Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?

Questions 28

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NCLEX Practice Questions Physical Assessment Questions

Question 1 of 9

Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?

Correct Answer: A

Rationale: Mr. Patel's case involves an enlarged liver, which warrants further investigation to determine the underlying cause. An ultrasound of the liver would provide valuable information regarding the size, shape, and texture of the liver, helping to identify any potential abnormalities such as liver cirrhosis, fatty liver disease, or liver tumors. This imaging study can also help differentiate between different conditions that may be causing the liver enlargement, guiding subsequent diagnostic and treatment decisions. Therefore, obtaining an ultrasound of the liver is the most appropriate next step in evaluating Mr. Patel's condition.

Question 2 of 9

Despite having high BP readings in the office, Mr. Kelly tells you that his readings at home are much lower. He checks them twice a day at the same time of day and has kept a log. How do you respond?

Correct Answer: A

Rationale: Mr. Kelly's scenario is consistent with the phenomenon called "white coat hypertension," where an individual's blood pressure readings are elevated in a medical setting due to anxiety or stress, but are normal when measured at home. This discrepancy between office and home readings is a key indicator of white coat hypertension. Additionally, the fact that Mr. Kelly has been consistently monitoring his blood pressure at home and has kept a log supports the likelihood that his elevated readings in the office are primarily due to the stress of being in that environment. It is important to acknowledge white coat hypertension as a common occurrence and not necessarily a reflection of true high blood pressure that requires immediate medical intervention.

Question 3 of 9

Which of the following conditions would produce a hyperresonant percussion note?

Correct Answer: A

Rationale: A hyperresonant percussion note is a more intense and booming sound heard during percussion of the thorax. This can occur when there is an increased amount of air present in the chest cavity. In the case of a large pneumothorax, which is the presence of air in the pleural space causing partial or complete collapse of the lung, the percussion note would be hyperresonant due to the increased air content in the thoracic cavity. Lobar pneumonia, pleural effusion, and empyema would typically produce dull or flat percussion notes due to the presence of fluid or solid material in the pleural space.

Question 4 of 9

A patient with hearing loss by whisper test is further examined with a tuning fork, using the Weber and Rinne maneuvers. The abnormal results are as follows: bone conduction is greater than air on the left, and the patient hears the sound of the tuning fork better on the left. Which of the following is most likely?

Correct Answer: A

Rationale: Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically around the stapes bone. In cases of otosclerosis, the bone conduction is greater than air conduction on the affected side, which is seen in the scenario described. The Weber test localizes to the affected ear, meaning the patient hears the sound of the tuning fork better in the left ear in this case. This is because the abnormal bone growth can restrict the movement of the ossicles, leading to a conductive hearing loss. Otosclerosis typically affects one ear, and its presentation aligns with the results of the hearing tests performed in this case.

Question 5 of 9

The components of the health history include all of the following except which one?

Correct Answer: B

Rationale: When conducting a health history assessment, the components typically include the review of systems, present illness, and personal and social items. The review of systems involves asking specific questions related to each system of the body to gather comprehensive information about the patient's overall health. Present illness focuses on the current chief complaint and symptoms the patient is experiencing. Personal and social items encompass details such as lifestyle habits, family history, medical history, and social support systems. The thorax and lungs are typically assessed as part of the physical examination, not specifically in the health history documentation.

Question 6 of 9

Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?

Correct Answer: C

Rationale: A positive transillumination test is a key finding that would lead you to suspect a hydrocele as the cause of scrotal swelling. In a hydrocele, the scrotal fluid transilluminates well, meaning that when a light is shone through the scrotum, it will appear as a fluid-filled sac with a clear glow. This is a characteristic feature of a hydrocele and helps differentiate it from other causes of scrotal swelling, such as hernias or testicular tumors. Presence of bowel sounds in the scrotum (Choice A) would be concerning for a hernia rather than a hydrocele. Being unable to palpate superior to the mass (Choice B) may suggest a large hydrocele but is not specific to diagnosing a hydrocele. The normal thickness of the skin of the scrotum (Choice D) can be found in various scrotal conditions and is not specific

Question 7 of 9

A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know her if she has this or not. Which of the following disease processes is a risk factor for peripheral vascular disease?

Correct Answer: B

Rationale: Coronary artery disease (CAD) is a significant risk factor for peripheral vascular disease (PVD). CAD is a condition where plaque builds up in the coronary arteries that supply blood to the heart muscle. This process is called atherosclerosis. Similarly, in PVD, atherosclerosis occurs in the peripheral arteries, affecting blood flow to the extremities, most commonly the legs. Individuals with CAD often have systemic atherosclerosis, which puts them at higher risk for developing PVD. Therefore, it is important for the 72-year-old teacher with CAD to be aware of this risk factor for PVD and consider appropriate screening and preventive measures.

Question 8 of 9

Which of the following lymph node groups is most commonly involved in breast cancer?

Correct Answer: C

Rationale: The pectoral lymph node group, also known as the Level III lymph nodes, is the most commonly involved in breast cancer metastasis. These lymph nodes are located along the lower border of the pectoralis minor muscle and are an important regional drainage site for breast tissue. Therefore, in cases of breast cancer, the pectoral lymph nodes are frequently affected due to their proximity to the breast tissue.

Question 9 of 9

A 56-year-old homosexual man presents with itching, anorectal pain, and tenesmus of 1 week's duration. Rectal examination reveals generalized tenderness without frank prostate abnormalities. Which of the following is most likely?

Correct Answer: C

Rationale: Given the patient's presentation of itching, anorectal pain, and tenesmus, along with rectal examination findings of generalized tenderness without prostate abnormalities, proctitis is the most likely diagnosis. Proctitis is inflammation of the rectal lining and is commonly associated with symptoms such as rectal pain, itching, tenesmus (feeling of incomplete defecation), and sometimes rectal bleeding. It can have various causes, including sexually transmitted infections (such as gonorrhea, chlamydia), inflammatory bowel disease, radiation therapy, or trauma.

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