NR509 / NR 509 Final Exam (Latest
): Advanced Physical
Assessment - Chamberlain
A 16-year-old male presents to the clinic with a history of a congenital right upper
eyelid drooping as represented in this image. He has no complaints and denies
injury or trauma. Which cranial nerve (CN) is involved in this condition? -
ANSWER CNIII
A 35-year-old female with a history of migraines presents to the clinic with
worsening symptoms for the past few weeks. She reports waking up at night with
headaches and nausea. Her only medication history is oral contraceptive pills
(OCPs). Otherwise, she states she is healthy. Which of the following actions if
taken by the NP is the best next step?
a. Take a further history and perform a very careful neurological examination
b. Prescribe a strong medication for her migraines
c. Reassure her that this is a common pattern with migraines
d. Order studies to evaluate potential transient ischemic attacks (TIAs) because she
is on OCPs
e. Treat her for sinusitis - ANSWER a. Take a further history and
perform a very careful neurological exam.
Explanation: The history of nightly awakening and nausea is concerning for
increased intracranial pressure from a tumor or other mass. (Brain tumor is not
common in a 35-year-old.) A careful neurological examination may uncover
deficits.
A grandmother is accompanying her 9-year-old granddaughter during a routine
physical examination. She asks you privately if her granddaughter has started
,puberty yet. During the examination, the NP notes asymmetric projection of the
areola and nipple of the right chest to form a secondary mound above the level of
the breast. The left breast is underdeveloped. These assessment findings are
consistent with which Tanner Stage of development? - ANSWER
Tanner Stage 4.
Explanation: Tanner Stage 4 is typically seen in girls around age 9-10, and is
characterized by the development of breast buds (asymmetric projection of the
areola and nipple of the right chest to form a secondary mound above the level of
the breast) and the beginning of pubic hair growth. It is also referred to as the "pre-
pubertal stage" and is the first stage of breast development. The left breast being
underdeveloped indicated that the girl is in Tanner Stage 4, as this is a common
characteristic of this stage of development
Primary prevention is defined as: - ANSWER Interventions designed
to prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations,
what is true about screening for breast cancer in average-risk women? -
ANSWER Mammography is recommended every 2 years for women
aged 50-74 with insufficient evidence for screening women over the age of 75.
Which of the following statements is true regarding recommendations by the
eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all
that apply. - ANSWER - Target blood pressure should be </= 150/90
mmHg but notes that if treatment results in SBP <140 and is "well tolerated and
without adverse effects to health or quality of live, treatment does not need to be
adjusted."
- In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear
optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality.
, Which of the following is a useful strategy when examining young children
between the ages of 1 and 4? - ANSWER Have the parent facilitate
the exam (e.g., removing clothes, holding the child on lap).
The NP is completing the review of systems on a 4-month-old female during a
routine encounter. Which statement from the parent may indicate a cardiac
problem in the infant and require a more thorough subjective history?
a. "The baby gets the hiccups often."
b. "It often takes the baby more than 30 minutes to finish a bottle."
c. "The baby's heart seems to beat rapidly sometimes."
d. "Sometimes the baby sounds congested." - ANSWER "It often
takes the baby more than 30 minutes to finish a bottle."
Explanation: This statement from the parent may indicate a cardiac problem in the
infant, such as congestive heart failure. Congestive heart failure can lead to poor
feeding and poor weight gain, which can result in the infant taking longer than
usual to finish a bottle. A more thorough subjective history should be taken,
including questions about the baby's feeding and weight gain, the presence of
respiratory symptoms, and any other signs and symptoms of a cardiac problem.
Additionally, a physical examination and diagnostic tests, such as an
electrocardiogram (ECG) or echocardiogram, may be necessary to evaluate for a
cardiac problem.
Which cranial nerve (CN) innervates the muscles of the pharynx and provides
sensory fibers to portions of the tympanic membrane, auditory canal, pharynx, and
the posterior third of the tongue? - ANSWER CN IX
(Glossopharyngeal)
The NP should suspect injury to which cranial nerve (CN) if a patient presents with
complaints of photosensitivity and uneven pupils after being struck in the eye with
a baseball? - ANSWER CNIII (Oculomotor)
): Advanced Physical
Assessment - Chamberlain
A 16-year-old male presents to the clinic with a history of a congenital right upper
eyelid drooping as represented in this image. He has no complaints and denies
injury or trauma. Which cranial nerve (CN) is involved in this condition? -
ANSWER CNIII
A 35-year-old female with a history of migraines presents to the clinic with
worsening symptoms for the past few weeks. She reports waking up at night with
headaches and nausea. Her only medication history is oral contraceptive pills
(OCPs). Otherwise, she states she is healthy. Which of the following actions if
taken by the NP is the best next step?
a. Take a further history and perform a very careful neurological examination
b. Prescribe a strong medication for her migraines
c. Reassure her that this is a common pattern with migraines
d. Order studies to evaluate potential transient ischemic attacks (TIAs) because she
is on OCPs
e. Treat her for sinusitis - ANSWER a. Take a further history and
perform a very careful neurological exam.
Explanation: The history of nightly awakening and nausea is concerning for
increased intracranial pressure from a tumor or other mass. (Brain tumor is not
common in a 35-year-old.) A careful neurological examination may uncover
deficits.
A grandmother is accompanying her 9-year-old granddaughter during a routine
physical examination. She asks you privately if her granddaughter has started
,puberty yet. During the examination, the NP notes asymmetric projection of the
areola and nipple of the right chest to form a secondary mound above the level of
the breast. The left breast is underdeveloped. These assessment findings are
consistent with which Tanner Stage of development? - ANSWER
Tanner Stage 4.
Explanation: Tanner Stage 4 is typically seen in girls around age 9-10, and is
characterized by the development of breast buds (asymmetric projection of the
areola and nipple of the right chest to form a secondary mound above the level of
the breast) and the beginning of pubic hair growth. It is also referred to as the "pre-
pubertal stage" and is the first stage of breast development. The left breast being
underdeveloped indicated that the girl is in Tanner Stage 4, as this is a common
characteristic of this stage of development
Primary prevention is defined as: - ANSWER Interventions designed
to prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations,
what is true about screening for breast cancer in average-risk women? -
ANSWER Mammography is recommended every 2 years for women
aged 50-74 with insufficient evidence for screening women over the age of 75.
Which of the following statements is true regarding recommendations by the
eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all
that apply. - ANSWER - Target blood pressure should be </= 150/90
mmHg but notes that if treatment results in SBP <140 and is "well tolerated and
without adverse effects to health or quality of live, treatment does not need to be
adjusted."
- In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear
optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality.
, Which of the following is a useful strategy when examining young children
between the ages of 1 and 4? - ANSWER Have the parent facilitate
the exam (e.g., removing clothes, holding the child on lap).
The NP is completing the review of systems on a 4-month-old female during a
routine encounter. Which statement from the parent may indicate a cardiac
problem in the infant and require a more thorough subjective history?
a. "The baby gets the hiccups often."
b. "It often takes the baby more than 30 minutes to finish a bottle."
c. "The baby's heart seems to beat rapidly sometimes."
d. "Sometimes the baby sounds congested." - ANSWER "It often
takes the baby more than 30 minutes to finish a bottle."
Explanation: This statement from the parent may indicate a cardiac problem in the
infant, such as congestive heart failure. Congestive heart failure can lead to poor
feeding and poor weight gain, which can result in the infant taking longer than
usual to finish a bottle. A more thorough subjective history should be taken,
including questions about the baby's feeding and weight gain, the presence of
respiratory symptoms, and any other signs and symptoms of a cardiac problem.
Additionally, a physical examination and diagnostic tests, such as an
electrocardiogram (ECG) or echocardiogram, may be necessary to evaluate for a
cardiac problem.
Which cranial nerve (CN) innervates the muscles of the pharynx and provides
sensory fibers to portions of the tympanic membrane, auditory canal, pharynx, and
the posterior third of the tongue? - ANSWER CN IX
(Glossopharyngeal)
The NP should suspect injury to which cranial nerve (CN) if a patient presents with
complaints of photosensitivity and uneven pupils after being struck in the eye with
a baseball? - ANSWER CNIII (Oculomotor)
