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NR509 Final Exam/ 88 Questions with
Answers/ 2024-
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."
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 The combination of both receptive and expressive aphasia is a characteristic of which type of speech disorder? global aphasia
The NP is assessing a 42-year-old female who presents to the clinic with recurring headaches. What is an effective question to ask the patient? Do you have any aura prior to the headaches? 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? The patient reports fever, night sweats, and thinks she lost weight. When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following? Active movement against gravity Which musculoskeletal disorder is paired correctly with the associated systemic manifestations? Lyme disease and expanding erythematous targetoid patch in early illness A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are expected assessment findings consistent with the diagnosis? Swelling of the synovial tissue in joints and tendon sheaths.
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
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 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? The vaccine can protect against anogenital lesions 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? Raised friable or lobed lesions An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge along with recent pelvic pain. 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? Cervical os
(BMI) is 27. Which of the following is the most likely interpretation of these findings? These findings suggest uterine fibroids 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 introitus. 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? These findings suggest candida vaginitis Cervical motion tenderness and/or adnexal tenderness are hallmarks of all the following conditions, EXCEPT? 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?
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-year- old 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?
The American Geriatrics Society (AGS) prefers the term "persistent pain" over the term "chronic pain". Which of the following physical assessment findings regarding blood pressure is consistent with the normal aging process and not a sign of cardiovascular disease? A net increase in pulse pressure with an increase in systolic pressure and a decrease in diastolic pressure Which of the following statements best demonstrates that the NP understands their role in caring for the aging population? I will evaluate geriatric conditions in terms of functionality and quality of life rather than via traditional disease models. Which of the following physiologic and psychologic changes are expected assessment findings with the normal aging process? Select all that apply A 25-year-old female presents to the clinic after a positive home pregnancy test. 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? Ask open-ended questions, allow her to make decisions that she feels are best for herself given the circumstance, and provide immediate or long-term referrals to domestic violence resources We have an expert-written solution to this problem! A 42-year-old female is at 39-weeks gestation. 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? 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.
