NR 509 Week 4 Midterm Exam Practice Questions - Filled Out..
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4. A 72-year-old male is admitted to intensive care from the Emergency Room for the initial complaint of chest pain. After the history and physical examination, the NP documents the following cardiovascular findings: JVP is 5 cm above the sternal angle with the head of the bed elevated to 50°. Carotid upstrokes are brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the anterior axillary line in the fifth and sixth intercostal spaces. S1 and S2 are soft. S3 is present at the apex. High-pitched harsh 2/6 holosystolic murmur best heard at the apex, radiating to the axilla. Which of the following possible diagnoses is based on the accurate interpretation of the assessment findings? A. These findings suggest heart failure. B. These findings suggest previous myocardial infarction. C. These findings suggest right carotid occlusion. D. These findings suggest mitral stenosis. E. These findings suggest aortic aneurysm. This scenario is word for word on pg 530 answer in red = these findings suggest heart failure with volume overload with possible left carotid occlusion and mitral regurgitation 5. A 76-year-old male presents to the office for a routine physical examination. The NP documents the following skin findings: Decreased elasticity with multiple lentiginous macules on habitually sun-exposed skin. Multiple, discrete, brown, stuck-on, non-indurated, verrucous plaques on the back and abdomen varying from 1-2 centimeters. Which of the following is the most accurate interpretation of these findings? A. These findings suggest seborrheic keratoses. B. These findings suggest actinic keratoses. C. These findings suggest malignant melanoma. D. These findings suggest lichen planus. E. These findings suggest psoriasis. This exact scenario is described on pg 286 = seborrheic keratosis Descrip琀椀on elements = number, color, shape, texture, primary lesion, loca琀椀on and con昀椀gura琀椀on Seborrheic keratoses Pg 286 5 mm - 2 cm tan to brown, oval, stuck on, flat topped verrucous (cauliflower like) plaques on the back and abd, following skin tension lines Actinic keratoses Pg 313 Superficial keratotic papules come and go on sun-damaged skin - keratotic scales can evolve and SCC (squamous cell carcinoma) is formed by keratin and can result in cutaneous horn - (scalp, lip, ears) Malignant melanoma Pg 286 Melanoma with all the classic features from the ABCD method: Asymmetry, Border irregularity, Color variation, and Diameter >6mm. When screening moles for melanomas, ABCD-EFG method. Asymmetry, boarder irregularity - ragged, notched, or blurred; color variation (more than 2 colors, esp blu-black, white or red); diameter >6 mm; evolving or changing rapidly in size, symptoms or morphology; elevation; firmness to palpation and proggressive Growing over several weeks…. Lichen planus 290 freq on wrist, forearms, genitals and lower legs. Psoriasis Pg 290 freq affects the scalp, extensor surfaces of the elbows and knees, umbilicus and the gluteal cleft.- 288 psoriasis commonly form plaques personal history of anxiety or mood disorder, childhood stressful life events or trauma, being female, chronic medical illness and behavioral inhibition. Pg 247 Anxiety is often comorbid with substance use and mood
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