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NR509 Week 8 Final Exam
Questions, Answers & Explanations
Question Q78
A 42-year-old female is at 39 weeks gestation. She reports no major issues except swelling in
her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP
notes a diastolic murmur. Which of the following is true about her presentation and the
appropriate next step by the NP?
Answer Choices
A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required at this
time.
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted. ✓
C. A leftward rotated apical impulse would confirm a diagnosis of heart failure in this patient; the
NP should order an echocardiogram.
D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has been
taking iron supplementation.
E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this patient's
differentials list.
✓ Correct Answer: B — A diastolic murmur during pregnancy is likely pathological;
further investigation and work-up is warranted.
Explanation: Diastolic murmurs are always pathological. Unlike systolic murmurs (which can be
benign flow murmurs in pregnancy), a diastolic murmur warrants further cardiac evaluation. Shortness
of breath and edema combined with a diastolic murmur raise concern for mitral stenosis or peripartum
cardiomyopathy.
,A 35-year-old woman presents to the clinic with a complaint of intermittent, bilateral nipple
discharge for several weeks. She denies local tenderness, fever, or systemic symptoms aside
from slightly irregular periods over the last few months. On examination, there was no erythema,
increased warmth, or streaking around the areolas. Scant discharge consistent with breast milk
but without any signs of blood or pus was expressed from each nipple. Screening laboratories
revealed a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Which of the following is the most accurate interpretation of
these findings?
Answer Choices
A. Prolactinoma ✓
B. Paget's disease of the breast
C. Occult pregnancy
D. Ductal carcinoma in situ
E. Mastitis
✓ Correct Answer: A — Prolactinoma
Explanation: Bilateral milky nipple discharge (galactorrhea) with irregular periods and normal
TSH/HCG strongly suggests hyperprolactinemia from a prolactinoma. Occult pregnancy is ruled out by
negative HCG. Paget's and DCIS present with unilateral bloody/serous discharge.
Mastitis presents with warmth, erythema, and systemic symptoms.
,Question Q33
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 Choices
A. I
B. II
C. III
D. IV ✓
E. Preadolescent
✓ Correct Answer: D — IV
Explanation: Tanner Stage IV is characterized by the areola and nipple projecting above the level of the
breast to form a secondary mound. Stage II is early breast budding; Stage III is further enlargement
without a separate mound; Stage V is the adult breast where the secondary mound recedes. Breast
asymmetry during puberty is a normal finding.
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extra per year?
,The image depicts a physical examination finding related to cranial nerve assessment (patient's
head tilted back, throat/neck region visible). Which cranial nerve is being tested? (Currently
selected: C)
Answer Choices
A. CN X
B. CN IX
C. CN VI ✓
D. CN XII
E. CN XI
✓ Correct Answer: C — CN VI
Explanation: CN VI (Abducens nerve) controls lateral eye movement via the lateral rectus muscle.
Among the options, CN IX controls swallowing/taste, CN X controls vagal functions, CN XI controls
head/shoulder movement, and CN XII controls tongue movement. The selected answer of CN VI relates
to lateral gaze testing.
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Question Q68
Primary prevention is defined as which of the following?
Answer Choices
A. Interventions designed to prevent disease. ✓
B. Interventions designed to prevent complications.
C. Interventions to find asymptomatic conditions.
D. Interventions including screening tests.
E. Interventions to find disease processes at an early stage.
✓ Correct Answer: A — Interventions designed to prevent disease.
Explanation: Primary prevention aims to prevent disease before it occurs (e.g., vaccines, lifestyle
modifications). Secondary prevention involves early detection of asymptomatic disease (options C, D, E).
Tertiary prevention focuses on reducing complications from existing disease (option B).
,A 24-year-old male presents with unilateral red eye, watery discharge, and preauricular
lymphadenopathy after a recent upper respiratory infection. Vision is unaffected and the pupil is
round and reactive. Which of the following is the most likely diagnosis?
Answer Choices
A. Bacterial conjunctivitis
B. Viral conjunctivitis ✓
C. Acute angle-closure glaucoma
D. Anterior uveitis
E. Allergic conjunctivitis
✓ Correct Answer: B — Viral conjunctivitis
Explanation: Viral conjunctivitis classically follows a URI and presents with watery discharge and
preauricular adenopathy, which distinguishes it from bacterial conjunctivitis (purulent discharge, no
adenopathy). Glaucoma and uveitis cause pain and vision changes; allergic conjunctivitis is typically
bilateral with itching.
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Question 7
During an otoscopic exam, the NP notes that the tympanic membrane is retracted, has
decreased mobility on insufflation, and air-fluid levels are visible behind it. The patient denies
pain or fever. Which condition best fits this finding?
Answer Choices
A. Acute otitis media
B. Otitis media with effusion ✓
C. Otitis externa
D. Cholesteatoma
E. Tympanic membrane perforation
✓ Correct Answer: B — Otitis media with effusion
Explanation: Otitis media with effusion presents with a retracted, poorly mobile tympanic membrane
and visible air-fluid levels without the acute pain/erythema of acute otitis media. Otitis externa involves
the canal, not the middle ear space.
,A patient reports a sensation of room spinning that is triggered only by specific head
movements and resolves within 30-60 seconds. The Dix-Hallpike maneuver reproduces the
symptom with rotatory nystagmus. Which diagnosis is most consistent with these findings?
Answer Choices
A. Meniere disease
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo ✓
D. Acoustic neuroma
E. Migrainous vertigo
✓ Correct Answer: C — Benign paroxysmal positional vertigo
Explanation: BPPV is caused by displaced otoconia in the semicircular canals, producing brief,
positional vertigo reproduced by the Dix-Hallpike maneuver. Meniere disease includes hearing loss and
tinnitus; vestibular neuritis causes continuous vertigo lasting days.
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Question 9
On examination of the oropharynx, the NP notes tonsillar exudate, tender anterior cervical
lymphadenopathy, fever, and absence of cough. Using the Centor criteria, which of the following
is the most appropriate next step?
Answer Choices
A. Reassurance and supportive care only
B. Rapid strep antigen testing ✓
C. Immediate empiric antibiotics without testing
D. Monospot testing only
E. Throat culture for fungal infection
✓ Correct Answer: B — Rapid strep antigen testing
Explanation: A Centor score of 3-4 (exudate, tender adenopathy, fever, no cough) warrants rapid
antigen testing to confirm group A streptococcus before initiating antibiotics, avoiding unnecessary
antibiotic use while still identifying true cases.
, A 60-year-old smoker presents with a painless ulcer on the lateral tongue that has not healed in
six weeks. Which of the following is the most appropriate next step?
Answer Choices
A. Prescribe a two-week course of antifungal therapy
B. Reassure the patient and recheck in three months
C. Refer for biopsy to evaluate for malignancy ✓
D. Recommend salt water rinses and recheck in one week
E. Prescribe a topical corticosteroid
✓ Correct Answer: C — Refer for biopsy to evaluate for malignancy
Explanation: Any oral ulcer persisting beyond 2-3 weeks, especially in a smoker, requires biopsy to
rule out squamous cell carcinoma. Tongue cancer often presents as a painless, non- healing ulcer on
the lateral tongue.
NR509 Week 8 Final Exam
Questions, Answers & Explanations
Question Q78
A 42-year-old female is at 39 weeks gestation. She reports no major issues except swelling in
her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP
notes a diastolic murmur. Which of the following is true about her presentation and the
appropriate next step by the NP?
Answer Choices
A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required at this
time.
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted. ✓
C. A leftward rotated apical impulse would confirm a diagnosis of heart failure in this patient; the
NP should order an echocardiogram.
D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has been
taking iron supplementation.
E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this patient's
differentials list.
✓ Correct Answer: B — A diastolic murmur during pregnancy is likely pathological;
further investigation and work-up is warranted.
Explanation: Diastolic murmurs are always pathological. Unlike systolic murmurs (which can be
benign flow murmurs in pregnancy), a diastolic murmur warrants further cardiac evaluation. Shortness
of breath and edema combined with a diastolic murmur raise concern for mitral stenosis or peripartum
cardiomyopathy.
,A 35-year-old woman presents to the clinic with a complaint of intermittent, bilateral nipple
discharge for several weeks. She denies local tenderness, fever, or systemic symptoms aside
from slightly irregular periods over the last few months. On examination, there was no erythema,
increased warmth, or streaking around the areolas. Scant discharge consistent with breast milk
but without any signs of blood or pus was expressed from each nipple. Screening laboratories
revealed a normal blood count, metabolic panel, thyroid-stimulating hormone, and human
chorionic gonadotropin (HCG) level. Which of the following is the most accurate interpretation of
these findings?
Answer Choices
A. Prolactinoma ✓
B. Paget's disease of the breast
C. Occult pregnancy
D. Ductal carcinoma in situ
E. Mastitis
✓ Correct Answer: A — Prolactinoma
Explanation: Bilateral milky nipple discharge (galactorrhea) with irregular periods and normal
TSH/HCG strongly suggests hyperprolactinemia from a prolactinoma. Occult pregnancy is ruled out by
negative HCG. Paget's and DCIS present with unilateral bloody/serous discharge.
Mastitis presents with warmth, erythema, and systemic symptoms.
,Question Q33
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 Choices
A. I
B. II
C. III
D. IV ✓
E. Preadolescent
✓ Correct Answer: D — IV
Explanation: Tanner Stage IV is characterized by the areola and nipple projecting above the level of the
breast to form a secondary mound. Stage II is early breast budding; Stage III is further enlargement
without a separate mound; Stage V is the adult breast where the secondary mound recedes. Breast
asymmetry during puberty is a normal finding.
Want to earn $1,500
extra per year?
,The image depicts a physical examination finding related to cranial nerve assessment (patient's
head tilted back, throat/neck region visible). Which cranial nerve is being tested? (Currently
selected: C)
Answer Choices
A. CN X
B. CN IX
C. CN VI ✓
D. CN XII
E. CN XI
✓ Correct Answer: C — CN VI
Explanation: CN VI (Abducens nerve) controls lateral eye movement via the lateral rectus muscle.
Among the options, CN IX controls swallowing/taste, CN X controls vagal functions, CN XI controls
head/shoulder movement, and CN XII controls tongue movement. The selected answer of CN VI relates
to lateral gaze testing.
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Question Q68
Primary prevention is defined as which of the following?
Answer Choices
A. Interventions designed to prevent disease. ✓
B. Interventions designed to prevent complications.
C. Interventions to find asymptomatic conditions.
D. Interventions including screening tests.
E. Interventions to find disease processes at an early stage.
✓ Correct Answer: A — Interventions designed to prevent disease.
Explanation: Primary prevention aims to prevent disease before it occurs (e.g., vaccines, lifestyle
modifications). Secondary prevention involves early detection of asymptomatic disease (options C, D, E).
Tertiary prevention focuses on reducing complications from existing disease (option B).
,A 24-year-old male presents with unilateral red eye, watery discharge, and preauricular
lymphadenopathy after a recent upper respiratory infection. Vision is unaffected and the pupil is
round and reactive. Which of the following is the most likely diagnosis?
Answer Choices
A. Bacterial conjunctivitis
B. Viral conjunctivitis ✓
C. Acute angle-closure glaucoma
D. Anterior uveitis
E. Allergic conjunctivitis
✓ Correct Answer: B — Viral conjunctivitis
Explanation: Viral conjunctivitis classically follows a URI and presents with watery discharge and
preauricular adenopathy, which distinguishes it from bacterial conjunctivitis (purulent discharge, no
adenopathy). Glaucoma and uveitis cause pain and vision changes; allergic conjunctivitis is typically
bilateral with itching.
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Question 7
During an otoscopic exam, the NP notes that the tympanic membrane is retracted, has
decreased mobility on insufflation, and air-fluid levels are visible behind it. The patient denies
pain or fever. Which condition best fits this finding?
Answer Choices
A. Acute otitis media
B. Otitis media with effusion ✓
C. Otitis externa
D. Cholesteatoma
E. Tympanic membrane perforation
✓ Correct Answer: B — Otitis media with effusion
Explanation: Otitis media with effusion presents with a retracted, poorly mobile tympanic membrane
and visible air-fluid levels without the acute pain/erythema of acute otitis media. Otitis externa involves
the canal, not the middle ear space.
,A patient reports a sensation of room spinning that is triggered only by specific head
movements and resolves within 30-60 seconds. The Dix-Hallpike maneuver reproduces the
symptom with rotatory nystagmus. Which diagnosis is most consistent with these findings?
Answer Choices
A. Meniere disease
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo ✓
D. Acoustic neuroma
E. Migrainous vertigo
✓ Correct Answer: C — Benign paroxysmal positional vertigo
Explanation: BPPV is caused by displaced otoconia in the semicircular canals, producing brief,
positional vertigo reproduced by the Dix-Hallpike maneuver. Meniere disease includes hearing loss and
tinnitus; vestibular neuritis causes continuous vertigo lasting days.
, classmerit.com — The Marketplace to Buy and Sell Study Materials
Question 9
On examination of the oropharynx, the NP notes tonsillar exudate, tender anterior cervical
lymphadenopathy, fever, and absence of cough. Using the Centor criteria, which of the following
is the most appropriate next step?
Answer Choices
A. Reassurance and supportive care only
B. Rapid strep antigen testing ✓
C. Immediate empiric antibiotics without testing
D. Monospot testing only
E. Throat culture for fungal infection
✓ Correct Answer: B — Rapid strep antigen testing
Explanation: A Centor score of 3-4 (exudate, tender adenopathy, fever, no cough) warrants rapid
antigen testing to confirm group A streptococcus before initiating antibiotics, avoiding unnecessary
antibiotic use while still identifying true cases.
, A 60-year-old smoker presents with a painless ulcer on the lateral tongue that has not healed in
six weeks. Which of the following is the most appropriate next step?
Answer Choices
A. Prescribe a two-week course of antifungal therapy
B. Reassure the patient and recheck in three months
C. Refer for biopsy to evaluate for malignancy ✓
D. Recommend salt water rinses and recheck in one week
E. Prescribe a topical corticosteroid
✓ Correct Answer: C — Refer for biopsy to evaluate for malignancy
Explanation: Any oral ulcer persisting beyond 2-3 weeks, especially in a smoker, requires biopsy to
rule out squamous cell carcinoma. Tongue cancer often presents as a painless, non- healing ulcer on
the lateral tongue.
