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Miami Dade College, Miami *
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Medicine
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Apr 3, 2024
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MSN5200 Blueprint Quiz #1
1.
What should the NP say to a patient who wishes to keep his kidney stones?
QUESTION Mr. L presents to the clinic with severe groin pain and a history of kidney stones. Mr. L's son tells you that for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?
A- "
With your father's permission, we will examine the stone and request that it be returned to him."
B- "The stone must be sent to the lab for examination and therefore cannot be kept."
C- "We cannot let him keep his stone because it violates our infection control policy."
D- "We don't know yet if your father has another kidney stone, so we must analyze this one."
E- "I have found it unwise to make these kinds of individual exceptions to hospital procedure
Answer: A - "With your father's permission, we will examine the stone and request that it be returned to him."
Rational: Health care providers should be willing to modify the delivery of health care in a manner that is respectful and in keeping with the patient's cultural background. It is better to mediate than to be coercive. The statement, "With your father's permission, we will examine the stone and request that it be returned to him" does this most effectively.
2.
Know macule, papule, cyst, plaque and patch
QUESTION A flat, nonpalpable lesion is described as a macule if the diameter is:
a. greater than 1 cm.
b. less than 1 cm.
c. greater than 2 cm.
d. too irregular to measure.
e. exactly 5 mm.
ANS: B
A macule by definition is a flat, circumscribed area that is less than 1 cm in diameter. An example of a macular rash is measles.
Macule: only color change, flat, and circumcised, less than 1cm
Papule: (outside) can feel, less than 1 cm, diameter caused by superficial thickening in epidermis
Cyst: (inside) encapsulated fluid filled cavity in dermis or subcutaneous layer, tensely elevating skin
Plaque: Papules coalesce to form surface elevation wider than 1 cm. A plateaulike, disk-
shaped lesion
Patch: Macule larger than 1cm
- nodule: (outside) solid elevated, hard or soft, larger than 1 cm, and may extend deeper
into dermis than papule
- tumor: (inside) larger than a few cm in diameter, firm or soft, deeper into dermis
- Wheal: superficial raised transient and erythematous, slightly irregular shape
- Urticaria: wheals coalece to form extensive reaction intensely pruritic
- Vesicle: (outside) elevated cavity containing free fluid up to 1cm, blister
- Bulla: (outside) vesicle Larger than 1cm superficial in epidermis
- Pustule: (outside) turbid fluid (pus) in the cavity; Circumscribed and elevated
Cyst
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21. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4.3-cm, rough, elevated area of psoriasis. This is an example of a. plaque.
b. patch. c. macule. d. papule. ANS: A A plaque, by definition, is an elevated, firm, rough lesion with a flat top surface larger than 1 cm in diameter, as seen in someone with, for example, psoriasis. 3.
Know the difference between ritual, norm, rite, and race
QUESTION Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator?
a. Race b. Rite c. Ritual d. Norm ANS: A
Race is a physical, not a cultural, differentiator.
Rite is a prescribed, formal, customary observance. the ceremonial practices of a church or group of churches.
Ritual is a stereotypic behavior regulating religious, social, and professional behaviors. It is a set of actions or words performed in a regular way, often as part of a religious ceremony.
A norm is a prescribed standard of allowable behavior within a group.
They are most defined as
rules or expectations that are socially enforced
4.
Know where to place items in the NP notes- review of systems, past medical history
Personal and social history, and chief complaint
Outline of the History
•
Chief concern (CC) or the reason for seeking care
•
History of present illness or problem (HPI)
•
Past medical history (PMH)
•
Family history (FH)
•
Personal and social history (PSH)
Review of systems (ROS)
Chief Concern
•
Note all significant complaints.
•
Seek answer to the question “What underlying problems or symptoms brought you here?”
•
Determine the duration of the current illness by asking “How long has this problem been
present?” Or “When did these symptoms begin?”
•
Note age, gender, marital status, occupation, and previous hospital admissions.
History of Present Illness:
Explore the following
•
Chronology of events
•
Health state before present problem
•
First symptoms
•
Exposure to infection or toxic agents
•
Typical attack
Illness impact on lifestyle
•
Stability of problem
•
Immediate reason for visit
•
Review of involved systems
•
Medications list
•
Complementary or alternative therapies
•
Chronology review
•
Problem list
Past Medical History:
Explore the following
•
Past medications
•
Allergies (drugs, environment, food)
•
Past transfusions
•
Recent screening tests
•
Emotional status
•
General health
•
Childhood illnesses
•
Major adult illnesses
•
Immunizations
•
Surgery
•
Serious injuries and resulting disability
•
Functional ability limitations
Family History:
Explore the following
•
Blood relatives with illness similar to the patient’s illness
•
Blood relatives with history of major disease
•
Determine if any cancers have been multiple, bilateral, occurred more than once in the family, and occurred at a young age (less than 50 years).
•
Note the age and outcome of any illness.
•
Note the ethnic and racial background of the family.
•
Note the age and health of the patient’s spouse/partner or the child’s parents.
•
A pedigree diagram helps illustrate the family members with a disorder.
•
There should be at least three generations for the pedigree
Personal and Social History:
Explore the following
•
Personal status
•
Habits
•
Sexual history
•
Home conditions
•
Occupation
•
Environment
•
Military record
•
Religious preference
•
Access to care
Review of Systems:
Explore the following
•
General constitutional symptoms
•
Skin, hair, and nails
•
Head and neck
•
Lymph nodes
•
Chest and lungs
•
Breasts
•
Heart and blood vessels
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•
Peripheral vascular
•
Hematologic
•
Gastrointestinal
•
Diet
•
Endocrine
•
Female
•
Male •
Genitourinary
•
Musculoskeletal
•
Neurologic
•
Psychiatric
•
Concluding questions Example
: Is there anything else that you think would be important for me to know? What problem concerns you most? What do you think is the matter with you? What worries you the most about how you are feeling?
General Constitutional Symptoms
•
Fever
•
Chills
•
Malaise
•
Fatigability
•
Night sweats
•
Sleep patterns
•
Weight (Average, Preferred, Present, Change)
QUESTION The chief concern:
A. Requires step-by-step evaluation of the circumstances
B. Explores the patient’s overall health
C. Is a statement about why the patient is seeking care
D. Is a detailed inquiry of possible concerns
ANS: C
Rationale: The chief concern answers the question: Why did the patient come in for health care?
QUESTION
The history of present illness includes which of the following:
A. Unique concerns that explain the prevention needed
B. Presence or absence of health-related issues
C. Chronologic ordering of events
D. General health and strength
Rationale: The history of present illness examines the chief concern and the associated symptoms in a chronologic order.
QUESTION Which of the following is initially appropriate in the management of a patient’s diagnosed problem?
A. Inform the patient of the treatment plan.
B. Give the patient detailed written instructions regarding the treatment plan.
C. Inform the patient that the plan has been tailored to his or her needs.
D. Inform the patient of treatment options and possible results.
Rationale: An initial approach to a patient’s problem should allow for the greatest patient autonomy and should promote patient participation. The well-informed patient is better able to
exercise autonomy. Only answer 4 does this.
QUESTION The effect of the chief concern on the patient's lifestyle is recorded in which section of the medical record?
a. Chief complaint
b. History of present illness
c. Past medical history
d. General patient information
e. Social history
ANS: B
The effect of the patient's complaint on his or her current everyday lifestyle or work performance is recorded in the history of present illness.
QUESTION The review of systems is a component of the:
a. physical examination.
b. health history.
c. assessment.
d. past medical and surgical history.
e. personal and social history.
ANS: E
Review of systems relates health history according to physical systems and is related just before
the actual physical examination.
QUESTION The patient's perceived disabilities and functional limitations are recorded in the:
a. problem list.
b. general patient information.
c. social history.
d. review of systems.
e
. past medical history
.
ANS: E
Past medical history contains information about the patient's lifetime as well as disabilities or functional limitations that alter activities of daily living.
QUESTION Allergies to drugs and foods are generally listed in which section of the medical record?
a. General patient information
b. Past medical history
c. Social history
d. Problem list
e. History of present illness
ANS: B
The past medical history section contains information such as drugs, foods, and environmental allergies.
QUESTION The examiner's evaluation of a patient's mental status belongs in the:
a. history of present illness.
b. review of systems.
c. physical examination.
d. patient education.
e. problem list.
ANS: C
Mental status assessment, including cognitive and emotional stability and speech and language,
is part of the physical examination. Anything subjective is part of the review of systems and those findings that are objective are part of the provider's assessment.
QUESTION The quality of a symptom, such as pain, is subjective information that should be:
a. deferred until the cause is determined.
b. described in the history using a 0 to 10 scale.
c. placed in the past medical history section.
d. placed in the history with objective data.
e. interpreted in light of your physical findings.
ANS: B
Pain is subjective, and only the patient can rate the perceived severity. Pain, therefore, should be recorded in the history using a 0 to 10 scale.
5.
When should the NP assess for domestic violence?
QUESTION Which statement is best for the nurse to use when preparing to administer the Abuse Assessment Screen? a. We are required by law to ask these questions. b. We need to talk about whether you believe you have been abused. c. We are asking these questions because we suspect that you are being abused. d. We need to ask the following questions because domestic violence is so common in our society. ANS: D Such an introduction alerts the woman that questions about domestic violence are coming and ensures the woman that she is not being singled out for these questions.
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6.
Know the types of histories- complete, problem or focused, interim, and inventory
Types of Histories
•
Complete history
•
Most often recorded the first time you see the patient
•
Inventory history
•
Related to but does not replace the complete history
•
Touches on major points without complete detail
•
Entire history will be completed in more than one session
•
Problem (or focused) history
•
Taken when a problem is acute so that only the need of the moment is given full attention
•
Interim history
•
Designed to chronicle events that have occurred since your last meeting with the
patient
•
Substance determined by nature of problem and need of the moment
•
Should always be complemented by the patient’s previous medical record
QUESTION A health history that is designed to chronicle events that have occurred since the patient’s last visit is called a:
A. Interim history
B. Problem history
C. Inventory history
D. Complete history
ANS: A
Rationale: A history that is gathered since the patient’s last visit is called an interim history as it only examines what has happened since the patient’s last visit.
QUESTION J.M. has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) history.
a. complete
b. inventory
c. problem or focused
d. interim
e. family
ANS: C
If the patient is well known or if you have been seeing the patient for the same problem over time, a focused history is appropriate.
7.
When should handwashing take place?(
faltan las preguntas relacionada
)
Resolved lol
1.
According to the guidelines for Standard Precautions, the caregiver’s hands should be washed 1.
only after touching body fluids with ungloved hands and between patient contacts.
2.
only after touching blood products with ungloved hands and after caring for infectious patients. 3.
only after working with patients who are thought to be infectious. 4.
after touching any body fluids or contaminated items, regardless of whether gloves are worn. ANS: D
Handwashing is to be done after removal of gloves, between patient contacts, and after touching body fluids, regardless of whether gloves are used. The nurse should never touch body fluids or blood products with ungloved hands. The nurse should use hand hygiene regardless of a patient’s possible infection. Hand hygiene
Use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring
for patients with known or suspected Clostridium difficile or norovirus during an outbreak.
Otherwise, the preferred method of hand hygiene in clinical situations is with an alcohol-
based hand rub (ABHR)
Use hand hygiene
• Before contact with a patient.
• Before performing an aseptic task (e.g., insertion of IV, preparing an injection).
• After contact with the patient or objects in the immediate vicinity of the patient.
• After contact with blood, body fluids or contaminated surfaces.
• If hands will be moving from a contaminated-body site to a clean body site during patient
care.
• After removal of personal protective equipment (PPE).
8.
What are the steps in assessing the abdomen?
QUESTION When examining the abdomen, which technique should be used first?
a. Inspection
b. Light palpation
c. Percussion
d. Auscultation
e. Direct palpation
ANS: A
Inspection is always used as the first technique in all physical examinations, including the
abdomen.
QUESTION Auscultation should be carried out last except when examining:
a. the neck area.
b. the abdomen.
c. the lungs.
d. the heart.
e. none of the above; auscultation is always carried out last in a proper physical
examination.
ANS: B
Auscultation is the last examination technique used for all areas except the abdomen. In this case, it is performed after inspection.
9.
Where do you write the symptoms to the chief complaint?
QUESTION The effect of the chief concern on the patient's lifestyle is recorded in which section of the medical record?
a. Chief complaint
b. History of present illness
c. Past medical history
d. General patient information
e. Social history
ANS: B
The effect of the patient's complaint on his or her current everyday lifestyle or work performance is recorded in the history of present illness.
10.
Know the ABCDEF of malignant melanoma
QUESTION Which of the following is an ABCD characteristic of malignant melanoma?
a. Asymmetric borders
b. Borders well demarcated
c. Color of lesion is uniform
d. Diameter less than 6 mm
e. Severe blistering or sunburns as a child
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ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as a child is a risk factor and not part of the ABCD characteristics.
11.
What could be pale, shiny skin of the lower extremities?
QUESTION Pale, shiny skin of the lower extremities may reflect:
excessive steroids. a. a history of vigorous exercise. b. peptic ulcer disease. c. vasculitis. d. systemic disease
Answer D: systemic disease
12.
Know the difference between telangiectasia, spider angioma, petechiae, purpura(
Falta la pregunta) Resolved lol
You are examining a pregnant patient and have noted a vascular lesion. When you blanch over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a 1.
telangiectasia. 2.
spider angioma. 3.
petechiae. 4.
purpura. ANS: B
Spider angiomas are dilated arterioles. A network of dilated capillaries radiate from the center arteriole, outward like a spider’s legs. Spider angiomas are often associated with high estrogen levels, as occur in pregnancy. Blanching over the center is followed by a rapid return of redness from the center outward. Telangiectasias refill erratically. Petechiae and purpura do not blanch. Small, minute bruises are called 1.
ecchymoses. 2.
petechiae. 3.
spider veins.
4.
telangiectasias. MSC: Physiologic Integrity: Physiologic Adaptation ANS: B
Petechiae are smaller than 0.5 cm in diameter. Ecchymoses are larger than 0.5 cm in diameter. Spider veins and telangiectasias are vascular lesions. Telangiectasias
are small, widened blood vessels on the skin. They are usually harmless but may be associated with several diseases.
Spider angioma:
Spider angioma
is an abnormal collection of blood vessels near the surface of the
skin. Causes.
Spider angiomas
are very common. They often occur in pregnant
Petechiae:
Petechiae are
pinpoint non-blanching spots that measure less than 2 mm in size and affect the skin and mucous
membranes.
Purpura:
is
any of several hemorrhagic states characterized by patches of purplish discoloration resulting
from extravasation of blood.
13.
What are pigmented, raised, warty lesion on the face?
QUESTION Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:
a. cutaneous tags from lentigines.
b. furuncles from folliculitis.
c. sebaceous hyperplasia from eczema.
d
. seborrheic keratoses from actinic keratoses.
e. herpes zoster from varicella.
ANS: D
Actinic keratoses have malignant potential, and seborrheic keratoses do not. Because they can look similar, an experienced practitioner should make the determination.
14.
How does a FNP assess if a child is being abused?
QUESTION You are conducting a preschool examination on a 5-year-old child. Which injury would most likely raise your suspicion that the child was being abused?
a. Recent bruising over both knees b. A healed laceration under the chin c. A bruise on the right shin with associated abrasion of tissue d. Bruises in various stages of resolution over body soft tissues e. A scab on the elbow
ANS: D Toddlers and older children who bruise themselves accidentally are bruised over bony prominences, such as the knees, elbows, chin, and shin. Bruises over soft tissues are more consistent with abuse
15.
Know the ABCDEF of malignant melanoma
QUESTION Which of the following is an ABCD characteristic of malignant melanoma?
a. Asymmetric borders
b. Borders well demarcated
c. Color of lesion is uniform
d. Diameter less than 6 mm
e. Severe blistering or sunburns as a child
ANS: A
The ABCD melanoma mnemonic includes asymmetry, borders that are irregular, color that is not the same all over, and diameter greater than 6 mm and growing. Severe blistering or sunburns as a child is a risk factor and not part of the ABCD characteristics.
16.
Know ptosis, nystagmus, astigmatism and exophthalmos(
falta nystagmus,
astigmatism and exophthalmos) Resolved QUESTION Ptosis may be secondary to:
a. blepharitis.
b. hyperthyroidism.
c. psoriasis.
d. paresis of a branch of cranial nerve III.
e. entropion.
ANS: D
Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve III. Hyperthyroidism causes exophthalmos, psoriasis is a skin condition, and blepharitis is a crusting of the eyelashes. Entropion is an inversion of the lower eyelid.
2.
A condition that typically develops by the age of 45 years is a. presbyopia.
b. hyperopia.
c. myopia. d. astigmatism. ANS: A
By 45 years of age, a condition known as presbyopia develops; presbyopia involves a weakening of accommodation. Hyperopia occurs in early infancy. Myopia and astigmatism can occur at any time.
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5.
Mrs. S. is a 69-year-old woman who presents for a physical examination. On inspection of her eyes, you note that the left upper eyelid droops, covering more of the iris than does
the right. This is recorded as 1.
exophthalmos on the right. 2.
ptosis on the left. 3.
nystagmus on the left. 4.
astigmatism on the right. ANS: B
Ptosis is when one of the upper eyelids covers more of the iris than the other lid, possibly extending over the pupil. 6.
A condition in which the eyelids do not completely meet to cover the globe is called
a. glaucoma. b
. lagophthalmos. c. exophthalmos. d. hordeolum. ANS: B
Lagophthalmos is a term used to describe the condition in which eyelids do not completely meet when closing. Glaucoma involves elevated pressure in the eye. Exophthalmus involves bulging eyes. A hordeolum is better known as a stye. Ptosis is caused by a congenital defect of the muscle around the eye controlled by cranial nerve
III.
Nystagmus:
is
a condition in which your eyes make rapid, repetitive, uncontrolled movements — such as up and down (vertical nystagmus), side to side (horizontal nystagmus) or in a circle (rotary nystagmus).
Astigmatism:
defect in the eye or in a lens caused by a deviation from
spherical
curvature
, which results in
distorted
images, as light rays are
prevented
from meeting at a common focus
Exophthalmos:
Exophthalmos describes
a condition where the eyeball protrudes from the eye socket, making it appear to bulge
. It can affect one or both eyes.
17.
What is a pterygium? Who is likely to get these?
QUESTION A pterygium is more common in people heavily exposed to:
a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.
e. lead.
ANS: C
Persons heavily exposed to ultraviolet light are more susceptible to pterygium developments. High altitudes, tuberculosis, lead, and cigarette smoke do not cause an overgrowth of the conjunctiva.
18.
Know Weber and Rinne
QUESTION You are performing Weber and Rinne hearing tests. For the Weber test, the sound lateralized to the unaffected ear; for the Rinne test, air conduction–to–bone conduction ratio is less than 2:1. You interpret these findings as suggestive of: a.
a defect in the inner ear.
b. a defect in the middle ear.
c. otitis externa. d. impacted cerumen. ANS: A These results are consistent with a sensorineural hearing loss, a defect in the inner ear. Otitis externa and impacted cerumen are conditions of the external ear that can cause conductive hearing problems.
QUESTION To perform the Rinne test, place the tuning fork on the:
a. top of the head.
b. mastoid bone.
c. forehead.
d. preauricular area.
e. occiput.
ANS: B
The tuning fork is initially placed against the mastoid bone for the Rinne test, a test for sensorineural loss. The tuning fork is placed on the midline top of the patient's head for the
Weber test, a test that helps assess unilateral hearing loss.
19.
When should the FNP do an ear examination on a child?
QUESTION When examining an infant's middle ear, the practitioner should use one hand to
stabilize the otoscope against the head while using the other hand to:
a. pull the auricle down and back.
b. hold the speculum in the canal.
c. distract the infant.
d. stabilize the chest.
e. pull the auricle up.
ANS: A
You should use your other hand to pull the auricle down and back in an effort to straighten the upward curvature of the canal.
20.
How do you palpate the inguinal nodes?
QUESTION To palpate the inguinal nodes, you should have the patient:
a. bend over a table and cough.
b. lie supine, with the knees slightly flexed.
c. lie supine, with the legs extended.
d. stand with the back extended.
e. lie prone, with the knees slightly flexed.
ANS: B
To palpate the inguinal nodes, you should have the patient lying supine, with the knees slightly flexed.
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