NUR 245 | NUR245 Exam 4: Health Assessment And
Promotion - MCPHS Updated and Latest Questions
and Correct Answers with Rationale
1. A 65-year-old male patient reports difficulty initiating urination and a weak stream. During
the assessment, the nurse notes a non-tender, symmetrically enlarged, smooth prostate
gland. Which differential diagnosis is most likely?
A. Prostate Cancer
B. Urethral Stricture
C. Prostatitis
D. Benign Prostatic Hyperplasia (BPH)
Correct Answer: D
Rationale: BPH typically presents with symmetrical enlargement and a smooth texture
during a digital rectal exam. These clinical findings contrast with prostate cancer, which
usually presents as hard, irregular nodules. The patient’s urinary symptoms are
characteristic of the mechanical obstruction caused by the enlarging gland. Prostatitis
would likely present with systemic symptoms and significant gland tenderness.
Understanding these physical differences allows the nurse to prioritize appropriate
screening and follow-up care for the patient.
2. During a musculoskeletal assessment, a patient exhibits a positive Phalen’s test. Which
lifestyle modification should the nurse prioritize in the teaching plan?
A. Increasing dietary calcium intake
B. Performing weight-bearing exercises
C. Implementing ergonomic workplace changes
D. Wearing high-top supportive sneakers
Correct Answer: C
Rationale: A positive Phalen’s test is a strong clinical indicator of Carpal Tunnel Syndrome
caused by median nerve compression. Ergonomic changes are essential to reduce the
repetitive strain that exacerbates this condition. While calcium and weight-bearing
exercises are vital for bone health, they do not address nerve compression in the wrist.
Supportive footwear is more relevant to lower extremity alignment or plantar fasciitis.
Educating the patient on wrist positioning helps prevent further injury and manage chronic
symptoms effectively.
,3. A nurse is assessing a patient for cerebellar function. Which of the following tests would
provide the most accurate assessment of this area?
A. Finger-to-nose test
B. Two-point discrimination
C. Deep tendon reflexes
D. Testing Cranial Nerve V
Correct Answer: A
Rationale: The finger-to-nose test evaluates coordination and smooth movement, which
are primary functions of the cerebellum. Two-point discrimination assesses the sensory
cortex rather than motor coordination. Deep tendon reflexes measure the integrity of the
spinal arc and motor pathways. Testing Cranial Nerve V focuses on facial sensation and
mastication muscle strength. By identifying cerebellar deficits, the nurse can better assess
the patient’s risk for falls and lack of motor control.
4. A 45-year-old female patient presents with a firm, non-tender, fixed mass in the upper
outer quadrant of her right breast. What is the nurse’s priority action?
A. Reassure the patient that most lumps are benign
B. Instruct the patient to monitor the lump for one menstrual cycle
C. Advise the patient to increase her caffeine intake to reduce cysts
D. Document the findings and facilitate a prompt referral for imaging
Correct Answer: D
Rationale: A fixed, non-tender mass is a significant clinical finding that is highly suspicious
for breast malignancy. Prompt referral for a mammogram or ultrasound is necessary to
ensure early diagnosis and treatment. Reassuring the patient without further investigation
is unsafe given the characteristics of the mass. Waiting for a menstrual cycle is
inappropriate for a fixed lump that does not change with hormonal shifts. The nurse plays a
critical role in navigating the patient through the diagnostic process for potential chronic
illness.
5. When assessing the Deep Tendon Reflexes (DTRs) of a patient, the nurse notes that the
response is very brisk and hyperactive with clonus. How should this be graded?
A. 1+
B. 2+
C. 3+
D. 4+
Correct Answer: D
, Rationale: A grade of 4+ indicates a very brisk, hyperactive reflex often associated with
clonus and upper motor neuron disease. Grade 2+ is considered normal, while 1+ is
diminished or sluggish. Grade 3+ is brisker than average but not necessarily indicative of
disease. Detecting hyperreflexia is crucial for identifying potential neurological
emergencies or chronic conditions like multiple sclerosis. The nurse must document these
findings accurately to communicate neurological changes to the healthcare team.
6. A nurse is providing health promotion teaching to a 50-year-old patient regarding
colorectal cancer screening. Which statement by the patient indicates a need for further
teaching?
A. I only need to start screening when I begin having rectal bleeding.
B. I can choose to do a fecal occult blood test every year instead of a colonoscopy.
C. I will need a colonoscopy every 10 years if my results are normal.
D. Polyps found during a colonoscopy can be removed to prevent cancer.
Correct Answer: A
Rationale: Colorectal cancer screening should begin at age 45 for average-risk individuals
regardless of the presence of symptoms. Rectal bleeding is often a late sign of cancer rather
than an early indicator. Colonoscopies every 10 years or annual fecal tests are standard
screening options. Removing polyps is a key preventive measure that reduces the incidence
of future malignancies. The nurse must emphasize that screening is designed to detect
issues before symptoms ever develop.
7. A patient presents with ‘the worst headache of my life’ and neck stiffness. Which cranial
nerve assessment is most critical in this acute scenario?
A. Cranial Nerve I (Olfactory)
B. Cranial Nerves III, IV, and VI (Extraocular movements)
C. Cranial Nerve VIII (Acoustic)
D. Cranial Nerve XI (Spinal Accessory)
Correct Answer: B
Rationale: Sudden severe headache and neck stiffness are signs of potential subarachnoid
hemorrhage or meningitis. Assessing extraocular movements helps identify increased
intracranial pressure or nerve palsies associated with brain herniation. While CN XI
involves the neck muscles, it does not provide critical data on intracranial status in an acute
bleed. Olfactory and acoustic nerves are less relevant in a life-threatening neurological
emergency. This assessment allows the nurse to rapidly identify neurological deterioration
and advocate for urgent intervention.
Promotion - MCPHS Updated and Latest Questions
and Correct Answers with Rationale
1. A 65-year-old male patient reports difficulty initiating urination and a weak stream. During
the assessment, the nurse notes a non-tender, symmetrically enlarged, smooth prostate
gland. Which differential diagnosis is most likely?
A. Prostate Cancer
B. Urethral Stricture
C. Prostatitis
D. Benign Prostatic Hyperplasia (BPH)
Correct Answer: D
Rationale: BPH typically presents with symmetrical enlargement and a smooth texture
during a digital rectal exam. These clinical findings contrast with prostate cancer, which
usually presents as hard, irregular nodules. The patient’s urinary symptoms are
characteristic of the mechanical obstruction caused by the enlarging gland. Prostatitis
would likely present with systemic symptoms and significant gland tenderness.
Understanding these physical differences allows the nurse to prioritize appropriate
screening and follow-up care for the patient.
2. During a musculoskeletal assessment, a patient exhibits a positive Phalen’s test. Which
lifestyle modification should the nurse prioritize in the teaching plan?
A. Increasing dietary calcium intake
B. Performing weight-bearing exercises
C. Implementing ergonomic workplace changes
D. Wearing high-top supportive sneakers
Correct Answer: C
Rationale: A positive Phalen’s test is a strong clinical indicator of Carpal Tunnel Syndrome
caused by median nerve compression. Ergonomic changes are essential to reduce the
repetitive strain that exacerbates this condition. While calcium and weight-bearing
exercises are vital for bone health, they do not address nerve compression in the wrist.
Supportive footwear is more relevant to lower extremity alignment or plantar fasciitis.
Educating the patient on wrist positioning helps prevent further injury and manage chronic
symptoms effectively.
,3. A nurse is assessing a patient for cerebellar function. Which of the following tests would
provide the most accurate assessment of this area?
A. Finger-to-nose test
B. Two-point discrimination
C. Deep tendon reflexes
D. Testing Cranial Nerve V
Correct Answer: A
Rationale: The finger-to-nose test evaluates coordination and smooth movement, which
are primary functions of the cerebellum. Two-point discrimination assesses the sensory
cortex rather than motor coordination. Deep tendon reflexes measure the integrity of the
spinal arc and motor pathways. Testing Cranial Nerve V focuses on facial sensation and
mastication muscle strength. By identifying cerebellar deficits, the nurse can better assess
the patient’s risk for falls and lack of motor control.
4. A 45-year-old female patient presents with a firm, non-tender, fixed mass in the upper
outer quadrant of her right breast. What is the nurse’s priority action?
A. Reassure the patient that most lumps are benign
B. Instruct the patient to monitor the lump for one menstrual cycle
C. Advise the patient to increase her caffeine intake to reduce cysts
D. Document the findings and facilitate a prompt referral for imaging
Correct Answer: D
Rationale: A fixed, non-tender mass is a significant clinical finding that is highly suspicious
for breast malignancy. Prompt referral for a mammogram or ultrasound is necessary to
ensure early diagnosis and treatment. Reassuring the patient without further investigation
is unsafe given the characteristics of the mass. Waiting for a menstrual cycle is
inappropriate for a fixed lump that does not change with hormonal shifts. The nurse plays a
critical role in navigating the patient through the diagnostic process for potential chronic
illness.
5. When assessing the Deep Tendon Reflexes (DTRs) of a patient, the nurse notes that the
response is very brisk and hyperactive with clonus. How should this be graded?
A. 1+
B. 2+
C. 3+
D. 4+
Correct Answer: D
, Rationale: A grade of 4+ indicates a very brisk, hyperactive reflex often associated with
clonus and upper motor neuron disease. Grade 2+ is considered normal, while 1+ is
diminished or sluggish. Grade 3+ is brisker than average but not necessarily indicative of
disease. Detecting hyperreflexia is crucial for identifying potential neurological
emergencies or chronic conditions like multiple sclerosis. The nurse must document these
findings accurately to communicate neurological changes to the healthcare team.
6. A nurse is providing health promotion teaching to a 50-year-old patient regarding
colorectal cancer screening. Which statement by the patient indicates a need for further
teaching?
A. I only need to start screening when I begin having rectal bleeding.
B. I can choose to do a fecal occult blood test every year instead of a colonoscopy.
C. I will need a colonoscopy every 10 years if my results are normal.
D. Polyps found during a colonoscopy can be removed to prevent cancer.
Correct Answer: A
Rationale: Colorectal cancer screening should begin at age 45 for average-risk individuals
regardless of the presence of symptoms. Rectal bleeding is often a late sign of cancer rather
than an early indicator. Colonoscopies every 10 years or annual fecal tests are standard
screening options. Removing polyps is a key preventive measure that reduces the incidence
of future malignancies. The nurse must emphasize that screening is designed to detect
issues before symptoms ever develop.
7. A patient presents with ‘the worst headache of my life’ and neck stiffness. Which cranial
nerve assessment is most critical in this acute scenario?
A. Cranial Nerve I (Olfactory)
B. Cranial Nerves III, IV, and VI (Extraocular movements)
C. Cranial Nerve VIII (Acoustic)
D. Cranial Nerve XI (Spinal Accessory)
Correct Answer: B
Rationale: Sudden severe headache and neck stiffness are signs of potential subarachnoid
hemorrhage or meningitis. Assessing extraocular movements helps identify increased
intracranial pressure or nerve palsies associated with brain herniation. While CN XI
involves the neck muscles, it does not provide critical data on intracranial status in an acute
bleed. Olfactory and acoustic nerves are less relevant in a life-threatening neurological
emergency. This assessment allows the nurse to rapidly identify neurological deterioration
and advocate for urgent intervention.
