NR603 Nursing APEA Predictor Exam Week 4 With Answers-317 Solved Questions

NURSING NR 603 WEEK 4 APEA PREDICTOR EXAM | QUESTIONS AND
ANSWERS WITH DETAILED EXPLANATIONS
1. During pregnancy, dyspnoea accompanied by increased respiratory rate, cough, rales, or
respiratory distress raises concerns of:
Answer: peripartum cardiomyopathy
Explanation:
Dyspnoeal 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 exophages, trachea, heart, and
great vessels is the:
Answer: mediastinum
Explanation:
The middle section of the thoracic cavity containing the oesophagus, 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 nonirritating 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, hematochromatosis (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. Semimembranous 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 thepatient:
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 "pseudoclaudication"
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 obtunded
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; hypalgesia to decreased sensitivity to pain;
hyperalgesia to increased sensitivity; and anesthesia 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 count140 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?
The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte
Answer: 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 nonmalignant 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: diarrhea:
Answer: vomiting of undigested food: weight loss: 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. Diarrhea 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 toas 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 cartel age 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 lesionis 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 maybe 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: who have cleft palates or lips and the caretaker is insecure
in his/her feeding abilities.
Answer: 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 semimembranous 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: pulmonary embolus: left ventricular hypertrophy: 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 hyperresonant 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 heartrate, 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 hemorrhoids, 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 dayto-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. Trans illumination 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 hemorrh ages 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 hemorrhage. 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 armand 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 note dat the anal
opening. This finding is most likely a(n):
Answer: a prolapsed internal hemorrhoid
Explanation:
Internal hemorrhoids 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 hemorrhoids 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 hyperemic 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 line a 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. Leukoplakia was noted during an exam of the mouth. This symptom may be:
Answer: precancerous
Explanation:
Leukoplakia 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 in attention,
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 dayto-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) A positive result in the described maneuver is known as a
"positive bulge sign." This sign indicates the presence of excess fluid (effusion) within the
knee joint.
Explanation:
Normally, when you compress the suprapatellar pouch and then push the patella sharply
against the femur, any fluid within the knee joint should move away from the area. However,
in the case of joint effusion (fluid accumulation within the knee joint), when you release the
pressure and push the patella back, the fluid will return to the suprapatellar pouch, causing a
bulge or a visible wave of fluid movement. This positive bulge sign is indicative of the
presence of knee effusion.
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) To test the thumb for
opposition, ask the patient to touch the thumb to the tip of each finger, one at a time,
including the little finger (pinky).
Explanation:
Opposition of the thumb refers to its ability to move across the palm and touch the tip of each
finger, including the little finger. This movement is essential for tasks requiring fine motor
skills and precision grip. Asking the patient to touch the thumb to the tip of each finger

assesses the range of motion and strength of the thumb muscles, particularly the opponens
pollicis muscle, which enables this movement.
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 18. 5 - 24. 9, the total weight gain should be:
Answer: 11-20 pounds.15-25 pounds.25-35 pounds Correct28-40 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 diarrhea or early intestinal
obstruction and ulcerative colitis.
261. On ophthalmoscopic exam of the older adult, there is an increased cup-to-discratio: 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.
Foul- smelling 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. Hemorrhoids 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 gynecologic etiologies 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). My xedema is seen in
hypo functioning of the thyroid gland.
289. 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.
290. 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.
291. 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.
292. 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.
293. 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 day-to- day tasks.
294. 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.
295. 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.
296. 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: grand mal seizure
During a 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.
297. Which technique best determines whether the tissues in the chest are air-filled, fluidfilled, 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.
298. 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 to absence of touch sensation.
299. 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.
300. 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.
301. 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.
302. 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.
303. 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.
304. 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.
305. 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.
306. 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.
307. 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
308. The adductor tubbercle of the knee is located:

Answer: medial surface
Explanation:
The adductor tubercle of the knee is located on the medial surface of the knee.
309. 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.
310. The calcaneus is located:
Answer: under the talus
Explanation:
The calcaneus is located under the talus and is known as the heel bone.
311. 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.
312. 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).
313. 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.
314. 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.
315. 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.
316. 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.