ATI RN
Physical Examination and Health Assessment 9th Edition Test Bank Questions
Question 1 of 9
You are performing a routine check-up on an 81-year-old retired cotton farmer in the vascular surgery clinic. You note that he has a history of chronic arterial insufficiency. Which of the following physical examination findings in the lower extremities would be expected with this disease?
Correct Answer: D
Rationale: Chronic arterial insufficiency results in poor blood flow to the lower extremities. This leads to inadequate oxygen and nutrient supply to the tissues, causing damage and changes in the skin. A common physical examination finding in chronic arterial insufficiency is thin, shiny, atrophic skin. The skin may appear pale, cool to the touch, and may have decreased hair growth. It is important to note that other findings such as diminished or absent pulses and reduced temperatures may also be present with chronic arterial insufficiency.
Question 2 of 9
Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?
Correct Answer: B
Rationale: The clinical presentation described in the question is consistent with Candida vaginitis, also known as vaginal yeast infection. Candida vaginitis typically presents with a thick, white, curdy discharge that can be visualized on examination. The low pH of 1 is characteristic of Candida infection. The negative KOH whiff test and absence of an unusual smell help differentiate Candida vaginitis from other types of vaginitis.
Question 3 of 9
Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites?
Correct Answer: B
Rationale: Ascites is the abnormal accumulation of fluid in the abdominal cavity. When ascites is present, dullness is typically heard on percussion due to the fluid in the abdomen. This dullness does not shift with changes in the patient's position. Therefore, the finding of dullness which remains despite a change in position would argue for the presence of ascites. The other choices (A, C, D) describe findings that are more consistent with gaseous distention rather than ascites.
Question 4 of 9
He is afebrile. His cardiac, lung, and abdominal examinations are normal. Visualization of the anus shows no erythema, masses, or inflammation. Digital rectal examination elicits an irregular, firm mass on the posterior side of the rectum. After you remove your finger you notice frank blood on your glove. What anal or rectal disorder is this patient most likely to have?
Correct Answer: D
Rationale: The patient in this scenario presents with symptoms suggestive of an anorectal disorder. The presence of an irregular, firm mass on the posterior side of the rectum, along with frank blood seen on the glove after a digital rectal examination, raises suspicion for an underlying anorectal cancer. Anorectal cancer can present with symptoms such as rectal bleeding, changes in bowel habits, palpable masses, and weight loss. In this case, the findings of an irregular mass and rectal bleeding are concerning for a malignant process such as anorectal cancer. Further evaluation with imaging studies and biopsy would be warranted for confirmation and to guide appropriate management.
Question 5 of 9
Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?
Correct Answer: B
Rationale: Option B, briefy summarizing what you heard from the patient in the first 5 minutes and then trying to have her focus on one aspect of what she told you, is the best technique to facilitate a more focused and efficient interview. This approach acknowledges the patient's need to talk while also guiding the conversation towards more relevant topics. By summarizing at the beginning, you demonstrate that you are listening, and by redirecting the conversation to specific points, you can ensure that important issues are addressed within the time constraints of the appointment. It can help streamline the visit and prevent it from meandering off track due to the patient's chattiness.
Question 6 of 9
A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair violinist in the local symphony orchestra and has started having symptoms during performances, such as sweating, shaking, and hyperventilating. It has gotten so bad that he has thought about giving up his first chair status so he does not have to play the solo during one of the movements. He says that he never has these symptoms during rehearsals or when he is practicing. He denies having any of these symptoms at any other time. His past medical history is unremarkable. He denies any tobacco use, drug use, or alcohol abuse. His parents are both healthy. On examination you see a young man who appears worried. His vital signs and physical examination are unremarkable. What type of anxiety disorder best describes his situation?
Correct Answer: C
Rationale: The young violinist is experiencing symptoms of anxiety specifically related to performing in front of others, which is characteristic of social phobia (also known as social anxiety disorder). The symptoms occur only during performances, indicating the anxiety is triggered by social situations where he is the center of attention. His ability to perform without symptoms during rehearsals or practice sessions further supports the diagnosis of social phobia, as the anxiety is specifically related to public performance. In contrast, panic disorder is characterized by recurrent, unexpected panic attacks that are not situation-specific, and specific phobia involves an intense fear of a specific object or situation, neither of which fully match this patient's presentation. Generalized anxiety disorder involves excessive worry and anxiety about various aspects of life, which is not the main feature of this case.
Question 7 of 9
In measuring the jugular venous pressure (JVP), which of the following is important?
Correct Answer: A
Rationale: It is crucial to keep the patient's torso at a 45-degree angle when measuring the jugular venous pressure (JVP). This position allows the internal jugular vein to partially collapse, ensuring accurate observation of the pulsations. Keeping the patient at a 45-degree angle provides a standardized position for JVP measurement and helps avoid errors in assessment.
Question 8 of 9
A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?
Correct Answer: B
Rationale: Based on the description provided, the skin lesions are most consistent with seborrheic keratosis. Seborrheic keratoses are common non-cancerous (benign) growths of the skin that often appear as brown, black, or light tan growths with a waxy, stuck-on appearance. They can vary in color and may be round or oval, with a well-defined border. Seborrheic keratoses are typically asymptomatic and can be found on various parts of the body including the face, arms, and legs. The dry, hard scale covering the lesion is typical for seborrheic keratoses.
Question 9 of 9
A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion, and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most likely?
Correct Answer: B
Rationale: Among the options presented, Hepatitis B (HBV) is most likely in this scenario. HBV can be transmitted through mucous membrane exposure to infectious blood or body fluids, including sexual contact. The daycare worker's history of not being sexually active for the past 10 months would not completely rule out the possibility of acquiring HBV through a past sexual encounter. Also, HBV can persist in the blood for prolonged periods, making it a likely cause of jaundice in this case. The other types of hepatitis (A, C, D) are less likely based on the information provided concerning the daycare worker's history and risk factors.