Test Bank For Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition

Name: Test Bank For Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition
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Make the most of your study time with Test Bank For Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition, an exam guide designed to enhance retention and recall.

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Chapter 1 Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Which type of clinical decision-making is most reliable?
A Intuitive
B Analytical
C Experiential
D Augenblick
____ 2. Which of the following is false? To obtain adequate history, health-care providers must be:
A Methodical and systematic
B
C
D
Attentive to the patient’s verbal and nonverbal language Able to
accurately interpret the patient’s responses Adept at reading into the
patient’s statements
____ 3. Essential parts of a health history include all of the following except:
A Chief complaint
B History of the present illness
C. Current vital signs
D All of the above are essential history components
____ 4.Which of the following is false?While performing the physical examination, the examiner must be able to:
A Differentiate between normal and abnormal findings
B
C
Recall knowledge of a range of conditions and their associated signs and symptoms Recognize how
certain conditions affect the response to other conditions
D Foresee unpredictable findings
____ 5. The following is the least reliable source of information for diagnostic statistics:
A Evidence-based investigations
B Primary reports of research
C Estimation based on a provider’s experience
D Published meta-analyses
____ 6.
A
The following can be used to assist in sound clinical decision-making: Algorithm
published in a peer-reviewed journal article
B Clinical practice guidelines
C Evidence-based research
D All of the above
____ 7. If a diagnostic study has high sensitivity, this indicates a:
A
B
C
High percentage of persons with the given condition will have an abnormal result
Low percentage of persons with the given condition will have an abnormal result Low likelihood
of normal result in persons without a given condition
D None of the above
____ 8. If a diagnostic study has high specificity, this indicates a:
A Low percentage of healthy individuals will show a normal result

B
C
D
High percentage of healthy individuals will show a normal result
High percentage of individuals with a disorder will show a normal result
Low percentage of individuals with a disorder will show an abnormal result
____ 9.
A
B
C
D
A likelihood ratio above 1 indicates that a diagnostic test showing a: Positive result is strongly associated with the
disease
Negative result is strongly associated with absence of the disease Positive result is weakly associated with the disease
Negative result is weakly associated with absence of the disease
____ 10. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical
modeling to express the likelihood of a condition in select situations, settings, and/or patients?
A
B
Clinical practice guideline
Clinical decision rule
C Clinical algorithm
Answer Section
MULTIPLE CHOICE
1. ANS: B
Croskerry (2009) describes two major types of clinical diagnostic decision-making: intuitive and analytical. Intuitive
decision-making (similar to Augenblink decision-making) is based on the experience and intuition of the clinician and is
less reliable and paired with fairly common errors. In contrast, analytical decision-making is based on careful consideration
and has greater reliability with rare errors.
2. ANS: D
To obtain adequate history, providers must be well organized, attentive to the patient’s verbal and nonverbal
language, and able to accurately interpret the patient’s responses to questions. Rather than reading into the patient’s
statements, they clarify any areas of uncertainty.
3. ANS: C
Vital signs are part of the physical examination portion of patient assessment, not part of the health history.
4. ANS: D
While performing the physical examination, the examiner must be able to differentiate between normal and abnormal
findings, recall knowledge of a range of conditions, including their associated signs and symptoms, recognize how certain
conditions affect the response to other conditions, and distinguish the relevance of varied abnormal findings.
5. ANS: C
Sources for diagnostic statistics include textbooks, primary reports of research, and published meta-analyses. Another source
of statistics, the one that has been most widely used and available for application to the reasoning process, is the estimation
based on a provider’s experience, although these are rarely accurate. Over the past decade, the availability of evidence on
which to base clinical reasoning is improving, and there is an increasing expectation that clinical reasoning be based on
scientific evidence. Evidence-based statistics are also increasingly being used to develop resources to facilitate clinical
decision-making.
6. ANS: D
To assist in clinical decision-making, a number of evidence-based resources have been developed to assist the clinician.
Resources, such as algorithms and clinical practice guidelines, assist in clinical reasoning when properly applied.
7. ANS: A

The sensitivity of a diagnostic study is the percentage of individuals with the target condition who show an
abnormal, or positive, result. A high sensitivity indicates that a greater percentage of persons with the given
condition will have an abnormal result.
8. ANS: B
The specificity of a diagnostic study is the percentage of normal, healthy individuals who have a normal result. The
greater the specificity, the greater the percentage of individuals who will have negative, or normal, results if they do
not have the target condition.
9. ANS: A
The likelihood ratio is the probability that a positive test result will be associated with a person who has the target
condition and a negative result will be associated with a healthy person. A likelihood ratio above 1 indicates that a
positive result is associated with the disease; a likelihood ratio less than 1 indicates that a negative result is
associated with an absence of the disease.
10. ANS: B
Clinical decision (or prediction) rules provide another support for clinical reasoning. Clinical decision rules are
evidence-based resources that provide probabilistic statements regarding the likelihood that a condition exists if
certain variables are met with regard to the prognosis of patients with specific findings. Decision rules use
mathematical models and are specific to certain situations, settings, and/or patient characteristics.

____
Chapter 2 Evidence-Based Health Screening
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. The first step in the genomic assessment of a patient is obtaining information regarding:
A Family history
B
C
D
Environmental exposures
Lifestyle and behaviors
Current medications
____ 2. An affected individual who manifests symptoms of a particular condition through whom a family
with a genetic disorder is ascertained is called a(n):
A Consultand
B
C
Consulband
Index patient
D Proband
____ 3. An autosomal dominant disorder involves the:
A X chromosome
B Y chromosome
C
D
Mitochondrial DNA Non-
sex chromosomes
____ 4. To illustrate a union between two second cousin family members in a pedigree, draw:
A Arrows pointing to the male and female
B Brackets around the male and female
C Double horizontal lines between the male and female
D Circles around the male and female
____ 5.
A
To illustrate two family members in an adoptive relationship in a pedigree: Arrows are
drawn pointing to the male and female
B Brackets are drawn around the male and female
C Double horizontal lines are drawn between the male and female
D Circles are drawn around the male and female
____ 6. When analyzing the pedigree for autosomal dominant disorders, it is common to see:
A Several generations of affected members
B Many consanguineous relationships
C
D
More members of the maternal lineage affected than paternal More
members of the paternal lineage affected than maternal
____ 7.
A
In autosomal recessive (AR) disorders, individuals need:
Only one mutated gene on the sex chromosomes to acquire the disease
B Only one mutated gene to acquire the disease
C Two mutated genes to acquire the disease
D Two mutated genes to become carriers

____ 8. In autosomal recessive disorders, carriers have:
A
B
C
D
Two mutated genes; one from each parent that cause disease
A mutation on a sex chromosome that causes a disease
A single gene mutation that causes the disease
One copy of a gene mutation but not the disease
____ 9.With an autosomal recessive disorder, it is important that parents understand that if they both carry a
mutation, the following are the risks to each of their offspring (each pregnancy):
A 50% chance that offspring will carry the disease
B
C
D
10% chance of offspring affected by disease 25%
chance children will carry the disease 10% chance
children will be disease free
____ 10. A woman with an X-linked dominant disorder will:
A Not be affected by the disorder herself
B Transmit the disorder to 50 % of her offspring (male or female)
C Not transmit the disorder to her daughters
D Transmit the disorder to only her daughters
____ 11.In creating your female patient’s pedigree, you note that she and both of her sisters were affected by the same genetic
disorder. Although neither of her parents had indications of the disorder, her paternal grandmother and her paternal
grandmother’s two sisters were affected by the same condition. This pattern suggests:
A Autosomal dominant disorder
B Chromosomal disorder
C
D
Mitochondrial DNA disorder X-
linked dominant disorder
____ 12. A woman affected with an X-linked recessive disorder:
A
B
C
D
Has one X chromosome affected by the mutation
Will transmit the disorder to all of her children
Will transmit the disorder to all of her sons
Will not transmit the mutation to any of her daughters
____ 13. Which of the following are found in an individual with aneuploidy?
A An abnormal number of chromosomes
B An X-linked disorder
C Select cells containing abnormal-appearing chromosomes
D An autosomal recessive disorder
____ 14. The pedigree of a family with a mitochondrial DNA disorder is unique in that:
A
B
C
None of the female offspring will have the disease
All offspring from an affected female will have disease
None of the offspring of an affected female will have the disease
D All the offspring from an affected male will have disease
____ 15. Which population is at highest risk for the occurrence of aneuploidy in offspring?

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A
B
C
Mothers younger than 18
Fathers younger than 18
Mothers over age 35
D Fathers over age 35
____ 16.
A
B
C
D
Approximately what percentage of cancers is due to a single-gene mutation?50% to 70%
30% to 40%
20% to 25%
5% to 10%
____ 17. According to the Genetic Information Nondiscrimination Act (GINA):
A
B
C
NPs should keep all genetic information of patients confidential
NPs must obtain informed consent prior to genetic testing of all patients Employers
cannot inquire about an employee’s genetic information
D All of the above
____ 18. The leading causes of death in the United States are due to:
A
B.
Multifactorial inheritance
Single gene mutations
C. X-linked disorders
D Aneuploidy
____ 19. Which of the following would be considered a “red flag” that requires more investigation in a patient
assessment?
A Colon cancer in family member at age 70
B
C
D
Breast cancer in family member at age 75 Myocardial
infarction in family member at age 35 All of the above
____ 20. When patients express variable forms of the same hereditary disorder, this is due to:
A Penetrance
B Aneuploidy
C
D
De novo mutation
Sporadic inheritance
____ 21. Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single
transverse palmar crease, and a low nasal bridge. These are referred to as:
A
B
Variable expressivity related to inherited disease
Dysmorphic features related to genetic disease
C De novo mutations of genetic disease
D Different penetrant signs of genetic disease
____ 22. In order to provide a comprehensive genetic history of a patient, the NP should:
A
B
C
Ask patients to complete a family history worksheet
Seek out pathology reports related to the patient’s disorder Interview
family members regarding genetic disorders
D All of the above

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Answer Section
MULTIPLE CHOICE
1. ANS: A
A critical first step in genomic assessment, including assessment of risk, is the use of family history. Family history
is considered the first genetic screen (Berry & Shooner 2004) and is a critical component of care because it reflects
shared genetic susceptibilities, shared environment, and common behaviors (Yoon, Scheuner, & Khoury 2003).
2. ANS: D
A proband is defined as the affected individual who manifests symptoms of a particular condition through whom a
family with a genetic disorder is ascertained (Pagon et al. 1993–2013). The proband is the affected individual
that brings the family to medical attention.
3.ANS:D
Autosomal dominant (AD) inheritance is a result of a gene mutation in one of the 22 autosomes.
4. ANS: C
A consanguineous family is related by descent from a common ancestry and is defined as a
“union between two individuals who are related as second cousins or closer” (Hamamy 2012). Consanguinity, if
present in the family history, is portrayed using two horizontal lines to establish the relationship between the
male and female partners.
5. ANS: B
For adopted members of the family, use brackets as the appropriate standardized pedigree symbol ([e.g.,
brackets]).
6. ANS: A
Pedigrees associated with autosomal dominant (AD) disorders typically reveal multiple affected family members
with the disease or syndrome. When analyzing the pedigree for AD disorders or syndromes, it is common to see a
“vertical” pattern denoting several generations of affected members.
7. ANS: C
In autosomal recessive (AR) disorders, the offspring inherits the condition by receiving one copy of the gene
mutation from each of the parents. Autosomal recessive disorders must be inherited through both parents (Nussbaum
et al. 2007). Individuals who have an AR disorder have two mutated genes, one on each locus of the chromosome.
Parents of an affected person are called carriers because each carries one copy of the mutation on one chromosome
and a normal gene on the other chromosome. Carriers typically are not affected by the disease.
8. ANS: D
Individuals who have an AR disorder have two mutated genes, one on each allele of the
chromosome. Parents of an affected person are called carriers because each parent carries one copy of the mutation
on one chromosome and a normal gene on the other chromosome. Carriers typically are not affected by the disease.
In pedigrees with an AR inheritance patterns, males and females will be equally affected because the gene mutation
is on an autosome.
9. ANS: A
It is important that parents understand that if they both carry a mutation, the risk to each of their offspring (each
pregnancy) is an independent event: 25% disease free, 25% affected, and 50% carrier.

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10. ANS: B
Everyone born with an X-linked dominant disorder will be affected with the disease. Transmission of the
disorder to the next generation varies by gender, however. A woman will transmit the mutation to 50% of all her
offspring (male or female).
11. ANS: D
A man with an X-linked dominant disorder will transmit the mutation to 100% of his daughters
(they receive his X chromosome) and none of his sons (they receive his Y chromosome). The
pedigree of a family with an X-linked dominant disorder would reveal all the daughters and none
of the sons affected with the disorder if the father has an X-linked disorder.
12. ANS: C
An X-linked recessive disorder means that in a woman, both X chromosomes must have the
mutation if she is to be affected. Because males have only one copy of the X chromosome, they
will be affected if their X chromosome carries the mutation.
13. ANS: A
An individual with an abnormal number of chromosomes has a condition called aneuploidy,
which is frequently associated with mental problems or physical problems or both (Jorde, Carey,
& Bamshad 2010; Nussbaum et al. 2007).
14. ANS: B
Mitochondrial DNA is inherited from the ovum and, therefore, from the mother. The pedigree of
a family with a mitochondrial DNA disorder is unique in that all offspring (regardless of gender)
of an affected female will have the disease, and none of the offspring from an affected male will
have the disease.
15. ANS: C
Some individuals or couples have unique identifiable risks that should be discussed prior to conception whenever
possible. For example, women who will be 35 years of age or older at delivery (advanced maternal age) are at
increased risk for aneuploidy.
16. ANS: D
The majority of cancers are sporadic or multifactorial due to a combination of genetic and environmental factors;
however, approximately 5% to 10% of all cancers are due to a single-
gene mutation (Garber & Offit 2005).
17. ANS: D
On May 21, 2008, President George W. Bush signed the Genetic Information Nondiscrimination
Act (GINA) to protect Americans against discrimination based upon their genetic information
when it comes to health insurance and employment, paving the way for patient personalized
genetic medicine without fear of discrimination (National Human Genome Research Institute
2012).
18. ANS: A
Most disease-causing conditions are not due to a single-gene disorder but are due to multifactorial
inheritance, a result of genomics and environmental or behavioral influences. In fact, the leading
causes of mortality in the United States—heart disease, cerebrovascular disease, diabetes, and cancer—are all
multifactorial. Most congenital malformation, hypertension, arthritis, asthma, obesity, epilepsy, Alzheimer’s, and mental
health disorders are also multifactorial.
19. ANS: C
Early onset cancer syndromes, heart disease, or dementia are red flags that warrant further investigation regarding
hereditary disorders.
20. ANS: A
Some disorders have a range of expression from mild to severe. This variability is referred to as
the penetrance of genetic disease. For example, patients with neurofibromatosis (NF1), an AD disorder of the
nervous system, may manifest with many forms of the disease. For instance, some patients with NF1 may have mild
symptoms, like café-au-lait spots or freckling on the axillary or

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skin, while others may have life-threatening spinal cord tumors or malignancy (Jorde, Carey, & Bamshad 2010;
Nussbaum et al. 2007).
21. ANS: B
Assessing for dysmorphic features may enable identification of certain syndromes or genetic or chromosomal
disorders (Jorde, Carey, & Bamshad 2010; Prichard & Korf 2008). Dysmorphology is defined as “the
study of abnormal physical development” (Jorde, Carey, & Bamshad 2010, 302).
22. ANS: D
Asking the patient to complete a family history worksheet prior to the appointment saves time in the visit while
offering the patient an opportunity to contribute to the collection of an accurate family history. Reviewing the
family information can also help establish family rapport while verifying medical conditions in individual family
members. If a hereditary condition is being considered but family medical information is unclear or unknown,
requesting medical records and pathology or autopsy reports may be warranted.

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Chapter 3 Abdominal Pain
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. When performing abdominal assessment, the clinician should perform examination techniques in the following order:
A Inspection, palpation, percussion, and auscultation
B. Inspection, percussion, palpation, and auscultation
C. Inspection, auscultation, percussion, and palpation
D Auscultation, palpation, percussion, and inspection
____ 2. The clinician should auscultate the abdomen to listen for possible bruits of the:
A Aorta
B. Renal artery
C. Iliac artery
D All of the above
____ 3. On abdominal examination, which of the following is assessed using percussion?
A Liver
B. Kidneys
C. Pancreas
D Esophagus
____ 4. In abdominal assessment, a digital rectal examination is performed to assess for:
A Hemorrhoids
B. Prostate size
C. Blood in stool
D Ureteral stenosis
____ 5. Rebound tenderness of the abdomen is a sign of:
A Constipation
B. Peritoneal inflammation
C. Elevated venous pressure
D Peritoneal edema
____ 6. While assessing the abdomen, the clinician deeply palpates the left lower quadrant of the abdomen, and this
causes pain in the patient’s right lower abdomen. This is most commonly indicative of:
A Constipation
B. Diverticulitis
C. Appendicitis
D Hepatitis
____ 7. Your patient complains of severe right lower quadrant abdominal pain. To assess the patient for
peritoneal inflammation, the examiner should:
A. Percuss the right lower quadrant of the abdomen
B. Deeply palpate the right lower quadrant of the abdomen
C. Auscultate the right lower quadrant for hyperactive bowel sounds
D. Strike the plantar surface of the patient’s heel while the patient is supine

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____ 8. Your patient is lying supine and you ask him to raise his leg while you place resistance against the thigh.
The examiner is testing the patient for:
A Psoas sign
B. Obturator sign
C. Rovsing’s sign
D Murphys’ sign
____ 9. A patient is lying supine and the clinician deeply palpates the right upper quadrant of the abdomen
while the patient inhales. The examiner is testing the patient for:
A Psoas sign
B. Obturator sign
C. Rovsing’s sign
D Murphys’ sign
____ 10. Your patient has abdominal pain, and it is worsened when the examiner rotates the patient’s right hip
inward with the knee bent and the obturator internus muscle is stretched. This is a sign of:
A Diverticulitis
B. Cholecystitis
C. Appendicitis
D Mesenteric adenitis
____ 11. On abdominal examination as the clinician presses on the right upper quadrant to assess liver size,
jugular vein distension becomes obvious. Hepatojugular reflux is indicative of:
A Acute hepatitis
B. Right ventricular failure
C. Cholecystitis
D Left ventricular failure
____ 12. Your patient demonstrates positive shifting dullness on percussion of the abdomen. This is indicative of:
A Cholecystitis
B. Appendicitis
C. Ascites
D Hepatitis
____ 13. Your 44-year-old female patient complains of right upper quadrant pain. Her skin and sclera are yellow,
and she has hyperbilirubinemia and elevated liver enzymes. The clinician should suspect:
A Acute pancreatitis
B. Biliary duct obstruction
C. Acute hepatitis
D Atypical appendicitis
____ 14. The most common cause of acute pancreatitis is:
A Trauma
B. Hepatitis virus A
C. Hyperlipidemia
D Alcohol abuse
____ 15. Your patient with pancreatitis has a Ranson rule score of 8. The clinician should recognize that this is a risk of:

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A Pleural involvement
B. Alcoholism
C. High mortality
D Bile duct obstruction
____ 16. Your patient complains of left upper quadrant pain, fever, extreme fatigue, and spontaneous bruising.
The clinician should recognize that these symptoms are often related to:
A Hematopoetic disorders
B. Hepatomegaly
C. Esophageal varices
D Pleural effusion
____ 17.A 16-year-old patient presents with sore throat, cervical lymphadenopathy, fever, extreme fatigue, and left upper quadrant
pain. The physical examination reveals splenomegaly. The clinician should recognize the probability of:
A Bacterial endocarditis
B. Infectious mononucleosis
C. Pneumonia with pleural effusion
D Pancreatic cancer
____ 18.Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3
weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The
clinician needs to consider:
A Diverticulitis
B. Appendicitis
C. Colon cancer
D Peptic ulcer disease
____ 19. Which of the following is the most common cause of heartburn-type epigastric pain?
A Decreased lower esophageal sphincter tone
B. Helicobacteria pylori infection of stomach
C. Esophageal spasm
D Excess use of NSAIDs
____ 20. A 22-year-old female enters the emergency room with complaints of right lower quadrant abdominal pain,
which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and
rebound tenderness over the right lower quadrant. The clinician should recognize the importance of:
A Digital rectal examination
B. Endoscopy
C. Ultrasound
D Pelvic examination
____ 21. The major sign of ectopic pregnancy is:
A. Sudden onset of severe epigastric pain
B. Amenorrhea with unilateral lower quadrant pain
C. Lower back and rectal pain
D. Palpable abdominal mass
____ 22. When ruptured ectopic pregnancy is suspected, the following procedure is most important:
A Culdocentesis

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B. CT scan
C. Abdominal x-ray
D Digital rectal examination
____ 23. The majority of colon cancers are located in the:
A Transverse colon
B. Cecum
C. Rectosigmoid region
D Ascending colon
____ 24. The following symptom(s) in the patient’s history should raise the clinician’s suspicion of colon cancer:
A Alternating constipation and diarrhea
B. Narrowed caliber of stool
C. Hematochezia
D All of the above
____ 25. A patient presents to the emergency department with nausea and severe, colicky back pain that radiates
into the groin. When asked to locate the pain, he points to the right costovertebral angle region. His physical
examination is unremarkable. Which of the following lab tests is most important for the diagnosis?
A Urinalysis
B. Serum electrolyte levels
C. Digital rectal exam
D Lumbar x-ray
____ 26.Your 34-year-old female patient complains of a feeling of “heaviness” in the right lower quadrant, achiness, and bloating.
On pelvic examination, there is a palpable mass in the right lower quadrant. Urine and serum pregnancy tests are negative.
The diagnostic tool that would be most helpful is:
A Digital rectal exam
B. Transvaginal ultrasound
C. Pap smear
D Urinalysis
____ 27. Your 54-year-old male patient complains of a painless “lump” in his lower left abdomen that comes and
goes for the past couple of weeks. When examining the abdomen, you should have the patient:
A Lie flat and take a deep breath
B. Stand and bear down against your hand
C. Prepare for a digital rectal examination
D Lie in a left lateral recumbent position
____ 28. A nurse practitioner reports that your patient’s abdominal x-ray demonstrates multiple air-fluid levels
in the bowel. This is a diagnostic finding found in:
A Appendicitis
B. Cholecystitis
C. Bowel obstruction
D Diverticulitis

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____ 29.A 76-year-oldpatient presents to the emergency department with severe left lower quadrant abdominal pain,
diarrhea, and fever. On physical examination, you note the patient has a positive heel strike, and left lower
abdominal rebound tenderness. These are typical signs and symptoms of which of the following conditions?
A Diverticulitis
B. Salpingitis
C. Inflammatory bowel disease
D Irritable bowel syndrome
____ 30. Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea?
A Viral gastroenteritis
B. Staphylococcal food poisoning
C. Acute hepatitis A
D E.coli gastroenteritis
____ 31.A patient presents to the emergency department with complaints of vomiting and abdominal pain. You note that the emesis
contains bile. On physical examination, there is diffuse tenderness, abdominal distension, and rushing, high-pitched bowel
sounds. Which of the following diagnoses would be most likely?
A Gastric outlet obstruction
B.
C.
Small bowel obstruction
Distal intestinal blockage
D Colonic obstruction
____ 32.Your 5-year-old female patient presents to the emergency department with sore throat, vomiting, ear ache, 103 degree fever,
photophobia, and nuchal rigidity. She has an episode of projectile vomiting while you are examining her. The clinician should
recognize that the following should be done:
A Abdominal x-ray
B. Fundoscopic examination
C. Lumbar puncture
D Analysis of vomitus
____ 33.A 9-year-old boy accompanied by his mother reports that since he came home from summer camp, he has had fever,
nausea, vomiting, severe abdominal cramps and watery stools that contain blood and mucus. The clinician should recognize
the importance of:
A. Stool for ova and parasites
B. Abdominal x-ray
C. Stool for clostridium
D. Fecal occult blood test
____ 34.A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At
times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for
the clinician to recognize the importance of:
A CBC with differential
B. Stool culture and sensitivity
C. Abdominal x-ray
D Colonoscopy
____ 35.A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The
symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the
episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any
abnormalities. This is a history and physical consistent with:
A Inflammatory bowel disease

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B. Irritable bowel syndrome
C. Laxative abuse
D Norovirus gastroenteritis
____ 36. A 78-year-old female patient is suffering from heart failure, GERD, diabetes, and depression. She
presents with complaints of frequent episodes of constipation. Her last bowel movement was 1 week ago. Upon
examination, you palpate a hard mass is the left lower quadrant of the abdomen. You review her list of
medications. Which of the following of her medications cause constipation?
A Digitalis (Lanoxin)
B. Amlodipine (Norvasc)
C. Sertraline (Zoloft)
D Metformin (Glucophage)
____ 37. You are examining a 55-year-old female patient with a history of alcohol abuse. She complains of
anorexia, nausea, pruritus, and weight loss over the last month. On physical examination, you note yellow hue of
the skin and sclera. Which of the following physical examination techniques is most important?
A Scratch test
B. Heel strike
C. Digital rectal examination
D Pelvic examination
____ 38. You observe Charcot’s triad of sign and symptoms in a patient under your care. This is commonly seen in
which of the following disorders?
A Cirrhosis
B. Pancreatitis
C. Cholangitis
D Portal hypertension
____ 39. A 59-year-old patient with history of alcohol abuse is admitted for hematemesis. On physical
examination, you note ascites and caput medusa. A likely cause for the hematemesis is:
A Peptic ulcer disease
B. Barrett’s esophagus
C. Pancreatitis
D Esophageal varices
____ 40.A 16-year-old female with anorexia and bulimia is admitted for hematemesis. She admits to inducing vomiting often. On
physical examination, you note pallor, BMI less than 15, and hypotension. A likely reason for hematemesis is:
A Mallory-Weiss tear
B. Cirrhosis
C. Peptic ulcer disease
D Esophageal varies
____ 41. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She
admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She
self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has
orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is:
A Mallory-Weiss tear
B. Esophageal varices

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Nursing

Test Bank For Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition

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