ATI RN
Physical Examination and Health Assessment 8th Edition Test Bank Questions
Question 1 of 9
A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?
Correct Answer: D
Rationale: The closed fist gesture over the sternum to describe chest pain is a typical characteristic of angina pectoris. Angina pectoris is chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. The gesture of clenching a fist over the sternum is often used to describe the tight, squeezing, or pressure-like discomfort experienced with angina. This type of chest pain is typically triggered by physical or emotional stress and is relieved by rest or medications like nitroglycerin. Considering the patient's age, smoking history, and the description of the chest pain gesture, angina pectoris should be a top consideration in this case.
Question 2 of 9
A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings?
Correct Answer: C
Rationale: The clinical presentation described in the scenario is classic for bacterial vaginosis (BV). BV is the most common cause of vaginal discharge in women of childbearing age. Key features of BV include a thin gray-white discharge with a fishy odor, which typically worsens after sexual intercourse and during menstruation. The discharge characteristically has a pH over 4.5, and the presence of clue cells on wet prep is diagnostic. Clue cells are vaginal epithelial cells covered with bacteria, giving them a stippled appearance when viewed under the microscope. These features are consistent with the findings in this patient.
Question 3 of 9
You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely?
Correct Answer: D
Rationale: The scenario described with a strong pulse followed by a weak pulse is characteristic of pulsus paradoxus, a finding often associated with cardiac tamponade. Cardiac tamponade is a medical emergency where there is an accumulation of fluid (such as blood) in the pericardial sac that exerts pressure on the heart, limiting its ability to pump effectively. As a result, patients may exhibit this pulsus paradoxus, where the pulse strength varies with respiration. The other conditions listed (emphysema, asthma exacerbation, severe left heart failure) are not typically associated with this specific pulsatile pattern.
Question 4 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 5 of 9
A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?
Correct Answer: D
Rationale: The closed fist gesture over the sternum to describe chest pain is a typical characteristic of angina pectoris. Angina pectoris is chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. The gesture of clenching a fist over the sternum is often used to describe the tight, squeezing, or pressure-like discomfort experienced with angina. This type of chest pain is typically triggered by physical or emotional stress and is relieved by rest or medications like nitroglycerin. Considering the patient's age, smoking history, and the description of the chest pain gesture, angina pectoris should be a top consideration in this case.
Question 6 of 9
You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient's pain make you concerned for this disease process?
Correct Answer: C
Rationale: Pain in the calf is a common symptom of atherosclerosis in the lower extremities, also known as peripheral artery disease (PAD). Atherosclerosis is the buildup of plaque in the arteries, leading to reduced blood flow. The calf pain associated with PAD is often described as cramping, aching, or fatigue that occurs during walking and is relieved with rest. This is called intermittent claudication. Thigh, knee, and ankle pain could have other causes, but calf pain specifically raises concerns for atherosclerosis in the lower extremities.
Question 7 of 9
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?
Correct Answer: B
Rationale: Urticaria, commonly known as hives, typically presents as raised, red, and itchy welts or wheals that can appear and disappear in various locations on the skin. Each lesion tends to last for many minutes before resolving and may be associated with itching or a burning sensation. Urticaria is often triggered by an allergic reaction to food, medications, insect bites, or other substances. The clinical presentation described in the question, involving an itchy rash that appears and disappears in different areas, is consistent with urticaria.
Question 8 of 9
A 25-year-old type 1 diabetic clerk presents to the emergency room with shortness of breath and states that his blood sugar was 605 at home. You diagnose the patient with diabetic ketoacidosis. What is the expected pattern of breathing?
Correct Answer: C
Rationale: In diabetic ketoacidosis (DKA), the body is in a state of metabolic acidosis due to the accumulation of ketones in the blood. One of the compensatory mechanisms to decrease the acidity in the body is increased breathing, known as Kussmaul breathing. This type of breathing is characterized by a rapid and deep pattern to blow off excess carbon dioxide and decrease the acidity of the blood. Therefore, in a patient with DKA, you would expect to observe rapid and deep breathing.
Question 9 of 9
A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis?
Correct Answer: B
Rationale: The description of dark tan patches with a reddish cast that have sharp borders and fine scales, especially more prominent on the upper back, chest, neck, and upper arms, is classic for tinea versicolor. Tinea versicolor is a superficial fungal infection caused by Malassezia species, which commonly affects individuals who sweat more, such as those working outdoors like the construction worker in this case. The rash is often pruritic (itchy) and can vary in color from tan to pink or red. The fine scales on the patches are a result of the accumulation of the yeast in the affected areas.