A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs?

Questions 28

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NCLEX Practice Questions Physical Assessment Questions

Question 1 of 9

A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs?

Correct Answer: A

Rationale: The most likely diagnosis for this patient's symptoms and signs is acute diverticulitis. His presentation of abdominal pain, constipation, and low-grade fever, along with tenderness over the left lower quadrant, is consistent with diverticulitis, which is inflammation or infection of small pouches (diverticula) that can develop in the colon. The history of recent onset of symptoms after consuming popcorn, typically a high-fiber food that can exacerbate diverticulitis, further supports this diagnosis. The negative fecal occult blood test makes more acute intra-abdominal processes like acute appendicitis less likely. Acute cholecystitis would present with right upper quadrant pain, and mesenteric ischemia typically presents with severe abdominal pain, nausea, and vomiting, as well as signs of abdominal distress.

Question 2 of 9

His head, eyes, ears, nose, and throat examinations are unremarkable. His lungs have normal breath sounds and there are no abnormalities with percussion and palpation of the chest. His heart has a normal S and S and no S or S . Further workup is pending. 1 2 3 4 Which disorder of the chest best describes these symptoms?

Correct Answer: D

Rationale: The symptoms described in the scenario point towards pleural pain. The examination findings of normal breath sounds, no abnormalities with percussion and palpation of the chest, and a normal heart sound (S1 and S2) suggest that the issue is more likely related to the pleura rather than the heart or major blood vessels. Pleural pain is typically sharp and worsens with deep breathing or coughing. This differs from angina pectoris, which is chest pain caused by reduced blood flow to the heart muscles due to coronary artery disease. Pericarditis involves inflammation of the pericardium, the membrane surrounding the heart, and usually presents with chest pain that is relieved by sitting up and leaning forward. Dissecting aortic aneurysm is a life-threatening condition characterized by severe, tearing chest pain that can radiate to the back. In this case, the lack of significant abnormalities on cardiac and vascular examination points towards ple

Question 3 of 9

A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely?

Correct Answer: A

Rationale: Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically around the stapes bone. In cases of otosclerosis, the bone conduction is greater than air conduction on the affected side, which is seen in the scenario described. The Weber test localizes to the affected ear, meaning the patient hears the sound of the tuning fork better in the left ear in this case. This is because the abnormal bone growth can restrict the movement of the ossicles, leading to a conductive hearing loss. Otosclerosis typically affects one ear, and its presentation aligns with the results of the hearing tests performed in this case.

Question 4 of 9

Diplopia, which is present with one eye covered, can be caused by which of the following problems?

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Question 5 of 9

A 56-year-old homosexual man presents with itching, anorectal pain, and tenesmus of 1 week's duration. Rectal examination reveals generalized tenderness without frank prostate abnormalities. Which of the following is most likely?

Correct Answer: C

Rationale: Given the patient's presentation of itching, anorectal pain, and tenesmus, along with rectal examination findings of generalized tenderness without prostate abnormalities, proctitis is the most likely diagnosis. Proctitis is inflammation of the rectal lining and is commonly associated with symptoms such as rectal pain, itching, tenesmus (feeling of incomplete defecation), and sometimes rectal bleeding. It can have various causes, including sexually transmitted infections (such as gonorrhea, chlamydia), inflammatory bowel disease, radiation therapy, or trauma.

Question 6 of 9

A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough?

Correct Answer: C

Rationale: A cough can be attributed to various anatomic regions. Cardiac conditions, such as heart failure or fluid overload, can lead to congestion in the lungs and irritation of the airway, resulting in a cough. Ophthalmologic, auditory, and endocrine regions are less commonly associated with causing a cough.

Question 7 of 9

A 67-year-old retired janitor comes to the clinic with his wife. She brought him in because she is concerned about his weight loss. He has a history of smoking 3 packs of cigarettes a day for 30 years, for a total of 90 pack-years. He has noticed a daily cough for the past several years, which he states is productive of sputum. He came into the clinic approximately 1 year ago, and at that time his weight was 140 pounds. Today, his weight is 110 pounds. Which one of the following questions would be the most important to ask if you suspect that he has lung cancer?

Correct Answer: D

Rationale: The most important question to ask in this scenario would be if the patient has tried to lose weight. Given the patient's significant unintentional weight loss (from 140 to 110 pounds in a year), especially in the context of a chronic cough and a long history of smoking, lung cancer becomes a top concern. Unintentional weight loss is a common symptom seen in patients with lung cancer. Therefore, understanding if the weight loss was intentional or unintentional can provide crucial information in the diagnostic evaluation for possible lung cancer.

Question 8 of 9

His head, eyes, ears, nose, throat, and neck examinations are normal. There are some crackles in the bases of each lung. During his cardiac examination there is an extra heart sound. Visualization of his penis shows an uncircumcised prepuce but no lesions or masses. Palpation of his scrotum shows generalized swelling, with no discrete masses. A gloved finger is placed through each inguinal ring, and with bearing down there are no bulges. The prostate is smooth and nontender. What abnormality of the scrotum is most likely the diagnosis?

Correct Answer: C

Rationale: Scrotal edema refers to swelling of the scrotum, which can be caused by various reasons such as infection, inflammation, trauma, or fluid collection. In this case, the examination findings of generalized swelling of the scrotum with no discrete masses or bulges on palpation suggest scrotal edema as the most likely diagnosis. The absence of bulges when a finger is placed through the inguinal rings with bearing down rules out a scrotal hernia. Hydrocele typically presents as a painless fluid-filled sac around the testicle, but there are no specific findings mentioned in the scenario to suggest a hydrocele. Varicocele involves dilated veins in the scrotum and may present as a soft lump that feels like a "bag of worms," which is not described in the examination findings provided.

Question 9 of 9

You are running late after your quarterly quality improvement meeting at the hospital and have just gotten paged from the nurses' station because a family member of one of your patients wants to talk with you about that patient's care. You have clinic this afternoon and are double- booked for the first appointment time; three other patients also have arrived and are sitting in the waiting room. Which of the following demeanors is a behavior consistent with skilled interviewing when you walk into the examination room to speak with your first clinic patient?

Correct Answer: D

Rationale: It is important to maintain a calm demeanor when walking into the examination room to speak with your first clinic patient, especially in a busy and high-pressure situation. Demonstrating calmness will help to build rapport with the patient, create a sense of trust, and promote effective communication. This demeanor will also convey professionalism and confidence, which are essential qualities for a healthcare provider. Displaying irritability, impatience, or boredom can negatively impact the patient-provider relationship and hinder effective communication, potentially compromising the quality of care provided.

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