ATI RN
Physical Assessment Nursing Practice Questions Questions
Question 1 of 9
Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?
Correct Answer: B
Rationale: The description provided by Alexandra includes information about the location (right upper quadrant), intensity (3 to 8 on a scale), duration (2 to 3 hours), periodicity (coming and going, worse after eating), exacerbating factors (greasy foods), frequency (initially once a week, now every other day), and aggravating factors (nothing makes it better). However, there is no mention of any associated manifestations such as nausea, vomiting, fever, or other symptoms that may be occurring alongside the abdominal pain. Associated manifestations are important for a comprehensive assessment and differential diagnosis of the symptom.
Question 2 of 9
You are beginning the examination of a patient. All of the following areas are important to observe as part of the General Survey except:
Correct Answer: D
Rationale: Blood pressure is not typically included in the initial assessment during the General Survey. The General Survey primarily focuses on obtaining an overall impression of the patient's health status and any noticeable cues such as level of consciousness, signs of distress, and appearance including dress, grooming, and personal hygiene. While blood pressure is an important vital sign to assess during a comprehensive examination, it is usually measured later in the assessment process and not part of the initial general observation.
Question 3 of 9
You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse?
Correct Answer: A
Rationale: The carotid pulse is typically palpable, meaning that you can feel it when you place your fingers lightly on the carotid artery located in the neck. In contrast, jugular venous pulsation is not typically palpable. When examining jugular venous pulsation, it is important to differentiate it from the carotid pulse by considering factors such as the quality of pulsation, response to pressure, and changes with position.
Question 4 of 9
A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells. What type of urinary tract pain is she most likely to have?
Correct Answer: B
Rationale: The policewoman's presentation of severe left-sided back pain radiating down into her groin, associated with nausea, blood in urine, and tenderness just inferior to the left costovertebral angle is highly suggestive of a kidney stone causing ureteral colic. Kidney stones are solid masses made of crystals that form in the kidneys and can cause sudden severe pain as they move through the urinary tract, leading to blockage and subsequent stretching of the ureter (the tube connecting the kidney to the bladder), resulting in pain that radiates from the flank down to the groin region. The presence of blood in the urine (hematuria) is a common finding with kidney stones due to irritation and damage to the ureteral lining as the stone passes. The negative urine pregnancy test rules out pregnancy-related causes of urinary symptoms. Musculoskeletal pain is less likely given the location and character of the pain
Question 5 of 9
Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true?
Correct Answer: D
Rationale: Option D, "Psychosocial reasons may cause this condition," is true. Vaginismus is a condition characterized by involuntary contractions of the muscles around the vaginal entrance, which can make sexual intercourse painful, difficult, or impossible. In many cases, this condition is linked with psychological factors such as anxiety, fear, past trauma, or relationship issues. These psychological factors can lead to the muscles tightening up in anticipation of pain or discomfort during intercourse, hence causing vaginismus. With appropriate psychological interventions like counseling, therapy, or relaxation techniques, individuals experiencing vaginismus can often overcome the condition and engage in pain-free intercourse.
Question 6 of 9
A 25-year-old accountant presents to your clinic, complaining of intermittent lower right- sided chest pain for several days. He describes it as knifelike and states it only lasts for 3 to 5 seconds, taking his breath away. He states he feels like he has to breathe shallowly to keep it from recurring. The only thing that makes it better is lying quietly on his right side. It is much worse when he takes a deep breath. He has taken some Tylenol and put a heating pad on his side but neither has helped. He remembers that 2 weeks ago he had an upper respiratory infection with a severe hacking cough. He denies any recent trauma. His past medical history is unremarkable. His parents and siblings are in good health. He has recently married, and his wife has a baby due in 2 months. He denies any smoking or illegal drug use. He drinks two to three beers once a month. He states that he eats a healthy diet and runs regularly, but not since his recent illness. He denies any cardiac, gastrointestinal, or musculoskeletal symptoms. On examination he is lying on his right side but appears quite comfortable. His temperature, blood pressure, pulse, and respirations are unremarkable. His chest has normal breath sounds on auscultation. Percussion of the chest is unremarkable. During palpation the ribs are nontender. What disorder of the chest best describes his symptoms?
Correct Answer: C
Rationale: The patient's symptoms of intermittent, sharp chest pain with breathing that worsens with deep breaths and is relieved by lying on the right side are suggestive of pleural pain. Pleuritic chest pain is often described as sharp or stabbing and occurs when the parietal pleura, the outer lining of the lungs, becomes inflamed or irritated. In this case, the patient's history of an upper respiratory infection with a severe hacking cough two weeks ago suggests that the pleural pain may be related to pleurisy or pleuritis, which can occur as a complication of respiratory infections.
Question 7 of 9
Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do?
Correct Answer: B
Rationale: Dakota's presentation of a rash with small, bright red marks that do not fade when pressed (non-blanching) along with a slight fever raises concern for a serious condition such as meningococcal infection. Non-blanching rashes, especially when associated with fever, can be a sign of meningococcal sepsis, a life-threatening condition that requires urgent medical attention. Admission to the hospital is warranted for close monitoring, further evaluation, and initiation of appropriate treatment if needed. It is important to err on the side of caution in such cases to ensure the best possible outcome for the patient.
Question 8 of 9
A 22-year-old unemployed roofer presents to your clinic, complaining of pain in his testicle and penis. He states the pain began last night and has steadily become worse. He states it hurts when he urinates and he has not attempted intercourse since the pain began. He has tried Tylenol and ibuprofen without improvement. He denies any fever or night sweats. His past medical history is unremarkable. He has had four previous sexual partners and has had a new partner for the last month. She is on oral contraceptives so he has not used condoms. His parents are both in good health. On examination you see a young man lying on his side. He appears mildly ill. His temperature is 2 and his blood pressure, respirations, and pulse are normal. On visualization of the penis he is circumcised, with no lesions or discharge from the meatus. Visualization of the scrotal skin appears unremarkable. Palpation of the testes shows severe tenderness at the superior pole of the normal-sized left testicle. He also has tenderness when you palpate the structures superior to the testicle through the scrotal wall. The right testicle is unremarkable. An examining finger is placed through each inguinal ring without bulges being noted with bearing down. His prostate examination is unremarkable. Urine analysis shows white blood cells and bacteria. What diagnosis of the male genitalia is most likely in this case?
Correct Answer: B
Rationale: The history and physical examination findings in this case are most consistent with acute epididymitis. Acute epididymitis is characterized by inflammation and infection of the epididymis, which is a tubular structure located behind the testicle that stores and carries sperm. Common symptoms of acute epididymitis include pain and swelling in the scrotum, testicular pain, pain with urination, and sometimes penile discharge. The patient's symptoms of testicular and penile pain, as well as pain with urination, are classic for epididymitis. The severe tenderness at the superior pole of the left testicle and tenderness on palpation of structures superior to the testicle through the scrotal wall further support this diagnosis. In addition, the presence of white blood cells and bacteria on urine analysis is consistent with an infectious process like epididymitis.
Question 9 of 9
A high school football player injured his wrist in a game. He is tender between the two tendons at the base of the thumb. Which of the following should be considered?
Correct Answer: A
Rationale: DeQuervain's tenosynovitis is a condition that involves inflammation of the tendons located at the base of the thumb. The tendons affected are the abductor pollicis longus and extensor pollicis brevis. It typically causes pain and tenderness at the base of the thumb, which can worsen with certain movements of the wrist and thumb. In the case of the high school football player, his tenderness between the two tendons at the base of the thumb is suggestive of DeQuervain's tenosynovitis. It is a common overuse injury in athletes, especially those involved in activities that require repetitive hand and wrist movements, such as gripping a football during play. Treatment usually involves rest, splinting, ice, anti-inflammatory medications, and physical therapy.