NR 509 APEA 3P EXAM WEEK 4 2024 UPDATE QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES ALREADY GRADED A+
A 59-year-old unemployed man complains of almost always feeling tired and hungry, despite getting sufficient rest and having a good appetite and access to sufficient food. The patient is obese and, despite the warm weather outside, wearing thermal socks with his sandals. He says this is because his feet are always cold and “feel funny.” With which body system should the clinician begin the examination?
b. Head and neck
Rationale: The physical examination should proceed “head to toe” to optimize patient comfort; minimize the number of changes in patient position; and, because it is always done in the same way, to ensure that nothing is missed. Even though symptoms are reported in the lower extremities, the examination will attend to this region at the appropriate time. The same argument applies to the posterior thorax, abdomen, and nervous system.
A 65-year-old retired pilot visits the clinic because of recurrent headache. The patient reports dizziness of recent onset (previous 2 weeks) and occasional numbness on the left side. Which of the following systems or regions should be examined in the clinician’s focused assessment?
Nervous
Rationale: The nervous system examination covers mental status, cranial nerves, motor and sensory systems, and reflexes. The presence of headache, dizziness, and numbness suggest nervous system involvement. Symptoms of cardiovascular involvement include palpitations, chest pain, edema, or heart murmurs, none of which are noted in the case description. Musculoskeletal problems are usually associated with muscle or joint pain or stiffness. The respiratory system should be examined when patients have a cough, difficulty breathing, or hemoptysis. The gastrointestinal system should be examined when patients complain of heartburn, irregular or bloody stools, or food intolerance (among other symptoms).
A 54-year-old diplomat working at the United Nations reports occasional chest pain and a sense of tightness in his chest when particularly stressed over work deadlines. The patient is 6 feet 4 inches tall. He has a temperature of 98.6ºF and blood pressure of 140/78. He has a cut over one eye that he says is “from shaving.” Which of the following represents subjective information about this patient?
d. Cut over eye from shaving
Rationale: Subjective information is any information that the patient reports but that is not directly observable or measurable. In this case, the cut is observable but the manner in which the cut was sustained is not. Shaving injuries are not usually seen above an eye, so this part of the patient’s report could be explored further. Temperature, blood pressure, and height are incorrect because these were measured by the clinician. Employment at the United Nations is incorrect because, although this was not measured by the clinician, it is a fact that can be verified objectively.
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