NR 509 Final Exam / NR509 Final Exam (New 2025): Advanced Physical Assessment

Question 1 The function of the auditory ossicles is to: transmit the light reflex to the light cone. transform sound vibrations into mechanical waves for the inner ear. to capture sound waves from the external ear for transmission into the middle ear. to separate the inner ear from the middle ear. Explanation: The function of the auditory ossicles is to transform sound vibrations into mechanical waves for the inner ear Question 2 A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of: an arrhythmia. a neurological condition. an inner ear infection. orthostatic hypotension. Explanation: Vertigo symptoms associated with neurologic conditions include: ataxia, diplopia, and dysarthria. Symptoms associated with cardiovascular conditions and vertigo include arrhythmias, orthostatic hypotension, vasovagal stimulation, lightheadedness, weakness, or presyncope. Question 3 A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with: a pinguecula. a chalazion. episcleritis. xanthelasma. Explanation: Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is an ocular inflammation of the episcleral vessels. Question 4 Assessment of a patient's visual acuity resulted in 20/200 using the Snellen eye chart. This means that: at 200 feet the patient can read printed information that a person with normal vision could read at 20 feet. at 20 feet the patient can read printed information that a person with normal vision could read at 200 feet. the patient has normal visual acuity. the patient may not be able to read so he should be tested with the picture or "E" eye charts. Explanation: Visual acuity that is corrected to 20/200 constitutes legal blindness. The larger the number under 20, the worse the visual acuity. If this is a new finding, the patient needs ophthalmologic evaluation. Question 5 Findings following assessment of a person's left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with: a conjugate gaze. left cranial nerve III (oculomotor) paralysis cranial nerve IV (trochlear) paralysis. cranial nerve VI (abducens) paralysis. Explanation: With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) appears in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question 6 Findings following assessment of a person's eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: a conjugate gaze. left cranial nerve III (oculomotor) paralysis cranial nerve IV (trochlear) paralysis. cranial nerve VI (abducens) paralysis. Explanation: In conjugate or normal gaze, the normal movement of the two eyes appears simultaneously in the same direction to bring something into view. With a left cranial nerve VI paralysis, a person's gaze would include eyes conjugate when looking to the right, esotropia (one or both eyes turn inward) in the left eye when looking straight ahead, and esotropia is maximum in the left eye when looking to the left. With a left cranial nerve III paralysis, upward, downward, or inward movements are impaired. The left eye is unable to look down when turned inward in a left cranial nerve IV paralysis. Question 7 A patient was diagnosed as being farsighted. The term for this condition is: hyperopia. myopia. strabismus. astigmatism. Explanation: Myopia, nearsightedness, occurs when light rays focus anterior to the retina. Hyperopia, farsightedness, occurs when light rays focus posterior to the retina. Strabismus, heterotropia, is a condition in which the eyes are not properly aligned with each other. In astigmatism, light rays do not focus correctly on the retina. This causes blurriness. Question 8 A buildup of excess fluid around the periphery of the eye orbits is known as: episcleritis. pinguecula. ptosis. periorbital edema. Explanation: An accumulation of fluid around the periphery of the eye orbits is known as periorbital edema. Question 9 In order to visualize the opening of Stensen's duct, examine the: dorsal surface of the tongue. area beneath the mandible at the angle of the jaw. buccal mucosa opposite the second molar. small openings along the sublingual fold under the tongue. Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. Question 10 What connects the middle ear to the nasopharynx? The tympanic membrane The proximal end of the eustachian tube The malleus The ossicles Explanation: The proximal end of the eustachian tube connects the middle ear to the nasopharynx.