A 29-year-old woman comes to your office. As you take the history, you notice that she is speaking very quickly, and jumping from topic to topic so rapidly that you have trouble following her. You are able to find some connections between ideas, but it is difficult. Which word describes this thought process?

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Physical Assessment NCLEX Practice Questions Questions

Question 1 of 9

A 29-year-old woman comes to your office. As you take the history, you notice that she is speaking very quickly, and jumping from topic to topic so rapidly that you have trouble following her. You are able to find some connections between ideas, but it is difficult. Which word describes this thought process?

Correct Answer: B

Rationale: When a person's thought process is characterized by speaking rapidly, jumping from topic to topic, and making loose or tangential connections between ideas, it is referred to as a "flight of ideas." This type of thought process is commonly seen in conditions such as mania, where there is a marked increase in goal-directed activity, energy, and racing thoughts. In contrast, derailment refers to a disorganized thought process where the individual is unable to maintain a logical progression in their speech. Circumstantiality involves providing excessive and unnecessary detail before eventually reaching the main point. Incoherence is used to describe speech that is incomprehensible and disjointed, lacking any logical connection between ideas.

Question 2 of 9

A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition?

Correct Answer: C

Rationale: The ankle-brachial index (ABI) is the appropriate test to initially evaluate for peripheral vascular disease in this case. ABI is a simple, non-invasive test that compares the blood pressure in the arms to the blood pressure in the legs. A lower ABI value indicates a higher likelihood of peripheral arterial disease (PAD). Given the patient's presentation of leg swelling and risk factors like smoking and hypertension, ABI can help determine the presence and severity of PAD, guiding further management and treatment decisions.

Question 3 of 9

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?

Correct Answer: C

Rationale: The characteristics described - being louder and higher in pitch, with a short silence between inspiration and expiration, and expiration being longer than inspiration - are indicative of the bronchial lung sound. The bronchial sound is typically heard over the trachea area and can be louder and higher-pitched than other lung sounds due to conduction of sounds through the bronchial tree. The short silence between inspiration and expiration is due to the short expiratory phase during which air rushes out quickly, whereas expiration is longer than inspiration in this sound due to the increased airflow velocity during expiration.

Question 4 of 9

A 29-year-old woman comes to your office. As you take the history, you notice that she is speaking very quickly, and jumping from topic to topic so rapidly that you have trouble following her. You are able to find some connections between ideas, but it is difficult. Which word describes this thought process?

Correct Answer: B

Rationale: When a person's thought process is characterized by speaking rapidly, jumping from topic to topic, and making loose or tangential connections between ideas, it is referred to as a "flight of ideas." This type of thought process is commonly seen in conditions such as mania, where there is a marked increase in goal-directed activity, energy, and racing thoughts. In contrast, derailment refers to a disorganized thought process where the individual is unable to maintain a logical progression in their speech. Circumstantiality involves providing excessive and unnecessary detail before eventually reaching the main point. Incoherence is used to describe speech that is incomprehensible and disjointed, lacking any logical connection between ideas.

Question 5 of 9

Her abdominal examination reveals a gravid uterus but is otherwise unremarkable. On visualization of the anus there is a slight red, moist- appearing protrusion from the anus. As you have her bear down, the protrusion grows larger. On digital rectal examination you can feel an enlarged tender area on the posterior side. There is some blood on the glove after the examination. What disorder of the anus or rectum best fits this presentation?

Correct Answer: C

Rationale: The described clinical presentation is consistent with internal hemorrhoids. The typical symptoms of internal hemorrhoids include painless rectal bleeding, protrusion from the anus during straining, and a feeling of incomplete evacuation. In this case, the protrusion is observed to be red, moist, and enlarges with bearing down, all indicative of internal hemorrhoids. The enlarged tender area felt on digital rectal examination supports the diagnosis. Additionally, the presence of blood on the glove after the examination is also suggestive of internal hemorrhoids causing bleeding. Anal fissures typically present with sharp pain during defecation and may have visible tears in the anal mucosa. External hemorrhoids are usually more painful and can be felt as a lump around the anus. Anorectal fistulas have different signs and symptoms, including discharge of pus and recurrent infections.

Question 6 of 9

Which of the following is true of jugular venous pressure (JVP) measurement?

Correct Answer: B

Rationale: Jugular venous pressure (JVP) is measured as the vertical height of the blood column in centimeters above the sternal angle (Angle of Louis). To measure the JVP accurately, the patient should be positioned at a 30-45 degree angle (not 45-degree angle as in choice A). The value obtained by measuring the JVP in centimeters is then added to 5 cm, which represents the distance from the sternal angle to the right atrium. Therefore, the formula for calculating JVP is the vertical height of the blood column in cm + 5 cm. A JVP below 9 cm (not 9 cm or choice C) is generally considered normal, while a JVP above that level is considered elevated. It is important to measure the JVP correctly and interpret the findings in the context of the patient's

Question 7 of 9

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?

Correct Answer: B

Rationale: The most likely pathologic process based on the patient's symptoms and history would be an inflammatory process. The patient's joint pain, fever, and family history of rheumatoid arthritis suggest the possibility of an autoimmune inflammatory condition like rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints, causing pain, swelling, and stiffness. The bilateral involvement of the wrists and fingers along with a family history of rheumatoid arthritis make this diagnosis more likely than an infectious, hematologic, or traumatic process in this case.

Question 8 of 9

Common or concerning symptoms to inquire about in the General Survey and vital signs include all of the following except:

Correct Answer: C

Rationale: Changes in weight, fatigue and weakness, fever and chills are common symptoms that can provide valuable information about a person's overall health. These symptoms may indicate underlying medical conditions and merit further investigation. However, a cough, while it can be a symptom of various respiratory or systemic illnesses, is not typically part of the General Survey and vital signs assessment. It is usually addressed in a more focused respiratory assessment.

Question 9 of 9

You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10- year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent?

Correct Answer: B

Rationale: Peripheral arterial disease (PAD) is considered a coronary heart disease risk equivalent, meaning it confers a similar risk as having a history of coronary heart disease itself. Individuals with PAD have a significantly increased risk of cardiovascular events such as heart attack and stroke. Therefore, when assessing the 10-year coronary heart disease risk of the 40-year-old banker, having peripheral arterial disease would be a crucial factor to consider in addition to other risk factors like hypertension, exercise habits, and smoking history.

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