NCLEX Practice Questions Physical Assessment

Correct Answer: A

Rationale: The most likely diagnosis for this patient's symptoms and signs is acute diverticulitis. His presentation of abdominal pain, constipation, and low-grade fever, along with tenderness over the left lower quadrant, is consistent with diverticulitis, which is inflammation or infection of small pouches (diverticula) that can develop in the colon. The history of recent onset of symptoms after consuming popcorn, typically a high-fiber food that can exacerbate diverticulitis, further supports this diagnosis. The negative fecal occult blood test makes more acute intra-abdominal processes like acute appendicitis less likely. Acute cholecystitis would present with right upper quadrant pain, and mesenteric ischemia typically presents with severe abdominal pain, nausea, and vomiting, as well as signs of abdominal distress.

Correct Answer: A

Rationale: Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically around the stapes bone. In cases of otosclerosis, the bone conduction is greater than air conduction on the affected side, which is seen in the scenario described. The Weber test localizes to the affected ear, meaning the patient hears the sound of the tuning fork better in the left ear in this case. This is because the abnormal bone growth can restrict the movement of the ossicles, leading to a conductive hearing loss. Otosclerosis typically affects one ear, and its presentation aligns with the results of the hearing tests performed in this case.

Correct Answer: D

Rationale: It is crucial to assess Adam's suicide risk immediately due to the statements he made about it being better if he were not here. This indicates possible suicidal ideation, which requires urgent attention and intervention. Asking directly about suicidal thoughts and intentions can help determine the level of risk and ensure that appropriate support and resources are provided to Adam. It is important to take any mention of suicide seriously and prioritize the safety and well-being of the individual in such situations.

Correct Answer: A

Rationale: Mr. Kelly's scenario is consistent with the phenomenon called "white coat hypertension," where an individual's blood pressure readings are elevated in a medical setting due to anxiety or stress, but are normal when measured at home. This discrepancy between office and home readings is a key indicator of white coat hypertension. Additionally, the fact that Mr. Kelly has been consistently monitoring his blood pressure at home and has kept a log supports the likelihood that his elevated readings in the office are primarily due to the stress of being in that environment. It is important to acknowledge white coat hypertension as a common occurrence and not necessarily a reflection of true high blood pressure that requires immediate medical intervention.

Correct Answer: C

Rationale: Given the patient's presentation of itching, anorectal pain, and tenesmus, along with rectal examination findings of generalized tenderness without prostate abnormalities, proctitis is the most likely diagnosis. Proctitis is inflammation of the rectal lining and is commonly associated with symptoms such as rectal pain, itching, tenesmus (feeling of incomplete defecation), and sometimes rectal bleeding. It can have various causes, including sexually transmitted infections (such as gonorrhea, chlamydia), inflammatory bowel disease, radiation therapy, or trauma.