NR 509 WEEK 2 EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 2025 LATEST
UPDATED AGRADE
Question 1
A mother brings her two-month-old daughter in for an examination and says, "My daughter
rolled over against the wall and now I have noticed that she has this soft spot on the top of her
head. Is there something terribly wrong?" The FNP's best response would be:
A) "That soft spot is normal and actually allows for growth of the brain during the first year of
your baby's life."
B) "We will need to order an immediate CT scan to rule out any internal injuries."
C) "You should have kept her head protected; this indicates potential head trauma."
D) "This is an abnormal finding and requires consultation with a neurosurgeon."
E) "That soft spot is called the posterior fontanelle and should be closing soon."
Correct Answer: A) "That soft spot is normal and actually allows for growth of the brain
during the first year of your baby's life."
Rationale: The soft spots on an infant's head are fontanelles, which are normal anatomical
features where the cranial bones have not yet fused. The anterior fontanelle (on top of the
head) is the larger one and remains open for brain growth during the first year of life
(typically closing between 9 months and 2 years). Reassuring the mother with this
explanation is key.
Question 2
During percussion, the FNP notes a dull percussion note elicited over a lung lobe. This most
likely results from:
A) Normal air-filled lung tissue.
B) Increased density of lung tissue.
C) Excessive air in the lung (hyperinflation).
D) A collapsed lung (pneumothorax).
E) Bronchitis with mucus production.
Correct Answer: B) Increased density of lung tissue.
Rationale: A dull percussion note over a lung lobe indicates increased density or
consolidation of lung tissue. This can be caused by conditions such as pneumonia (fluid or
exudate in the alveoli), pleural effusion (fluid in the pleural space), or atelectasis (collapsed
lung segment). Normal air-filled lung tissue produces resonance. Hyperinflation produces
hyperresonance.
Question 3
A patient is unable to differentiate between sharp and dull stimulation to both sides of her face.
The FNP suspects damage to:
A) The facial nerve (CN VII).
B) The trigeminal nerve (CN V).
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C) The vagus nerve (CN X).
D) The glossopharyngeal nerve (CN IX).
E) The hypoglossal nerve (CN XII).
Correct Answer: B) The trigeminal nerve (CN V).
Rationale: The trigeminal nerve (CN V) is responsible for sensory innervation of the face,
including touch, pain (sharp/dull), and temperature. Inability to differentiate between
sharp and dull stimulation on the face points to damage of this nerve. The facial nerve (CN
VII) is primarily motor for facial expressions.
Question 4
When examining the face, the FNP is aware that the two pairs of salivary glands that are
accessible to examination are the _____ glands.
A) Sublingual and parotid.
B) Parotid and submandibular.
C) Sublingual and submandibular.
D) Lacrimal and parotid.
E) Thyroid and parotid.
Correct Answer: B) Parotid and submandibular.
Rationale: The parotid glands are located anterior to the earlobes and superficial to the
masseter muscle. The submandibular glands are located beneath the mandible at the angle
of the jaw. Both are accessible to palpation during a physical examination. The sublingual
glands are located under the tongue and are not typically accessible to external palpation.
Question 5
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her
head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by
____.
A) X; asking the patient to swallow.
B) VII; asking the patient to smile.
C) XI; asking the patient to shrug her shoulders against resistance.
D) IX; testing the gag reflex.
E) XII; asking the patient to stick out her tongue.
Correct Answer: C) XI; asking the patient to shrug her shoulders against resistance.
Rationale: Cranial Nerve XI (Spinal Accessory Nerve) innervates the sternomastoid and
trapezius muscles, which are responsible for neck rotation, shoulder shrug, and head
turning. Therefore, assessing the patient's ability to shrug shoulders against resistance
directly tests the function of CN XI.
Question 6
When examining a patient's cranial nerve function, the FNP remembers that the muscles in the
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neck that are innervated by CN XI are the:
A) Masseter and temporalis.
B) Orbicularis oculi and orbicularis oris.
C) Sternomastoid and trapezius.
D) Rectus abdominis and obliques.
E) Splenius capitis and semispinalis.
Correct Answer: C) Sternomastoid and trapezius.
Rationale: The Spinal Accessory Nerve (CN XI) provides motor innervation to the
sternomastoid muscle (responsible for head rotation and flexion) and the trapezius muscle
(responsible for shoulder shrug and scapular movement).
Question 7
The patient's laboratory data reveal an elevated thyroxine (T4) level. The FNP would proceed
with an examination of the _____ gland.
A) Pituitary.
B) Adrenal.
C) Parotid.
D) Thyroid.
E) Thymus.
Correct Answer: D) Thyroid.
Rationale: Thyroxine (T4) is one of the primary hormones produced by the thyroid gland.
An elevated T4 level indicates hyperthyroidism or an overactive thyroid gland, making an
examination of the thyroid gland (for enlargement, nodules, tenderness) the logical next
step.
Question 8
A patient says that she has recently noticed a lump in the front of her neck below her "Adam's
apple" that seems to be getting bigger. During the assessment, the finding that leads the FNP to
suspect that this may not be a cancerous thyroid nodule is that the lump:
A) Is fixed and hard.
B) Is mobile and not hard.
C) Is associated with hoarseness.
D) Is rapidly growing.
E) Is accompanied by lymphadenopathy.
Correct Answer: B) Is mobile and not hard.
Rationale: Benign thyroid nodules are typically mobile and soft to firm in consistency.
Malignant (cancerous) thyroid nodules, in contrast, are often characterized by being hard,
fixed (non-movable), rapidly growing, and sometimes associated with hoarseness (due to
nerve involvement) or regional lymphadenopathy.
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Question 9
The FNP notices that the patient's submental lymph nodes are enlarged. In an effort to identify
the cause of the node enlargement, the FNP would assess the patient's:
A) Abdomen for hepatosplenomegaly.
B) Area proximal to the enlarged node.
C) Inguinal area for additional lymphadenopathy.
D) General nutritional status.
E) Skin for signs of systemic disease.
Correct Answer: B) Area proximal to the enlarged node.
Rationale: When assessing enlarged lymph nodes, the nurse should always examine the area
that drains into those particular nodes. The submental lymph nodes primarily drain the
lower lip, floor of the mouth, and anterior tongue. Therefore, assessing these proximal
areas (e.g., mouth, lips, chin) is crucial to find the potential source of infection or
inflammation causing the lymphadenopathy.
Question 10
The FNP is aware that the four main areas in the body where lymph nodes are accessible to
examination are the:
A) Head and neck, arms, inguinal area, and axillae.
B) Chest, abdomen, legs, and back.
C) Face, scalp, hands, and feet.
D) Thorax, pelvis, thighs, and calves.
E) Skull, jaw, elbows, and knees.
Correct Answer: A) Head and neck, arms, inguinal area, and axillae.
Rationale: The four major areas where superficial lymph nodes are readily accessible for
palpation during a physical examination are the head and neck, arms (including
epitrochlear nodes), inguinal area, and axillae.
Question 11
A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his
eyes. The FNP should know that floaters are usually not significant and are caused by:
A) Retinal detachment.
B) Diabetic retinopathy.
C) Condensed vitreous fibers.
D) Cataracts.
E) Glaucoma.
Correct Answer: C) Condensed vitreous fibers.
Rationale: Floaters are commonly perceived as small specks, dots, or strands that drift
through the field of vision. They are usually caused by benign condensation or shrinkage of
the vitreous humor (the gel-like substance that fills the eye). While a sudden increase in
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) 2025 LATEST
UPDATED AGRADE
Question 1
A mother brings her two-month-old daughter in for an examination and says, "My daughter
rolled over against the wall and now I have noticed that she has this soft spot on the top of her
head. Is there something terribly wrong?" The FNP's best response would be:
A) "That soft spot is normal and actually allows for growth of the brain during the first year of
your baby's life."
B) "We will need to order an immediate CT scan to rule out any internal injuries."
C) "You should have kept her head protected; this indicates potential head trauma."
D) "This is an abnormal finding and requires consultation with a neurosurgeon."
E) "That soft spot is called the posterior fontanelle and should be closing soon."
Correct Answer: A) "That soft spot is normal and actually allows for growth of the brain
during the first year of your baby's life."
Rationale: The soft spots on an infant's head are fontanelles, which are normal anatomical
features where the cranial bones have not yet fused. The anterior fontanelle (on top of the
head) is the larger one and remains open for brain growth during the first year of life
(typically closing between 9 months and 2 years). Reassuring the mother with this
explanation is key.
Question 2
During percussion, the FNP notes a dull percussion note elicited over a lung lobe. This most
likely results from:
A) Normal air-filled lung tissue.
B) Increased density of lung tissue.
C) Excessive air in the lung (hyperinflation).
D) A collapsed lung (pneumothorax).
E) Bronchitis with mucus production.
Correct Answer: B) Increased density of lung tissue.
Rationale: A dull percussion note over a lung lobe indicates increased density or
consolidation of lung tissue. This can be caused by conditions such as pneumonia (fluid or
exudate in the alveoli), pleural effusion (fluid in the pleural space), or atelectasis (collapsed
lung segment). Normal air-filled lung tissue produces resonance. Hyperinflation produces
hyperresonance.
Question 3
A patient is unable to differentiate between sharp and dull stimulation to both sides of her face.
The FNP suspects damage to:
A) The facial nerve (CN VII).
B) The trigeminal nerve (CN V).
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C) The vagus nerve (CN X).
D) The glossopharyngeal nerve (CN IX).
E) The hypoglossal nerve (CN XII).
Correct Answer: B) The trigeminal nerve (CN V).
Rationale: The trigeminal nerve (CN V) is responsible for sensory innervation of the face,
including touch, pain (sharp/dull), and temperature. Inability to differentiate between
sharp and dull stimulation on the face points to damage of this nerve. The facial nerve (CN
VII) is primarily motor for facial expressions.
Question 4
When examining the face, the FNP is aware that the two pairs of salivary glands that are
accessible to examination are the _____ glands.
A) Sublingual and parotid.
B) Parotid and submandibular.
C) Sublingual and submandibular.
D) Lacrimal and parotid.
E) Thyroid and parotid.
Correct Answer: B) Parotid and submandibular.
Rationale: The parotid glands are located anterior to the earlobes and superficial to the
masseter muscle. The submandibular glands are located beneath the mandible at the angle
of the jaw. Both are accessible to palpation during a physical examination. The sublingual
glands are located under the tongue and are not typically accessible to external palpation.
Question 5
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her
head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by
____.
A) X; asking the patient to swallow.
B) VII; asking the patient to smile.
C) XI; asking the patient to shrug her shoulders against resistance.
D) IX; testing the gag reflex.
E) XII; asking the patient to stick out her tongue.
Correct Answer: C) XI; asking the patient to shrug her shoulders against resistance.
Rationale: Cranial Nerve XI (Spinal Accessory Nerve) innervates the sternomastoid and
trapezius muscles, which are responsible for neck rotation, shoulder shrug, and head
turning. Therefore, assessing the patient's ability to shrug shoulders against resistance
directly tests the function of CN XI.
Question 6
When examining a patient's cranial nerve function, the FNP remembers that the muscles in the
,[Type here]
neck that are innervated by CN XI are the:
A) Masseter and temporalis.
B) Orbicularis oculi and orbicularis oris.
C) Sternomastoid and trapezius.
D) Rectus abdominis and obliques.
E) Splenius capitis and semispinalis.
Correct Answer: C) Sternomastoid and trapezius.
Rationale: The Spinal Accessory Nerve (CN XI) provides motor innervation to the
sternomastoid muscle (responsible for head rotation and flexion) and the trapezius muscle
(responsible for shoulder shrug and scapular movement).
Question 7
The patient's laboratory data reveal an elevated thyroxine (T4) level. The FNP would proceed
with an examination of the _____ gland.
A) Pituitary.
B) Adrenal.
C) Parotid.
D) Thyroid.
E) Thymus.
Correct Answer: D) Thyroid.
Rationale: Thyroxine (T4) is one of the primary hormones produced by the thyroid gland.
An elevated T4 level indicates hyperthyroidism or an overactive thyroid gland, making an
examination of the thyroid gland (for enlargement, nodules, tenderness) the logical next
step.
Question 8
A patient says that she has recently noticed a lump in the front of her neck below her "Adam's
apple" that seems to be getting bigger. During the assessment, the finding that leads the FNP to
suspect that this may not be a cancerous thyroid nodule is that the lump:
A) Is fixed and hard.
B) Is mobile and not hard.
C) Is associated with hoarseness.
D) Is rapidly growing.
E) Is accompanied by lymphadenopathy.
Correct Answer: B) Is mobile and not hard.
Rationale: Benign thyroid nodules are typically mobile and soft to firm in consistency.
Malignant (cancerous) thyroid nodules, in contrast, are often characterized by being hard,
fixed (non-movable), rapidly growing, and sometimes associated with hoarseness (due to
nerve involvement) or regional lymphadenopathy.
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Question 9
The FNP notices that the patient's submental lymph nodes are enlarged. In an effort to identify
the cause of the node enlargement, the FNP would assess the patient's:
A) Abdomen for hepatosplenomegaly.
B) Area proximal to the enlarged node.
C) Inguinal area for additional lymphadenopathy.
D) General nutritional status.
E) Skin for signs of systemic disease.
Correct Answer: B) Area proximal to the enlarged node.
Rationale: When assessing enlarged lymph nodes, the nurse should always examine the area
that drains into those particular nodes. The submental lymph nodes primarily drain the
lower lip, floor of the mouth, and anterior tongue. Therefore, assessing these proximal
areas (e.g., mouth, lips, chin) is crucial to find the potential source of infection or
inflammation causing the lymphadenopathy.
Question 10
The FNP is aware that the four main areas in the body where lymph nodes are accessible to
examination are the:
A) Head and neck, arms, inguinal area, and axillae.
B) Chest, abdomen, legs, and back.
C) Face, scalp, hands, and feet.
D) Thorax, pelvis, thighs, and calves.
E) Skull, jaw, elbows, and knees.
Correct Answer: A) Head and neck, arms, inguinal area, and axillae.
Rationale: The four major areas where superficial lymph nodes are readily accessible for
palpation during a physical examination are the head and neck, arms (including
epitrochlear nodes), inguinal area, and axillae.
Question 11
A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his
eyes. The FNP should know that floaters are usually not significant and are caused by:
A) Retinal detachment.
B) Diabetic retinopathy.
C) Condensed vitreous fibers.
D) Cataracts.
E) Glaucoma.
Correct Answer: C) Condensed vitreous fibers.
Rationale: Floaters are commonly perceived as small specks, dots, or strands that drift
through the field of vision. They are usually caused by benign condensation or shrinkage of
the vitreous humor (the gel-like substance that fills the eye). While a sudden increase in
