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NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 1 Discussion Building a Health History
Effective communication is vital to constructing an accurate and detailed patient history. Many factors, including age, gender, ethnicity, and environmental setting, influence a patient’s health or illness. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.
Photo Credit: Getty Images/Caiaimage
To prepare:
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
By Day 1 of this week, your instructor will assign you a new patient profile for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s social determinants of health?
What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
Identify any potential health-related risks based on the patient’s age, gender, ethnicity, or environmental setting that should be considered.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of Seidel’s Guide to Physical Examination text or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1
Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 2 Discussion Diversity and Health Assessments
In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain weight above what is considered healthy. Randall explained—from her observations and experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).
Photo Credit: Getty Images
Randall’s statements sparked much controversy and debate; however, they emphasize an underlying reality in healthcare: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into consideration when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.
To prepare:
Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
By Day 1 of this week, your instructor will assign you a case study. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3 of Week 2
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 8 Discussion Assessing Musculoskeletal Pain
The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To prepare:
By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Review the following case studies:

Case 1: Back Pain
Photo Credit: University of Virginia. (n.d.).Lumbar Spine Anatomy [Photograph].Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain
Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.
A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Case 3: Knee Pain
Photo Credit: University of Virginia. (n.d.).Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of the University of Virginia.
A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. What additional history do you need to determine the causes of knee pain? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

Concerning the case study you were assigned:
Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
By Day 3 of Week 8
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts and post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 8
Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 3 Assignment Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to interpret the results accurately.
These diagnostic tests affect adults, but body measurements can also provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.
Photo Credit: Getty Images/Hero Images
For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.
To Prepare
Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You will also review examples of pediatric patients and their families regarding BMI.
By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1) or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
Based on the risks you identified, consider what further information you would need to fully understand the child’s health. Think about how you could sensitively gather this information.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment
Assignment (3–4 pages, not including title and reference pages):
Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:
Include the following:
A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
What is its purpose?
How is it conducted?
What information does it gather?
Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
Assignment Option 2: Child Health Case:
Include the following:
An explanation of the health issues and risks that are relevant to the child you were assigned.
Describe additional information you would need in order to assess his or her weight-related health further.
Identify and describe any risks and consider further information you would need to understand the child’s healthfully. Think about how you could sensitively gather this information.
Considering the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 4 Assignment Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use differential diagnosis techniques to determine the most likely condition.
To Prepare
Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to examine for this Lab Assignment closely.
Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the diagnosis, and why.
Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five conditions for the skin graphic you chose. Determine which is most likely to be the diagnosis and explain your reasoning using at least three references, one from current evidence-based literature from your search and two from this week’s Learning Resources.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 5 Assignment Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat
Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
Review this week’s Learning Resources and consider the insights they provide.
Consider what history would be necessary to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 6 Assignment Assessing the Abdomen
A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, the doctor ordered a CT scan as a precaution. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.
In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.
To Prepare
Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.
With regard to the Episodic note case study provided:
Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Analyze the objective portion of the note. List additional information that should be included in the documentation.
Is the assessment supported by the subjective and objective information? Why or why not?
What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 9 Assignment Case Study Assignment: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates how impactful brain disorders can be to a patient’s quality of life. Accurately assessing neurological symptoms is a complex process involving analyzing many factors.
In this Case Study Assignment, you will consider case studies describing abnormal findings in patients in a clinical setting.
To Prepare
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
With regard to the case study you were assigned:
Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 10 Assignment Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to assess patients with problems in these areas accurately.

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients and which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare

· Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.

· Based on the Episodic note case study:

· Review this week’s Learning Resources and consider their insights about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.

· Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.

· Consider what history would be necessary to collect from the patient in the case study.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by subjective and objective information? Why or why not?

· Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not? Identify three conditions that may be considered a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

· Evaluate abnormal findings on the genitalia and rectum

· Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the breasts, genitalia, prostate, and rectum

GENITALIA ASSESSMENT

Subjective:

· CC: “I have bumps on my bottom that I want to have checked out.”

· HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

· PMH: Asthma

· Medications: Symbicort 160/4.5mcg

· Allergies: NKDA

· FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

· Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

· VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

· Heart: RRR, no murmurs

· Lungs: CTA, chest wall symmetrical

· Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia.

· Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

· Diagnostics: HSV specimen obtained

Assessment:

· Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Assignment: Lab Assignment: Assessing the Genitalia and Rectum

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by subjective and objective information? Why or why not?

· Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not? Identify three conditions that may be considered a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 11 Assignment Ethical Concerns

Assignment 1: Lab Assignment: Ethical Concerns

As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur?

In this Lab Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios.

To Prepare

Review the scenarios provided by your instructor for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your scenarios.

• Based      on the scenarios provided:
  • Select one scenario and reflect on the material presented throughout this course.
  • What necessary information would need to be obtained about the patient through health assessments and diagnostic assessments?
  • Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.

CASE STUDY 1

The parents of a 16-year-old male is seen for his required physical examination before starting sports. His parents are opposed to him receiving any vaccines.

The Lab Assignment

Write a detailed one-page narrative explaining the health assessment information required for diagnosing your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least three different references from current evidence-based literature.

NURS6512 Advanced Health Assessment and Diagnostic Reasoning Week 6 Exam
Question 1

You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:
Answers:
B. a multinodular goiter.
D. thyroiditis.
A. a congenital anomaly.
C. a normal thyroid gland.
Question 2Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?
Answers:
A. Coronal sutures
D. Nose and thyroid cartilages
C. Mandible and maxilla bones
B. Hyoid and cricoid cartilages
Question 3Peritonitis produces bowel sounds that are:
Answers:
hyperactive.
absent.
high pitched.
hypoactive.
Question 4When communicating with older children and teenagers, you should be sensitive to their:
Answers:
desire for adult companionship.
natural urge to communicate.
need for verbal instructions.
typical reluctance to talk.
Question 5The review of systems is a component of the:
Answers:
assessment.
physical examination.
health history.
past medical/surgical history.
Question 6You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:
Answers:
D. purpura.
A. telangiectasia.
B. spider angioma.
C. petechiae.
Question 7Mr. Akins is a 78-year-old patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.

Answers:
a. Loss of high frequency
b. Progression is slow
c. Bone conduction heard longer than air conduction
d. Sounds may be garbled and difficult to localize
e. Results from cranial nerve VII
f. Unable to hear in a crowded room
Question 8A guideline for history taking is for caregivers to:
Answers:
write detailed information as stated by patients so that their priorities are reflected.
make notes sparingly so that patients can be observed during the history taking.
ask direct questions before open-ended questions so that data move from simple to complex.
ask for a complete history at once so that data are not forgotten between meetings.
Question 9Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a:
Answers:
A. parotid gland tumor.
B. branchial cleft cyst.
C. Stensen duct stone.
D. thyroglossal duct cyst.
Question 10A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
Answers:
use topical over-the-counter hemorrhoid treatment for 1 week.
eat six small meals a day.
come to the laboratory for a stool guaiac test.
exercise and eat more fiber.
Question 11
Which cranial nerves innervate the face?
Answers:
D. VIII and IX
B. III and VI
A. II and V
C. V and VII
Question 12Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at:
Answers:
D. C4 to C5.
B. C2 to C3.
C. C3 to C4.
A. C1 to C2.
Question 13Expected hair distribution changes in older adults include:
Answers:
increased terminal hair follicles on the scalp.
more prominent peripheral extremity hair production.
more prominent axillary and pubic hair production.
increased terminal hair follicles to the tragus of men’s ears.
Question 14The attitudes of the health care professional:
Answers:
do not influence patient behavior.
are culturally derived.
are largely irrelevant to the success of relationships with the patient.
are difficult for the patient to sense.
Question 15Which of the following is the most vital nutrient?
Answers:
Protein
Carbohydrate
Water
Fat
Question 16The recommended minimum daily protein requirement for the normal adult is ______.
Answer:
Evaluation Method          Answer  Case Sensitivity
Match  10% to 35% of total calories
Contains              10 to 35 percent
Pattern Match    It is recommended that protein content of the diet be 10% to 35% of total calories, or 46 g in adults.
Contains              10% to 35%
Question 17Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an):
Answers:
ethnic assessment.
functional assessment.
social history.
genetic examination.
Question 18When examining the skull of a 4-month-old baby, you should normally find:
Answers:
D. overlap of cranial bones.
A. closure of the anterior fontanel.
C. ossification of all sutures.
B. closure of the posterior fontanel.
Question 19Periods of silence during the interview can serve important purposes, such as:
Answers:
allowing the clinician to catch up on documentation.
increasing the length of the visit.
providing time for reflection.
promoting calmness.
Question 20After thorough inspection of the abdomen, the next assessment step is:
Answers:
palpation.
percussion.
rectal examination.
auscultation.