ATI RN
Test Bank Physical Examination and Health Assessment Questions
Question 1 of 9
You are seeing an elderly man with multiple complaints. He has chronic arthritis, pain from an old war injury, and headaches. Today he complains of these pains, as well as dull chest pain under his sternum. What would the order of priority be for your problem list?
Correct Answer: D
Rationale: The correct order of priority for the problem list in this case would be chest pain, headaches, arthritis, and war injury pain. Chest pain should always be a priority as it could indicate a serious or life-threatening condition such as a heart attack. Headaches, while important, are less urgent than chest pain. Arthritis can generally be managed without immediate intervention, making it a lower priority. Finally, the pain from the old war injury, while significant, is not as urgent as the other complaints.
Question 2 of 9
Mrs. H. comes to your clinic, wanting antibiotics for a sinus infection. When you enter the room, she appears to be very angry. She has a raised tone of voice and states that she has been waiting for the past hour and has to get back to work. She states that she is unimpressed by the reception staff, the nurse, and the clinic in general and wants to know why the office wouldn't call in an antibiotic for her. Which of the following techniques is not useful in helping to calm this patient?
Correct Answer: A
Rationale: Acknowledging and taking responsibility for any part you may have played in provoking the patient's anger is important in effectively addressing the situation. By avoiding admission of your lateness, you may come across as dismissive of the patient's feelings and not addressing the issue at hand. It is essential to validate the patient's feelings and work towards finding a solution rather than avoiding the issue.
Question 3 of 9
Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him?
Correct Answer: D
Rationale: Weight loss can have a significant impact on the health problems associated with obesity. Even a modest weight loss of around 10% can lead to noticeable improvements in conditions such as diabetes, hypertension, osteoarthritis, and obstructive sleep apnea. Encouraging Mr. Curtiss to focus on achieving a meaningful but achievable goal, such as a 10% weight loss, can help him experience positive changes in his health and overall wellbeing, even if his ultimate goal weight seems far away. This approach can also help to boost his motivation and confidence in his ability to make progress towards better health.
Question 4 of 9
A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis?
Correct Answer: B
Rationale: The description of an oval, brown, slightly elevated lesion with a flat surface and rough, wartlike texture on palpation is characteristic of a seborrheic keratosis. Seborrheic keratoses are common benign skin growths that typically occur in older adults. They can vary in color, ranging from tan to dark brown, and often have a waxy or stuck-on appearance. The lesion described does not fit the typical characteristics of actinic keratosis, basal cell carcinoma, or squamous cell carcinoma.
Question 5 of 9
A 55-year-old married homemaker comes to your clinic, complaining of 6 months of vaginal itching and discomfort with intercourse. She has not had a discharge and has had no pain with urination. She has not had a period in over 2 years. She has no other symptoms. Her past medical history consists of removal of her gallbladder. She denies use of tobacco, alcohol, and illegal drugs. Her mother has breast cancer, and her father has coronary artery disease, high blood pressure, and Alzheimer's disease. On examination she appears healthy and has unremarkable vital signs. There is no lymphadenopathy with palpation of the inguinal nodes. Visualization of the vulva shows dry skin but no lesions or masses. The labia are somewhat smaller than usual. Speculum examination reveals scant discharge, and the vaginal walls are red, dry, and bleed easily. Bimanual examination is unremarkable. The KOH whiff test produces no unusual odor and there are no clue cells on the wet prep. What form of vaginitis is this patient most likely to have?
Correct Answer: D
Rationale: The patient's presentation is consistent with atrophic vaginitis, also known as vaginal atrophy. This condition typically occurs in postmenopausal women due to a decrease in estrogen levels, leading to thinning, drying, and inflammation of the vaginal walls. Symptoms of atrophic vaginitis include vaginal dryness, itching, discomfort with intercourse, and sometimes light bleeding after intercourse. The absence of vaginal discharge and the presence of vaginal dryness and bleeding easily upon examination suggest atrophic vaginitis as the most likely cause in this patient. Other causes of vaginitis such as Trichomonas vaginitis, Candida vaginitis, and bacterial vaginosis typically present with different symptoms and findings on examination.
Question 6 of 9
Linda is a 29-year-old who had excruciating pain which started under her lower ribs on the right side. The pain eventually moved to her lateral abdomen and then into her right lower quadrant. Which is most likely, given this presentation?
Correct Answer: A
Rationale: The progression of excruciating pain starting under the lower ribs on the right side, then moving to the lateral abdomen, and finally settling in the right lower quadrant is classic for appendicitis. Appendicitis is an inflammation of the appendix, a small tube-like structure attached to the cecum (beginning of the large intestine). The pain typically starts around the umbilicus and then migrates to the right lower quadrant, where the appendix is located. Other symptoms that may accompany appendicitis include fever, nausea, vomiting, loss of appetite, and tenderness at McBurney's point (a specific area in the abdomen). It is a medical emergency that requires immediate attention to avoid complications such as perforation and peritonitis.
Question 7 of 9
A 20-year-old part-time college student comes to your clinic, complaining of growths on his penile shaft. They have been there for about 6 weeks and haven't gone away. In fact, he thinks there may be more now. He denies any pain with intercourse or urination. He has had three former partners and has been with his current girlfriend for 6 months. He says that because she is on the pill they don't use condoms. He denies any fever, weight loss, or night sweats. His past medical history is unremarkable. In addition to college, he works part-time for his father in construction. He is engaged to be married and has no children. His father is healthy, and his mother has hypothyroidism. On examination the young man appears healthy. His vital signs are unremarkable. On visualization of his penis you see several moist papules along all sides of his penile shaft and even two on the corona. He has been circumcised. On palpation of his inguinal region there is no inguinal lymphadenopathy. Which abnormality of the penis does this patient most likely have?
Correct Answer: A
Rationale: The patient in the case presented has multiple moist papules on the penile shaft and corona, which are classic features of condylomata acuminata, also known as genital warts. Condylomata acuminata are caused by the human papillomavirus (HPV) and are typically painless, unlike other conditions such as genital herpes or syphilitic chancre which may be associated with pain or tender sores. Given the patient's history of multiple sexual partners and lack of condom use with his current girlfriend, there is a higher likelihood of exposure to HPV. Condylomata acuminata can be treated with various options including topical agents, cryotherapy, or surgical removal, and it is important to address the potential risk of HPV transmission to sexual partners.
Question 8 of 9
You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you search out?
Correct Answer: D
Rationale: Finding a bounding carotid pulse suggests a wide pulse pressure, which can be associated with aortic insufficiency. Aortic insufficiency (also known as aortic regurgitation) is characterized by the backflow of blood from the aorta into the left ventricle during diastole due to incomplete closure of the aortic valve. This results in increased stroke volume and left ventricular pressure, leading to widened pulse pressure and a bounding arterial pulse. Therefore, when a bounding carotid pulse is detected in a patient, it is important to search for signs and symptoms of aortic insufficiency, such as a diastolic murmur heard best at the left sternal border and radiating to the neck.
Question 9 of 9
Where is the point of maximal impulse (PMI) normally located?
Correct Answer: A
Rationale: The point of maximal impulse (PMI), also known as the apical impulse, is the point where the left ventricle is closest to the chest wall. Normally, the PMI is located in the left 5th intercostal space, around 7 to 9 cm lateral to the sternum. This area corresponds to the apex of the heart. By palpating the PMI, healthcare providers can assess the size, strength, and regularity of the heart's contractions, which can provide important diagnostic information about cardiac health. Locating the PMI accurately is essential for physical examination and diagnosis of cardiac conditions.