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

ATI RN

ATI RN Test Bank

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

A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs?

Correct Answer: A

Rationale: The most likely diagnosis for this patient's symptoms and signs is acute diverticulitis. His presentation of abdominal pain, constipation, and low-grade fever, along with tenderness over the left lower quadrant, is consistent with diverticulitis, which is inflammation or infection of small pouches (diverticula) that can develop in the colon. The history of recent onset of symptoms after consuming popcorn, typically a high-fiber food that can exacerbate diverticulitis, further supports this diagnosis. The negative fecal occult blood test makes more acute intra-abdominal processes like acute appendicitis less likely. Acute cholecystitis would present with right upper quadrant pain, and mesenteric ischemia typically presents with severe abdominal pain, nausea, and vomiting, as well as signs of abdominal distress.

Question 3 of 9

His head, eyes, ears, nose, throat, and neck examinations are normal. There are some crackles in the bases of each lung. During his cardiac examination there is an extra heart sound. Visualization of his penis shows an uncircumcised prepuce but no lesions or masses. Palpation of his scrotum shows generalized swelling, with no discrete masses. A gloved finger is placed through each inguinal ring, and with bearing down there are no bulges. The prostate is smooth and nontender. What abnormality of the scrotum is most likely the diagnosis?

Correct Answer: C

Rationale: Scrotal edema refers to swelling of the scrotum, which can be caused by various reasons such as infection, inflammation, trauma, or fluid collection. In this case, the examination findings of generalized swelling of the scrotum with no discrete masses or bulges on palpation suggest scrotal edema as the most likely diagnosis. The absence of bulges when a finger is placed through the inguinal rings with bearing down rules out a scrotal hernia. Hydrocele typically presents as a painless fluid-filled sac around the testicle, but there are no specific findings mentioned in the scenario to suggest a hydrocele. Varicocele involves dilated veins in the scrotum and may present as a soft lump that feels like a "bag of worms," which is not described in the examination findings provided.

Question 4 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 5 of 9

Diplopia, which is present with one eye covered, can be caused by which of the following problems?

Correct Answer: C

Rationale: Diplopia occurring when one eye is covered is a condition known as monocular diplopia. This symptom is typically not caused by problems within the eye itself, such as irregularities in the cornea or lens. Instead, monocular diplopia with one eye covered is more likely to be an indication of a neurological issue, often involving the brainstem. Lesions or damage in the brainstem can disrupt the normal coordination of eye movements, leading to the perception of double vision when one eye is closed. Weakness of CN III (oculomotor nerve) or CN IV (trochlear nerve) may cause diplopia when both eyes are open, but it would not typically manifest as monocular diplopia.

Question 6 of 9

She is concerned about her risk for developing heart disease. Which of the following factors is used to estimate the 10-year risk of developing coronary heart disease?

Correct Answer: A

Rationale: Ethnicity is one of the factors used to estimate the 10-year risk of developing coronary heart disease. Different ethnic groups may have varying risks for heart disease based on genetic predisposition, lifestyle factors, and cultural practices. For example, individuals of South Asian descent have been found to have a higher risk of heart disease compared to other ethnic groups. Therefore, considering ethnicity is essential when assessing the overall risk of developing heart disease in an individual.

Question 7 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 8 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 9 of 9

Which is true of splitting of the second heart sound?

Correct Answer: C

Rationale: Splitting of the second heart sound is when the aortic and pulmonic valves close at slightly different times, resulting in two distinct components to the sound. This split is best heard over the apex of the heart, typically with the diaphragm of the stethoscope. The aortic component is heard first and represents closure of the aortic valve, followed by the pulmonic component, representing closure of the pulmonic valve. The split can narrow during inspiration and widen during expiration, which is important to keep in mind during assessment.

Access More Questions!

ATI RN Basic


$89/ 30 days

ATI RN Premium


$150/ 90 days