NR 511 Week 2 Practice Questions
1. Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny
nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal
turbinates. What is your diagnosis?
• Allergic rhinitis (The symptoms of hay fever, also called allergic rhinitis, are similar to those of viral
rhinitis but usually persist and are seasonal in nature. When assessing the nasal mucosa, you will observe
that the turbinates are usually pale or violaceous because of venous engorgement)
• Viral rhinitis (with viral rhinitis, the turbinates are typically erythematous)
• Nasal polyps (With nasal polyps, there are usually yellowish, boggy masses of hypertrophic mucosa)
• Nasal vestibulitis from folliculitis (Nasal vestibulitis usually results from folliculitis of the hairs that line
the nares)
2. A 75-year-old African American male presents to your family practice office complaining of visual impairment.
He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past
6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He
also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is
23 mm Hg. What is his most likely diagnosis?
• Open-angle glaucoma (This is the typical presentation of chronic, or open-angle, glaucoma)
• Angle-closure glaucoma (This is an acute, painful form of glaucoma)
• Cataracts (This is a loss of central vision)
• Macular degeneration (This also affects central vision)
3. Which of the following is not a cause of conductive hearing loss?
• Presbycusis (This is a cause of sensorineural hearing loss)
• Cerumen impaction.
• Otitis media.
• Otosclerosis.
4. Which of the following is not a complication of untreated group A streptococcal pharyngitis?
• Glomerulonephritis.
• Rheumatic heart disease.
• Scarlet fever.
• Hemolytic anemia (This is a complication of mononucleosis)
5. Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the
office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless,
white, slightly raised patches in her mouth. This is probably caused by:
• Herpes simplex (Herpes simplex (a viral infection) sores are usually discrete and not spread over a large
area)
• Aphthous ulcers (Aphthous ulcers (canker sores) are extremely painful)
• Candidiasis (Painless, white, slightly raised patches in a client’s mouth are probably caused by candidiasis
(thrush)
• Oral cancer (Cancerous lesions are usually discrete and not spread over a large area)
6. Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like “a curtain came down over my eye.”
She doesn’t have any pain or redness. What do you suspect?
• Retinal detachment (The classic sign of retinal detachment is a client stating that “a curtain came down
over my eye.” Typically, the person presents with blurred vision in 1 eye that becomes progressively worse,
with no pain or redness)
• Acute angle-closure glaucoma (In older adults with acute angle-closure glaucoma, there is a rapid onset,
with severe pain and profound visual loss. The eye is red, with a steamy cornea and a dilated pupil)
• Open-angle glaucoma (In older adults with open-angle glaucoma, there is an insidious onset, a gradual loss
of peripheral vision over a period of years, and a perception of “halos” around lights)
• Cataract (With a cataract, there is blurred vision that is progressive over months or years and no pain or
redness)
7. While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are
abnormally narrow. What are you examining?
, • The nasolabial folds (The nasolabial folds are the skin creases that extend from the angle of the nose to the
corners of the mouth)
• The openings between the margins of the upper and lower eyelids (The palpebral fissures are the openings
between the margins of the upper and lower eyelids. Someone who appears to be squinting is said to have
narrow palpebral fissures)
• The thyroid gland in relation to the trachea (The thyroid is a butterfly-shaped gland located in the front of
the neck, just below the Adam’s apple; it is wrapped around the trachea)
• The distance between the trigeminal nerve branches (The trigeminal nerve is the fifth cranial nerve located
within the brain. It is composed of 3 branches—ophthalmic, maxillary, and mandibular—and is primarily
responsible for transmitting sensations from the face to the brain. It is also the nerve that controls the
muscles used for chewing)
8. When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse
practitioner should document this finding as:
• Conductive deafness (With conductive deafness, sound lateralizes to the defective ear because it is
transmitted through bone rather than air)
• Perceptive deafness (With perceptive deafness, sound lateralizes to the better ear)
• A normal finding (A Weber test assesses hearing by bone conduction. With normal hearing, sound is heard
equally well in both ears, meaning there is no lateralization)
• Nerve damage (Damage to cranial nerve VIII (CN VIII), the vestibulocochlear nerve, causes symptoms of
hearing loss, vertigo, and loss of equilibrium)
9. What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive
treatment and referral?
• There is a change in the child’s hearing threshold to greater than 25 dB (If a child with otitis media with
effusion has a change in the hearing threshold greater than 25 dB and has notable speech and language
delays, more aggressive treatment is indicated. When the child’s hearing examination reveals a change in
the hearing threshold, it is extremely important that the provider evaluate the child’s achievement of
developmental milestones in speech and language. Any abnormal findings warrant referral)
• The child has become a fussy eater.
• The child’s speech and language skills seem slightly delayed.
• Persistent rhinitis is present.
10. A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at
the end of a night of performing, a problem that is compounded by the noisy environment of the club. These
symptoms are most characteristic of which of the following?
• Sensorineural loss (Sensorineural loss comes from exposure to loud noises, inner ear infections, tumors,
congenital and familial disorders, and aging. The results of the Weber and Rinne tests will assist in the
diagnosis)
• Conductive loss (The etiology of conductive loss includes ear infection, presence of a foreign body,
perforated drum, and otosclerosis of the ossicles)
• Tinnitus (Tinnitus is ringing in the ears. The client does not complain of this symptom)
• Vertigo (Vertigo is dizziness associated with inner ear dysfunction. The client does not complain of this
symptom)
11. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that
“some foods get stuck” and she has been having “heartburn” at night when she lies down, especially if she has had a
heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or
change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family
history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and
the stool is occult blood (OB) negative. What is the most likely diagnosis?
• Esophageal varices.
• Esophageal cancer.
• Gastroesophageal reflux disease (GERD) (Though the historical data are incomplete, this client has no
obvious risk factors for esophageal varices or esophageal cancer. She is a nondrinker and denies weight loss
and changes in bowel function or color of stools, which could be a clue to a gastrointestinal bleed. The fact
that her worst symptoms occur at night with regurgitation and heartburn is classic for GERD. Dysphagia is
frequently a prominent symptom of GERD. She has no abdominal tenderness, and aside from the nighttime
symptoms and dysphagia, she reports no symptoms with food or lack of food)
• Peptic ulcer disease (PUD).
, 12. Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral
secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do
you suspect?
• Epiglottitis (A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions,
respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of
epiglottitis)
• Group A beta-hemolytic streptococcal pharyngitis (Streptococcal pharyngitis presents with cervical
adenitis, petechiae, a beefy-red uvula, and a tonsillar exudate)
• Tonsillitis (A mild case of tonsillitis may appear to be only a slight sore throat. A more severe case would
involve inflamed, swollen tonsils; a very sore throat; and a high fever)
• Diphtheria (Diphtheria starts with a sore throat, fever, headache, and nausea, and then progresses to patches
of grayish or dirty-yellowish membranes in the throat that eventually grow into 1 membrane)
13. An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is
blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers
being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the
trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus.
Based on what you know to be complications of this disease, you explain to her that she needs:
• Antibiotics.
• A biopsy of the rash.
• Immediate hospitalization.
• Ophthalmological consultation (In this case, because the herpes virus seems to be along the ophthalmic
branch of cranial nerve V, there is considerable risk that this client could develop permanent damage in that
eye; therefore, an ophthalmological consult needs to be arranged promptly to ascertain current damage and
prevent any further damage)
14. You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this
finding?
• Grade 1 (Grade 1 indicates the tonsils are visible)
• Grade 2 (Grade 2 indicates the tonsils are halfway between the tonsillar pillars and the uvula)
• Grade 3 (Grade 3 indicates the tonsils are touching the uvula. Tonsils are enlarged to 2, 3, or 4 with an
acute infection)
• Grade 4 (Grade 4 indicates the tonsils are touching each other)
15. Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What
instructions for taking the medication do you give Michael?
• “Dilute the oral medication with one tablespoon of water for easier digestion.” (The oral medication should
not be diluted, as that may compromise the absorption)
• “Take the medication with meals so that it’s absorbed better.” (Taking the medication with meals may
compromise the absorption)
• “Swish and swallow the medication.” (When ordering nystatin (Mycostatin) for an oral fungal infection,
tell the client to swish the medication in the mouth to coat all the lesions and then to swallow it)
• “Apply the medication only to the lesions.” (It is almost impossible to apply this liquid medication to only
the lesions; swishing it in the mouth coats all the lesions more effectively)
16. April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that
they may be cancerous skin lesions. You tell her that they are probably:
• Xanthelasmas (Xanthelasmas are soft, raised, yellow plaques on the eyelids at the inner canthi. They appear
frequently in women, in their 50s. Xanthelasmas occur with both high and normal lipid levels and have no
pathological significance)
• Pingueculae (Pingueculae are yellowish, elevated nodules appearing on the sclera. They are caused by a
thickening of the bulbar conjunctiva from prolonged exposure to the sun, wind, and dust)
• The result of arcus senilis (Arcus senilis appears as gray-white arcs or circles around the limbus and is a
result of deposits of lipid material that make the cornea look cloudy)
• Actinic keratosis (Actinic keratoses are wartlike growths on the skin that occur in middle-aged or older
adults and are caused by excessive exposure to the sun)
17. Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of
headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as
a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It
started approximately 2 days ago and is still present. What kind of headache is she describing?
1. Jill, a 34-year-old bank teller, presents with symptoms of hay fever. She complains of nasal congestion, runny
nose with clear mucus, and itchy nose and eyes. On physical assessment, you observe that she has pale nasal
turbinates. What is your diagnosis?
• Allergic rhinitis (The symptoms of hay fever, also called allergic rhinitis, are similar to those of viral
rhinitis but usually persist and are seasonal in nature. When assessing the nasal mucosa, you will observe
that the turbinates are usually pale or violaceous because of venous engorgement)
• Viral rhinitis (with viral rhinitis, the turbinates are typically erythematous)
• Nasal polyps (With nasal polyps, there are usually yellowish, boggy masses of hypertrophic mucosa)
• Nasal vestibulitis from folliculitis (Nasal vestibulitis usually results from folliculitis of the hairs that line
the nares)
2. A 75-year-old African American male presents to your family practice office complaining of visual impairment.
He has worn corrective lenses for many years but has noticed that his vision has gotten progressively worse the past
6 months. He denies pain. He states his vision is worse in both eyes in the peripheral aspects of his visual field. He
also notes trouble driving at night and halos around street lights at night. You test his intraocular pressure, and it is
23 mm Hg. What is his most likely diagnosis?
• Open-angle glaucoma (This is the typical presentation of chronic, or open-angle, glaucoma)
• Angle-closure glaucoma (This is an acute, painful form of glaucoma)
• Cataracts (This is a loss of central vision)
• Macular degeneration (This also affects central vision)
3. Which of the following is not a cause of conductive hearing loss?
• Presbycusis (This is a cause of sensorineural hearing loss)
• Cerumen impaction.
• Otitis media.
• Otosclerosis.
4. Which of the following is not a complication of untreated group A streptococcal pharyngitis?
• Glomerulonephritis.
• Rheumatic heart disease.
• Scarlet fever.
• Hemolytic anemia (This is a complication of mononucleosis)
5. Alexandra, age 34, was treated with oral antibiotics 2 weeks ago for a urinary tract infection. She is seen in the
office today for a follow-up visit. On physical examination, the nurse practitioner notices that she has some painless,
white, slightly raised patches in her mouth. This is probably caused by:
• Herpes simplex (Herpes simplex (a viral infection) sores are usually discrete and not spread over a large
area)
• Aphthous ulcers (Aphthous ulcers (canker sores) are extremely painful)
• Candidiasis (Painless, white, slightly raised patches in a client’s mouth are probably caused by candidiasis
(thrush)
• Oral cancer (Cancerous lesions are usually discrete and not spread over a large area)
6. Mattie, age 64, presents with blurred vision in 1 eye and states that it felt like “a curtain came down over my eye.”
She doesn’t have any pain or redness. What do you suspect?
• Retinal detachment (The classic sign of retinal detachment is a client stating that “a curtain came down
over my eye.” Typically, the person presents with blurred vision in 1 eye that becomes progressively worse,
with no pain or redness)
• Acute angle-closure glaucoma (In older adults with acute angle-closure glaucoma, there is a rapid onset,
with severe pain and profound visual loss. The eye is red, with a steamy cornea and a dilated pupil)
• Open-angle glaucoma (In older adults with open-angle glaucoma, there is an insidious onset, a gradual loss
of peripheral vision over a period of years, and a perception of “halos” around lights)
• Cataract (With a cataract, there is blurred vision that is progressive over months or years and no pain or
redness)
7. While doing a face, head, and neck examination on a 16-year-old patient, you note that the palpebral fissures are
abnormally narrow. What are you examining?
, • The nasolabial folds (The nasolabial folds are the skin creases that extend from the angle of the nose to the
corners of the mouth)
• The openings between the margins of the upper and lower eyelids (The palpebral fissures are the openings
between the margins of the upper and lower eyelids. Someone who appears to be squinting is said to have
narrow palpebral fissures)
• The thyroid gland in relation to the trachea (The thyroid is a butterfly-shaped gland located in the front of
the neck, just below the Adam’s apple; it is wrapped around the trachea)
• The distance between the trigeminal nerve branches (The trigeminal nerve is the fifth cranial nerve located
within the brain. It is composed of 3 branches—ophthalmic, maxillary, and mandibular—and is primarily
responsible for transmitting sensations from the face to the brain. It is also the nerve that controls the
muscles used for chewing)
8. When the Weber test is performed with a tuning fork to assess hearing and there is no lateralization, the nurse
practitioner should document this finding as:
• Conductive deafness (With conductive deafness, sound lateralizes to the defective ear because it is
transmitted through bone rather than air)
• Perceptive deafness (With perceptive deafness, sound lateralizes to the better ear)
• A normal finding (A Weber test assesses hearing by bone conduction. With normal hearing, sound is heard
equally well in both ears, meaning there is no lateralization)
• Nerve damage (Damage to cranial nerve VIII (CN VIII), the vestibulocochlear nerve, causes symptoms of
hearing loss, vertigo, and loss of equilibrium)
9. What significant finding(s) in a 3-year-old child with otitis media with effusion would prompt more aggressive
treatment and referral?
• There is a change in the child’s hearing threshold to greater than 25 dB (If a child with otitis media with
effusion has a change in the hearing threshold greater than 25 dB and has notable speech and language
delays, more aggressive treatment is indicated. When the child’s hearing examination reveals a change in
the hearing threshold, it is extremely important that the provider evaluate the child’s achievement of
developmental milestones in speech and language. Any abnormal findings warrant referral)
• The child has become a fussy eater.
• The child’s speech and language skills seem slightly delayed.
• Persistent rhinitis is present.
10. A 25-year-old client who plays in a band complains that he finds it difficult to understand his fellow musicians at
the end of a night of performing, a problem that is compounded by the noisy environment of the club. These
symptoms are most characteristic of which of the following?
• Sensorineural loss (Sensorineural loss comes from exposure to loud noises, inner ear infections, tumors,
congenital and familial disorders, and aging. The results of the Weber and Rinne tests will assist in the
diagnosis)
• Conductive loss (The etiology of conductive loss includes ear infection, presence of a foreign body,
perforated drum, and otosclerosis of the ossicles)
• Tinnitus (Tinnitus is ringing in the ears. The client does not complain of this symptom)
• Vertigo (Vertigo is dizziness associated with inner ear dysfunction. The client does not complain of this
symptom)
11. A 64-year-old obese woman comes in complaining of difficulty swallowing for the past 3 weeks. She states that
“some foods get stuck” and she has been having “heartburn” at night when she lies down, especially if she has had a
heavy meal. Occasionally, she awakes at night coughing. She denies weight gain and/or weight loss, vomiting, or
change in bowel movements or color of stools. She denies alcohol and tobacco use. There is no pertinent family
history or findings on review of systems (ROS). Physical examination is normal, with no abdominal tenderness, and
the stool is occult blood (OB) negative. What is the most likely diagnosis?
• Esophageal varices.
• Esophageal cancer.
• Gastroesophageal reflux disease (GERD) (Though the historical data are incomplete, this client has no
obvious risk factors for esophageal varices or esophageal cancer. She is a nondrinker and denies weight loss
and changes in bowel function or color of stools, which could be a clue to a gastrointestinal bleed. The fact
that her worst symptoms occur at night with regurgitation and heartburn is classic for GERD. Dysphagia is
frequently a prominent symptom of GERD. She has no abdominal tenderness, and aside from the nighttime
symptoms and dysphagia, she reports no symptoms with food or lack of food)
• Peptic ulcer disease (PUD).
, 12. Marcia, age 4, is brought in to the office by her mother. She has a sore throat, difficulty swallowing, copious oral
secretions, respiratory difficulty, stridor, and a temperature of 102°F but no pharyngeal erythema or cough. What do
you suspect?
• Epiglottitis (A symptom cluster of severe throat pain with difficulty swallowing, copious oral secretions,
respiratory difficulty, stridor, and fever but without pharyngeal erythema or cough is indicative of
epiglottitis)
• Group A beta-hemolytic streptococcal pharyngitis (Streptococcal pharyngitis presents with cervical
adenitis, petechiae, a beefy-red uvula, and a tonsillar exudate)
• Tonsillitis (A mild case of tonsillitis may appear to be only a slight sore throat. A more severe case would
involve inflamed, swollen tonsils; a very sore throat; and a high fever)
• Diphtheria (Diphtheria starts with a sore throat, fever, headache, and nausea, and then progresses to patches
of grayish or dirty-yellowish membranes in the throat that eventually grow into 1 membrane)
13. An 80-year-old woman comes in to the office with complaints of a rash on the left side of her face that is
blistered and painful and accompanied by left-sided eye pain. The rash broke out 2 days ago, and she remembers
being very tired and feeling feverish for a week before the rash appeared. On examination, the rash follows the
trigeminal nerve on the left, and she has some scleral injection and tearing. You suspect herpes zoster ophthalmicus.
Based on what you know to be complications of this disease, you explain to her that she needs:
• Antibiotics.
• A biopsy of the rash.
• Immediate hospitalization.
• Ophthalmological consultation (In this case, because the herpes virus seems to be along the ophthalmic
branch of cranial nerve V, there is considerable risk that this client could develop permanent damage in that
eye; therefore, an ophthalmological consult needs to be arranged promptly to ascertain current damage and
prevent any further damage)
14. You are assessing a first grader and find that the tonsils are touching the uvula. How would you grade this
finding?
• Grade 1 (Grade 1 indicates the tonsils are visible)
• Grade 2 (Grade 2 indicates the tonsils are halfway between the tonsillar pillars and the uvula)
• Grade 3 (Grade 3 indicates the tonsils are touching the uvula. Tonsils are enlarged to 2, 3, or 4 with an
acute infection)
• Grade 4 (Grade 4 indicates the tonsils are touching each other)
15. Nystatin (Mycostatin) is ordered for Michael, a 56-year-old banker who has an oral fungal infection. What
instructions for taking the medication do you give Michael?
• “Dilute the oral medication with one tablespoon of water for easier digestion.” (The oral medication should
not be diluted, as that may compromise the absorption)
• “Take the medication with meals so that it’s absorbed better.” (Taking the medication with meals may
compromise the absorption)
• “Swish and swallow the medication.” (When ordering nystatin (Mycostatin) for an oral fungal infection,
tell the client to swish the medication in the mouth to coat all the lesions and then to swallow it)
• “Apply the medication only to the lesions.” (It is almost impossible to apply this liquid medication to only
the lesions; swishing it in the mouth coats all the lesions more effectively)
16. April, age 50, presents with soft, raised, yellow plaques on her eyelids at the inner canthi. She is concerned that
they may be cancerous skin lesions. You tell her that they are probably:
• Xanthelasmas (Xanthelasmas are soft, raised, yellow plaques on the eyelids at the inner canthi. They appear
frequently in women, in their 50s. Xanthelasmas occur with both high and normal lipid levels and have no
pathological significance)
• Pingueculae (Pingueculae are yellowish, elevated nodules appearing on the sclera. They are caused by a
thickening of the bulbar conjunctiva from prolonged exposure to the sun, wind, and dust)
• The result of arcus senilis (Arcus senilis appears as gray-white arcs or circles around the limbus and is a
result of deposits of lipid material that make the cornea look cloudy)
• Actinic keratosis (Actinic keratoses are wartlike growths on the skin that occur in middle-aged or older
adults and are caused by excessive exposure to the sun)
17. Cynthia, a 31-year-old woman with a history of depression, is seen in the office today for complaints of
headaches. She was recently promoted at her job, and this has caused increased stress. She describes the headache as
a tightening (viselike) feeling in the temporal and nuchal areas. The pain is bilateral and tends to wax and wane. It
started approximately 2 days ago and is still present. What kind of headache is she describing?
