ATI RN
physical assessment test bank Questions
Question 1 of 5
An 82-year-old man, Mr. A, complains of worsening nocturia, occurring four times per night. His other lower urinary tract symptoms are slow stream, occasional urgency, and urgency-related leakage once weekly. Medical problems include poorly controlled hypertension, diastolic heart failure, hyperlipidemia, osteoarthritis, and prediabetes. His medications include lisinopril 20 mg daily, metoprolol succinate 75 mg daily, atorvastatin 10 mg daily, metformin 500 mg twice daily, hydrocodone-acetaminophen as needed, and aspirin 81 mg daily. Amlodipine 5 mg daily was recently added by his cardiologist. On review of systems, Mr. A complains that nocturia is causing daytime fatigue, and he is more constipated. Physical examination is notable for blood pressure 162/83 mmHg, heart rate 60 beats per minute, clear lungs, soft abdomen, enlarged prostate, and 21 pre-tibial edema.
Correct Answer: D
Rationale: The correct answer is
D) Add tamsulosin.
Tamsulosin is a selective alpha-1 blocker commonly used to treat symptoms of benign prostatic hyperplasia (BPH), such as an enlarged prostate, slow stream, urgency, and nocturia. In this case, Mr. A's physical examination shows an enlarged prostate, which is likely contributing to his lower urinary tract symptoms. By adding tamsulosin, it can help relax the smooth muscle in the prostate and bladder neck, improving urine flow and reducing nocturia.
Option A is incorrect because naproxen is not indicated for BPH or lower urinary tract symptoms. Stopping hydrocodone-acetaminophen may lead to inadequate pain control.
Option B is incorrect as stopping amlodipine, a calcium channel blocker, may worsen Mr. A's diastolic heart failure and hypertension. Increasing lisinopril may not address the underlying cause of his urinary symptoms.
Option C is incorrect because adding furosemide may exacerbate Mr. A's current issues with constipation and may not address the underlying cause of his urinary symptoms.
Educationally, this question highlights the importance of recognizing the role of BPH in elderly male patients presenting with lower urinary tract symptoms. It emphasizes considering appropriate pharmacological management based on the patient's specific symptoms and comorbidities to optimize treatment outcomes. Understanding the mechanism of action of medications and their indications is crucial in making informed clinical decisions.
Question 2 of 5
A 70-year-old woman reports sexual pain with deep penetration only. What is the most likely cause of her problem?
Correct Answer: A
Rationale: In this scenario, the most likely cause of the 70-year-old woman's sexual pain with deep penetration is vaginal atrophy (option
A). Vaginal atrophy is a common condition in postmenopausal women due to decreased estrogen levels, leading to thinning, drying, and inflammation of the vaginal walls, causing pain during intercourse.
Option B, provoked vulvar vestibulodynia, is characterized by pain at the vaginal opening, not deep penetration. Option C, high-tone pelvic floor dysfunction, typically presents with pelvic pain and urinary symptoms, not specifically pain during deep penetration. Option D, endometriosis, is associated with pelvic pain, irregular bleeding, and infertility, not solely pain with deep penetration.
Educationally, understanding the differential diagnosis of sexual pain in women is crucial for healthcare providers to provide accurate diagnosis and appropriate treatment. Recognizing the symptoms and causes of vaginal atrophy can lead to effective management strategies such as vaginal moisturizers, lubricants, hormone therapy, and lifestyle modifications to improve the quality of life in postmenopausal women experiencing sexual pain.
Question 3 of 5
An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years increasingly complains of constipation despite adequate medical treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals well-circumscribed pelvic masses, the largest adherent to the ovarian ligament. The best first step is:
Correct Answer: A
Rationale: In this scenario, the correct answer is
A) Referral to a gynecological oncologist. This is the best first step because the presence of well-circumscribed pelvic masses, especially one adherent to the ovarian ligament in an elderly woman with a history of increasing constipation, raises a strong suspicion of ovarian cancer. Referring the patient to a specialist in gynecological oncology ensures that she receives the appropriate evaluation, diagnostic testing, and treatment in a timely manner.
Option
B) Transcutaneous CT guided biopsy is not the best initial step because direct visualization and biopsy during surgery provide a more accurate diagnosis in suspected ovarian cancer cases.
Option
C) Advise observation is incorrect because the presence of pelvic masses and symptoms warrants further investigation and intervention rather than observation.
Option
D) Referring to hospice is premature and inappropriate without a confirmed diagnosis and exploration of treatment options. It is essential to pursue a proper diagnostic workup and consider all available treatment options before discussing end-of-life care.
Educationally, this question emphasizes the importance of recognizing clinical presentations suggestive of ovarian cancer, understanding the appropriate referral pathways for suspected gynecological malignancies, and highlighting the significance of prompt and specialized care in the management of such cases. It underscores the need for a comprehensive approach to patient care, involving multidisciplinary teams in the diagnosis and management of complex medical conditions.
Question 4 of 5
A 66-year-old man complains of nocturia (three to four times a night), hesitancy, and incomplete emptying of the bladder. Physical examination reveals an enlarged, nontender prostate, about 40 g in size without discrete nodules. Urinalysis reveals hematuria without leukocyte esterase. Upon further evaluation, the hematuria is attributed to his BPH. The patient declines surgical options at this time. Which of the following medications would be most appropriate?
Correct Answer: B
Rationale: In this case, the most appropriate medication for the 66-year-old man with BPH who has declined surgical options is Doxazosin (option
B). Doxazosin is an alpha-1 adrenergic blocker that helps relax the smooth muscle in the prostate and bladder neck, improving urinary symptoms associated with BPH such as hesitancy and incomplete emptying of the bladder. It does not shrink the prostate but helps alleviate symptoms.
Option A, Oxybutynin, is a medication used for overactive bladder and would not address the underlying issue of BPH in this patient. Option C, Finasteride, is a 5-alpha reductase inhibitor that can help shrink the prostate over time but may not provide immediate relief for bothersome symptoms like nocturia. Option D, Silodosin, is another alpha-1 adrenergic blocker like Doxazosin but may not be as commonly used or as well-established for BPH management in clinical practice.
In an educational context, understanding the rationale behind selecting appropriate medications for BPH is crucial for healthcare providers to provide optimal care for patients. It is important to consider both the mechanism of action of the medications and the specific symptoms and preferences of the individual patient when making treatment decisions in clinical practice.
Question 5 of 5
The US Advisory Committee on Immunization Practices and the Centers for Disease Control currently recommend which one of the following?
Correct Answer: D
Rationale: The correct answer is
D) All of these are recommended. This recommendation is supported by the US Advisory Committee on Immunization Practices and the Centers for Disease Control.
Option A is incorrect because it does not address the need for a one-time revaccination for pneumonia as recommended for certain individuals. Option B is incorrect as it focuses only on high-risk older adults and does not encompass the broader recommendation for all older adults. Option C is incorrect as it only addresses the revaccination for pneumonia in specific circumstances, not the broader recommendations for influenza and pneumococcal vaccination.
Educationally, it is important to understand the current vaccination recommendations for older adults to ensure their health and well-being. Staying up-to-date with immunization guidelines is crucial for healthcare providers to provide optimal care to their patients, especially in the context of preventing infectious diseases in vulnerable populations. This knowledge is essential in clinical practice to promote preventive healthcare strategies and improve patient outcomes.