NR 509 WEEK 3 EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 2025 LATEST
UPDATED AGRADE
Question 1
The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry.
This finding would be related to which factor?
A) Increased vascularity of the skin in the elderly
B) Increased numbers of sweat and sebaceous glands in the elderly
C) An increase in elastin and a decrease in subcutaneous fat in the elderly
D) An increased loss of elastin and a decrease in subcutaneous fat in the elderly
E) Increased melanin production in the elderly
Correct Answer: D) An increased loss of elastin and a decrease in subcutaneous fat in the
elderly
Rationale: As individuals age, there is a natural loss of elastin (which provides skin
elasticity) and a decrease in subcutaneous fat. These changes contribute to the
characteristic wrinkled, thin, lax, and dry appearance of elderly skin. Vascularity tends to
decrease, and sweat/sebaceous gland activity often diminishes, leading to dryness.
Question 2
A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair for
about three days with his feet down, and he wants the nurse to evaluate his feet. During the
assessment, the nurse might expect to find:
A) Pallor.
B) Coolness.
C) Distended veins.
D) Prolonged capillary filling time.
E) Absence of pedal pulses.
Correct Answer: C) Distended veins
Rationale: Confinement to a recliner with feet down (dependent position) for an extended
period would lead to venous pooling in the lower extremities due to gravity and lack of
muscle pump activity. This increased hydrostatic pressure would result in distended veins
and likely dependent edema. Pallor, coolness, and prolonged capillary filling time are signs
of arterial insufficiency, which is not suggested by this scenario.
Question 3
The nurse notices that a school-aged child has bluish-white, red-based spots in her mouth that are
elevated about 1 mm to 3 mm. What other signs would the nurse expect to find in this patient?
A) A pink, papular rash on the face and neck.
B) Pruritic vesicles over her trunk and neck.
C) Hyperpigmentation on the chest, abdomen, and the back of the arms.
D) A red-purple, maculopapular, blotchy rash behind the ears and on the face.
E) A "strawberry tongue" and peeling skin on fingertips.
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Correct Answer: D) A red-purple, maculopapular, blotchy rash behind the ears and on the
face
Rationale: The description of bluish-white, red-based spots in the mouth (Koplik spots) is
pathognomonic for measles (rubeola). These spots typically appear 1-2 days before the
characteristic maculopapular rash, which usually starts behind the ears, on the face, and
then spreads downwards over the body.
Question 4
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm
in diameter. When documenting this finding, the nurse would report this as a:
A) Bulla.
B) Wheal.
C) Pustule.
D) Papule.
E) Nodule.
Correct Answer: D) Papule.
Rationale: A papule is defined as a solid, elevated, circumscribed lesion that is less than 1
cm in diameter. A bulla is a large blister (>1 cm). A wheal is a superficial, raised, transient
lesion (e.g., mosquito bite). A pustule is a pus-filled vesicle. A nodule is solid, elevated, and
larger than a papule (>1 cm).
Question 5
A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up
appointment. On assessment, the nurse might expect to see which assessment finding?
A) Anasarca.
B) Scleroderma.
C) Pedal erythema.
D) Clubbing of the nails.
E) Jaundice.
Correct Answer: D) Clubbing of the nails
Rationale: Clubbing of the nails (bulbous enlargement of the fingertips with increased nail
plate curvature) is a classic physical finding associated with chronic hypoxemia, which is
common in clients with severe chronic obstructive pulmonary disease (COPD), including
emphysema and chronic bronchitis. Anasarca is generalized edema. Scleroderma is a
connective tissue disease. Pedal erythema is redness of the feet, which could have many
causes.
Question 6
A 19-year-old college student is brought to the emergency department with a severe headache he
describes as "like nothing I've ever had before." His temperature is 104° F, and he has a stiff
neck. The nurse looks for other signs and symptoms of which problem?
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A) Head injury.
B) Cluster headache.
C) Migraine headache.
D) Meningeal inflammation.
E) Tension headache.
Correct Answer: D) Meningeal inflammation
Rationale: The triad of severe headache (especially described as "worst ever"), high fever
(104°F), and a stiff neck (nuchal rigidity) are classic symptoms of meningeal inflammation,
most commonly seen in meningitis. This is a medical emergency requiring urgent diagnosis
and treatment.
Question 7
During an examination of a female patient, the nurse notes lymphadenopathy and suspects an
acute infection. Acutely infected lymph nodes would be:
A) Clumped.
B) Unilateral.
C) Firm but freely movable.
D) Firm and nontender.
E) Fixed and matted.
Correct Answer: C) Firm but freely movable.
Rationale: Acutely infected lymph nodes are typically enlarged, firm, warm, tender, and
freely movable. They are often unilateral. Chronic inflammation or malignancy can lead to
matted, fixed, or hard, nontender nodes. "Clumped" is vague, but "firm but freely
movable" is a hallmark of acute infection.
Question 8
A patient visits the clinic because he has recently noticed that the left side of his mouth is
paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse suspects that he has:
A) Cushing's syndrome.
B) Parkinson disease.
C) Bell's palsy.
D) Had a cerebrovascular accident (stroke).
E) Trigeminal neuralgia.
Correct Answer: C) Bell's palsy.
Rationale: Bell's palsy is an acute, temporary paralysis or weakness of the facial muscles on
one side of the face. It affects the facial nerve (Cranial Nerve VII) and causes symptoms
such as inability to raise the eyebrow, wrinkle the forehead, close the eye tightly, smile, or
whistle. A cerebrovascular accident (stroke) causing facial paralysis usually spares the
forehead (the patient can raise their eyebrow).
, [Type here]
Question 9
A male patient with a history of AIDS has come in for an examination and he states, "I think that
I have the mumps." The nurse would begin by examining the:
A) Thyroid gland.
B) Parotid gland.
C) Cervical lymph nodes.
D) Mouth and skin for lesions.
E) Submandibular glands.
Correct Answer: B) Parotid gland.
Rationale: The mumps virus primarily causes swelling of the parotid glands, which are
located anterior to the earlobe and extend down to the angle of the jaw. Given the patient's
concern about "mumps," the nurse would start by examining these glands for swelling and
tenderness. While HIV/AIDS patients can have other swellings or lesions, addressing the
stated concern is appropriate.
Question 10
When examining the eye, the nurse notices that the patient's eyelid margins approximate
completely. The nurse recognizes that this assessment finding:
A) Is expected.
B) May indicate a problem with extraocular muscles.
C) May result in problems with tearing.
D) Indicates increased intraocular pressure.
E) Is a sign of ptosis.
Correct Answer: A) Is expected.
Rationale: Eyelid margins that approximate completely (meaning they close fully and
evenly) is a normal and expected finding. It indicates proper eyelid function, which is
essential for protecting the eye, distributing tears, and preventing dryness. Problems with
approximation (e.g., lagophthalmos, ectropion) would lead to tearing or corneal dryness.
Question 11
During an assessment, the nurse notices that an elderly patient has tears rolling down his face
from his left eye. Closer examination shows that the lower lid is loose and rolling outward. The
patient complains of his eye feeling "dry and itchy." Which action by the nurse is correct?
A) Assess the eye for a possible foreign body.
B) Document the finding as ptosis.
C) Assess for other signs of ectropion.
D) Contact the prescriber because these are signs of basal cell carcinoma.
E) Advise the patient to use artificial tears.
Correct Answer: C) Assess for other signs of ectropion.
Rationale: The description of the lower lid being loose and rolling outward, with tears
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 2025 LATEST
UPDATED AGRADE
Question 1
The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry.
This finding would be related to which factor?
A) Increased vascularity of the skin in the elderly
B) Increased numbers of sweat and sebaceous glands in the elderly
C) An increase in elastin and a decrease in subcutaneous fat in the elderly
D) An increased loss of elastin and a decrease in subcutaneous fat in the elderly
E) Increased melanin production in the elderly
Correct Answer: D) An increased loss of elastin and a decrease in subcutaneous fat in the
elderly
Rationale: As individuals age, there is a natural loss of elastin (which provides skin
elasticity) and a decrease in subcutaneous fat. These changes contribute to the
characteristic wrinkled, thin, lax, and dry appearance of elderly skin. Vascularity tends to
decrease, and sweat/sebaceous gland activity often diminishes, leading to dryness.
Question 2
A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair for
about three days with his feet down, and he wants the nurse to evaluate his feet. During the
assessment, the nurse might expect to find:
A) Pallor.
B) Coolness.
C) Distended veins.
D) Prolonged capillary filling time.
E) Absence of pedal pulses.
Correct Answer: C) Distended veins
Rationale: Confinement to a recliner with feet down (dependent position) for an extended
period would lead to venous pooling in the lower extremities due to gravity and lack of
muscle pump activity. This increased hydrostatic pressure would result in distended veins
and likely dependent edema. Pallor, coolness, and prolonged capillary filling time are signs
of arterial insufficiency, which is not suggested by this scenario.
Question 3
The nurse notices that a school-aged child has bluish-white, red-based spots in her mouth that are
elevated about 1 mm to 3 mm. What other signs would the nurse expect to find in this patient?
A) A pink, papular rash on the face and neck.
B) Pruritic vesicles over her trunk and neck.
C) Hyperpigmentation on the chest, abdomen, and the back of the arms.
D) A red-purple, maculopapular, blotchy rash behind the ears and on the face.
E) A "strawberry tongue" and peeling skin on fingertips.
,[Type here]
Correct Answer: D) A red-purple, maculopapular, blotchy rash behind the ears and on the
face
Rationale: The description of bluish-white, red-based spots in the mouth (Koplik spots) is
pathognomonic for measles (rubeola). These spots typically appear 1-2 days before the
characteristic maculopapular rash, which usually starts behind the ears, on the face, and
then spreads downwards over the body.
Question 4
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm
in diameter. When documenting this finding, the nurse would report this as a:
A) Bulla.
B) Wheal.
C) Pustule.
D) Papule.
E) Nodule.
Correct Answer: D) Papule.
Rationale: A papule is defined as a solid, elevated, circumscribed lesion that is less than 1
cm in diameter. A bulla is a large blister (>1 cm). A wheal is a superficial, raised, transient
lesion (e.g., mosquito bite). A pustule is a pus-filled vesicle. A nodule is solid, elevated, and
larger than a papule (>1 cm).
Question 5
A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up
appointment. On assessment, the nurse might expect to see which assessment finding?
A) Anasarca.
B) Scleroderma.
C) Pedal erythema.
D) Clubbing of the nails.
E) Jaundice.
Correct Answer: D) Clubbing of the nails
Rationale: Clubbing of the nails (bulbous enlargement of the fingertips with increased nail
plate curvature) is a classic physical finding associated with chronic hypoxemia, which is
common in clients with severe chronic obstructive pulmonary disease (COPD), including
emphysema and chronic bronchitis. Anasarca is generalized edema. Scleroderma is a
connective tissue disease. Pedal erythema is redness of the feet, which could have many
causes.
Question 6
A 19-year-old college student is brought to the emergency department with a severe headache he
describes as "like nothing I've ever had before." His temperature is 104° F, and he has a stiff
neck. The nurse looks for other signs and symptoms of which problem?
,[Type here]
A) Head injury.
B) Cluster headache.
C) Migraine headache.
D) Meningeal inflammation.
E) Tension headache.
Correct Answer: D) Meningeal inflammation
Rationale: The triad of severe headache (especially described as "worst ever"), high fever
(104°F), and a stiff neck (nuchal rigidity) are classic symptoms of meningeal inflammation,
most commonly seen in meningitis. This is a medical emergency requiring urgent diagnosis
and treatment.
Question 7
During an examination of a female patient, the nurse notes lymphadenopathy and suspects an
acute infection. Acutely infected lymph nodes would be:
A) Clumped.
B) Unilateral.
C) Firm but freely movable.
D) Firm and nontender.
E) Fixed and matted.
Correct Answer: C) Firm but freely movable.
Rationale: Acutely infected lymph nodes are typically enlarged, firm, warm, tender, and
freely movable. They are often unilateral. Chronic inflammation or malignancy can lead to
matted, fixed, or hard, nontender nodes. "Clumped" is vague, but "firm but freely
movable" is a hallmark of acute infection.
Question 8
A patient visits the clinic because he has recently noticed that the left side of his mouth is
paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse suspects that he has:
A) Cushing's syndrome.
B) Parkinson disease.
C) Bell's palsy.
D) Had a cerebrovascular accident (stroke).
E) Trigeminal neuralgia.
Correct Answer: C) Bell's palsy.
Rationale: Bell's palsy is an acute, temporary paralysis or weakness of the facial muscles on
one side of the face. It affects the facial nerve (Cranial Nerve VII) and causes symptoms
such as inability to raise the eyebrow, wrinkle the forehead, close the eye tightly, smile, or
whistle. A cerebrovascular accident (stroke) causing facial paralysis usually spares the
forehead (the patient can raise their eyebrow).
, [Type here]
Question 9
A male patient with a history of AIDS has come in for an examination and he states, "I think that
I have the mumps." The nurse would begin by examining the:
A) Thyroid gland.
B) Parotid gland.
C) Cervical lymph nodes.
D) Mouth and skin for lesions.
E) Submandibular glands.
Correct Answer: B) Parotid gland.
Rationale: The mumps virus primarily causes swelling of the parotid glands, which are
located anterior to the earlobe and extend down to the angle of the jaw. Given the patient's
concern about "mumps," the nurse would start by examining these glands for swelling and
tenderness. While HIV/AIDS patients can have other swellings or lesions, addressing the
stated concern is appropriate.
Question 10
When examining the eye, the nurse notices that the patient's eyelid margins approximate
completely. The nurse recognizes that this assessment finding:
A) Is expected.
B) May indicate a problem with extraocular muscles.
C) May result in problems with tearing.
D) Indicates increased intraocular pressure.
E) Is a sign of ptosis.
Correct Answer: A) Is expected.
Rationale: Eyelid margins that approximate completely (meaning they close fully and
evenly) is a normal and expected finding. It indicates proper eyelid function, which is
essential for protecting the eye, distributing tears, and preventing dryness. Problems with
approximation (e.g., lagophthalmos, ectropion) would lead to tearing or corneal dryness.
Question 11
During an assessment, the nurse notices that an elderly patient has tears rolling down his face
from his left eye. Closer examination shows that the lower lid is loose and rolling outward. The
patient complains of his eye feeling "dry and itchy." Which action by the nurse is correct?
A) Assess the eye for a possible foreign body.
B) Document the finding as ptosis.
C) Assess for other signs of ectropion.
D) Contact the prescriber because these are signs of basal cell carcinoma.
E) Advise the patient to use artificial tears.
Correct Answer: C) Assess for other signs of ectropion.
Rationale: The description of the lower lid being loose and rolling outward, with tears
