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NU 650 MIDTERM EXAM 2025|ACTUAL 220
QUESTIONS AND ANSWERS|GRADED A+|NEW
An 85 y.o. woman is brought to the urgent care center for possible aspiration pneumonia. The NP understands that, based on normal anatomy adventitious lung sounds will most likely be heard in which of the following areas? A. left upper lobe B. left middle & lower lobes C. right upper lobe D. Right middle and lower lobes D Barrel chest is an abnormal chest configuration that may occur in which of the following disorders? A. COPD B. Pneumonia C. Pneumothorax D. TBA A Bronchovesticular sounds are heard normally at which location? A. second intercostal space anteriorly bilaterally B. base of lungs bilaterally, posteriorly C. laterally at the midaxillary line, bilaterally
D. Bilaterally at the mid-clabicular line, 5th intercostal space A Normally when the lung fields are percussed the resulting sound is described as _______: A. hyperresonant B. resonant C. tympanic D. Dull B The clinic has extended hours to provide flu vaccines and preventative teaching for the community. Based on current CDC influenza vaccine recommendations, the NP understands which of the following patients has a contraindication and cannot receive the vaccine? A. healthy 2 month baby girl B. primagravida at 32 weeks C. 60 y.o male with hx CHF D. 45 y.o female with BMI of 42 A The NP will nose a history of chronic cough based on the patients report of symptoms lasting for: A. 1 week B. 4 weeks
D
Which of the following is an expected change of aging? A. supraclavicular retractions with inspiration B. Kyphosis C. There is a decrease of the elastic properties within lungs D. Pectus excavatum C Cultural Humility: A process that requires humility as individuals continually engage in self- reflection and self-critique as lifelong learners and reflective practitioners. 3 Dimensions of cultural humility
- Self-awareness: learn about your own biases; we all have them.
- Respectful communication: work to eliminate assumptions about what is "normal". Learn directly from your patients; they are the experts on their culture and illness.
- Collaborative partnerships: build your patient relationships on respect and mutually acceptable plans. True or False: The beginning NP should focus on interpreting the findings of the physical examination.
False Which of the following statements represents a general goal for the comprehensive or focused physical examination? a. Avoid unnecessary changes in position b. Maximize patient comfort c. Enhance clinical efficiency d. all of the above D You are performing a thorough cardiac examination. Which of the following chambers of the heart can you assess by palpation? A) Left atrium B) Right atrium C) Right ventricle D) Sinus node C What is responsible for the inspiratory splitting of S2? A) Closure of aortic, then pulmonic valves B) Closure of mitral, then tricuspid valves C) Closure of aortic, then tricuspid valves D) Closure of mitral, then pulmonic valves A
C) Stage 1 hypertension D) Stage 2 hypertension B Prehypertension = 120-139/80- 89 You are participating in a health fair and performing cholesterol screens. One person has a cholesterol of 225. 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? A) Ethnicity B) Alcohol intake C) Gender D) Asthma C You are evaluating a 40-year-old banker for coronary heart disease risk factors. He has a history of hypertension, which is well-controlled on his current medications. He does not smoke; he does 45 minutes of aerobic exercise five times weekly. You are calculating his 10-year coronary heart disease risk. Which of the following conditions is considered to be a coronary heart disease risk equivalent? A) Hypertension B) Peripheral arterial disease C) Systemic lupus erythematosus D) Chronic obstructive pulmonary disease (COPD) B
You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure they can distinguish between the jugular venous pulsation and the carotid pulse. Which one of the following characteristics is typical of the carotid pulse? A) Palpable B) Soft, rapid, undulating quality C) Pulsation eliminated by light pressure on the vessel D) Level of pulsation changes with changes in position A A 68-year-old mechanic presents to the emergency room for shortness of breath. You are concerned about a cardiac cause and measure his jugular venous pressure (JVP). It is elevated. Which one of the following conditions is a potential cause of elevated JVP? A) Left-sided heart failure B) Mitral stenosis C) Constrictive pericarditis D) Aortic aneurysm C You are palpating the apical impulse in a patient with heart disease and find that the amplitude is diffuse and increased. Which of the following conditions could be a potential cause of an increase in the amplitude of the impulse? A) Hypothyroidism B) Aortic stenosis, with pressure overload of the left ventricle C) Mitral stenosis, with volume overload of the left atrium
B) Atrial flutter C) Sinus arrhythmia D) Atrial fibrillation A Where is the point of maximal impulse (PMI) normally located? A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum B) In the left 5th intercostal space, 10 to 12 cm lateral to the sternum C) In the left 5th intercostal space, in the anterior axillary line D) In the left 5th intercostal space, in the midaxillary line A Which of the following events occurs at the start of diastole? A) Closure of the tricuspid valve B) Opening of the pulmonic valve C) Closure of the aortic valve D) Production of the first heart sound (S1) C
Which is true of a third heart sound (S3)? A) It marks atrial contraction. B) It reflects normal compliance of the left ventricle. C) It is caused by rapid deceleration of blood against the ventricular wall. D) It is not heard in atrial fibrillation. C Which is true of splitting of the second heart sound? A) It is best heard over the pulmonic area with the bell of the stethoscope. B) It normally increases with exhalation. C) It is best heard over the apex. D) It does not vary with respiration. A Which of the following is true of jugular venous pressure (JVP) measurement? A) It is measured with the patient at a 45-degree angle. B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP. C) A JVP below 9 cm is abnormal.
A) Every 6 months B) Every year C) Every 2 years D) Every 5 years C Which of the following is a clinical identifier of metabolic syndrome? A) Waist circumference of 38 inches for a male B) Waist circumference of 34 inches for a female C) BP of 134/88 for a male D) BP of 128/84 for a female C Mrs. Adams would like to begin an exercise program and was told to exercise as intensely as necessary to obtain a heart rate 60% or greater of her maximum heart rate. She is 52. What heart rate should she achieve? A) 80 B) 100 C) 120 D) 140 B
In measuring the jugular venous pressure (JVP), which of the following is important? A) Keep the patient's torso at a 45-degree angle. B) Measure the highest visible pressure, usually at end expiration. C) Add the vertical height over the sternal notch to a 5-cm constant. D) Realize that a total value of over 12 cm is abnormal. B You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you search out? A) Mitral valve prolapse B) Pulmonic stenosis C) Tricuspid insufficiency D) Aortic insufficiency D To hear a soft murmur or bruit, which of the following may be necessary? A) Asking the patient to hold her breath B) Asking the patient in the next bed to turn down the TV C) Checking your stethoscope for air leaks
C) Fever D) Hypertension D You are examining a patient with emphysema in exacerbation and are having difficulty hearing his heart sounds. What should you do to obtain a good exam? A) Listen in the epigastrium. B) Listen to the patient in the left lateral decubitus position. C) Ask the patient to hold his breath for 30 seconds. D) Listen posteriorly. A You are listening carefully for S2 splitting. Which of the following will help? A) Using the diaphragm with light pressure over the 2nd right intercostal space B) Using the bell with light pressure over the 2nd left intercostal space C) Using the diaphragm with firm pressure over the apex D) Using the bell with firm pressure over the lower left sternal border B Which of the following is true of a grade 4-intensity murmur? A) It is moderately loud.
B) It can be heard with the stethoscope off the chest. C) It can be heard with the stethoscope partially off the chest. D) It is associated with a "thrill." D Which valve lesion typically produces a murmur of equal intensity throughout systole? A) Aortic stenosis B) Mitral insufficiency C) Pulmonic stenosis D) Aortic insufficiency B You notice a patient has a strong pulse and then a weak pulse. This pattern continues. Which of the following is likely? A) Emphysema B) Asthma exacerbation C) Severe left heart failure D) Cardiac tamponade C
A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know if she has this or not. Which of the following disease process is a risk factor for peripheral vascular disease? A) Gastroesophageal reflux disease B) Coronary artery disease C) Migraine headaches D) Osteoarthritis B A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition? A) Venogram B)CT scan of the lower legs C) Ankle-brachial index (ABI) D) PET sca C A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to
your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms? A) Femoral pulse, popliteal pulse B) Dorsalis pedis pulse, posterior tibial pulse C) Carotid pulse D) Radial pulse, brachial pulse D You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination? A) Size, symmetry, and skin color B) Muscle bulk and tone C) Nodules in joints D) Lower extremity strength A You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and
