A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is the most likely cause of this neck pain?

Questions 27

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ATI RN Test Bank

Physical Examination and Health Assessment 8th Edition Test Bank Questions

Question 1 of 9

A 50-year-old realtor comes to your office for evaluation of neck pain. She was in a motor vehicle collision 2 days ago and was assessed by the emergency medical technicians on site, but she didn't think that she needed to go to the emergency room at that time. Now, she has severe pain and stiffness in her neck. On physical examination, you note pain and spasm over the paraspinous muscles on the left side of the neck, and pain when you make the patient do active range of motion of the cervical spine. What is the most likely cause of this neck pain?

Correct Answer: C

Rationale: The most likely cause of neck pain in this scenario is a cervical sprain. A cervical sprain is an injury to the ligaments in the neck as a result of sudden force or trauma, such as a motor vehicle collision. The symptoms of a cervical sprain typically include pain, stiffness in the neck, and muscle spasm. The fact that the patient has pain and spasm over the paraspinous muscles on one side of the neck, along with pain during active range of motion, is characteristic of a sprain. It is important to consider this diagnosis in individuals who have recently experienced trauma to the neck region. Treatment for a cervical sprain usually includes pain management, rest, and gentle stretching exercises to help with recovery.

Question 2 of 9

Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient?

Correct Answer: C

Rationale: Mrs. R. is exhibiting characteristics of a silent patient because she does not respond or engage in conversation when directly asked a question by the healthcare provider. In this case, Mrs. R.'s lack of verbal response could be due to various reasons such as shyness, anxiety, cognitive impairment, or communication barriers. It is important for healthcare providers to recognize and adapt to different communication styles and preferences of patients to ensure effective patient-provider interaction and care. In situations like these, it may be helpful to provide alternative communication methods or allow more time for the patient to respond comfortably.

Question 3 of 9

Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?

Correct Answer: B

Rationale: The description of dark, granular material resembling coffee grounds in the vomitus suggests upper gastrointestinal bleeding. One common cause of upper GI bleeding is a peptic ulcer, which can present with symptoms such as vomiting blood or coffee ground material. Peptic ulcers can develop in the stomach or the upper part of the small intestine (duodenum). Risk factors for peptic ulcers include infection with Helicobacter pylori bacteria, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, and alcohol consumption. Prompt evaluation and management are necessary in cases of upper GI bleeding to address the underlying cause and prevent complications.

Question 4 of 9

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?

Correct Answer: D

Rationale: By telling the patient what to expect, giving her the option to stop or take a break, and checking in with her multiple times during the examination, you are accomplishing all of the above.

Question 5 of 9

You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases, located on the distal extremities. This would be consistent with which of the following?

Correct Answer: D

Rationale: The description provided indicates a presentation consistent with gonococcal arthritis. Gonococcal arthritis is an infectious arthritis caused by the bacteria Neisseria gonorrhoeae. Symptoms typically include red, swollen, and painful joints, especially affecting the distal joints of the limbs. The presence of papules, pustules, and vesicles on reddened bases at the distal extremities is characteristic of disseminated gonococcal infection. In women, the DIP joint involvement in the finger can be indicative of this condition. Prompt diagnosis and treatment with antibiotics are essential to prevent complications associated with gonococcal arthritis. It is important to consider a sexually transmitted infection like gonorrhea in young patients presenting with joint symptoms and cutaneous findings.

Question 6 of 9

You are performing a thorough cardiac examination. Which of the following chambers of the heart can you assess by palpation?

Correct Answer: C

Rationale: The right ventricle is the only chamber of the heart that can be assessed by palpation during a cardiac examination. The right ventricle is located close to the sternum on the anterior chest wall, making it accessible for palpation. By palpating the area near the lower left sternal border, just beside the sternum, a healthcare provider can assess the size and function of the right ventricle. It is important to note that the other chambers of the heart (left atrium and right atrium) are not typically assessed by palpation due to their deeper location within the chest cavity. The sinus node, which is responsible for generating the heart's electrical impulses, is also not directly palpable during a cardiac examination.

Question 7 of 9

You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur?

Correct Answer: B

Rationale: Leaning forward in the upright position increases venous return and systemic vascular resistance, which can help accentuate the intensity of aortic regurgitation murmur. This position helps to bring the heart closer to the chest wall, making the murmur easier to auscultate and potentially increasing its intensity.

Question 8 of 9

Which is true of women who have had a unilateral mastectomy?

Correct Answer: B

Rationale: Even after a unilateral mastectomy, women should continue to self-examine and have regular clinical examinations for any signs of recurrence or new masses. It is important to closely monitor the surgical scar area for any changes or abnormalities, as breast cancer can still occur in the remaining breast tissue. Regular breast examinations remain important in the early detection of any potential issues, even after mastectomy.

Question 9 of 9

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?

Correct Answer: D

Rationale: A subconjunctival hemorrhage is a common and benign condition characterized by blood in the space between the conjunctiva and sclera of the eye. The condition often presents as a painless, sharply demarcated area of redness on the white part of the eye, typically without associated discharge or visual disturbances. In this case, the absence of eye pain, discharge, visual disturbances, and clear cornea make subconjunctival hemorrhage the most likely diagnosis. The history of forceful coughing with a recent cold is also consistent with the increased intraocular pressure leading to a rupture of a small blood vessel, resulting in the hemorrhage. Treatment is not usually required as the condition is self-limiting and resolves on its own over time.

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