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NR509 / NR 509 Final Exam (Latest 2024 / 2025): Advanced Physical Assessment - Chamberlain, Exams of Nursing

Staffordshire UniversityNursing

NR509 / NR 509 Final Exam (Latest 2024 / 2025): Advanced Physical Assessment - Chamberlain

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2023/2024

Available from 04/27/2024

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NR 509 Final Exam
1. A 35-year-old female with a history of migraines pre-
sents 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?
2. A grandmother is accompanying her 9-year-old grand-
daughter 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?
3. Primary prevention is defined as which of the follow-
ing?
4. 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?
5. Which of the following statements is true regarding
recommendations by the eighth Joint National Com-
mittee (JNC8) for adults aged 60 and older? Select all
that apply.
Take a further his-
tory and perform a
very careful neuro-
logical exam
IV
Interventions de-
signed to prevent
disease
Mammography is
recommended
every 2 years for
women aged
50-74 with
insufficient
evidence for
screening women
over the age of 75.
Target blood pres-
sure should be
</= 150/90 mmHg
but notes that if
treatment results
in SBP <140 and
is "well tolerated
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15

Partial preview of the text

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NR 509 Final Exam

  1. A 35-year-old female with a history of migraines pre- sents 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?
  2. A grandmother is accompanying her 9 - year-old grand- daughter 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?
  3. Primary prevention is defined as which of the follow- ing?
  4. 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?
  5. Which of the following statements is true regarding recommendations by the eighth Joint National Com- mittee (JNC8) for adults aged 60 and older? Select all that apply. Take a further his- tory and perform a very careful neuro- logical exam IV Interventions de- signed to prevent disease Mammography is recommended every 2 years for women aged 50 - 74 with insufficient evidence for screening women over the age of 75. Target blood pres- sure should be </= 150/90 mmHg but notes that if treatment results in SBP <140 and is "well tolerated

NR 509 Final Exam

  1. Which of the following is a useful strategy when ex- amining young children between the ages of 1 and 4?
  2. 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?
  3. A 16 - year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as repre- sented 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 and without ad- verse 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/ to 80 appear optimal for no- table reductions in stroke, cardiovas- cular events, and all-cause mortality. Have the par- ent facilitate the exam (e.g., remov- ing clothes, hold- ing the child on lap). "It often takes the baby more than 30 minutes to finish a bottle." CNIII
  4. CN IX

NR 509 Final Exam

  1. A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are expected assessment findings consistent with the diagnosis?
  2. A 58-year-old male complains of pain in his knees, hips, hands, wrists, neck, and lower back. Based on the joints involved, the NP suspects that the patient most likely has which condition?
  3. A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to find on examination that is most consistent with the diagno- sis?
  4. What is the action(s) of the erector spinae muscle group?
  5. A 17-year-old male presents to the clinic for a fol- low-up appointment. He fractured his left arm 8 weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are unequal and there is winging of the scapula. The NP suspects contralat- eral weakness and muscle wasting as the etiology for the winged scapula. Which of the following physi- cal assessment maneuvers should the NP perform to confirm the suspension?
  6. A 31-year-old female presents to the clinic with a worsening stiff, painful neck. On inspection, the pa- tient'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? matous targetoid patch in early ill- ness Swelling of the synovial tissue in joints and tendon sheaths. Osteoarthritis Flexed forward posture with low- er extremity weak- ness Extension of the spine Compare the strength of the trapezius muscles Torticollis
  7. Sacrospinalis

NR 509 Final Exam

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?

  1. A 58-year-old male complains of lower back pain for many years. He denies a recent injury. On examina- tion, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of the follow- ing conditions is most consistent with this physical sign?
  2. Which of the following statements is true regarding prostate cancer screening?
  3. 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 ankylosing spondylitis Setting nor- mal cut-offs for prostate-specif- ic antigen (PSA) testing relies on balancing This patient is at an elevated risk of prostate cancer at age 82 years with prostate cancer but died recently due to his fam- at age 87 years from a myocardial infarction before the ily history; thus, 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 screen- ing?
  4. A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A re- cent 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 devel- oped episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find? screening modali- ties should be dis- cussed between the patient and provider. Inflammatory bow- el disease

NR 509 Final Exam

cle bulk and tone. Strength 5/5 throughout. No prona- tor 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?

  1. Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description: Examin- er's hands placed on anterior shoulders while patient shrugs both shoulders upward against hands.
  2. What assessment test is being performed in this im- age? ADA Description: Tuning fork on top of the head.
  3. A 74 - year-old man presents to the clinic for a sched- uled annual examination. He has a history of hyper- tension and diabetes, both controlled with medica- tion. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal as- sessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina.
  4. 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 can- cer/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 re- quest for screening? 35.35.

CNXI

Weber test Cotton wool spots Deny her request, inform the pa- tient that she has had three negative screenings in the last 10 years and no longer requires screening, and fo- cus on the reason for the visit.

NR 509 Final Exam

Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?

  1. A 21-year-old female presents for her first annual exam. She reports concern because her female part- ner was recently diagnosed with condyloma acumi- nata and wonders if she could also be infected. If true, what physical assessment findings would the NP expect to find during the speculum examination?
  2. An 18 - year-old female presents to the clinic complain- ing of a thick and yellow vaginal discharge along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID). During the specu- lum examination, the NP would expect to find purulent discharge in the following area(s) which is consistent with the diagnosis of PID?
  3. A 23-year-old female presents to the clinic. She has decided to discontinue using condoms and would like a different birth control option. Her last pelvic exam was 2 years ago when she had a negative Pap smear and STI screening. Her LMP was 2 days ago, and she is still spotting. She last had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her speculum exam during this office en- counter. What is the best evidence-based rationale for the decision to postpone her exam?
  4. A 24-year-old female presents to the clinic for an an- nual exam. The NP proceeds to perform a Pap smear and understands that the most important area on the cervix to obtain cells for the Pap smear is where?
  5. A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses. She reached menarche at age 13 years and has had reg- ular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her hus- The vaccine can protect against anogenital lesions Raised friable or lobed lesions Cervical os She is on her menses Transformation zone These findings suggest uterine fi- broids

NR 509 Final Exam

4.5. Which of the following is the most accurate in- terpretation of these findings?

  1. The NP knows it is possible to palpate multiple struc- tures 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?
  2. What are the most predominant risk factors for prostate cancer?
  3. 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 cholecysti- tis. The NP knows to perform which assessment test next?
  4. Pain in the right-lower quadrant (RLQ) during deep, even palpation of the left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what pos- itive assessment finding?
  5. The NP suspects a patient has appendicitis. Identify the physical examination maneuver done by applying pressure halfway between the umbilicus and the an- terior spine of the ilium?
  6. Which assessment finding would be most suggestive of a diagnosis of biliary colic?
  7. Which of the following physical assessment finding is most suggestive of peritonitis secondary to a rup- tured appendix? Internal inguinal rings Age Ethnicity Family history Murphy Sign Blumberg sign McBurney Sign Associated right shoulder pain Pressing down onto the abdomen firmly and quick- ly withdrawals the hand produces pain

NR 509 Final Exam

  1. A 76-year-old female presents to the office for an an- nual physical. Upon reviewing her history, she had a positive FOBT on one occasion at age 66 years. Sub- sequent colonoscopy revealed internal hemorrhoids and sigmoid diverticuli only. She has no firstdegree relatives with a history of colorectal cancer or adeno- matous polyps. What is the U.S. Preventive Services Task Force (USPSTF) screening recommendation for this particular patient?
  2. A 30-year-old male is admitted to the hospital for ab- dominal pain. He reports steady, aching pain that be- gan 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 fol- lowing 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 palpa- ble masses. No CVA tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate interpretation of these findings?
  3. 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?
  4. The NP conducted a physical assessment on a 79 - year-old male who lives independently in subsi- dized 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, Do not screen rou- tinely These findings suggest acute peritonitis The tool as- sesses for func- tional deficits which are strong predictors of pa- tient outcomes in the elderly. The patient has chronic allergies

NR 509 Final Exam

  1. Which of the following statements are true about the presentation of pain and pain assessment in the older adult? Select all that apply
  2. Which of the following physical assessment findings regarding blood pressure is consistent with the nor- mal aging process and not a sign of cardiovascular disease?
  3. Which of the following statements best demonstrates that the NP understands their role in caring for the aging population?
  4. Which of the following physiologic and psychologic changes are expected assessment findings with the normal aging process? Select all that apply
  5. A 25 - year-old female presents to the clinic after a pos- itive home pregnancy test. She confides in you that her live-in, male partner has been verbally threatening ity and specificity it has for younger populations Older patients are less likely to re- port pain symp- toms than younger patients The American Geriatrics Society (AGS) prefers the term "persistent pain" over the term "chronic pain". A net increase in pulse pressure with an increase in systolic pres- sure and a de- crease in diastolic pressure I will evaluate geri- atric conditions in terms of function- ality and quality of life rather than via traditional disease models. Ask open-ended questions, allow her to make de-

her. She denies interest in involving law enforcement. cisions that she Additionally, she reports that she has a 3- year-old daughter who lives in the home. What is the appropri- ate next step by the NP?

  1. A 42 - year-old female is at 39 - weeks gestation. She re- ports no major issues except swelling in her feet and shortness of breath which she assumed is normal for feels are best for herself given the circumstance, and provide immediate or long-term refer- rals to domestic vi- olence resources A diastolic mur- mur during preg- nancy is likely pregnancy. On exam, the NP notes a diastolic murmur. pathological; fur- Which of the following is true about her presentation and the appropriate next step by the NP?
  2. A 32 - year-old primigravid woman is at 27 weeks gesta- tion. She presents with nausea, vomiting, urinary fre- quency, discomfort in the lower abdomen, tenderness over the suprapubic area, and severe constipation. Which of the following is true regarding these preg- nancy symptoms?
  3. A 24 - year-old female presents to the clinic concerned ther investigation and work-up is warranted Iron supplemen- tation, hormonal changes, slowed intestinal transit, physical pressure from the gravid uterus, and in- creased blood vol- ume all con- tribute to abdom- inal symptoms in pregnant women. an internal cervi- that she may be pregnant. Her LMP was 7 - weeks ago, cal os closed to the 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
  4. A 20 - year-old female presents to the clinic with symp- toms of fatigue, nausea, and an increase in urina- tion. She is sexually active, and her male partner width of a fingertip a bluish hue to the cervix 3/27/

etiology? ADA Description: Infant with a red, facial rash.

  1. 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?
  2. A 2-month-old female is accompanied by her par- ents for her first visit to the practice. When review- ing the hospital medical records of her birth, the NP notes documentation regarding significantly edema- tous hands and feet present at birth. Upon physical examination of the infant, the NP finds skin folds that 16 weeks The infant's growth chart with con- cern for height and length. The infant's abili- run along the sides of the neck down to the shoulders. ty to properly latch Which of the following should be assessed and moni- tored by the NP and parents related to these findings? Select all that apply.
  3. The NP is observing a female pediatric patient during a routine physical. She can jump in place and bal- ance 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. 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 develop- mental age.
  5. Of the following statements, which is accurate regard- ing growth and assessment charts published by the National Center for Health Statistics? Select all that apply. during breastfeed- ing. The infant's fluid gain or loss. 4 years 12 months All charts include height, weight, and head circum- ference for chil- dren up to 36 months.
  1. A 25-year-old male presents to the clinic with a com- plaint 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 col- itis (UC). He also reports being in an active sexual new relationship with a male partner. After conduct- ing a history and physical exam, the NP documents the following anorectal findings: Perirectal area in- flamed; no ulcerations, open sores, fissures, or verru- ca. Scant, whiteyellow, mucoid, rectal discharge not- ed. Unable to examine external sphincter, rectal vault, or prostate because of spasm of the external sphinc- ter and marked inflammation and tenderness of anal canal. Which of the following is the most accurate interpretation of these findings?
  2. A 54 - year-old female with a history of migraines since childhood presents to the clinic with chronic intermit- tent, progressive pulsatile headaches which are sim- ilar in nature to prior attacks and precipitated by cur- rent life stressors. The headaches are accompanied by nausea and vomiting. She denies constitutional symptoms. On examination, she has elevated blood pressure but otherwise a normal cardiovascular, neu- rologic, and fundoscopic examination. Based on the history and physical examination findings, which di- Growth charts are available for chil- dren with specific conditions such as Down syndrome or Turner syndrome. Growth charts are available for use in infants born pre- maturely. These findings suggest infectious proctitis Migraine Tension
  1. A 26-year-old female presents to the Emergency De- partment with intense abdominal pain for 6 hours, light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a history of gallstones and is concerned that she is hav- ing another gallbladder attack. She denies nausea and vomiting, and her last normal bowel movement was this morning. She reports that her LMP was 10 weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. A ²-human chorionic go- nadotropin (²hCG) blood test is pending. The NP per- forms an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. Which of the follow- ing is the most likely etiology for these assessment findings?
  2. 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 fol- lowing is the most accurate interpretation of these findings?
  3. An NP student conducted a clinical breast examina- tion on a 27 - year-old female with a history of fibroade- nomas. 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? Ruptured ectopic pregnancy These findings suggest a cyst rubbery, mobile, nontender mass located in the right breast, in the 10:30 position from the nipple
  1. A 24-year-old male presents to the office for evalu- ation 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
  2. A 34 - year-old female arrives at the clinic for a prenatal, If a pregnant pa- 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
  3. 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? tient does not in- tend to quit tobac- co, cutting down is still consid- ered beneficial to the pregnancy and should be encour- aged. Pregnant women are not routine- ly screened for hepatitis C, but this test should be added to the panel of prenatal blood tests for pa- tients with a his- tory of intravenous drug use Ectopic pregnanct