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NR509 Final Exam Questions with
Simplified Solution
1. A 35-year-old female with a history of migraines presents to the clinic with
worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step?: Take a further history and perform a very careful neurological exam
2. A grandmother is accompanying her 9-year-old granddaughter during a routine
physical examination. She asks you privately if her granddaughter has started puberty yet. During the examination, the NP notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound above the level of the breast. The left breast is underdeveloped. These assessment findings are consistent with which Tanner Stage of development?- : IV
3. Primary prevention is defined as which of the following?: Interventions designed to
prevent disease
4. Based on the U.S. Preventive Services Task Force (USPSTF) recommenda-tions,
which of the following statements is true about screening for breast cancer in average- risk women?: Mammography is recommended every 2 years for women aged 50-74 with insuflcient evidence for screening women over the age of 75.
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5. Which of the following statements is true regarding recommendations by the
eighth Joint National Committee ( JNC8) for adults aged 60 and older? Select all that apply.: Target blood pressure should be = 150/90 mmHg but notes that if treatment results in SBP <140 and is "well tolerated and without adverse ettects to health or quality of live, treatment does not need to be adjusted." In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear optimal for notable reductions in stroke, cardiovascular events, and all-cause mortality.
6. Which of the following is a useful strategy when examining young children between the
ages of 1 and 4?: Have the parent facilitate the exam (e.g., removing clothes, holding the child on lap).
7. The NP is completing the review of systems on a 4-month-old female during a
routine encounter. Which statement from the parent may indicate a cardiac problem in the infant and require a more thorough subjective history?: "It often takes the baby more than 30 minutes to finish a bottle."
8. A 16-year-old male presents to the clinic with a history of a congenital right upper
eyelid drooping as represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition? Patient with eyelid drooping: CNIII
9. Which cranial nerve (CN) innervates the muscles of the pharynx and pro-vides
sensory fibers to portions of the tympanic membrane, auditory canal, pharynx, and the posterior third of the tongue?: CN IX
4 / 23 the following are expected assessment findings consistent with the diagno-sis?: Swelling of the synovial tissue in joints and tendon sheaths.
18. A 58-year-old male complains of pain in his knees, hips, hands, wrists,
neck, and lower back. Based on the joints involved, the NP suspects that the patient most likely has which condition?: Osteoarthritis
19. A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign
should the NP expect to find on examination that is most consistent with the diagnosis?: Flexed forward posture with lower extremity weakness
20. What is the action(s) of the erector spinae muscle group?: Extension of the spine
21. A 17-year-old male presents to the clinic for a follow-up appointment. He
fractured his left arm 8 weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle wasting as the etiology for the winged scapula. Which of the following physical assessment maneuvers should the NP perform to confirm the suspension?: Compare the strength of the trapezius muscles
22. A 31-year-old female presents to the clinic with a worsening stiff, painful
neck. On inspection, the patient's head is laterally deviated toward the shoul-der and rotated. Given this specific physical assessment finding, what condi-tion should the NP suspect as a differential diagnosis?: Torticollis
23. During an evaluation of an athletic 30-year-old female, the NP conducts an
active range of motion evaluation at the neck. All of the following muscles are being
5 / 23 assessed when the patient is asked to extend, flex, and rotate the neck, EXCEPT?: Sacrospinalis
24. A 58-year-old male complains of lower back pain for many years. He denies
a recent injury. On examination, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of the following conditions is most consistent with this physical sign?: ankylosing spondylitis
25. Which of the following statements is true regarding prostate cancer screen-
ing?: Setting normal cut-otts for prostate-specific antigen (PSA) testing relies on balancing
26. A 53-year-old African American male presents for discussion of his prostate
cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer risk for this patient and subsequent screening?: This patient is at an elevated risk of prostate cancer due to his family history; thus, screening modalities should be discussed between the patient and provider.
27. A 34-year-old female presents to primary care for follow-up regarding
anal pain with defecation. A recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of pain. In addition, today she reports that she has developed episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find?:
7 / 23 for 20 years. After a careful history and physical examination, the NP docu-ments the following nervous system findings: Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Oriented to person, place, and time. Speech is fluent, follows commands. Detailed cognitive testing deferred. Cranial Nerves: I— not tested; II through XII intact. Motor: Normal muscle bulk and tone. Strength 5/ throughout. No pronator drift. Cerebellar—Rapid alter-nating movements (RAMs), finger-to-nose (F’N), heel-to-shin (H’S) intact. Gait with normal stance and stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the following is the most accurate interpretation of these findings?: These findings suggest no abdnormalities
31. Which cranial nerve (CN) is being assessed by the examiner in this image?
ADA Description: Examiner's hands placed on anterior shoulders while patient shrugs both shoulders upward against hands.: CNXI
32. What assessment test is being performed in this image? ADA Description:
Tuning fork on top of the head.: Weber test
33. A 74-year-old man presents to the clinic for a scheduled annual exami-
nation. He has a history of hypertension and diabetes, both controlled with medication. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal assessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of
8 / 23 unmyelinated ganglion cell axons of the retina.: Cotton wool spots
34. A 66-year-old female presents to the office for a focused visit to discuss
hypertension management strategies. During the interview, the patient asks the NP if she could be screened today for cervical cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no abnormal findings, and no history of cancer. What is the best action the NP should take regarding the patient's request for screening?: Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no longer requires screening, and focus on the reason for the visit.
35. Of the following statements, which is true regarding the human
papillo-mavirus (HPV) vaccine?: The vaccine can protect against anogenital lesions
36. A 21-year-old female presents for her first annual exam. She reports con-
cern because her female partner was recently diagnosed with condyloma acuminata and wonders if she could also be infected. If true, what physical assessment findings would the NP expect to find during the speculum exam-ination?: Raised friable or lobed lesions
37. An 18-year-old female presents to the clinic complaining of a thick and yel-
low vaginal discharge along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID). During the speculum examination, the NP would expect to find purulent discharge in the following area(s) which is consistent with the
10 / 23 discharge and severe itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination, there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. Which of the following is the most accurate interpretation of these findings?: These findings suggest candida vaginitis
42. Cervical motion tenderness and/or adnexal tenderness are hallmarks of all
the following conditions, EXCEPT?: Bacterial vaginosis
43. A 30-year-old female presents to the clinic with complaints of a
bad-smelling vaginal discharge with some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She also reports that the smell increased after intercourse and during her period last week. After a careful history and physical assessment, the NP documents the following pelvic and anorectal examination findings: Bilateral shotty inguinal adenopa-thy. External genitalia without erythema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings?: These findings suggest bacterial vaginosis
44. The NP knows it is possible to palpate multiple structures in relation to the
11 / 23 inguinal canal and related hernias while performing a physical examination on male patients. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region?: Internal inguinal rings
45. What are the most predominant risk factors for prostate cancer?: Age
Ethnicity Family history
46. A patient presents with right-upper quadrant (RUQ) pain but does not
have any tenderness on palpation in the RUQ. The NP is suspicious of acute cholecystitis. The NP knows to perform which assessment test next?: Murphy Sign
47. Pain in the right-lower quadrant (RLQ) during deep, even palpation of the
left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what positive assessment finding?: Blumberg sign
48. The NP suspects a patient has appendicitis. Identify the physical examina-
tion maneuver done by applying pressure halfway between the umbilicus and the anterior spine of the ilium?: McBurney Sign
49. Which assessment finding would be most suggestive of a diagnosis of
biliary colic?: Associated right shoulder pain
50. Which of the following physical assessment finding is most suggestive of
peritonitis secondary to a ruptured appendix?: Pressing down onto the abdomen firmly and quickly withdrawals the hand produces pain
51. A 76-year-old female presents to the office for an annual physical. Upon
13 / 23 independently in subsidized housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows: Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm, round, regular, equally reactive to light and accommodation. Extraocular movements intact. Disc margins sharp, without hemorrhages or exudates. Mild arteriolar narrowing. TMs with good cone of light. Weber midline. AC > BC. Nasal mucosa erythematous, septum deviated to the right, turbinates mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue midline, slight beefy redness. Pharynx is mildly erythema-tous with cobblestoning. Which of the following is the most accurate inter-pretation of the findings?: The patient has chronic allergies
55. The staff NP in a nursing home is conducting a physical assessment on an
84-year-old male resident who is pleasant, active, and cooperative. The skin findings in this image are observed during the examination. The staff and patient deny any known injury or trauma. The NP should document these findings as consistent with which of the following? ADA Description: Extensor surface of the right forearm with emphasis on well- demarcated vividly purple macules and patches: Actinic purpura
56. An 80-year-old woman who lives alone at home presents with concerns
about maintaining her independent living status. She continues to drive and
14 / 23 care for herself and her pet dog but reports two falls over the past 4 months. During one fall, she struck her head, causing a contusion over the right eye. She attributes these episodes to environmental factors. Once she tripped over a rug, and once she misjudged the depth of the curb while crossing the street.
16 / 23 that she has a 3- year-old daughter who lives in the home. What is the appropriate next step by the NP?: Ask open-ended questions, allow her to make decisions that she feels are best for herself given the circumstance, and provide immediate or long-term referrals to domestic violence resources
63. A 42-year-old female is at 39-weeks gestation. She reports no major issues
except swelling in her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP notes a diastolic murmur. Which of the following is true about her presentation and the appropriate next step by the NP?: A diastolic murmur during pregnancy is likely pathological; further investigation and work-up is warranted
64. A 32-year-old primigravid woman is at 27 weeks gestation. She presents
with nausea, vomiting, urinary frequency, discomfort in the lower abdomen, tenderness over the suprapubic area, and severe constipation. Which of the following is true regarding these pregnancy symptoms?: Iron supplementation, hor-monal changes, slowed intestinal transit, physical pressure from the gravid uterus, and increased blood volume all contribute to abdominal symptoms in pregnant women.
65. A 24-year-old female presents to the clinic concerned that she may be preg-
nant. Her LMP was 7-weeks ago, and the urine human chorionic gonadotropin (HCG) test is positive. What can the NP expect to find on physical examination, assuming a normal pregnancy? Select all that apply: an internal cervical os closed to the width of a fingertip a bluish hue to the cervix
66. A 20-year-old female presents to the clinic with symptoms of fatigue,
17 / 23 nausea, and an increase in urination. She is sexually active, and her male partner uses condoms occasionally. A urine pregnancy test is positive. Her last menstrual period was 3 months ago (6/20/2021). Using the Naegele rule, what is the estimated date of delivery (EDD, or due date)?: 3/27/
67. The NP is conducting a physical assessment on a woman in her 26th week
of pregnancy. Which of the examination finding is worrisome for a potential, emergent condition?: Facial edema
68. The NP is documenting the obstetric history of a patient. Her history in-
cludes two spontaneous miscarriages at 16- and 24-weeks' gestation, four living children (one set of twins) who were delivered at term, and a current pregnancy. How would this be documented?: G6P
69. An 11-month-old infant male is accompanied to the clinic by his father. The
father is concerned about the skin rash on this son's arms represented in this image. Family history is significant for a 4-year-old sibling with atopic dermatitis and asthma. Which of the following is the best documentation of the integument findings?: Erythematous, patches and plaques involving the extensor surfaces of the bilateral antecubital fossa. Mild, secondary excoriations present with serous exudate. No streaking. Scant purulent drainage
70. A mother brings her 15-day-old female infant to the outpatient clinic for
evaluation of a rash that appeared suddenly after visiting family in Florida. It is August and the house did not have air conditioning. The infant is afebrile, eating and drinking well, and does not appear to be in distress. The physical assessment
19 / 23 "mama" and "dada" specifically, and indicates his wants by vocalization and pointing. Based on your observations, determine his developmental age.: 12 months
75. Of the following statements, which is accurate regarding growth and as-
sessment charts published by the National Center for Health Statistics? Select all that apply.: All charts include height, weight, and head circumference for children up to 36 months. Growth charts are available for children with specific conditions such as Down syndrome or Turner syndrome. Growth charts are available for use in infants born prematurely.
76. A 25-year-old male presents to the clinic with a complaint of severe rectal
pain during defecation. The pain is so severe he waits several days before having a bowel movement. He has a history of ulcerative colitis (UC). He also reports being in an active sexual new relationship with a male partner. After conducting a history and physical exam, the NP documents the following anorectal findings: Perirectal area inflamed; no ulcerations, open sores, fis-sures, or verruca. Scant, whiteyellow, mucoid, rectal discharge noted. Unable to examine external sphincter, rectal vault, or prostate because of spasm of the external sphincter and marked inflammation and tenderness of anal canal. Which of the following is the most accurate interpretation of these findings?: These findings suggest infectious proctitis
77. A 54-year-old female with a history of migraines since childhood presents
20 / 23 to the clinic with chronic intermittent, progressive pulsatile headaches which are similar in nature to prior attacks and precipitated by current life stressors. The headaches are accompanied by nausea and vomiting. She denies con-stitutional symptoms. On examination, she has elevated blood pressure but otherwise a normal cardiovascular, neurologic, and fundoscopic examination. Based on the history and physical examination findings, which diagnoses are appropriate for the differential diagnosis (DDx) list? Select all that apply.: Mi-graine Tension
78. A 50-year-old female presents to the clinic for evaluation of neck stiffness
and aching pain. She was a restrained driver in a low-speed, rear-end, motor vehicle collision 1 day ago. The pain started several hours after the accident. On physical examination, you note muscle spasms over the paraspinous mus-cles on the left side of the neck, as well as pain reported during active range of motion of the cervical spine. No neurological deficits are noted. Which of the following is the most accurate interpretation of these findings?: These findings suggest cervical strain
79. Which muscle(s) are being assessed during active rotation of the neck?: Ster-
nocleidomastoid
80. A 34-year-old female presents to the office with left elbow pain following
rigorous training for a tennis match. Tenderness is noted with palpation in the area on the image marked by the red circle. What correlative diagnosis does this
