NR509 FINAL EXAM 2023/2024 ADVANCED
PHYSICAL ASSESSMENT QUESTIONS AND
ANSWERS GRADED A+
• When performing a visual acuity test the nurse practitioner notes 20/30 in the left
eyeand 20/40 in the right eye using the Snellen eye chart. This means:
• have the patient returning in two weeks for a follow up vision screen
• dilated the eye and retest
• refer the patient to an ophthalmologist
• document this as a normal finding
• The American psychiatric association’s diagnostic and statistical manual of mental
disorder defines Munchausen Syndrome By Proxy
• a self-inflicted injury to gain attention
• a caregiver making up or causing an illness or injury in a person under his or
her care
• an abusive behavior that does not involve the caregiver
• a situation in which the abuser is often inattentive and uncaring toward the victim
Munchausen syndrome by proxy is a mental illness and a form of child abuse. The
caretaker of a child, most often a mother, either makes up fake symptoms or causes real
symptoms to makeit look like the child is sick.
• Symptoms of depression are a side effect of which neurotransmitter medication?
• dopamine serotonin, norepinephrine
• gabapentin
• mil
• cortisol
• Which lesion is dark raised and asymmetric with irregular border? Quizlet Bates
Chapter 20
• Nevus
• Actinic keratosis
• Keratoacanthoma
• Melanoma
• A 32 years old woman presents with dull puffiness of the ayes pronounced not
pitting periorbital edema this finding is suggestive of this condition? APEA
• Nephrotic syndrome
• Myxedema
• Cushing syndrome
,• Sinusitis
Myxedema is a deposition of mucopolysaccarides in the dermis. Is commonly found if
patients with advanced hypothyroidism. The classic skin changes are: swelling of face,
lips, eyelids, and tongue or swelling and thickening of skin anywhere on the body,
especially in the lower legs.
Myxedema is the hallmark of Grave’s disease, an autoimmune form of hyperthyroidism.
Myxedema can also occur in Hashimoto’s thyroiditis a form of hypothyroidism.
• A 42 years old woman with a past medical history of migraine headaches is
requesting prophylactic medication treatment. Which medication should the Nurse
practitioner prescribe?
• Sumatriptan (Imitrex)
• Amitriptyline (Elavil)
• Verapamil (verelan)
• Metoprolol (Lopressor)
Amitriptyline (Elavil) is a tricyclic antidepresant and is considered offlabel use for
prophylactictreatment of migrane. Sumatriptan (Imimtrex) Is aTriptans used to abort
migraine
• A pediatric patient has areas of scaling on the scalp with round patches of alopecia.
This clinical finding is consistent with:
• Tinea capitis
• Seborrheic dermatitis
• Trichotillomania
• Alopecia areata
• What is the appropriate prophylactic medication for an 18 years old woman with a
past medical history of migraine headaches?
• Sumatriptan (Imitrex)b) Propanolol (Inderal)
• Ibuprofeno (motrin)
• Dihydroergotamine (DHE)
• Why would a combined hormonal contraceptive be contraindicated in a 36 year old
patient with a past medical history of type 2 diabetes, obesity, chronic smoking and
sedentary life
• She is obese
• She has type 2 diabetes mellitus
• Her age and tobacco use
,• She leads a sedentary lifestyle
Combined oral contraceptive is contraindicated in women older than 45, breastfeeding,
smoking,HTN, diabetes or hx of stroke
• During the breast examination of a perimenopausal woman the NP detects a bloody
spontaneous discharge from the right nipple. This indicates further evaluation.
• Fibroadenoma
• Polycystic breast disease Generalized breast pain or tenderness. Green or dark
brown nonbloody nipple discharge that tends to leak without pressure or squeezing
• An intraductal papilloma
• Pituitary prolactinoma
Intraductal papillomas are usually solitary and smaller than 1 cm. They are located in large
lactiferous sinuses or ducts and have a tendency to bleed. Quizlet Nipple Discharge
• Rh negative women should receive Rho (D) immunoglobulin at what gestational
time?
• 6 weeks
• 12 weeks
• 28 weeks
• 35 weeks
What happens is the client is Rh negative and has a negative antibody screen?
She will need repeat antibody screens and should receive Rho(D) immune globulin
(RhoGAM) at 28 weeks' gestation (Quizlet Antepartum Diagnostic Testing Saunders)
• When interpreting a complete blood count (CBC) lab report which of the following
results describes the size of the RBCs?
• Hemoglobin
• Mean corpuscular volume (MCV)
• Red cell distribution width (RDw)
• Hematocrit
The mean corpuscle (cell) volume (MCV) is a measurement of the average size of the
RBCs. Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher
MCV.
• What medication should be avoided when prescribe prophylactic therapy for
headache
• Verapamil
• Propranolol
• Venlataxin (Effexor)
• Nimodipine
, Serotonin Norepinephrine Reuptake inhibitor have the most serious side effect. Patients
shouldhave drug free period for 3-4 weeks after every 6 months of treatment
(pharmacology book page 1047)
• What is the mechanism of action of prostaglandin E1 (PG1) in a patient with
transpositionof the great arteries
• To maintain equal pressure in the ventricles
• To maintain patency of the great arteries
• To produce vasodilation on …………….
• To prevent cyanotic episodes by trapping blood in the lower …………
• Which of the following complaints best describes lower extremity calf pain
associatedwith peripheral artery disease
• A sharp stabbing pains
• A dull pain or cramp
• An electric shock
• A pulsating pain
Peripheral artery disease signs and symptoms include: Painful cramping in one or both of
yourhips, thighs or calf muscles after certain activities, such as walking or climbing stairs
(claudication) Leg numbness or weakness. Coldness in your lower leg or foot, especially
whencompared with the other side. (Mayoclinic)
• Which of the following conditions is NOT a typical finding of hyperprolactinemia
in a47- year-old premenopausal woman?
• Hirsutism
• Gynecomastia
• Oligomenorrhea
• Acne
Hyperprolactinemia causes typical symptoms in premenopausal women and in men, but
not in postmenopausal women. Premenopausal women — Hyperprolactinemia in
premenopausalwomen causes hypogonadism, with symptoms that include infertility,
oligomenorrhea, or amenorrhea and less often galactorrhea. (uptodate.com/clinical-
manifestations)
• When treating a patient with asthma who is experiencing acute wheezing which
medication should be given to relieve the symptom?
• Short acting bronchodilator
• Long acting bronchodilator
• Inhaled corticosteroid
• Combination of methylxanthine and long acting bronchodilator
Short-Acting Beta Agonist (SABA) inhalers; used for acute asthma attacks; quickly reduce
airway constriction & restore normal airflow; agonists/stimulators of adrenergic receptors
PHYSICAL ASSESSMENT QUESTIONS AND
ANSWERS GRADED A+
• When performing a visual acuity test the nurse practitioner notes 20/30 in the left
eyeand 20/40 in the right eye using the Snellen eye chart. This means:
• have the patient returning in two weeks for a follow up vision screen
• dilated the eye and retest
• refer the patient to an ophthalmologist
• document this as a normal finding
• The American psychiatric association’s diagnostic and statistical manual of mental
disorder defines Munchausen Syndrome By Proxy
• a self-inflicted injury to gain attention
• a caregiver making up or causing an illness or injury in a person under his or
her care
• an abusive behavior that does not involve the caregiver
• a situation in which the abuser is often inattentive and uncaring toward the victim
Munchausen syndrome by proxy is a mental illness and a form of child abuse. The
caretaker of a child, most often a mother, either makes up fake symptoms or causes real
symptoms to makeit look like the child is sick.
• Symptoms of depression are a side effect of which neurotransmitter medication?
• dopamine serotonin, norepinephrine
• gabapentin
• mil
• cortisol
• Which lesion is dark raised and asymmetric with irregular border? Quizlet Bates
Chapter 20
• Nevus
• Actinic keratosis
• Keratoacanthoma
• Melanoma
• A 32 years old woman presents with dull puffiness of the ayes pronounced not
pitting periorbital edema this finding is suggestive of this condition? APEA
• Nephrotic syndrome
• Myxedema
• Cushing syndrome
,• Sinusitis
Myxedema is a deposition of mucopolysaccarides in the dermis. Is commonly found if
patients with advanced hypothyroidism. The classic skin changes are: swelling of face,
lips, eyelids, and tongue or swelling and thickening of skin anywhere on the body,
especially in the lower legs.
Myxedema is the hallmark of Grave’s disease, an autoimmune form of hyperthyroidism.
Myxedema can also occur in Hashimoto’s thyroiditis a form of hypothyroidism.
• A 42 years old woman with a past medical history of migraine headaches is
requesting prophylactic medication treatment. Which medication should the Nurse
practitioner prescribe?
• Sumatriptan (Imitrex)
• Amitriptyline (Elavil)
• Verapamil (verelan)
• Metoprolol (Lopressor)
Amitriptyline (Elavil) is a tricyclic antidepresant and is considered offlabel use for
prophylactictreatment of migrane. Sumatriptan (Imimtrex) Is aTriptans used to abort
migraine
• A pediatric patient has areas of scaling on the scalp with round patches of alopecia.
This clinical finding is consistent with:
• Tinea capitis
• Seborrheic dermatitis
• Trichotillomania
• Alopecia areata
• What is the appropriate prophylactic medication for an 18 years old woman with a
past medical history of migraine headaches?
• Sumatriptan (Imitrex)b) Propanolol (Inderal)
• Ibuprofeno (motrin)
• Dihydroergotamine (DHE)
• Why would a combined hormonal contraceptive be contraindicated in a 36 year old
patient with a past medical history of type 2 diabetes, obesity, chronic smoking and
sedentary life
• She is obese
• She has type 2 diabetes mellitus
• Her age and tobacco use
,• She leads a sedentary lifestyle
Combined oral contraceptive is contraindicated in women older than 45, breastfeeding,
smoking,HTN, diabetes or hx of stroke
• During the breast examination of a perimenopausal woman the NP detects a bloody
spontaneous discharge from the right nipple. This indicates further evaluation.
• Fibroadenoma
• Polycystic breast disease Generalized breast pain or tenderness. Green or dark
brown nonbloody nipple discharge that tends to leak without pressure or squeezing
• An intraductal papilloma
• Pituitary prolactinoma
Intraductal papillomas are usually solitary and smaller than 1 cm. They are located in large
lactiferous sinuses or ducts and have a tendency to bleed. Quizlet Nipple Discharge
• Rh negative women should receive Rho (D) immunoglobulin at what gestational
time?
• 6 weeks
• 12 weeks
• 28 weeks
• 35 weeks
What happens is the client is Rh negative and has a negative antibody screen?
She will need repeat antibody screens and should receive Rho(D) immune globulin
(RhoGAM) at 28 weeks' gestation (Quizlet Antepartum Diagnostic Testing Saunders)
• When interpreting a complete blood count (CBC) lab report which of the following
results describes the size of the RBCs?
• Hemoglobin
• Mean corpuscular volume (MCV)
• Red cell distribution width (RDw)
• Hematocrit
The mean corpuscle (cell) volume (MCV) is a measurement of the average size of the
RBCs. Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher
MCV.
• What medication should be avoided when prescribe prophylactic therapy for
headache
• Verapamil
• Propranolol
• Venlataxin (Effexor)
• Nimodipine
, Serotonin Norepinephrine Reuptake inhibitor have the most serious side effect. Patients
shouldhave drug free period for 3-4 weeks after every 6 months of treatment
(pharmacology book page 1047)
• What is the mechanism of action of prostaglandin E1 (PG1) in a patient with
transpositionof the great arteries
• To maintain equal pressure in the ventricles
• To maintain patency of the great arteries
• To produce vasodilation on …………….
• To prevent cyanotic episodes by trapping blood in the lower …………
• Which of the following complaints best describes lower extremity calf pain
associatedwith peripheral artery disease
• A sharp stabbing pains
• A dull pain or cramp
• An electric shock
• A pulsating pain
Peripheral artery disease signs and symptoms include: Painful cramping in one or both of
yourhips, thighs or calf muscles after certain activities, such as walking or climbing stairs
(claudication) Leg numbness or weakness. Coldness in your lower leg or foot, especially
whencompared with the other side. (Mayoclinic)
• Which of the following conditions is NOT a typical finding of hyperprolactinemia
in a47- year-old premenopausal woman?
• Hirsutism
• Gynecomastia
• Oligomenorrhea
• Acne
Hyperprolactinemia causes typical symptoms in premenopausal women and in men, but
not in postmenopausal women. Premenopausal women — Hyperprolactinemia in
premenopausalwomen causes hypogonadism, with symptoms that include infertility,
oligomenorrhea, or amenorrhea and less often galactorrhea. (uptodate.com/clinical-
manifestations)
• When treating a patient with asthma who is experiencing acute wheezing which
medication should be given to relieve the symptom?
• Short acting bronchodilator
• Long acting bronchodilator
• Inhaled corticosteroid
• Combination of methylxanthine and long acting bronchodilator
Short-Acting Beta Agonist (SABA) inhalers; used for acute asthma attacks; quickly reduce
airway constriction & restore normal airflow; agonists/stimulators of adrenergic receptors
