NR 509 Week 8 Final Exam Practice Solutions

NR 509 Week 8 Final Exam Solutions

1. A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the past few 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 granddaughter during a routine physical 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 following?
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 Committee (JNC8) for adults aged 60 and older? Select all that
6. Which of the following is a useful strategy when examining young children between the ages of 1 and 4?
7. 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?
8. A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as represented in this He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition?
9. 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?
10. 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?
11. Which of the following statements is true regarding risks and rapid recognition of suspected stroke?
12. The combination of both receptive and expressive aphasia is a characteristic of which type of speech disorder?
13. The NP is assessing a 42-year-old female who presents to the clinic with recurring What is an effective question to ask the patient?
14. A 55-year-old female presents to the clinic with a headache. During the interview, which of the following symptoms should prompt the NP to be concerned and investigate further?
15. When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following?
16. Which musculoskeletal disorder is paired correctly with the associated systemic manifestations?
17. A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are expected assessment findings consistent with the diagnosis?
18. A 58-year-old male complains of pain in his knees, hips, hands, wrists, neck, and lower Based on the joints involved, the NP suspects that the patient most likely has which condition?
19. A 55-year-old male has a diagnosis of lumbar spinal Which sign should the NP expect to find on examination that is most consistent with the diagnosis?
20. What is the action(s) of the erector spinae muscle group?
21. A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8 weeks ago and remains in a Upon inspection, the NP finds that his shoulder heights are unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle wasting as the etiology for the winged scapula. Which of the following physical assessment maneuvers should the NP perform to confirm the suspension?
22. 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?
23. 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?
24. A 58-year-old male complains of lower back pain for many 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?
25. Which of the following statements is true regarding prostate cancer screening?
26. 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 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?
27. A 34-year-old female presents to primary care for follow-up regarding anal pain with 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?
28. A 45-year-old female presents to the primary care 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?
29. 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?
30. A 50-year-old male presents to the office for a routine physical 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?
31. 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
32. What assessment test is being performed in this image? ADA Description: Tuning fork on top of the
33. A 74-year-old man presents to the clinic for a scheduled annual 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.
34. A 66-year-old female presents to the office for a focused visit to discuss hypertension management 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?
35. Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?
36. A 21-year-old female presents for her first annual exam. She reports concern because her female partner was recently diagnosed with condyloma acuminata and wonders if she could also be infected. If true, what physical assessment findings would the NP expect to find during the speculum examination?
37. An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge along with recent pelvic Her history is significant for pelvic inflammatory disease (PID). During the speculum examination, the NP would expect to find purulent discharge in the following area(s) which is consistent with the diagnosis of PID?
38. 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 She last had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her speculum exam during this office encounter. What is the best evidence-based rationale for the decision to postpone her exam?
39. A 24-year-old female presents to the clinic for an annual 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?
40. A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her She reached menarche at age 13 years and has had regular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states this has been going on for about a year but seems to be getting worse. Her LMP was 1 week ago. On a bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. Which of the following is the most likely interpretation of these findings?
41. A 48-year-old female presents to the clinic with complaints of heavy vaginal discharge and severe itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the On speculum examination, there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. Which of the following is the most accurate interpretation of these findings?
42. Cervical motion tenderness and/or adnexal tenderness are hallmarks of all the following conditions, EXCEPT?
43. A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with some mild itching for about 3 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?
44. 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 Which of the following is not palpable during an external examination of the abdominal wall or inguinal region?
45. What are the most predominant risk factors for prostate cancer?
46. A patient presents with right-upper quadrant (RUQ) pain but does not have any tenderness on palpation in the The NP is suspicious of acute cholecystitis. The NP knows to perform which assessment test next?
47. 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?
48. 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?
49. Which assessment finding would be most suggestive of a diagnosis of biliary colic?
50. Which of the following physical assessment finding is most suggestive of peritonitis secondary to a ruptured appendix?
51. A 76-year-old female presents to the office for an annual 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?
52. A 30-year-old male is admitted to the hospital for abdominal 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?
53. 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?
54. The NP conducted a physical assessment on a 79-year-old male who lives independently in subsidized 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?
55. The staff NP in a nursing home is conducting a physical assessment on an 84-year- old male resident who is pleasant, active, and 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?
56. An 80-year-old woman who lives alone at home presents with concerns about maintaining her independent living She continues to drive and care for herself and her pet dog but reports two falls over the past 4 months. During one fall, she struck her head, causing a contusion over the right eye. She attributes these episodes to environmental factors. Once she tripped over a rug, and once she misjudged the depth of the curb while crossing the street. Which of the following would be the best approach to this patient?
57. Concerning alcohol consumption in older adults, which of the following is true?
58. Which of the following statements are true about the presentation of pain and pain assessment in the older adult? Select all that apply
59. The American Geriatrics Society (AGS) prefers the term “persistent pain” over the term “chronic pain”.
60. Which of the following physical assessment findings regarding blood pressure is consistent with the normal aging process and not a sign of cardiovascular disease?
61. Which of the following statements best demonstrates that the NP understands their role in caring for the aging population?
62. A 25-year-old female presents to the clinic after a positive home pregnancy She confides in you that her live-in, male partner has been verbally threatening her. She denies interest in involving law enforcement. Additionally, she reports that she has a 3- year-old daughter who lives in the home. What is the appropriate next step by the NP?
63. A 42-year-old female is at 39-weeks She reports no major issues except swelling in her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP notes a diastolic murmur. Which of the following is true about her presentation and the appropriate next step by the NP?
64. A 32-year-old primigravid woman is at 27 weeks 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?
65. A 24-year-old female presents to the clinic concerned that she may be 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
66. A 20-year-old female presents to the clinic with symptoms of fatigue, nausea, and an increase in 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)?
67. The NP is conducting a physical assessment on a woman in her 26th week of Which of the examination finding is worrisome for a potential, emergent condition?
68. 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?
69. 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 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?
70. 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 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.
71. The NP assesses for the Moro Reflex as part of an infant routine physical The NP should suspect a neurologic disease if the reflex has not disappeared by what specific timeframe?
72. A 2-month-old female is accompanied by her parents for her first visit to the 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.
73. The NP is observing a female pediatric patient during a routine 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
74. The NP is observing a full-term infant 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.
75. Of the following statements, which is accurate regarding growth and assessment charts published by the National Center for Health Statistics? Select all that
76. A 25-year-old male presents to the clinic with a complaint of severe rectal pain during 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?
77. A 54-year-old female with a history of migraines since childhood presents to the clinic with chronic intermittent, progressive pulsatile headaches which are similar in nature to prior attacks and precipitated by current life The headaches are accompanied by nausea and vomiting. She denies constitutional symptoms. On examination, she has elevated blood pressure but otherwise a normal cardiovascular, neurologic, and fundoscopic examination. Based on the history and physical examination findings, which diagnoses are appropriate for the differential diagnosis (DDx) list? Select all that apply.
78. A 50-year-old female presents to the clinic for evaluation of neck stiffness and aching pain. She was a restrained driver in a low-speed, rear-end, motor vehicle collision 1 day The pain started several hours after the accident. On physical examination, you note muscle spasms over the paraspinous muscles on the left side of the neck, as well as pain reported during active range of motion of the cervical spine. No neurological deficits are noted. Which of the following is the most accurate interpretation of these findings?
79. Which muscle(s) are being assessed during active rotation of the neck?
80. A 34-year-old female presents to the office with left elbow pain following rigorous training for a tennis match. Tenderness is noted with palpation in the area on the image marked by the red What correlative diagnosis does this assessment finding indicate? ADA Description: Left elbow with emphasis on the small, tuberculated eminence, curved a little forward, about 1 cm from the joint.
81. A 35-year-old male presents to the clinic for a routine physical His only complaint is a feeling of heaviness in his scrotum. He denies injury or trauma. After conducting a history and physical, the NP documents the following genitourinary (GU) findings: Uncircumcised penis; prepuce easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes descended bilaterally; right testicle smooth; 1 × 1 cm firm, fixed, nontender, nodule on the left lateral testicle. Epididymis nontender. No inguinal or femoral hernias. Negative CVA tenderness. Which of the following is the most accurate interpretation of these findings?
82. A 26-year-old female presents to the Emergency Department with intense abdominal pain for 6 hours, light-headedness, and a fainting episode that finally prompted her to seek medical She has a history of gallstones and is concerned that she is having 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 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?
83. 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 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?
84. An NP student conducted a clinical breast examination on a 27-year-old female with a history of 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?
85. A 24-year-old male presents to the office for evaluation of a lump under his left 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?
86. A 34-year-old female arrives at the clinic for a prenatal, second-trimester 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
87. A 27-year-old female presents to the outpatient clinic with acute abdominal pain and uterine 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?
88. The NP knows measurement of growth is one of the most important indicators of infant Deviations may provide an early indication of an underlying problem. What is the minimum variation that indicates a more detailed evaluation is needed?