jarvis physical examination and health assessment test bank

Questions 81

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jarvis physical examination and health assessment test bank Questions

Question 1 of 5

An 85-year-old man with newly diagnosed nonvalvular atrial fibrillation comes to the office for a follow-up. Which medication change would be most appropriate for reducing his stroke risk?

Correct Answer: C

Rationale: The correct answer is C: Stop aspirin and begin apixaban 5 mg twice a day. The rationale is that for stroke risk reduction in nonvalvular atrial fibrillation, anticoagulation therapy with direct oral anticoagulants (DOACs) like apixaban is preferred over antiplatelet therapy like aspirin. DOACs have been shown to be more effective in reducing stroke risk with a lower bleeding risk compared to warfarin. Choice A is incorrect as aspirin alone is not sufficient for stroke prevention in atrial fibrillation. Choice B is incorrect as warfarin has more monitoring requirements and potential drug interactions compared to DOACs like apixaban. Choice D is incorrect as aspirin and apixaban together are not recommended due to increased bleeding risk.

Question 2 of 5

You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning?

Correct Answer: B

Rationale: Correct Answer: B Rationale: 1. Adaptive questioning involves tailoring the questioning style to the patient's responses and needs to gather more detailed information. 2. Reassuring the patient that the symptoms are benign and not related to cancer is not a component of adaptive questioning as it can lead to bias and may hinder the patient from providing accurate information. 3. Directed questioning (A) helps to gather specific information systematically, offering choices (C) helps clarify symptoms, and asking for specific details (D) aids in understanding the patient's experiences. 4. By reassuring the patient prematurely, you may miss important details or dismiss potential concerns that could be relevant to the patient's condition.

Question 3 of 5

During a clinical examination, you observe that a patient's ears are positioned significantly below the level of the lateral eye canthi. What might this indicate about the patient's head and neck anatomy?

Correct Answer: B

Rationale: The correct answer is B: Potential congenital deformity. This observation suggests a condition called "low-set ears," which can be a sign of certain congenital anomalies affecting the development of the head and neck structures during fetal growth. It is important to investigate further to rule out any associated syndromes or genetic disorders. Choice A: Normal anatomical variation is incorrect because this positioning is not commonly considered a normal variation in the general population. Choice C: Increased risk of hearing loss is incorrect as the position of the ears alone does not directly correlate with hearing loss. Choice D: No clinical significance is incorrect because this observation warrants further evaluation to assess for potential underlying issues.

Question 4 of 5

Treatment for early PD in an otherwise healthy older patient without significant functional impairment should begin with:

Correct Answer: B

Rationale: The correct answer is B: Dopamine agonist. In early PD, dopamine agonists are preferred due to their lower risk of motor complications compared to levodopa. Dopamine agonists help improve motor symptoms by directly stimulating dopamine receptors. COMT inhibitors are usually used in combination with levodopa to prolong its effects. Levodopa is effective but can lead to motor complications with long-term use. Careful observation is not a treatment strategy and delays symptom management. Therefore, starting with a dopamine agonist is the most suitable option for early PD to manage symptoms effectively with minimal risk of motor complications.

Question 5 of 5

Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to �run into the bushes and go.� Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried �those Kegel exercises� in the past without success. Which of the following is the most appropriate recommendation for Ms. J?

Correct Answer: B

Rationale: The correct answer is B: Referral for biofeedback training in pelvic muscle exercise. Biofeedback training helps Ms. J improve her pelvic muscle control, which can address her urinary leakage issue. It is specifically tailored to strengthen the pelvic floor muscles, which can help with urinary incontinence. This option is appropriate for Ms. J as she has already tried Kegel exercises without success. Option A: Bladder training focuses on scheduling toilet trips and gradually increasing the time between trips. It may not be as effective for Ms. J's specific issue with leakage during physical activity. Option C: Solifenacin is a medication for overactive bladder symptoms, which may not be the best approach for Ms. J who has stress urinary incontinence. Option D: Topical estrogen is used for menopausal symptoms and genitourinary atrophy, which may not directly address Ms. J's issue with urinary leakage during physical activity.

Similar Questions

Ms. J, who is 82 years old, complains of urine leakage while playing golf. This has gotten worse over the past year, and she rarely makes it through nine holes without feeling like she needs to �run into the bushes and go.� Leakage is usually small volume, but causes her extreme embarrassment because she is afraid she will smell of urine. She has tried limiting caffeine in the morning before she golfs and avoiding drinking water while playing, to no effect. She also tried �those Kegel exercises� in the past without success. Which of the following is the most appropriate recommendation for Ms. J?
On examination of the neck, a dome-shaped lesion in the dermis forming a benign closed firm sac attached to the epidermis is noted on the right lateral side of the neck. The type of lesion is known as:
Mr. Roberts, a 72-year-old patient who has sought medical care on an intermittent basis in the past, complains of aching discomfort in his perineal area, urinary urgency, and frequency for the past few years. He also complains of insomnia and intermittent anxiety that he attributes to loneliness after his wife�s death about a year ago. Digital rectal examination (DRE) reveals a slightly enlarged, nontender prostate with no palpable nodules. Perineal examination is normal. Bladder scan is unremarkable and postvoid residual urine volume is 50 mL. Urinalysis shows no WBCs or RBCs. Urine culture is negative. Previous treatment has included dietary modifications and alpha-blocker medication. What is the most appropriate next step?
Symptoms consistent with later-stage human immunodeficiency disease (HIV) typically include all of the following except:
Ms. Wright comes to your office, complaining of palpitations. While checking her pulse you notice an irregular rhythm. When you listen to her heart, every fourth beat sounds different. It sounds like a triplet rather than the usual "lub dup." How would you document your examination?

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