NR509 FINAL EXAM ACTUAL EXAM 2026 | ALL QUESTIONS AND CORRECT
ANSWERS | VERIFIED ANSWERS | UPDATED VERSION | JUST RELEASED
Question 1
A 35-year-old female with a history of migraines presents with worsening symptoms. She reports
waking up at night with headaches and nausea. Her current medications include oral
contraceptive pills (OCPs). Which of the following is the most appropriate next step for the
Nurse Practitioner?
A) Prescribe a sumatriptan injection for acute relief.
B) Recommend switching to a different form of birth control.
C) Take a further history and perform a very careful neurological exam.
D) Advise the patient to keep a headache diary for one month.
E) Diagnose the patient with "migraine with aura" based on her age.
Correct Answer: C) Take a further history and perform a very careful neurological exam
Rationale: Headaches that wake a patient from sleep or are associated with nausea/vomiting
are "red flags" (SNOOP criteria) for increased intracranial pressure or secondary causes,
such as a brain tumor or vascular event. While she has a history of migraines, the
"worsening" nature and nocturnal symptoms require the clinician to rule out serious
underlying pathology before assuming it is a primary headache disorder. Furthermore,
OCP use in women with migraines can increase the risk of stroke, necessitating a thorough
neurological evaluation.
Question 2
During a routine physical examination of a 9-year-old female, the NP notes an asymmetric
projection of the areola and nipple of the right chest to form a secondary mound above the level
of the breast, while the left breast remains underdeveloped. Which Tanner Stage of development
is this consistent with?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
, 2
Correct Answer: D) IV
Rationale: Tanner Stage IV in breast development is characterized by the projection of the
areola and nipple to form a secondary mound above the level of the breast. Stage I is pre-
pubertal; Stage II involves the breast bud; Stage III involves further enlargement of the
breast and areola with no separation of their contours; and Stage V represents the mature
stage with recession of the secondary mound into the general contour of the breast.
Question 3
Which of the following best defines "Primary Prevention" in healthcare?
A) Screening tests to detect disease in early, asymptomatic stages.
B) Interventions designed to prevent the onset of disease.
C) Treatments aimed at reducing the impact of long-term disease.
D) Rehabilitative services following an acute medical event.
E) Counseling for patients who already have a confirmed diagnosis.
Correct Answer: B) Interventions designed to prevent disease
Rationale: Primary prevention aims to prevent disease or injury before it ever occurs.
Examples include immunizations, counseling on tobacco cessation to prevent lung cancer,
and promoting healthy diets to prevent cardiovascular disease. Secondary prevention
involves screening (like Pap smears or mammograms) to detect existing disease early, and
tertiary prevention focuses on managing established disease to prevent further
complications.
Question 4
Based on current U.S. Preventive Services Task Force (USPSTF) recommendations, which
statement regarding breast cancer screening in average-risk women is correct?
A) Screening should begin annually at age 40 for all women.
B) Mammography is recommended every 2 years for women aged 50–74.
C) All women over the age of 75 should receive annual mammograms.
D) Clinical breast exams are the only recommended tool for women under 50.
E) Mammography is recommended every year for women aged 40–50.
, 3
Correct Answer: B) Mammography is recommended every 2 years for women aged 50-74
with insufficient evidence for screening women over the age of 75.
Rationale: The USPSTF currently recommends biennial (every two years) screening
mammography for women aged 50 to 74. For women aged 40 to 49, the decision to start
screening should be an individual one based on risk and patient preference. The Task Force
has concluded that the current evidence is insufficient to assess the benefits and harms of
screening in women 75 years and older.
Question 5
According to the JNC8 guidelines for adults aged 60 and older, which of the following
statements is true regarding blood pressure management?
A) Target blood pressure must always be strictly less than 130/80 mmHg.
B) Target blood pressure should be ≤ 150/90 mmHg.
C) If SBP is <140 mmHg and well-tolerated, treatment must be decreased to avoid hypotension.
D) Blood pressure targets of 160/100 mmHg are optimal for those over 80.
E) Medication should be stopped immediately if the patient is over 90.
Correct Answer: B) Target blood pressure should be ≤ 150/90 mmHg.
Rationale: JNC8 recommends that in the general population aged ≥60 years,
pharmacological treatment should be initiated to lower blood pressure (BP) to a target of
<150/90 mmHg. However, they also note that if treatment results in lower levels (e.g., SBP
<140) and is well-tolerated without adverse effects on quality of life, the regimen does not
necessarily need to be adjusted. For those aged 80 or older, BP targets of 140–150/70–80 are
associated with reductions in stroke and cardiovascular events.
Question 6
When conducting a physical examination on a child between the ages of 1 and 4, which strategy
is most likely to be successful?
A) Ask the parent to leave the room to build rapport with the child.
B) Perform the most invasive parts of the exam (ears/throat) first.
C) Have the parent facilitate the exam (e.g., removing clothes, holding child on lap).
, 4
D) Speak in a very loud, authoritative voice to maintain control.
E) Direct all questions to the child and ignore the parent.
Correct Answer: C) Have the parent facilitate the exam (e.g., removing clothes, holding the
child on lap).
Rationale: Children in the toddler and preschool age range often experience stranger
anxiety. Keeping the child on the parent's lap helps them feel secure and cooperative. The
NP should use a calm approach, save the most distressing parts of the exam (ears and
mouth) for the very end, and engage the parent to assist in the process.
Question 7
The NP is performing a review of systems on a 4-month-old female. Which statement from the
parent is a "red flag" for a potential cardiac problem?
A) "The baby sleeps for 6 hours straight at night."
B) "It often takes the baby more than 30 minutes to finish a bottle."
C) "The baby cries when her diaper is being changed."
D) "The baby has two bowel movements per day."
E) "The baby likes to suck on her fingers between feedings."
Correct Answer: B) "It often takes the baby more than 30 minutes to finish a bottle."
Rationale: Poor feeding and "tiring easily" during feedings (taking >30 minutes to finish a
standard bottle) are classic signs of infant heart failure or significant congenital heart
disease. These infants lack the cardiac output to manage the physical work of sucking and
swallowing, often presenting with diaphoresis during feeds or poor weight gain (failure to
thrive).
Question 8
A 16-year-old male presents with congenital right upper eyelid drooping (ptosis). He denies any
history of trauma or injury. Which cranial nerve (CN) is primarily involved in this condition?
A) CN II
B) CN III
C) CN IV
ANSWERS | VERIFIED ANSWERS | UPDATED VERSION | JUST RELEASED
Question 1
A 35-year-old female with a history of migraines presents with worsening symptoms. She reports
waking up at night with headaches and nausea. Her current medications include oral
contraceptive pills (OCPs). Which of the following is the most appropriate next step for the
Nurse Practitioner?
A) Prescribe a sumatriptan injection for acute relief.
B) Recommend switching to a different form of birth control.
C) Take a further history and perform a very careful neurological exam.
D) Advise the patient to keep a headache diary for one month.
E) Diagnose the patient with "migraine with aura" based on her age.
Correct Answer: C) Take a further history and perform a very careful neurological exam
Rationale: Headaches that wake a patient from sleep or are associated with nausea/vomiting
are "red flags" (SNOOP criteria) for increased intracranial pressure or secondary causes,
such as a brain tumor or vascular event. While she has a history of migraines, the
"worsening" nature and nocturnal symptoms require the clinician to rule out serious
underlying pathology before assuming it is a primary headache disorder. Furthermore,
OCP use in women with migraines can increase the risk of stroke, necessitating a thorough
neurological evaluation.
Question 2
During a routine physical examination of a 9-year-old female, the NP notes an asymmetric
projection of the areola and nipple of the right chest to form a secondary mound above the level
of the breast, while the left breast remains underdeveloped. Which Tanner Stage of development
is this consistent with?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
, 2
Correct Answer: D) IV
Rationale: Tanner Stage IV in breast development is characterized by the projection of the
areola and nipple to form a secondary mound above the level of the breast. Stage I is pre-
pubertal; Stage II involves the breast bud; Stage III involves further enlargement of the
breast and areola with no separation of their contours; and Stage V represents the mature
stage with recession of the secondary mound into the general contour of the breast.
Question 3
Which of the following best defines "Primary Prevention" in healthcare?
A) Screening tests to detect disease in early, asymptomatic stages.
B) Interventions designed to prevent the onset of disease.
C) Treatments aimed at reducing the impact of long-term disease.
D) Rehabilitative services following an acute medical event.
E) Counseling for patients who already have a confirmed diagnosis.
Correct Answer: B) Interventions designed to prevent disease
Rationale: Primary prevention aims to prevent disease or injury before it ever occurs.
Examples include immunizations, counseling on tobacco cessation to prevent lung cancer,
and promoting healthy diets to prevent cardiovascular disease. Secondary prevention
involves screening (like Pap smears or mammograms) to detect existing disease early, and
tertiary prevention focuses on managing established disease to prevent further
complications.
Question 4
Based on current U.S. Preventive Services Task Force (USPSTF) recommendations, which
statement regarding breast cancer screening in average-risk women is correct?
A) Screening should begin annually at age 40 for all women.
B) Mammography is recommended every 2 years for women aged 50–74.
C) All women over the age of 75 should receive annual mammograms.
D) Clinical breast exams are the only recommended tool for women under 50.
E) Mammography is recommended every year for women aged 40–50.
, 3
Correct Answer: B) Mammography is recommended every 2 years for women aged 50-74
with insufficient evidence for screening women over the age of 75.
Rationale: The USPSTF currently recommends biennial (every two years) screening
mammography for women aged 50 to 74. For women aged 40 to 49, the decision to start
screening should be an individual one based on risk and patient preference. The Task Force
has concluded that the current evidence is insufficient to assess the benefits and harms of
screening in women 75 years and older.
Question 5
According to the JNC8 guidelines for adults aged 60 and older, which of the following
statements is true regarding blood pressure management?
A) Target blood pressure must always be strictly less than 130/80 mmHg.
B) Target blood pressure should be ≤ 150/90 mmHg.
C) If SBP is <140 mmHg and well-tolerated, treatment must be decreased to avoid hypotension.
D) Blood pressure targets of 160/100 mmHg are optimal for those over 80.
E) Medication should be stopped immediately if the patient is over 90.
Correct Answer: B) Target blood pressure should be ≤ 150/90 mmHg.
Rationale: JNC8 recommends that in the general population aged ≥60 years,
pharmacological treatment should be initiated to lower blood pressure (BP) to a target of
<150/90 mmHg. However, they also note that if treatment results in lower levels (e.g., SBP
<140) and is well-tolerated without adverse effects on quality of life, the regimen does not
necessarily need to be adjusted. For those aged 80 or older, BP targets of 140–150/70–80 are
associated with reductions in stroke and cardiovascular events.
Question 6
When conducting a physical examination on a child between the ages of 1 and 4, which strategy
is most likely to be successful?
A) Ask the parent to leave the room to build rapport with the child.
B) Perform the most invasive parts of the exam (ears/throat) first.
C) Have the parent facilitate the exam (e.g., removing clothes, holding child on lap).
, 4
D) Speak in a very loud, authoritative voice to maintain control.
E) Direct all questions to the child and ignore the parent.
Correct Answer: C) Have the parent facilitate the exam (e.g., removing clothes, holding the
child on lap).
Rationale: Children in the toddler and preschool age range often experience stranger
anxiety. Keeping the child on the parent's lap helps them feel secure and cooperative. The
NP should use a calm approach, save the most distressing parts of the exam (ears and
mouth) for the very end, and engage the parent to assist in the process.
Question 7
The NP is performing a review of systems on a 4-month-old female. Which statement from the
parent is a "red flag" for a potential cardiac problem?
A) "The baby sleeps for 6 hours straight at night."
B) "It often takes the baby more than 30 minutes to finish a bottle."
C) "The baby cries when her diaper is being changed."
D) "The baby has two bowel movements per day."
E) "The baby likes to suck on her fingers between feedings."
Correct Answer: B) "It often takes the baby more than 30 minutes to finish a bottle."
Rationale: Poor feeding and "tiring easily" during feedings (taking >30 minutes to finish a
standard bottle) are classic signs of infant heart failure or significant congenital heart
disease. These infants lack the cardiac output to manage the physical work of sucking and
swallowing, often presenting with diaphoresis during feeds or poor weight gain (failure to
thrive).
Question 8
A 16-year-old male presents with congenital right upper eyelid drooping (ptosis). He denies any
history of trauma or injury. Which cranial nerve (CN) is primarily involved in this condition?
A) CN II
B) CN III
C) CN IV
