NR509 Week 8 Final Exam
Questions, Answers & Explanations
Question Q78
A 42-year-old female is at 39 weeks gestation. She reports no major issues except swelling in
her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP
notes a diastolic murmur. Which of the following is true about her presentation and the
appropriate next step by the NP?
Answer Choices
A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required
at this time.
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted. ✓
C. A leftward rotated apical impulse would confirm a diagnosis of heart failure in this patient;
the NP should order an echocardiogram.
D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has
been taking iron supplementation.
E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this
patient's differentials list.
✓ Correct Answer: B — A diastolic murmur during pregnancy is likely pathological;
further investigation and work-up is warranted.
Explanation: Diastolic murmurs are always pathological. Unlike systolic murmurs (which can
be benign flow murmurs in pregnancy), a diastolic murmur warrants further cardiac evaluation.
Shortness of breath and edema combined with a diastolic murmur raise concern for mitral
stenosis or peripartum cardiomyopathy.
,Question Q60
A 35-year-old woman presents to the clinic with a complaint of intermittent, bilateral nipple
discharge for several weeks. She denies local tenderness, fever, or systemic symptoms aside
from slightly irregular periods over the last few months. On examination, there was no erythema,
increased warmth, or streaking around the areolas. Scant discharge consistent with breast milk
but without any signs of blood or pus was expressed from each nipple. Screening laboratories
revealed a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Which of the following is the most accurate interpretation of
these findings?
Answer Choices
A. Prolactinoma ✓
B. Paget's disease of the breast
C. Occult pregnancy
D. Ductal carcinoma in situ
E. Mastitis
✓ Correct Answer: A — Prolactinoma
Explanation: Bilateral milky nipple discharge (galactorrhea) with irregular periods and normal
TSH/HCG strongly suggests hyperprolactinemia from a prolactinoma. Occult pregnancy is ruled
out by negative HCG. Paget's and DCIS present with unilateral bloody/serous discharge.
Mastitis presents with warmth, erythema, and systemic symptoms.
,Question Q33
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 development?
Answer Choices
A. I
B. II
C. III
D. IV ✓
E. Preadolescent
✓ Correct Answer: D — IV
Explanation: Tanner Stage IV is characterized by the areola and nipple projecting above the
level of the breast to form a secondary mound. Stage II is early breast budding; Stage III is
further enlargement without a separate mound; Stage V is the adult breast where the secondary
mound recedes. Breast asymmetry during puberty is a normal finding.
, Question Q64
The image depicts a physical examination finding related to cranial nerve assessment (patient's
head tilted back, throat/neck region visible). Which cranial nerve is being tested? (Currently
selected: C)
Answer Choices
A. CN X
B. CN IX
C. CN VI ✓
D. CN XII
E. CN XI
✓ Correct Answer: C — CN VI
Explanation: CN VI (Abducens nerve) controls lateral eye movement via the lateral rectus
muscle. Among the options, CN IX controls swallowing/taste, CN X controls vagal functions, CN
XI controls head/shoulder movement, and CN XII controls tongue movement. The selected
answer of CN VI relates to lateral gaze testing.
Questions, Answers & Explanations
Question Q78
A 42-year-old female is at 39 weeks gestation. She reports no major issues except swelling in
her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP
notes a diastolic murmur. Which of the following is true about her presentation and the
appropriate next step by the NP?
Answer Choices
A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required
at this time.
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted. ✓
C. A leftward rotated apical impulse would confirm a diagnosis of heart failure in this patient;
the NP should order an echocardiogram.
D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has
been taking iron supplementation.
E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this
patient's differentials list.
✓ Correct Answer: B — A diastolic murmur during pregnancy is likely pathological;
further investigation and work-up is warranted.
Explanation: Diastolic murmurs are always pathological. Unlike systolic murmurs (which can
be benign flow murmurs in pregnancy), a diastolic murmur warrants further cardiac evaluation.
Shortness of breath and edema combined with a diastolic murmur raise concern for mitral
stenosis or peripartum cardiomyopathy.
,Question Q60
A 35-year-old woman presents to the clinic with a complaint of intermittent, bilateral nipple
discharge for several weeks. She denies local tenderness, fever, or systemic symptoms aside
from slightly irregular periods over the last few months. On examination, there was no erythema,
increased warmth, or streaking around the areolas. Scant discharge consistent with breast milk
but without any signs of blood or pus was expressed from each nipple. Screening laboratories
revealed a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Which of the following is the most accurate interpretation of
these findings?
Answer Choices
A. Prolactinoma ✓
B. Paget's disease of the breast
C. Occult pregnancy
D. Ductal carcinoma in situ
E. Mastitis
✓ Correct Answer: A — Prolactinoma
Explanation: Bilateral milky nipple discharge (galactorrhea) with irregular periods and normal
TSH/HCG strongly suggests hyperprolactinemia from a prolactinoma. Occult pregnancy is ruled
out by negative HCG. Paget's and DCIS present with unilateral bloody/serous discharge.
Mastitis presents with warmth, erythema, and systemic symptoms.
,Question Q33
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 development?
Answer Choices
A. I
B. II
C. III
D. IV ✓
E. Preadolescent
✓ Correct Answer: D — IV
Explanation: Tanner Stage IV is characterized by the areola and nipple projecting above the
level of the breast to form a secondary mound. Stage II is early breast budding; Stage III is
further enlargement without a separate mound; Stage V is the adult breast where the secondary
mound recedes. Breast asymmetry during puberty is a normal finding.
, Question Q64
The image depicts a physical examination finding related to cranial nerve assessment (patient's
head tilted back, throat/neck region visible). Which cranial nerve is being tested? (Currently
selected: C)
Answer Choices
A. CN X
B. CN IX
C. CN VI ✓
D. CN XII
E. CN XI
✓ Correct Answer: C — CN VI
Explanation: CN VI (Abducens nerve) controls lateral eye movement via the lateral rectus
muscle. Among the options, CN IX controls swallowing/taste, CN X controls vagal functions, CN
XI controls head/shoulder movement, and CN XII controls tongue movement. The selected
answer of CN VI relates to lateral gaze testing.
