CHAMBERLAIN COLLEGE OF NURSING NR 509 APEA TEST
(HEENT) - VERSION 2
Advanced Physical Assessment – Head, Eyes, Ears, Nose, and Throat
150 Multiple-Choice Questions with Correct Answers and Detailed Rationales
Exam Title: NR 509 APEA Advanced Physical Assessment: Comprehensive HEENT Examination –
Version 2 with 150 Multiple-Choice Questions Covering Advanced Clinical Reasoning, Differential
Diagnosis, Pathophysiology, and Evidence-Based Assessment of Head, Eyes, Ears, Nose, and Throat
Systems for Graduate Nursing Practice
Difficulty Level: Advanced / Mixed
Target Audience: Graduate-level nursing students, Nurse Practitioner students, and advanced practice
nursing professionals preparing for the Chamberlain College of Nursing NR 509 APEA HEENT
examination
SECTION A: HEAD AND NEUROLOGICAL ASSESSMENT (Questions 1–
15)
Question 1
A 72-year-old patient presents with a new-onset headache described as a "band-like" pressure around
the entire head, worse in the evening. The patient reports difficulty concentrating and mild nausea.
Vital signs are normal. The most likely diagnosis is:
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Giant cell arteritis
Correct Answer: A
,Rationale: Tension-type headaches present as bilateral, band-like pressure or tightness, often worse in
the evening, without the autonomic symptoms or severe nausea seen in migraines. Giant cell arteritis
presents with temporal headache, jaw claudication, and elevated ESR in patients over 50.
Question 2
The trigeminal nerve (cranial nerve V) provides motor innervation to which of the following muscles?
A. Muscles of facial expression
B. Muscles of mastication
C. Sternocleidomastoid muscle
D. Muscles of the tongue
Correct Answer: B
Rationale: Cranial nerve V (Trigeminal) provides motor innervation to the muscles of mastication
(masseter, temporalis, medial and lateral pterygoids). Cranial nerve VII (Facial) innervates muscles of
facial expression. Cranial nerve XI (Accessory) innervates the sternocleidomastoid and trapezius. Cranial
nerve XII (Hypoglossal) innervates the tongue muscles.
Question 3
A 45-year-old patient presents with a 2-month history of progressively worsening headache, morning
nausea, and visual disturbances. Fundoscopic examination reveals bilateral optic disc edema with
blurred margins. The most likely diagnosis is:
A. Migraine with aura
B. Pseudotumor cerebri
C. Glaucoma
D. Optic neuritis
Correct Answer: B
Rationale: Pseudotumor cerebri (idiopathic intracranial hypertension) presents with headache, nausea,
visual disturbances, and bilateral papilledema (optic disc edema) in the absence of an intracranial
mass. It is most common in obese women of childbearing age. Migraines do not cause papilledema.
Glaucoma causes optic disc cupping. Optic neuritis causes unilateral vision loss.
,Question 4
The normal adult skull should be:
A. Symmetric, smooth, with no palpable bony prominences
B. Symmetric, with palpable bony ridges and prominences
C. Asymmetric with palpable bony defects
D. Symmetric but with a palpable fontanelle
Correct Answer: A
Rationale: The normal adult skull is symmetric and smooth with no palpable bony prominences or
defects. Palpable bony ridges are normal in infants but not in adults. Asymmetry or bony defects
suggest pathology such as fracture, tumor, or Paget's disease. Fontanelles are present only in infants.
Question 5
A patient presents with a headache that is worse in the morning, associated with vomiting, and
relieved by sitting upright. These findings are most suggestive of:
A. Tension headache
B. Increased intracranial pressure
C. Migraine without aura
D. Sinus headache
Correct Answer: B
Rationale: Headaches associated with increased intracranial pressure are typically worse in the
morning (due to fluid shifts during sleep), associated with vomiting (often projectile), and relieved by
sitting upright. These are "red flag" findings requiring immediate evaluation. Tension headaches do not
have these features.
Question 6
The spinal accessory nerve (cranial nerve XI) is assessed by:
A. Asking the patient to shrug the shoulders against resistance
B. Asking the patient to protrude the tongue
, C. Asking the patient to follow a finger with the eyes
D. Asking the patient to smile and frown
Correct Answer: A
Rationale: Cranial nerve XI (Spinal Accessory) innervates the sternocleidomastoid and trapezius
muscles. Assessment includes asking the patient to shrug the shoulders against resistance (trapezius)
and turn the head against resistance (sternocleidomastoid). Tongue protrusion assesses CN XII. Eye
movements assess CN III, IV, VI. Facial expressions assess CN VII.
Question 7
A 68-year-old patient presents with a new-onset, unilateral headache in the temporal region, scalp
tenderness, and jaw pain when chewing. Laboratory studies reveal an elevated ESR and CRP. The most
likely diagnosis is:
A. Tension headache
B. Migraine
C. Giant cell arteritis
D. Trigeminal neuralgia
Correct Answer: C
Rationale: Giant cell arteritis (temporal arteritis) presents with new-onset unilateral temporal
headache, scalp tenderness, jaw claudication (pain with chewing), and elevated inflammatory markers
(ESR, CRP) in patients over 50. It is a vasculitis requiring urgent treatment with corticosteroids to
prevent vision loss. Trigeminal neuralgia causes electric shock-like facial pain.
Question 8
During palpation of the head, you note a soft, fluctuant, non-tender swelling over the occipital region
in a 2-month-old infant. This finding is most consistent with:
A. Cephalohematoma
B. Caput succedaneum
C. Encephalocele
D. Craniosynostosis
(HEENT) - VERSION 2
Advanced Physical Assessment – Head, Eyes, Ears, Nose, and Throat
150 Multiple-Choice Questions with Correct Answers and Detailed Rationales
Exam Title: NR 509 APEA Advanced Physical Assessment: Comprehensive HEENT Examination –
Version 2 with 150 Multiple-Choice Questions Covering Advanced Clinical Reasoning, Differential
Diagnosis, Pathophysiology, and Evidence-Based Assessment of Head, Eyes, Ears, Nose, and Throat
Systems for Graduate Nursing Practice
Difficulty Level: Advanced / Mixed
Target Audience: Graduate-level nursing students, Nurse Practitioner students, and advanced practice
nursing professionals preparing for the Chamberlain College of Nursing NR 509 APEA HEENT
examination
SECTION A: HEAD AND NEUROLOGICAL ASSESSMENT (Questions 1–
15)
Question 1
A 72-year-old patient presents with a new-onset headache described as a "band-like" pressure around
the entire head, worse in the evening. The patient reports difficulty concentrating and mild nausea.
Vital signs are normal. The most likely diagnosis is:
A. Tension-type headache
B. Migraine without aura
C. Cluster headache
D. Giant cell arteritis
Correct Answer: A
,Rationale: Tension-type headaches present as bilateral, band-like pressure or tightness, often worse in
the evening, without the autonomic symptoms or severe nausea seen in migraines. Giant cell arteritis
presents with temporal headache, jaw claudication, and elevated ESR in patients over 50.
Question 2
The trigeminal nerve (cranial nerve V) provides motor innervation to which of the following muscles?
A. Muscles of facial expression
B. Muscles of mastication
C. Sternocleidomastoid muscle
D. Muscles of the tongue
Correct Answer: B
Rationale: Cranial nerve V (Trigeminal) provides motor innervation to the muscles of mastication
(masseter, temporalis, medial and lateral pterygoids). Cranial nerve VII (Facial) innervates muscles of
facial expression. Cranial nerve XI (Accessory) innervates the sternocleidomastoid and trapezius. Cranial
nerve XII (Hypoglossal) innervates the tongue muscles.
Question 3
A 45-year-old patient presents with a 2-month history of progressively worsening headache, morning
nausea, and visual disturbances. Fundoscopic examination reveals bilateral optic disc edema with
blurred margins. The most likely diagnosis is:
A. Migraine with aura
B. Pseudotumor cerebri
C. Glaucoma
D. Optic neuritis
Correct Answer: B
Rationale: Pseudotumor cerebri (idiopathic intracranial hypertension) presents with headache, nausea,
visual disturbances, and bilateral papilledema (optic disc edema) in the absence of an intracranial
mass. It is most common in obese women of childbearing age. Migraines do not cause papilledema.
Glaucoma causes optic disc cupping. Optic neuritis causes unilateral vision loss.
,Question 4
The normal adult skull should be:
A. Symmetric, smooth, with no palpable bony prominences
B. Symmetric, with palpable bony ridges and prominences
C. Asymmetric with palpable bony defects
D. Symmetric but with a palpable fontanelle
Correct Answer: A
Rationale: The normal adult skull is symmetric and smooth with no palpable bony prominences or
defects. Palpable bony ridges are normal in infants but not in adults. Asymmetry or bony defects
suggest pathology such as fracture, tumor, or Paget's disease. Fontanelles are present only in infants.
Question 5
A patient presents with a headache that is worse in the morning, associated with vomiting, and
relieved by sitting upright. These findings are most suggestive of:
A. Tension headache
B. Increased intracranial pressure
C. Migraine without aura
D. Sinus headache
Correct Answer: B
Rationale: Headaches associated with increased intracranial pressure are typically worse in the
morning (due to fluid shifts during sleep), associated with vomiting (often projectile), and relieved by
sitting upright. These are "red flag" findings requiring immediate evaluation. Tension headaches do not
have these features.
Question 6
The spinal accessory nerve (cranial nerve XI) is assessed by:
A. Asking the patient to shrug the shoulders against resistance
B. Asking the patient to protrude the tongue
, C. Asking the patient to follow a finger with the eyes
D. Asking the patient to smile and frown
Correct Answer: A
Rationale: Cranial nerve XI (Spinal Accessory) innervates the sternocleidomastoid and trapezius
muscles. Assessment includes asking the patient to shrug the shoulders against resistance (trapezius)
and turn the head against resistance (sternocleidomastoid). Tongue protrusion assesses CN XII. Eye
movements assess CN III, IV, VI. Facial expressions assess CN VII.
Question 7
A 68-year-old patient presents with a new-onset, unilateral headache in the temporal region, scalp
tenderness, and jaw pain when chewing. Laboratory studies reveal an elevated ESR and CRP. The most
likely diagnosis is:
A. Tension headache
B. Migraine
C. Giant cell arteritis
D. Trigeminal neuralgia
Correct Answer: C
Rationale: Giant cell arteritis (temporal arteritis) presents with new-onset unilateral temporal
headache, scalp tenderness, jaw claudication (pain with chewing), and elevated inflammatory markers
(ESR, CRP) in patients over 50. It is a vasculitis requiring urgent treatment with corticosteroids to
prevent vision loss. Trigeminal neuralgia causes electric shock-like facial pain.
Question 8
During palpation of the head, you note a soft, fluctuant, non-tender swelling over the occipital region
in a 2-month-old infant. This finding is most consistent with:
A. Cephalohematoma
B. Caput succedaneum
C. Encephalocele
D. Craniosynostosis
