An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

Questions 27

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ATI RN Test Bank

Health Assessment and Physical Examination Test Bank Questions

Question 1 of 9

An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

Correct Answer: B

Rationale: In an elderly woman with a history of coronary bypass surgery presenting with severe, diffuse abdominal pain that is not worsened by abdominal palpation, neuropathy should be suspected. Neuropathy refers to nerve damage, which can result in abnormal sensations of pain, often described as burning, shooting, or stabbing. Abdominal neuropathy can be caused by various conditions such as diabetes, alcohol abuse, vitamin deficiencies, or certain medications. The absence of worsening pain upon palpation makes organic abdominal pathology less likely, suggesting a neuropathic etiology. In this case, further evaluation and testing for neuropathy would be warranted.

Question 2 of 9

You are excited about a positive test finding you have just noticed on physical examination of your patient. You go on to do more examination, laboratory work, and diagnostic tests, only to find that there is no sign of the disease you thought would correlate with the finding. This same experience happens several times. What should you conclude?

Correct Answer: B

Rationale: The repeated scenario of finding a positive test result that does not correlate with the suspected disease indicates a lack of specificity for the test in question. In such cases, it is important to use the test when there is a higher suspicion for a specific condition that is known to correlate with the finding. By using the test selectively in situations where it is more likely to provide accurate information, its utility can be maximized and unnecessary further workup can be avoided. This approach allows for a more targeted and efficient use of resources in the diagnostic process.

Question 3 of 9

A 58-year-old teacher presents to your clinic with a complaint of breathlessness with activity. The patient has no chronic conditions and does not take any medications, herbs, or supplements. Which of the following symptoms is appropriate to ask about in the cardiovascular review of systems?

Correct Answer: B

Rationale: Orthopnea is a symptom characterized by difficulty breathing while lying flat that improves when sitting or standing upright. This symptom is specifically related to cardiovascular conditions, such as heart failure, in which fluid accumulates in the lungs when lying down. Considering the patient's complaint of breathlessness with activity and the need to assess for cardiovascular issues, asking about orthopnea would be most appropriate to gain insights into potential heart-related causes of the symptoms. Abdominal pain (A), hematochezia (C), and tenesmus (D) are not typically associated with cardiovascular conditions and are less relevant to the patient's presentation.

Question 4 of 9

A high school soccer player "blew out his knee" when the opposing goalie's head and shoulder struck his flexed knee while the goalie was diving for the ball. All of the following structures were involved in some way in his injury, but which of the following is actually an extra-articular structure?

Correct Answer: D

Rationale: Tendons are the correct answer as they are an extra-articular structure. Tendons are fibrous connective tissue that attach muscles to bones, providing stability and transmitting forces during movements. In the context of the scenario provided, the player's knee injury involved structures within the joint such as the synovium (A), joint capsule (B), and juxta-articular bone (C), but the tendons (D) are located outside of the joint itself.

Question 5 of 9

A patient is examined with the ophthalmoscope and found to have red reflexes bilaterally. Which of the following have you essentially excluded from your differential?

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Question 6 of 9

To hear a soft murmur or bruit, which of the following may be necessary?

Correct Answer: D

Rationale: To hear a soft murmur or bruit clearly, it is important to minimize any background noise or distractions that may interfere with your ability to auscultate effectively. Therefore, asking the patient to hold her breath (choice A) can help reduce noise caused by the patient's respiration. Asking the patient in the next bed to turn down the TV (choice B) can also help eliminate external noise that may disrupt your ability to hear subtle sounds. Checking your stethoscope for air leaks (choice C) is crucial to ensure that you are hearing sounds accurately and not being affected by any equipment issues. By combining these strategies, you can create an optimal environment for listening to soft murmurs or bruits.

Question 7 of 9

An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?

Correct Answer: B

Rationale: In an elderly woman with a history of coronary bypass surgery presenting with severe, diffuse abdominal pain that is not worsened by abdominal palpation, neuropathy should be suspected. Neuropathy refers to nerve damage, which can result in abnormal sensations of pain, often described as burning, shooting, or stabbing. Abdominal neuropathy can be caused by various conditions such as diabetes, alcohol abuse, vitamin deficiencies, or certain medications. The absence of worsening pain upon palpation makes organic abdominal pathology less likely, suggesting a neuropathic etiology. In this case, further evaluation and testing for neuropathy would be warranted.

Question 8 of 9

A sudden, painless unilateral vision loss may be caused by which of the following?

Correct Answer: A

Rationale: A sudden, painless unilateral vision loss may be caused by a retinal detachment. Retinal detachment occurs when the retina, which is the light-sensitive tissue lining the back of the eye, pulls away from its normal position. This can lead to visual disturbances, including sudden loss of vision in one eye. Retinal detachment can be a medical emergency and requires prompt evaluation and treatment to prevent permanent vision loss. Other conditions mentioned in the choices, such as corneal ulcer, acute glaucoma, and uveitis, may also cause vision problems but are less likely to present with a sudden and painless unilateral vision loss as a primary symptom.

Question 9 of 9

A patient is concerned about a dark skin lesion on her anterolateral abdomen. It has not changed, and there is no discharge or bleeding. On examination there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is this lesion?

Correct Answer: D

Rationale: Given the description provided, the lesion appears to be a dermatofibroma. Dermatofibromas are common benign skin lesions that typically present as a firm, solitary nodule on the skin. They commonly occur on the lower extremities but can also be found on the trunk. The characteristics of a dermatofibroma include being firm to the touch, having regular borders, being evenly pigmented, and a diameter typically less than 1 cm to 2 cm. They are usually painless and do not change significantly over time.

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