Week 8 Exit Exam: NR 667 / NR 667 (Latest Update 2026/2027)
FNP Capstone Practicum and Intensive CEA
100 Questions | Questions and Answers | Grade A
Section 1: Advanced Health Assessment and Clinical Reasoning (Q1-Q15)
Q1. A 58-year-old male presents with substernal chest pressure radiating to the left arm and jaw, onset 20 minutes ago while
mowing the lawn. He is diaphoretic and anxious. Which component of the comprehensive health history is MOST critical to obtain
immediately?
A. Complete family history including all cardiovascular conditions
B. Detailed history of present illness focusing on onset, quality, radiation, severity, and modifying factors of chest pain [CORRECT]
C. Complete review of systems covering all 14 body systems
D. Social history including occupation, exercise habits, and stress levels
Correct Answer: B
Rationale: In a patient presenting with acute chest pain with red flag features (radiation to arm/jaw, diaphoresis), the immediate priority is obtaining a
thorough History of Present Illness (HPI) using OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing,
Severity). This information is critical for rapidly differentiating life-threatening conditions such as acute myocardial infarction, pulmonary embolism, and
aortic dissection. While family history, ROS, and social history are important components of a comprehensive assessment, they are not the priority in an
acute presentation with red flag symptoms. The HPI guides immediate triage and intervention decisions per the clinical reasoning process.
Q2. A 45-year-old female presents with a chief complaint of chronic headaches. During the focused physical examination, the FNP
uses an ophthalmoscope. Which structure is the FNP specifically evaluating when examining the fundus?
A. Corneal reflex and pupil reactivity
B. Retina, optic disc, and retinal vasculature [CORRECT]
C. Lens opacity and cataract formation
D. Extraocular muscle function and cranial nerves III, IV, VI
Correct Answer: B
Rationale: The ophthalmoscope is used to perform a fundoscopic examination, which evaluates the retina, optic disc (including the cup-to-disc ratio),
macula, and retinal vasculature. This examination is essential for identifying hypertensive retinopathy, diabetic retinopathy, papilledema (indicating
increased intracranial pressure), and optic atrophy. Corneal reflex and pupil reactivity are assessed without an ophthalmoscope. Lens opacity is evaluated
by direct observation or slit-lamp examination. Extraocular muscles are assessed by having the patient follow a finger in an H-pattern.
Q3. The FNP is performing a cardiovascular examination on a 62-year-old patient with a history of heart failure. During
auscultation, the FNP hears an S3 gallop at the apex. Which clinical condition is most commonly associated with an S3 heart sound?
A. Aortic stenosis and left ventricular hypertrophy
B. Ventricular dysfunction and heart failure (reduced ejection fraction) [CORRECT]
C. Pulmonary hypertension and right ventricular hypertrophy
D. Hypertrophic cardiomyopathy and systolic anterior motion
Correct Answer: B
Rationale: An S3 heart sound (ventricular gallop) is a low-frequency sound heard immediately after S2 during early diastole. It is caused by rapid
ventricular filling into a stiff, noncompliant ventricle and is classically associated with ventricular dysfunction and heart failure with reduced ejection
fraction (systolic HF). An S4 heart sound is associated with a stiff, hypertrophied ventricle as seen in hypertension or hypertrophic cardiomyopathy. Aortic
stenosis produces a systolic ejection murmur, not an S3. Pulmonary hypertension may produce a loud P2 component of S2. The S3 is a key clinical finding
suggesting worsening or decompensated heart failure requiring urgent management.
Q4. A 72-year-old patient presents with new-onset confusion, a temperature of 101.2F, heart rate 110 bpm, blood pressure 88/58
mmHg, and respiratory rate 24/min. The FNP recognizes red flag symptoms. Which condition should be the HIGHEST priority in
the differential diagnosis?
A. Urinary tract infection in an elderly patient
B. Sepsis with possible septic shock requiring emergent transfer [CORRECT]
C. Alzheimer's disease with behavioral disturbance
D. Dehydration from inadequate oral intake
Correct Answer: B
Rationale: This patient presents with classic red flag symptoms for sepsis and septic shock: altered mental status (new-onset confusion is a hallmark of
sepsis in elderly patients), fever, tachycardia, hypotension, and tachypnea. This meets SIRS criteria and the patient is hypotensive, indicating progression to
Page 1
, NR 667 - FNP Capstone CEA Exit Exam | Chamberlain University | 2026-2027
septic shock. Sepsis is a medical emergency requiring immediate recognition and intervention (fluid resuscitation, broad-spectrum antibiotics, and emergent
hospital transfer). While UTI is a common source of sepsis in elderly patients, it is not the highest priority diagnosis given the systemic presentation.
Alzheimer's disease would not cause fever, hypotension, and tachycardia. Sepsis recognition follows the ABC framework: this patient has both breathing
(tachypnea) and circulation (hypotension, tachycardia) compromise.
Q5. The FNP is conducting a telehealth visit for a 35-year-old patient who reports a sore throat for 3 days. Which telehealth
assessment technique is MOST appropriate during a video-based examination?
A. Instruct the patient to self-palpate the thyroid and report findings
B. Ask the patient to open their mouth wide, depress the tongue, and shine a light toward the posterior pharynx while the FNP
observes via video [CORRECT]
C. Request the patient to come to the office for all throat complaints
D. Prescribe antibiotics based on symptom description without visualization
Correct Answer: B
Rationale: During a telehealth visit for a sore throat, the FNP can guide the patient to perform a limited self-examination by opening the mouth wide,
depressing the tongue with a tongue depressor or spoon handle, and using a bright light source (phone flashlight) directed toward the posterior pharynx. The
FNP observes via video for tonsillar exudate, erythema, and swelling. This technique is appropriate for initial assessment and helps determine whether a
Centor score can be applied. While some conditions require in-person evaluation, video-guided examination is a valid telehealth technique. Prescribing
antibiotics without visualization is not evidence-based and contributes to antibiotic resistance.
Q6. The FNP is performing a respiratory examination on a patient with suspected pneumonia. Which examination finding would the
FNP expect to auscultate?
A. Wheezing bilaterally with prolonged expiratory phase
B. Crackles (rales) over the affected lung field with egophony [CORRECT]
C. Hyperresonance on percussion of the affected area
D. Decreased tactile fremitus over the affected lung field
Correct Answer: B
Rationale: Pneumonia causes consolidation of lung tissue as alveoli fill with fluid, pus, and cellular debris. On auscultation, crackles (rales) are heard over
the consolidated area, particularly during inspiration. Egophony (increased resonance of E-to-A sound change) is also present due to tissue consolidation.
Wheezing is associated with asthma or COPD. Hyperresonance on percussion suggests pneumothorax or hyperinflation (COPD/emphysema). Decreased
tactile fremitus suggests pleural effusion or pneumothorax (air/fluid between the lung and chest wall dampens sound transmission). In pneumonia, tactile
fremitus would be increased (not decreased) due to tissue consolidation improving sound transmission.
Q7. During a focused neurological examination, the FNP assesses deep tendon reflexes (DTRs). A patient has absent DTRs
bilaterally in the lower extremities. Which condition should the FNP consider in the differential diagnosis?
A. Hyperthyroidism with increased reflex reactivity
B. Diabetic peripheral neuropathy causing hyporeflexia [CORRECT]
C. Acute stroke affecting the corticospinal tract
D. Cervical radiculopathy at C5-C6
Correct Answer: B
Rationale: Absent or diminished deep tendon reflexes bilaterally in the lower extremities suggest hyporeflexia, which is classically associated with
peripheral neuropathy. Diabetic peripheral neuropathy is the most common cause of bilateral hyporeflexia in primary care, resulting from demyelination
and axonal damage to peripheral nerves. Hyperthyroidism causes hyperreflexia (increased reflex reactivity). Acute stroke affecting the upper motor neurons
(corticospinal tract) causes hyperreflexia (not absent reflexes) on the affected side, often with a Babinski sign. Cervical radiculopathy causes hyporeflexia in
a specific dermatomal/myotomal pattern (unilateral), not bilateral. The FNP should also assess for other neuropathy findings including decreased sensation,
distal muscle weakness, and gait changes.
Q8. The FNP is performing a comprehensive health assessment on a new patient. Which component of the past medical history is
MOST important for guiding preventive care decisions?
A. Number of previous hospitalizations
B. Previous surgical procedures with dates [CORRECT]
C. Complete immunization record and preventive screening history
D. Detailed medication list including OTC and supplements
Correct Answer: B
Rationale: While all components of the past medical history are important, the immunization record and preventive screening history are MOST important
for guiding preventive care decisions. The FNP uses this information to identify gaps in immunizations (influenza, pneumococcal, Tdap, shingles, COVID-19,
HPV) and preventive screenings (mammography, colonoscopy, Pap smear, PSA, DEXA, lipid panels). This directly informs the health promotion and disease
prevention plan. Hospitalizations and surgical history guide acute and chronic management. Medication list is essential for medication reconciliation and
safety but preventive care is guided by immunization and screening status.
Page 2
, NR 667 - FNP Capstone CEA Exit Exam | Chamberlain University | 2026-2027
Q9. A 50-year-old patient presents with acute onset of severe right flank pain radiating to the groin, accompanied by nausea and
vomiting. The pain is colicky (comes in waves). Which anatomical localization is MOST consistent with these findings?
A. Right upper quadrant (hepatic/biliary pathology)
B. Right flank/renal angle (ureteral/renal pathology) [CORRECT]
C. Right lower quadrant (appendiceal pathology)
D. Right hip (musculoskeletal pathology)
Correct Answer: B
Rationale: The acute onset of severe right flank pain radiating to the groin with a colicky quality is the classic presentation of ureteral colic from a ureteral
stone (nephrolithiasis). The pain originates in the flank/renal angle and radiates anteriorly to the groin as the stone moves through the ureter. This
presentation follows the clinical reasoning process: the pain is localized to the kidney/ureter anatomically. Right upper quadrant pain would suggest biliary
colic (cholecystitis or choledocholithiasis) but typically radiates to the right scapula. Right lower quadrant pain suggests appendicitis but has a different
character (constant, progressive). Right hip pain would have musculoskeletal features.
Q10. The FNP is performing a musculoskeletal examination of the knee. The patient reports medial knee pain after a twisting injury
during basketball. Which special test should the FNP perform to assess for a meniscal tear?
A. Lachman test
B. McMurray test [CORRECT]
C. Anterior drawer test
D. Valgus stress test
Correct Answer: B
Rationale: The McMurray test is the primary special test for assessing meniscal tears in the knee. The FNP flexes the patient's knee, then applies medial
rotation and valgus force while extending (testing the lateral meniscus) or lateral rotation and varus force while extending (testing the medial meniscus). A
positive test produces a palpable or audible click with pain along the joint line, indicating a meniscal tear. The Lachman test and anterior drawer test assess
for anterior cruciate ligament (ACL) integrity. The valgus stress test evaluates the medial collateral ligament (MCL). Each special test targets a specific
anatomical structure, and the FNP must select the appropriate test based on the clinical presentation.
Q11. A 65-year-old patient with type 2 diabetes presents for a routine follow-up. The FNP performs a monofilament examination on
the patient's feet. Which finding indicates the presence of diabetic peripheral neuropathy?
A. Patient correctly identifies 9 out of 10 monofilament applications
B. Patient is unable to feel the 5.07 (10-g) monofilament at one or more tested sites [CORRECT]
C. Patient reports mild tingling but can differentiate sharp from dull sensation
D. Patient has normal sensation with the monofilament at all sites
Correct Answer: B
Rationale: The 5.07 (10-g) monofilament test is the standard screening tool for diabetic peripheral neuropathy. The inability to feel the monofilament at one
or more of the standard testing sites (typically plantar surface of the great toe, third toe, and fifth metatarsal head on each foot) indicates loss of protective
sensation and establishes the diagnosis of diabetic peripheral neuropathy. This finding is clinically significant because loss of protective sensation places the
patient at high risk for foot ulcers and amputation. The patient requires intensive foot care education, referral for podiatric care, and more frequent foot
examinations. Normal sensation or correct identification of most applications does not indicate neuropathy.
Q12. The FNP is performing an abdominal examination on a patient with suspected ascites. Which physical examination technique
is MOST appropriate to detect the presence of ascites?
A. McBurney point tenderness
B. Shifting dullness on percussion [CORRECT]
C. Murphy sign assessment
D. Rebound tenderness at McBurney point
Correct Answer: B
Rationale: Shifting dullness is the classic physical examination technique for detecting ascites (free fluid in the peritoneal cavity). The FNP percusses the
abdomen with the patient supine, identifies a region of dullness (indicating fluid), then has the patient roll onto one side. If the dullness shifts to the
dependent side, this confirms the presence of free-flowing ascitic fluid. McBurney point tenderness suggests appendicitis. Murphy sign suggests cholecystitis.
Rebound tenderness suggests peritonitis. Fluid wave test is another technique for ascites detection, but shifting dullness is the most commonly taught and
performed method in primary care settings.
Q13. The FNP is conducting a focused assessment of the thyroid gland. Which technique is correct for thyroid palpation?
A. Palpate the thyroid from behind the patient using both hands while the patient swallows
B. Palpate the thyroid from the front using the fingertips only without having the patient swallow [CORRECT]
C. Use deep palpation with direct pressure to assess the thyroid isthmus
D. Have the patient look upward while the FNP palpates without the swallowing maneuver
Correct Answer: B
Page 3
FNP Capstone Practicum and Intensive CEA
100 Questions | Questions and Answers | Grade A
Section 1: Advanced Health Assessment and Clinical Reasoning (Q1-Q15)
Q1. A 58-year-old male presents with substernal chest pressure radiating to the left arm and jaw, onset 20 minutes ago while
mowing the lawn. He is diaphoretic and anxious. Which component of the comprehensive health history is MOST critical to obtain
immediately?
A. Complete family history including all cardiovascular conditions
B. Detailed history of present illness focusing on onset, quality, radiation, severity, and modifying factors of chest pain [CORRECT]
C. Complete review of systems covering all 14 body systems
D. Social history including occupation, exercise habits, and stress levels
Correct Answer: B
Rationale: In a patient presenting with acute chest pain with red flag features (radiation to arm/jaw, diaphoresis), the immediate priority is obtaining a
thorough History of Present Illness (HPI) using OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing,
Severity). This information is critical for rapidly differentiating life-threatening conditions such as acute myocardial infarction, pulmonary embolism, and
aortic dissection. While family history, ROS, and social history are important components of a comprehensive assessment, they are not the priority in an
acute presentation with red flag symptoms. The HPI guides immediate triage and intervention decisions per the clinical reasoning process.
Q2. A 45-year-old female presents with a chief complaint of chronic headaches. During the focused physical examination, the FNP
uses an ophthalmoscope. Which structure is the FNP specifically evaluating when examining the fundus?
A. Corneal reflex and pupil reactivity
B. Retina, optic disc, and retinal vasculature [CORRECT]
C. Lens opacity and cataract formation
D. Extraocular muscle function and cranial nerves III, IV, VI
Correct Answer: B
Rationale: The ophthalmoscope is used to perform a fundoscopic examination, which evaluates the retina, optic disc (including the cup-to-disc ratio),
macula, and retinal vasculature. This examination is essential for identifying hypertensive retinopathy, diabetic retinopathy, papilledema (indicating
increased intracranial pressure), and optic atrophy. Corneal reflex and pupil reactivity are assessed without an ophthalmoscope. Lens opacity is evaluated
by direct observation or slit-lamp examination. Extraocular muscles are assessed by having the patient follow a finger in an H-pattern.
Q3. The FNP is performing a cardiovascular examination on a 62-year-old patient with a history of heart failure. During
auscultation, the FNP hears an S3 gallop at the apex. Which clinical condition is most commonly associated with an S3 heart sound?
A. Aortic stenosis and left ventricular hypertrophy
B. Ventricular dysfunction and heart failure (reduced ejection fraction) [CORRECT]
C. Pulmonary hypertension and right ventricular hypertrophy
D. Hypertrophic cardiomyopathy and systolic anterior motion
Correct Answer: B
Rationale: An S3 heart sound (ventricular gallop) is a low-frequency sound heard immediately after S2 during early diastole. It is caused by rapid
ventricular filling into a stiff, noncompliant ventricle and is classically associated with ventricular dysfunction and heart failure with reduced ejection
fraction (systolic HF). An S4 heart sound is associated with a stiff, hypertrophied ventricle as seen in hypertension or hypertrophic cardiomyopathy. Aortic
stenosis produces a systolic ejection murmur, not an S3. Pulmonary hypertension may produce a loud P2 component of S2. The S3 is a key clinical finding
suggesting worsening or decompensated heart failure requiring urgent management.
Q4. A 72-year-old patient presents with new-onset confusion, a temperature of 101.2F, heart rate 110 bpm, blood pressure 88/58
mmHg, and respiratory rate 24/min. The FNP recognizes red flag symptoms. Which condition should be the HIGHEST priority in
the differential diagnosis?
A. Urinary tract infection in an elderly patient
B. Sepsis with possible septic shock requiring emergent transfer [CORRECT]
C. Alzheimer's disease with behavioral disturbance
D. Dehydration from inadequate oral intake
Correct Answer: B
Rationale: This patient presents with classic red flag symptoms for sepsis and septic shock: altered mental status (new-onset confusion is a hallmark of
sepsis in elderly patients), fever, tachycardia, hypotension, and tachypnea. This meets SIRS criteria and the patient is hypotensive, indicating progression to
Page 1
, NR 667 - FNP Capstone CEA Exit Exam | Chamberlain University | 2026-2027
septic shock. Sepsis is a medical emergency requiring immediate recognition and intervention (fluid resuscitation, broad-spectrum antibiotics, and emergent
hospital transfer). While UTI is a common source of sepsis in elderly patients, it is not the highest priority diagnosis given the systemic presentation.
Alzheimer's disease would not cause fever, hypotension, and tachycardia. Sepsis recognition follows the ABC framework: this patient has both breathing
(tachypnea) and circulation (hypotension, tachycardia) compromise.
Q5. The FNP is conducting a telehealth visit for a 35-year-old patient who reports a sore throat for 3 days. Which telehealth
assessment technique is MOST appropriate during a video-based examination?
A. Instruct the patient to self-palpate the thyroid and report findings
B. Ask the patient to open their mouth wide, depress the tongue, and shine a light toward the posterior pharynx while the FNP
observes via video [CORRECT]
C. Request the patient to come to the office for all throat complaints
D. Prescribe antibiotics based on symptom description without visualization
Correct Answer: B
Rationale: During a telehealth visit for a sore throat, the FNP can guide the patient to perform a limited self-examination by opening the mouth wide,
depressing the tongue with a tongue depressor or spoon handle, and using a bright light source (phone flashlight) directed toward the posterior pharynx. The
FNP observes via video for tonsillar exudate, erythema, and swelling. This technique is appropriate for initial assessment and helps determine whether a
Centor score can be applied. While some conditions require in-person evaluation, video-guided examination is a valid telehealth technique. Prescribing
antibiotics without visualization is not evidence-based and contributes to antibiotic resistance.
Q6. The FNP is performing a respiratory examination on a patient with suspected pneumonia. Which examination finding would the
FNP expect to auscultate?
A. Wheezing bilaterally with prolonged expiratory phase
B. Crackles (rales) over the affected lung field with egophony [CORRECT]
C. Hyperresonance on percussion of the affected area
D. Decreased tactile fremitus over the affected lung field
Correct Answer: B
Rationale: Pneumonia causes consolidation of lung tissue as alveoli fill with fluid, pus, and cellular debris. On auscultation, crackles (rales) are heard over
the consolidated area, particularly during inspiration. Egophony (increased resonance of E-to-A sound change) is also present due to tissue consolidation.
Wheezing is associated with asthma or COPD. Hyperresonance on percussion suggests pneumothorax or hyperinflation (COPD/emphysema). Decreased
tactile fremitus suggests pleural effusion or pneumothorax (air/fluid between the lung and chest wall dampens sound transmission). In pneumonia, tactile
fremitus would be increased (not decreased) due to tissue consolidation improving sound transmission.
Q7. During a focused neurological examination, the FNP assesses deep tendon reflexes (DTRs). A patient has absent DTRs
bilaterally in the lower extremities. Which condition should the FNP consider in the differential diagnosis?
A. Hyperthyroidism with increased reflex reactivity
B. Diabetic peripheral neuropathy causing hyporeflexia [CORRECT]
C. Acute stroke affecting the corticospinal tract
D. Cervical radiculopathy at C5-C6
Correct Answer: B
Rationale: Absent or diminished deep tendon reflexes bilaterally in the lower extremities suggest hyporeflexia, which is classically associated with
peripheral neuropathy. Diabetic peripheral neuropathy is the most common cause of bilateral hyporeflexia in primary care, resulting from demyelination
and axonal damage to peripheral nerves. Hyperthyroidism causes hyperreflexia (increased reflex reactivity). Acute stroke affecting the upper motor neurons
(corticospinal tract) causes hyperreflexia (not absent reflexes) on the affected side, often with a Babinski sign. Cervical radiculopathy causes hyporeflexia in
a specific dermatomal/myotomal pattern (unilateral), not bilateral. The FNP should also assess for other neuropathy findings including decreased sensation,
distal muscle weakness, and gait changes.
Q8. The FNP is performing a comprehensive health assessment on a new patient. Which component of the past medical history is
MOST important for guiding preventive care decisions?
A. Number of previous hospitalizations
B. Previous surgical procedures with dates [CORRECT]
C. Complete immunization record and preventive screening history
D. Detailed medication list including OTC and supplements
Correct Answer: B
Rationale: While all components of the past medical history are important, the immunization record and preventive screening history are MOST important
for guiding preventive care decisions. The FNP uses this information to identify gaps in immunizations (influenza, pneumococcal, Tdap, shingles, COVID-19,
HPV) and preventive screenings (mammography, colonoscopy, Pap smear, PSA, DEXA, lipid panels). This directly informs the health promotion and disease
prevention plan. Hospitalizations and surgical history guide acute and chronic management. Medication list is essential for medication reconciliation and
safety but preventive care is guided by immunization and screening status.
Page 2
, NR 667 - FNP Capstone CEA Exit Exam | Chamberlain University | 2026-2027
Q9. A 50-year-old patient presents with acute onset of severe right flank pain radiating to the groin, accompanied by nausea and
vomiting. The pain is colicky (comes in waves). Which anatomical localization is MOST consistent with these findings?
A. Right upper quadrant (hepatic/biliary pathology)
B. Right flank/renal angle (ureteral/renal pathology) [CORRECT]
C. Right lower quadrant (appendiceal pathology)
D. Right hip (musculoskeletal pathology)
Correct Answer: B
Rationale: The acute onset of severe right flank pain radiating to the groin with a colicky quality is the classic presentation of ureteral colic from a ureteral
stone (nephrolithiasis). The pain originates in the flank/renal angle and radiates anteriorly to the groin as the stone moves through the ureter. This
presentation follows the clinical reasoning process: the pain is localized to the kidney/ureter anatomically. Right upper quadrant pain would suggest biliary
colic (cholecystitis or choledocholithiasis) but typically radiates to the right scapula. Right lower quadrant pain suggests appendicitis but has a different
character (constant, progressive). Right hip pain would have musculoskeletal features.
Q10. The FNP is performing a musculoskeletal examination of the knee. The patient reports medial knee pain after a twisting injury
during basketball. Which special test should the FNP perform to assess for a meniscal tear?
A. Lachman test
B. McMurray test [CORRECT]
C. Anterior drawer test
D. Valgus stress test
Correct Answer: B
Rationale: The McMurray test is the primary special test for assessing meniscal tears in the knee. The FNP flexes the patient's knee, then applies medial
rotation and valgus force while extending (testing the lateral meniscus) or lateral rotation and varus force while extending (testing the medial meniscus). A
positive test produces a palpable or audible click with pain along the joint line, indicating a meniscal tear. The Lachman test and anterior drawer test assess
for anterior cruciate ligament (ACL) integrity. The valgus stress test evaluates the medial collateral ligament (MCL). Each special test targets a specific
anatomical structure, and the FNP must select the appropriate test based on the clinical presentation.
Q11. A 65-year-old patient with type 2 diabetes presents for a routine follow-up. The FNP performs a monofilament examination on
the patient's feet. Which finding indicates the presence of diabetic peripheral neuropathy?
A. Patient correctly identifies 9 out of 10 monofilament applications
B. Patient is unable to feel the 5.07 (10-g) monofilament at one or more tested sites [CORRECT]
C. Patient reports mild tingling but can differentiate sharp from dull sensation
D. Patient has normal sensation with the monofilament at all sites
Correct Answer: B
Rationale: The 5.07 (10-g) monofilament test is the standard screening tool for diabetic peripheral neuropathy. The inability to feel the monofilament at one
or more of the standard testing sites (typically plantar surface of the great toe, third toe, and fifth metatarsal head on each foot) indicates loss of protective
sensation and establishes the diagnosis of diabetic peripheral neuropathy. This finding is clinically significant because loss of protective sensation places the
patient at high risk for foot ulcers and amputation. The patient requires intensive foot care education, referral for podiatric care, and more frequent foot
examinations. Normal sensation or correct identification of most applications does not indicate neuropathy.
Q12. The FNP is performing an abdominal examination on a patient with suspected ascites. Which physical examination technique
is MOST appropriate to detect the presence of ascites?
A. McBurney point tenderness
B. Shifting dullness on percussion [CORRECT]
C. Murphy sign assessment
D. Rebound tenderness at McBurney point
Correct Answer: B
Rationale: Shifting dullness is the classic physical examination technique for detecting ascites (free fluid in the peritoneal cavity). The FNP percusses the
abdomen with the patient supine, identifies a region of dullness (indicating fluid), then has the patient roll onto one side. If the dullness shifts to the
dependent side, this confirms the presence of free-flowing ascitic fluid. McBurney point tenderness suggests appendicitis. Murphy sign suggests cholecystitis.
Rebound tenderness suggests peritonitis. Fluid wave test is another technique for ascites detection, but shifting dullness is the most commonly taught and
performed method in primary care settings.
Q13. The FNP is conducting a focused assessment of the thyroid gland. Which technique is correct for thyroid palpation?
A. Palpate the thyroid from behind the patient using both hands while the patient swallows
B. Palpate the thyroid from the front using the fingertips only without having the patient swallow [CORRECT]
C. Use deep palpation with direct pressure to assess the thyroid isthmus
D. Have the patient look upward while the FNP palpates without the swallowing maneuver
Correct Answer: B
Page 3
