- Sinusitis: The patient’s symptoms of a runny nose and ears that feel full, as well as the presence of pale, boggy nasal mucosa and enlarged nasal turbinates, suggest the possibility of sinusitis, which is an inflammation of the sinuses (Hammer & McPhee, 2018). A nasal endoscopy or sinus imaging test can help confirm this diagnosis.
- Common cold: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are consistent with the common cold, a viral infection of the upper respiratory tract. A throat culture can help confirm this diagnosis.
- Influenza: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are also consistent with influenza, which is a viral infection of the respiratory tract. A throat culture or blood test can help confirm this diagnosis.
- Adenovirus infection: Adenovirus respiratory infection could also manifest as a runny nose, itchy eyes, and a tickle in the throat. A throat culture or blood test can help confirm this diagnosis.
Conclusion
In sum, the patient in this case study is a 28-year-old woman who is experiencing a runny nose and itchy eyes, which occur every spring and last for six to eight weeks. She also has a tickling sensation in her throat, and her ears feel full and sometimes pop. Possible diagnostic tests for her symptoms include allergy testing, nasal endoscopy, sinus imaging, throat culture, and a complete blood count. Differential diagnoses for her condition include allergic rhinitis, sinusitis, the common cold, influenza, and adenovirus infection.
NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat References
Emeryk, A., Emeryk-Maksymiuk, J., & Janeczek, K. (2019). New guidelines for the treatment of seasonal allergic rhinitis. Postepy Dermatologii i Alergologii, 36(3), 255–260. https://doi.org/10.5114/ada.2018.75749
Hammer, G. D., & McPhee, S. J. (2018). Pathophysiology of disease: An introduction to clinical medicine 8E (8th ed.). McGraw-Hill Education. https://www.mheducation.co.uk/ise-pathophysiology-of-disease-an-introduction-to-clinical-medicine-8e-9781260288513-emea#:~:text=The%20goal%20of%20this%20trusted%20text%20is%20to
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. https://books.google.co.uk/books?id=3QgyAgAAQBAJ&printsec=frontcover#v=onepage&q&f=false
Submission and Grading Information for NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK5Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 5 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 5 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria for NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat
To access your rubric:
- Week 5 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
- To check your Assignment draft for authenticity:
- Submit your Week 5 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 5
- To participate in this Assignment:
- Week 5 Assignment 1
NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS 6512 Week 5 Assignment 1 Rubric
Grid View
List View
- Excellent
- Good
- Fair
- Poor
Using the Episodic/Focused SOAP Template:
- Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.
- Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.
45 (45%) – 50 (50%)
- The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study.
- The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
39 (39%) – 44 (44%)
- The response accurately follows the SOAP format to document the patient in the assigned case study.
- The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
33 (33%) – 38 (38%)
- The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy.
- The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.
0 (0%) – 32 (32%)
- The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat.
- The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
·
List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
30 (30%) – 35 (35%)
- The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the five conditions selected NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat.
24 (24%) – 29 (29%)
- The response lists four or five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.
18 (18%) – 23 (23%)
The response lists three to five possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.
0 (0%) – 17 (17%)
- The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
- Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
- A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
- Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
- Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.
3 (3%) – 3 (3%)
- Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
- Purpose, introduction, and conclusion of the assignment are vague or off topic.
0 (0%) – 2 (2%)
- Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
- No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
- Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
- Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3 (3%) – 3 (3%)
- Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 2 (2%)
- Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
- Uses correct APA format with no errors.
4 (4%) – 4 (4%)
- Contains a few (1 or 2) APA format errors.
3 (3%) – 3 (3%)
- Contains several (3 or 4) APA format errors.
0 (0%) – 2 (2%)
- Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS 6512 Week 5 Assignment 1 Rubric.
NURS 6512 Week 11: Exam
Question 11 pts
You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?
Group of answer choices
Cervical spine radiograph
Mini-Mental State Examination
Nerve conduction studies
Visual acuity
Question 21 pts
In the adult, the apical impulse should be most visible when the patient is in what position?
Group of answer choices
Supine
Lithotomy
Right lateral recumbent
Upright
Question 31 pts
Recent unilateral inversion of a previously everted nipple suggests:
Group of answer choices
cancer.
benign breast disease.
pregnancy.
mastitis.
Question 41 pts
Loss of immediate and recent memory with retention of remote memory suggests:
Group of answer choices
attention-deficit/hyperactivity disorder (ADHD).
impaired judgment.
stupor.
dementia.
Question 51 pts
It is especially important to test for ankle clonus if:
Group of answer choices
deep tendon reflexes are hyperactive.
the patient has a positive Kernig sign.
the Romberg sign is positive.
the patient has peripheral neuropathy.
Question 61 pts
If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?
Group of answer choices
CN I, olfactory
CN V, trigeminal
CN IX, glossopharyngeal
CN XI, spinal accessory
Question 71 pts
A grade IV mitral regurgitation murmur would:
Group of answer choices
be described as a diastolic murmur.
not be expected to have a thrill.
radiate to the axilla.
be heard best at the base.
Question 81 pts
To hear diastolic heart sounds, you should ask patients to:
Group of answer choices
lie on their back.
lie on their left sides.
lie on their right side.
sit up and lean forward.
Question 91 pts
If your patient has nipple discharge, you will most likely need a:
Group of answer choices
Vacutainer tube.
glass slide and fixative.
specimen jar with formaldehyde.
tape strip to test pH.
Question 101 pts
You are examining Mr. S., a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial occlusion?
Group of answer choices
Thick, calloused skin
Ruddy, thin skin
Warmer temperature of extremity in contrast to other body parts
Loss of hair over the extremity
Question 111 pts
A 56-year-old male presents to the clinic to see the nurse practitioner with complaints of shortness of breath for 1 months, 15-pound weight gain and lower extremity edema. Vitals are as follows: HR: 120, Respirations 30, Blood Pressure: 138/90, BMI: 40; Oxygen saturation of 90%. On examination patient is noted to have jugular venous distention, enlarged liver, and crackles are noted on examination. A chest x-ray is completed and shows findings consistent with which diagnosis? Based on this scenario and imaging what is the most likely diagnosis?
Group of answer choices
Right Sided Congestive Heart Failure
Left Sided Congestive Heart Failure
Pneumonia
Emphysema
Question 121 pts
Palpation of a normal prostate in an older adult is likely to feel:
Group of answer choices
cool.
grainy.
polypoid.
rubbery.
Question 131 pts
During chest assessment, you note the patient’s voice quality while auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and the e’s sound like a s. This sound is indicative of:
Group of answer choices
lung consolidation.
emphysema.
bronchial obstruction.
asthma.
Question 141 pts
Throughout the history and physical examination, the clinician should:
Group of answer choices
concentrate on emotional issues.
follow an inflexible sequence.
deal only with previously identified problems.
evaluate the whole patient.
Question 151 pts
While examining a 30-year-old woman, you note that one breast is slightly larger than the other. In response to this finding, you should:
Group of answer choices
note the finding in the patient’s record.
ask the patient if she has ever had breast cancer.
tell the patient to get a mammogram as soon as possible.
tell the patient to get a mammary sonogram as soon as possible.
Question 161 pts
Which of the following statements is true regarding the examination of peripheral arteries?
Group of answer choices
The thumb should never be used to assess pulses.
Palpate at least one pulse in each extremity, usually the most proximal one.
The pulses are most readily felt over bony prominences.
Extremity pulses do not normally generate waveforms.
Question 171 pts
When is the mental status portion of the neurologic system examination performed?
Group of answer choices
During the history-taking process
During the time when questions related to memory are asked
Constantly, throughout the entire interaction with a patient
During assessment of cranial nerves and deep tendon reflexes
Question 181 pts
Which condition is considered progressive rather than reversible?
Group of answer choices
Delirium
Dementia
Depression
Anxiety
Question 191 pts
Which portion of the physical examination is best done with the patient standing?
Group of answer choices
Spinal
Rectal
Neurologic
Musculoskeletal
Question 201 pts
Darian is a 14-year-old adolescent who states his right testicle has a soft swollen mass. The testicle is not painful upon palpation. The right inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with:
Group of answer choices
hydrocele
testicular cancer
rectocele.
scrotal hernia.
Question 211 pts
The presence of cervical motion tenderness may indicate:
Group of answer choices
pregnancy.
nulliparity.
pelvic inflammatory disease.
vulvovaginitis.
Question 221 pts
You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the:
Group of answer choices
back.
palms.
fingertips.
upper arms.
Question 231 pts
The Mini-Mental State Examination should be administered for the patient who:
Group of answer choices
gets lost in her neighborhood.
sleeps an excessive amount of time.
has repetitive ritualistic behaviors.
uses illegal hallucinogenic drugs.
Question 241 pts
An elderly female was recently diagnosed with osteoporosis 2 weeks ago. What is the hallmark appearance of a patient with this diagnosis?
Group of answer choices
Dowager hump
Scoliosis
Ankylosing Spondylitis
Herniated Lumbar Disk
Question 251 pts
Ulnar deviation and boutonniere deformities are characteristic of:
Group of answer choices
osteoarthritis.
osteoporosis.
congenital defects.
rheumatoid arthritis.
Question 261 pts
One of the most important aspects to consider in the orthopedic screening examination is:
Group of answer choices
muscle contraction.
flexibility.
balance.
symmetry.
Question 271 pts
Adrian Thomas is a 19-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her father reports that Adrian, apart from occasional sinus infections, Adrian is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Adrian’s current problem?
Group of answer choices
Anorexia symptoms
Cocaine use
Last menses
Covid-19 contact
Question 281 pts
The Mini-Mental State Examination:
Group of answer choices
may be used to quantitatively estimate cognitive changes.
may be used to qualitatively estimate personality disorders.
scores do not vary with regard to age or education.
will determine the cause of memory loss.
Question 291 pts
The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the:
Group of answer choices
P wave.
QRS complex.
PR interval.
T wave.
Question 301 pts
A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarction. During the health history interview of his family history, he relates that his father had died of “heart trouble.” The most important follow-up question you should pose is which of the following?
Group of answer choices
“Did your father have coronary bypass surgery?”
“Did your father’s father have heart trouble also?”
“What were your father’s usual dietary habits?”
“What age was your father at the time of his death?”
Question 311 pts
The family history for a patient with joint pain should include information about siblings with:
Group of answer choices
trauma to the skeletal system.
chronic atopic dermatitis.
genetic disorders.
obesity.
Question 321 pts
Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:
Group of answer choices
uremia.
tuberculosis.
hepatic dysfunction.
diabetic ketoacidosis.
Question 331 pts
At your first meeting with a patient, it is usually best to say:
Group of answer choices
“Let’s get to the point.”
“I hope you will learn to trust me.”
“Let me tell you what I can do for you.”
“Tell me about yourself.”
Question 341 pts
A parent is advised to restrict contact or collision sports participation for their child. An example of a sport in which this child could participate is:
Group of answer choices
hockey.
roller skating.
riflery.
skateboarding.
Question 351 pts
A 62 year old female presents to the clinic with complains of chest pain and heart palpitations that started 3 days ago. Patient states she is healthy and only has a history of hypertension and tachycardia. Patient is currently taking Norvasc 10mg daily and Coreg 6.25 mg BID. You order an EKG and it shows heart rate above 200 beats/min and the ECG may look like a sawtooth cog.
What is the most likely diagnosis of this patient?
Group of answer choices
Atrial Flutter
Supraventricular Tachycardia
NSR
Afib with Right Ventricular Response
Question 361 pts
The reliability of health-related findings and observations is the responsibility of the:
Group of answer choices
patient.
health care professionals.
attending physician.
professional and the patient.
Question 371 pts
If pitting edema is unilateral, you would suspect occlusion of a:
Group of answer choices
lymphatic duct.
major vein.
surface capillary.
superficial artery.
Question 381 pts
The finger-to-nose test allows assessment of:
Group of answer choices
coordination and fine motor function.
point location.
sensory function.
two-point discrimination.
Question 391 pts
When assessing a 17-year-old for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test, you would also perform a test for the _____ sign.
Group of answer choices
Kernig
Babinski
obturator
Brudzinski
Question 401 pts
Diabetic peripheral neuropathy will likely produce:
Group of answer choices
hyperactive ankle reflexes.
diminished pain sensation.
exaggerated vibratory sense.
hypersensitive temperature perception.
Question 411 pts
For purposes of examination and communication of physical findings, the breast is divided into:
Group of answer choices
halves (upper and lower).
thirds (left, middle, and right).
four quadrants plus a tail.
circles (six consecutive rings, each 1 inch farther away from nipple).
Question 421 pts
While collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding:
Group of answer choices
history of medication allergies.
alcohol, tobacco, and caffeine use.
level of personal education.
amount of personal income.
Question 431 pts
Which medical condition would exclude a person from sports participation?
Group of answer choices
Asthma
Fever
Controlled seizures
HIV-positive status
Question 441 pts
Temporalis and masseter muscles are evaluated by:
Group of answer choices
having the patient clench his or her teeth.
asking patient to fully extend his or her neck.
passively opening the patient’s jaw.
having the patient shrug his or her shoulders.
Question 451 pts
The adnexa of the uterus are composed of the:
Group of answer choices
corpus and cervix.
fallopian tubes and ovaries.
uterosacral and broad ligaments.
vagina and fundus.
Question 461 pts
The physical assessment technique most frequently used to assess joint symmetry is:
Group of answer choices
inspection.
palpation.
percussion.
the use of joint calipers.
Question 471 pts
While interviewing a 70-year-old female clinic patient, she tells you that she takes ginkgo biloba and St. John’s wort. You make a short note to check for results of the:
Group of answer choices
Denver II.
Mini-Mental State Examination.
Glasgow Coma Scale.
Goodenough-Harris Drawing Test.
Question 481 pts
You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should:
Group of answer choices
chart the finding as paraphimosis.
inquire about previous penile infections.
retract the foreskin firmly.
transilluminate the glans.
Question 491 pts
The examiner percusses for diaphragmatic excursion along the:
Group of answer choices
midvertebral line.
midaxillary line.
scapular line.
sternum.
Question 501 pts
A positive straight leg raise test usually indicates:
Group of answer choices
leg length discrepancy.
lumbar nerve root irritation.
hip bursitis.
improperly conditioned muscles.
Question 511 pts
The best way to ease the apprehension of a 3-year-old child before a physical examination is to:
Group of answer choices
explain that you will be gentle.
let the child hold the stethoscope while you listen.
tell the child he or she will get a lollipop for good behavior.
hand the child a picture book.
Question 521 pts
You are assessing Mr. Z.’s fluid volume status as a result of heart failure. If your finger depresses a patient’s edematous ankle to a depth of 6 mm, you should record this pitting as:
Group of answer choices
1+.
2+.
3+.
4+.
Question 531 pts
You are reviewing an ECG of a 43 year old new patient. The patient has a history of second-degree heart block. The ECG shows the PR interval is increases with each beat until a QRS is dropped. What is this type of block called?
Group of answer choices
Second degree heart block, type 2: Mobitz 2
First degree heart block
Second degree heart block, type 1: Wenckebach/Mobitz 1
Third degree-complete heart block
Question 541 pts
When assessing superficial pain, touch, vibration, and position perceptions, you are testing:
Group of answer choices
motor function.
cerebellar function.
sensory function.
tendon reflexes.
Question 551 pts
When you attempt to move a 10-month-old child from his mother’s lap to the examination table, he screams loudly. Your best action is to:
Group of answer choices
move the child to the examination table and proceed matter-of-factly with the examination.
perform the examination while the child is in the mother’s lap.
ask the mother to get the child to stop crying.
defer the examination until another day.
Question 561 pts
A 40 yr old female presents to the clinic with complaints of low back and buttock pain. Pt states the buttock pain radiates from one side to the other. On examination, the patient is noted to have limited ROM of the shoulders, chest wall, hips, and knees. Upon xray, you find gross postural changes and there is a severe deformity of the vertebral column.
What is the most likely diagnosis for this patient?
Group of answer choices
Lumbar Radiculopathy
Herniated Lumbar Disk
Lumbar Stenosis
Ankylosing Spondylitis
Question 571 pts
Examination of the patient in the lithotomy, or knee-chest, position includes:
Group of answer choices
inspection for inguinal hernias.
palpation of anal sphincter tone.
percussion of pelvic structures.
stereognosis testing.
Question 581 pts
A red, hot swollen joint in a 40-year-old man should lead you to suspect:
Group of answer choices
trauma.
bursitis.
gout.
cellulitis.
Question 591 pts
You are conducting an examination of Mr. Curtis’s heart and blood vessels and auscultate a grade III murmur. The intensity of this murmur is:
Group of answer choices
barely discernible.
moderately loud.
loud with palpable thrill.
very loud without a stethoscope.
Question 601 pts
A common finding in markedly obese and pregnant women is:
Group of answer choices
kyphosis.
lordosis.
paraphimosis.
scoliosis.
Question 611 pts
You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is apathetic and has disturbed thoughts and language patterns. The nurse recognizes this behavior pattern as consistent with a diagnosis of:
Group of answer choices
depression.
autistic disorder.
mania.
schizophrenia.
Question 621 pts
Part of the screening orthopedic component of the examination includes evaluating the person while he or she is:
Group of answer choices
performing push-ups.
duck walking.
twisting at the waist.
crossing the arms over the chest.
Question 631 pts
The Denver II is a tool used to determine:
Group of answer choices
a child’s IQ.
a child’s mood.
whether a child is educable.
whether a child is developing as expected.
Question 641 pts
When palpating joints, crepitus may occur when:
Group of answer choices
irregular bony surfaces rub together.
supporting muscles are excessively spastic.
joints are excessively lax.
there is excess fluid within the synovial membrane.
Question 651 pts
The musculoskeletal examination should begin when:
Group of answer choices
the patient enters the examination room.
during the collection of subjective data.
when height is measured.
when joint mobility is assessed.
Question 661 pts
The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg.
Group of answer choices
5
10
20
25
Question 671 pts
Bimanual examination of the uterus includes:
Group of answer choices
grasping the vaginal wall and pulling it downward.
inserting one finger into the fundus.
placing the thumb on the clitoris and forefinger on the cervix.
grasping the cervix between the examining fingers.
Question 681 pts
Inspection of the scrotum should reveal:
Group of answer choices
two testes per sac.
smooth scrotal sacs.
left scrotal sac lower than the right.
lightly pigmented skin.
Question 691 pts
An ophthalmoscopic eye examination involves:
Group of answer choices
lens inspection.
near vision evaluation.
sclera observation.
visual field assessment.
Question 701 pts
Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:
Group of answer choices
percussing all lung fields.
auscultating the lung bases.
determining tactile fremitus.
estimating diaphragmatic excursion.
Question 711 pts
Your 15-year-old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You should question this patient about her:
Group of answer choices
sleep patterns.
salt intake.
aerobic workouts.
menstrual cycles.
Question 721 pts
Palpation of epitrochlear nodes is part of the:
Group of answer choices
examination of the upper extremities.
assessment of the chest and thorax.
palpation of the abdomen.
examination of the head and neck.
Question 731 pts
When conducting a geriatric assessment, basic activities of daily living (ADLs) include:
Group of answer choices
bathing.
housekeeping.
medication compliance.
communication skills.
Question 741 pts
Electrical activity recorded by the electrocardiogram (ECG) tracing that denotes the spread of the stimulus through the atria is the:
Group of answer choices
P wave.
PR interval.
QRS complex.
ST segment.
Question 751 pts
Which cranial nerves are usually evaluated during the examination of the eyes?
Group of answer choices
I and II
II and IX
III and VI
IV and VII
Question 761 pts
The checkout station for preparticipation physical evaluation (PPE) is critical because at this point:
Group of answer choices
all completed forms are distributed.
parental cosignatures are obtained.
the relevant history is obtained.
coordination of follow-ups is reviewed.
Question 771 pts
A finding that is indicative of osteoarthritis is:
Group of answer choices
swan neck deformities.
Bouchard nodes.
ganglions.
Heberden nodes.
Question 781 pts
Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of:
Group of answer choices
adolescents.
infants.
older adults.
middle-age adults.
Question 791 pts
Breath sounds normally heard over the trachea are called:
Group of answer choices
bronchovesicular.
amphoric.
vesicular.
bronchial.
Question 801 pts
An idiopathic spasm of arterioles in the digits is termed:
Group of answer choices
arteriosclerosis obliterans.
giant cell arteritis.
peripheral arterial aneurysm.
Raynaud disease.
Question 811 pts
You are examining a patient in the emergency department who has recently sustained head trauma. In order to initially assess this patient’s neurologic status, you would:
Group of answer choices
ask him to discriminate between the smell of orange and peppermint.
test the six cardinal points of gaze.
palpate the jaw muscles as the patient clenches teeth.
observe for swallowing and test the gag reflex.
Question 821 pts
The rectal past medical history of all patients should include inquiry about:
Group of answer choices
bowel habits.
dietary habits.
hemorrhoid surgery.
laxative use.
Question 831 pts
Which one of the following techniques is used to detect a torn meniscus?
Group of answer choices
McMurray test
Thomas test
Trendelenburg test
Drawer test
Question 841 pts
Kawasaki disease is suspected when assessments of a child reveal:
Group of answer choices
conjunctival injection, strawberry tongue, and edema of the hands and feet.
conjunctival infection, lymphadenopathy, and a vesicular rash.
low-grade fever, strawberry tongue, and edema of the hands and feet.
dermatomal bullae rash, high fever, and cyanotic hands and feet.
Question 851 pts
A patient in the deepest coma would be scored a _____ on the Glasgow Coma Scale.
Group of answer choices
1
3
10
15
Question 861 pts
Anterior cruciate ligament integrity is assessed via the _____ test.
Group of answer choices
Lachman
straight leg raise
Homan
Thomas
Question 871 pts
During a routine prenatal visit, Ms. T. was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T. that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:
Group of answer choices
are usual conditions during pregnancy.
indicate a need for hospitalization.
indicate the need for amniocentesis.
suggest that she is having twins.
Question 881 pts
You order an ECG on a patient that c/o feeling heart palpitations, chest pain, shortness of breath. Your ECG shows irregular heart rate and you determine that you need to call EMS immediately because this rhythm can cause death. What rhythm would you suspect the ECG is showing?
Group of answer choices
Atrial Fibrillation
Ventricular Fibrillation
Asystole
Ventricular Tachycardia
Question 891 pts
Cranial nerve XII may be assessed in an infant by:
Group of answer choices
watching the infant s facial expressions when crying.
observing the infant suck and swallow.
clapping hands and watching the infant blink.
observing the infant’s rooting reflex.
Question 901 pts
You are initially evaluating the equilibrium of Ms. Q. You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q. has a positive:
Group of answer choices
Kernig sign.
Homan sign.
McMurray test.
Romberg sign.
Question 911 pts
A 25 yo AA female has come to the clinic because she has missed her menstrual period this month and 2 months before. She says her cycles are irregular and she wants to be on birth control to help regulate them. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to:
Group of answer choices
suggest a pregnancy test
instruct her that this is a side effect of birth control injection therapy.
refer her to a gynecologist for pap smear
schedule an appointment with a surgeon.
Question 921 pts
Montgomery tubercles are most prominent in the breasts of:
Group of answer choices
adult males.
patients with lung disease.
pubertal females.
pregnant women.
Question 931 pts
To assess a cremasteric reflex, the examiner strokes the:
Group of answer choices
skin around the anus and observes for the anal wink.
abdomen and observes whether the umbilicus moves away from the stimulus.
inner thigh and observes whether the testicle and scrotum rise on the stroked side.
palm and observes whether the fingers attempt to grasp.
Question 941 pts
When the Goodenough-Harris Drawing Test is administered to a child, the evaluator principally observes the:
Group of answer choices
presence and form of body parts.
gender and race of the person drawn.
approximate age and posture of the person drawn.
length of time needed to draw a stick man.
Question 951 pts
Your patient’s chief complaint is repeated pencil-like stools. Further examination should include:
Group of answer choices
stool culture.
parasite testing.
digital rectal examination (DRE).
prostate examination.
Question 961 pts
Assessing orientation to person, place, and time helps determine:
Group of answer choices
ability to understand analogies.
abstract reasoning.
attention span.
state of consciousness.
Question 971 pts
An examiner has rotated a brush several times into the cervical os. The brush was withdrawn and stroked lightly on a glass slide. The slide was sprayed with fixative. Which type of specimen requires this technique for collection?
Group of answer choices
Gonococcal culture
Cytology smear
Haemophilus smear
Trichomonas smear
Question 981 pts
Nerves that arise from the brain rather than the spinal cord are called:
Group of answer choices
sympathetic.
parasympathetic.
cranial.
autonomic.
Question 991 pts
Functional assessment is most important during the examination of a(n):
Group of answer choices
adolescent.
infant.
older adult.
young adult.
Question 1001 pts
Postural hypotension is defined as a _____ when the patient stands, compared with sitting or supine readings.
Group of answer choices
systolic pressure drop of more than 15 mm Hg with a pulse rate increase
pulse rate decrease with a systolic pressure increase of at least 15 mm Hg
diastolic pressure increase of more than 5 mm Hg and no pulse rate changes
pulse rate decrease and diastolic pressure decrease of more than 5 mm Hg
Also Read: Assignment: Advanced Levels of Clinical Inquiry and Systematic Reviews
