NR 603 Week 4 APEA Predictor Exam Study Guide 316 Questions-Answers, Exams of Nursing

Download NR 603 Week 4 APEA Predictor Exam Study Guide 316 Questions-Answers and more Exams Nursing in PDF only on Docsity! 1. During pregnancy, dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concerns of: Explanation: Dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concerns of possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy. 2. The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the: Explanation: The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the mediastinum. The right and left pleural cavities, are on either side of the mediastinum and those contain the lungs. The visceral pleura encloses the lung. The pericardium surrounds the heart. 3. A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: Explanation: Cranial Nerve | is the olfactory nerve responsible for the sense of smell. To test the sense of smell, the examiner presents the patient with familiar and nonirritating odors. A person should normally perceive odor on each side and correctly identify the source. Cranial Nerves II and Ill assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and balance. 4. Atransient ischemic attack is: Explanation: TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. The other terms are not related to the new definitions. 5. The term asteatosis refers to: Explanation: Physiologic changes of aging include loss of elastic turgor, and wrinkling. Skin that appears dry, flaky, rough, and itchy is termed asteatosis. Sun exposure can cause damage to the skin resembling an appearance as weather beaten, thickened, yellowed, and deeply furrowed. Seborrheic keratosis appear as raised, yellowish lesions that feel greasy, velvety, or warty. Painful vesicular lesions in a dermatomal distribution may suggest herpes zoster. 6. An enlarged liver with a smooth tender edge may suggest: Explanation: An enlarged liver with a smooth, tender edge suggests inflammation, as in hepatitis, or venous congestion, as in right-sided heart failure. Cirrhosis, hematochromatosis (increased amount of iron in the blood), and lymphoma produce an enlarged liver with a firm, nontender edge. An enlarged liver that is firm or hard and has an irregular edge or surface suggests hepatocellular carcinoma. 7. New onset hypertension with proteinuria or end-organ damage is: preeclampsia Explanation: Chronic hypertension occurs when systolic BP (SBP) >140 mm Hg or diastolic BP (DBP) >90 mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum. Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in the absence of proteinuria. Pre-eclampsia occurs ina woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage. Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause. 8. The psoas muscle group and muscles of the abdominal wall assist with: Explanation: The psoas muscle group and muscles of the abdominal wall assist with flexion. The deep intrinsic muscles of the back assist with extension. The abdominal muscles and intrinsic muscles of the back assist with rotation. Lateral bending uses the abdominal muscles and intrinsic muscles of the back. 9. "Preterm small for gestational age" (SGA) infants are prone to: Explanation: "Preterm appropriate for gestational age" (AGA) infants are prone to respiratory distress syndrome, apnea, patent ductus arteriosus with left-to-right shunt, and infection. "Preterm 18. When assessing a 3-month-old for developmental dysplasia of the hips (DDH), which one of the following symptoms would be suspicious of dysplasia? Explanation: Developmental dysplasia of the hips (DDH) presents with limitation of abduction, shortening of the extremity, as the head of the femur does not fit into the acetabulum, and a positive Ortolani's (it clicks when maneuvered). DDH presents with asymmetry of the gluteal folds. 19. A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis is suspected because the pain radiates to the: Explanation: Acute cholecystitis presents with right upper quadrant and upper abdominal pain radiating to the right scapular area. It is usually steady and aching. Pain in the epigastric area could be associated with peptic ulcer or dyspepsia. Cancer of the stomach can present with epigastric pain. Acute mechanical colon obstruction presents with pain in the lower abdomen. 20. The preauricular lymph node is located: Explanation: The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process. 21. Cessation of the menses for 12 months is termed: Explanation: Menopause is defined as cessation of menses for 12 months, progressing through several stages of erratic cyclical bleeding. Oligomenorrhea is infrequent bleeding with menses occurring greater than 35-day intervals, or 4-9 menstrual cycles per year. Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals. Metrorrhagia refers to intermenstrual bleeding. 22. The gastrocnemius and soleus muscles are located by palpating the: Explanation: The gastrocnemius and soleus muscles are located by palpating the posterior surface of the lower leg. 23. One cause of nasal septum perforation may be: Explanation: Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation. 24. Tenderness in the costovertebral angles may signify: Explanation: Because the kidney lies directly under the costovertebral angle, tenderness over this area would be related to renal issues such as renal stones or pyelonephritis. 25. A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: easily lapses into an unresponsive state Explanation: A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. 26. A flat affect can be an identifiable finding in an older adult who has: Explanation: Flat affect occurs in depression, Parkinson’s disease, or Alzheimer’s disease. 27. Pain and crepitus over the patella suggests: Explanation: Pain and crepitus over the patella suggests roughening of the patellar undersurface that articulates with the femur. Tenderness over the patellar tendon or inability to extend the knee suggests a partial or complete tear of the patellar tendon. A degenerative patella produces pain with compression and patellar movement during quadriceps contraction. Swelling above and adjacent to the patella suggest synovial thickening or effusion of the knee joint. 28. A child with a heart murmur audible at the lower left sternal border would be suggestive of: ventricular septal defect Explanation: This type murmur is not considered a normal finding in children. The murmur associated with a ventricular septal defect is audible at the lower left sternal border. A child with a heart murmur located at the midsternum or upper right sternal border and associated with a click could be suggestive of aortic valve stenosis. A murmur located at the upper left sternal border with a prominent ejection click in early systole could be suggestive of pulmonary valve stenosis. 29. In order to visualize the opening of Stensen's duct, examine the: Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct erythematous and enlarged, The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. 30. Hyperalgesia refers to: increased sensitivity to pain Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. 31. The part of the brain that maintains homeostasis is the: Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. 32. A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: Tenderness along the posterior medial malleolus suggests posterior tibial tendinitis. Bone spurs may be present on the calcaneus as bony projections and may cause numbness, tenderness, or pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. 42. Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a: cystourethrocele Explanation: When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. 43. A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings onexam reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute. Tachypnea in this child is most likely related to the Explanation: In children, heart and respiratory rates will increase with fever. For every degree of fever the respiratory rate will increase 3-4 breaths/minutes and the heart rate will increase 8-10 beats/minute. 44, A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with: Explanation: Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse. The discharge associated with gonorrhea is usually thick and bloody. 45. When assessing plantar reflexes, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the right foot. Absence of movement of the big toe is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. 46. Which disorder of the eye can be detected with the cover-uncover and the Hirschberg test? Explanation: Strabismus is misalignment of the eyes and can be assessed using the cover-uncover teats and the Hirschberg test (corneal light reflex). With the cover-uncover test, eye muscle weakness is seen as eye deviation when the eye is uncovered. With Hirschberg's test, an asymmetric light reflex indicates a deviation. Cataracts are visualized by a cloudiness or opacity in the lens. Conjunctivitis is diagnosed by observation of a discharge from the eyes and erythema of the conjunctiva. Amblyopia is diagnosed by visual assessment and testing by an optometrist or ophthalmologist. 47. If fetal movement cannot be perceived after 24 weeks gestation, all of the following may beconsidered except: Explanation: If fetal movement cannot be perceived after 24 weeks, consider error in calculating gestational age, fetal death or severe morbidity, or false pregnancy. Confirm fetal health and gestational age with an ultrasound. 48. To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labiamajora and: Explanation: To palpate an indirect inguinal hernia ina woman, have her stand and palpate in the labia majora and upward to just lateral to the pubic tubercles. 49. Bilateral exophthalmos suggests: Explanation: Exophthalmos is an abnormal protrusion of the eye. When it presents bilaterally, it is suggestive of Grave's disease, a form of hyperthyroidism. Unilateral exophthalmos may be due to Grave's disease or to a tumor or inflammation of the orbit. Hashimoto's thyroiditis, hypothyroidism, and goiter do not present with exophthalmos. 50. If regular uterine contractions occur prior to 37 weeks gestation, this could be: Explanation: Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor. 51. A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write is termed: Explanation: With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. 52. When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion of the knee is known as the: Explanation: When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. A positive balloon sign in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. Balloting the patella occurs by compressing the suprapatellar pouch and pushing the patella sharply against the femur, causing fluid to return to the suprapatellar pouch. McMurray's test checks for tears in the medial menis 53. Which nerve runs from the spine through the neck, the axilla, and into the arm? Explanation: The brachial plexus is a network of nerve fibers that runs from the spine through the neck, the axilla, and into the arm. This network of nerves passes through the cervico-axillary canal to reach the axilla and innervates brachium (upper arm), antebrachium (forearm), and hand. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. Explanation: The discharge associated with bacterial vaginosis can be gray or white, thin, malodorous, and not usually profuse. The odor is usually fishy. Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. The discharge associated with gonorrhea is usually thick and bloody. 65. The classic signs of a basilar skull fracture include hemotympanum and: CSF leak from nose and ears Explanation: Signs of a basilar skull fracture are battle's sign, raccoon eyes, rhinorrhea, otorrhea and hemotympanum (blood in the tympanic cavity). Intracranial hematoma is associated with a general skull fracture. Pain in the occipital region is associated with occipital fracture. Bilateral retinal hemorrhages are associated with shaken baby syndrome. 66. Respiratory effort in the neonate is initiated at birth as a result of: Explanation: Chemical, thermal, and mechanical factors influence respiration as follows: breathing is initiated by a lack of oxygen and a high level of carbon dioxide in the blood stream. This stimulates the respiratory center in the medulla of the brain. Initiation of respiration is aided by the compression of the chest wall during the birth process, the cool air on the wet face, and the general handling of the body and limbs. A healthy baby cries almost immediately, but he has to breathe to be able to cry. With the first breath, the blood vessels in the lung expand. Spontaneous breathing is now established. Pulmonary venous return to the heart increases. This results in left arterial pressure exceeding right arterial pressure. Right to left shunting through the foramen ovale is reduced. 67. At what age does an infant copy sounds and gestures of others? Explanation: Anormal nine-month infant should display stranger awareness, have a favorite toy, understand no, copy sounds and gestures of others, use fingers to point at things, play peek-a-boo, sit without support, and display the pincer grasp. 68. Stool that appears bloody, mucoid, or with pus, may indicate: Explanation: Crohn's disease usually presents with blood, mucus, or pus in the stool. Thin, pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid colon. Constipation produces hard, dry stool. In the presence of hemorrhoids, the stool may appear blood streaked. 69. A patient complains of a sore tongue. Findings reveal a smooth and erythematous tongue. This condition is termed: Explanation: Glossitis is a term used to describe a sore tongue with an erythematous and smooth surface or a general inflammation of the tongue. Gingivitis refers to an inflammation of the gums. Stomatitis describes inflammation of the mouth including the mucous membranes and the lips. Candidiasis refers to a yeast infection of the mouth and presents with yellowish white patchy lesions in the mouth and tongue. 70. During pregnancy, what sound may be auscultated at the second or third intercostal space at the sternal border due to increased blood flow through the vessels? Explanation: Avenous hum, or continuous mammary souffle that occurs during pregnancy is due to increased blood flow through normal vessels. The mammary souffle is commonly heard during late pregnancy or lactation. It is heard loudest in the second or third intercostal space at the sternal border, and is typically both systolic and diastolic, though only the systolic component may be audible. 71. Part of the nutritional assessment includes anthropometric measurements. These measurements include all of the following except: height and weight: blood pressure, pulse, and respiration: mass index (BMI): basal metabolic rate (BMR). Explanation: Anthropometric measurements are a set of noninvasive, quantitative techniques for determining an individual's body fat composition by measuring, recording, and analyzing specific dimensions of the body: height, weight, BMI, BMR, distribution of body fat, and skin fold thickness. Vital signs are considered physiologic measurements. 72. Cognitive and language development between twelve years and adulthood, follows which one of Piaget's stages of development? Explanation: Cognitive and language development between twelve years and adulthood, follows the formal operational stage of Piaget's stages of development. 73. If a newborn develops a cephalohematoma, the newborn is at an increased risk for: Explanation: Cephalohematomas are characterized by bleeding between the bone and the periosteum. Because of breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. They do not increase the risk for infections. Caput succedaneum is an edematous area on the head from pressure against the cervix. Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas. 74. A 40 year old male complains of right flank pain. His temperature is 102° F. These symptoms may be characteristic of: Explanation: Kidney pain in the flank area and groin that is accompanied by fever and chills is consistent with acute pyelonephritis. Renal or ureteral colic usually presents with a sudden onset of pain in the flank area, abdomen, or groin. Chills and fever do not generally accompany urinary calculi. In men, painful urination without frequency or urgency suggests urethritis. Acute prostatitis presents with frequency, urgency, and dysuria. 75. When examining a patient with atopic dermatitis, there is a thickening and roughening of the skin with increased visibility of the normal skin furrows. This condition is termed: Explanation: Lichenification is defined as the thickening and roughening of the skin with increased visibility of the normal skin furrows (numerous grooves of variable depth on the surface of the epidermis). Atrophy is thinning of the skin with loss of normal skin furrows. Excoriation of the skin is an abrasion or scratch mark. The burrow of a scabies lesion includes small papules, pustules, lichenified areas and excoriations. 76. When eliciting deep tendon reflexes in the biceps, the nurse practitioner notes an abnormal reflex in the right biceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. 77. Arhythmic oscillatory movement of a body part resulting from the contraction of opposingmuscle groups is: Explanation: process of the scapula. The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. There is no manubrium joint; it is the broad upper part of the sternum. 86. The axioscapular group of muscles: pulls the shoulder backward Explanation: The axioscapular group pulls the shoulder backward and rotates the scapula. The scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and depresses and rotates the head of the humerus. The axiohumeral group produces internal rotation of the shoulder. The serratus anterior draws the shoulder blade forward. 87. The ankle is a hinge formed by the tibia, fibula, and the: Explanation: The ankle is a hinge formed by the tibia, fibula, and the talus. The tibia and fibula act as a mortise, stabilizing the joint while bracing the talus like an inverted cup. 88. The maxillary sinuses: Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind the ethmoidal sinuses. 89. The dorsiflexors muscles in the foot include the: Explanation: The dorsiflexors in the foot include the anterior tibial muscles and the toe extensors. 90. In renal adaptation of the newborn, which one of the following statements is correct? Explanation: In the neonate the kidneys are structurally complete but physiologically immature. The glomeruli have an inability to filter and concentrate urine, therefore glucose and amino acids escape and there is decreased ability to remove uric acid crystals which give the reddish appearance to the urine. There is an inability to adapt to fluid and electrolyte stress leading to loss of bicarbonate and poor reabsorption. This puts the neonate at increased risk of metabolic acidosis. The tubules are short/narrow which causes a problem with reabsorption. The nephrons function well within a month. ADH inhibits diuresis and the immature kidney causes an increased risk for dehydration. 91. When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is: Explanation: A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and/or intercostal muscles. If fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. This finding is not consistent with cystic breast disease or indicative of nonmalignant masses. 92. An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true? Explanation: Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake. 93. According to the U.S. Preventive Services Task Force, older adults should be screened for colorectal cancer with high-sensitivity fecal occult blood tests (FOBTs) every: Explanation: The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is small. 94. The great saphenous vein enters the deep venous system by way of the: femoral vein Explanation: The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of the deep venous system below the inguinal ligament. 95. When discussing the musculoskeletal system, all of the following statements related to articular structure disease are true except which one? Explanation: Articular disease typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion due either to stiffness or to pain. Extra-articular disease typically involves selected regions of the joint and types of movement. 96. Signs and symptoms associated with diabetic gastroparesis may include all of the followingexcept: vomiting of undigested food: weight loss: diarrhea: erratic glucose levels. Explanation: Diabetic gastroparesis occurs as a result of damage to the vagus nerve (controls the movement of food through the digestive system). Signs and symptoms associated with diabetic gastroparesis may include vomiting of undigested food, weight loss, erratic glucose levels, and gastroesophageal reflux. Diarrhea is not associated with diabetic gastroparesis or vagus nerve disorders since the vagus nerve innervates the stomach. 97. The portion of the umbilicus in a newborn that is covered with a firm gelatinous substanceand dries up within two weeks of birth is known as: Explanation: The umbilicus amniotic refers to the amniotic portion of the umbilical cord which is covered with a firm gelatinous substance. This portion dries up and falls out within two weeks of birth. The portion of the umbilicus ina newborn that is covered with skin and retracts to become flush with the abdominal wall, is known as the umbilicus cutis. An umbilical hernia in infants is a defect in the abdominal wall which can measure up to six centimeters. An umbilical granuloma reflects granulation tissue at the base of the navel formed during the healing process. 98. A patient was recently diagnosed with gluten intolerance and needs instructions on what foods to eat. The patient should be told that a gluten restricted diet includes: corn Explanation: A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye). Corn and rice, and soybean products are allowed but processed foods are not. 99. When percussing a protuberant abdomen, tympany is audible. This is consistent with all of the following conditions except: intestinal obstruction: increased intestinal gas production: a large solid tumor: a paralytic ileus. Explanation: A protuberant abdomen that is tympanic throughout when percussed can suggest intestinal obstruction, increased gas production, or a paralytic ileus. A solid mass gives a dull sound on percussion. 100. The Glasgow coma scale assesses: Explanation: Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glasgow Coma Scale was designed and should be used to assess the depth and duration of Explanation: In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder, lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. 110. Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: Explanation: The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. 111. At what age should an infant begin to say consonant sounds? Explanation: Asix-month-old infant should be able achieve these tasks: look at self in the mirror, respond to his own name, begin to say consonant sounds, begin to pass things from one hand to another, roll over in both directions, know familiar faces, and begin to know if someone is a stranger. 112. Genu varum refers to: Explanation: The term genu valgum refers to knock knees and genu varum refers to bow leggedness. Talipes equinovarus is the term that describes a clubfoot. Toeing inward or outward of the feet is known as tibial torsion. 113. When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the: Explanation: When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the posterior portion of the medial meniscus. 114, Breastfeeding is contraindicated for an infant diagnosed with which one of the following conditions? Explanation: Galactosemia is the lack of a specific enzyme in the liver that breaks down galactose into glucose. Some infants may inherit a gene that allows for some galactose metabolism. However, if the baby has “classic galactosemia” in which the baby has no galactose metabolizing enzymes, the baby will need to be weaned abruptly, and then fed a lactose free formula. Breast feeding is not contraindicated in the other conditions. 115. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner's right hand: Explanation: In order to examine the tongue, ask the patient stick out his the tongue and with the examiner's right hand, grasp the tip of the tongue with a gauze and gently pull it to the patient's left. Inspect the side of the tongue, then palpate it with the left hand, feeling for any induration. Reverse the procedure for the other side. Inspecting for tongue symmetry checks function of cranial nerve XII, hypoglossal. Stimulating the patient to cough and eliciting the gag reflex do not have anything to do with the tongue examination. 116. The ankle-brachial index is a screening test used to assess a person's risk for: Explanation: The ankle-brachial index test is a quick, noninvasive way to check a person's risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system. 117. The central nervous system extends from the medulla into the: Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. 118. The Weber test uses a tuning fork to test hearing. The frequency range closest to that of conversational speech would be one with a frequency of: Explanation: The Weber hearing test screens for unilateral conductive hearing loss with a tuning fork. The tuning fork is measured in frequencies of 256 Hz or 512 Hz. These frequencies fall within the range of conversational speech. The ideal frequency for the Weber test is 256 Hz. A frequency of 512 Hz is the ideal frequency for the Rinne hearing test. 119. The nurse practitioner holds the infant around the trunk. One sole touches the table. Thehip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. This maneuver assesses the: placing and stepping reflexes Explanation: The placing or stepping reflex (formerly known as the dancing reflex) is assessed by holding the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine curves toward the stimulus. To elicit the positive support reflex, hold the infant around the trunk, lower the infant until the feet touch a flat surface. Hips, knees, ankles extend and the infant stands up, partially bearing weight. 120. Which of the following findings in a preschooler would indicate the need for further evaluation? Explanation: Achild who responds to facial expressions and gestures rather than to verbal explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler. 121. Decreased spinal mobility in the lumbar region could be suggestive of: Explanation: Decreased spinal mobility in the lumbar region could be suggestive of osteoarthritis or ankylosing spondylitis. Dupuytren's contracture affects the hands. Torticollis would present a lateral deviation and rotation of the head. Kyphosis affects the thoracic spine. 122. An inward turning of the lower lid margin is called: Explanation: Entropion is more common in the elderly and occurs when the lower lid margin turns inward. When this irritates the conjunctiva and the lower cornea. Ectropion occurs when the lower lid turns outward and exposes the palpebral conjunctiva. Ptosis is a drooping of the upper eyelid. 131. When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the most appropriate for this child? Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line Explanation: The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line would be if the child had situs inversus or dextrocardia. 132. After attempting to elicit the Moro reflex in a newborn, the nurse practitioner identifies absence of movement of the left arm. The next assessment would be to: Explanation: A positive Moro reflex occurs when both arms are extended. If this response is not elicited bilaterally, the nurse practitioner should assess the clavicle. If the clavicle is fractured, the Moro response will be demonstrated on the unaffected side only. Babinski reflex assesses for neurological abnormalities. Gallant reflex is checked while the infant is prone and assesses for trunk incurvation. Ortolani maneuver assesses for congenital hip dysplasia. 133. Raised or flat, deep purple colored lesions noted in the mouth may be suggestive of: Explanation: Kaposi's sarcoma (a low-grade vascular tumor associated with human herpes virus 8), is associated with flat or raised deep purple colored lesions of the mouth. Approximately one third of patients with Kaposi’s sarcoma have lesions in the oral cavity. Other sites that could be affected include the gastrointestinal tract and the lungs. Koplik's spots are frequently seen in the early stage of measles (roseola) and appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. Torus palatinus develops as a bony growth in the hard palate and is common in adults. Fordyce spots or granules appear as yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands. 134. A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with: Explanation: Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is an ocular inflammation of the episcleral vessels. 135. Congenital cysts located at the midline of the neck just above the thyroid cartilage and may open under the tongue are know as: Explanation: Thyroglossal duct cysts are located at the midline of the neck just above the thyroid cartilage. They may open under the tongue. A preauricular cyst has pin-hole sized pits located anterior to the helix of the ear and may be associated with hearing loss. Small dimples appearing anterior to the midportion of the sternocleidomastoid muscle are known as brachial cleft cysts and may be associated with a sinus tract. Hypoglossal refers to the hypoglossal nerve and not to cysts. 136. The nurse practitioner places the infant lying supine on the exam table, and then makes aloud noise. The infant's arms abduct and extend with hands open and legs flexed. This maneuver assesses: Explanation: The maneuver described assesses the Moro or startle reflex. To elicit the asymmetric tonic neck reflex, with the infant supine, the nurse practitioner would turn the head to one side, holding the jaw over the shoulder. The arms and legs on the side to which the head is turned extend while the opposite arm and leg flex. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine should curve toward the stimulus. 137. According to the most recent recommendation from U.S. Preventive Services Task Force, an adult aged 65 should be screened for breast cancer: Explanation: The Task Force recommends screening for breast cancer with mammography every 2 years for women ages 50-74 and cites insufficient evidence for women 75 years and older. 138. That portion of the ear that consists of the auricle and ear canal is the: Explanation: The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The auditory canal opens behind a nodular protuberance that points backward over the entrance to the canal, known as the tragus. 139. The cranial sutures are closed on the head of a 9 month old infant. This indicates: craniosynostosis Explanation: Craniosynostosis is defined as the premature closing of the sutures in young children. When this occurs, a bony ridge can be felt along the suture line. This is not a normal finding since the sutures usually fuse between 12 and 18 months. Hydrocephalus refers to fluid on the brain and would appear as an enlarged head with sutures remaining open. Opisthotonos is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position. This abnormal posturing is an extrapyramidal effect and is caused by spasm of the axial muscles along the spinal column. 140. A decrease in the degree of density in a bone that results in fragile bones is referred to as: osteoporosis Explanation: Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis leads to abnormally porous bone that is compressible, like a sponge. Osteopenia is a condition of bone that makes it slightly less dense than normal bone, but not as severe as in osteoporosis. Osteomyelitis refers to an infection in the bone. Osteoarthritis is a term used to describe degenerative joint disease. 141. Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed: Explanation: Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud's disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. 142. A patient presents with a fiery red, slightly raised 2 cm lesion on the upper truck that blanches when pressure is applied. The body of the lesion is surrounded by erythema and radiating legs. This is most likely: Explanation: A spider angioma is fiery red, slightly raised and surrounded by erythema and radiating legs that blanch with pressure. These are usually seen in patients with liver disease, pregnancy, vitamin B deficiency, and sometimes patients with no disease. The spider vein is blue. Cherry angiomas are bright or ruby red and increase in size and number as one ages. Petechiae are deep red or reddish purple and are seen when blood is outside the vessels. This suggests a bleeding disorder or injury to the skin. 143. A cartilage-like articulation between the pubic bones is known as the: Explanation: The pubic symphysis is a cartilage-like articulation between the pubic bones. The anterior superior iliac spine is the area where the iliac crest terminates anteriorly on the ilium. A long the hilar region. Crackles are adventitious sounds heard in the lungs and may be due to abnormalities in the lungs. 151. Fasciculations in atrophic muscles suggest: Explanation: Fasciculations are small muscle twitches and can be found in any muscle of the body. Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles, this may suggest a lower motor neuron disease. They are not seen in central or peripheral nervous system disease or rheumatoid arthritis. 152. To test the thumb for flexion, ask the patient to: move his thumb across Explanation: To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To test extension, ask the patient to move his thumb from the base of the fifth finger, across the palm, and then as far away from the palm as possible. Touching the thumb to each of the other fingers tests opposition. Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. Moving the thumb back to its neutral position assesses adduction. 153. Whena patient complains of joint pain as progressing from one joint to another, the examiner should consider this pattern of involvement as migratory. This type of involvement would most likely be observed in a patient who has: Explanation: A migratory pattern would involve migrating pain from joint to joint or steadily spreading from one joint to multiple joints. Examples of this type of joint pain migration is seen in patients who have rheumatic fever or gonococcal arthritis. Gout usually involves one joint and typically affects the first toe. Bursitis is consistent with extra-articular pain that occurs in inflammatory conditions. Osteomyelitis usually presents suddenly with a swollen joint and pain. This is more commonly seen in children. 154, During late adolescence, achievements are marked by: Explanation: During the late adolescence, achievements are marked by moral thinking 155. By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as: the straight-leg raise Explanation: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as the straight leg raise and is used to evaluate sciatica. It is positive if there is pain down the back of the leg below the knee. Ipsilateral calf wasting and weak ankle dorsiflexion may be present. 156. The groove of the radiocarpal joint is located: On the dorsum of the wrist (between the radial and ulna) Explanation: The groove of the radiocarpal joint is located on the dorsum of the wrist. 157. Inspection of the hip begins with careful observation of a patient's gait. A patient's foot moves forward without bearing weight. This is known as the: Explanation: Inspection of the hip begins with careful observation of a patient's gait. There are 2 phases of gait: stance and swing. The swing phase occurs when the foot moves forward and does not bear weight. The stance phase occurs when the foot is on the ground bearing weight. 158. When assessing a preschooler's mouth, the number of deciduous teeth seen should be: Explanation: Children get their first 20 deciduous teeth between the ages of 6 months and 5 years. Permanent teeth begin to erupt around 6 years of age when the deciduous teeth begin to fall out. All 32 permanent teeth usually erupt by late adolescence. 159. The most common cause of bacterial pharyngeal infections in children is: A beta-hemolytic Streptococcus Explanation: Pharyngitis is caused by swelling between the tonsils and the larynx. Most sore throats are caused by colds, the flu, Coxsackie virus or mononucleosis. Bacteria that cause pharyngitis include group A beta-hemolytic Streptococcus, and less commonly, Corynebacterium, gonorrhea, and Chlamydia can cause sore throat. 160. A buildup of excess fluid around the periphery of the eye orbits is known as: Explanation: An accumulation of fluid around the periphery of the eye orbits is known as periorbital edema. 161. Symptoms of acrocyanosis in the newborn include: Explanation: Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. 162. The structure that creates a channel for the spinal nerve roots is known as the: Explanation: The intervertebral foramen creates a channel for the spinal nerve roots. The vertebral foramen encloses the spinal cord. The transverse foramen creates a channel for the vertebral artery. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets. 163. Retraction of the nipple and areola suggest: Explanation: Retraction of the nipple and areola suggest an underlying breast mass. This is not normal and never found in association with cystic breast disease or fibroadenoma. 164. If a patient presents with non-midline lumbar back pain, the nurse practitioner should assess for: Explanation: For midline back pain, assess for musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, and, rarely, epidural abscess. Muscle strain, sacroiliitis, trochanteric bursitis, sciatica, and hip arthritis is suggestive of non-midline back pain. Pyelonephritis and renal stones may also be suggestive of non-midline back pain. 165. On examination of the foot, the nurse practitioner notes acute inflammation of the first metatarsophalangeal joint. This finding could be consistent with: Explanation: Acute inflammation of the first metatarsophalangeal joint suggests gout. 166. When assessing a normal 5-year-old, the last site to assess would be the: Explanation: The throat and mouth are considered invasive sites and should be performed last. 167. The palpation technique used to assess respiratory expansion of the chest is placing the hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and grasping a small fold of skin between the thumbs. Then: 177. When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are: Explanation: A patient with left sided heart failure experiences increased pressure in the pulmonary veins causing congestion and interstitial edema. The breath sounds are vesicular with late inspiratory crackles in the dependent portions of the lungs and are resonant on percussion. Consolidation in the lungs produces bronchial breath sounds with late inspiratory crackles over the involved area and is dull on percussion. A normal lung has vesicular breath sounds without adventitious sounds and is resonant on percussion. Chronic obstructive lung disease produces decreased breath sounds with some audible wheezes and is hyperresonant on percussion. 178. Assessment findings in a newborn at birth include: irregular respirations without crying, heart rate of 105 beats/minute, grimaces with reflex stimulation, kicking of both feet, and moving of both arms. The body and face are pink and hands and feet are cyanotic. What is the APGAR score? Explanation: APGAR stands for: Activity, Pulse, Grimace, Appearance, and Respiration. It is an objective score of the condition of a baby immediately after birth and is determined by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs receives 0, 1, or 2 points. An Apgar score of 10 means an infant is in the best possible condition. The Apgar score is done routinely 60 seconds after the birth of the infant. A child with a score of 0 to 3 needs immediate resuscitation. The Apgar score is often repeated 5 minutes after birth, and in the event of a difficult resuscitation. The Apgar score may be done again at 10, 15, and 20 minutes. This infant's score is 7: He receives a 1 for respiration, 2 for heart rate, 1 for grimace, 1 for color, and 2 for activity. Scores 7 and greater are generally considered to be normal. 179. A patient complains of severe epigastric pain that radiates to the posterior trunk and entire abdomen. This type of pain can be suggestive of: Explanation: Acute pancreatitis is inflammation of the pancreas. The pain is poorly localized in the abdomen, therefore, can be epigastric and may radiate to the posterior trunk. Biliary colic, sudden obstruction of the cystic or common bile ducts by a gallstone is characterized by pain in the epigastric or right upper quadrant and may radiate to the right scapula or shoulder. Pain in the periumbilical area that radiates to the right lower quadrant is usually seen in patients who have appendicitis. Stomach cancer may presents with pain in the patient's epigastric area. 180. The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of: Explanation: Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation, electrode dislocation, poor contact or interference by other tissues. Symptoms include dizziness, lightheadedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest. Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of pacemaker malfunction. 181. In an infant, a repetitive, short expiratory sound is known as: Explanation: In an infant, a repetitive, short expiratory sound is known as grunting and is a sign of respiratory distress. The sound elicited with stridor would be a high-pitched, inspiratory noise. In an infant with nasal flaring, an enlargement of both nasal openings would flare during inspiration. Wheezing denotes a musical expiratory sound. All these conditions are signs of respiratory distress in an infant. 182. The patella rests on the: articulating surface of the femur Explanation: The patella rests on the anterior articulating surface of the femur midway between the epicondyles, embedded in the tendon of the quadriceps muscle. 183. A six-year-old child presents with a few small vesicles that are honey-colored and weeping around the left nare. These lesions are consistent with: Explanation: Impetigo usually appears as red crusty lesions on the face, especially around a child's nose and mouth. The lesions burst and develop honey-colored crusts. Varicella is characteristic of papules, vesicles, and crusted lesions occurring simultaneously. Herpes simplex on the lips and mouth appear as small vesicles or blisters and are termed "fever blisters" or "cold sores". Shingles appear as vesicles or blisters in clusters along the entire path of the nerve or in certain areas supplied by the nerve. 184, To test the thumb for adduction, ask the patient to place the fingers and thumbs in the neutral position with the palm up and move the thumb anteriorly away from the palm and then: Explanation: Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm and then back to its neutral position assesses adduction. To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To test extension, ask the patient to move his thumb from the base of the fifth finger, across the palm, and then as far away from the palm as possible. Touching the thumb to each of the other fingers tests opposition. Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. 185. A patient complains of an unpleasant abdominal fullness after a light meal. This complaint may be consistent with: diabetic gastroparesis Explanation: Complaints of an unpleasant abdominal fullness after a light or moderate meal, or the inability to eat a full meal is often seen in patients with diabetic gastroparesis, gastric outlet obstruction, gastric cancer, early satiety in hepatitis, or those taking anticholinergic medications. 186. Which technique would be least effective in gaining the cooperation of a toddler during aphysical exam? Explanation: Telling the child that another child the same age was not afraid would not be an effective technique as a toddler is unable to process that concept. The other choices are appropriate techniques. 187. While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a: Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. 188. Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation of the head. This condition is suggestive of: Explanation: Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation of the head. This condition is suggestive of torticollis. 189. If a patient describes his stool as thin and "pencil-like", this could be associated with: awareness of one's environment and confused thinking. In the older adult, it is defined as a geriatric syndrome or condition occurring as a temporary state of confusion and may be the first clue to infection or problems with medications. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive physiological capacity occurring in the absence of identifiable illness is known as frailty. 199. If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and: Explanation: If urethritis or inflammation of the paraurethral glands is suspected, the examiner should insert the index finger into the vagina and milk the urethra gently from inside outward. Note any discharge from or about the urethral meatus. If present, it should be cultured. 200. When palpating the carotid pulse, it is important to: Explanation: The carotid artery should be palpated gently and while the patient is sitting or lying down. The patient's chin should be elevated to allow easy palpation and yet not enough to tighten the neck muscles. Stimulating its baroreceptors with low palpation can provoke severe bradycardia or cause cardiac arrest in some sensitive persons. Also, carotid arteries should never be palpated at the same time. This may limit blood flow to the head, possibly leading to fainting or cerebral ischemia. A carotid pulse is palpable between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage 201. A 40-year-old male states that he felt "something" above his left testis. On examination, a painless cyst is noted above the left testicle. Transillumination is positive. This is consistent with a: Explanation: A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate and are difficult to distinguish clinically. An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. Additionally, the scrotum may be reddened and the vas deferens inflamed. Coexisting urinary tract infection, or prostatitis, supports the diagnosis. Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms" upon palpation of the scrotum. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection. 202. During pregnancy, a patient's fundal height measured 26 centimeters. This would suggest that the gestational age was: Explanation: Uterine fundal height measured in centimeters correlates with gestational age between 18 and 34 weeks. Fundal height is measured in centimeters from symphysis pubis to top of uterus. This is know as McDonald's rule. 2034When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is: Explanation: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is a positive Romberg test and suggestive of ataxia related toa dorsal column disease. In cerebellar ataxia, the patient has difficulty standing with feet together whether the eyes are open or closed. With corticospinal tract damage, the gait is affected and the patient is unable to heel-walk. B04) The group of muscles that lies medial and swings the thigh toward the body is known as the: Explanation: The group of muscles that lies medial and swings the thigh toward the body is known as the adductor group. The group of muscles that lies laterally and swings the thigh away from the body is known as the abductor group. The group of muscles that lies posteriorly and extends the thigh is known as the extensor group. The group of muscles that lies anteriorly and flexes the thigh is known as the flexor group. 2054 in the older adult, the test for leg mobility is known as the: Explanation: The test for leg mobility, also known as the timed “get up and go” test for gait and balance, is an excellent screen for risk of falling. Ask the patient to get up from a chair, walk 10 feet, turn, and return to the chair. Most older adults can complete this test in 10 seconds. BOI Examination of the nasolacrimal duct reveals a mucopurulent discharge from the puncta. This finding is suggestive of: Explanation: An obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta of the eye. Conjunctivitis is an inflammation of the conjunctiva and findings include red, burning, and itchy eyes. Dacryocystitis is an inflammation of the lacrimal sac, the area between the lower eyelid and the nose. Dacryocystitis presents as a painful, red, and tender area around the eye especially near the nose. A pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust. 207) when trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient: Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. 208. When performing an examination of the rectal area, a linear tear at the anal opening was observed. This could be indicative of: Explanation: A linear crack or tear suggests an anal fissure from large, hard stools, inflammatory bowel disease, or sexually transmitted diseases. 205] when examining the prostate gland the examiner should inform the patient that this procedure may: Explanation: When examining the prostate gland on a male patient, the examiner should inform the patient that this procedure may prompt an urge to urinate but reassure him that he will not void on himself. 20) when administering ear drops to a 6-year-old, the pinna should be pulled: Explanation: To examine the ears of an infant it is usually necessary to pull the auricle backward and downward. In the older child, the external ear is pulled backward and upward. mask more serious problems. Compression is appropriate for sports injuries, but heat application should not be an immediate action. While rest is important after a sprain, early mobility hastens recovery. iS) the vertebral column angles sharply posteriorly and becomes immovable at the: Explanation: The vertebral column angles sharply posteriorly and becomes immovable at the lumbosacral junction. The intervertebral discs cushion movement between vertebrae and allow the vertebral column to curve, flex, and bend. The coccyx is the final segment of the vertebral column and serves as an attachment for various tendons, muscles, and ligaments. It also supports weight while sitting. The sacroiliac joint overlays the posterior superior iliac spine. B20) when auscultating heart sounds in a newborn, if a louder than normal pulmonic component (P2) is audible, suspect: Explanation: The aortic (A2), or first component of the second sound at the base, is normally louder than the pulmonic (P2), or second component. A louder than normal pulmonic component, particularly when louder than the aortic sound, suggests pulmonary hypertension. Bi the nurse practitioner places an infant lying supine on the exam table, and turns the head to one side, holding the jaw over the shoulder. The arms and legs on the side to which the head is turned extend, while the opposite arm and leg flex. This maneuver assesses: Explanation: The maneuver described assesses the asymmetric tonic neck reflex. Moro or startle reflex assesses arm abduction and extension, open hands, and flexed legs in response to a loud noise. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine should curve toward the stimulus. @2Bwhen performing a rectal exam, a reddish, moist, protruding mass is noted at the anal opening. This finding is most likely a(n): Explanation: Internal hemorrhoids are enlargements of the normal vascular cushions located above the pectinate line. They are not usually visible but may become visible if prolapse occurs after defecation. They would appear in the anal canal as reddish, moist, protruding masses. External hemorrhoids are dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. They present as tender, swollen, bluish, ovoid masses at the anal margin. A tender, purulent, reddened mass palpated in the rectum would be consistent with an anal abscess, especially in the presence of fever and chills. Rectal polyps are typically located in the rectum and ,if palpable, feel soft to touch. 223. A chancre is defined as a: Explanation: Achancre is defined as a painless ulceration formed during the primary stages of syphilis. A group of scattered small vesicles is associated with genital herpes. Papules appearing in many shapes that can be raised, flat, or cauliflower-like are characteristic of genital warts (condylomata acuminata). Non-tender indurated nodules are associated with carcinoma of the penis. Baa discriminative sensation that describes the ability to identify an object by feeling it is: Explanation: A discriminative sensation that describes the ability to identify an object by feeling it is stereognosis. The patients eyes must be closed. Graphesthesia, or number identification, is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. The ability to identify an object touching 2 areas simultaneously is termed two-point discrimination. Astereognosis is a term used to describe the inability to recognize objects placed in the hand. 225. Newborns are classified according to their gestational age and weight. A newborn weighing less than 2,500 grams at birth is: Explanation: A newborn weighing less than 1,000 grams at birth is classified as an extremely low birth weight; less than 1,500 grams as very low birth weight; less than 2,500 grams as low birth weight; and greater than 2,500 grams as normal birth weight. 26. On ophthalmoscopic examination, optic atrophy appears: Explanation: In optic atrophy, there is death of the optic nerve fibers. This leads to loss of the tiny disc vessels giving a white appearance. A pink and hyperemic disc is seen in patients with papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are tiny with disc margins that appear sharp. A pale disc with a backward depression is characteristic of glaucomatous cupping. 227. Examination of the abdomen reveals a small midline protrusion in the linea alba. This finding is consistent with an: Explanation: The linea alba runs from the xiphoid process to the pubic symphysis. The presence of a small midline protrusion through a defect in the linea alba suggests an epigastric hernia. An incisional hernia is a protrusion through an operative scar. A protrusion through a defective umbilical ring is termed an umbilical hernia. This condition is commonly seen in infants. An inguinal hernia presents as a protrusion of abdominal contents in the inguinal canal. The inguinal canal is situated just above the medial half of the inguinal ligament in the area of the groin on both sides of the abdomen. 228. An irregular shaped bony feature at the lateral top of the femur is known as the: Explanation: An irregular shaped bony feature at the top of the femur is known as the greater trochanter. It is not to be confused with the head of the femur. 229. Leukoplakia was noted during an exam of the mouth. This symptom may be: precancerous Explanation: Leukoplakia are thickened white patches located on any area of the mouth. These patches cannot be rubbed off. Most are not serious but some can be considered precancerous. Therefore, they should be evaluated. These lesions are not considered normal findings. Periodontal disease usually includes an infection of the gums and may involve the teeth. Generally, the infection causes redness and swelling but not white patches. 230. Metatarsalgia is a term used to describe: Explanation: Metatarsalgia is a term used to describe pain and tenderness in the metatarsals. Activities such as running and jumping and wearing ill-fitting shoes can cause this condition. 231. During pregnancy, if fundal height is 4 centimeters larger than expected, consider all of the following except: large for gestational age infant extra amniotic fluid uterine leiomyoma fetal anomaly Explanation: If fundal height is 4 centimeters or larger than expected, consider multiple gestation, a large fetus, extra amniotic fluid, or uterine leiomyoma. If fundal height is 4 centimeters or smaller than expected, consider low level of amniotic fluid, missed abortion, intrauterine growth restriction, or fetal anomaly. All of these conditions should be investigated by ultrasound. 232. Which one of the following ligaments of the foot is most at risk for injury from inversion? Barbiturates, alcohol and benzodiazepines fall in this class. Amphetamines are CNS stimulants. The teenager would exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial infarction, or death. Marijuana intoxication would present with relaxation, euphoria, detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia. 24iThe posterior auricular lymph node is located: Explanation: The posterior auricular nodes are superficial to the mastoid process. The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly BA29A serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking is referred to as: Explanation: Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. In the older adult, it is defined as a geriatric syndrome or condition occurring as a temporary state of confusion and may be the first clue to infection or problems with medications. A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive physiological capacity occurring in the absence of identifiable illness is known as frailty. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Functional impairment is a health condition in which the normal function of a part of the body is less than full capacity. One of the defining characteristics of functional impairment is that the reduction in physical or mental capacity is sufficient to interfere with managing day-to-day tasks. 243 when compressing the suprapatellar pouch and pushing the patella sharply against the femur, fluid is noted to return to the suprapatellar pouch. This is known as a positive: balloting sign (see 52) PA visorders of speech fall into three groups that affect all of the following except the: Explanation: Disorders of speech fall into three groups affecting: (1) the voice, (2) the articulation of words, and (3) the production and comprehension of language. The written language is not included in the disorders of speech. B45 To test the thumb for opposition, ask the patient to: touch the thumb to each of the other QAI Assessing the neurological status of a child with a ventriculoperitoneal shunt should include: use of the Glasgow coma scale Explanation: The Glasgow coma scale addresses eye, verbal, and motor responses to determine a neurological assessment score and is the first sign of improvement or deterioration in neurological status. Also, signs of increased intracranial pressure should be assessed. Kernig's sign is any resistance or pain when the child is supine and the leg is extended and knee bent. A positive sign is more consistent with meningitis. Brudzinski's sign is an involuntary flexion of the knee or hip when the child is in the supine position and the neck is flexed and is also consistent with meningitis. The Monroe-Kellie Doctrine states that the sum of brain, CSF, and blood within the cranial vault is constant. So an increase or decrease in one causes a compensatory increase or decrease in one or both of the others. It is an hypothesis and not an assessment. Baa patient presents with persistent thoughts of contamination, and dressing and undressing rituals. These symptoms are consistent with: obsessive -compulsive disorder (OCD) Explanation: Obsessive-compulsive disorder is characterized by recurrent, irrational, obsessive thoughts and uncontrollable compulsive behaviors. Control of self, others and the environment is of utmost importance. Posttraumatic stress disorder is associated with exposure to an extremely traumatic situation or event: witnessing an accidental death, experiencing rape, or torture. Panic disorder is characterized by recurrent panic attacks. General anxiety disorder is characterized by pervasive, persistent anxiety of at least 6 months duration without panic attacks. Baa twelve-month-old was recently diagnosed with Acquired Immunodeficiency Syndrome (AIDS). The mother asks the nurse practitioner: "How could my child have acquired AIDS?" The best response from the nurse practitioner should be that: "Children under two years of age usually acquire AIDS: Perinatally through an HIV infected mother Explanation: Perinatally is the acquired mode for infants. Children usually over five years of age acquire AIDS through sexual abuse. HIV does not survive in the environment and there is no evidence to date to support the fact That AIDS is acquired through casual contact or by sharing car seats with HIV infected seats. othe Sexual Maturity Rating in boys includes 5 stages. Characteristics indicative of Stage 4 would include: Explanation: The Sexual Maturity Rating is also termed Tanner Staging, named after Dr. James Tanner. The stages are characterized by the following findings: Stage 1: prepubertal: absent pubic hair, same size, proportion of penis, testes, scrotum as in childhood; Stage 2: Sparse growth of long downy hair at the base of the penis, minimal or no enlargement of penis, enlargement of testes, pigmentation of scrotal sac; Stage 3: Increase in amount of pubic hair with curling, significant enlargement in penis, further enlargement of testes; Stage 4: Pubic hair is adult like in type but not distribution, development of facial and axillary hair, further enlargement of testes and penis; Stage 5: Pubic hair in medial aspects of thighs; linea alba. BBO} slow, persistent fungal infection of fingernails and toenails is: Explanation: Onychomycosis is a slow, persistent fungal infection of fingernails and toenails causing change in color, texture, and thickness. The nail may crumble or break with loosening of the nail plate, usually beginning at the distal edge and progressing proximally. Leukonychia is a white discoloration appearing on nails. The most common cause is injury to the base of the nail (the matrix) where the nail is formed. Psoriasis of the nails may appear as small pits in the nail. Paronychia is red, swollen, tender inflammation of the nail folds. BB what part of the ear consists mainly of cartilage covered by skin and has a firm yet somewhat elastic feature? Explanation: The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The external ear consists of the auricle and ear canal. The auricle has a prominent curved outer ridge known as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The ear canal opens behind a nodular protuberance that points backward over the entrance to the canal. This is called the tragus. B52 when examining the ankle and foot of a patient, the nurse practitioner instructs the patient to point the foot toward the ceiling. This motion assesses: Explanation: Having the patient point the foot toward the ceiling assesses ankle extension. Having the patient point the foot toward the floor assesses ankle flexion. Having the patient move the heel inward assesses inversion. Having the patient move the heel outward assesses eversion. B53) when performing a pelvic exam on a pregnant woman, a larger speculum may be neededbecause of: Explanation: Because of vaginal wall relaxation, a larger than usual speculum may be needed. BEAM According to the Tanner stages of development (Sexual Maturity Rating), breast development in Stage 5 in females includes the: Explanation: Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as tight, and bursting around the affected area. The pain may be accompanied by swelling and tenderness. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. BE5N which nerve in the arm originates in the axilla and travels down the arm ina shallow depression on the surface of the humerus? Explanation: The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. The brachial plexus runs from the spine through the neck, the axilla, and into the arm. BEG winging of the scapula can be noted in patients with all of the following conditions except: liver disease. injury to the long thoracic nerve muscular dystrophy. weakness of the serratus anterior muscle Explanation: Normally, the scapulae lie close to the thorax. However, in winging of the scapula the medial border of the scapula juts backward. It suggests weakness of the serratus anterior muscle, seen in muscular dystrophy or injury to the long thoracic nerve. Winging is not characteristic of liver disease. Be7jRedness, bleeding, pain, and swelling of the gums is most likely: Explanation: Swelling, pain, erythema, and bleeding of the gums are symptoms of gingivitis. Stomatitis refers to inflammation of the mouth. Leukoplakia presents as thickened white patches anywhere in the oral mucosa. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They usually appear as round or oval ulcers, can be white or yellowish gray in color, and surrounded by a halo of reddened mucosa BERNA child presents with fever of 102.5 °F for the past five days. Kawasaki disease is suspected if which of the following groups of symptoms is present? Explanation: In Kawasaki disease there is persistent fever for 5 days. In order to be diagnosed with Kawasaki disease, a child must present with 4 of the following 5 symptoms. These include: cervical lymphadenopathy, bilateral conjunctivitis, macular rash, edema of the hand and/or feet, and strawberry tongue. Pounding pulse, elevated B/P, and chronic hemolytic anemia are not consistent with Kawasaki disease. Retinopathy and jaundice are more consistent with sickle cell disease. Group A beta hemolytic strep and erythema marginatum are common with rheumatic heart disease. BES 25-year-old with the mental age of a toddler, who exhibits limited language skills and can be trained in very basic activities of daily living, such as dressing, hygiene and feeding, would be classified as: Explanation: Amildly mentally retarded person is educable with a mental age of 8 to 12 years old. A severely mentally retarded person has an IQ between 25-40, limited communication, capable of learning certain self-care activities, and the mental age of a toddler. A moderately mentally retarded person is trainable with a mental age of a 3 to 7 year old and an IQ of 35-55. A profoundly mentally retarded person has an IQ less than 20,the mental age of an infant, and requires complete custodial care. 270MMon auscultation of the chest, if the patient says "ninety-nine" and it is clearly heard, this is indicative of: Explanation: Bronchophony indicates density and usually repeating the words ninety-nine produces that sound. Egophony, saying ee-ee-ee-ee, is more indicative of consolidation or compression in the area. Whispered pectoriloquy, whispering one-two-three, is more faint than bronchophony, and heard over areas of small amounts of consolidation. Inflammation would produce more of a wheezing sound in the chest and is associated with narrowed airways (as heard during asthma exacerbation). 27 an infant learns to move the shoulders before learning to control fine finger movement. This is an example of which type of developmental progression? Explanation: Proximodistal principle of development proceeds from the development of motor skills from the center of the body outward. An example is an infant learning shoulder movement before fine finger movement. General to specific development refers to development from a generalized movement to a specific movement. The infant must make random leg movements before he is able to coordinate the leg muscles well enough to crawl or walk. Neurologic development progresses centrally to peripherally. This means that the infant must learn head control before trunk control. Cephalocaudal principle of development proceeds from the head to the lower part of the trunk and usually occurs from conception to 5 months of age. 272. The term used to describe skin that is red over the entire body is: Explanation: Erythroderma occurs when a skin condition affects the whole body or nearly the whole body, resulting in a red appearance all over. Dark-colored adherent crust of dead tissue found on some ulcers is referred to as eschar. An excoriation is a scratch mark or surface injury penetrating the dermis. Exfoliation refers to peeling skin. B73) when examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the: Explanation: When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the posterior portion of the medial meniscus. W7Apuring the infant and toddler years, achievements are marked by: Explanation: During the infant and toddler years, achievements are marked by cause and effect B75lon examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of: Explanation: When the pupil is large, regular, and usually unilateral and the reaction to light is severely reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's moon facies, buffalo hump, or hypertrichosis. Diabetes may produce any of these skin conditions: necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive xanthomas, and peripheral vascular disease. 285i symptoms of bacterial conjunctivitis in an infant include: Explanation: Symptoms of bacterial conjunctivitis in an infant include eyelid edema, bulbar conjunctival injection, purulent or mucopurulent discharge. Viral conjunctivitis presents with eyelid ecchymosis and watery discharge from the eyes. It can have an abrupt onset and present is one or both eyes. A vesicular rash or ulceration of the eyelids with a watery discharge from the eyes is seen in Herpes simplex viral infection of the eyes. Medication induced conjunctivitis presents with a contact dermatitis of the eyelids and a subconjunctival, multilobulated yellow mass. BREA child presenting with a unilateral, purulent rhinorrhea accompanied by headaches, sore throat and facial tenderness may be suggestive of: Explanation: Achild presenting with a unilateral, purulent rhinorrhea accompanied by headaches, sore throat and facial tenderness may be suggestive of sinusitis. 287. Lower abdominal pain accompanied by fever or shock in older adults could be consistent with: ischemic colitis Explanation: Lower abdominal pain accompanied by fever or shock in older adults could be consistent with ischemic colitis. Generally the abdomen is soft on palpation. Hemorrhoids typically present with noticeable blood on the tissue paper, surface of stool, or dripping in the toilet. Colon cancer can cause bloody stools but usually presents with changes in bowel habits and weight loss. Blood in the stool is usually the only symptom seen with adenomatous polyps. 288. Chronic pelvic pain may be secondary to all of the above except:sexually transmitted diseases sexual abuse. fibroids peptic Explanation: Chronic pelvic pain (CPP) refers to pain of at least 6 months duration that occurs below the umbilicus. While gynecologic etiologies are common, CPP may be secondary to conditions in the urinary tract, GI tract, musculoskeletal system, and in the setting of mental health issues. Peptic ulcer disease affects the upper GI tract and produces symptoms above the umbilicus. 289. Hyperfunctioning of the thyroid gland could lead to all the following disorders except: Grave's disease. thyrotoxicosis myxedema (does not cause) toxic goiter. Explanation: Hyperfunctioning of the thyroid gland leads to a hypermetabolic state causing an increase in metabolic function, increased oxygen consumption by tissues, and heat production. Disorders include: Grave's disease, toxic goiter, thyroid storm (thyrotoxicosis). Myxedema is seen in hypofunctioning of the thyroid gland. 289. When examining the knee, which of the following symptoms could be indicative of a positive Adduction (Varus) Stress Test? Explanation: The Adduction (or Varus) Stress Test is a maneuver that evaluates the function of the lateral collateral ligament. To perform this test, the knee is held in 30 degrees of flexion. With one hand on the medial side of the knee and one hand on the ankle, an adduction force is gently applied. If pain is noted in the lateral joint line, this could be indicative of a lateral collateral ligament tear. When tenderness extends more to the proximal or distal joint line, the collateral ligament may be the cause of pain instead of the meniscus. 290. Joint pain that is localized and involves one joint, would be documented as: Explanation: If the joint pain is localized and involves only one joint, it is monoarticular. Extra-articular is a term used to describe joint structures and would include periarticular ligaments, tendons, bursae, muscle, fascia, bones, nerves, and overlying skin. Joint pain that is polyarticular involves several joints. Radicular pain refers to pain that radiates along the dermatome of a nerve due to inflammation or irritation of a nerve root at its connection to the spinal column, as with sciatica pain. 291. The ankle-brachial index is a screening test used to assess a person's risk for: Explanation: The ankle-brachial index test is a quick, noninvasive way to check a person's risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system. 292. The structure that encloses the spinal cord is known as the: Explanation: The vertebral foramen encloses the spinal cord. The structure that projects from the spinal column posteriorly in the midline is referred to as the spinous process. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets. 293. A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive physiological capacity occurring in the absence of identifiable illness is known as: Explanation: A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive physiological capacity occurring in the absence of identifiable illness is known as frailty. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. In the older adult, it is defined as a geriatric syndrome or condition occurring as a temporary state of confusion and may be the first clue to infection or problems with medications. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Functional impairment is a health condition in which the normal function of a part of the body is less than full capacity. One of the defining characteristics of functional impairment is that the reduction in physical or mental capacity is sufficient to interfere with managing day-today tasks. 294. When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve? Explanation: Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and vagus nerves. 295. When performing the bimanual vaginal exam, uterine enlargement is noted. This enlargement could suggest: Explanation: 304. If abdominal pain persists when the patient raises his head and shoulders, the origin of the tenderness is probably: Explanation: Tenderness may originate in the abdominal wall. When the patient raises his head and shoulders, the pain will persist. However, if the tenderness originates from deep in the abdomen, the pain usually decreases because it is protected by the tightened muscles. With inflammation from the pleural cavity, abdominal pain and tenderness may mimic acute cholecystitis or appendicitis. This pain increases with breathing and causes chest pain. In pancreatitis, epigastric and rebound tenderness is observed but the abdominal wall is usually soft. 305. On examination of an eighteen-year-old which one of the following neurological signs would not be helpful if meningitis is suspected? Explanation: If meningitis is suspected, nuchal rigidity, positive Brudzinski sign, and Kernig's sign should all be assessed. If these meningeal signs are positive, meningitis is suspected. A loss of anal reflex would suggest a lesion in the S2, 3, and 4 reflex arc. Therefore, it would not be helpful with the differential diagnosis. 306. Acholic stools are associated with: Explanation: Stools that are pale or clay or putty-colored are termed acholic. Acholic stools may occur briefly in viral hepatitis but are more common in obstructive jaundice. 307. Irregular brownish patches around the forehead, cheeks, nose, and jaw noted during pregnancy are: Explanation: Irregular brownish patches around the forehead, cheeks, nose, and jaw noted during pregnancy are known as chloasma (or melasma) or the "mask of pregnancy". This is considered a normal finding 308. The adductor tubbercle of the knee is located: Explanation: The adductor tubercle of the knee is located on the medial surface of the knee. 309. The anterior drawer sign is used to assess instability of the: anterior cruciate ligament (ACL) Explanation: The anterior drawer sign is used to evaluate the anterior cruciate ligament (ACL) for instability. A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign suggestive of an ACL tear. 310. The calcaneus is located: under the talus Explanation: The calcaneus is located under the talus and is known as the heel bone. 311. One of the anterior thoracic landmarks is the costal angle. It is located: Explanation: The right and left costal margins form an angle where they meet at the xiphoid process. This is the costal angle. The angle should be 90 degrees or less. However, the angle increases when the rib cage is chronically over inflated, as in emphysema. Sito auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope:between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border Explanation: Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). B23) The six to eight year-old school age child is able to: participate in competitive activities Explanation: By six to eight years of age, the school aged child is able to perform several of the following tasks: demonstrate nervous habits, have well established hand eye coordination, collect things, enjoy hobbies, enjoy a challenge, and prefers playing with the same sex friends. The other choices are consistent with the development of a 8-10 year-olds. Bwhen assessing anal reflexes, the nurse practitioner strokes the four quadrants of the anus with a cotton swab. A loss of anal reflex is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. BU5)The lower tip of the scapula is located: Explanation: The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the seventh or eighth rib. Bi6)Primary dysmenorrhea results from: Explanation: Dysmenorrhea is defined as pain with menses. The causes can be either primary or secondary. Primary dysmenorrhea occurs without an organic cause whereas with secondary dysmenorrhea, there is an organic cause. Primary dysmenorrhea results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline. Causes of secondary dysmenorrhea include endometriosis, adenomyosis (endometriosis in the muscular layers of the uterus), pelvic inflammatory disease, and endometrial polyps. 316. proficient