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

Download NR509 / NR 509 Final Exam (Latest 2024 / 2025): Advanced Physical Assessment - Chamberlain and more Exams Nursing in PDF only on Docsity! 1 / 21 NR 509 Final Exam 1. A 35-year-old female with a history of migraines pre- sents to the clinic with worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step? 2. A grandmother is accompanying her 9-year-old grand- daughter during a routine physical examination. She asks you privately if her granddaughter has started puberty yet. During the examination, the NP notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound above the level of the breast. The left breast is underdeveloped. These assessment findings are consistent with which Tanner Stage of development? 3. Primary prevention is defined as which of the follow- ing? 4. Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the following statements is true about screening for breast cancer in average-risk women? 5. Which of the following statements is true regarding recommendations by the eighth Joint National Com- mittee (JNC8) for adults aged 60 and older? Select all that apply. Take a further his- tory and perform a very careful neuro- logical exam IV Interventions de- signed to prevent disease Mammography is recommended every 2 years for women aged 50-74 with insufficient evidence for screening women over the age of 75. Target blood pres- sure should be </= 150/90 mmHg but notes that if treatment results in SBP <140 and is "well tolerated 2 / 21 NR 509 Final Exam 6. Which of the following is a useful strategy when ex- amining young children between the ages of 1 and 4? 7. The NP is completing the review of systems on a 4-month-old female during a routine encounter. Which statement from the parent may indicate a cardiac problem in the infant and require a more thorough subjective history? 8. A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as repre- sented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition? Patient with eyelid drooping and without ad- verse effects to health or quality of live, treatment does not need to be adjusted." In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear optimal for no- table reductions in stroke, cardiovas- cular events, and all-cause mortality. Have the par- ent facilitate the exam (e.g., remov- ing clothes, hold- ing the child on lap). "It often takes the baby more than 30 minutes to finish a bottle." CNIII 9. CN IX 5 / 21 NR 509 Final Exam During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion evaluation at the neck. All of the following muscles are being assessed when the patient is asked to extend, flex, and rotate the neck, EXCEPT? 24. A 58-year-old male complains of lower back pain for many years. He denies a recent injury. On examina- tion, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of the follow- ing conditions is most consistent with this physical sign? 25. Which of the following statements is true regarding prostate cancer screening? 26. A 53-year-old African American male presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed ankylosing spondylitis Setting nor- mal cut-offs for prostate-specif- ic antigen (PSA) testing relies on balancing This patient is at an elevated risk of prostate cancer at age 82 years with prostate cancer but died recently due to his fam- at age 87 years from a myocardial infarction before the ily history; thus, disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer risk for this patient and subsequent screen- ing? 27. A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A re- cent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of pain. In addition, today she reports that she has devel- oped episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find? screening modali- ties should be dis- cussed between the patient and provider. Inflammatory bow- el disease 6 / 21 NR 509 Final Exam 28. A 45-year-old female presents to the primary care clin- ic. She complains of recently experiencing a change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well as Crohn's dis- ease. Her family medical history includes a maternal aunt who died of colon cancer at age 49 years. Which of the following historical elements would be most concerning for colon cancer in this patient? 29. A 67-year-old female presents to the office for an annual check-up. She retired as a police captain at age 66. Now she enjoys gardening and water aero- bics several days a week. She states, "staying active keeps me limber". After a careful history and physical examination, the NP documents the following muscu- loskeletal system findings: Full range of motion in all joints. Hands with Heberden nodes at the DIP joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and rotation of both hips. Full range of mo- tion in the knees, with moderate crepitus. No effusion but bony enlargement along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first MTP joints. Which of the following is the most accurate interpretation of these findings? 30. A 50-year-old male presents to the office for a rou- tine physical examination. He has no complaints. His PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is taking fenofi- brate. On the social history intake form, he report- ed consuming 8 ounces of malt liquor daily for 20 years. After a careful history and physical examina- tion, the NP documents the following nervous system findings: Mental Status: Alert, relaxed, and coopera- tive. 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 mus- recent onset of small-caliber stools These findings suggest os- teoarthritis These findings suggest no abd- normalities 7 / 21 NR 509 Final Exam cle bulk and tone. Strength 5/5 throughout. No prona- tor drift. Cerebellar—Rapid alternating movements (RAMs), finger-to-nose (F’N), heel-to-shin (H’S) intact. Gait with normal stance and stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the following is the most accurate interpretation of these findings? 31. Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description: Examin- er's hands placed on anterior shoulders while patient shrugs both shoulders upward against hands. 32. What assessment test is being performed in this im- age? ADA Description: Tuning fork on top of the head. 33. A 74-year-old man presents to the clinic for a sched- uled annual examination. He has a history of hyper- tension and diabetes, both controlled with medica- tion. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal as- sessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina. 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 can- cer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no abnormal findings, and no history of cancer. What is the best action the NP should take regarding the patient's re- quest for screening? 35. 35. CNXI Weber test Cotton wool spots Deny her request, inform the pa- tient that she has had three negative screenings in the last 10 years and no longer requires screening, and fo- cus on the reason for the visit. 10 / 21 NR 509 Final Exam >4.5. Which of the following is the most accurate in- terpretation of these findings? 44. The NP knows it is possible to palpate multiple struc- tures in relation to the inguinal canal and related hernias while performing a physical examination on male patients. Which of the following is not palpable during an external examination of the abdominal wall or inguinal region? 45. What are the most predominant risk factors for prostate cancer? 46. A patient presents with right-upper quadrant (RUQ) pain but does not have any tenderness on palpation in the RUQ. The NP is suspicious of acute cholecysti- tis. The NP knows to perform which assessment test next? 47. Pain in the right-lower quadrant (RLQ) during deep, even palpation of the left-lower quadrant (LLQ) then quickly withdrawing your fingers indicates what pos- itive assessment finding? 48. The NP suspects a patient has appendicitis. Identify the physical examination maneuver done by applying pressure halfway between the umbilicus and the an- terior spine of the ilium? 49. Which assessment finding would be most suggestive of a diagnosis of biliary colic? 50. Which of the following physical assessment finding is most suggestive of peritonitis secondary to a rup- tured appendix? Internal inguinal rings Age Ethnicity Family history Murphy Sign Blumberg sign McBurney Sign Associated right shoulder pain Pressing down onto the abdomen firmly and quick- ly withdrawals the hand produces pain 11 / 21 NR 509 Final Exam 51. A 76-year-old female presents to the office for an an- nual physical. Upon reviewing her history, she had a positive FOBT on one occasion at age 66 years. Sub- sequent colonoscopy revealed internal hemorrhoids and sigmoid diverticuli only. She has no firstdegree relatives with a history of colorectal cancer or adeno- matous polyps. What is the U.S. Preventive Services Task Force (USPSTF) screening recommendation for this particular patient? 52. A 30-year-old male is admitted to the hospital for ab- dominal pain. He reports steady, aching pain that be- gan suddenly around his naval and now involves the lower abdomen. He also reports a decreased appetite with nausea but no vomiting. After a careful history and physical examination, the NP documents the fol- lowing abdominal findings: The abdomen is flat, firm, and rigid, with increased tenderness and guarding in the right lower quadrant. No bowel sounds heard. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpa- ble masses. No CVA tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate interpretation of these findings? 53. The NP student is precepting with a provider in a geriatric-based clinic. The provider asks the student if he is familiar with the 10-Minute Geriatric Screener. Which of the following statements best demonstrates that the NP understands this assessment tool? 54. The NP conducted a physical assessment on a 79-year-old male who lives independently in subsi- dized housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows: Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm, Do not screen rou- tinely These findings suggest acute peritonitis The tool as- sesses for func- tional deficits which are strong predictors of pa- tient outcomes in the elderly. The patient has chronic allergies 12 / 21 NR 509 Final Exam round, regular, equally reactive to light and accommo- dation. Extraocular movements intact. Disc margins sharp, without hemorrhages or exudates. Mild arte- riolar narrowing. TMs with good cone of light. Weber midline. AC > BC. Nasal mucosa erythematous, sep- tum deviated to the right, turbinates mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue midline, slight beefy redness. Pharynx is mildly erythematous with cobblestoning. Which of the following is the most accurate interpre- tation of the findings? 55. The staff NP in a nursing home is conducting a phys- ical 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 fore- arm with emphasis on well-demarcated vividly purple macules and patches 56. An 80-year-old woman who lives alone at home pre- sents with concerns about maintaining her indepen- dent living status. She continues to drive and care for herself and her pet dog but reports two falls over the past 4 months. During one fall, she struck her head, causing a contusion over the right eye. She attributes these episodes to environmental factors. Once she tripped over a rug, and once she misjudged the depth of the curb while crossing the street. Which of the following would be the best approach to this patient? 57. Concerning alcohol consumption in older adults, which of the following is true? Actinic purpura Perform a compre- hensive assess- ment of fall risk and plan preven- tive interventions The CAGE screening for alco- hol abuse retains the same sensitiv- 15 / 21 uses condoms occasionally. A urine pregnancy test is positive. Her last menstrual period was 3 months ago (6/20/2021). Using the Naegele rule, what is the estimated date of delivery (EDD, or due date)? 67. The NP is conducting a physical assessment on a woman in her 26th week of pregnancy. Which of the ex- amination finding is worrisome for a potential, emer- gent condition? 68. The NP is documenting the obstetric history of a pa- tient. Her history includes two spontaneous miscar- riages at 16- and 24-weeks' gestation, four living chil- dren (one set of twins) who were delivered at term, and a current pregnancy. How would this be documented? 69. An 11-month-old infant male is accompanied to the clinic by his father. The father is concerned about the skin rash on this son's arms represented in this 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 integu- ment findings? 70. A mother brings her 15-day-old female infant to the outpatient clinic for evaluation of a rash that appeared suddenly after visiting family in Florida. It is August and the house did not have air conditioning. The in- fant is afebrile, eating and drinking well, and does not appear to be in distress. The physical assessment findings are represented in this image. Based on the history and examination findings, what is the likely Facial edema G6P3024 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 miliaria rubra 16 / 21 etiology? ADA Description: Infant with a red, facial rash. 71. The NP assesses for the Moro Reflex as part of an infant routine physical examination. The NP should suspect a neurologic disease if the reflex has not disappeared by what specific timeframe? 72. A 2-month-old female is accompanied by her par- ents for her first visit to the practice. When review- ing the hospital medical records of her birth, the NP notes documentation regarding significantly edema- tous hands and feet present at birth. Upon physical examination of the infant, the NP finds skin folds that 16 weeks The infant's growth chart with con- cern for height and length. The infant's abili- run along the sides of the neck down to the shoulders. ty to properly latch Which of the following should be assessed and moni- tored by the NP and parents related to these findings? Select all that apply. 73. The NP is observing a female pediatric patient during a routine physical. She can jump in place and bal- ance on one foot. She speaks in full sentences and her mother states that she can feed herself. Based on your observations and the history, determine her developmental age 74. The NP is observing a full-term infant male. He can pull to a stand, use "mama" and "dada" specifically, and indicates his wants by vocalization and pointing. Based on your observations, determine his develop- mental age. 75. Of the following statements, which is accurate regard- ing growth and assessment charts published by the National Center for Health Statistics? Select all that apply. during breastfeed- ing. The infant's fluid gain or loss. 4 years 12 months All charts include height, weight, and head circum- ference for chil- dren up to 36 months. 17 / 21 76. A 25-year-old male presents to the clinic with a com- plaint of severe rectal pain during defecation. The pain is so severe he waits several days before having a bowel movement. He has a history of ulcerative col- itis (UC). He also reports being in an active sexual new relationship with a male partner. After conduct- ing a history and physical exam, the NP documents the following anorectal findings: Perirectal area in- flamed; no ulcerations, open sores, fissures, or verru- ca. Scant, whiteyellow, mucoid, rectal discharge not- ed. Unable to examine external sphincter, rectal vault, or prostate because of spasm of the external sphinc- ter and marked inflammation and tenderness of anal canal. Which of the following is the most accurate interpretation of these findings? 77. A 54-year-old female with a history of migraines since childhood presents to the clinic with chronic intermit- tent, progressive pulsatile headaches which are sim- ilar in nature to prior attacks and precipitated by cur- rent life stressors. The headaches are accompanied by nausea and vomiting. She denies constitutional symptoms. On examination, she has elevated blood pressure but otherwise a normal cardiovascular, neu- rologic, and fundoscopic examination. Based on the history and physical examination findings, which di- Growth charts are available for chil- dren with specific conditions such as Down syndrome or Turner syndrome. Growth charts are available for use in infants born pre- maturely. These findings suggest infectious proctitis Migraine Tension 20 / 21 85. A 24-year-old male presents to the office for evalu- ation of a lump under his left nipple. He reports no other symptoms, denies trauma or injury, and reports no known family history of a first-degree relative with breast cancer. On examination, the NP notes a firm, 2-cm mass under his areola. What is the most likely etiology for these findings? Breast cancer 86. A 34-year-old female arrives at the clinic for a prenatal, If a pregnant pa- second-trimester appointment. During the interview, her behavior is concerning for intoxication, and she smells of alcohol and cigarettes. She reveals a history of intravenous drug use "10-years ago". How should the NP counsel this patient? Select all that apply 87. A 27-year-old female presents to the outpatient clinic with acute abdominal pain and uterine bleeding. Her last menstrual period was 6-weeks ago. She and her husband have been trying to conceive for almost one year. On physical examination, the NP palpates an ill-defined, adnexal mass in the left lower quadrant. The urine pregnancy test results are pending. Based on the history and examination findings, what is the most likely etiology? tient does not in- tend to quit tobac- co, cutting down is still consid- ered beneficial to the pregnancy and should be encour- aged. Pregnant women are not routine- ly screened for hepatitis C, but this test should be added to the panel of prenatal blood tests for pa- tients with a his- tory of intravenous drug use Ectopic pregnanct 21 / 21 88. The NP knows measurement of growth is one of the most important indicators of infant health. Deviations may provide an early indication of an underlying prob- lem. What is the minimum variation that indicates a more detailed evaluation is needed? Beyond 2 standard deviations for age range