ATI RN
Physical Examination and Health Assessment 8th Edition Test Bank Questions
Question 1 of 5
Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for 2 days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect?
Correct Answer: B
Rationale: The description of dark, granular material resembling coffee grounds in the vomitus suggests upper gastrointestinal bleeding. One common cause of upper GI bleeding is a peptic ulcer, which can present with symptoms such as vomiting blood or coffee ground material. Peptic ulcers can develop in the stomach or the upper part of the small intestine (duodenum). Risk factors for peptic ulcers include infection with Helicobacter pylori bacteria, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, and alcohol consumption. Prompt evaluation and management are necessary in cases of upper GI bleeding to address the underlying cause and prevent complications.
Question 2 of 5
You are working in a college health clinic and seeing a young woman with a red, painful, swollen DIP joint on the left index finger. There are also a few papules, pustules, and vesicles on reddened bases, located on the distal extremities. This would be consistent with which of the following?
Correct Answer: D
Rationale: The description provided indicates a presentation consistent with gonococcal arthritis. Gonococcal arthritis is an infectious arthritis caused by the bacteria Neisseria gonorrhoeae. Symptoms typically include red, swollen, and painful joints, especially affecting the distal joints of the limbs. The presence of papules, pustules, and vesicles on reddened bases at the distal extremities is characteristic of disseminated gonococcal infection. In women, the DIP joint involvement in the finger can be indicative of this condition. Prompt diagnosis and treatment with antibiotics are essential to prevent complications associated with gonococcal arthritis. It is important to consider a sexually transmitted infection like gonorrhea in young patients presenting with joint symptoms and cutaneous findings.
Question 3 of 5
A 30-year-old paralegal analyst comes to your clinic, complaining of a bad-smelling vaginal discharge with some mild itching, present for about 3 weeks. She tried douching but it did not help. She has had no pain with urination or with sexual intercourse. She has noticed the smell increased after intercourse and during her period last week. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of one spontaneous vaginal delivery. She is married and has one child. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died from a heart disease. On examination she appears healthy and has unremarkable vital signs. On examination of the perineum there are no lesions noted. On palpation of the inguinal nodes there is no lymphadenopathy. On speculum examination a thin gray-white discharge is seen in the vault. The pH of the discharge is over 5 and there is a fishy odor when potassium hydroxide (KOH) is applied to the vaginal secretions on the slide. Wet prep shows epithelial cells with stippled borders (clue cells). What type of vaginitis best describes her findings?
Correct Answer: C
Rationale: The clinical presentation described in the scenario is classic for bacterial vaginosis (BV). BV is the most common cause of vaginal discharge in women of childbearing age. Key features of BV include a thin gray-white discharge with a fishy odor, which typically worsens after sexual intercourse and during menstruation. The discharge characteristically has a pH over 4.5, and the presence of clue cells on wet prep is diagnostic. Clue cells are vaginal epithelial cells covered with bacteria, giving them a stippled appearance when viewed under the microscope. These features are consistent with the findings in this patient.
Question 4 of 5
Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn't say anything in response to your question. This is an example of which type of challenging patient?
Correct Answer: C
Rationale: Mrs. R. is exhibiting characteristics of a silent patient because she does not respond or engage in conversation when directly asked a question by the healthcare provider. In this case, Mrs. R.'s lack of verbal response could be due to various reasons such as shyness, anxiety, cognitive impairment, or communication barriers. It is important for healthcare providers to recognize and adapt to different communication styles and preferences of patients to ensure effective patient-provider interaction and care. In situations like these, it may be helpful to provide alternative communication methods or allow more time for the patient to respond comfortably.
Question 5 of 5
Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem?
Correct Answer: B
Rationale: Given the information provided about Jim's recent separation from his wife after a long marriage, coupled with the fact that he still experiences early morning erections, the likely cause for his sexual function difficulties is psychological issues. Separation, divorce, or relationship problems can have a significant impact on a person's sexual function due to emotional stress, anxiety, depression, or other mental health issues. In Jim's case, the presence of early morning erections suggests that there may not be a physiological issue like decreased testosterone levels, abnormal circulation, or impaired neural innervation. Instead, the situation seems more related to his emotional state and psychological well-being following the separation. It would be advisable for Jim to seek counseling or therapy to address these psychological factors affecting his sexual function.
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