NR509 Final Exam
1. A 35-year-old female with a history of migraines presents 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?: Take a further history
and perform a very careful neurological exam
2. A grandmother is accompanying her 9-year-old granddaughter 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
PR
development?: IV
3. Primary prevention is defined as which of the following?: Interventions
designed to prevent disease
4. Based on the U.S. Preventive Services Task Force (USPSTF)
O
recommendations, which of the following statements is true about screening
for breast cancer in average-risk women?: Mammography is recommended
every 2 years for women aged 50-74 with insufficient evidence for screening women
FD
over the age of 75.
5. Which of the following statements is true regarding recommendations by
the eighth Joint National Committee (JNC8) for adults aged 60 and older?
Select all that apply.: Target blood pressure should be </= 150/90 mmHg but notes
O
that if treatment results in SBP <140 and is "well tolerated and without adverse
effects to health or quality of live, treatment does not need to be adjusted."
C
In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear
optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality.
6. Which of the following is a useful strategy when examining young
children between the ages of 1 and 4?: Have the parent facilitate the exam (e.g.,
removing clothes, holding the child on lap).
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?: "It often takes the baby more than 30 minutes to finish a bottle."
,8. A 16-year-old male presents to the clinic with a history of a congenital
right upper eyelid drooping as represented 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: CNIII
9. Which cranial nerve (CN) innervates the muscles of the pharynx and
provides sensory fibers to portions of the tympanic membrane, auditory
canal, pharynx, and the posterior third of the tongue?: CN IX
10. The NP should suspect injury to which cranial nerve (CN) if a patient
presents with complaints of photosensitivity and uneven pupils after being
struck in the eye with a baseball?: CNIII
11. Which of the following statements is true regarding risks and rapid
PR
recognition of suspected stroke? Select all that apply: Obesity doubles the risk
of stroke even without associated glucose intolerance
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke 12.
The combination of both receptive and expressive aphasia is a characteristic
O
of which type of speech disorder?: global aphasia
13. The NP is assessing a 42-year-old female who presents to the clinic
FD
with recurring headaches. What is an effective question to ask the patient?:
Do you have any aura prior to the headaches?
14. A 55-year-old female presents to the clinic with a headache. During the
interview, which of the following symptoms should prompt the NP to be
concerned and investigate further?: The patient reports fever, night sweats,
O
and thinks she lost weight.
15. When grading muscle strength on a scale of 1 to 5, a grade of 3
C
indicates which of the following?: Active movement against gravity
16. Which musculoskeletal disorder is paired correctly with the associated
systemic manifestations?: Lyme disease and expanding erythematous targetoid
patch in early illness
17. A 62-year-old female has a diagnosis of rheumatoid arthritis (RA).
Which of the following are expected assessment findings consistent with
the diagnosis?: Swelling of the synovial tissue in joints and tendon sheaths.
18. A 58-year-old male complains of pain in his knees, hips, hands, wrists,
neck, and lower back. Based on the joints involved, the NP suspects that the
patient most likely has which condition?: Osteoarthritis
, .
19. A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which
sign should the NP expect to find on examination that is most consistent
with the diagnosis?: Flexed forward posture with lower extremity weakness
20. What is the action(s) of the erector spinae muscle group?: Extension of
the spine
21 A 17-year-old male presents to the clinic for a follow-up appointment. He
fractured his left arm 8 weeks ago and remains in a cast. Upon inspection,
the NP finds that his shoulder heights are unequal and there is winging of
the scapula. The NP suspects contralateral weakness and muscle wasting
as the etiology for the winged scapula. Which of the following physical
assessment maneuvers should the NP perform to confirm the suspension?:
Compare the strength of the trapezius muscles
PR
22. A 31-year-old female presents to the clinic with a worsening stiff, painful
neck. On inspection, the patient's head is laterally deviated toward the
shoulder and rotated. Given this specific physical assessment finding, what
condition should the NP suspect as a differential diagnosis?: Torticollis
23. During an evaluation of an athletic 30-year-old female, the NP conducts
O
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
FD
neck,
EXCEPT?: Sacrospinalis
24. A 58-year-old male complains of lower back pain for many years. He
denies a recent injury. On examination, the NP finds that the patient has
tenderness to palpation over the sacroiliac joint. Which of the following
O
conditions is most consistent with this physical sign?: ankylosing spondylitis
25. Which of the following statements is true regarding prostate cancer
C
screening?: Setting normal cut-offs for prostate-specific antigen (PSA) testing
relies on balancing
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 at age 82 years with prostate cancer but died recently at age 87
years from a myocardial infarction before the 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
screening?: This patient is at an elevated risk of prostate cancer due to his family
history; thus, screening modalities should be discussed between the patient and
provider.
1. A 35-year-old female with a history of migraines presents 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?: Take a further history
and perform a very careful neurological exam
2. A grandmother is accompanying her 9-year-old granddaughter 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
PR
development?: IV
3. Primary prevention is defined as which of the following?: Interventions
designed to prevent disease
4. Based on the U.S. Preventive Services Task Force (USPSTF)
O
recommendations, which of the following statements is true about screening
for breast cancer in average-risk women?: Mammography is recommended
every 2 years for women aged 50-74 with insufficient evidence for screening women
FD
over the age of 75.
5. Which of the following statements is true regarding recommendations by
the eighth Joint National Committee (JNC8) for adults aged 60 and older?
Select all that apply.: Target blood pressure should be </= 150/90 mmHg but notes
O
that if treatment results in SBP <140 and is "well tolerated and without adverse
effects to health or quality of live, treatment does not need to be adjusted."
C
In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear
optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality.
6. Which of the following is a useful strategy when examining young
children between the ages of 1 and 4?: Have the parent facilitate the exam (e.g.,
removing clothes, holding the child on lap).
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?: "It often takes the baby more than 30 minutes to finish a bottle."
,8. A 16-year-old male presents to the clinic with a history of a congenital
right upper eyelid drooping as represented 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: CNIII
9. Which cranial nerve (CN) innervates the muscles of the pharynx and
provides sensory fibers to portions of the tympanic membrane, auditory
canal, pharynx, and the posterior third of the tongue?: CN IX
10. The NP should suspect injury to which cranial nerve (CN) if a patient
presents with complaints of photosensitivity and uneven pupils after being
struck in the eye with a baseball?: CNIII
11. Which of the following statements is true regarding risks and rapid
PR
recognition of suspected stroke? Select all that apply: Obesity doubles the risk
of stroke even without associated glucose intolerance
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke 12.
The combination of both receptive and expressive aphasia is a characteristic
O
of which type of speech disorder?: global aphasia
13. The NP is assessing a 42-year-old female who presents to the clinic
FD
with recurring headaches. What is an effective question to ask the patient?:
Do you have any aura prior to the headaches?
14. A 55-year-old female presents to the clinic with a headache. During the
interview, which of the following symptoms should prompt the NP to be
concerned and investigate further?: The patient reports fever, night sweats,
O
and thinks she lost weight.
15. When grading muscle strength on a scale of 1 to 5, a grade of 3
C
indicates which of the following?: Active movement against gravity
16. Which musculoskeletal disorder is paired correctly with the associated
systemic manifestations?: Lyme disease and expanding erythematous targetoid
patch in early illness
17. A 62-year-old female has a diagnosis of rheumatoid arthritis (RA).
Which of the following are expected assessment findings consistent with
the diagnosis?: Swelling of the synovial tissue in joints and tendon sheaths.
18. A 58-year-old male complains of pain in his knees, hips, hands, wrists,
neck, and lower back. Based on the joints involved, the NP suspects that the
patient most likely has which condition?: Osteoarthritis
, .
19. A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which
sign should the NP expect to find on examination that is most consistent
with the diagnosis?: Flexed forward posture with lower extremity weakness
20. What is the action(s) of the erector spinae muscle group?: Extension of
the spine
21 A 17-year-old male presents to the clinic for a follow-up appointment. He
fractured his left arm 8 weeks ago and remains in a cast. Upon inspection,
the NP finds that his shoulder heights are unequal and there is winging of
the scapula. The NP suspects contralateral weakness and muscle wasting
as the etiology for the winged scapula. Which of the following physical
assessment maneuvers should the NP perform to confirm the suspension?:
Compare the strength of the trapezius muscles
PR
22. A 31-year-old female presents to the clinic with a worsening stiff, painful
neck. On inspection, the patient's head is laterally deviated toward the
shoulder and rotated. Given this specific physical assessment finding, what
condition should the NP suspect as a differential diagnosis?: Torticollis
23. During an evaluation of an athletic 30-year-old female, the NP conducts
O
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
FD
neck,
EXCEPT?: Sacrospinalis
24. A 58-year-old male complains of lower back pain for many years. He
denies a recent injury. On examination, the NP finds that the patient has
tenderness to palpation over the sacroiliac joint. Which of the following
O
conditions is most consistent with this physical sign?: ankylosing spondylitis
25. Which of the following statements is true regarding prostate cancer
C
screening?: Setting normal cut-offs for prostate-specific antigen (PSA) testing
relies on balancing
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 at age 82 years with prostate cancer but died recently at age 87
years from a myocardial infarction before the 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
screening?: This patient is at an elevated risk of prostate cancer due to his family
history; thus, screening modalities should be discussed between the patient and
provider.
