NR 509
FINAL EXAM PREP
(300+ Practice Questions)
(Week’s 5 – 8 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
SECTION 1 ....................................................................2
SECTION 2 ..................................................................63
SECTION 3 ................................................................140
SECTION 1
1. A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in
her 60s. A younger cousin developed the disease a few years ago before the age of
50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In
addition, the patient suffered from lymphoma in her 20s and had radiation to the
chest. She did take hormone replacement therapy for a few years before data
emerged that this may contribute to breast cancer risk. She has had several
abnormal mammograms in her 50s for persistently dense breasts with subtle
findings, but follow-up biopsies never showed any malignant pathology. Which of
the following is true regarding magnetic resonance imaging (MRI) screening of this
patient?
a. No agency recommends breast MRI for a patient such as this one, who has moderately
but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense
of markedly decreased specificity (i.e., the ability to rule out disease in healthy patients).
d. Breast MRI is the sole recommended screening modality for women with a history of
chest radiation.
e. Hormone replacement therapy history alone is sufficient to qualify for MRI screening.
Correct Answer: C — Regardless of recommendations, the high sensitivity of breast
MRI comes at the expense of markedly decreased specificity (i.e., the ability to rule
out disease in healthy patients).
, Rationale: This patient has moderate risk factors (family history, chest radiation, HRT
use, dense breasts), but breast MRI is primarily recommended for high-risk women (e.g.,
BRCA carriers, lifetime risk >20–25%). MRI has very high sensitivity (around 90%) but
lower specificity than mammography, resulting in more false positives, callbacks, and
biopsies. The USPSTF does not recommend routine MRI for average-risk or moderate-risk
women. Chest radiation history increases risk but does not alone mandate MRI without
other high-risk features.
2. A 66-year-old female museum curator presents for a routine annual examination.
On examination, a notably enlarged supraclavicular lymph node is appreciated on
the right side. The lymph node is nontender and feels firm and rubbery. She denies
any localized or systemic symptoms such as breast lumps, fevers, or night sweats.
She has been taking conjugated estrogen tablets for 9 years since menopause,
though she has not taken progestin compounds since she had a hysterectomy for
heavy bleeding at age 45 years. Which of the following is true about this
presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics
of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
Correct Answer: E — Metastatic breast cancer cells may spread directly into the
infraclavicular and then supraclavicular nodes without first causing notable
changes in the axillary nodes.
Rationale: The supraclavicular lymph nodes (particularly on the left, Virchow's node) are
a critical drainage site for thoracic and abdominal malignancies. In breast cancer,
metastasis can bypass the axilla and spread directly to infraclavicular and supraclavicular
nodes. A firm, rubbery, nontender node in a postmenopausal woman on long-term
estrogen therapy is suspicious for malignancy and requires urgent workup, including
breast imaging and possible biopsy. Supraclavicular nodes are never considered "benign
by location" and always warrant evaluation when enlarged.
FINAL EXAM PREP
(300+ Practice Questions)
(Week’s 5 – 8 Covered)
Verified Questions & Answers With Rationales
(Advanced Physical Assessment)
Chamberlain
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
SECTION 1 ....................................................................2
SECTION 2 ..................................................................63
SECTION 3 ................................................................140
SECTION 1
1. A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in
her 60s. A younger cousin developed the disease a few years ago before the age of
50 years, but this individual was not tested for the BRCA1 and BRCA2 genes. In
addition, the patient suffered from lymphoma in her 20s and had radiation to the
chest. She did take hormone replacement therapy for a few years before data
emerged that this may contribute to breast cancer risk. She has had several
abnormal mammograms in her 50s for persistently dense breasts with subtle
findings, but follow-up biopsies never showed any malignant pathology. Which of
the following is true regarding magnetic resonance imaging (MRI) screening of this
patient?
a. No agency recommends breast MRI for a patient such as this one, who has moderately
but not extraordinary risk factors for breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense
of markedly decreased specificity (i.e., the ability to rule out disease in healthy patients).
d. Breast MRI is the sole recommended screening modality for women with a history of
chest radiation.
e. Hormone replacement therapy history alone is sufficient to qualify for MRI screening.
Correct Answer: C — Regardless of recommendations, the high sensitivity of breast
MRI comes at the expense of markedly decreased specificity (i.e., the ability to rule
out disease in healthy patients).
, Rationale: This patient has moderate risk factors (family history, chest radiation, HRT
use, dense breasts), but breast MRI is primarily recommended for high-risk women (e.g.,
BRCA carriers, lifetime risk >20–25%). MRI has very high sensitivity (around 90%) but
lower specificity than mammography, resulting in more false positives, callbacks, and
biopsies. The USPSTF does not recommend routine MRI for average-risk or moderate-risk
women. Chest radiation history increases risk but does not alone mandate MRI without
other high-risk features.
2. A 66-year-old female museum curator presents for a routine annual examination.
On examination, a notably enlarged supraclavicular lymph node is appreciated on
the right side. The lymph node is nontender and feels firm and rubbery. She denies
any localized or systemic symptoms such as breast lumps, fevers, or night sweats.
She has been taking conjugated estrogen tablets for 9 years since menopause,
though she has not taken progestin compounds since she had a hysterectomy for
heavy bleeding at age 45 years. Which of the following is true about this
presentation of lymphadenopathy?
a. Breast cancer always presents with axillary lymphadenopathy because the lymphatics
of the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
Correct Answer: E — Metastatic breast cancer cells may spread directly into the
infraclavicular and then supraclavicular nodes without first causing notable
changes in the axillary nodes.
Rationale: The supraclavicular lymph nodes (particularly on the left, Virchow's node) are
a critical drainage site for thoracic and abdominal malignancies. In breast cancer,
metastasis can bypass the axilla and spread directly to infraclavicular and supraclavicular
nodes. A firm, rubbery, nontender node in a postmenopausal woman on long-term
estrogen therapy is suspicious for malignancy and requires urgent workup, including
breast imaging and possible biopsy. Supraclavicular nodes are never considered "benign
by location" and always warrant evaluation when enlarged.
