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(Completed) NR509 Week 8 Final Exam Questions and Correct Answers

During a routine physical exam, a 28-year-old male patient is found to have a painless nodule on his testis. What is the MOST appropriate next step?

Answers: A – D

1. Order a scrotal ultrasound and refer to urology for further evaluation ✅
   B. Prescribe antibiotics for a possible infection
   C. Reassure the patient and schedule a follow-up in six months
   D. Perform a testicular biopsy in the clinic

Correct Answer: A. Order a scrotal ultrasound and refer to urology for further evaluation

A 30-year-old female presents to the clinic with a malodorous vaginal discharge and mild vulvar itching that has persisted for approximately three weeks. She denies dysuria and dyspareunia but notes that the odor worsens after intercourse and during her recent menstrual period. Pelvic and rectal exam findings include: No erythema or lesions of the external genitalia. Thin, white, homogeneous vaginal discharge with a mild fishy odor. No discharge is visible from the cervical os after swabbing. Vaginal pH >4.5. Uterus midline, no adnexal masses. Rectal exam is unremarkable. Based on clinical history and examination findings, which of the following is the MOST accurate interpretation of these findings?

Answers: A – D

1. Chlamydial cervicitis
   B. Bacterial vaginosis ✅
   C. Trichomoniasis
   D. Vulvovaginal candidiasis

Correct Answer: B. Bacterial vaginosis

A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses. Symptoms have been ongoing for approximately 12 months and are worsening. She reached menarche at age 13 years and her cycles have remained regular when not pregnant. She is a G4P3, and her partner has had a vasectomy. Her LMP was 1 week ago. On bimanual exam, large mass is palpated which is located midline between the substernal notch and the umbilicus. Adnexal areas are without abnormality, and the rectal exam is normal. Which is the MOST LIKELY interpretation of these findings?

Answers: A – D

1. Pregnancy
   B. Bartholin gland enlargement
   C. Ovarian mass
   D. Fundal uterine fibroids ✅

Correct Answer: D. Fundal uterine fibroids

When palpating the left lower quadrant (LLQ), which of the following structures is most likely to be palpable if stool is present?

Answers: A – D

1. Sigmoid colon ✅
   B. Appendix
   C. Gallbladder
   D. Duodenum

Correct Answer: A. Sigmoid colon

A 35-year-old female with a known history of migraines presents with worsening symptoms. She reports waking up at night with headaches and nausea, which is new. Medications include progestin-only pill (POP) and a multivitamin. She otherwise considers herself healthy and denies other medical conditions. Which action by the NP is the MOST appropriate next step?

Answers: A – D

1. Discontinue OCPs and diagnose her with medication-overuse headache
   B. Continue POPs and recommend over-the-counter analgesics for migraine management
   C. Prescribe a triptan for acute migraine relief and reassess in two weeks
   D. Refer for neuroimaging to evaluate secondary causes of headache ✅

Correct Answer: D. Refer for neuroimaging to evaluate secondary causes of headache

A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is involved in this condition?

ADA Description: Male with right upper eyelid drooping.

Answers: A – D

1. Oculomotor (CN III) ✅
   B. Vagus (CN X)
   C. Optic (CN II)
   D. Trochlear (CN IV)

Correct Answer: A. Oculomotor (CN III)

A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to find on examination that is MOST consistent with the diagnosis?

Answers: A – D

1. Positive straight-leg raise
   B. Positive Romberg test
   C. Thoracic kyphosis
   D. Flexed forward posture with lower extremity weakness ✅

Correct Answer: D. Flexed forward posture with lower extremity weakness

Which characteristic is MOST associated with rheumatoid arthritis (RA)?

Answers: A – D

1. Additive and progressive joint pain with symmetric involvement ✅
   B. Migratory joint pain that shifts from one joint to another
   C. Asymmetric joint involvement affecting large joints like the hips and shoulders
   D. Pain that spreads from one joint to multiple joints

Correct Answer: A. Additive and progressive joint pain with symmetric involvement

During the health history of a 72-year-old man, you ask about his urination pattern. Which of the following symptoms is most suggestive of benign prostatic hyperplasia (BPH)?

Answers: A – D

1. Severe pain with urination and foul-smelling urine
   B. Blood in the urine and lower back pain
   C. Difficulty starting the urine stream and frequent nighttime urination ✅
   D. Continuous dribbling of urine with urgency

Correct Answer: C. Difficulty starting the urine stream and frequent nighttime urination

Which findings are MOST associated with hyperreflexia?

Answers: A – D

1. Weakness, spasticity, and a positive Babinski sign ✅
   B. Loss of deep tendon reflexes and fasciculations
   C. Flaccid paralysis and muscle atrophy
   D. Hypotonia and absent Babinski sign

Correct Answer: A. Weakness, spasticity, and a positive Babinski sign

During abdominal percussion, which finding is MOST suggestive of intestinal obstruction or paralytic ileus?

Answers: A – D

1. Dullness over both flanks
   B. Tympany throughout a protuberant abdomen ✅
   C. Tympany in the right lower quadrant of a distended abdomen
   D. Scattered dullness in all four quadrants of a rounded abdomen

Correct Answer: B. Tympany throughout a protuberant abdomen

Which of the following physical assessment findings regarding blood pressure is consistent with the normal aging process and not a sign of cardiovascular disease?

Answers: A – D

1. A widened pulse pressure with decreased systolic and diastolic pressures
   B. A drop in systolic pressure of 25 mm Hg when rising from a supine to standing position
   C. A narrowed pulse pressure with increased systolic and diastolic components
   D. A net increase in pulse pressure with an increase in systolic pressure and a decrease in diastolic pressure ✅

Correct Answer: D. A net increase in pulse pressure with an increase in systolic pressure and a decrease in diastolic pressure

A patient reports difficulty swallowing solid foods but denies difficulty with liquids. The clinician should suspect:

Answers: A – D

1. Esophageal stricture ✅
   B. Achalasia
   C. Esophageal dysmotility
   D. Zenker diverticulum

Correct Answer: A. Esophageal stricture

Which of the following is the correct sequence for conducting a musculoskeletal exam?

Answers: A – D

1. Inspection, palpation, range of motion, special maneuvers ✅
   B. Palpation, inspection, range of motion, special maneuvers
   C. Special maneuvers, palpation, inspection, range of motion
   D. Range of motion, special maneuvers, palpation, inspection

Correct Answer: A. Inspection, palpation, range of motion, special maneuvers

A 58-year-old male presents with a longstanding history of lower back pain. He denies any recent trauma. On physical examination, the NP notes tenderness to palpation over the sacroiliac joint. Which is MOST consistent with this physical finding?

Answers: A – D

1. Lumbar disc herniation
   B. Mechanical low back pain due to poor posture
   C. Spinal stenosis
   D. Ankylosing spondylitis ✅

Correct Answer: D. Ankylosing spondylitis

A 21-year-old female presents for her first annual exam. She reports concern because her female partner was recently diagnosed with condyloma acuminata and wonders if she could also be infected. What physical assessment findings would the NP expect to find during the speculum examination if infected?

Answers: A – D

1. Pink or white, cauliflower-like lesions ✅
   B. Bright red, soft lesions arising from the cervical canal
   C. Several shallow ulcers with a red base
   D. Small red granular spots or petechiae on the cervix

Correct Answer: A. Pink or white, cauliflower-like lesions

Which peritoneal sign is most specific for peritonitis?

Answers: A – D

1. Hyperactive bowel sounds
   B. Voluntary guarding
   C. Rigidity ✅
   D. Abdominal distension

Correct Answer: C. Rigidity

A 45-year-old female presents to the primary care clinic with a recent change in bowel habits. Her past medical history includes bleeding peptic ulcers and Crohn’s disease. Her family history reveals a maternal aunt who died of colon cancer at age 49. Which of the following historical elements is MOST concerning for colon cancer in this patient?

Answers: A – D

1. History of bleeding peptic ulcers
   B. Family history of colon cancer before age 50 ✅
   C. Diagnosis of Crohn’s disease
   D. Change in bowel movement patterns

Correct Answer: B. Family history of colon cancer before age 50

The NP suspects appendicitis in a patient presenting with right lower quadrant abdominal pain. During the physical examination, the NP applies pressure at a point located halfway between the umbilicus and the anterior superior iliac spine (ASIS). Which of the following physical exam maneuvers is being performed?

Answers: A – D

1. Rovsing’s sign
   B. McBurney’s sign ✅
   C. Murphy’s sign
   D. Psoas sign

Correct Answer: B. McBurney’s sign

The NP knows measurement of growth is one of the most important indicators of infant health. Deviations may provide an early indication of an underlying problem. What is the minimum variation that indicates a more detailed evaluation is needed?

Answers: A – D

1. Beyond 1 standard deviation for age
   B. Beyond 3 standard deviations for age
   C. Beyond 2 standard deviations for age ✅
   D. Beyond 4 standard deviations for age

Correct Answer: C. Beyond 2 standard deviations for age

A 67-year-old female presents for an annual check-up. She retired as a police captain at age 66 who now enjoys gardening and water aerobics several days a week. She states, “staying active keeps me limber.” The history and physical examination reveal full range of motion in all joints. Positive Heberden nodes at the DIP joints and Bouchard nodes at the PIP joints, bilaterally. Mild pain with flexion, extension, and rotation of both hips. There is full range of motion in the knees with moderate crepitus but no effusion. There is bony enlargement along the tibiofemoral joint line bilaterally. Bilateral feet with hallux valgus at the first MTP joints. What do these findings suggest?

Answers: A – D

1. Osteoarthritis ✅
   B. Osteoporosis
   C. Rheumatoid arthritis
   D. Bursitis

Correct Answer: A. Osteoarthritis

The NP is determining the gestational age of a pregnant patient who reports her last menstrual period (LMP) as January 15, 2024. Using Naegele’s rule, what is estimated date of delivery (EDD)?

Answers: A – D

1. October 15, 2024
   B. November 15, 2024
   C. November 22, 2024 ✅
   D. October 22, 2024

Correct Answer: C. November 22, 2024

Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?

Answers: A – D

1. Ideally, the vaccine should be administered within 3 years of first intercourse
   B. The vaccine can protect against anogenital lesions ✅
   C. The vaccine covers all strains of the HPV virus
   D. The vaccine does not lower the risk of oropharyngeal cancers

Correct Answer: B. The vaccine can protect against anogenital lesions

A 20-year-old female presents to the clinic with symptoms of fatigue, nausea, and an increase in urination. Her urine pregnancy test is positive and her last menstrual period (LMP) was on June 20, 2021. Using the Naegele rule, what is the estimated date of delivery?

Answers: A – D

1. April 27, 2022
   B. February 27, 2022
   C. March 27, 2022 ✅
   D. January 13, 2022

Correct Answer: C. March 27, 2022

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Related: (Completed) NR548 Week 8 Final Exam Questions and Correct Answers