ATI RN
Physical Assessment Nursing Practice Questions Questions
Question 1 of 9
Glaucoma is the leading cause of blindness in African Americans and the second leading cause of blindness overall. What features would be noted on funduscopic examination?
Correct Answer: A
Rationale: Glaucoma is a progressive optic neuropathy characterized by changes to the optic nerve head. One of the hallmark features seen on funduscopic examination in glaucoma is an increased cup-to-disc ratio. This refers to the ratio of the size of the optic cup (depression in the center of the optic nerve head) to the size of the optic disc (the pinkish-orange area around the cup). In glaucoma, there is typically an enlargement of the cup relative to the disc due to damage of the retinal ganglion cell axons. This change is often associated with thinning of the neuroretinal rim and loss of nerve fibers.
Question 2 of 9
A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked as well, and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process?
Correct Answer: C
Rationale: The most likely pathologic process in this scenario is degenerative. The history provided includes chronic intermittent neck pain that worsened after a specific activity (wallpapering) but resolved with rest. The patient's age (47 years old) is also suggestive of degenerative changes in the spine. Additionally, the use of over-the-counter medications to manage the pain points towards a chronic condition such as degenerative changes in the cervical spine, possibly cervical spondylosis or osteoarthritis. There is no mention of any infectious symptoms, trauma, or neoplastic features in the presentation.
Question 3 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 4 of 9
You are palpating the abdomen and feel a small mass. Which of the following would you do next?
Correct Answer: A
Rationale: When palpating the abdomen and feeling a small mass, the next step would be to perform an ultrasound. Ultrasound imaging is a non-invasive and reliable way to further evaluate the size, location, and characteristics of the mass. It can provide valuable information to determine the nature of the mass, such as whether it is a cyst, a solid mass, or another type of abnormality. This imaging modality can help guide further management and treatment decisions, such as determining if surgery is necessary or if further monitoring is required. Ultrasound is a safe and commonly used tool in assessing abdominal masses, making it an appropriate next step in this scenario.
Question 5 of 9
You are examining a patient with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good examination?
Correct Answer: D
Rationale: In a patient with emphysema, lung hyperinflation can make it difficult to hear heart sounds anteriorly. Listening posteriorly, especially between the scapulae, can often provide a clearer auscultation of the heart sounds due to reduced interference from lung sounds. The posterior approach can also help avoid any abdominal sounds that might obscure the cardiac sounds when auscultating in the epigastrium. It is important to make sure the patient is in a comfortable position for better examination, and in this case, listening posteriorly would be the best choice for assessing heart sounds in a patient with emphysema in exacerbation.
Question 6 of 9
Her cardiac, lung, and abdominal examinations are normal. On visualization of her anus, no inflammation, masses, or fissures are noted. When she is asked to bear down, you see a rosette of red mucosa prolapsing from the anus. On digital rectal examination there are no masses and no blood is found on the glove. What disorder of the anus or rectum is this likely to be?
Correct Answer: A
Rationale: The findings described in the scenario point towards rectal prolapse. Rectal prolapse, also known as procidentia or rectal procidentia, is the full-thickness protrusion of the rectal wall through the anus. The characteristic presentation often includes the protrusion of a rosette of red mucosa from the anus when the patient bears down. This is consistent with the visual assessment mentioned in the scenario.
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
Which of the following regarding jugular venous pulsations is a systolic phenomenon?
Correct Answer: C
Rationale: The upstroke of the "a" wave in the jugular venous pulsations coincides with systole. The "a" wave is caused by atrial contraction, which occurs during ventricular systole. In contrast, the "x" descent is a diastolic phenomenon representing the atrial relaxation, the "y" descent follows atrial emptying in early diastole, and the "v" wave corresponds to venous filling during late diastole.
Question 9 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.