NR-509 WEEK 3 QUIZ EXAM with Questions
and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Physical Assessment Techniques
2. HEENT (Head, Eyes, Ears, Nose, Throat) Examination
3. Skin, Hair, and Nail Assessment
4. Cranial Nerve Function and Testing
5. Clinical Decision Making in Primary Care
1. During a routine physical assessment of a 45-year-old patient, you note a firm, non-tender, fixed
nodule on the thyroid gland. What is the most appropriate next step?
A. Reassess the thyroid in 3 months.
B. Order a thyroid ultrasound and fine-needle aspiration biopsy.
C. Prescribe levothyroxine to suppress TSH levels.
D. Order a serum TSH and Free T4 level.
CORRECT ANSWER : B
Rationale: A firm, fixed, and non-tender nodule is highly suspicious for malignancy. While
thyroid function tests (D) are part of the workup, they do not rule out cancer; ultrasound and
biopsy are necessary to definitively assess for thyroid carcinoma. Options A and C are
inappropriate as they delay diagnosis of a potentially malignant lesion.
2. A 30-year-old patient presents with sudden onset of severe eye pain, blurred vision, and a "halo"
around lights. Physical exam reveals a fixed, mid-dilated pupil and a cloudy cornea. What is the
suspected diagnosis?
, A. Conjunctivitis
B. Acute angle-closure glaucoma
C. Cataracts
D. Uveitis
CORRECT ANSWER : B
Rationale: These classic symptoms (halos, severe pain, mid-dilated pupil) are indicative of an
ophthalmologic emergency. Conjunctivitis (A) typically presents with discharge without severe
pain; cataracts (C) present with painless, gradual clouding; uveitis (D) presents with eye pain
and photophobia but usually a constricted pupil.
3. When examining the optic disc, you observe blurred margins and an elevated appearance. This is
a clinical sign of:
A. Glaucoma
B. Increased intracranial pressure (Papilledema)
C. Diabetic retinopathy
D. Hypertensive retinopathy
CORRECT ANSWER : B
Rationale: Papilledema is the swelling of the optic disc due to increased intracranial pressure.
Glaucoma (A) causes disc cupping. Diabetic (C) and hypertensive (D) retinopathies involve
microvascular changes like exudates, hemorrhages, or arteriolar narrowing rather than disc
elevation.
4. A 60-year-old patient reports difficulty hearing high-pitched sounds and difficulty following
conversations in crowded rooms. What is the most likely finding upon Weber test?
A. Lateralization to the affected ear (conductive loss).
B. Lateralization to the unaffected ear (sensorineural loss).
C. No lateralization.
D. Air conduction greater than bone conduction.
CORRECT ANSWER : B
, Rationale: Presbycusis is a sensorineural hearing loss; in sensorineural loss, the Weber test
lateralizes to the healthier (unaffected) ear because the affected cochlea cannot perceive the
sound. Conductive loss (A) would lateralize to the affected ear. Option C and D represent
normal findings or improper testing for this pathology.
5. A patient presents with a history of recurrent nosebleeds. Upon examination of the nasal septum,
you see a small, friable vessel on the anterior inferior septum. This area is known as:
A. Kiesselbach’s plexus
B. Little’s area
C. The superior turbinate
D. The posterior ethmoid artery
CORRECT ANSWER : B
Rationale: Little’s area (or Kiesselbach’s plexus) is the most common site for anterior epistaxis
due to the convergence of multiple arteries. The other options refer to anatomical structures not
associated with the primary site of anterior nosebleeds.
6. You are evaluating a patient for facial nerve (CN VII) palsy. Which clinical observation
confirms a peripheral lesion rather than a central lesion?
A. Inability to smile on the affected side.
B. Inability to wrinkle the forehead on the affected side.
C. Slight drooping of the corner of the mouth.
D. Normal eyelid closure.
CORRECT ANSWER : B
Rationale: In a peripheral facial nerve lesion (Bell’s palsy), the entire side of the face is
paralyzed, including the forehead. In a central lesion (like a stroke), the forehead is spared
because of bilateral innervation. Options A, C, and D are seen in both peripheral and central
lesions.
7. A patient presents with a sore throat, tonsillar exudate, and tender anterior cervical
lymphadenopathy. According to the Centor criteria, what is the next step?
A. Immediate administration of antibiotics.
B. Rapid antigen detection test for Group A Streptococcus.
, C. Supportive care only.
D. CBC to rule out mononucleosis.
CORRECT ANSWER : B
Rationale: Given the high Centor score, testing for GABHS is required to confirm the diagnosis
before prescribing antibiotics to ensure antibiotic stewardship. Option A is inappropriate
without confirmation. Option C ignores the potential bacterial etiology. Option D is not the
priority for a suspected strep infection.
8. When testing the pupillary light reflex, you notice that when light is shone in the right eye,
neither eye constricts. When light is shone in the left eye, both eyes constrict. Where is the
lesion?
A. Right Oculomotor nerve (CN III)
B. Right Optic nerve (CN II)
C. Left Optic nerve (CN II)
D. Left Oculomotor nerve (CN III)
CORRECT ANSWER : B
Rationale: The lack of response in either eye when the right eye is stimulated indicates an
afferent defect on the right side. Since the left eye responds when the left eye is stimulated, the
motor pathway (efferent) is intact. This points to a right optic nerve lesion.
9. A patient has a painless, firm, mobile nodule on the eyelid that has been present for several
months. What is the most likely diagnosis?
A. Hordeolum (Stye)
B. Chalazion
C. Blepharitis
D. Entropion
CORRECT ANSWER : B
Rationale: A chalazion is a chronic granulomatous inflammation of a Meibomian gland,
presenting as a painless, firm lump. A hordeolum (A) is an acute, painful infection. Blepharitis
(C) involves inflammation of the lid margins. Entropion (D) is an inward turning of the eyelid.
and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Physical Assessment Techniques
2. HEENT (Head, Eyes, Ears, Nose, Throat) Examination
3. Skin, Hair, and Nail Assessment
4. Cranial Nerve Function and Testing
5. Clinical Decision Making in Primary Care
1. During a routine physical assessment of a 45-year-old patient, you note a firm, non-tender, fixed
nodule on the thyroid gland. What is the most appropriate next step?
A. Reassess the thyroid in 3 months.
B. Order a thyroid ultrasound and fine-needle aspiration biopsy.
C. Prescribe levothyroxine to suppress TSH levels.
D. Order a serum TSH and Free T4 level.
CORRECT ANSWER : B
Rationale: A firm, fixed, and non-tender nodule is highly suspicious for malignancy. While
thyroid function tests (D) are part of the workup, they do not rule out cancer; ultrasound and
biopsy are necessary to definitively assess for thyroid carcinoma. Options A and C are
inappropriate as they delay diagnosis of a potentially malignant lesion.
2. A 30-year-old patient presents with sudden onset of severe eye pain, blurred vision, and a "halo"
around lights. Physical exam reveals a fixed, mid-dilated pupil and a cloudy cornea. What is the
suspected diagnosis?
, A. Conjunctivitis
B. Acute angle-closure glaucoma
C. Cataracts
D. Uveitis
CORRECT ANSWER : B
Rationale: These classic symptoms (halos, severe pain, mid-dilated pupil) are indicative of an
ophthalmologic emergency. Conjunctivitis (A) typically presents with discharge without severe
pain; cataracts (C) present with painless, gradual clouding; uveitis (D) presents with eye pain
and photophobia but usually a constricted pupil.
3. When examining the optic disc, you observe blurred margins and an elevated appearance. This is
a clinical sign of:
A. Glaucoma
B. Increased intracranial pressure (Papilledema)
C. Diabetic retinopathy
D. Hypertensive retinopathy
CORRECT ANSWER : B
Rationale: Papilledema is the swelling of the optic disc due to increased intracranial pressure.
Glaucoma (A) causes disc cupping. Diabetic (C) and hypertensive (D) retinopathies involve
microvascular changes like exudates, hemorrhages, or arteriolar narrowing rather than disc
elevation.
4. A 60-year-old patient reports difficulty hearing high-pitched sounds and difficulty following
conversations in crowded rooms. What is the most likely finding upon Weber test?
A. Lateralization to the affected ear (conductive loss).
B. Lateralization to the unaffected ear (sensorineural loss).
C. No lateralization.
D. Air conduction greater than bone conduction.
CORRECT ANSWER : B
, Rationale: Presbycusis is a sensorineural hearing loss; in sensorineural loss, the Weber test
lateralizes to the healthier (unaffected) ear because the affected cochlea cannot perceive the
sound. Conductive loss (A) would lateralize to the affected ear. Option C and D represent
normal findings or improper testing for this pathology.
5. A patient presents with a history of recurrent nosebleeds. Upon examination of the nasal septum,
you see a small, friable vessel on the anterior inferior septum. This area is known as:
A. Kiesselbach’s plexus
B. Little’s area
C. The superior turbinate
D. The posterior ethmoid artery
CORRECT ANSWER : B
Rationale: Little’s area (or Kiesselbach’s plexus) is the most common site for anterior epistaxis
due to the convergence of multiple arteries. The other options refer to anatomical structures not
associated with the primary site of anterior nosebleeds.
6. You are evaluating a patient for facial nerve (CN VII) palsy. Which clinical observation
confirms a peripheral lesion rather than a central lesion?
A. Inability to smile on the affected side.
B. Inability to wrinkle the forehead on the affected side.
C. Slight drooping of the corner of the mouth.
D. Normal eyelid closure.
CORRECT ANSWER : B
Rationale: In a peripheral facial nerve lesion (Bell’s palsy), the entire side of the face is
paralyzed, including the forehead. In a central lesion (like a stroke), the forehead is spared
because of bilateral innervation. Options A, C, and D are seen in both peripheral and central
lesions.
7. A patient presents with a sore throat, tonsillar exudate, and tender anterior cervical
lymphadenopathy. According to the Centor criteria, what is the next step?
A. Immediate administration of antibiotics.
B. Rapid antigen detection test for Group A Streptococcus.
, C. Supportive care only.
D. CBC to rule out mononucleosis.
CORRECT ANSWER : B
Rationale: Given the high Centor score, testing for GABHS is required to confirm the diagnosis
before prescribing antibiotics to ensure antibiotic stewardship. Option A is inappropriate
without confirmation. Option C ignores the potential bacterial etiology. Option D is not the
priority for a suspected strep infection.
8. When testing the pupillary light reflex, you notice that when light is shone in the right eye,
neither eye constricts. When light is shone in the left eye, both eyes constrict. Where is the
lesion?
A. Right Oculomotor nerve (CN III)
B. Right Optic nerve (CN II)
C. Left Optic nerve (CN II)
D. Left Oculomotor nerve (CN III)
CORRECT ANSWER : B
Rationale: The lack of response in either eye when the right eye is stimulated indicates an
afferent defect on the right side. Since the left eye responds when the left eye is stimulated, the
motor pathway (efferent) is intact. This points to a right optic nerve lesion.
9. A patient has a painless, firm, mobile nodule on the eyelid that has been present for several
months. What is the most likely diagnosis?
A. Hordeolum (Stye)
B. Chalazion
C. Blepharitis
D. Entropion
CORRECT ANSWER : B
Rationale: A chalazion is a chronic granulomatous inflammation of a Meibomian gland,
presenting as a painless, firm lump. A hordeolum (A) is an acute, painful infection. Blepharitis
(C) involves inflammation of the lid margins. Entropion (D) is an inward turning of the eyelid.
