ATI Nursing NR 603 APEA Predictor Week 4 Exam With Answers-317 Solved Questions

NURSING NR 603 WEEK 4 APEA PREDICTOR EXAM|QUESTIONS AND
ANSWERS WITH DETAILED EXPLANATIONS
1. During pregnancy, dyspnea accompanied by increased respiratory rate, cough, rales, or
respiratory distress raises concerns of:
Answer: peripartum cardiomyopathy
Explanation:
Dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises
concerns of possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy.
2. The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great
vessels is the:
Answer: mediastinum
Explanation:
The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great
vessels is the mediastinum. The right and left pleural cavities, are on either side of the
mediastinum and those contain the lungs. The visceral pleura encloses the lung. The
pericardium surrounds the heart.
3. A patient is unable to identify the smell of an orange. This inability could reflect an
abnormality in cranial nerves:
Answer: CN I
Explanation:
Cranial Nerve I is the olfactory nerve responsible for the sense of smell. To test the sense of
smell, the examiner presents the patient with familiar and non-irritating odors.
A person should normally perceive odor on each side and correctly identify the source. Cranial
Nerves II and III assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and
balance.
4. A transient ischemic attack is:

Answer: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal
ischemia, without acute infarction
Explanation:
TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain,
spinal cord, or retinal ischemia, without acute infarction.” Ischemic stroke is “an infarction of
central nervous system tissue” that may be symptomatic or silent. The other terms are not
related to the new definitions.
5. The term asteatosis refers to:
Answer: skin that is dry, flaky, rough, and often itchy
Explanation:
Physiologic changes of aging include loss of elastic turgor, and wrinkling. Skin that appears dry,
flaky, rough, and itchy is termed asteatosis. Sun exposure can cause damage to the skin
resembling an appearance as weather beaten, thickened, yellowed, and deeply furrowed.
Seborrheic keratosis appear as raised, yellowish lesions that feel greasy, velvety, or warty.
Painful vesicular lesions in a dermatomal distribution may suggest herpes zoster.
6. An enlarged liver with a smooth tender edge may suggest:
Answer: right-sided heart failure.
Explanation:
An enlarged liver with a smooth, tender edge suggests inflammation, as in hepatitis, or venous
congestion, as in right-sided heart failure. Cirrhosis, hemochromatosis (increased amount of
iron in the blood), and lymphoma produce an enlarged liver with a firm, nontender edge. An
enlarged liver that is firm or hard and has an irregular edge or surface suggests hepatocellular
carcinoma.
7. New onset hypertension with proteinuria or end-organ damage is:
Answer: preeclampsia
Explanation:
Chronic hypertension occurs when systolic BP (SBP) > 140 mm Hg or diastolic BP (DBP) >90
mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum.

Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in
the absence of proteinuria. Pre-eclampsia occurs in a woman who was previously normotensive
but now has new onset hypertension with either proteinuria or end-organ damage. Primary
hypertension, formerly known as essential hypertension, is a disorder which is associated with
elevated blood pressure and an unidentifiable cause.
8. The psoas muscle group and muscles of the abdominal wall assist with:
Answer: flexion
Explanation:
The psoas muscle group and muscles of the abdominal wall assist with flexion. The deep
intrinsic muscles of the back assist with extension. The abdominal muscles and intrinsic
muscles of the back assist with rotation. Lateral bending uses the abdominal muscles and
intrinsic muscles of the back.
9. "Preterm small for gestational age" (SGA) infants are prone to:
Answer: hypocalcemia
Explanation:
"Preterm appropriate for gestational age" (AGA) infants are prone to respiratory distress
syndrome, apnea, patent ductus arteriosus with left-to-right shunt, and infection. "Preterm small
for gestational age" (SGA) infants are more likely to experience asphyxia, hypoglycemia, and
hypocalcemia.
10. Swelling noted 1-2 inches below the knee joint and on the medial surface of the knee would
be suggestive of:
Answer: anserine bursitis
Explanation:
Swelling 1-2 inches below the knee joint and on the medial surface would be suggestive of
anserine bursitis. Swelling over the tibial tubercle suggests infrapatellar bursitis. Swelling over
the patella suggests prepatellar bursitis. Semimembranosus bursitis would be suggested by
swelling on the posterior and medial surface of the knee.

11. A patient states that the only way he can sleep at night is to use several pillows or to sleep
upright in a recliner. This sleep pattern is most consistent with:
Answer: obstructive lung disease
Explanation:
With obstructive lung disease, the patient experiences orthopnea, dyspnea that occurs when the
patient lies down but improves with sitting. Therefore, the patient would use several pillows or
sleep upright in a recliner. Orthopnea is seen in obstructive lung disease, mitral stenosis, and
heart failure. Paroxysmal nocturnal dyspnea describe episodes of sudden dyspnea that cause the
patient to awaken from sleep where the patient must sit up, walk, or stand for it to resolve.
Coughing and wheezing may also occur. Angina pectoris commonly creates chest pain or
shortness of breath. Jugular venous pressure reflects right atrial pressure and volume status. In
cases of cardiac or pulmonary dysfunction, jugular venous pressures usually raise.
12. A positive obturator sign would elicit pain in the:
Answer: right hypogastric area
Explanation:
Assessment of the obturator sign is performed by flexing. By flexing the patient's right thigh at
the hip with the knees bent, rotating the leg internally at the hip. If this causes increased pain in
the right epigastric area, then the obturator sign is positive.
Hypogastric pain occurs as the obturator muscle rubs an inflamed appendix.
13. The lateral bone that serves as a strut between the scapula and the sternum is known as the:
Answer: clavicle
Explanation:
The lateral bone that serves as a strut between the scapula and the sternum is known as the
clavicle. The humerus is the long bone of the upper arm. The acromion process is an extension
of the spine of the scapula and located at the highest point of the shoulder. The thick curved
extension of the superior border of the scapula is referred to as the coracoid process.
14. When examining the foot of a patient, the nurse practitioner notes focal heel tenderness on
palpation of the plantar fascia. This could be suggestive of:

Answer: plantar fasciitis
Explanation:
Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. Bone spurs
may be present on the calcaneus as bony projections and may cause numbness, tenderness, or
pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis,
infection of the ankle, or ligamentous injury. Tenderness along the posterior medial malleolus
suggests posterior tibial tendinitis.
15. When examining the conjunctiva and sclera, have the patient look upward and then:
Answer: depress both lower lids with your thumbs, exposing the sclera and conjunctiva
Explanation:
When examining the conjunctiva and the sclera, the best way to expose these structures is to
have the patient look upward and depress both lower lids with your thumbs. Covering one eye
while visualizing the other eyes checks for visual acuity. Observing for excessive tearing or
dryness assesses the lacrimal apparatus. Checking the position of the lids may identify
variations and abnormalities in the eyelids.
16. The groove of the metacarpophalangeal joint can be palpated by having the patient:
Answer: flex his hand
Explanation:
The groove of the metacarpophalangeal joints can be palpated by having the patient flex his
hand.
17. A patient complains of shooting pains below the knee radiating into the lateral leg and calf.
This type of low back pain is referred to as:
Answer: radicular low back pain
Explanation:
Radicular low back pain, or sciatica, presents with shooting pains below the knee, into the
lateral leg or posterior calf. It may be accompanied by paresthesias and/or weakness in the
affected leg. Mechanical low back pain often arises from muscle and ligament injuries (70%) or
age-related intervertebral disc or facet disease. Common symptoms include aching pain in the

lumbosacral area that radiates to the upper leg. Common risk factors include heavy lifting, poor
conditioning, and obesity. Lumbar spinal stenosis or "pseudo claudication" refers to pain in the
back or legs with walking that improves with rest, lumbar flexion, or both.
18. When assessing a 3-month-old for developmental dysplasia of the hips (DDH), which one of
the following symptoms would be suspicious of dysplasia?
Answer: Limitation of abduction of the affected extremity, shortening of the femur and positive
Ortolani’s sign
Explanation:
Developmental dysplasia of the hips (DDH) presents with limitation of abduction, shortening of
the extremity, as the head of the femur does not fit into the acetabulum, and a positive Ortolani's
(it clicks when maneuvered). DDH presents with asymmetry of the gluteal folds.
19. A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis
is suspected because the pain radiates to the:
Answer: right scapula area
Explanation:
Acute cholecystitis presents with right upper quadrant and upper abdominal pain radiating to the
right scapular area. It is usually steady and aching. Pain in the epigastric area could be
associated with peptic ulcer or dyspepsia. Cancer of the stomach can present with epigastric
pain. Acute mechanical colon obstruction presents with pain in the lower abdomen.
20. The preauricular lymph node is located:
Answer: in front of the ear
Explanation:
The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at
the angle of the mandible. The occipital lymph nodes are located at the base of the skull
posteriorly. The posterior auricular nodes are superficial to the mastoid process.
21. Cessation of the menses for 12 months is termed:
Answer: menopause

Explanation:
Menopause is defined as cessation of menses for 12 months, progressing through several stages
of erratic cyclical bleeding. Oligomenorrhea is infrequent bleeding with menses occurring
greater than 35-day intervals, or 4-9 menstrual cycles per year.
Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals.
Metrorrhagia refers to intermenstrual bleeding.
22. The gastrocnemius and soleus muscles are located by palpating the:
Answer: posterior surface of the lower leg
Explanation:
The gastrocnemius and soleus muscles are located by palpating the posterior surface of the
lower leg.
23. One cause of nasal septum perforation may be:
Answer: intranasal use of cocaine
Explanation:
Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of
cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal
septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation.
24. Tenderness in the costovertebral angles may signify:
Answer: pyelonephritis
Explanation:
Because the kidney lies directly under the costovertebral angle, tenderness over this area would
be related to renal issues such as renal stones or pyelonephritis.
25. A patient presents with an altered level of consciousness. He/she is considered in a stuporous
state if he/she:
Answer: arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses,
and easily lapses into an unresponsive state
Explanation:

A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are
slow, and lapses into an unresponsive state. A lethargic patient appears drowsy but opens the
eyes, looks at the examiners, answers the questions, and then falls asleep. An obtruded patient
opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A
comatose patient remains unarousable with eyes closed. There is no evident response to inner
need or external stimuli.
26. A flat affect can be an identifiable finding in an older adult who has:
Answer: depression
Explanation:
Flat affect occurs in depression, Parkinson’s disease, or Alzheimer’s disease.
27. Pain and crepitus over the patella suggests:
Answer: roughening of the patellar undersurface
Explanation:
Pain and crepitus over the patella suggests roughening of the patellar undersurface that
articulates with the femur. Tenderness over the patellar tendon or inability to extend the knee
suggests a partial or complete tear of the patellar tendon. A degenerative patella produces pain
with compression and patellar movement during quadriceps contraction. Swelling above and
adjacent to the patella suggest synovial thickening or effusion of the knee joint.
28. A child with a heart murmur audible at the lower left sternal border would be suggestive of:
Answer: ventricular septal defect
Explanation:
This type murmur is not considered a normal finding in children. The murmur associated with a
ventricular septal defect is audible at the lower left sternal border. A child with a heart murmur
located at the midsternum or upper right sternal border and associated with a click could be
suggestive of aortic valve stenosis. A murmur located at the upper left sternal border with a
prominent ejection click in early systole could be suggestive of pulmonary valve stenosis.
29. In order to visualize the opening of Stensen's duct, examine the:

Answer: buccal mucosa opposite the second molar
Explanation:
The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear
extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs
forward to an opening on the buccal mucosa opposite the second molar. If blood comes out
through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled,
it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears
erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the
mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth
and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies
within the floor of the mouth under the tongue. It has many small openings along the sublingual
fold under the tongue.
30. Hyperalgesia refers to:
Answer: increased sensitivity to pain
Explanation:
Analgesia refers to absence of pain sensation; hypoalgesia to decreased sensitivity to pain;
hyperalgesia to increased sensitivity; and anaesthesia to absence of touch sensation.
31. The part of the brain that maintains homeostasis is the:
Answer: hypothalamus
Explanation:
The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood
pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such
as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary
gland.
32. A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two
falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner
should take is:
Answer: obtain cognitive and functional assessment

Explanation:
High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait
and balance and those with two or more falls in the prior 12 months, an acute fall, and/or
difficulties with gait and balance, require further assessment to determine the reasons for the
falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment
and determining multifactorial fall risks are essential to the preventing future falls.
33. Which one of the following symptoms would be seen in a 39 week gestational age patient
who was suspected of having HELLP syndrome?
Answer: Vomiting, flu - like symptoms, and platelet count 140 mm Hg or diastolic BP (DBP) >90
mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum.
Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in
the absence of proteinuria. Pre-eclampsia occurs in a woman who was previously normotensive
but now has new onset hypertension with either proteinuria or end-organ damage. Primary
hypertension, formerly known as essential hypertension, is a disorder which is associated with
elevated blood pressure and an unidentifiable cause.
83. The lateral collateral ligament of the knee:
Answer: connects the lateral femoral epicondyle and the head of the fibula
Explanation:
The lateral collateral ligament (LCL) connects the lateral femoral epicondyle and the head of
the fibula. The anterior cruciate ligament (ACL) crosses obliquely from the anterior medial tibia
to the lateral femoral condyle, preventing the tibia from sliding forward on the femur. The
posterior cruciate ligament (PCL) crosses from the posterior tibia and lateral meniscus to the
medial femoral condyle, preventing the tibia from slipping backward on the femur. The medial
and lateral menisci are fibrocartilaginous discs that cushion the action of the femur on the tibia.
84. Which of the following procedures should NOT be performed in a comatose patient?
Answer: Dilate the pupils
Explanation:
When assessing a comatose patient, the nurse practitioner should not dilate the eyes because
pupillary reaction is the single most important clue to the underlying cause of the coma:
structural or metabolic. The other procedures can be performed on a comatose patient.
85. Where the head of the humerus articulates with the shallow glenoid fossa of the scapula is
known as the:
Answer: glenohumeral joint
Explanation:

The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid
fossa of the scapula. This joint is deeply situated and not normally palpable. The
acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion
process of the scapula. The convex medial end of the clavicle articulates with the concave
hollow in the upper sternum to form the sternoclavicular joint. There is no manubrium joint; it
is the broad upper part of the sternum.
86. The axioscapular group of muscles:
Answer: pulls the shoulder backward
Explanation:
The axioscapular group pulls the shoulder backward and rotates the scapula. The
scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and
depresses and rotates the head of the humerus. The axiohumeral group produces internal
rotation of the shoulder. The serratus anterior draws the shoulder blade forward.
87. The ankle is a hinge formed by the tibia, fibula, and the:
Answer: talus
Explanation:
The ankle is a hinge formed by the tibia, fibula, and the talus. The tibia and fibula act as a
mortise, stabilizing the joint while bracing the talus like an inverted cup.
88. The maxillary sinuses:
Answer: surround the nasal cavity
Explanation:
The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The
maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the
eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind
the ethmoidal sinuses.
89. The dorsiflexors muscles in the foot include the:
Answer: toe extensors

Explanation:
The dorsiflexors in the foot include the anterior tibial muscles and the toe extensors.
90. In renal adaptation of the newborn, which one of the following statements is correct?
Answer: The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte
stress.
Explanation:
In the neonate the kidneys are structurally complete but physiologically immature. The
glomeruli have an inability to filter and concentrate urine, therefore glucose and amino acids
escape and there is decreased ability to remove uric acid crystals which give the reddish
appearance to the urine. There is an inability to adapt to fluid and electrolyte stress leading to
loss of bicarbonate and poor reabsorption. This puts the neonate at increased risk of metabolic
acidosis. The tubules are short/narrow which causes a problem with reabsorption. The nephrons
function well within a month. ADH inhibits diuresis and the immature kidney causes an
increased risk for dehydration.
91. When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This
suggests that the mass is:
Answer: attached to the rib or intercostal muscle
Explanation:
A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and/or intercostal
muscles. If fixed when the hand is pressed against the hip, it is attached to the pectoral fascia.
This finding is not consistent with cystic breast disease or indicative of non-malignant masses.
92. An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and
expiration. Which statement is true?
Answer: This is a normal exam
Explanation:
Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases
with respiration and is considered normal in children. There is no need for an echo or referral to
a cardiologist nor should the child be evaluated for caffeine intake.

93. According to the U.S. Preventive Services Task Force, older adults should be screened for
colorectal cancer with high-sensitivity fecal occult blood tests (FOBTs) every:
Answer: year
Explanation:
The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years,
sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3
years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against
routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is
small.
94. The great saphenous vein enters the deep venous system by way of the:
Answer: femoral vein
Explanation:
The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of
the deep venous system below the inguinal ligament.
95. When discussing the musculoskeletal system, all of the following statements related to
articular structure disease are true except which one?
Answer: Articular disease is usually due to stiffness or pain
Explanation:
Articular disease typically involves swelling and tenderness of the entire joint and limits both
active and passive range of motion due either to stiffness or to pain. Extra-articular disease
typically involves selected regions of the joint and types of movement.
96. Signs and symptoms associated with diabetic gastroparesis may include all of the following
except:
Answer: vomiting of undigested food: weight loss: diarrhoea: erratic glucose levels.
Explanation:
Diabetic gastroparesis occurs as a result of damage to the vagus nerve (controls the movement
of food through the digestive system). Signs and symptoms associated with diabetic

gastroparesis may include vomiting of undigested food, weight loss, erratic glucose levels, and
gastroesophageal reflux. Diarrhoea is not associated with diabetic gastroparesis or vagus nerve
disorders since the vagus nerve innervates the stomach.
97. The portion of the umbilicus in a newborn that is covered with a firm gelatinous substance
and dries up within two weeks of birth is known as:
Answer: the umbilicus amniotic
Explanation:
The umbilicus amniotic refers to the amniotic portion of the umbilical cord which is covered
with a firm gelatinous substance. This portion dries up and falls out within two weeks of birth.
The portion of the umbilicus in a newborn that is covered with skin and retracts to become flush
with the abdominal wall, is known as the umbilicus cutis. An umbilical hernia in infants is a
defect in the abdominal wall which can measure up to six centimeters. An umbilical granuloma
reflects granulation tissue at the base of the navel formed during the healing process.
98. A patient was recently diagnosed with gluten intolerance and needs instructions on what
foods to eat. The patient should be told that a gluten restricted diet includes:
Answer: corn
Explanation:
A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as
wheat, barley, rye and triticale (a cross between wheat and rye). Corn and rice, and soybean
products are allowed but processed foods are not.
99. When percussing a protuberant abdomen, tympany is audible. This is consistent with all of
the following conditions except:
Answer: intestinal obstruction: increased intestinal gas production: a large solid tumor: a
paralytic ileus
Explanation:
A protuberant abdomen that is tympanic throughout when percussed can suggest intestinal
obstruction, increased gas production, or a paralytic ileus. A solid mass gives a dull sound on
percussion.

100. The Glasgow coma scale assesses:
Answer: motor response
Explanation:
Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the
Glasgow Coma Scale was designed and should be used to assess the depth and duration of coma
and impaired consciousness. This scale helps to gauge the impact of a wide variety of
conditions such as acute brain injury due to traumatic and/or vascular injuries or infections,
metabolic disorders such as hepatic or renal failure, hypoglycemia, or diabetic ketoacidosis.
Cranial nerve, auditory, and pupillary responses are not included in the come scale assessment.
101. Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of
the following forefoot abnormalities except:
Answer: Achilles tendinitis
Explanation:
Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux
valgus, metatarsalgia, and Morton's neuroma. Achilles tendinitis more commonly occurs in
runners and affects the posterior foot as opposed to the forefoot.
102. One maneuver used to assess coordination is to observe the patient:
Answer: walking heel-to-toe in a straight line
Explanation:
To assess coordination, observe the patient’s performance in rapid alternating movements,
point- to-point movements, gait and other related body movements, standing in specified ways.
Walking heel-to-toe would be an example of observing the patient's gait. Dorsiflexion would be
assessing the patient's joint function. Squeezing the examiner's fingers would be one way to
assess hand grasp. Counting has nothing to do with coordination.
103. A small, tuberculated eminence, curved a little forward, and giving attachment to the radial
collateral ligament of the elbow-joint is referred to as the:
Answer: lateral epicondyle of the humerus

Explanation:
A small, tuberculated eminence, curved a little forward, and giving attachment to the radial
collateral ligament of the elbow-joint is referred to as the lateral epicondyle of the humerus.
104. Uncontrolled electrical activity in the brain, which may produce minor physical signs,
thought disturbances, or disturbed motor activity is:
Answer: seizure
Explanation:
A seizure is an uncontrolled electrical activity in the brain which may produce minor physical
signs, thought disturbances, or disturbed motor activity, or a combination of symptoms.
Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the
limbs.
Bradykinesia is the term used to describe the impaired ability to adjust to one's body position.
This symptom is noted in patients who have Parkinson's disease. A rhythmic oscillatory
movement of a body part resulting from the contraction of opposing muscle groups is a tremor.
105. A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the
neck is usually associated with:
Answer: an aortic dissection
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and physical exam can
help the clinician determine a likely cause. A sudden sharp pain that radiates to the back or into
the neck is usually associated with aortic dissection. Exertional pain can be angina pectoris.
Symptoms most often seen with myocardial infarction include a retrosternal type pain that often
radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain
associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents
with a sharp knifelike pain. Any pain in the chest is cardiac until proven otherwise.
106. Involuntary movements of the body that involve larger portions of the body, including the
trunk resulting in grotesque, twisted postures are suggestive of:
Answer: dystonic movements

Explanation:
Dystonic movements are similar to athetoid movements, but often involve larger portions of the
body, including the trunk. Grotesque, twisted postures may result. Facial tics are brief,
repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples
include repetitive winking, grimacing, and shoulder shrugging. Athetoid movements are slower
and more twisting and writhing than choreiform movements, and have a larger amplitude. They
most commonly involve the face and the distal extremities. Oral–facial dyskinesias are
rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue:
grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and
deviations of the jaw. These are involuntary movements.
107. To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular
movements in an infant, the nurse practitioner would:
Answer: observe how well the infant tracks the nurse practitioner's face
Explanation:
To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular
movements in an infant, the nurse practitioner would observe how well the infant tracks the
nurse practitioner's face.
108. In infants, the palmar grasp reflex ceases after :
Answer: 4 months
Explanation:
In infants, the palmar grasp reflex ceases after 4 months. Persistence beyond this time suggests
pyramidal tract dysfunction.
109. A patient experienced a neck injury yesterday and presents to the nurse practitioner with
aching paracervical pain and stiffness. Other complaints include dizziness, malaise, and fatigue.
These findings may be associated with:
Answer: neck pain with whiplash
Explanation:

In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins
the day after injury and may be accompanied by occipital headaches, dizziness, and malaise.
Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and
ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder,
lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology.
Symptoms may include sharp burning or tingling pain in the neck and one arm with associated
paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated
with bilateral weakness and paresthesias in both upper and lower extremities.
110. Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to:
Answer: motor nerve fibers
Explanation:
The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and
from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses
outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both
sensory (afferent) and motor (efferent) fibers.
111. At what age should an infant begin to say consonant sounds?
Answer: Six months
Explanation:
A six-month-old infant should be able achieve these tasks: look at self in the mirror, respond to
his own name, begin to say consonant sounds, begin to pass things from one hand to another,
roll over in both directions, know familiar faces, and begin to know if someone is a stranger.
112. Genu varum refers to:
Answer: bow leggedness
Explanation:
The term genu valgum refers to knock knees and genu varum refers to bow leggedness. Talipes
equinovarus is the term that describes a clubfoot. Toeing inward or outward of the feet is known
as tibial torsion.

113. When examining the medial and lateral meniscus, a click along the medial joint with
valgus stress, external rotation, and leg extension suggests a probable tear of the:
Answer: posterior portion of the medial meniscus
Explanation:
When examining the medial and lateral meniscus, a click along the medial joint with valgus
stress, external rotation, and leg extension suggests a probable tear of the posterior portion of
the medial meniscus.
114. Breastfeeding is contraindicated for an infant diagnosed with which one of the following
conditions?
Answer: Galactosemia
Explanation:
Galactosemia is the lack of a specific enzyme in the liver that breaks down galactose into
glucose. Some infants may inherit a gene that allows for some galactose metabolism. However,
if the baby has “classic galactosemia” in which the baby has no galactose metabolizing
enzymes, the baby will need to be weaned abruptly, and then fed a lactose free formula. Breast
feeding is not contraindicated in the other conditions.
115. In order to examine the tongue, ask the patient to stick out his tongue and with the
examiner's right hand:
Answer: gently pull it to the left side , and inspect the side of the tongue
Explanation:
In order to examine the tongue, ask the patient stick out his the tongue and with the examiner's
right hand, grasp the tip of the tongue with a gauze and gently pull it to the patient's left. Inspect
the side of the tongue, then palpate it with the left hand, feeling for any induration. Reverse the
procedure for the other side. Inspecting for tongue symmetry checks function of cranial nerve
XII, hypoglossal. Stimulating the patient to cough and eliciting the gag reflex do not have
anything to do with the tongue examination.
116. The ankle-brachial index is a screening test used to assess a person's risk for:
Answer: peripheral artery disease

Explanation:
The ankle-brachial index test is a quick, non-invasive way to check a person's risk for peripheral
artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the
difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous
thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the
venous system.
117. The central nervous system extends from the medulla into the:
Answer: spinal cord
Explanation:
Below the medulla, the central nervous system extends into the elongated spinal cord, encased
within the bony vertebral column and terminating at the first or second lumbar vertebra.
118. The Weber test uses a tuning fork to test hearing. The frequency range closest to that of
conversational speech would be one with a frequency of:
Answer: 512 Hz
Explanation:
The Weber hearing test screens for unilateral conductive hearing loss with a tuning fork. The
tuning fork is measured in frequencies of 256 Hz or 512 Hz. These frequencies fall within the
range of conversational speech. The ideal frequency for the Weber test is 256 Hz. A frequency
of 512 Hz is the ideal frequency for the Rinne hearing test.
119. The nurse practitioner holds the infant around the trunk. One sole touches the table. The
hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will
occur. This maneuver assesses the:
Answer: placing and stepping reflexes
Explanation:
The placing or stepping reflex (formerly known as the dancing reflex) is assessed by holding the
infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and
the other foot will step forward. Alternating stepping will occur.

To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head
will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited
when the infant is supported prone with one hand, and then one side of the back (one centimeter
from the midline), is stroked from the shoulder to the buttocks. The spine curves toward the
stimulus. To elicit the positive support reflex, hold the infant around the trunk, lower the infant
until the feet touch a flat surface. Hips, knees, ankles extend and the infant stands up, partially
bearing weight.
120. Which of the following findings in a preschooler would indicate the need for further
evaluation?
Answer: Responds to facial expressions and gestures rather than to verbal explanations
Explanation:
A child who responds to facial expressions and gestures rather than to verbal explanations is
probably expressions rather than verbal clues. These children may have a hearing deficit that
needs further evaluation. The other choices are normal behaviors for the preschooler.
121. Decreased spinal mobility in the lumbar region could be suggestive of:
Answer: osteoarthritis
Explanation:
Decreased spinal mobility in the lumbar region could be suggestive of osteoarthritis or
ankylosing spondylitis. Dupuytren's contracture affects the hands. Torticollis would present a
lateral deviation and rotation of the head. Kyphosis affects the thoracic spine.
122. An inward turning of the lower lid margin is called:
Answer: entropion
Explanation:
Entropion is more common in the elderly and occurs when the lower lid margin turns inward.
When this irritates the conjunctiva and the lower cornea. Ectropion occurs when the lower lid
turns outward and exposes the palpebral conjunctiva. Ptosis is a drooping of the upper eyelid.
An epicanthal fold is a vertical fold of skin that lies over the medial canthus of the eye.

123. Restrictions of internal and external rotation of the hip are sensitive indicators of:
Answer: arthritis
Explanation:
Restrictions of internal and external rotation of the hip are sensitive indicators of arthritis.
Lumbar lordosis, scoliosis, and kyphosis do not generally affect internal or external rotation of
the hip.
124. The cervical opening or shortening noted during a bimanual examination prior to 37 weeks
gestation, may indicate:
Answer: preterm labor
Explanation:
The cervical opening or shortening noted during a bimanual examination prior to 37 weeks, may
indicate preterm labor.
125. An adolescent visits the nurse practitioner for a sports participation physical. The nurse
practitioner instructs the adolescent to stand erect with his arms at his sides. The nurse
practitioner stands behind the adolescent and observes his spine and hip. This maneuver
assesses for:
Answer: leg-length discrepancy
Explanation:
This maneuver assesses for leg-length discrepancy or asymmetry from scoliosis.
126. The part of the peripheral nervous system that controls involuntary actions is known as the:
Answer: autonomic nervous system
Explanation:
The autonomic nervous system is part of the peripheral nervous system and generates
autonomic reflex responses and consists of the sympathetic and parasympathetic nervous
systems. The part of the peripheral nervous system that regulates muscle movement and
response to the sensations of pain and touch is the somatic nervous system. The sympathetic
nervous system mobilizes organs and their functions during times of stress and arousal. The

parasympathetic nervous system conserves energy and resources during times of rest and
relaxation.
127. A patient presents with findings of pain, warmth, redness, and swelling below the inner
canthus toward nose. Tearing is present and when pressure is applied to the lacrimal sac,
purulent discharge from the puncta is noted. This is suggestive of:
Answer: dacryocystitis
Explanation:
Dacryocystitis is an infection and blockage of lacrimal sac and duct. Symptoms include pain,
warmth, redness, and swelling below the inner canthus toward the nose. Tearing is usually
present and when pressure is applied to the lacrimal sac, a purulent discharge from the puncta
can be noted. Red, scaly, greasy flakes and thickened, crusted lid margins are consistent with
blepharitis. Symptoms include burning, itching, tearing, foreign body sensation, and some pain.
Hordeolum is an infection usually secondary to localized Staphylococcal infection of the hair
follicles at the lid margin.
128. A forty-year-old man presents with a slow growing lesion on the face. Further examination
reveals a lesion with a depressed center, a firm elevated border, and visible telangiectatic
vessels. This is most consistent with:
Answer: basal cell carcinoma
Explanation:
Basal cell carcinoma typically presents with an initial translucent nodule that spreads, leaving a
depressed center, a firm elevated border, and visible telangiectatic vessels.
They usually appear in adults over forty and seldom metastasize. Squamous cell carcinoma
appear on sun exposed skin of fair skinned adults over sixty and look like scaly red patches,
open sores, elevated growths with a central depression, or warts; they may crust or bleed.
Kaposi's sarcoma is seen in patients with AIDS and appears in many forms and on any part of
the body. The abnormal cells form purple, red, or brown blotches or tumors on the skin and can
become life threatening when the lesions are in the lungs, liver, or digestive tract.

129. Breath sounds consisting of a full inspiratory phase and a shortened and softer expiratory
phase normally audible over the hilar region of the chest are termed:
Answer: bronchovesicular
Explanation:
Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer
expiratory phase. They are normally heard over the hilar region (center of the lungs near the
heart). Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short,
almost silent expiratory phase. They are heard over the periphery of the lung field. Bronchial
breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase
usually being louder. They are normally heard over the trachea and larynx.
130. A child sustained a "full-thickness" burn injury. This type injury involves tissue destruction
down to the:
Answer: subcutaneous tissue
Explanation:
A full-thickness burn involves all skin layers, including the epidermis, dermis, and the
subcutaneous tissue and fat. Muscles and tendons may be involved. A superficial thickness burn
involves the epidermis only. A superficial partial thickness burn involves the epidermis and the
dermis. A deep thickness burn involves the entire layer of dermis, and is more severe than a
superficial partial thickness burn.
131. When assessing the heart rate of a healthy 13-month-old child, which one of the following
sites is the most appropriate for this child?
Answer: Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line
Explanation:
The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th
intercostal space to the left of the midclavicular line. The only time one would auscultate the
right midclavicular line would be if the child had situs inversus or dextrocardia.
132. After attempting to elicit the Moro reflex in a newborn, the nurse practitioner identifies
absence of movement of the left arm. The next assessment would be to:

Answer: examine the clavicle
Explanation:
A positive Moro reflex occurs when both arms are extended. If this response is not elicited
bilaterally, the nurse practitioner should assess the clavicle. If the clavicle is fractured, the Moro
response will be demonstrated on the unaffected side only. Babinski reflex assesses for
neurological abnormalities. Gallant reflex is checked while the infant is prone and assesses for
trunk incurvation. Ortolani maneuver assesses for congenital hip dysplasia.
133. Raised or flat, deep purple colored lesions noted in the mouth may be suggestive of:
Answer: Kaposi's sarcoma
Explanation:
Kaposi's sarcoma (a low-grade vascular tumor associated with human herpes virus 8), is
associated with flat or raised deep purple colored lesions of the mouth. Approximately one third
of patients with Kaposi’s sarcoma have lesions in the oral cavity. Other sites that could be
affected include the gastrointestinal tract and the lungs. Koplik's spots are frequently seen in the
early stage of measles (roseola) and appear as small white specks that resemble grains of salt on
a red background on the buccal mucosa. Torus palatinus develops as a bony growth in the hard
palate and is common in adults. Fordyce spots or granules appear as yellow spots in the buccal
mucosa or on the lips. They are considered normal sebaceous glands.
134. A 60-year-old was concerned about a yellowish colored lesion above her right eyelid.
Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of
her right eyelid. This finding is most consistent with:
Answer: xanthelasma
Explanation:
Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or
both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to
harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A
chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is an ocular
inflammation of the episcleral vessels.

135. Congenital cysts located at the midline of the neck just above the thyroid cartilage and may
open under the tongue are know as:
Answer: thyroglossal duct cysts
Explanation:
Thyroglossal duct cysts are located at the midline of the neck just above the thyroid cartilage.
They may open under the tongue. A preauricular cyst has pin-hole sized pits located anterior to
the helix of the ear and may be associated with hearing loss. Small dimples appearing anterior
to the midportion of the sternocleidomastoid muscle are known as brachial cleft cysts and may
be associated with a sinus tract. Hypoglossal refers to the hypoglossal nerve and not to cysts.
136. The nurse practitioner places the infant lying supine on the exam table, and then makes a
loud noise. The infant's arms abduct and extend with hands open and legs flexed. This
maneuver assesses:
Answer: Moro reflex
Explanation:
The maneuver described assesses the Moro or startle reflex. To elicit the asymmetric tonic neck
reflex, with the infant supine, the nurse practitioner would turn the head to one side, holding the
jaw over the shoulder. The arms and legs on the side to which the head is turned extend while
the opposite arm and leg flex. To elicit the Landau reflex, the infant is suspended prone with one
hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk
incurvation reflex, is elicited when the infant is supported prone with one hand, and then one
side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks.
The spine should curve toward the stimulus.
137. According to the most recent recommendation from U.S. Preventive Services Task Force,
an adult aged 65 should be screened for breast cancer:
Answer: every 2 years
Explanation:
The Task Force recommends screening for breast cancer with mammography every 2 years for
women ages 50-74 and cites insufficient evidence for women 75 years and older.

138. That portion of the ear that consists of the auricle and ear canal is the:
Answer: external ear
Explanation:
The external ear consists of the auricle and ear canal. The auricle is made of cartilage covered
by skin and has a firm, elastic consistency. The auricle has a prominent curved outer ridge
known as the helix. The antihelix is a curved prominence that is parallel and anterior to the
helix. The auditory canal opens behind a nodular protuberance that points backward over the
entrance to the canal, known as the tragus.
139. The cranial sutures are closed on the head of a 9 month old infant. This indicates:
Answer: craniosynostosis
Explanation:
Craniosynostosis is defined as the premature closing of the sutures in young children. When this
occurs, a bony ridge can be felt along the suture line. This is not a normal finding since the
sutures usually fuse between 12 and 18 months. Hydrocephalus refers to fluid on the brain and
would appear as an enlarged head with sutures remaining open. Opisthotonos is a state of severe
hyperextension and spasticity in which an individual's head, neck and spinal column enter into a
complete "bridging" or "arching" position. This abnormal posturing is an extrapyramidal effect
and is caused by spasm of the axial muscles along the spinal column.
140. A decrease in the degree of density in a bone that results in fragile bones is referred to as:
Answer: osteoporosis
Explanation:
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its
strength and resulting in fragile bones. Osteoporosis leads to abnormally porous bone that is
compressible, like a sponge. Osteopenia is a condition of bone that makes it slightly less dense
than normal bone, but not as severe as in osteoporosis. Osteomyelitis refers to an infection in
the bone. Osteoarthritis is a term used to describe degenerative joint disease.
141. Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed:
Answer: intermittent claudication

Explanation:
Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed
intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic
limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal
area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication.
Raynaud's disease usually presents with numbness or tingling in the distal portions of one or
more fingers aggravated by cold or emotional stress.
142. A patient presents with a fiery red, slightly raised 2 cm lesion on the upper truck that
blanches when pressure is applied. The body of the lesion is surrounded by erythema and
radiating legs. This is most likely:
Answer: a spider angioma
Explanation:
A spider angioma is fiery red, slightly raised and surrounded by erythema and radiating legs that
blanch with pressure. These are usually seen in patients with liver disease, pregnancy, vitamin B
deficiency, and sometimes patients with no disease. The spider vein is blue. Cherry angiomas
are bright or ruby red and increase in size and number as one ages. Petechiae are deep red or
reddish purple and are seen when blood is outside the vessels. This suggests a bleeding disorder
or injury to the skin.
143. A cartilage-like articulation between the pubic bones is known as the:
Answer: pubic symphysis
Explanation:
The pubic symphysis is a cartilage-like articulation between the pubic bones. The anterior
superior iliac spine is the area where the iliac crest terminates anteriorly on the ilium. A long
curved bone along the uppermost part of the ilium is known as the iliac crest. The superior
ramus of pubis are the pubic bones that help form the obturator foramen.
144. Warning signs of peripheral artery disease may include all of the following except:
Answer: aching or numbness that limits walking: non-healing lesions of the legs: .abdominal
pain after meals with weight loss: persistent cough

Explanation:
Patients with peripheral artery disease (PAD) may not experience any symptoms or may
experience a variety of symptoms that indicate ischemia. Some warning signs of peripheral
artery disease include: fatigue, aching, numbness, pain that limits walking, or poorly healing
lesions on the legs. The nurse practitioner should conduct a thorough assessment and review of
symptoms to detect early warning signs and differentiate nonatherosclerotic and nonvascular
conditions. PAD is a treatable condition. When recognized early and appropriately managed,
complications that can lead to limb loss can be minimized.
145. When auscultating the heart, a scratchy, continuous murmur is audible during atrial systole
and ventricular systole and diastole. This finding may be indicative of a:
Answer: pericardial friction rub
Explanation:
Cardiovascular sounds that extend beyond one phase of the cardiac cycle are considered
continuous murmurs. Pericardial friction rubs usually produces a scratchy, scraping sound with
a high pitch. They are heard best with the diaphragm and are associated with friction from
cardiac movement in the pericardial sac. If they are heard in atrial systole and ventricular
systole and diastole, then the diagnosis is made. Venous hums are benign sounds resulting from
turbulence in the jugular veins. They can produce a humming or roaring sound and are heard
best with the bell of the stethoscope during diastole. Venous hums are common in children and
may be present in patients who have anemia or hyperthyroidism. The murmur of a patent ductus
arteriosus produces a harsh, machine-like sound and is loudest during late systole. The murmur
of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout
systole.
146. The function of the labyrinth in the inner ear is to:
Answer: maintain equilibrium
Explanation:
The inner ear has 2 main functions: hearing and balance. The cochlear system is dedicated to
hearing and the vestibular system is dedicated to balance. The labyrinth is part of the
semicircular canals and the vestibular system and is responsible for balance.

147. An intermediate stage between the expected cognitive decline of normal aging and the
more serious decline of dementia is known as:
Answer: cognitive impairment
Explanation:
Cognitive impairment is an intermediate stage between the expected cognitive decline of normal
aging and the more serious decline of dementia. Delirium is a serious disturbance in a person's
mental abilities that results in a decreased awareness of one's environment and confused
thinking. In the older adult, it is defined as a geriatric syndrome or condition occurring as a
temporary state of confusion and may be the first clue to infection or problems with
medications. Functional impairment is a health condition in which the normal function of a part
of the body is less than full capacity. One of the defining characteristics of functional
impairment is that the reduction in physical or mental capacity is sufficient to interfere with
managing day-today tasks. A multifactorial geriatric condition or syndrome characterized by an
age related lack of adaptive physiological capacity occurring in the absence of identifiable
illness is known as frailty.
148. Symptoms of a child suspected of having a diagnosis of mixed failure to thrive (FTT) are
usually seen in children:
Answer: who have cleft palates or lips and the caretaker is insecure in his/her feeding abilities
Correct.
Explanation:
Children with cleft lips and/or palates are at risk for aspiration when feeding. This can cause
concern or fear for the parent/caregiver. This is considered a type of mixed FTT.
Children with CHD fall in the category of an organic type of FTT. Children of mothers with
post partal depression may have a non-organic type of FTT. Cerebral palsy children with
feeding tubes have a non-organic type of FTT. Feeding through feeding tubes actually increases
the nutritional intake and calories and improves FTT.
149. Which of the following is the most age appropriate play for an 8-year-old girl?
Answer: A board game

Explanation:
School-age children like the competitiveness of board games. Dress up is a preschool activity,
experimenting with make-up is an adolescent activity and school age children like small puzzle
pieces where as preschoolers like large puzzle pieces.
150. Breath sounds auscultated over the periphery of the lung fields are quiet and wispy during
the inspiratory phase followed by a short, almost silent expiratory phase. These breath sounds
are considered:
Answer: vesicular
Explanation:
The three normal breath sounds are vesicular, bronchovesicular, and bronchial. Vesicular breath
sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory
phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of a
full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are
normally heard over the trachea and larynx. Bronchovesicular breath sounds consist of a full
inspiratory phase with a shortened and softer expiratory phase. They are normally heard over
the hilar region. Crackles are adventitious sounds heard in the lungs and may be due to
abnormalities in the lungs.
151. Fasciculations in atrophic muscles suggest:
Answer: a lower motor neuron disease
Explanation:
Fasciculations are small muscle twitches and can be found in any muscle of the body.
Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles,
this may suggest a lower motor neuron disease. They are not seen in central or peripheral
nervous system disease or rheumatoid arthritis.
152. To test the thumb for flexion, ask the patient to:
Answer: move his thumb across his palm and touch the base of the fifth finger
Explanation:

To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth
finger. To test extension, ask the patient to move his thumb from the base of the fifth finger,
across the palm, and then as far away from the palm as possible. Touching the thumb to each of
the other fingers tests opposition. Placing the fingers and thumbs in the neutral position with the
palm up and moving the thumb anteriorly away from the palm assesses abduction. Moving the
thumb back to its neutral position assesses adduction.
153. When a patient complains of joint pain as progressing from one joint to another, the
examiner should consider this pattern of involvement as migratory. This type of involvement
would most likely be observed in a patient who has:
Answer: rheumatic fever
Explanation:
A migratory pattern would involve migrating pain from joint to joint or steadily spreading from
one joint to multiple joints. Examples of this type of joint pain migration is seen in patients who
have rheumatic fever or gonococcal arthritis. Gout usually involves one joint and typically
affects the first toe. Bursitis is consistent with extra-articular pain that occurs in inflammatory
conditions. Osteomyelitis usually presents suddenly with a swollen joint and pain. This is more
commonly seen in children.
154. During late adolescence, achievements are marked by:
Answer: moral thinking
Explanation:
During the late adolescence, achievements are marked by moral thinking
155. By placing the patient in the supine position, the nurse practitioner raises the patient's
relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This
maneuver is known as:
Answer: the straight-leg raise
Explanation:
By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed
and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is

known as the straight leg raise and is used to evaluate sciatica. It is positive if there is pain
down the back of the leg below the knee. Ipsilateral calf wasting and weak ankle dorsiflexion
may be present.
156. The groove of the radiocarpal joint is located:
Answer: On the dorsum of the wrist (between the radial and ulna)
Explanation:
The groove of the radiocarpal joint is located on the dorsum of the wrist.
157. Inspection of the hip begins with careful observation of a patient's gait. A patient's foot
moves forward without bearing weight. This is known as the:
Answer: swing phase of gait
Explanation:
Inspection of the hip begins with careful observation of a patient's gait. There are 2 phases of
gait: stance and swing. The swing phase occurs when the foot moves forward and does not bear
weight. The stance phase occurs when the foot is on the ground bearing weight.
158. When assessing a preschooler's mouth, the number of deciduous teeth seen should be:
Answer: 16-20
Explanation:
Children get their first 20 deciduous teeth between the ages of 6 months and 5 years. Permanent
teeth begin to erupt around 6 years of age when the deciduous teeth begin to fall out. All 32
permanent teeth usually erupt by late adolescence.
159. The most common cause of bacterial pharyngeal infections in children is:
Answer: A beta-hemolytic Streptococcus
Explanation:
Pharyngitis is caused by swelling between the tonsils and the larynx. Most sore throats are
caused by colds, the flu, Coxsackie virus or mononucleosis. Bacteria that cause pharyngitis
include group A beta-hemolytic Streptococcus, and less commonly, Corynebacterium,
gonorrhea, and Chlamydia can cause sore throat.

160. A buildup of excess fluid around the periphery of the eye orbits is known as:
Answer: periorbital edema
Explanation:
An accumulation of fluid around the periphery of the eye orbits is known as periorbital edema.
161. Symptoms of acrocyanosis in the newborn include:
Answer: bluish color of the feet and the hands
Explanation:
Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and
typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively
common finding shortly after birth. The skin in the infant is usually well perfused, and the
tongue and mucous membranes in the mouth are pink, a finding that assures that central
cyanosis is not present.
162. The structure that creates a channel for the spinal nerve roots is known as the:
Answer: intervertebral foramen
Explanation:
The intervertebral foramen creates a channel for the spinal nerve roots. The vertebral foramen
encloses the spinal cord. The transverse foramen creates a channel for the vertebral artery. The
articular processes are located on each side of the vertebra at the junction of the pedicles and the
laminae, also referred to as the articular facets.
163. Retraction of the nipple and areola suggest:
Answer: an underlying breast mass
Explanation:
Retraction of the nipple and areola suggest an underlying breast mass. This is not normal and
never found in association with cystic breast disease or fibroadenoma.
164. If a patient presents with non-midline lumbar back pain, the nurse practitioner should
assess for:

Answer: muscle strain
Explanation:
For midline back pain, assess for musculoligamentous injury, disc herniation, vertebral collapse,
spinal cord metastases, and, rarely, epidural abscess. Muscle strain, sacroiliitis, trochanteric
bursitis, sciatica, and hip arthritis is suggestive of non-midline back pain. Pyelonephritis and
renal stones may also be suggestive of non-midline back pain.
165. On examination of the foot, the nurse practitioner notes acute inflammation of the first
metatarsophalangeal joint. This finding could be consistent with:
Answer: gout
Explanation:
Acute inflammation of the first metatarsophalangeal joint suggests gout.
166. When assessing a normal 5-year-old, the last site to assess would be the:
Answer: throat
Explanation:
The throat and mouth are considered invasive sites and should be performed last.
167. The palpation technique used to assess respiratory expansion of the chest is placing the
hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the
hand medially and grasping a small fold of skin between the thumbs. Then:
Answer: ask the patient to take a deep breathe and note any delay in expansion during
inhalation
Explanation:
To assess the respiratory expansion of the chest, the examiner places his hands on the eight or
tenth ribs posteriorly with the thumbs close to the vertebrae, slides the hand medially and grasps
a small fold of skin between the thumbs then asks the patient to take a deep breath. The thumbs
should move evenly away from the vertebrae during inspiration and there should be no delay in
expansion.

168. When assessing the skin, it is noted to be thickened, taut, and shiny in appearance. This
could be associated with:
Answer: scleroderma
Explanation:
Scleroderma appears as skin that is thickened, taut, and shiny in appearance. Psoriasis presents
as silvery, scaly papules or plaques, mainly on the extensor surfaces of the skin. In patients who
have hyperthyroidism, the skin has a velvety appearance and is usually warm to touch. Skin that
appears very dry, rough, and cool to touch can be associated with hypothyroidism.
169. The semimembranosus bursa of the knee lies:
Answer: on the posterior and medial surface of the knee
Explanation:
The large semimembranosus bursa lies on the posterior and medial surfaces of the knee. The
prepatellar bursa lies between the patella and the overlying skin. The suprapatellar pouch of the
knee lies upward and deep to the quadriceps muscle. The anserine bursa lies 1-2 inches below
the knee joint on the medial surface.
170. To test the supraspinatus, anterior and lateral deltoid, and pectoralis major, the nurse
practitioner would have the patient perform which shoulder movement.
Answer: Abduction
Explanation:
To test the supraspinatus, anterior and lateral deltoid, and pectoralis major, the nurse practitioner
would have the patient abduct his arm.
171. The term used to refer to skin that is peeling is:
Answer: exfoliation
Explanation:
Dark-colored adherent crust of dead tissue found on some ulcers is referred to as eschar.
Erythroderma occurs when a skin condition affects the whole body or nearly the whole body,
resulting in a red appearance all over. An excoriation is a scratch mark or surface injury
penetrating the dermis. Exfoliation refers to peeling skin.

172. A patient presents with midline, lumbar back pain. The nurse practitioner should assess for:
Answer: disc herniation
Explanation:
For midline back pain, assess for musculoligamentous injury, disc herniation, vertebral collapse,
spinal cord metastases, and, rarely, epidural abscess. Muscle strain, sacroiliitis, bursitis, and
sciatica is suggestive of non-midline back pain.
173. Orthopnea is typically associated with all of the following conditions except:
Answer: left ventricular hypertrophy: pulmonary embolus:mitral stenosis: obstructive lung
disease.
Explanation:
Orthopnea is defined as dyspnea that occurs when the patient is lying down and improves when
the patient sits or stands up. It is generally seen in patients with mitral stenosis, left ventricular
hypertrophy, and in obstructive lung disease. With a pulmonary embolus, the dyspnea is sudden
and uncomfortable in any position.
174. To assess the facial nerve (CN VII) for motor function in an infant, the nurse practitioner
would:
Answer: note facial symmetry while the infant cries or smiles
Explanation:
To access the facial nerve (CN VII) for motor function in an infant, the nurse practitioner would
note facial symmetry while the infant cries or smiles. The other choices do not assess the facial
nerve.
175. The nine to ten year old school aged child:
Answer: is conscious of fairness
Explanation:
By nine to ten years of age, the school aged child is able to perform several of the following
tasks: question the reason for things, demonstrate excessive concern with competition and
performance, overestimates own abilities, consider clubs important, conscious of fairness, and

usually likes reading and writing. The other choices are consistent with the development of a
11- 12 year-olds.
176. The forward slippage of one vertebrae resulting in spinal cord compression is referred to
as:
Answer: spondylolisthesis
Explanation:
The forward slippage of one vertebrae resulting in spinal cord compression is referred to as
spondylolisthesis.
177. When auscultating breath sounds in a patient who has left sided heart failure, the breath
sounds are:
Answer: Vesicular with late inspiratory crackles in the dependent portions of the lungs and
resonant on percussion
Explanation:
A patient with left sided heart failure experiences increased pressure in the pulmonary veins
causing congestion and interstitial edema. The breath sounds are vesicular with late inspiratory
crackles in the dependent portions of the lungs and are resonant on percussion. Consolidation in
the lungs produces bronchial breath sounds with late inspiratory crackles over the involved area
and is dull on percussion. A normal lung has vesicular breath sounds without adventitious
sounds and is resonant on percussion. Chronic obstructive lung disease produces decreased
breath sounds with some audible wheezes and is hyper resonant on percussion.
178. Assessment findings in a newborn at birth include: irregular respirations without crying,
heart rate of 105 beats/minute, grimaces with reflex stimulation, kicking of both feet, and
moving of both arms. The body and face are pink and hands and feet are cyanotic. What is the
APGAR score?
Answer: 7
Explanation:
APGAR stands for: Activity, Pulse, Grimace, Appearance, and Respiration. It is an objective
score of the condition of a baby immediately after birth and is determined by scoring the heart

rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of
these objective signs receives 0, 1, or 2 points. An Apgar score of 10 means an infant is in the
best possible condition. The Apgar score is done routinely 60 seconds after the birth of the
infant. A child with a score of 0 to 3 needs immediate resuscitation. The Apgar score is often
repeated 5 minutes after birth, and in the event of a difficult resuscitation. The Apgar score may
be done again at 10, 15, and 20 minutes. This infant's score is 7: He receives a 1 for respiration,
2 for heart rate, 1 for grimace, 1 for color, and 2 for activity. Scores 7 and greater are generally
considered to be normal.
179. A patient complains of severe epigastric pain that radiates to the posterior trunk and entire
abdomen. This type of pain can be suggestive of:
Answer: acute pancreatitis
Explanation:
Acute pancreatitis is inflammation of the pancreas. The pain is poorly localized in the abdomen,
therefore, can be epigastric and may radiate to the posterior trunk. Biliary colic, sudden
obstruction of the cystic or common bile ducts by a gallstone is characterized by pain in the
epigastric or right upper quadrant and may radiate to the right scapula or shoulder. Pain in the
periumbilical area that radiates to the right lower quadrant is usually seen in patients who have
appendicitis. Stomach cancer may presents with pain in the patient's epigastric area.
180. The patient has had an internal pacemaker in place for five years. Pacemaker failure is
being considered because over the past few days, the patient has been experiencing episodes of:
Answer: hiccoughs
Explanation:
Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation,
electrode dislocation, poor contact or interference by other tissues. Symptoms include dizziness,
light-headedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest.
Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of
pacemaker malfunction.
181. In an infant, a repetitive, short expiratory sound is known as:

Answer: grunting
Explanation:
In an infant, a repetitive, short expiratory sound is known as grunting and is a sign of respiratory
distress. The sound elicited with stridor would be a high-pitched, inspiratory noise. In an infant
with nasal flaring, an enlargement of both nasal openings would flare during inspiration.
Wheezing denotes a musical expiratory sound. All these conditions are signs of respiratory
distress in an infant.
182. The patella rests on the:
Answer: articulating surface of the femur
Explanation:
The patella rests on the anterior articulating surface of the femur midway between the
epicondyles, embedded in the tendon of the quadriceps muscle.
183. A six-year-old child presents with a few small vesicles that are honey colored and weeping
around the left nare. These lesions are consistent with:
Answer: impetigo
Explanation:
Impetigo usually appears as red crusty lesions on the face, especially around a child's nose and
mouth. The lesions burst and develop honey-colored crusts. Varicella is characteristic of
papules, vesicles, and crusted lesions occurring simultaneously. Herpes simplex on the lips and
mouth appear as small vesicles or blisters and are termed "fever blisters" or "cold sores".
Shingles appear as vesicles or blisters in clusters along the entire path of the nerve or in certain
areas supplied by the nerve.
184. To test the thumb for adduction, ask the patient to place the fingers and thumbs in the
neutral position with the palm up and move the thumb anteriorly away from the palm and then:
Answer: back to its neutral position
Explanation:
Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb
anteriorly away from the palm and then back to its neutral position assesses adduction. To test

the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To
test extension, ask the patient to move his thumb from the base of the fifth finger, across the
palm, and then as far away from the palm as possible. Touching the thumb to each of the other
fingers tests opposition. Placing the fingers and thumbs in the neutral position with the palm up
and moving the thumb anteriorly away from the palm assesses abduction.
185. A patient complains of an unpleasant abdominal fullness after a light meal. This complaint
may be consistent with:
Answer: diabetic gastroparesis
Explanation:
Complaints of an unpleasant abdominal fullness after a light or moderate meal, or the inability
to eat a full meal is often seen in patients with diabetic gastroparesis, gastric outlet obstruction,
gastric cancer, early satiety in hepatitis, or those taking anticholinergic medications.
186. Which technique would be least effective in gaining the cooperation of a toddler during a
physical exam?
Answer: Tell the child that another child the same age was not afraid
Explanation:
Telling the child that another child the same age was not afraid would not be an effective
technique as a toddler is unable to process that concept. The other choices are appropriate
techniques.
187. While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a
pain sensation on the right cheek. This finding could be consistent with a:
Answer: cranial nerve disorder
Explanation:
While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient
reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve
disorder, such as trigeminal neuralgia.

188. Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation
of the head. This condition is suggestive of:
Answer: torticollis
Explanation:
Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation of
the head. This condition is suggestive of torticollis.
189. If a patient describes his stool as thin and "pencil-like", this could be associated with:
Answer: a lesion in the sigmoid colon
Explanation:
Thin, pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid colon.
Constipation produces hard, dry stool. In the presence of haemorrhoids, the stool may appear
blood streaked. Crohn's disease may present with blood, mucus, or pus in the stool.
190. When evaluating the six cardinal directions of gaze, a loss of conjugate movements is
noted when the patient looks to his left. This finding could be consistent with damage to which
cranial nerve?
Answer: Nerve IV (CN IV)
Explanation:
To evaluate the extraocular movements in the six cardinal directions of gaze, the examiner
should look for loss of conjugate movements in any of the six directions. If there is
discongruent gaze, this could be suggestive of damage to cranial nerves CN III, IV, and VI Oculomotor, Trochlear, and Abducens nerves.
191. With Duchenne muscular dystrophy:
Answer: include a waddling gait, lordosis and presence of Gower's sign
Explanation:
Duchenne muscular dystrophy (DMD) is an X-link inherited recessive disorder and is passed
from mother to male offspring. DMD is a congenital disorder with symptoms appearing during
the 2nd and 3rd year of life. Tremors, hypertonicity and seizures are more consistent with
cerebral palsy. Waddling gait, lordosis and Gower's maneuver are signs of DMD. Gower's sign

is classic for DMD. The patient has to use his hands and arms to "walk" up his own body from a
squatting position due to lack of hip and thigh muscle strength.
192. o estimate the expected date of delivery (EDD) using Naegele's rule, if the last menses was
March 3, 2014, the EDD would be:
Answer: December 10, 2014
Explanation:
The expected date of delivery is 40 weeks from the first date of the LMP. Using Naegele’s rule,
the EDD can be estimated by taking the LMP, adding 7 days, subtracting 3 months, and adding
1 year.
193. Adventitious breath sounds, such as crackles, are:
Answer: popping, frying sounds, may be low or high-pitched and usually heard on inspiration
Explanation:
Crackles are termed coarse, medium, or fine and usually produce a popping, frying sound.
Coarse crackles are low-pitched while fine crackles are high-pitched. Coarse sounds are heard
on inspiration and sometimes expiration, medium crackles in the middle of inspiration, and fine
crackles at the end of inspiration. Rhonchi are continuous, low-pitched and heard on expiration.
Wheezes are continuous high-pitched and musical. A pleural friction rub produces a dry, grating
sound.
194. The term used to describe low back pain with nerve pain that radiates down the leg is:
Answer: sciatica
Explanation:
The term used to describe low back pain with nerve pain that radiates down the leg is sciatica.
Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially
in the hands, frequently occurring with impending hepatic coma and other forms of metabolic
encephalopathy. This is also called flapping tremor. A dermatome is a band of skin innervated
by the sensory root of a single spinal nerve. Stereognosis refers to the ability to identify an
object by feeling it.

195. When the term rubor is used in describing the skin, it means that the appearance is:
Answer: dusky red
Explanation:
Rubor is a term used to describe the response of the skin to inflammation. Skin that appears
dusky red is rubor.
196. Assessment findings in an infant with increased intracranial pressure would include:
Answer: drowsiness
Explanation:
Symptoms of increased intracranial pressure in an infant include: drowsiness, separated sutures
on the skull, bulging fontanel, and vomiting. Papilledema can be observed in people of any age,
but is relatively uncommon in infants because the bones of the skull are not fully fused together
at this age.
197. When suspecting pediculosis capitis, the chief complaint is:
Answer: itching
Explanation:
With pediculosis capitis (lice), itching is the most common symptom and is caused by an
allergic reaction. Lice will bite the skin in order to feed on the infected person's blood. Saliva
from these bites causes the allergic reaction and itching. The lice lay eggs that eventually hatch
which causes more irritation. Vesicles, fluid filled lesions, are not usually seen in this condition.
Alopecia may be seen with tinea capitis.
198. What geriatric condition is characterized by reduction in physical or mental capacity
sufficient to interfere with managing day to day tasks?
Answer: Functional impairment
Explanation:
Functional impairment is a health condition in which the normal function of a part of the body is
less than full capacity. One of the defining characteristics of functional impairment is that the
reduction in physical or mental capacity is sufficient to interfere with managing day-to-day
tasks. Delirium is a serious disturbance in a person's mental abilities that results in a decreased

awareness of one's environment and confused thinking. In the older adult, it is defined as a
geriatric syndrome or condition occurring as a temporary state of confusion and may be the first
clue to infection or problems with medications. Cognitive impairment is an intermediate stage
between the expected cognitive decline of normal aging and the more serious decline of
dementia. A multifactorial geriatric condition or syndrome characterized by an age-related lack
of adaptive physiological capacity occurring in the absence of identifiable illness is known as
frailty.
199. If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the
index finger should be inserted into the vagina and:
Answer: milk the urethra gently from the inside outward
Explanation:
If urethritis or inflammation of the paraurethral glands is suspected, the examiner should insert
the index finger into the vagina and milk the urethra gently from inside outward. Note any
discharge from or about the urethral meatus. If present, it should be cultured.
200. When palpating the carotid pulse, it is important to:
Answer: position the patient in the lying or sitting positions
Explanation:
The carotid artery should be palpated gently and while the patient is sitting or lying down. The
patient's chin should be elevated to allow easy palpation and yet not enough to tighten the neck
muscles. Stimulating its baroreceptors with low palpation can provoke severe bradycardia or
cause cardiac arrest in some sensitive persons. Also, carotid arteries should never be palpated at
the same time. This may limit blood flow to the head, possibly leading to fainting or cerebral
ischemia. A carotid pulse is palpable between the anterior border of the sternocleidomastoid
muscle, above the hyoid bone and lateral to the thyroid cartilage
201. A 40 -year-old male states that he felt "something" above his left testis. On examination, a
painless cyst is noted above the left testicle. Transillumination is positive. This is consistent
with a:
Answer: spermatocele of the epididymis

Explanation:
A painless, movable cystic mass just above the testicle suggests a spermatocele or an
epididymal cyst. Both transilluminate and are difficult to distinguish clinically. An acutely
inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle.
Additionally, the scrotum may be reddened and the vas deferens inflamed. Coexisting urinary
tract infection, or prostatitis, supports the diagnosis. Varicocele refers to varicose veins of the
spermatic cord, usually found on the left. It feels like a soft “bag of worms" upon palpation of
the scrotum. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely
painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes
red and edematous. There is no associated urinary infection.
202. During pregnancy, a patient's fundal height measured 26 centimeters. This would suggest
that the gestational age was:
Answer: 26 weeks
Explanation:
Uterine fundal height measured in centimeters correlates with gestational age between 18 and
34 weeks. Fundal height is measured in centimeters from symphysis pubis to top of uterus. This
is know as McDonald's rule.
203. When assessing the patient's sense of position, instruct the patient to first stand with his
feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses
his balance with his eyes closed, this is:
Answer: suggestive of ataxia related to dorsal column disease
Explanation:
When assessing the patient's sense of position, instruct the patient to first stand with his feet
together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his
balance with his eyes closed, this is a positive Romberg test and suggestive of ataxia related to a
dorsal column disease. In cerebellar ataxia, the patient has difficulty standing with feet together
whether the eyes are open or closed. With corticospinal tract damage, the gait is affected and the
patient is unable to heel walk.

204. The group of muscles that lies medial and swings the thigh toward the body is known as
the:
Answer: adductor group
Explanation:
The group of muscles that lies medial and swings the thigh toward the body is known as the
adductor group. The group of muscles that lies laterally and swings the thigh away from the
body is known as the abductor group. The group of muscles that lies posteriorly and extends the
thigh is known as the extensor group. The group of muscles that lies anteriorly and flexes the
thigh is known as the flexor group.
205. In the older adult, the test for leg mobility is known as the:
Answer: timed "get up and go test"
Explanation:
The test for leg mobility, also known as the timed “get up and go” test for gait and balance, is an
excellent screen for risk of falling. Ask the patient to get up from a chair, walk 10 feet, turn, and
return to the chair. Most older adults can complete this test in 10 seconds.
206. Examination of the nasolacrimal duct reveals a mucopurulent discharge from the puncta.
This finding is suggestive of:
Answer: an obstructed nasolacrimal duct
Explanation:
An obstructed nasolacrimal duct would present with a mucopurulent discharge from the puncta
of the eye. Conjunctivitis is an inflammation of the conjunctiva and findings include red,
burning, and itchy eyes. Dacryocystitis is an inflammation of the lacrimal sac, the area between
the lower eyelid and the nose. Dacryocystitis presents as a painful, red, and tender area around
the eye especially near the nose. A pinguecula refers to a harmless yellowish triangular nodule
noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in
patients who are exposed chronically to dust.
207. When trying to determine the level of consciousness in a patient whose level of
consciousness is altered, a comatose patient:

Answer: unarousable with eyes closed
Explanation:
A comatose patient remains unarousable with eyes closed. There is no evident response to inner
need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the
examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and
looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient
arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into
an unresponsive state.
208. When performing an examination of the rectal area, a linear tear at the anal opening was
observed. This could be indicative of:
Answer: .an anal fissure
Explanation:
A linear crack or tear suggests an anal fissure from large, hard stools, inflammatory bowel
disease, or sexually transmitted diseases.
209. When examining the prostate gland the examiner should inform the patient that this
procedure may:
Answer: prompt an urge to urinate
Explanation:
When examining the prostate gland on a male patient, the examiner should inform the patient
that this procedure may prompt an urge to urinate but reassure him that he will not void on
himself.
210. When administering ear drops to a 6-year-old, the pinna should be pulled:
Answer: upward and back
Explanation:
To examine the ears of an infant it is usually necessary to pull the auricle backward and
downward. In the older child, the external ear is pulled backward and upward.

211. A patient who is being evaluated for frequent headaches, mentions that the headache
worsens with coughing, sneezing, or when changing positions. Increasing pain with these
maneuvers may be suggestive of:
Answer: a brain tumor
Explanation:
If coughing, sneezing, or changing positions increases the pain associated with the headache,
sinusitis or a brain tumor may be considered. Migraines may present with symptoms of nausea
and vomiting. Brain tumors and subarachnoid haemorrhages can also present with nausea and
vomiting.
212. When assessing the knee, the examiner instructs the patient to sit and swing his lower leg
away from midline. This motion would assess knee:
Answer: external rotation
Explanation:
Instructing the patient to swing his leg away from his midline while sitting assesses external
rotation of the knee. Having the patient straighten his leg assesses extension of the knee. The
examiner instructs the patient to bend his knee. This maneuver assesses knee flexion. Internal
rotation of the knee is elicited by having the patient swing his lower leg toward the midline
while sitting.
213. By five years of age, the child is:
Answer: perform a somersault
Explanation:
By five years of age, the child is able to perform several of the following tasks: perform a
somersault, hop and skip, swing and climb, use the toilet without assistance in cleaning self, and
stand on one foot at least 10 seconds. The other choices are consistent with the physical
development of a 6 year-old.
214. A condition that involves optic nerve damage and visual field changes is termed:
Answer: glaucoma
Explanation:

Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that
produces optic nerve damage and visual field changes. The risk of glaucoma increases with age
but can occur in anyone in any age-group. Retinoblastoma is a rapidly developing tumor and is
the most common malignant tumor of the eye in children. A cataract is an opacity of the lens
and may be seen through the pupil. Pterygium is a triangular thickening of the bulbar
conjunctiva that grows slowly across the outer surface of the cornea and may interfere with
vision but does not cause blindness.
215. Vasculitis on the extremities and an erythematous to salmon-colored rash over the trunk are
skin lesions that may be attributed to:
Answer: rheumatoid arthritis
Explanation:
Erythematous to salmon-colored rashes are skin conditions associated with rheumatoid arthritis.
Scleroderma presents as a thickened, taut, and shiny skin appearance. Systemic lupus
erythematosus associated skin lesions include: malar (butterfly) rash, discoid rash, alopecia,
vasculitis, oral ulcers, and Raynaud’s phenomenon. Thrombocytopenia presents with
generalized petechiae and ecchymosis.
216. A 45-year-old patient complains of vertigo, tinnitus and pressure in the right ear. These
symptoms are consistent with:
Answer: Meniere's disease
Explanation:
Meniere's Disease begins with a episodic vertigo and a feeling of fullness or pressure in the
affected ear along with fluctuating tinnitus. Dizziness associated with benign positional vertigo
typically occurs when the patient rolls over onto the affected side or with tilting the head
upward. Nausea and vomiting may be present. Cluster headaches are usually one sided and the
patient often has a runny nose with reddening and tearing of the nose without mention of
dizziness. In vestibular neuronitis, the dizziness is sudden followed by nausea and vomiting
without tinnitus.

217. With the adult patient lying supine, the nurse practitioner flexes the patient's neck while
observing the hips and knees. Flexion of both hips and knees was noted. This is a positive:
Answer: Brudzinski's sign
Explanation:
To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for
Brudzinski's sign. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and
then straighten the knee. Pain and increased resistance to extending the knee are positive for
Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the
patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness
with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of
meningeal inflammation from meningitis or subarachnoid haemorrhage. To elicit the Babinski
response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of
an applicator stick; plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's
sign.
218. Immediate treatment for a sprain includes:
Answer: rest and cold applications
Explanation:
Resting the extremity and applying ice is the most immediate actions to relieve swelling of the
injured joint. Rest and elevation are appropriate, but giving pain medication immediately may
mask more serious problems. Compression is appropriate for sports injuries, but heat
application should not be an immediate action. While rest is important after a sprain, early
mobility hastens recovery.
219. The vertebral column angles sharply posteriorly and becomes immovable at the:
Answer: lumbosacral junction
Explanation:
The vertebral column angles sharply posteriorly and becomes immovable at the lumbosacral
junction. The intervertebral discs cushion movement between vertebrae and allow the vertebral
column to curve, flex, and bend. The coccyx is the final segment of the vertebral column and

serves as an attachment for various tendons, muscles, and ligaments. It also supports weight
while sitting. The sacroiliac joint overlays the posterior superior iliac spine.
220. When auscultating heart sounds in a newborn, if a louder than normal pulmonic component
(P2) is audible, suspect:
Answer: pulmonary hypertension
Explanation: The aortic (A2), or first component of the second sound at the base, is normally
louder than the pulmonic (P2), or second component. A louder than normal pulmonic
component, particularly when louder than the aortic sound, suggests pulmonary hypertension.
221. The nurse practitioner places an infant lying supine on the exam table, and turns the head
to one side, holding the jaw over the shoulder. The arms and legs on the side to which the head
is turned extend, while the opposite arm and leg flex. This maneuver assesses:
Answer: the asymmetric tonic neck reflex
Explanation:
The maneuver described assesses the asymmetric tonic neck reflex. Moro or startle reflex
assesses arm abduction and extension, open hands, and flexed legs in response to a loud noise.
To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head
will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited
when the infant is supported prone with one hand, and then one side of the back (one centimeter
from the midline), is stroked from the shoulder to the buttocks. The spine should curve toward
the stimulus.
222. When performing a rectal exam, a reddish, moist, protruding mass is noted at the anal
opening. This finding is most likely a(n):
Answer: a prolapsed internal haemorrhoid
Explanation:
Internal haemorrhoids are enlargements of the normal vascular cushions located above the
pectinate line. They are not usually visible but may become visible if prolapse occurs after
defecation. They would appear in the anal canal as reddish, moist, protruding masses. External
haemorrhoids are dilated hemorrhoidal veins that originate below the pectinate line and are

covered with skin. They present as tender, swollen, bluish, ovoid masses at the anal margin. A
tender, purulent, reddened mass palpated in the rectum would be consistent with an anal
abscess, especially in the presence of fever and chills. Rectal polyps are typically located in the
rectum and ,if palpable, feel soft to touch.
223. A chancre is defined as a:
Answer: painless ulceration
Explanation:
A chancre is defined as a painless ulceration formed during the primary stages of syphilis. A
group of scattered small vesicles is associated with genital herpes. Papules appearing in many
shapes that can be raised, flat, or cauliflower-like are characteristic of genital warts
(condylomata acuminata). Non-tender indurated nodules are associated with carcinoma of the
penis.
224. A discriminative sensation that describes the ability to identify an object by feeling it is:
Answer: stereognosis
Explanation:
A discriminative sensation that describes the ability to identify an object by feeling it is
stereognosis. The patients eyes must be closed. Graphesthesia, or number identification, is the
ability to identify a number when drawn in the hand of a patient whose eyes are closed. The
ability to identify an object touching 2 areas simultaneously is termed two-point discrimination.
Astereognosis is a term used to describe the inability to recognize objects placed in the hand.
225. Newborns are classified according to their gestational age and weight. A newborn weighing
less than 2,500 grams at birth is:
Answer: low birth weight
Explanation:
A newborn weighing less than 1,000 grams at birth is classified as an extremely low birth
weight; less than 1,500 grams as very low birth weight; less than 2,500 grams as low birth
weight; and greater than 2,500 grams as normal birth weight.

226. On ophthalmoscopic examination, optic atrophy appears:
Answer: white
Explanation:
In optic atrophy, there is death of the optic nerve fibers. This leads to loss of the tiny disc
vessels giving a white appearance. A pink and hyperaemic disc is seen in patients with
papilledema. The normal disc appears yellowish-orange to creamy pink and the disc vessels are
tiny with disc margins that appear sharp. A pale disc with a backward depression is
characteristic of glaucomatous cupping.
227. Examination of the abdomen reveals a small midline protrusion in the linea alba. This
finding is consistent with an:
Answer: epigastric hernia
Explanation:
The linea alba runs from the xiphoid process to the pubic symphysis. The presence of a small
midline protrusion through a defect in the linea alba suggests an epigastric hernia. An incisional
hernia is a protrusion through an operative scar. A protrusion through a defective umbilical ring
is termed an umbilical hernia. This condition is commonly seen in infants. An inguinal hernia
presents as a protrusion of abdominal contents in the inguinal canal. The inguinal canal is
situated just above the medial half of the inguinal ligament in the area of the groin on both sides
of the abdomen.
228. An irregular shaped bony feature at the lateral top of the femur is known as the:
Answer: greater trochanter
Explanation:
An irregular shaped bony feature at the top of the femur is known as the greater trochanter. It is
not to be confused with the head of the femur.
229. Leucoplakia was noted during an exam of the mouth. This symptom may be:
Answer: precancerous
Explanation:

Leucoplakia are thickened white patches located on any area of the mouth. These patches
cannot be rubbed off. Most are not serious but some can be considered precancerous. Therefore,
they should be evaluated. These lesions are not considered normal findings. Periodontal disease
usually includes an infection of the gums and may involve the teeth. Generally, the infection
causes redness and swelling but not white patches.
230. Metatarsalgia is a term used to describe:
Answer: pain and tenderness in the metatarsals
Explanation:
Metatarsalgia is a term used to describe pain and tenderness in the metatarsals. Activities such
as running and jumping and wearing ill-fitting shoes can cause this condition.
231. During pregnancy, if fundal height is 4 centimeters larger than expected, consider all of the
following except:
Answer: large for gestational age infant extra amniotic fluid uterine leiomyoma fetal anomaly
Explanation:
If fundal height is 4 centimeters or larger than expected, consider multiple gestation, a large
fetus, extra amniotic fluid, or uterine leiomyoma. If fundal height is 4 centimeters or smaller
than expected, consider low level of amniotic fluid, missed abortion, intrauterine growth
restriction, or fetal anomaly. All of these conditions should be investigated by ultrasound.
232. Which one of the following ligaments of the foot is most at risk for injury from inversion?
Answer: Anterior talofibular
Explanation:
The three ligaments of the foot with higher risk for injury are the anterior talofibular ligament,
the calcaneofibular ligament and the posterior talofibular ligament. The anterior talofibular
ligament is most at risk in injury from inversion (heel bows inward) injuries.
233. On assessment, which one of the following symptoms would be noted as a compensatory
response to chronic hypoxia?
Answer: Hematocrit (HCT) of 55%

Explanation:
With chronic hypoxia, the body attempts to improve tissue oxygenation by producing additional
red blood cells and thereby increasing the oxygen carrying capacity of the blood; this condition
is termed polycythemia. Clubbing is a classic symptom of chronic hypoxia. Lab values denoting
increased RBC such as HCT of 55-60% would be indicative of polycythemia. Pulmonary
hypertension is a clinical consequence of increased pressure in the pulmonary arteries and is
seen in children with congenital heart defects but it is not a direct result of hypoxia.
Dehydration can occur rapidly in children with cyanotic heart defects; however, it is not a
compensatory mechanism of chronic hypoxia. Anemia may develop as a result of poor tissue
oxygenation secondary to decreased blood viscosity not increased as in polycythemia.
234. By four years of age, the child is able to:
Answer: say a poem from memory
Explanation:
By four years of age, the child is able to perform several of the following tasks: say a poem or
sing a song from memory, tell stories, say first and last name, and know some basic rules of
grammar like "he" and "she". The other choices are consistent with the language development
of a 5 year-old.
235. Hyperpigmentation of the skin and mucous membranes can be seen in patients who:
Answer: Addison's Disease
Explanation:
Hyperpigmentation of skin and mucous membranes is usually seen in patients who have
Addison's Disease. Hairy leukoplakia can be seen in patients who have AIDS.
Cushing's disease can present with any of the following skin lesions: striae, skin atrophy,
purpura, ecchymosis, telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis.
Diabetes may produce any of these skin conditions: necrobiosis lipoidica diabeticorum, diabetic
bullae, diabetic dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic
ulcers, eruptive xanthomas, and peripheral vascular disease.

236. The nurse practitioner instructs the patient to bend forward and try to touch his toes. This
maneuver would elicit:
Answer: flexion of the lumbar spine
Explanation:
Bending forward while trying to touch the toes is an example of flexion of the lumbar spine.
Extension would be noted by having the patient bend backward as far as possible. Instructing
the patient to rotate from side to side in a standing position would create rotation of the back.
Bending to the side from the waist would be an example of lateral bending.
237. The area at the posterior aspect of the spine lateral to the sacroiliac joint is known as the:
Answer: posterior superior iliac spine
Explanation:
The posterior superior aspect of the spine lateral to the sacroiliac joint is known as the posterior
superior iliac spine. The ischial tuberosity is a large swelling posteriorly on the superior ramus
of the ischium. It marks the lateral boundary of the pelvic outlet and bares most of the weight
when sitting. The superior ramus of pubis are the pubic bones that help form the obturator
foramen. The pubic symphysis is a cartilage-like articulation between the pubic bones.
238. A 55-year-old patient visits the nurse practitioner for an annual exam. Stool sample
revealed hematochezia. The patient is otherwise asymptomatic. This finding could be associated
with:
Answer: ischemic colitis
Explanation:
Blood in the stools, hematochezia, is often the only symptom seen with adenomatous polyps.
Although adenomatous polyps are benign, they are the most common cause of colorectal cancer.
Lower abdominal pain accompanied by fever or shock in older adults could be consistent with
ischemic colitis. Generally, the abdomen is soft on palpation. Hemorrhoids typically present
with noticeable blood on the tissue paper, surface of stool, or dripping in the toilet. Colon cancer
can cause bloody stool but usually presents with changes in bowel habits and weight loss.
239. When inspecting the face, asymmetry is noted. This finding could be suggestive of:

Answer: temporomandibular joint dysfunction syndrome
Explanation:
Facial asymmetry can be seen in temporomandibular joint dysfunction syndrome (TMJ).
240. A teenager presents with signs of being gleeful, somewhat drowsy, and unable to focus. On
examination , B/P 90/65, pupils constricted, and speech slurred. These symptoms are consistent
with:
Answer: opioid intoxication.
Explanation:
Opioid intoxication may cause euphoria, drowsiness, constricted pupils, memory and judgment
impairment, and slurred speech. Impaired memory, poor judgment, and inattention, slurred
speech, drowsiness, and irritability are suggestive of central nervous system depressants (CNS).
Barbiturates, alcohol and benzodiazepines fall in this class. Amphetamines are CNS stimulants.
The teenager would exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial
infarction, or death. Marijuana intoxication would present with relaxation, euphoria,
detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia.
241. The posterior auricular lymph node is located:
Answer: superficial to the mastoid process
Explanation:
The posterior auricular nodes are superficial to the mastoid process. The preauricular lymph
nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible.
The occipital lymph nodes are located at the base of the skull posteriorly
242. A serious disturbance in a person's mental abilities that results in a decreased awareness of
one's environment and confused thinking is referred to as:
Answer: delirium
Explanation:
Delirium is a serious disturbance in a person's mental abilities that results in a decreased
awareness of one's environment and confused thinking. In the older adult, it is defined as a
geriatric syndrome or condition occurring as a temporary state of confusion and may be the first

clue to infection or problems with medications. A multifactorial geriatric condition or syndrome
characterized by an age-related lack of adaptive physiological capacity occurring in the absence
of identifiable illness is known as frailty. Cognitive impairment is an intermediate stage between
the expected cognitive decline of normal aging and the more serious decline of dementia.
Functional impairment is a health condition in which the normal function of a part of the body is
less than full capacity. One of the defining characteristics of functional impairment is that the
reduction in physical or mental capacity is sufficient to interfere with managing day-to-day
tasks.
243. When compressing the suprapatellar pouch and pushing the patella sharply against the
femur, fluid is noted to return to the suprapatellar pouch. This is known as a positive:
Answer: balloting sign (see 52)
Explanation:
A positive bulge sign or ballottement indicates the presence of excess synovial fluid, which can
occur in various conditions such as arthritis, trauma, or infection.
244. Disorders of speech fall into three groups that affect all of the following except the:
Answer: written language
Explanation:
Disorders of speech fall into three groups affecting: (1) the voice, (2) the articulation of words,
and (3) the production and comprehension of language. The written language is not included in
the disorders of speech.
245. To test the thumb for opposition, ask the patient to:
Answer: touch the thumb to each of the other fingertips. (152)
Explanation:
During the test, observe if the patient can touch the tip of the little finger with the thumb easily
and whether they can do so without difficulty or pain.
246. Assessing the neurological status of a child with a ventriculoperitoneal shunt should
include:

Answer: use of the Glasgow coma scale
Explanation:
The Glasgow coma scale addresses eye, verbal, and motor responses to determine a
neurological assessment score and is the first sign of improvement or deterioration in
neurological status.
Also, signs of increased intracranial pressure should be assessed. Kernig's sign is any resistance
or pain when the child is supine and the leg is extended and knee bent. A positive sign is more
consistent with meningitis. Brudzinski's sign is an involuntary flexion of the knee or hip when
the child is in the supine position and the neck is flexed and is also consistent with meningitis.
The Monroe-Kellie Doctrine states that the sum of brain, CSF, and blood within the cranial
vault is constant. So an increase or decrease in one causes a compensatory increase or decrease
in one or both of the others. It is an hypothesis and not an assessment.
247. A patient presents with persistent thoughts of contamination, and dressing and undressing
rituals. These symptoms are consistent with:
Answer: obsessive -compulsive disorder (OCD)
Explanation:
Obsessive-compulsive disorder is characterized by recurrent, irrational, obsessive thoughts and
uncontrollable compulsive behaviors. Control of self, others and the environment is of utmost
importance. Posttraumatic stress disorder is associated with exposure to an extremely traumatic
situation or event: witnessing an accidental death, experiencing rape, or torture. Panic disorder
is characterized by recurrent panic attacks. General anxiety disorder is characterized by
pervasive, persistent anxiety of at least 6 months duration without panic attacks.
248. A twelve-month-old was recently diagnosed with Acquired Immunodeficiency Syndrome
(AIDS). The mother asks the nurse practitioner: "How could my child have acquired AIDS?"
The best response from the nurse practitioner should be that: "Children under two years of age
usually acquire AIDS:
Answer: perinatally through an HIV infected mother
Explanation:

Perinatally is the acquired mode for infants. Children usually over five years of age acquire
AIDS through sexual abuse. HIV does not survive in the environment and there is no evidence
to date to support the fact That AIDS is acquired through casual contact or by sharing car seats
with HIV infected seats.
249. The Sexual Maturity Rating in boys includes 5 stages. Characteristics indicative of Stage 4
would include:
Answer: coarse and curly hair as in the adult covering the pubic area, enlargement in length and
breadth of the penis and enlargement of the testes and scrotum with scrotal skin darkened
Explanation:
The Sexual Maturity Rating is also termed Tanner Staging, named after Dr. James Tanner. The
stages are characterized by the following findings: Stage 1: prepubertal: absent pubic hair, same
size, proportion of penis, testes, scrotum as in childhood; Stage 2: Sparse growth of long downy
hair at the base of the penis, minimal or no enlargement of penis, enlargement of testes,
pigmentation of scrotal sac; Stage 3: Increase in amount of pubic hair with curling, significant
enlargement in penis, further enlargement of testes; Stage 4: Pubic hair is adult like in type but
not distribution, development of facial and axillary hair, further enlargement of testes and penis;
Stage 5: Pubic hair in medial aspects of thighs; linea alba.
250. A slow, persistent fungal infection of fingernails and toenails is:
Answer: onychomycosis
Explanation:
Onychomycosis is a slow, persistent fungal infection of fingernails and toenails causing change
in color, texture, and thickness. The nail may crumble or break with loosening of the nail plate,
usually beginning at the distal edge and progressing proximally. Leukonychia is a white
discoloration appearing on nails. The most common cause is injury to the base of the nail (the
matrix) where the nail is formed. Psoriasis of the nails may appear as small pits in the nail.
Paronychia is red, swollen, tender inflammation of the nail folds.
251. What part of the ear consists mainly of cartilage covered by skin and has a firm yet
somewhat elastic feature?

Answer: Auricle
Explanation:
The auricle is made of cartilage covered by skin and has a firm, elastic consistency. The external
ear consists of the auricle and ear canal. The auricle has a prominent curved outer ridge known
as the helix. The antihelix is a curved prominence that is parallel and anterior to the helix. The
ear canal opens behind a nodular protuberance that points backward over the entrance to the
canal. This is called the tragus.
252. When examining the ankle and foot of a patient, the nurse practitioner instructs the patient
to point the foot toward the ceiling. This motion assesses:
Answer: ankle extension
Explanation:
Having the patient point the foot toward the ceiling assesses ankle extension. Having the patient
point the foot toward the floor assesses ankle flexion. Having the patient move the heel inward
assesses inversion. Having the patient move the heel outward assesses eversion.
253. When performing a pelvic exam on a pregnant woman, a larger speculum may be needed
because of:
Answer: vaginal wall relaxation
Explanation:
Because of vaginal wall relaxation, a larger than usual speculum may be needed.
254. According to the Tanner stages of development (Sexual Maturity Rating), breast
development in Stage 5 in females includes the:
Answer: projection of the nipple only
Explanation:
According to the Tanner stages of development (Sexual Maturity Rating), breast development in
Stage 5 in females includes projection of the nipple only. This is called the mature stage. Areola
has receded to general contour of the breast although in some normal individuals, the areola
continues to form a secondary mound.

255. During pregnancy, a palpable softening of the cervical isthmus is noted. This finding is:
Answer: Hegar's sign
Explanation:
Hegar’s sign is the palpable softening of the cervical isthmus, the portion of the uterus that
narrows into the cervix. Increased vascularity throughout the pelvis during pregnancy gives the
vagina a bluish color, known as Chadwick’s sign. As the skin over the abdomen stretches to
accommodate the fetus, purplish striae gravidarum (“stretch marks”) may appear. Linea nigra is
a brownish black pigmented vertical stripe along the midline skin of the abdomen.
256. Physical signs associated with cervical myelopathy from cervical cord compression
include:
Answer: flexion with resulting sensation of electrical shock radiating down the spine
Explanation:
Physical signs associated with cervical myelopathy from cervical cord compression may include
hyperreflexia, clonus at the wrists, knee or ankle, gait disturbances and positive Lhermitte's
sign: neck flexion with resulting sensation of electrical shock radiating down the spine.
Weakness in the triceps and finger flexors and extensors is associated with cervical
radiculopathy from nerve root compression. Mechanical neck pain with whiplash results in
decreased neck range of motion, perceived weakness of the upper extremities, and paracervical
tenderness. Local neck muscle tenderness is associated with mechanical neck pain.
257. Weight gain should be monitored during pregnancy. For a pregnant woman whose BMI is
Answer: 18. 5 - 24.9, the total weight gain should be: 11-20 pounds 15-25 pounds 25-35
pounds Correct 28-40 pounds.
Explanation:
Weight gain should be closely monitored during pregnancy, as both excessive and inadequate
weight gain are associated with poor birth outcomes. The pregnant woman who has a BMI of <
18.5, should gain 28-40 pounds; BMI 18.5-24.9 should gain 25-35 pounds; BMI 25-29.9 should
gain 15-25 pounds; and the obese pregnant woman should gain 11-20 pounds.

258. A patient has a papule with an ulcerated center on the lower lid and medial canthus of the
eye. This is consistent with:
Answer: basal cell carcinoma
Explanation:
Although a basal call carcinoma of the eyelid is uncommon, it does occur most often on the
lower lid and medial canthus. It looks like a papule with an ulcerated center. Metastasis is rare
but should be referred for removal. Dacryocystitis is an infection and blockage of the lacrimal
sac and duct. Hordeolum is often secondary to localized staphylococcal infection of the hair
follicles at the lid margin. Chalazion is a beady nodule protruding on the lid
259. To palpate the trochanteric bursa, position the patient:
Answer: on one side, hip flexed, and internally rotated
Explanation:
To palpate the trochanteric bursa, position the patient on one side, hip flexed, and internally
rotated.
260. Bowel sounds may be decreased in the presence of:
Answer: peritonitis
Explanation:
Bowel sounds are decreased then absent in adynamic ileus and peritonitis. They are decreased in
constipation. Bowel sounds may be increased in the presence of diarrhoea or early intestinal
obstruction and ulcerative colitis.
261. On ophthalmoscopic exam of the older adult, there is an increased cup-to-disc ratio: This
finding is suggestive of:
Answer: open angle glaucoma
Explanation:
The cup-to-disc ratio compares the diameter of the "cup" portion of the optic disc with the total
diameter of the optic disc. In glaucoma, an increase in intraocular pressure will damage the
delicate nerve fibers and produces additional cupping of the optic disc. As glaucoma worsens,
the cup enlarges until it occupies most of the disc area.

262. When examining the elbow for range of motion, the nurse practitioner instructs the patient
to turn his palm upward. This motion is an example of:
Answer: supination.
Explanation:
Instructing the patient to turn his palm upward is supination. Extension occurs with
straightening the elbow. Flexion occurs with bending the elbow. Turning the palms downward
demonstrates pronation.
263. A 6-month-old presents today for a well child visit. He is sitting in his mother's lap.
Assessment should begin with:
Answer: auscultating the heart and lungs
Explanation:
When assessing a quiet infant, auscultate the heart and lungs first. The other parts of the exam
may cause the infant to cry making auscultation of heart and breath sounds difficult to hear.
264. A patient complains of a tight, bursting pain in the calf that increases with walking.
Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with:
Answer: deep venous thrombosis
Explanation:
Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as
tight, and bursting around the affected area. The pain may be accompanied by swelling and
tenderness. Reynaud's disease usually affects the distal portions of the fingers and causes pain
especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due
to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The
pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or
foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds.
265. Which nerve in the arm originates in the axilla and travels down the arm in a shallow
depression on the surface of the humerus?
Answer: Radial nerve

Explanation:
The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial
groove) on the surface of the humerus. The median nerve is located on the ventral forearm and
is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in
the ulnar groove between the medial epicondyle and the olecranon process. The brachial plexus
runs from the spine through the neck, the axilla, and into the arm.
266. Winging of the scapula can be noted in patients with all of the following conditions except:
Answer: • liver disease.
• injury to the long thoracic
• nerve muscular dystrophy.
• weakness of the serratus anterior muscle
Explanation:
Normally, the scapulae lie close to the thorax. However, in winging of the scapula the medial
border of the scapula juts backward. It suggests weakness of the serratus anterior muscle, seen
in muscular dystrophy or injury to the long thoracic nerve. Winging is not characteristic of liver
disease.
267. Redness, bleeding, pain, and swelling of the gums is most likely:
Answer: gingivitis
Explanation:
Swelling, pain, erythema, and bleeding of the gums are symptoms of gingivitis. Stomatitis refers
to inflammation of the mouth. Leukoplakia presents as thickened white patches anywhere in the
oral mucosa. Aphthous ulcers can appear anywhere on the buccal mucosa or tongue. They
usually appear as round or oval ulcers, can be white or yellowish gray in color, and surrounded
by a halo of reddened mucosa
268. A child presents with fever of 102.5 °F for the past five days. Kawasaki disease is
suspected if which of the following groups of symptoms is present?
Answer: Cervical lymphadenopathy, bilateral non-purulent conjunctivitis, periungual
desquamation, and polymorphous rash

Explanation:
In Kawasaki disease there is persistent fever for 5 days. In order to be diagnosed with Kawasaki
disease, a child must present with 4 of the following 5 symptoms. These include: cervical
lymphadenopathy, bilateral conjunctivitis, macular rash, edema of the hand and/or feet, and
strawberry tongue. Pounding pulse, elevated B/P, and chronic hemolytic anemia are not
consistent with Kawasaki disease. Retinopathy and jaundice are more consistent with sickle cell
disease. Group A beta hemolytic strep and erythema marginatum are common with rheumatic
heart disease.
269. A 25-year-old with the mental age of a toddler, who exhibits limited language skills and
can be trained in very basic activities of daily living, such as dressing, hygiene and feeding,
would be classified as:
Answer: severely mentally retarded
Explanation:
A mildly mentally retarded person is educable with a mental age of 8 to 12 years old. A severely
mentally retarded person has an IQ between 25-40, limited communication, capable of learning
certain self-care activities, and the mental age of a toddler. A moderately mentally retarded
person is trainable with a mental age of a 3 to 7 year old and an IQ of 35-55. A profoundly
mentally retarded person has an IQ less than 20,the mental age of an infant, and requires
complete custodial care.
270. On auscultation of the chest, if the patient says "ninety-nine" and it is clearly heard, this is
indicative of:
Answer: lung density in the area
Explanation:
Bronchophony indicates density and usually repeating the words ninety-nine produces that
sound. Egophony, saying ee-ee-ee-ee, is more indicative of consolidation or compression in the
area. Whispered pectoriloquy, whispering one-two-three, is more faint than bronchophony, and
heard over areas of small amounts of consolidation. Inflammation would produce more of a
wheezing sound in the chest and is associated with narrowed airways (as heard during asthma
exacerbation).

271. An infant learns to move the shoulders before learning to control fine finger movement.
This is an example of which type of developmental progression?
Answer: Proximodistal
Explanation:
Proximodistal principle of development proceeds from the development of motor skills from the
center of the body outward. An example is an infant learning shoulder movement before fine
finger movement. General to specific development refers to development from a generalized
movement to a specific movement. The infant must make random leg movements before he is
able to coordinate the leg muscles well enough to crawl or walk. Neurologic development
progresses centrally to peripherally. This means that the infant must learn head control before
trunk control.
Cephalocaudal principle of development proceeds from the head to the lower part of the trunk
and usually occurs from conception to 5 months of age.
272. The term used to describe skin that is red over the entire body is:
Answer: erythroderma
Explanation:
Erythroderma occurs when a skin condition affects the whole body or nearly the whole body,
resulting in a red appearance all over. Dark-colored adherent crust of dead tissue found on some
ulcers is referred to as eschar. An excoriation is a scratch mark or surface injury penetrating the
dermis. Exfoliation refers to peeling skin.
273. When examining the medial and lateral meniscus, a click along the medial joint with
valgus stress, external rotation, and leg extension suggests a probable tear of the:
Answer: posterior portion of the medial meniscus
Explanation:
When examining the medial and lateral meniscus, a click along the medial joint with valgus
stress, external rotation, and leg extension suggests a probable tear of the posterior portion of
the medial meniscus.

274. During the infant and toddler years, achievements are marked by:
Answer: cause and effect
Explanation:
During the infant and toddler years, achievements are marked by cause and effect
275. On examination of the pupils, both are round but the right pupil appears larger than the left
and reacts much slower to light. This condition may be indicative of:
Answer: a tonic pupil
Explanation:
When the pupil is large, regular, and usually unilateral and the reaction to light is severely
reduced and slowed, or even absent, this condition is referred to as a tonic pupil or Adele's
pupil. Paralysis of the oculomotor cranial nerve (CN III), the dilated pupil is fixed to light and
near accommodation. Ptosis and lateral deviation of the eye are usually present. In Horner's
syndrome, the affected pupil reacts briskly to light and near effort but the pupil is small. The
pupils in Argyll Robertson condition appear small and irregular shaped and accommodate but
do not react to light.
276. In which of the following situations would it be difficult for the examiner to palpate an
ovary during the bimanual vaginal exam?
Answer: A woman who is anxious
Explanation:
Normal ovaries are usually tender to palpation but could pose difficulty in some women. They
are usually palpable in slender, relaxed women but are difficult or impossible to feel in women
who are obese or anxious. Three to five years after menopause, ovaries are atrophic and usually
nonpalpable.
277. The sphenoidal sinuses:
Answer: are located behind the ethmoidal sinuses
Explanation:
The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The
sphenoidal sinuses lie just behind the ethmoidal sinuses. The maxillary sinuses are located

around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are
located above the eyes.
278. The area at the posterior aspect of the spine lateral to the sacroiliac joint is known as the:
Answer: posterior superior iliac spine
Explanation:
The posterior superior aspect of the spine lateral to the sacroiliac joint is known as the posterior
superior iliac spine. The ischial tuberosity is a large swelling posteriorly on the superior ramus
of the ischium. It marks the lateral boundary of the pelvic outlet and bares most of the weight
when sitting. The superior ramus of pubis are the pubic bones that help form the obturator
foramen. The pubic symphysis is a cartilage-like articulation between the pubic bones.
279. A patient presents with a productive cough. Which one of the following descriptions of the
mucus is correct?
Answer: Tenacious sputum is consistent with patients who have cystic fibrosis
Explanation:
Purulent sputum is yellow or green whereas mucoid sputum is translucent, white, or gray. Foulsmelling sputum is present in anaerobic lung abscess. Tenacious sputum is present in patients
who have cystic fibrosis. Large volumes of purulent sputum are present in bronchiectasis or
lung abscess.
280. A bruit heard in the epigastric area with both systolic and diastolic components is
suggestive of:
Answer: renal artery stenosis
Explanation:
A bruit heard in the epigastric area, upper quadrants, or in the costovertebral region that has
both systolic and diastolic components is suggestive of renal artery stenosis. Aortic
regurgitation could be evidenced by the presence of S1, S2, and a diastolic murmur. Femoral
artery occlusion would produce a cold, painful, discolored lower extremity. A pulsation visible
or palpable in the epigastrium could be consistent with an aortic aneurysm.

281. A congenital fissure noted at the medial line of the palate is known as a:
Answer: cleft palate
Explanation:
A congenital fissure noted at the medial line of the palate is known as a cleft palate.
282. Dysphonia refers to:
Answer: an impairment in volume of the voice
Explanation:
Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice.
Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve
supply.
Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue,
palate, or pharynx). Aphasia refers to a disorder in producing or understanding language.
283. An adolescent visits the nurse practitioner for a sports participation physical. The nurse
practitioner instructs the adolescent to shrug his shoulders against resistance. This maneuver
assesses for:
Answer: strength of the trapezius muscles
Explanation:
This maneuver assesses strength of the shoulder and trapezius muscle.
284. Hairy leukoplakia may be associated with:
Answer: acquired immunodeficiency syndrome (AIDS)
Explanation:
Hyperpigmentation of skin and mucous membranes is usually seen in patients who have
Addison's Disease. Hairy leukoplakia can be seen in patients who have AIDS. Cushing's disease
can present with any of the following skin lesions: striae, skin atrophy, purpura, ecchymosis,
telangiectasias, acne, moon facies, buffalo hump, or hypertrichosis. Diabetes may produce any
of these skin conditions: necrobiosis lipoidica diabeticorum, diabetic bullae, diabetic
dermopathy, granuloma annulare, acanthosis nigricans, candidiasis, neuropathic ulcers, eruptive
xanthomas, and peripheral vascular disease.

285. Symptoms of bacterial conjunctivitis in an infant include:
Answer: eyelid edema and purulent discharge from the eyes
Explanation:
Symptoms of bacterial conjunctivitis in an infant include eyelid edema, bulbar conjunctival
injection, purulent or mucopurulent discharge. Viral conjunctivitis presents with eyelid
ecchymosis and watery discharge from the eyes. It can have an abrupt onset and present is one
or both eyes. A vesicular rash or ulceration of the eyelids with a watery discharge from the eyes
is seen in Herpes simplex viral infection of the eyes. Medication induced conjunctivitis presents
with a contact dermatitis of the eyelids and a subconjunctival, multilobulated yellow mass.
286. A child presenting with a unilateral, purulent rhinorrhea accompanied by headaches, sore
throat and facial tenderness may be suggestive of:
Answer: sinusitis
Explanation:
A child presenting with a unilateral, purulent rhinorrhea accompanied by headaches, sore throat
and facial tenderness may be suggestive of sinusitis.
287. Lower abdominal pain accompanied by fever or shock in older adults could be consistent
with:
Answer: ischemic colitis
Explanation:
Lower abdominal pain accompanied by fever or shock in older adults could be consistent with
ischemic colitis. Generally the abdomen is soft on palpation. Haemorrhoids typically present
with noticeable blood on the tissue paper, surface of stool, or dripping in the toilet. Colon cancer
can cause bloody stools but usually presents with changes in bowel habits and weight loss.
Blood in the stool is usually the only symptom seen with adenomatous polyps.
288. Chronic pelvic pain may be secondary to all of the above except:
Answer: • sexually transmitted diseases
• sexual abuse

• fibroids
• peptic ulcer disease
Explanation:
Chronic pelvic pain (CPP) refers to pain of at least 6 months duration that occurs below the
umbilicus. While gynaecologic etiologists are common, CPP may be secondary to conditions in
the urinary tract, GI tract, musculoskeletal system, and in the setting of mental health issues.
Peptic ulcer disease affects the upper GI tract and produces symptoms above the umbilicus.
289. Hyperfunctioning of the thyroid gland could lead to all the following disorders except:
Answer: • Grave's disease.
• thyrotoxicosis
• myxedema (does not cause)
• toxic goiter.
Explanation:
Hyperfunctioning of the thyroid gland leads to a hypermetabolic state causing an increase in
metabolic function, increased oxygen consumption by tissues, and heat production. Disorders
include: Grave's disease, toxic goiter, thyroid storm (thyrotoxicosis). Myxedema is seen in
hypofunctioning of the thyroid gland.
290. When examining the knee, which of the following symptoms could be indicative of a
positive Adduction (Varus) Stress Test?
Answer: Pain in the lateral joint line
Explanation:
The Adduction (or Varus) Stress Test is a maneuver that evaluates the function of the lateral
collateral ligament. To perform this test, the knee is held in 30 degrees of flexion. With one
hand on the medial side of the knee and one hand on the ankle, an adduction force is gently
applied. If pain is noted in the lateral joint line, this could be indicative of a lateral collateral
ligament tear. When tenderness extends more to the proximal or distal joint line, the collateral
ligament may be the cause of pain instead of the meniscus.
291. Joint pain that is localized and involves one joint, would be documented as:

Answer: monoarticular joint pain
Explanation:
If the joint pain is localized and involves only one joint, it is monoarticular. Extra-articular is a
term used to describe joint structures and would include periarticular ligaments, tendons,
bursae, muscle, fascia, bones, nerves, and overlying skin. Joint pain that is polyarticular
involves several joints. Radicular pain refers to pain that radiates along the dermatome of a
nerve due to inflammation or irritation of a nerve root at its connection to the spinal column, as
with sciatica pain.
292. The ankle-brachial index is a screening test used to assess a person's risk for:
Answer: peripheral artery disease
Explanation:
The ankle-brachial index test is a quick, noninvasive way to check a person's risk for peripheral
artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the
difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous
thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the
venous system.
293. The structure that encloses the spinal cord is known as the:
Answer: vertebral foramen
Explanation:
The vertebral foramen encloses the spinal cord. The structure that projects from the spinal
column posteriorly in the midline is referred to as the spinous process. The articular processes
are located on each side of the vertebra at the junction of the pedicles and the laminae, also
referred to as the articular facets.
294. A multifactorial geriatric condition or syndrome characterized by an age related lack of
adaptive physiological capacity occurring in the absence of identifiable illness is known as:
Answer: frailty
Explanation:

A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive
physiological capacity occurring in the absence of identifiable illness is known as frailty.
Delirium is a serious disturbance in a person's mental abilities that results in a decreased
awareness of one's environment and confused thinking. In the older adult, it is defined as a
geriatric syndrome or condition occurring as a temporary state of confusion and may be the first
clue to infection or problems with medications. Cognitive impairment is an intermediate stage
between the expected cognitive decline of normal aging and the more serious decline of
dementia. Functional impairment is a health condition in which the normal function of a part of
the body is less than full capacity. One of the defining characteristics of functional impairment
is that the reduction in physical or mental capacity is sufficient to interfere with managing dayto- day tasks.
295. When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently
stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted.
This finding could be suggestive of a unilateral lesion in which cranial nerve?
Answer: Cranial Nerve IX (CN IX)
Explanation:
Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and
vagus nerves.
296. When performing the bimanual vaginal exam, uterine enlargement is noted. This
enlargement could suggest:
Answer: a malignancy
Explanation:
Uterine enlargement may suggest pregnancy, uterine myomas (fibroids), or malignancy.
Retroversion or retroflexion of the uterus, and pelvic inflammatory disease are not typical
findings with enlargement of the uterus.
297. During this type of seizure activity, the patient loses consciousness suddenly, sometimes
with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person

becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. This type of
seizure activity is referred to as a:
Answer: grand mal seizure
Explanation:
During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and
the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic.
A clonic phase of rhythmic muscular contraction follows. Focal seizures that become
generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the
aura and a unilateral neurologic deficit is present during the postictal period. Focal seizures with
impairment of consciousness the person appears confused. Automatisms include automatic
motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes.
Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to
other body parts on the same side with the patient remaining conscious are known as Jacksonian
seizures.
298. Which technique best determines whether the tissues in the chest are air-filled, fluid- filled,
or solid?
Answer: Percussion
Explanation:
Percussion of the chest produces audible sounds and palpable vibrations, thus, assisting in
determining if the underlying tissues are filled with air or fluid or if they are solid. However,
percussion will not help detect deep seated lesions. Auscultation assesses the flow of air through
the tracheobronchial tree. Palpation focuses on tenderness and abnormalities in the overlying
skin , respiratory expansion, and fremitus. Inspection notes the shape of the chest and they way
it moves with inspiration and expiration.
299. Analgesia refers to:
Answer: absence of pain sensation
Explanation:
Analgesia refers to absence of pain sensation; hypalgesia pain; hyperalgesia to increased
sensitivity; and anesthesia to decreased sensitivity to absence of touch sensation.

300. To test the anterior and lateral deltoid, pectoralis major, coracobrachialis and biceps brachii
muscles, the nurse practitioner would have the patient perform which shoulder movement?
Answer: Flexion
Explanation:
To test the anterior and lateral deltoid, pectoralis major, coracobrachialis or biceps brachii
muscles, the nurse practitioner would have the patient flex his arm.
301. When comparing veins and arteries in the eyes of older adults, the arteries appear:
Answer: less brilliant
Explanation:
In older adults, the fundi lose their youthful shine and light reflections. The arteries look
narrowed, pale, straight, and less brilliant than in young or middle adults.
302. When examining the ankle and foot of a patient, the nurse practitioner instructs the patient
to point the foot toward the floor. This motion assesses:
Answer: ankle flexion
Explanation:
Having the patient point the foot toward the floor assesses . Having the patient point the foot
toward the ceiling assesses ankle extension. Having the patient move the heel inward assesses
ankle inversion. Having the patient move the heel outward assesses eversion.
303. Children presenting with congenital heart defects that result in right to left shunting would
most likely exhibit which of the following symptoms?
Answer: Cyanosis, decreased cardiac output, and desaturated systemic blood
Explanation:
Hypoplastic left heart syndrome, truncus arteriosus, and transposition of the great arteries as
well as total anomalus pulmonary venous return all fall in the mixed defects category and result
in a right to left shunting. The symptoms that are usually seen are cyanosis, decreased cardiac
output, and desaturated systemic blood flow along with poor tissue perfusion and symptoms of

heart failure: increased pressure and increased fluid volume in the heart. The other symptoms
are not consistent with right to left shunting.
304. The patella rests on the:
Answer: articulating surface of the femur
Explanation:
The patella rests on the anterior articulating surface of the femur midway between the
epicondyles, embedded in the tendon of the quadriceps muscle.
305. If abdominal pain persists when the patient raises his head and shoulders, the origin of the
tenderness is probably:
Answer: in the abdominal wall.
Explanation:
Tenderness may originate in the abdominal wall. When the patient raises his head and shoulders,
the pain will persist. However, if the tenderness originates from deep in the abdomen, the pain
usually decreases because it is protected by the tightened muscles. With inflammation from the
pleural cavity, abdominal pain and tenderness may mimic acute cholecystitis or appendicitis.
This pain increases with breathing and causes chest pain. In pancreatitis, epigastric and rebound
tenderness is observed but the abdominal wall is usually soft.
306. On examination of an eighteen-year-old which one of the following neurological signs
would not be helpful if meningitis is suspected?
Answer: Loss of the anal reflex
Explanation:
If meningitis is suspected, nuchal rigidity, positive Brudzinski sign, and Kernig's sign should all
be assessed. If these meningeal signs are positive, meningitis is suspected. A loss of anal reflex
would suggest a lesion in the S2, 3, and 4 reflex arc. Therefore, it would not be helpful with the
differential diagnosis.
307. Acholic stools are associated with:
Answer: obstructive jaundice

Explanation:
Stools that are pale or clay or putty-colored are termed acholic. Acholic stools may occur briefly
in viral hepatitis but are more common in obstructive jaundice.
308. Irregular brownish patches around the forehead, cheeks, nose, and jaw noted during
pregnancy are:
Answer: chloasma
Explanation:
Irregular brownish patches around the forehead, cheeks, nose, and jaw noted during pregnancy
are known as chloasma (or melasma) or the "mask of pregnancy". This is considered a normal
finding
309. The adductor tubercle of the knee is located:
Answer: medial surface
Explanation:
The adductor tubercle of the knee is located on the medial surface of the knee.
310. The anterior drawer sign is used to assess instability of the:
Answer: anterior cruciate ligament (ACL)
Explanation:
The anterior drawer sign is used to evaluate the anterior cruciate ligament (ACL) for instability.
A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign
suggestive of an ACL tear.
311. The calcaneus is located:
Answer: under the talus
Explanation:
The calcaneus is located under the talus and is known as the heel bone.
312. One of the anterior thoracic landmarks is the costal angle. It is located:

Answer: where the right and left costal margins form an angle where they meet at the xiphoid
process
Explanation:
The right and left costal margins form an angle where they meet at the xiphoid process. This is
the costal angle. The angle should be 90 degrees or less. However, the angle increases when the
rib cage is chronically over inflated, as in emphysema.
313. To auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope:
Answer: between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the anterior chest,
beginning with the patient in the supine position and using the diaphragm of the stethoscope.
The aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal
border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th
intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the
2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between
the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB).
314. The six to eight year-old school age child is able to:
Answer: participate in competitive activities
Explanation:
By six to eight years of age, the school aged child is able to perform several of the following
tasks: demonstrate nervous habits, have well established hand eye coordination, collect things,
enjoy hobbies, enjoy a challenge, and prefers playing with the same sex friends. The other
choices are consistent with the development of a 8-10 year-olds.
315. When assessing anal reflexes, the nurse practitioner strokes the four quadrants of the anus
with a cotton swab. A loss of anal reflex is noted. This finding could be suggestive of a
pathologic lesion in which segmented level of the spine?
Answer: Sacral 2, 3, and 4
Explanation:

Superficial (cutaneous) reflexes and their corresponding spinal segments include the following:
Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and
sacral 1; and Anal: sacral 2, 3, 4.
316. The lower tip of the scapula is located:
Answer: the seventh or eighth rib
Explanation:
The scapulae are located symmetrically in each hemithorax. The lower tip is usually at the
seventh or eighth rib.
317. Primary dysmenorrhea results from:
Answer: increased prostaglandin production during the luteal phase of the menstrual cycle
Explanation:
Dysmenorrhea is defined as pain with menses. The causes can be either primary or secondary.
Primary dysmenorrhea occurs without an organic cause whereas with secondary dysmenorrhea,
there is an organic cause. Primary dysmenorrhea results from increased prostaglandin
production during the luteal phase of the menstrual cycle, when estrogen and progesterone
levels decline.
Causes of secondary dysmenorrhea include endometriosis, adenomyosis (endometriosis in the
muscular layers of the uterus), pelvic inflammatory disease, and endometrial polyps.