ATI RN
Physical Assessment Nursing Practice Questions Questions
Question 1 of 9
A 22-year-old unemployed roofer presents to your clinic, complaining of pain in his testicle and penis. He states the pain began last night and has steadily become worse. He states it hurts when he urinates and he has not attempted intercourse since the pain began. He has tried Tylenol and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She is on oral contraceptives so he has not used condoms. His parents are both in good health. On examination you see a young man lying on his side. He appears mildly ill. His temperature is 2 and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised, with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?
Correct Answer: B
Rationale: The history and physical examination findings in this case are most consistent with acute epididymitis. Acute epididymitis is characterized by inflammation and infection of the epididymis, which is a tubular structure located behind the testicle that stores and carries sperm. Common symptoms of acute epididymitis include pain and swelling in the scrotum, testicular pain, pain with urination, and sometimes penile discharge. The patient's symptoms of testicular and penile pain, as well as pain with urination, are classic for epididymitis. The severe tenderness at the superior pole of the left testicle and tenderness on palpation of structures superior to the testicle through the scrotal wall further support this diagnosis. In addition, the presence of white blood cells and bacteria on urine analysis is consistent with an infectious process like epididymitis.
Question 2 of 9
A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked as well, and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process?
Correct Answer: C
Rationale: The most likely pathologic process in this scenario is degenerative. The history provided includes chronic intermittent neck pain that worsened after a specific activity (wallpapering) but resolved with rest. The patient's age (47 years old) is also suggestive of degenerative changes in the spine. Additionally, the use of over-the-counter medications to manage the pain points towards a chronic condition such as degenerative changes in the cervical spine, possibly cervical spondylosis or osteoarthritis. There is no mention of any infectious symptoms, trauma, or neoplastic features in the presentation.
Question 3 of 9
You arrive at the bedside of an elderly woman who has had a stroke, affecting her entire right side. She cannot speak (aphasia). You are supposed to examine her. You notice that the last examiner left her socks at the bottom of the bed, and although sensitive areas are covered by a sheet, the blanket is heaped by her feet at the bottom of the bed. What would you do next?
Correct Answer: C
Rationale: The best course of action would be to put her socks back on and cover her completely before beginning the evaluation. It is important to prioritize the patient's dignity and comfort by ensuring they are appropriately covered. This also helps in maintaining the patient's sense of privacy during the examination, especially considering the sensitive nature of the situation with the elderly woman having a stroke and aphasia. By taking the time to properly dress and cover the patient before conducting the examination, you are showing respect and compassion for the patient's well-being.
Question 4 of 9
A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered?
Correct Answer: A
Rationale: DeQuervain's tenosynovitis is a condition that involves inflammation of the tendons located at the base of the thumb. The tendons affected are the abductor pollicis longus and extensor pollicis brevis. It typically causes pain and tenderness at the base of the thumb, which can worsen with certain movements of the wrist and thumb. In the case of the high school football player, his tenderness between the two tendons at the base of the thumb is suggestive of DeQuervain's tenosynovitis. It is a common overuse injury in athletes, especially those involved in activities that require repetitive hand and wrist movements, such as gripping a football during play. Treatment usually involves rest, splinting, ice, anti-inflammatory medications, and physical therapy.
Question 5 of 9
Which of the following regarding jugular venous pulsations is a systolic phenomenon?
Correct Answer: C
Rationale: The upstroke of the "a" wave in the jugular venous pulsations coincides with systole. The "a" wave is caused by atrial contraction, which occurs during ventricular systole. In contrast, the "x" descent is a diastolic phenomenon representing the atrial relaxation, the "y" descent follows atrial emptying in early diastole, and the "v" wave corresponds to venous filling during late diastole.
Question 6 of 9
You are examining a patient with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good examination?
Correct Answer: D
Rationale: In a patient with emphysema, lung hyperinflation can make it difficult to hear heart sounds anteriorly. Listening posteriorly, especially between the scapulae, can often provide a clearer auscultation of the heart sounds due to reduced interference from lung sounds. The posterior approach can also help avoid any abdominal sounds that might obscure the cardiac sounds when auscultating in the epigastrium. It is important to make sure the patient is in a comfortable position for better examination, and in this case, listening posteriorly would be the best choice for assessing heart sounds in a patient with emphysema in exacerbation.
Question 7 of 9
A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells. What type of urinary tract pain is she most likely to have?
Correct Answer: B
Rationale: The policewoman's presentation of severe left-sided back pain radiating down into her groin, associated with nausea, blood in urine, and tenderness just inferior to the left costovertebral angle is highly suggestive of a kidney stone causing ureteral colic. Kidney stones are solid masses made of crystals that form in the kidneys and can cause sudden severe pain as they move through the urinary tract, leading to blockage and subsequent stretching of the ureter (the tube connecting the kidney to the bladder), resulting in pain that radiates from the flank down to the groin region. The presence of blood in the urine (hematuria) is a common finding with kidney stones due to irritation and damage to the ureteral lining as the stone passes. The negative urine pregnancy test rules out pregnancy-related causes of urinary symptoms. Musculoskeletal pain is less likely given the location and character of the pain
Question 8 of 9
A 22-year-old unemployed roofer presents to your clinic, complaining of pain in his testicle and penis. He states the pain began last night and has steadily become worse. He states it hurts when he urinates and he has not attempted intercourse since the pain began. He has tried Tylenol and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She is on oral contraceptives so he has not used condoms. His parents are both in good health. On examination you see a young man lying on his side. He appears mildly ill. His temperature is 2 and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised, with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?
Correct Answer: B
Rationale: The history and physical examination findings in this case are most consistent with acute epididymitis. Acute epididymitis is characterized by inflammation and infection of the epididymis, which is a tubular structure located behind the testicle that stores and carries sperm. Common symptoms of acute epididymitis include pain and swelling in the scrotum, testicular pain, pain with urination, and sometimes penile discharge. The patient's symptoms of testicular and penile pain, as well as pain with urination, are classic for epididymitis. The severe tenderness at the superior pole of the left testicle and tenderness on palpation of structures superior to the testicle through the scrotal wall further support this diagnosis. In addition, the presence of white blood cells and bacteria on urine analysis is consistent with an infectious process like epididymitis.
Question 9 of 9
A 25-year-old accountant presents to your clinic, complaining of intermittent lower right- sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from recurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. He has taken some Tylenol and put a heating pad on his side but neither has helped. He remembers that 2 weeks ago he had an upper respiratory infection with a severe hacking cough. He denies any recent trauma. His past medical history is unremarkable. His parents and siblings are in good health. He has recently married, and his wife has a baby due in 2 months. He denies any smoking or illegal drug use. He drinks two to three beers once a month. He states that he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, gastrointestinal, or musculoskeletal symptoms. On examination he is lying on his right side but appears quite comfortable. His temperature, blood pressure, pulse, and respirations are unremarkable. His chest has normal breath sounds on auscultation. Percussion of the chest is unremarkable. During palpation the ribs are nontender. What disorder of the chest best describes his symptoms?
Correct Answer: C
Rationale: The patient's symptoms of intermittent, sharp chest pain with breathing that worsens with deep breaths and is relieved by lying on the right side are suggestive of pleural pain. Pleuritic chest pain is often described as sharp or stabbing and occurs when the parietal pleura, the outer lining of the lungs, becomes inflamed or irritated. In this case, the patient's history of an upper respiratory infection with a severe hacking cough two weeks ago suggests that the pleural pain may be related to pleurisy or pleuritis, which can occur as a complication of respiratory infections.