NR509 Final Exam Practice Questions
with complete solutions And Rationales
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?
IV
Primary prevention is defined as which of the following?
Interventions designed to prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the
following statements is true about screening for breast cancer in average-risk women?
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.
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?
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?
"It often takes the baby more than 30 minutes to finish a bottle."
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?
Patient with eyelid drooping
CNIII
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?
CN IX
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?
CNIII
Which of the following statements is true regarding risks and rapid recognition of suspected
stroke? Select all that apply
Obesity doubles the risk of stroke even without associated glucose intolerance
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke
The combination of both receptive and expressive aphasia is a characteristic of which type of
speech disorder?
,global aphasia
The NP is assessing a 42-year-old female who presents to the clinic with recurring headaches. What
is an effective question to ask the patient?
Do you have any aura prior to the headaches?
A 55-year-old female presents to the clinic with a headache. During the interview, which of the
following symptoms should prompt the NP to be concerned and investigate further?
The patient reports fever, night sweats, and thinks she lost weight.
When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following?
Active movement against gravity
Which musculoskeletal disorder is paired correctly with the associated systemic manifestations?
Lyme disease and expanding erythematous targetoid patch in early illness
A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are
expected assessment findings consistent with the diagnosis?
Swelling of the synovial tissue in joints and tendon sheaths
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?
Take a further history and perform a very careful neurological exam
A 58-year-old male complains of pain in his knees, hips, hands, wrists, neck, and lower back. Based
on the joints involved, the NP suspects that the patient most likely has which condition?
Osteoarthritis
A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to
find on examination that is most consistent with the diagnosis?
Flexed forward posture with lower extremity weakness
What is the action(s) of the erector spinae muscle group?
Extension of the spine
A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8
weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are
unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle
wasting as the etiology for the winged scapula. Which of the following physical assessment
maneuvers should the NP perform to confirm the suspension?
Compare the strength of the trapezius muscles
During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion
evaluation at the neck. All of the following muscles are being assessed when the patient is asked to
extend, flex, and rotate the neck, EXCEPT?
Sacrospinalis
Which of the following statements is true regarding prostate cancer screening?
Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing
A 53-year-old African American male presents for discussion of his prostate cancer risk and
possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer
but died recently at age 87 years from a myocardial infarction before the disease progressed.
Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and
two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer
risk for this patient and subsequent screening?
This patient is at an elevated risk of prostate cancer due to his family history; thus, screening modalities
should be discussed between the patient and provider.
A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A
recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source
,of pain. In addition, today she reports that she has developed episodic abdominal discomfort and
sores in her mouth. Which of the following underlying conditions is the NP most likely to find?
Inflammatory bowel disease
A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a
change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well
as Crohn's disease. Her family medical history includes a maternal aunt who died of colon cancer at
age 49 years. Which of the following historical elements would be most concerning for colon cancer
in this patient?
recent onset of small-caliber stools
A 67-year-old female presents to the office for an annual check-up. She retired as a police captain
at age 66. Now she enjoys gardening and water aerobics several days a week. She states, "staying
active keeps me limber". After a careful history and physical examination, the NP documents the
following musculoskeletal system findings: Full range of motion in all joints. Hands with Heberden
nodes at the DIP joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and
rotation of both hips. Full range of motion in the knees, with moderate crepitus. No effusion but
bony enlargement along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the
first MTP joints. Which of the following is the most accurate interpretation of these findings?
These findings suggest osteoarthritis
A 50-year-old male presents to the office for a routine physical examination. He has no complaints.
His PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is
taking fenofibrate. On the social history intake form, he reported consuming 8 ounces of malt
liquor daily for 20 years. After a careful history and physical examination, the NP documents the
following nervous system findings: Mental Status: Alert, relaxed, and cooperative. Thought process
coherent. Oriented to person, place, and time. Speech is fluent, follows commands. Detailed
cognitive testing deferred. Cranial Nerves: I—not tested; II through XII intact. Motor: Normal
muscle bulk and tone. Strength 5/5 throughout. No pronator drift. Cerebellar—Rapid alternating
movements (RAMs), finger-to-nose (F→N), heel-to-shin (H→S) intact. Gait with normal stance and
stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance
with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the
following is the most accurate interpretation of these findings?
These findings suggest no abdnormalities
Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description:
Examiner's hands placed on anterior shoulders while patient shrugs both shoulders upward against
hands.
CNXI
What assessment test is being performed in this image? ADA Description: Tuning fork on top of
the head.
Weber test
A 74-year-old man presents to the clinic for a scheduled annual examination. He has a history of
hypertension and diabetes, both controlled with medication. He denies any complaints. The NP
performed a fundoscopic examination. Identify the abnormal assessment findings in this image.
ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated
ganglion cell axons of the retina.
Cotton wool spots
A 66-year-old female presents to the office for a focused visit to discuss hypertension management
strategies. During the interview, the patient asks the NP if she could be screened today for cervical
cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no
abnormal findings, and no history of cancer. What is the best action the NP should take regarding
the patient's request for screening?
Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no
longer requires screening, and focus on the reason for the visit.
, Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?
The vaccine can protect against anogenital lesions
A 21-year-old female presents for her first annual exam. She reports concern because her female
partner was recently diagnosed with condyloma acuminata and wonders if she could also be
infected. If true, what physical assessment findings would the NP expect to find during the
speculum examination?
Raised friable or lobed lesions
An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge
along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID).
During the speculum examination, the NP would expect to find purulent discharge in the following
area(s) which is consistent with the diagnosis of PID?
Cervical os
A 23-year-old female presents to the clinic. She has decided to discontinue using condoms and
would like a different birth control option. Her last pelvic exam was 2 years ago when she had a
negative Pap smear and STI screening. Her LMP was 2 days ago, and she is still spotting. She last
had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her
speculum exam during this office encounter. What is the best evidence-based rationale for the
decision to postpone her exam?
She is on her menses
A 24-year-old female presents to the clinic for an annual exam. The NP proceeds to perform a Pap
smear and understands that the most important area on the cervix to obtain cells for the Pap smear
is where?
Transformation zone
A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses.
She reached menarche at age 13 years and has had regular periods except during her pregnancies.
She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states
this has been going on for about a year but seems to be getting worse. Her LMP was 1 week ago. On
a bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is
nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. Which of the following
is the most likely interpretation of these findings?
These findings suggest uterine fibroids
A 48-year-old female presents to the clinic with complaints of heavy vaginal discharge and severe
itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the
introitus. On speculum examination, there is a copious amount of this discharge. The pH of the
discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding
hyphae. Which of the following is the most accurate interpretation of these findings?
These findings suggest candida vaginitis
Cervical motion tenderness and/or adnexal tenderness are hallmarks of all the following conditions,
EXCEPT?
Bacterial vaginosis
A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with
some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She
also reports that the smell increased after intercourse and during her period last week. After a
careful history and physical assessment, the NP documents the following pelvic and anorectal
examination findings: Bilateral shotty inguinal adenopathy. External genitalia without erythema or
lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy
odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no
adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of
vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings?
These findings suggest bacterial vaginosis
with complete solutions And Rationales
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?
IV
Primary prevention is defined as which of the following?
Interventions designed to prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the
following statements is true about screening for breast cancer in average-risk women?
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.
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?
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?
"It often takes the baby more than 30 minutes to finish a bottle."
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?
Patient with eyelid drooping
CNIII
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?
CN IX
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?
CNIII
Which of the following statements is true regarding risks and rapid recognition of suspected
stroke? Select all that apply
Obesity doubles the risk of stroke even without associated glucose intolerance
Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke
The combination of both receptive and expressive aphasia is a characteristic of which type of
speech disorder?
,global aphasia
The NP is assessing a 42-year-old female who presents to the clinic with recurring headaches. What
is an effective question to ask the patient?
Do you have any aura prior to the headaches?
A 55-year-old female presents to the clinic with a headache. During the interview, which of the
following symptoms should prompt the NP to be concerned and investigate further?
The patient reports fever, night sweats, and thinks she lost weight.
When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following?
Active movement against gravity
Which musculoskeletal disorder is paired correctly with the associated systemic manifestations?
Lyme disease and expanding erythematous targetoid patch in early illness
A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are
expected assessment findings consistent with the diagnosis?
Swelling of the synovial tissue in joints and tendon sheaths
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?
Take a further history and perform a very careful neurological exam
A 58-year-old male complains of pain in his knees, hips, hands, wrists, neck, and lower back. Based
on the joints involved, the NP suspects that the patient most likely has which condition?
Osteoarthritis
A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to
find on examination that is most consistent with the diagnosis?
Flexed forward posture with lower extremity weakness
What is the action(s) of the erector spinae muscle group?
Extension of the spine
A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8
weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are
unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle
wasting as the etiology for the winged scapula. Which of the following physical assessment
maneuvers should the NP perform to confirm the suspension?
Compare the strength of the trapezius muscles
During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion
evaluation at the neck. All of the following muscles are being assessed when the patient is asked to
extend, flex, and rotate the neck, EXCEPT?
Sacrospinalis
Which of the following statements is true regarding prostate cancer screening?
Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing
A 53-year-old African American male presents for discussion of his prostate cancer risk and
possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer
but died recently at age 87 years from a myocardial infarction before the disease progressed.
Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and
two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer
risk for this patient and subsequent screening?
This patient is at an elevated risk of prostate cancer due to his family history; thus, screening modalities
should be discussed between the patient and provider.
A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A
recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source
,of pain. In addition, today she reports that she has developed episodic abdominal discomfort and
sores in her mouth. Which of the following underlying conditions is the NP most likely to find?
Inflammatory bowel disease
A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a
change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well
as Crohn's disease. Her family medical history includes a maternal aunt who died of colon cancer at
age 49 years. Which of the following historical elements would be most concerning for colon cancer
in this patient?
recent onset of small-caliber stools
A 67-year-old female presents to the office for an annual check-up. She retired as a police captain
at age 66. Now she enjoys gardening and water aerobics several days a week. She states, "staying
active keeps me limber". After a careful history and physical examination, the NP documents the
following musculoskeletal system findings: Full range of motion in all joints. Hands with Heberden
nodes at the DIP joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and
rotation of both hips. Full range of motion in the knees, with moderate crepitus. No effusion but
bony enlargement along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the
first MTP joints. Which of the following is the most accurate interpretation of these findings?
These findings suggest osteoarthritis
A 50-year-old male presents to the office for a routine physical examination. He has no complaints.
His PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is
taking fenofibrate. On the social history intake form, he reported consuming 8 ounces of malt
liquor daily for 20 years. After a careful history and physical examination, the NP documents the
following nervous system findings: Mental Status: Alert, relaxed, and cooperative. Thought process
coherent. Oriented to person, place, and time. Speech is fluent, follows commands. Detailed
cognitive testing deferred. Cranial Nerves: I—not tested; II through XII intact. Motor: Normal
muscle bulk and tone. Strength 5/5 throughout. No pronator drift. Cerebellar—Rapid alternating
movements (RAMs), finger-to-nose (F→N), heel-to-shin (H→S) intact. Gait with normal stance and
stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance
with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the
following is the most accurate interpretation of these findings?
These findings suggest no abdnormalities
Which cranial nerve (CN) is being assessed by the examiner in this image? ADA Description:
Examiner's hands placed on anterior shoulders while patient shrugs both shoulders upward against
hands.
CNXI
What assessment test is being performed in this image? ADA Description: Tuning fork on top of
the head.
Weber test
A 74-year-old man presents to the clinic for a scheduled annual examination. He has a history of
hypertension and diabetes, both controlled with medication. He denies any complaints. The NP
performed a fundoscopic examination. Identify the abnormal assessment findings in this image.
ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated
ganglion cell axons of the retina.
Cotton wool spots
A 66-year-old female presents to the office for a focused visit to discuss hypertension management
strategies. During the interview, the patient asks the NP if she could be screened today for cervical
cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no
abnormal findings, and no history of cancer. What is the best action the NP should take regarding
the patient's request for screening?
Deny her request, inform the patient that she has had three negative screenings in the last 10 years and no
longer requires screening, and focus on the reason for the visit.
, Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?
The vaccine can protect against anogenital lesions
A 21-year-old female presents for her first annual exam. She reports concern because her female
partner was recently diagnosed with condyloma acuminata and wonders if she could also be
infected. If true, what physical assessment findings would the NP expect to find during the
speculum examination?
Raised friable or lobed lesions
An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge
along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID).
During the speculum examination, the NP would expect to find purulent discharge in the following
area(s) which is consistent with the diagnosis of PID?
Cervical os
A 23-year-old female presents to the clinic. She has decided to discontinue using condoms and
would like a different birth control option. Her last pelvic exam was 2 years ago when she had a
negative Pap smear and STI screening. Her LMP was 2 days ago, and she is still spotting. She last
had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her
speculum exam during this office encounter. What is the best evidence-based rationale for the
decision to postpone her exam?
She is on her menses
A 24-year-old female presents to the clinic for an annual exam. The NP proceeds to perform a Pap
smear and understands that the most important area on the cervix to obtain cells for the Pap smear
is where?
Transformation zone
A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses.
She reached menarche at age 13 years and has had regular periods except during her pregnancies.
She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states
this has been going on for about a year but seems to be getting worse. Her LMP was 1 week ago. On
a bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is
nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. Which of the following
is the most likely interpretation of these findings?
These findings suggest uterine fibroids
A 48-year-old female presents to the clinic with complaints of heavy vaginal discharge and severe
itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the
introitus. On speculum examination, there is a copious amount of this discharge. The pH of the
discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding
hyphae. Which of the following is the most accurate interpretation of these findings?
These findings suggest candida vaginitis
Cervical motion tenderness and/or adnexal tenderness are hallmarks of all the following conditions,
EXCEPT?
Bacterial vaginosis
A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with
some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She
also reports that the smell increased after intercourse and during her period last week. After a
careful history and physical assessment, the NP documents the following pelvic and anorectal
examination findings: Bilateral shotty inguinal adenopathy. External genitalia without erythema or
lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy
odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no
adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of
vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings?
These findings suggest bacterial vaginosis
