NSG6020 FINAL EXAM (3 VERSIONS)/ NSG 6020 FINAL EXAM (LATEST, 2021): SOUTH UNIVERSITY |100% CORRECT ANSWERS, DOWNLOAD TO SCORE “A”|

NSG6020 FINAL EXAM (3 VERSIONS)/ NSG 6020 FINAL EXAM (LATEST, 2021): SOUTH UNIVERSITY |100% CORRECT ANSWERS, DOWNLOAD TO SCORE “A”| NSG6020 Final Exam Version-1 Question 1 A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? A) Infectious B) Inflammatory C) Hematologic D) Traumatic Question 2 A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Actinic lentigines D) Heavy sun exposure Question 3 A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter's weight. You measure her daughter's height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate? A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic. B) Reassure the mother that this is a normal body weight. C) Give the patient information about exercise because the patient is obese. D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese. Question 4 A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months.They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office. Question 5 Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely? A) An enlarged lymph node B) A sebaceous cyst C) An actinic keratosis D) A malignant lesion Question 6 A patient comes to you for the appearance of red patches on his forearms that have been present for several months. They remain for several weeks. He denies a history of trauma. Which of the following is likely? A) Actinic keratoses B) Pseudoscars C) Actinic purpura D) Cherry angiomas Question 7 A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion Question 8 A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma Question 9 A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough? A) Ophthalmologic B) Auditory C) Cardiac D) Endocrine Question 10 A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying to him. He admits to lip-reading more. He has a history of noise exposure in his young adult years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based on this information, what is the most likely finding regarding his hearing acuity? A) Loss of acuity for middle-range sounds B) Increase of acuity for low-range sounds C) Loss of acuity for high-range sounds D) Increase of acuity for high-range sounds Question 11 Mrs.Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Urticaria, or hives C) Psoriasis D) Purpura Question 12 A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story Question 13 An 89-year-old retired school principal comes for an annual check-up. She would like to know whether or not she should undergo a screening colonoscopy. She has never done this before. Which of the following factors should not be considered when discussing whether she should go for this screening test? A) Life expectancy B) Time interval until benefit from screening accrues C) Patient preference D) Current age of patient Question 14 You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter 6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter 6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter 6 mm; E = evolution Question 15 A 79-year-old retired banker comes to your office for evaluation of difficulty with urination; he gets up five to six times per night to urinate and has to go at least that often in the daytime. He does not feel as if his bladder empties completely; the strength of the urinary stream is diminished. He denies dysuria or hematuria. This problem has been present for several years but has worsened over the last 8 months. You palpate his prostate. What is your expected physical examination finding, based on this description? A) Normal size, smooth B) Normal size, boggy C) Enlarged size, smooth D) Enlarged size, boggy Question 16 A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection Question 17 A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most likely pathologic process? A) Infection B) Inflammation C) Allergic D) Vascular Question 18 A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs.Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma Question 19 An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia Question 20 A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema Question 21 Which of the following booster immunizations is recommended in the older adult population? A) Tetanus B) Diphtheria C) Measles D) Mumps Question 22 A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to? A) Musculoskeletal B) Reproductive C) Urinary D) Endocrine Question 23 Ms.Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient. Question 24 You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your "routine" when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers? A) Continue asking these questions in a more selective way. B) Stop asking these questions, because they are low yield. C) Question the validity of the questions. D) Ask these questions of all your patients. Question 25 On routine screening you notice that the cup-to-disc ratio of the patient's right eye is 1:2. What ocular condition should you suspect? A) Macular degeneration B) Diabetic retinopathy C) Hypertensive retinopathy D) Glaucoma Question 26 Mrs.Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems. Question 27 A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process? A) Infectious B) Neoplastic C) Degenerative D) Traumatic Question 28 A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema Question 29 Which of the following changes are expected in vision as part of the normal aging process? A) Cataracts B) Glaucoma C) Macular degeneration D) Blurring of near vision Question 30 You are examining an unconscious patient from another region and notice Beau's lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next? A) Conclude this is caused by a cultural practice. B) Conclude this finding is most likely secondary to trauma. C) Look for information from family and records regarding any problems which occurred 3 months ago. D) Ask about dietary intake. VERSION 2 - A 65-year-old patient remarks that she just can’t believe that her breasts sag so much. She states it must be from lack of exercise. What explanation should the nurse offer her? After menopause, the glandular and fat tissue atrophies, causing breast size and
 elasticity to diminish, resulting in breasts that sag. - The mother of a 10-year-old boy asks the nurse to discuss the recognition of puberty. The nurse should reply by saying: “Puberty usuallybegins about age fifteen.” “The first sign of puberty is enlargement of the testes.” “Penis size does not increase until about the age of sixteen.” "The development ofpubic hair precedes testicular or penis enlargement.” 4. During an examination, the nurse notes severe nystagmus in both eyes of a patient. Which of the following conclusions is correct? 1.This is a normal occurrence. 2.This may indicate disease of the cerebellum or brainstem. 3.This is a sign that the patient is nervous about the examination. 4.This indicates a visual problem and a referral to an ophthalmologist is indicated. End-point nystagmus at an extreme lateral gaze occurs normally. Assess any other nystagmus carefully. Severe nystagmus occurs with disease of the vestibular system, cerebellum, or brainstem. 1. A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her physician evaluated the lump and determined that it “was nothing to worry about.” The examination validates the presence of a mass in the right upper outer quadrant at 1 o’clock, approximately 5 cm from the nipple. It is firm, mobile, nontender, with borders that are not well defined. The nurse’s recommendation to her is: “Because of the change in consistency of the lump, it should be further evaluatedby a physician.” 1. A patient's mother has noticed that her son, who has been to a new babysitter, has some blisters and scabs on his face and buttocks. On examination, the nurse notices moist, thin-roofed vesicles with a thin erythematous base and suspects: Impetigo 9. A 16-yr-old girl is being seen at clinic for gastrointestinal complaints+weight loss. Nurse determines that many of her complaints may be related to erratic eating patterns, eating predominantly fast foods, + high caffeine intake. In this situation, which is most appropriate when collecting current dietary intake information? I picked keep a log of 2 work days and 1 weekend 10. A patient has a positive Homans' sign. The nurse knows that a positive Homans' sign may indicate: deep vein thrombosis. (this wasn’t an option …. It said venous insufficiency or thrombophlebitis ) 9. A 15-year-old boy is seen in the clinic for complaints of “dull pain and pulling” in the scrotal area. On examination the nurse palpates a soft, irregular mass posterior to and above the testis on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with: varicocele 10. The nurse is bathing an 80-year-old man and notices that his skin is wrinkled,thin, lax, and dry. This finding would be related to which factor? An increased loss of elastin and a decrease in subcutaneous fat in the elderly 17. In assessment of 1-month-old, nurse notes a lack of response to noise or stimulation. mother reports that in the last week he has been sleeping all the time + when awake all he does is cry. nurse hears that infant’s cries are very high pitched and shrill. What would be nurse’s appropriate response? 1.Refer the infant for further testing. 2.Talk with the mother about eating habits. 3.Nothing; these are expected findings for an infant this age. 4.Tell the mother to bring the baby back in a week for a recheck. A high-pitched shrill cry or cat-sounding screech occurs with central nervous system damage. Lethargy, hyporeactivity, hyperirritability, and parent’s report of significant change in behavior all warrant referral. 11. A 14-year-old girl is anxious about not having reached menarche. When taking the history, the nurse should ascertain which of the following?The age: she began to develop breasts 12. During an examination, the nurse notes a supernumerary nipple just under the patient’s left breast. The patient tells the nurse that she always thought it was a mole. Which statement about this finding is correct? It is a normal variation and not a significant finding 23. In a person with an upper motor neuron lesion such as a cerebrovascular accident, which of the following physical assessment findings would the nurse expect to see? 1.Hyperreflexia 2.Fasciculations 3.Loss of muscle tone and flaccidity 4.Atrophy and wasting of the muscles Hyperreflexia, diminished or absent superficial reflexes, increased muscle tone or spasticity can be expected with upper motor neuron lesions. 27. uring an examination, you note that a male patient has a red, round, superficial ulcer with a yellowish-serous discharge on his penis. Upon palpation, you note a nontender base that feels like a small button between your thumb and fingers. At this point you suspect that this patient has: syphilitic chancre 28. During an interview, a patient reveals that she is pregnant. She states that she is not sure whether shewill breastfeed her baby and asks for some information about this. Which of these statements by the nurse is accurate with regard tobreastfeeding? “Breastfeeding provides the perfect food and antibodies for your baby.” or Breast-feeding may reduce the risk of breast cancer. 30. The nurse practitioner is examining only the rectal area of a woman and should place the woman in what position? The nurse should place the female patient in lithotomy position if examining genitalia as well; use the left lateral decubitus 33. A man found wandering in park at 2AM has been brought to emergency department for examination because he said he fell+hit head. During examination, nurse asks him to use his index finger to touch nurse’s finger, then own nose, then nurse’s finger again (moved to a different location). patient is clumsy, unable to follow the instructions, +overshoots mark, missing finger. nurse suspects... 1.Cerebral injury 2.Cerebrovascular accident 3.Acute alcohol intoxication 4.Peripheral neuropathy . During an assessment, the nurse notes that a patient's left arm is swollen from the shoulder down to the fingers, with nonpitting edema. The right arm is normal. The patient had a mastectomy 1 year ago. The nurse suspects which problem? Lymphedema . The assessment of an 80-year-old patient, the nurse notes that his hands show tremors when he reaches for something and that his head is always nodding. There is no associated rigidity with movement. Which of the following statements is most accurate? these findings are normal 44. Which of the following statements is true regarding the arterial system? The arterial system is a high-pressure system. 45. A patient who is visiting the clinic complains of having "stomach pains for 2 weeks" and describes his stools as being "soft and black" for about the last 10 days. He denies taking any medications. The NP is aware that these symptoms are most indicative of: occult blood resulting from gastrointestinal bleeding. 47. When assessing a patient the nurse practitioner documents the left femoral pulse as 0/0-4+. Which of the following findings would the nurse practitioner expect at the dorsalis pedis pulse? 0/0-4+Pulsations are graded on a four-point scale: 0, absent; 1+, weak; 2+, normal; 3+, increased; 4+, bounding. If a pulse is absent at the femoral site, one would expect the dorsalis pedis pulse to be absent also. 49. The nurse practitioner is doing an assessment on a 29-year-old woman who visits the clinic complaining of "always dropping things and falling down." While testing rapid alternating movements, the nurse practitioner notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What might the nurse practitioner suspect? Dysfunction of the cerebellum In rapid, alternating movements, slow, clumsy, and sloppy response occurs with cerebellar disease. 50. The wife of a 65 year old man tells the nurse that she is concerned because she has noted a change in her husband's personality and ability to understand. He also cries and becomes angry very easily. The nurse recalls that the cerebral lobe responsible for these behaviors is which of the following? Frontal 51. A male patient with possible fertility problems asks the nurse where sperm is produced. The nurse knows that sperm production occurs in the: testes. 52. Which of the following statements reflects the best approach to teaching a woman about breast self-examination (BSE)? "BSE on a monthly basis will help you feel familiar with your own breasts and their normal variations." 53. When assessing a patient's pulse, the nurse practitioner notes that the amplitude is weaker during inspiration and stronger during expiration. When the nurse practitioner measures the blood pressure, the reading decreases 20 mm Hg during inspiration and increases with expiration. This patient is experiencing: pulsus paradoxus. 57. Assessment of a 60-yr-old patient has taken longer than anticipated. in testing pain perception nurse decides to complete the test as quickly as possible. When nurse applies sharp point of pin on his arm several times, he is only able to identify these as one 'very sharp prick.' most accurate explanation? hyperesthesia as a result of aging process likely the result of the summation effect. 3.The nurse was probably not poking hard enough with the pin in the other areas. 4.The patient most likely has analgesia in some areas of arm and hyperalgesia in others. ANS: 2Let at least 2 seconds elapse between each stimulus to avoid summation. With summation, frequent consecutive stimuli are perceived as one strong stimulus. 57. Assessing a 7-month-old infant you make a loud noise and note the following response: Abduction and flexion of arms and legs; fanning of fingers and curling of index finger and thumb in C-position; followed by infant bringing in arms and legs to body. What do you know about this? 1.This could indicate brachial nerve palsy 2.This is an expected startle response at this age 3.This reflex should disappear between 1 and 4 months of age 4.It is normal as long as movements are symmetrical bilaterally 61. Which of the following veins are responsible for most of the venous return in the arm? 1.Deep veins 2.Ulnar veins 3.Subclavian veins 4.Superficial veins 62. A man who has had gout for several years comes to the clinic with a "problem with my toe." On examination, the nurse practitioner notes the presence of hard, painless nodules over the great toe; one had burst open with a chalky discharge. This finding is known as: Tophi are collections of sodium urate crystals resulting from chronic gout in and around the joint that cause extreme swelling and joint deformity. They appear as hard, painless nodules (tophi) over the metatarsophalangeal joint of the first toe and they sometimes burst with a chalky discharge 64. A 70-year-old patient is scheduled for open-heart surgery. The surgeon plans to use the great saphenous vein for the coronary bypass grafts. The patient asks, “What happens to my circulation when the veins are removed?” The nurse should reply: “Because the deeper veins in your leg are in good condition, this vein can be removed without harming your circulation.” 65. When observing the vestibule, the nurse practitioner should be able to see the: Urethral meatus and vaginal orifice 66. When the nurse is conducting sexual history from a male adolescent, which statement would be most appropriate to use at the beginning of the interview? Often boys your age have questions about sexual activity 70. Mrs. A has had arthritis for years and is starting to notice that her fingers are drifting to this side. This is commonly referred to as: ulnar deviation 72. A 14-year-old boy who has been diagnosed with Osgood-Schlatter disease reports painful swelling just below the knee for the past 5 months. Which response by the nurse practitioner is appropriate? "Your disease is due to repeated stress on the patellar tendon. It is usually self-limited, and your symptoms should resolve with rest." 75. The nurse practitioner has completed the musculoskeletal examination of a patient’s knee and has found a positive bulge sign. The nurse suspects: Swelling from fluid in the suprapatellar pouch 76. Which of the following statements is true with regard to the history of a postmenopausal woman? ASK IF SHE EVER HAS VAGINAL BLEEDING 78. During a physical examination, a 45-year-old woman states that she has had a crusty, itchy rash on her breast for about 2 weeks. In trying to find the cause of the rash, which of these would beimportant for the nurse to determine? Where did it first appear—on the nipple, the areola, or the surrounding skin? ??? CONCERN FOR PAGETS DISEASE 80. The patient is in her first trimester of pregnancy. She complains of feeling nauseated and has vomited on occasion. She tells the nurse that she did not have this with her first pregnancy. She asks the nurse, "What is causing this and when will it end?" How should the nurse respond? The nausea is caused by elevated levels of progesterone and estrogen, and the nausea should end once her body adjusts to the increased hormone levels. 81. A professional tennis player comes in complaining of a sore elbow. You suspect that he has tenderness at: the medial and lateral epicondyle 85. In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Whichof the following describes the nurse’s best course of action? Explain that this condition may be the result of hormonal changes and recommendthat he see his physician. 88. During an annual check-up of a 55 y/o patient, the nurse discusses the early detection measures for colon cancer. The nurse should mention the need for a colonoscopy every 10 years 89. What are the two main parts of the nervous system? Central Nervous System (CNS) and Peripheral Nervous System (PNS) 90. While obtaining a history of a 3-month old infant from the mother, the nurse practitioner asks about the baby's ability to suck and grasp the mother's finger. What is the nurse practitioner assessing? REFLEXES NSG 6020 FINAL EXAM Version-3 Question1 Question : You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? Student Answer: Moist and smooth Moist and rough Dry and smooth Dry and rough Question 2. Question : You are assessing a patient with joint pain and are trying to decide whether it is inflammatory or noninflammatory in nature. Which one of the following symptoms is consistent with an inflammatory process? Student Answer: Tenderness Cool temperature Ecchymosis Nodules Question 3. Question : A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? Student Answer: Actinic keratosis Seborrheic keratosis Basal cell carcinoma Squamous cell carcinoma Question 4. Question : A 28-year-old graduate student comes to your clinic for evaluation of pain “all over.” With further questioning, she is able to relate that the pain is worse in the neck, shoulders, hands, low back, and knees. She denies swelling in her joints. She states that the pain is worse in the morning. There is no limitation in her range of motion. On physical examination, she has several points on the muscles of the neck, shoulders, and back that are tender to palpation. Muscle strength and range of motion are normal. Which one of the following is likely the cause of her pain? Student Answer: Rheumatoid arthritis Osteoarthritis Fibromyalgia Polymyalgia rheumatica Question 5. Question : Heberden’s nodes are commonly found in which one of the following diseases? Student Answer: Rheumatoid arthritis Degenerative joint disease Psoriatic arthritis Septic arthritis Question 6. Question : A new patient is complaining of severe pruritus that is worse at night. Several family members also have the same symptoms. Upon examination, areas of excoriated papules are noted on some of the interdigital webs of both hands and on the axillae. This finding is most consistent with: Student Answer: Contact dermatitis Impetigo Larva migrans Scabies Question 7. Question : An obese 55-year-old woman went through menarche at age 16 and menopause 2 years ago. She is concerned because an aunt had severe osteoporosis. Which one of the following is a risk factor for osteoporosis? Student Answer: Obesity Late menopause Having an aunt with osteoporosis Delayed menarche Question 8. Question : Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? Student Answer: Conclude that these are lesions she has had for a long time. Wait for her to mention them before asking further questions. Ask how she acquired them. Conduct the visit as usual for the patient. Question 9. Question : A 58-year-old man comes to your office complaining of bilateral back pain that now awakens him at night. This has been steadily increasing for the past 2 months. Which one of the following is the most reassuring in this patient with back pain? Student Answer: Age over 50 Pain at night Pain lasting more than 1 month or not responding to therapy Pain that is bilateral Question 10. Question : The Phalen’s test is used to evaluate: Student Answer: Inflammation of the median nerve Rheumatoid arthritis Degenerative joint changes Chronic tenosynovitis Question 11. Question : Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling? Student Answer: The presence of bowel sounds in the scrotum Being unable to palpate superior to the mass A positive transillumination test Normal thickness of the skin of the scrotum Question 12. Question : You are examining a newborn and note that the right testicle is not in the scrotum. What should you do next? Student Answer: Refer to urology Recheck in six months Tell the parent the testicle is absent but that this should not affect fertility Attempt to bring down the testis from the inguinal canal Question 13. Question : A 50-year-old truck driver comes to your clinic for a work physical. He has had no upper respiratory, cardiac, pulmonary, gastrointestinal, urinary, or musculoskeletal system complaints. His past medical history is significant for mild arthritis and prior knee surgery in college. He is married and just changed jobs, working for a different trucking company. He smokes one pack of cigarettes a day, drinks less than six beers a week, and denies using any illegal drugs. His mother has high blood pressure and arthritis and his father died of lung cancer in his sixties. On examination, his blood pressure is 130/80 and his pulse is 80. His cardiac, lung, and abdominal examinations are normal. He has no inguinal hernia, but on his digital rectal examination you palpate a soft, smooth, and nontender pedunculated mass on the posterior wall of the rectum. What anal, rectal, or prostate disorder best fits his presentation? Student Answer: Internal hemorrhoid Prostate cancer Anorectal cancer Rectal polyp Question 14. Question : A 15-year-old high school football player is brought to your office by his mother. He is complaining of severe testicular pain since exactly 8:00 this morning. He denies any sexual activity and states that he hurts so bad he can't even urinate. He is nauseated and is throwing up. He denies any recent illness or fever. His past medical history is unremarkable. He denies any tobacco, alcohol, or drug use. His parents are both in good health. On examination, you see a young teenager lying on the bed with an emesis basin. He is very uncomfortable and keeps shifting his position. His blood pressure is 150/100, his pulse is 110, and his respirations are 24. On visualization of the penis, he is circumcised and there are no lesions and no discharge from the meatus. His scrotal skin is tense and red. Palpation of the left testicle causes severe pain and the patient begins to cry. His prostate examination is unremarkable. His cremasteric reflex is absent on the left but is normal on the right. By catheter you get a urine sample and the analysis is unremarkable. You send the boy with his mother to the emergency room for further workup. Student Answer: Acute orchitis Acute epididymitis Torsion of the spermatic cord Prostatitis Question 15. Question : Which is true of prostate cancer? Student Answer: It is commonly lethal. It is one of the less common forms of cancer. Family history does not appear to be a risk factor. Ethnicity is a risk factor. Question 16. Question : Which of the following conditions involves a tight prepuce which, once retracted, cannot be returned? Student Answer: Phimosis Paraphimosis Balanitis Balanoposthitis Question1 7. Question : A 12-year-old is brought to your clinic by his father. He was taught in his health class at school to do monthly testicular self-examinations. Yesterday, when he felt his left testicle, it was enlarged and tender. He isn't sure if he has had burning with urination and he says he has never had sexual intercourse. He has had a sore throat, cough, and runny nose for the last three days. His past medical history is significant for a tonsillectomy as a small child. His father has high blood pressure and his mother is healthy. On examination, you see a child in no acute distress. His temperature is 100.8 and his blood pressure and pulse are unremarkable. On visualization of his penis, he is uncircumcised and has no lesions or discharge. His scrotum is red and tense on the left and normal appearing on the right. Palpating his left testicle reveals a mildly sore swollen testicle. The right testicle is unremarkable. An examining finger is put through both inguinal rings, and there are no bulges with bearing down. His prostate examination is unremarkable. Urine analysis is also unremarkable. What abnormality of the testes does this child most likely have? Student Answer: Acute orchitis Acute epididymitis Torsion of the spermatic cord Prostatitis Question 18. Question : The most common cause of cancer deaths in males is: Student Answer: Lung cancer Prostate cancer Colon cancer Skin cancer Question 19. Question : Important techniques in performing the rectal examination include which of the following? Student Answer: Lubrication Waiting for the sphincter to relax Explaining what the patient should expect with each step before it occurs All of the above Question 20. Question : Jim is a 47-year-old man who is having difficulties with sexual function. He is recently separated from his wife of 20 years. He notes that he has early morning erections but otherwise cannot function. Which of the following is a likely cause for his problem? Student Answer: Decreased testosterone levels Psychological issues Abnormal hypogastric arterial circulation Impaired neural innervation Question 1 : Which of the following is true of human papilloma virus (HPV) infection? Student Answer: Pap smear is a relatively ineffective screening method. It commonly resolves spontaneously in one to two years. It is the second most common STI in the United States. HPV infections cause a small but important number of cervical cancers. Question 2. Question : Which of the following is the most effective pattern of palpation for breast cancer? Student Answer: Beginning at the nipple, make an ever-enlarging spiral. Divide the breast into quadrants and inspect each systematically. Examine in lines resembling the back and forth pattern of mowing a lawn. Beginning at the nipple, palpate vertically in a stripe pattern. Question 3. Question : A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination, you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise, his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia? Student Answer: Breast cancer Imbalance of hormones of puberty Drug use Question 4. Question : Which of the following represents metrorrhagia? Student Answer: Fewer than 21 days between menses Excessive flow Infrequent bleeding Bleeding between periods Question 5. Question : What does a KOH (potassium hydroxide) prep help the nurse practitioner diagnose? Student Answer: Herpes zoster infections Yeast infections Herpes simplex infections Viral infections Question 6. Question : Abby is a newly married woman who is unable to have intercourse because of vaginismus. Which of the following is true? Student Answer: This is most likely due to lack of lubrication. This is most likely due to atrophic vaginitis. This is most likely due to pressure on an ovary. Psychosocial reasons may cause this condition. Question 7. Question : A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis? Student Answer: Breast tissue Fibrocystic disease Breast cancer Lymph node Question 8. Question : Which of the following is true regarding breast self-examination? Student Answer: It has been shown to reduce mortality from breast cancer. It is recommended unanimously by organizations making screening recommendations. A high proportion of breast masses are detected by breast self-examination. The undue fear caused by finding a mass justifies omitting instruction in breast self-examination. Question 9. Question : A 23-year-old computer programmer comes to your office for an annual examination. She has recently become sexually active and wants to be placed on birth control. Her only complaint is that the skin in her armpits has become darker. She states it looks like dirt, and she scrubs her skin nightly with soap and water but the color stays. Her past medical symptoms consist of acne and mild obesity. Her periods have been irregular for 3 years. Her mother has type 2 diabetes, and her father has high blood pressure. The patient denies using tobacco but has four to five drinks on Friday and Saturday nights. She denies any illegal drug use. On examination, you see a mildly obese female who is breathing comfortably. Her vital signs are unremarkable. Looking under her axilla, you see dark, velvet-like skin. Her annual examination is otherwise unremarkable. What disorder of the breast or axilla is she most likely to have? Student Answer: Peau d'orange Acanthosis nigricans Hidradenitis suppurativa Question 10. Question : Which of the following is true of women who have had a unilateral mastectomy? Student Answer: They no longer require breast examination. They should be examined carefully along the surgical scar for masses. Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer. Women with breast reconstruction over their mastectomy site no longer require examination. Question : A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about three days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, three days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for over fifty years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination, he appears his stated age and is in no acute distress. His temperature is 100.9 degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable and his fecal occult blood test is negative. His prostate is slightly enlarged but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs? Student Answer: Acute diverticulitis Acute cholecystitis Acute appendicitis Mesenteric ischemia Question 2. Question : Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with emesis, which has been occurring for two days. He does note a dark, granular substance resembling the coffee left in the filter after brewing. What do you suspect? Student Answer: Bleeding from a diverticulum Bleeding from a peptic ulcer Bleeding from a colon cancer Bleeding from cholecystitis Question 3. Question : A 26-year-old sports store manager comes to your clinic, complaining of severe right-sided abdominal pain for twelve hours. He began having a stomachache yesterday, with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was the night before and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination, he appears ill and is lying on his right side. His temperature is 100.4 degrees and his heart rate is 110. His bowel sounds are decreased and he has rebound and involuntary guarding, one-third of the way between the anterior superior iliac spine and the umbilicus in the right lower quadrant (RLQ). His rectal, inguinal, prostate, penile, and testicular examinations are normal. What is the most likely cause of his pain? Student Answer: Acute appendicitis Acute mechanical intestinal obstruction Acute cholecystitis Mesenteric ischemia Question 4. Question : Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate? Student Answer: His spleen is definitely enlarged and further workup is warranted. His spleen is possibly enlarged and close attention should be paid to further examination. His spleen is possibly enlarged and further workup is warranted. His spleen is definitely normal. Question 5. Question : Diminished radial pulses may be seen in patients with which of the following? Student Answer: Aortic insufficiency Hyperthyroidism Arterial emboli Early “warm” septic shock Question 6. Question : A 42-year-old florist comes to your office, complaining of chronic constipation for the last six months. She has had no nausea, vomiting, or diarrhea, and no abdominal pain or cramping. She denies any recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new medications. During the review of systems (ROS), you note that she has felt fatigued, had some weight gain, has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary artery disease. There is no family history of cancers. On examination, she appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the Achilles tendons. What is the best choice for the cause of her constipation? Student Answer: Large bowel obstruction Irritable bowel syndrome Rectal cancer Hypothyroidism Question 7. Question : A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of sixteen, but is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system? Student Answer: Intermittent claudication Chest pressure with exertion Shortness of breath Knee pain Question 8. Question : You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient's pain make you concerned for this disease process? Student Answer: Thigh Knee Calf Ankle Question 9. Question : A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms? Student Answer: Femoral pulse, popliteal pulse Dorsalis pedis pulse, posterior tibial pulse Carotid pulse Radial pulse, brachial pulse Question 10. Question : Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant (LUQ) pain. On examination of this area, a rough grating noise is heard. What is this sound? Student Answer: It is a splenic rub. It is a variant of bowel noise. It represents borborygmi. It is a vascular noise. Question : A 30-year-old woman with a history of mitral valve problems states that she has been “very tired.” She has started waking up at night and feels like her “heart is pounding.” During the assessment, the nurse practitioner palpates a thrill and lift at the fifth left intercostal space midclavicular line. In the same area the nurse practitioner also auscultates a blowing, swishing sound right after S1. These findings would be most consistent with: Student Answer: heart failure. aortic stenosis. pulmonary edema. mitral regurgitation. Instructor Explanation: Mitral regurgitation subjective findings include fatigue, palpitation, and orthopnea. Objective findings are (1) a thrill in systole at apex, (2) lift at apex, (3) apical impulse displaced down and to the left, (4) S1 diminished, S2 accentuated, S3 at apex often present, and (5) murmur: pansystolic, often loud, blowing, best heard at apex, radiating well to the left axilla. 4 of 4 Question 2. Question : A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse practitioner suspects: Student Answer: hypertension. cluster headaches. tension headaches. migraine headaches. Instructor Explanation: Cluster headaches produce pain around the eye, temple, forehead, and cheek and are unilateral and always on the same side of the head. They are excruciating and occur once or twice per day and last 1/2 to 2 hours each. 4 of 4 Question 3. Question : A patient complains that while studying for an examination he began to notice a severe headache in the frontotemporal area of his head that is throbbing and is somewhat relieved when he lies down. He tells the nurse practitioner that his mother also had these headaches. The nurse practitioner suspects that he may be suffering from: Student Answer: hypertension. cluster headaches. tension headaches. migraine headaches. Instructor Explanation: Migraine headaches tend to be supraorbital, retro-orbital, or frontotemporal with a throbbing quality. They are of a severe quality and are relieved by lying down. Migraines are associated with family history of migraine. 4 of 4 Question 4. Question : A patient tells the nurse practitioner that he is very nervous, that he is nauseated, and that he “feels hot.” This type of data would be: Student Answer: objective. reflective. subjective. introspective Instructor Explanation: Subjective data are what the person says about himself or herself during history taking. 4 of 4 Question 5. Question : The most important reason to share information and offer brief teaching while performing the physical examination is to help: Student Answer: the examiner feel more comfortable and gain control of the situation. build rapport and increase the patient’s confidence in the examiner. the patient understand his or her disease process and treatment modalities. the patient identify questions about his or her disease and potential areas of patient education. Instructor Explanation: Sharing of information builds rapport and increases the patient’s confidence in you as an examiner. It also gives the patient a little more control in a situation in which it’s easy to feel completely helpless. 4 of 4 Question 6. Question : A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that reassures the nurse practitioner that this may not be a cancerous thyroid nodule is that the lump (nodule): Student Answer: is tender. is mobile and not hard. disappears when the patient smiles. is hard and fixed to the surrounding structures. Instructor Explanation: Suspect any painless, rapidly growing nodule, especially the appearance of a single nodule in a young person. Cancerous nodules tend to be hard and are fixed to surrounding structures. 4 of 4 Question 7. Question : A patient visits the clinic because he has recently noticed that the left side of his mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse practitioner suspects that he has: Student Answer: Cushing’s syndrome. Parkinson’s syndrome. Bell’s palsy. had a cerebrovascular accident (stroke). Instructor Explanation: With an upper motor neuron lesion (as with CVA) the patient will have paralysis of lower facial muscles, but the upper half of the face is not affected owing to the intact nerve from the unaffected hemisphere. The person is still able to wrinkle the forehead and close the eyes. 4 of 4 Question 8. Question : The temporomandibular joint is just below the temporal artery and anterior to the: Student Answer: hyoid. vagus. tragus. mandible. Instructor Explanation: The temporomandibular joint is just below the temporal artery and anterior to the tragus. 4 of 4 Question 9. Question : During an examination of a patient’s abdomen, the nurse practitioner notes that the abdomen is rounded and firm to the touch. During percussion, the nurse practitioner notes a drum-like quality of the sound across the quadrants. This type of sound indicates: Student Answer: constipation. air-filled areas. the presence of a tumor. the presence of dense organs. Instructor Explanation: A musical or drum-like sound (tympany) is the sound heard when percussion occurs over air-filled viscus, such as the stomach or intestines. 4 of 4 Question 10. Question : A patient tells the nurse that he is allergic to penicillin. What would be the nurse practitioner’s best response to this information? Student Answer: “Are you allergic to any other drugs?” “How often have you received penicillin?” “I’ll write your allergy on your chart so you won’t receive any.” “Please describe what happens to you when you take penicillin.” Instructor Explanation: Note both the allergen (medication, food, or contact agent, such as fabric or environmental agent) and the reaction (rash, itching, runny nose, watery eyes, difficulty breathing). With a drug, this symptom should not be a side effect but a true allergic reaction. 4 of 4 Question 11. Question : A patient’s thyroid is enlarged, and the nurse practitioner is preparing to auscultate the thyroid for the presence of a bruit. A bruit is a: Student Answer: low gurgling sound best heard with the diaphragm of the stethoscope. loud, whooshing, blowing sound best heard with the bell of the stethoscope. soft, whooshing, pulsatile sound best heard with the bell of the stethoscope. high-pitched tinkling sound best heard with the diaphragm of the stethoscope. Instructor Explanation: If the thyroid gland is enlarged, auscultate it for the presence of a bruit, which is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. 4 of 4 Question 12. Question : After completing an initial assessment on a patient, the nurse practitioner has documented that his respirations are eupneic and his pulse is 58. This type of data would be: Student Answer: objective. reflective. subjective. introspective. Instructor Explanation: Objective data are what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical exam. 4 of 4 Question 13. Question : A patient tells the nurse that she has had abdominal pain for the past week. What would be the best response by the nurse? Student Answer: “Can you point to where it hurts?” “We’ll talk more about that later in the interview.” “What have you had to eat in the last 24 hours?” “Have you ever had any surgeries on your abdomen?” Instructor Explanation: A final summary of any symptom the person has should include, along with seven other critical characteristics, “Location: specific.” Ask the person to point to the location. 4 of 4 Question 14. Question : A teenage patient comes to the emergency department with complaints of an inability to “breathe and a sharp pain in my left chest.” The assessment findings include the following: cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the left. This description is consistent with: Student Answer: bronchitis. a pneumothorax. acute pneumonia. an asthmatic attack. Instructor Explanation: With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax is large, tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus, tracheal deviation to the unaffected side, decreased chest expansion, hyperresonant percussion tones, and decreased or absent breath sounds are assessed. 4 of 4 Question 15. Question : The inspection phase of the physical assessment: Student Answer: yields little information. takes time and reveals a surprising amount of information. may be somewhat uncomfortable for the expert practitioner. requires a quick glance at the patient’s body systems before proceeding on with palpation. Instructor Explanation: A focused inspection takes time and yields a surprising amount of data. Initially, the examiner may feel uncomfortable “staring” at the person without also “doing something.” 4 of 4 Question 16. Question : The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. What would be an appropriate response by the nurse practitioner? Student Answer: “It is unusual for a small child to have frequent ear infections unless there is something else wrong.” “We need to check the immune system of your son to see why he is having so many ear infections.” “Ear infections are not uncommon in infants and toddlers because they tend to have more cerumen in the external ear.” “Your son’s eustachian tube is shorter and wider than yours because of his age, which allows for infections to develop more easily.” Instructor Explanation: The infant’s eustachian tube is relatively shorter and wider, and its position is more horizontal than the adult’s, so it is easier for pathogens from the nasopharynx to migrate through to the middle ear. 4 of 4 Question 17. Question : The nurse practitioner would use bimanual palpation technique in which situation? Student Answer: Palpating the thorax of an infant Palpating the kidneys and uterus Assessing pulsations and vibrations Assessing the presence of tenderness and pain Instructor Explanation: Bimanual palpation requires the use of both hands to envelop or capture certain body parts or organs such as the kidneys, uterus, or adnexa. 4 of 4 Question 18. Question : The patient’s record, laboratory studies, objective data, and subjective data combine to form the: Student Answer: database. admitting data. financial statement. discharge summary. Instructor Explanation: Together with the patient’s record and laboratory studies, the objective and subjective data form the database. 4 of 4 Question 19. Question : When preparing to perform a physical examination on an infant, the examiner should: Student Answer: have the parent remove all clothing except the diaper on a boy. instruct the parent to feed the infant immediately before the exam. encourage the infant to suck on a pacifier during the abdominal exam. ask the parent to briefly leave the room when assessing the infant’s vital signs. Instructor Explanation: The parent should always be present for the child’s feeling of security and to understand normal growth and development. Timing of the examination should be 1 to 2 hours after feeding when the baby is not too drowsy nor too hungry. Infants do not object to being nude; clothing should be removed and a diaper left on a boy. 4 of 4 Question 20. Question : The nurse practitioner notices that an infant has a large, soft lump on the side of his head and that his mother is very concerned. She tells the nurse practitioner that she noticed the lump about 8 hours after her baby’s birth, and that it seems to be getting bigger. One possible explanation for this is: Student Answer: hydrocephalus. craniosynostosis. cephalhematoma. caput succedaneum. Instructor Explanation: A cephalhematoma is a subperiosteal hemorrhage that is the result of birth trauma. It is soft, fluctuant, and well defined over one cranial bone. It appears several hours after birth and gradually increases in size. 4 of 4 Question 21. Question : When examining an infant, the nurse practitioner should examine which area first? Student Answer: Ear Nose Throat Abdomen Instructor Explanation: Perform the least distressing steps first. Save the invasive steps of examination of the eye, ear