ATI RN
jarvis physical examination and health assessment test bank Questions
Question 1 of 9
An 80-year-old woman that you follow in a nursing home has an acute decline in her mental status. She has a fever >100°F, but no other focal complaints or findings on physical examination except for a chronic indwelling urinary catheter. What statement is true?
Correct Answer: A
Rationale: The correct answer is A because in an older adult with an indwelling urinary catheter, a fever >100°F can be a sign of urinary tract infection (UTI) or urosepsis. Given her acute decline in mental status and fever, empiric antibiotic therapy is warranted to treat a potential infection. Choice B is incorrect because older adults with indwelling catheters are at increased risk for UTIs and bloodstream infections. Choice C is incorrect as obtaining a urine culture is important to confirm the diagnosis and guide appropriate antibiotic therapy. Choice D is incorrect as the duration of antibiotic treatment for a UTI is typically longer than 3 days.
Question 2 of 9
Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to “run into the bushes and go.” Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried “those Kegel exercises” in the past without success. Which of the following is the most appropriate recommendation for Ms. J?
Correct Answer: B
Rationale: The correct answer is B: Referral for biofeedback training in pelvic muscle exercise. Biofeedback training helps Ms. J improve her pelvic muscle control, which can address her urinary leakage issue. It is specifically tailored to strengthen the pelvic floor muscles, which can help with urinary incontinence. This option is appropriate for Ms. J as she has already tried Kegel exercises without success. Option A: Bladder training focuses on scheduling toilet trips and gradually increasing the time between trips. It may not be as effective for Ms. J's specific issue with leakage during physical activity. Option C: Solifenacin is a medication for overactive bladder symptoms, which may not be the best approach for Ms. J who has stress urinary incontinence. Option D: Topical estrogen is used for menopausal symptoms and genitourinary atrophy, which may not directly address Ms. J's issue with urinary leakage during physical activity.
Question 3 of 9
A 19-year-old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis?
Correct Answer: C
Rationale: The correct answer is C. Meningitis typically presents with neck stiffness due to meningeal irritation. In choice C, the patient has a tender neck to palpation and is unable to perform range of motion, indicating meningeal inflammation. Choices A, B, and D all describe a normal head and fundi exam, which is not consistent with meningitis. Choice B mentions muscle spasm and limited range of motion to the right, but this is more suggestive of a musculoskeletal issue rather than meningitis. Choice D describes a normal neck exam, which is not in line with the presentation of meningitis.
Question 4 of 9
Janeway lesions, petechiae, and Osler nodes are associated with:
Correct Answer: B
Rationale: Step-by-step rationale for why B is correct: Janeway lesions, petechiae, and Osler nodes are classic signs of infective endocarditis. Janeway lesions are painless erythematous macules on palms/soles, petechiae are small red/purple spots due to microemboli, and Osler nodes are tender subcutaneous nodules on fingers/toes. These findings indicate systemic embolization and immune complex deposition in infective endocarditis. Other choices are incorrect as they do not typically present with these specific dermatologic findings.
Question 5 of 9
A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient's complete history and physical examination. When you palpate the pulse, what do you expect to feel?
Correct Answer: B
Rationale: The correct answer is B: Small amplitude, weak. In congestive heart failure, the heart's ability to pump effectively is compromised, leading to decreased cardiac output. This results in a weakened pulse with reduced amplitude. Palpating a small, weak pulse in this patient is expected due to poor cardiac function. Choices A and C are incorrect because a large, forceful pulse is not expected in congestive heart failure, and a normal pulse may not reflect the compromised cardiac function. Choice D, bigeminal, refers to an abnormal rhythm characterized by every other heartbeat being premature and is not typically associated with congestive heart failure.
Question 6 of 9
Symptoms consistent with later-stage human immunodeficiency disease (HIV) typically include all of the following except:
Correct Answer: C
Rationale: The correct answer is C: Persistent vomiting. This is because persistent vomiting is not typically associated with later-stage HIV disease. Night sweats, lymphadenopathy for more than 3 months, and persistent, unexplained fatigue are commonly seen in later-stage HIV. Vomiting may occur in earlier stages due to opportunistic infections, but it is not a hallmark symptom of advanced HIV.
Question 7 of 9
A 78-year-old male is being treated for hypertension. The nurse knows that the most appropriate first-line therapy in older adults is:
Correct Answer: A
Rationale: The correct answer is A: Diuretics. In older adults, diuretics are considered the most appropriate first-line therapy for hypertension due to their effectiveness in reducing blood pressure and preventing complications such as heart failure. Diuretics are well-tolerated, have a long history of use, and are cost-effective. They are especially beneficial in older adults with volume overload or fluid retention. Beta-blockers (B) may be less effective in older adults and can have more side effects. ACE inhibitors (C) are commonly used but may pose risks of hyperkalemia and renal dysfunction in older adults. Calcium channel blockers (D) are effective but may increase the risk of falls and fractures in older adults.
Question 8 of 9
A 16-year-old high school junior is brought to your clinic by his father. The teenager was taught in his health class at school to do monthly testicular self-examinations. Yesterday when he felt his left testicle it was enlarged and tender. He isn't sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last 3 days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination you see a teenager in no acute distress. His temperature is 8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this teenager most likely have?
Correct Answer: A
Rationale: The correct answer is A: Acute orchitis. Orchitis is inflammation of the testicle that can cause testicular enlargement and tenderness. In this case, the teenager presents with a swollen and sore left testicle, which aligns with the symptoms of orchitis. The patient's history of upper respiratory symptoms suggests a viral infection, which can lead to orchitis. The normal prostate exam and urine analysis rule out prostatitis. Acute epididymitis typically presents with pain and swelling in the epididymis, not the testicle itself. Torsion of the spermatic cord would present with sudden, severe testicular pain and is an emergency requiring immediate surgical intervention.
Question 9 of 9
Explain the significance of decreased tactile fremitus in the context of respiratory assessments.
Correct Answer: B
Rationale: The correct answer is B because decreased tactile fremitus suggests fluid or air in the pleural space, which can occur in conditions like pleural effusion or pneumothorax. This decrease in tactile fremitus is due to the transmission of vibrations from the vocal cords being impeded by the presence of fluid or air between the lung and chest wall. Choices A, C, and D are incorrect because decreased tactile fremitus is not typically associated with increased lung density, normal lung function, or lung tumors.