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NR 509 Final Exam Questions and
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A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step? Take a further history and perform a very careful neurological exam A grandmother is accompanying her 9-year-old granddaughter during a routine physical examination. She asks you privately if her granddaughter has started puberty yet. During the examination, the NP notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound above the level of the breast. The left breast is underdeveloped. These assessment findings are consistent with which Tanner Stage of development? IV Primary prevention is defined as which of the following? Interventions designed to prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the following statements is true about screening for breast cancer in average-risk women? Mammography is recommended every 2 years for women aged 50-74 with insufficient evidence for screening women over the age of 75. Which of the following statements is true regarding recommendations by the eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all that apply. Target blood pressure should be </= 150/90 mmHg but notes that if treatment results in SBP <140 and is “well tolerated and without adverse effects to health or quality of live, treatment does not need to be adjusted.” In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear optimal for notable reductions in stroke, cardiovascular events, and all-cause mortality. Which of the following is a useful strategy when examining young children between the ages of 1 and 4? Have the parent facilitate the exam (e.g., removing clothes, holding the child on lap). The NP is completing the review of systems on a 4-month-old female during a routine encounter. Which statement from the parent may indicate a cardiac problem in the infant and require a more thorough subjective history? “It often takes the baby more than 30 minutes to finish a bottle.” A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition? Patient with eyelid drooping CNIII Which cranial nerve (CN) innervates the muscles of the pharynx and provides sensory fibers to portions of the tympanic membrane, auditory canal, pharynx, and the posterior third of the tongue? CN IX The NP should suspect injury to which cranial nerve (CN) if a patient presents with complaints of photosensitivity and uneven pupils after being struck in the eye with a baseball? CNIII Which of the following statements is true regarding risks and rapid recognition of suspected stroke? Select all that apply Obesity doubles the risk of stroke even without associated glucose intolerance Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke
A 31-year-old female presents to the clinic with a worsening stiff, painful neck. On inspection, the patient’s head is laterally deviated toward the shoulder and rotated. Given this specific physical assessment finding, what condition should the NP suspect as a differential diagnosis? Torticollis During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion evaluation at the neck. All of the following muscles are being assessed when the patient is asked to extend, flex, and rotate the neck, EXCEPT? Sacrospinalis A 58-year-old male complains of lower back pain for many years. He denies a recent injury. On examination, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of the following conditions is most consistent with this physical sign? ankylosing spondylitis Which of the following statements is true regarding prostate cancer screening? Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing A 53-year-old African American male presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer risk for this patient and subsequent screening? This patient is at an elevated risk of prostate cancer due to his family history; thus, screening modalities should be discussed between the patient and provider. A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of pain. In addition, today she reports that she has developed episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find? Inflammatory bowel disease A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well as Crohn's disease. Her family medical history includes a maternal aunt who died of colon cancer at age 49 years. Which of the following historical elements would be most concerning for colon cancer in this patient? recent onset of small-caliber stools A 67-year-old female presents to the office for an annual check-up. She retired as a police captain at age
- Now she enjoys gardening and water aerobics several days a week. She states, “staying active keeps me limber”. After a careful history and physical examination, the NP documents the following musculoskeletal system findings: Full range of motion in all joints. Hands with Heberden nodes at the DIP
joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and rotation of both hips. Full range of motion in the knees, with moderate crepitus. No effusion but bony enlargement along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first MTP joints. Which of the following is the most accurate interpretation of these findings? These findings suggest osteoarthritis A 50-year-old male presents to the office for a routine physical examination. He has no complaints. His PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is taking fenofibrate. On the social history intake form, he reported consuming 8 ounces of malt liquor daily for 20 years. After a careful history and physical examination, the NP documents the following nervous system findings: Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Oriented to person, place, and time. Speech is fluent, follows commands. Detailed cognitive testing deferred. Cranial Nerves: I—not tested; II through XII intact. Motor: Normal muscle bulk and tone. Strength 5/5 throughout. No pronator drift. Cerebellar—Rapid alternating movements (RAMs), finger-to-nose (F→N), heel-to-shin (H→S) intact. Gait with normal stance and stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the following is the most accurate interpretation of these findings? These findings suggest no abdnormalities Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description: Examiner’s hands placed on anterior shoulders while patient shrugs both shoulders upward against hands. CNXI What assessment test is being performed in this image? ADA Description: Tuning fork on top of the head. Weber test A 74-year-old man presents to the clinic for a scheduled annual examination. He has a history of hypertension and diabetes, both controlled with medication. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal assessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina. Cotton wool spots A 66-year-old female presents to the office for a focused visit to discuss hypertension management strategies. During the interview, the patient asks the NP if she could be screened today for cervical cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no abnormal findings, and no history of cancer. What is the best action the NP should take regarding the patient’s request for screening? Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no longer requires screening, and focus on the reason for the visit. Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?
Bacterial vaginosis A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She also reports that the smell increased after intercourse and during her period last week. After a careful history and physical assessment, the NP documents the following pelvic and anorectal examination findings: Bilateral shotty inguinal adenopathy. External genitalia without erythema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings? These findings suggest bacterial vaginosis The NP knows it is possible to palpate multiple structures in relation to the inguinal canal and related hernias while performing a physical examination on male patients. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region? Internal inguinal rings What are the most predominant risk factors for prostate cancer? Age Ethnicity Family history A patient presents with right-upper quadrant (RUQ) pain but does not have any tenderness on palpation in the RUQ. The NP is suspicious of acute cholecystitis. The NP knows to perform which assessment test next? Murphy Sign Pain in the right-lower quadrant (RLQ) during deep, even palpation of the left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what positive assessment finding? Blumberg sign The NP suspects a patient has appendicitis. Identify the physical examination maneuver done by applying pressure halfway between the umbilicus and the anterior spine of the ilium? McBurney Sign Which assessment finding would be most suggestive of a diagnosis of biliary colic? Associated right shoulder pain
Which of the following physical assessment finding is most suggestive of peritonitis secondary to a ruptured appendix? Pressing down onto the abdomen firmly and quickly withdrawals the hand produces pain A 76-year-old female presents to the office for an annual physical. Upon reviewing her history, she had a positive FOBT on one occasion at age 66 years. Subsequent colonoscopy revealed internal hemorrhoids and sigmoid diverticuli only. She has no firstdegree relatives with a history of colorectal cancer or adenomatous polyps. What is the U.S. Preventive Services Task Force (USPSTF) screening recommendation for this particular patient? Do not screen routinely A 30-year-old male is admitted to the hospital for abdominal pain. He reports steady, aching pain that began suddenly around his naval and now involves the lower abdomen. He also reports a decreased appetite with nausea but no vomiting. After a careful history and physical examination, the NP documents the following abdominal findings: The abdomen is flat, firm, and rigid, with increased tenderness and guarding in the right lower quadrant. No bowel sounds heard. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate interpretation of these findings? These findings suggest acute peritonitis The NP student is precepting with a provider in a geriatric-based clinic. The provider asks the student if he is familiar with the 10-Minute Geriatric Screener. Which of the following statements best demonstrates that the NP understands this assessment tool? The tool assesses for functional deficits which are strong predictors of patient outcomes in the elderly. The NP conducted a physical assessment on a 79-year-old male who lives independently in subsidized housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows: Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm, round, regular, equally reactive to light and accommodation. Extraocular movements intact. Disc margins sharp, without hemorrhages or exudates. Mild arteriolar narrowing. TMs with good cone of light. Weber midline. AC > BC. Nasal mucosa erythematous, septum deviated to the right, turbinates mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue midline, slight beefy redness. Pharynx is mildly erythematous with cobblestoning. Which of the following is the most accurate interpretation of the findings? The patient has chronic allergies The staff NP in a nursing home is conducting a physical assessment on an 84-yearold male resident who is pleasant, active, and cooperative. The skin findings in this image are observed during the examination. The staff and patient deny any known injury or trauma. The NP should document these findings as consistent with which of the following?
A diastolic murmur during pregnancy is likely pathological; further investigation and work-up is warranted A 32-year-old primigravid woman is at 27 weeks gestation. She presents with nausea, vomiting, urinary frequency, discomfort in the lower abdomen, tenderness over the suprapubic area, and severe constipation. Which of the following is true regarding these pregnancy symptoms? Iron supplementation, hormonal changes, slowed intestinal transit, physical pressure from the gravid uterus, and increased blood volume all contribute to abdominal symptoms in pregnant women. A 24-year-old female presents to the clinic concerned that she may be pregnant. Her LMP was 7-weeks ago, and the urine human chorionic gonadotropin (HCG) test is positive. What can the NP expect to find on physical examination, assuming a normal pregnancy? Select all that apply an internal cervical os closed to the width of a fingertip a bluish hue to the cervix A 20-year-old female presents to the clinic with symptoms of fatigue, nausea, and an increase in urination. She is sexually active, and her male partner uses condoms occasionally. A urine pregnancy test is positive. Her last menstrual period was 3 months ago (6/20/2021). Using the Naegele rule, what is the estimated date of delivery (EDD, or due date)? 3/27/ The NP is conducting a physical assessment on a woman in her 26th week of pregnancy. Which of the examination finding is worrisome for a potential, emergent condition? Facial edema The NP is documenting the obstetric history of a patient. Her history includes two spontaneous miscarriages at 16- and 24-weeks’ gestation, four living children (one set of twins) who were delivered at term, and a current pregnancy. How would this be documented? G6P An 11-month-old infant male is accompanied to the clinic by his father. The father is concerned about the skin rash on this son’s arms represented in this image. Family history is significant for a 4-year-old sibling with atopic dermatitis and asthma. Which of the following is the best documentation of the integument findings? Erythematous, patches and plaques involving the extensor surfaces of the bilateral antecubital fossa. Mild, secondary excoriations present with serous exudate. No streaking. Scant purulent drainage A mother brings her 15-day-old female infant to the outpatient clinic for evaluation of a rash that appeared suddenly after visiting family in Florida. It is August and the house did not have air conditioning. The infant is afebrile, eating and drinking well, and does not appear to be in distress. The physical assessment findings are represented in this image. Based on the history and examination findings, what is the likely etiology? ADA Description: Infant with a red, facial rash.
miliaria rubra The NP assesses for the Moro Reflex as part of an infant routine physical examination. The NP should suspect a neurologic disease if the reflex has not disappeared by what specific timeframe? 16 weeks A 2-month-old female is accompanied by her parents for her first visit to the practice. When reviewing the hospital medical records of her birth, the NP notes documentation regarding significantly edematous hands and feet present at birth. Upon physical examination of the infant, the NP finds skin folds that run along the sides of the neck down to the shoulders. Which of the following should be assessed and monitored by the NP and parents related to these findings? Select all that apply. The infant’s growth chart with concern for height and length. The infant’s ability to properly latch during breastfeeding. The infant’s fluid gain or loss. The NP is observing a female pediatric patient during a routine physical. She can jump in place and balance on one foot. She speaks in full sentences and her mother states that she can feed herself. Based on your observations and the history, determine her developmental age 4 years The NP is observing a full-term infant male. He can pull to a stand, use “mama” and “dada” specifically, and indicates his wants by vocalization and pointing. Based on your observations, determine his developmental age. 12 months Of the following statements, which is accurate regarding growth and assessment charts published by the National Center for Health Statistics? Select all that apply. All charts include height, weight, and head circumference for children up to 36 months. Growth charts are available for children with specific conditions such as Down syndrome or Turner syndrome. Growth charts are available for use in infants born prematurely. A 25-year-old male presents to the clinic with a complaint of severe rectal pain during defecation. The pain is so severe he waits several days before having a bowel movement. He has a history of ulcerative colitis (UC). He also reports being in an active sexual new relationship with a male partner. After conducting a history and physical exam, the NP documents the following anorectal findings: Perirectal area inflamed; no ulcerations, open sores, fissures, or verruca. Scant, whiteyellow, mucoid, rectal discharge noted. Unable to examine external sphincter, rectal vault, or prostate because of spasm of the external sphincter and marked inflammation and tenderness of anal canal. Which of the following is the most accurate interpretation of these findings?
weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. A β-human chorionic gonadotropin (β-hCG) blood test is pending. The NP performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. Which of the following is the most likely etiology for these assessment findings? Ruptured ectopic pregnancy A 42-year-old female presents to the office for her annual well-woman examination. She has a history of fibrocystic breast changes since her mid-20s, so she did not report any new issues except that her right breast feels “heavier” than usual. After a careful history and physical examination, the NP documents the following breast findings: Breasts pendulous with diffuse fibrocystic changes. Single firm 1 × 1 cm mass, mobile, and nontender, with overlying peau d’orange appearance in the right breast, upper outer quadrant at 11 o’clock, 2 cm from the nipple. Which of the following is the most accurate interpretation of these findings? These findings suggest a cyst An NP student conducted a clinical breast examination on a 27-year-old female with a history of fibroadenomas. The NP palpated a rubbery, mobile, nontender mass in the right breast. The mass was located 3 cm proximal to and 3 cm to the left of the nipple. Which of the following would be the most appropriate way to document the physical assessment findings? rubbery, mobile, nontender mass located in the right breast, in the 10:30 position from the nipple A 24-year-old male presents to the office for evaluation of a lump under his left nipple. He reports no other symptoms, denies trauma or injury, and reports no known family history of a first-degree relative with breast cancer. On examination, the NP notes a firm, 2-cm mass under his areola. What is the most likely etiology for these findings? Breast cancer A 34-year-old female arrives at the clinic for a prenatal, second-trimester appointment. During the interview, her behavior is concerning for intoxication, and she smells of alcohol and cigarettes. She reveals a history of intravenous drug use “10-years ago”. How should the NP counsel this patient? Select all that apply If a pregnant patient does not intend to quit tobacco, cutting down is still considered beneficial to the pregnancy and should be encouraged. Pregnant women are not routinely screened for hepatitis C, but this test should be added to the panel of prenatal blood tests for patients with a history of intravenous drug use A 27-year-old female presents to the outpatient clinic with acute abdominal pain and uterine bleeding. Her last menstrual period was 6-weeks ago. She and her husband have been trying to conceive for almost one year. On physical examination, the NP palpates an ill-defined, adnexal mass in the left lower
quadrant. The urine pregnancy test results are pending. Based on the history and examination findings, what is the most likely etiology? Ectopic pregnanct The NP knows measurement of growth is one of the most important indicators of infant health. Deviations may provide an early indication of an underlying problem. What is the minimum variation that indicates a more detailed evaluation is needed? Beyond 2 standard deviations for age range
