Comprehensive NR509 Week 8 champion Final
Exam with questions and correct answers
A 30-year-old male is admitted to the hospital for abdominal pain. He reports steady, aching pain that
began suddenly around his naval and now involves the lower abdomen. He also reports a decreased
appetite with nausea but no vomiting. After a careful history and physical examination, the NP
documents the following abdominal findings: The abdomen is flat, firm, and rigid, with increased
tenderness and guarding in the right lower quadrant. No bowel sounds heard. Liver percusses to 7 cm
in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA
tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate
interpretation of these findings?
These findings suggest acute peritonitis
The NP student is precepting with a provider in a geriatric-based clinic. The provider asks the student
if he is familiar with the 10-Minute Geriatric Screener. Which of the following statements best
demonstrates that the NP understands this assessment tool?
The tool assesses for functional deficits which are strong predictors of patient outcomes in the elderly.
A 54-year-old female with a history of migraines since childhood presents to the clinic with chronic
intermittent, progressive pulsatile headaches which are similar in nature to prior attacks and
precipitated by current life stressors. The headaches are accompanied by nausea and vomiting. She
denies constitutional symptoms. On examination, she has elevated blood pressure but otherwise a
normal cardiovascular, neurologic, and fundoscopic examination. Based on the history and physical
examination findings, which diagnoses are appropriate for the differential diagnosis (DDx) list? Select
all that apply.
Migraine
Tension
A 50-year-old female presents to the clinic for evaluation of neck stiffness and aching pain. She was a
restrained driver in a low-speed, rear-end, motor vehicle collision 1 day ago. The pain started several
hours after the accident. On physical examination, you note muscle spasms over the paraspinous
muscles on the left side of the neck, as well as pain reported during active range of motion of the
cervical spine. No neurological deficits are noted. Which of the following is the most accurate
interpretation of these findings?
These findings suggest cervical strain
Which muscle(s) are being assessed during active rotation of the neck?
Sternocleidomastoid
A 34-year-old female presents to the office with left elbow pain following rigorous training for a
tennis match. Tenderness is noted with palpation in the area on the image marked by the red circle.
What correlative diagnosis does this assessment finding indicate? ADA Description: Left elbow with
emphasis on the small, tuberculated eminence, curved a little forward, about 1 cm from the joint.
, lateral epicondylitis
A 35-year-old male presents to the clinic for a routine physical examination. His only complaint is a
feeling of heaviness in his scrotum. He denies injury or trauma. After conducting a history and
physical, the NP documents the following genitourinary (GU) findings: Uncircumcised penis; prepuce
easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes
descended bilaterally; right testicle smooth; 1 × 1 cm firm, fixed, nontender, nodule on the left lateral
testicle. Epididymis nontender. No inguinal or femoral hernias. Negative CVA tenderness. Which of
the following is the most accurate interpretation of these findings?
These findings suggest testicular cancer
A 26-year-old female presents to the Emergency Department with intense abdominal pain for 6 hours,
light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has
a history of gallstones and is concerned that she is having another gallbladder attack. She denies
nausea and vomiting, and her last normal bowel movement was this morning. She reports that her
LMP was 10 weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC orally. A β-human chorionic gonadotropin (β-hCG) blood
test is pending. The NP performs an abdominal exam prior to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound tenderness. Which of the following is the most likely
etiology for these assessment findings?
Ruptured ectopic pregnancy
The NP conducted a physical assessment on a 79-year-old male who lives independently in subsidized
housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows:
Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm,
round, regular, equally reactive to light and accommodation. Extraocular movements intact. Disc
margins sharp, without hemorrhages or exudates. Mild arteriolar narrowing. TMs with good cone of
light. Weber midline. AC > BC. Nasal mucosa erythematous, septum deviated to the right, turbinates
mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue
midline, slight beefy redness. Pharynx is mildly erythematous with cobblestoning. Which of the
following is the most accurate interpretation of the findings?
The patient has chronic allergies
The staff NP in a nursing home is conducting a physical assessment on an 84-year-old male resident
who is pleasant, active, and cooperative. The skin findings in this image are observed during the
examination. The staff and patient deny any known injury or trauma. The NP should document these
findings as consistent with which of the following?
ADA Description: Extensor surface of the right forearm with emphasis on well-demarcated vividly
purple macules and patches
Actinic purpura
An 80-year-old woman who lives alone at home presents with concerns about maintaining her
independent living status. She continues to drive and care for herself and her pet dog but reports two
Exam with questions and correct answers
A 30-year-old male is admitted to the hospital for abdominal pain. He reports steady, aching pain that
began suddenly around his naval and now involves the lower abdomen. He also reports a decreased
appetite with nausea but no vomiting. After a careful history and physical examination, the NP
documents the following abdominal findings: The abdomen is flat, firm, and rigid, with increased
tenderness and guarding in the right lower quadrant. No bowel sounds heard. Liver percusses to 7 cm
in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA
tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate
interpretation of these findings?
These findings suggest acute peritonitis
The NP student is precepting with a provider in a geriatric-based clinic. The provider asks the student
if he is familiar with the 10-Minute Geriatric Screener. Which of the following statements best
demonstrates that the NP understands this assessment tool?
The tool assesses for functional deficits which are strong predictors of patient outcomes in the elderly.
A 54-year-old female with a history of migraines since childhood presents to the clinic with chronic
intermittent, progressive pulsatile headaches which are similar in nature to prior attacks and
precipitated by current life stressors. The headaches are accompanied by nausea and vomiting. She
denies constitutional symptoms. On examination, she has elevated blood pressure but otherwise a
normal cardiovascular, neurologic, and fundoscopic examination. Based on the history and physical
examination findings, which diagnoses are appropriate for the differential diagnosis (DDx) list? Select
all that apply.
Migraine
Tension
A 50-year-old female presents to the clinic for evaluation of neck stiffness and aching pain. She was a
restrained driver in a low-speed, rear-end, motor vehicle collision 1 day ago. The pain started several
hours after the accident. On physical examination, you note muscle spasms over the paraspinous
muscles on the left side of the neck, as well as pain reported during active range of motion of the
cervical spine. No neurological deficits are noted. Which of the following is the most accurate
interpretation of these findings?
These findings suggest cervical strain
Which muscle(s) are being assessed during active rotation of the neck?
Sternocleidomastoid
A 34-year-old female presents to the office with left elbow pain following rigorous training for a
tennis match. Tenderness is noted with palpation in the area on the image marked by the red circle.
What correlative diagnosis does this assessment finding indicate? ADA Description: Left elbow with
emphasis on the small, tuberculated eminence, curved a little forward, about 1 cm from the joint.
, lateral epicondylitis
A 35-year-old male presents to the clinic for a routine physical examination. His only complaint is a
feeling of heaviness in his scrotum. He denies injury or trauma. After conducting a history and
physical, the NP documents the following genitourinary (GU) findings: Uncircumcised penis; prepuce
easily retractable. No penile discharge or lesions. No scrotal swelling or discoloration. Testes
descended bilaterally; right testicle smooth; 1 × 1 cm firm, fixed, nontender, nodule on the left lateral
testicle. Epididymis nontender. No inguinal or femoral hernias. Negative CVA tenderness. Which of
the following is the most accurate interpretation of these findings?
These findings suggest testicular cancer
A 26-year-old female presents to the Emergency Department with intense abdominal pain for 6 hours,
light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has
a history of gallstones and is concerned that she is having another gallbladder attack. She denies
nausea and vomiting, and her last normal bowel movement was this morning. She reports that her
LMP was 10 weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen
saturation, 99%; and temperature, 37.3ºC orally. A β-human chorionic gonadotropin (β-hCG) blood
test is pending. The NP performs an abdominal exam prior to her pelvic exam and, on palpation of her
abdomen, finds involuntary rigidity and rebound tenderness. Which of the following is the most likely
etiology for these assessment findings?
Ruptured ectopic pregnancy
The NP conducted a physical assessment on a 79-year-old male who lives independently in subsidized
housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows:
Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm,
round, regular, equally reactive to light and accommodation. Extraocular movements intact. Disc
margins sharp, without hemorrhages or exudates. Mild arteriolar narrowing. TMs with good cone of
light. Weber midline. AC > BC. Nasal mucosa erythematous, septum deviated to the right, turbinates
mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue
midline, slight beefy redness. Pharynx is mildly erythematous with cobblestoning. Which of the
following is the most accurate interpretation of the findings?
The patient has chronic allergies
The staff NP in a nursing home is conducting a physical assessment on an 84-year-old male resident
who is pleasant, active, and cooperative. The skin findings in this image are observed during the
examination. The staff and patient deny any known injury or trauma. The NP should document these
findings as consistent with which of the following?
ADA Description: Extensor surface of the right forearm with emphasis on well-demarcated vividly
purple macules and patches
Actinic purpura
An 80-year-old woman who lives alone at home presents with concerns about maintaining her
independent living status. She continues to drive and care for herself and her pet dog but reports two
