NR509 weeks 1-4 questions and answers 2026\2027
A+ Grade
A loud or augmented S1 occurs when
- correct answer The left ventricular (LV) pressure is increased.
What conditions can cause a loud S1
- correct answer Increased contractility with exercise
Increased contractility in sympathetic nervous system stimulation such as with inotropic drugs
Hyper-metabolic states such as hyperthyroidism or pheochromocytoma
Conditions of hyper-dynamic circulation such as anemia
Short PR-interval
A diminished SI can occur due to
- correct answer Increased distance between the heart and chest wall - obesity, COPD/barrel chests and
pericardial effusions
Decreased contractility as in heart failure
Prolonged PR-interval
Left-bundle-branch block (LBBB)
Signs of hypothyroid
- correct answer Cold intolerance
Weight gain
Bradycardia
Dry flakey skin
Coarse hair
Fatigue / lethargy
,Swelling o face and peripheries
Constipation
Weakness, muscle cramps, arthralgias, paresthesias, impaired memory, and hearing
Signs of Hyperthyroid
- correct answer Heat intolerance / excessive sweating
Weight loss with increased appetite
Palpitations
Smooth silky skin
Fine hair
Diarrhea
Nervousness / anxiety
Tremor
Redness and scaling of the scalp could indicate
- correct answer Seborrheic dermatitis or Psoriasis
Soft lumps on the scalp could indicate
- correct answer Pilar cysts (Wens).
Why should the NP be concerned if they find pigmented nevi on the scalp
- correct answer Could indicate melanoma
Brown lesions on the scalp are indicative of
- correct answer Melanoma and its mimics
What would the NP be concerned for if she noticed the patient had an enlarged skull
- correct answer Hydrocephalus
or Paget's Disease of the bone.
,In a woman with hirsutism, what would the NP consider assessing for
- correct answer PCOS
A small hard tender "tonsillar node" high and deep between the mandible and the SCM is probably
- correct answer an elongated temporal styloid process.
Enlargement of a supraclavicular node, especially on the left (Virchow's node), suggests
- correct answer possible metastasis from a thoracic or an abdominal malignancy.
Masses in the neck may cause tracheal deviation to one side, raising suspicion of conditions in the
thorax such as
- correct answer a mediastinal mass, atelectasis, or a large pneumothorax
When assessing shortness of breath, always remember to listen over the trachea for
- correct answer stridor for upper airway etiologies in addition to examining the lungs.
Stridor is an
- correct answer Ominous, high-pitched musical sound from severe subglottic or tracheal obstruction
that signals a respiratory emergency.
Causes include epiglottitis,2 foreign body, goiter, and stenosis from placement of an artificial airway.
Retrosternal goiters can cause
- correct answer hoarseness
shortness of breath
stridor
or dysphagia from tracheal compression.
Neck hyperextension and arm elevation may cause flushing from compression of the thoracic inlet from
the gland itself or from clavicular movement (Pemberton sign). More than 85% of goiters are benign.
What should the NP be concerned for i the thyroid gland is soft upon palpation
- correct answer Graves disease. The thyroid gland may also be nodular
, A firm thyroid raises concern for
- correct answer Hashimoto thyroiditis (though not always uniformly) and malignancy.
A tender thyroid indicates
- correct answer thyroiditis.
JVD is a hallmark sign of
- correct answer heart failure
Thyroid dysfunction can be defined biochemically based on levels of
- correct answer thyroid-stimulating hormone (TSH) and thyroid hormones (thyroxine [T4],
triiodothyronine [T3]).
Subclinical hypothyroidism is associated with increased risk for
- correct answer cardiovascular disease
Subclinical hyperthyroidism is associated with
- correct answer cardiovascular mortality, A-fib, and decreased bone density
Hypothyroid risk factors
- correct answer Autoimmune thyroiditis
Older age
Caucasian
T1DM
Down syndrome
Goiter
External beam radiation to the head and neck area Family history.
Hyperthyroidism risk factors
- correct answer Female gender
Older age
African ancestry
A+ Grade
A loud or augmented S1 occurs when
- correct answer The left ventricular (LV) pressure is increased.
What conditions can cause a loud S1
- correct answer Increased contractility with exercise
Increased contractility in sympathetic nervous system stimulation such as with inotropic drugs
Hyper-metabolic states such as hyperthyroidism or pheochromocytoma
Conditions of hyper-dynamic circulation such as anemia
Short PR-interval
A diminished SI can occur due to
- correct answer Increased distance between the heart and chest wall - obesity, COPD/barrel chests and
pericardial effusions
Decreased contractility as in heart failure
Prolonged PR-interval
Left-bundle-branch block (LBBB)
Signs of hypothyroid
- correct answer Cold intolerance
Weight gain
Bradycardia
Dry flakey skin
Coarse hair
Fatigue / lethargy
,Swelling o face and peripheries
Constipation
Weakness, muscle cramps, arthralgias, paresthesias, impaired memory, and hearing
Signs of Hyperthyroid
- correct answer Heat intolerance / excessive sweating
Weight loss with increased appetite
Palpitations
Smooth silky skin
Fine hair
Diarrhea
Nervousness / anxiety
Tremor
Redness and scaling of the scalp could indicate
- correct answer Seborrheic dermatitis or Psoriasis
Soft lumps on the scalp could indicate
- correct answer Pilar cysts (Wens).
Why should the NP be concerned if they find pigmented nevi on the scalp
- correct answer Could indicate melanoma
Brown lesions on the scalp are indicative of
- correct answer Melanoma and its mimics
What would the NP be concerned for if she noticed the patient had an enlarged skull
- correct answer Hydrocephalus
or Paget's Disease of the bone.
,In a woman with hirsutism, what would the NP consider assessing for
- correct answer PCOS
A small hard tender "tonsillar node" high and deep between the mandible and the SCM is probably
- correct answer an elongated temporal styloid process.
Enlargement of a supraclavicular node, especially on the left (Virchow's node), suggests
- correct answer possible metastasis from a thoracic or an abdominal malignancy.
Masses in the neck may cause tracheal deviation to one side, raising suspicion of conditions in the
thorax such as
- correct answer a mediastinal mass, atelectasis, or a large pneumothorax
When assessing shortness of breath, always remember to listen over the trachea for
- correct answer stridor for upper airway etiologies in addition to examining the lungs.
Stridor is an
- correct answer Ominous, high-pitched musical sound from severe subglottic or tracheal obstruction
that signals a respiratory emergency.
Causes include epiglottitis,2 foreign body, goiter, and stenosis from placement of an artificial airway.
Retrosternal goiters can cause
- correct answer hoarseness
shortness of breath
stridor
or dysphagia from tracheal compression.
Neck hyperextension and arm elevation may cause flushing from compression of the thoracic inlet from
the gland itself or from clavicular movement (Pemberton sign). More than 85% of goiters are benign.
What should the NP be concerned for i the thyroid gland is soft upon palpation
- correct answer Graves disease. The thyroid gland may also be nodular
, A firm thyroid raises concern for
- correct answer Hashimoto thyroiditis (though not always uniformly) and malignancy.
A tender thyroid indicates
- correct answer thyroiditis.
JVD is a hallmark sign of
- correct answer heart failure
Thyroid dysfunction can be defined biochemically based on levels of
- correct answer thyroid-stimulating hormone (TSH) and thyroid hormones (thyroxine [T4],
triiodothyronine [T3]).
Subclinical hypothyroidism is associated with increased risk for
- correct answer cardiovascular disease
Subclinical hyperthyroidism is associated with
- correct answer cardiovascular mortality, A-fib, and decreased bone density
Hypothyroid risk factors
- correct answer Autoimmune thyroiditis
Older age
Caucasian
T1DM
Down syndrome
Goiter
External beam radiation to the head and neck area Family history.
Hyperthyroidism risk factors
- correct answer Female gender
Older age
African ancestry
