ATI RN
Test Bank Physical Examination and Health Assessment Questions
Question 1 of 9
A 77-year-old retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long-term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition?
Correct Answer: D
Rationale: Hypertension, or high blood pressure, is not typically associated with causing ulcers in the lower extremities. The most common causes of lower extremity ulcers are arterial insufficiency, venous insufficiency, and diminished sensation in pressure points. Arterial insufficiency leads to decreased blood flow to the lower extremities, causing tissue damage and ulcers. Venous insufficiency results in poor circulation and increased pressure in the veins, leading to ulcers. Diminished sensation in pressure points, often seen in conditions like diabetes, can cause ulcers due to lack of feeling and increased risk of trauma. So, hypertension is not directly related to the development of lower extremity ulcers.
Question 2 of 9
A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over 2 years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer, and her father has coronary artery disease, high blood pressure, and Alzheimer's disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge, and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep. What form of vaginitis is this patient most likely to have?
Correct Answer: D
Rationale: The patient's presentation is consistent with atrophic vaginitis, also known as vaginal atrophy. This condition typically occurs in postmenopausal women due to a decrease in estrogen levels, leading to thinning, drying, and inflammation of the vaginal walls. Symptoms of atrophic vaginitis include vaginal dryness, itching, discomfort with intercourse, and sometimes light bleeding after intercourse. The absence of vaginal discharge and the presence of vaginal dryness and bleeding easily upon examination suggest atrophic vaginitis as the most likely cause in this patient. Other causes of vaginitis such as Trichomonas vaginitis, Candida vaginitis, and bacterial vaginosis typically present with different symptoms and findings on examination.
Question 3 of 9
A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?
Correct Answer: B
Rationale: The description of an oval, brown, slightly elevated lesion with a flat surface and rough, wartlike texture on palpation is characteristic of a seborrheic keratosis. Seborrheic keratoses are common benign skin growths that typically occur in older adults. They can vary in color, ranging from tan to dark brown, and often have a waxy or stuck-on appearance. The lesion described does not fit the typical characteristics of actinic keratosis, basal cell carcinoma, or squamous cell carcinoma.
Question 4 of 9
A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do?
Correct Answer: C
Rationale: The presentation of multiple small, blood-red, raised lesions over the anterior chest and abdomen in a middle-aged man raises concern for a condition known as cherry angiomas. Cherry angiomas are common benign vascular growths often seen in middle-aged and older individuals. They are typically asymptomatic and do not require treatment unless they are bothersome to the patient cosmetically.
Question 5 of 9
The following information is best placed in which category? "The patient was treated for an asthma exacerbation in the hospital last year; the patient has never been intubated."
Correct Answer: A
Rationale: The information provided about the patient being treated for an asthma exacerbation and not being intubated falls under the category of adult illnesses. Asthma is a common respiratory condition that affects people of various ages but is more prevalent in adults. The fact that the patient was treated for an asthma exacerbation and has not required intubation indicates a relevant medical history related to adult illnesses and respiratory conditions. This information would be considered when evaluating and managing the patient's current health status and potential risks related to respiratory issues.
Question 6 of 9
Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't call in an antibiotic for her. Which of the following techniques is not useful in helping to calm this patient?
Correct Answer: A
Rationale: Acknowledging and taking responsibility for any part you may have played in provoking the patient's anger is important in effectively addressing the situation. By avoiding admission of your lateness, you may come across as dismissive of the patient's feelings and not addressing the issue at hand. It is essential to validate the patient's feelings and work towards finding a solution rather than avoiding the issue.
Question 7 of 9
Dawn is a 55-year-old woman who comes in today for her yearly wellness examination. You carefully perform the rectal examination in the lithotomy position and feel a mass against the bowel wall which is firm and immobile. Which of the following is most likely?
Correct Answer: A
Rationale: The presence of a firm and immobile mass felt against the bowel wall during a rectal examination is concerning for a potential malignancy, such as colon cancer. Other conditions such as hemorrhoids or anal fissures are typically not associated with a mass that is firm and immobile. The "Valve of Houston" is a term that does not pertain to this scenario and is not a recognized medical entity. Therefore, the most likely diagnosis based on the given information is colon cancer, and further evaluation such as a colonoscopy would be warranted for definitive diagnosis and management.
Question 8 of 9
A 17-year-old high school senior presents to your clinic in acute respiratory distress. Between shallow breaths he states he was at home finishing his homework when he suddenly began having right-sided chest pain and severe shortness of breath. He denies any recent traumas or illnesses. His past medical history is unremarkable. He doesn't smoke but drinks several beers on the weekend. He has tried marijuana several times but denies any other illegal drugs. He is an honors student and is on the basketball team. His parents are both in good health. He denies any recent weight gain, weight loss, fever, or night sweats. On examination you see a tall, thin young man in obvious distress. He is diaphoretic and is breathing at a rate of 35 breaths per minute. On auscultation you hear no breath sounds on the right side of his superior chest wall. On percussion he is hyperresonant over the right upper lobe. With palpation he has absent fremitus over the right upper lobe. What disorder of the thorax or lung best describes his symptoms?
Correct Answer: A
Rationale: The clinical presentation of this 17-year-old high school senior is concerning for a spontaneous pneumothorax. A spontaneous pneumothorax occurs when air enters the pleural space, resulting in lung collapse. Risk factors for spontaneous pneumothorax include tall, thin body habitus and smoking. In this case, the patient's sudden onset of right-sided chest pain and severe shortness of breath, along with absent breath sounds on the right side of the chest and hyperresonance on percussion, are consistent with a pneumothorax. The absence of lung sounds and fremitus on palpation over the right upper lobe further support this diagnosis. Chronic obstructive pulmonary disease (COPD) and asthma typically present with more chronic symptoms, while pneumonia is usually associated with fever, productive cough, and other signs of infection. Given the history and physical examination findings, spontaneous pneumothorax is the most
Question 9 of 9
A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims for 30 minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of something grating when he tries overhead movements of his arm. On physical examination, you note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop arm test is negative, and there is no limitation with shoulder shrug. The patient is not holding his arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm is at the patient's side, flexed to 90 degrees, and then supinated against resistance. Based on this description, what is the most likely cause of his shoulder pain?
Correct Answer: C
Rationale: The description of the patient's left shoulder pain, with a sharp catching pain and a sensation of something grating during overhead movements, in addition to tenderness just below the tip of the acromion in the area of tendon insertions, is suggestive of calcific tendinitis. Calcific tendinitis occurs when calcium deposits form within a tendon, most commonly affecting the rotator cuff tendons. This condition can cause pain, tenderness, and limited range of motion, particularly with certain movements like overhead reaching. The negative drop arm test, lack of limitation with shoulder shrug, absence of tenderness to palpation in the bicipital groove, and the patient not holding his arm close to his side help differentiate calcific tendinitis from other shoulder pathologies like rotator cuff tendinitis, rotator cuff tear, and bicipital tendinitis.