• NUR 509 09/07/2026
NUR 509 - FNP ADULTS FINAL EXAM 2 PREP
NEWEST 2026/2027 ACTUAL EXAM COMPLETE
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALE
A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a rectal
examination, stating that, "Some trainee once did that and it hurt badly." Which of the following is true about
the innervation of the anus and rectum that may explain this patient's experience of discomfort?
a. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves,
making the rectum the most likely source of this patient's discomfort.
b. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves,
making the anus the most likely source of this patient's discomfort.
c. Proximal to the dentate line, the lower gastrointestinal tract is innervated primarily by somatosensory nerves,
P 1
, • NUR 509 09/07/2026
making the proximal reach of the examination the most likely site of this patient's pain.
d. The anal canal has a rich somatosensory innervation,
d. The anal canal has a rich somatosensory innervation, making poorly directed examinations painful in this area.
Rationale: The anal canal is characterized by somatosensory innervation, whereas the rectum has little such
nerve supply. Thus, the patient's discomfort likely occurred due to the stretch of the anal canal rather than
disruption of the more proximal rectal mucosa.
A 54-year-old male with a strong family history of breast and prostate cancer presents to his primary care
provider to discuss prostate screening. His father died at age 73 years from prostate cancer that was not
detected on routine digital rectal examinations (DREs), and he would like to minimize his chance of a similar
occurrence. Which of the following is true regarding the anatomy and screening of the prostate by DRE?
a. All three lobes of the prostate are palpable on DRE.
b. The seminal vesicles are palpable distal to the prostate on DRE.
c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE.
d. The median sulcus divides the lateral lobes from the median lobe and is palpable on DRE.
e. A prostate of 5 cm diameter without palpable nodes or masses represents a normal prostate examination.
c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE.
Rationale: Due to its location at the anterior aspect of the urethra, the median lobe of the prostate is not
palpable on DRE, nor are small tumors in this area
A third-year medical student rotating on the internal medicine service performs a digital rectal examination
(DRE) on a 56-year-old female patient. The patient has been admitted for suspicion of a myocardial infarction,
and confirmation that there is no blood in the stool is required before anticoagulation can be started. The
student reports that the fecal occult blood test was negative but notes that he palpated a structure through the
anterior rectum that he could not identify. The attending physician confirms normal anatomy and reviews with
the student that the most likely identity of the structure palpable is which of the following?
a. Sacrum
b. Pectinate line
c. Uterine fundus
d. Prostate
e. Cervix
P 2
, • NUR 509 09/07/2026
e. Cervix
Rationale: The cervix is often palpable through the anterior rectal wall on DRE of female patients.
A 45-year-old female executive reports to her primary care provider that she has recently experienced a change
in the patterns of her bowel movements. She expresses a great concern as her family history includes a maternal
aunt who died of colon cancer at age 49 years; her mother has had colonoscopies every 3 years with numerous
adenomatous polyps removed. Which of the following historical elements would be the most concerning for
colon cancer in this patient?
a. Long-term history of hemorrhoids
b. Recent history of black, tarry stools
c. Remote history of anal pruritus
d. New-onset anal fissures
e. Recent onset of small-caliber stools
e. Recent onset of small-caliber stools
Rationale: Small-caliber stools may be caused by narrowing of the colon due to a mass. Colonoscopy should be
performed to rule out such pathology, especially in a patient with such a notable family history.
A 49-year-old customer service representative presents to his gastroenterologist for follow-up of his long-
standing inflammatory bowel disease (IBD). He was diagnosed with ulcerative colitis (UC) at age 37 years and
has had irregular care for this condition since then. His sole colonoscopy was done at the time of diagnosis 12
years ago. His only relevant family history is of prostate cancer in his father; his mother and sisters are healthy.
Which of the following is true about recommended screening for colon cancer in this patient?
a. The patient should begin screening for colon cancer 10 years prior to the age of onset of his father's prostate
cancer.
b. The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer.
c. The patient is due for routine age-based colon cancer screening by colonoscopy regardless of his risk factors.
d. The patient has a reassuring family history and t
b. The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer.
Rationale: The two forms of IBD (UC and Crohn disease) increase the risk of colon cancer and do warrant
increased screening at shortened intervals. The patient should begin screening for colon cancer 10 years prior to
the age of onset of his father's prostate cancer is incorrect because family history of breast, ovarian, or colon
cancer increases an individual's risk of colon cancer, whereas family history of prostate cancer alone does not
increase an individual's risk of colon cancer and thus does not indicate increased screening. (Of note, prostate
cancer may rarely be a manifestation of the BRCA genetic mutation that would put this patient at higher risk for
P 3
, • NUR 509 09/07/2026
many types cancer, but this would usually be accompanied by a family history of many cancers, especially breast
and ovarian cancer in the female line.)
A 49-year-old male with well-controlled HIV undergoes a proctoscopic examination as routine screening for anal
cancer. The patient is asymptomatic and specifically denies complaints of frequent urination (frequency), large
volume of urination (polyuria), or repeated urination at night (nocturia). Under direct visualization, the clinician
observes a clear, circumferential demarcation of proximal versus distal tissue. This demarcation was not palpable
on digital rectal examination (DRE) prior to proctoscopy. What is the most likely origin of this finding?
a. Pathological constriction of the anal canal
b. Normal anatomy of the mucosal surface
c. Carcinoma
d. Valve of Houston
e. External anal sphincter
b. Normal anatomy of the mucosal surface
Rationale: The circumferential border between the anal canal and rectum is visible on proctoscopic examination
but is not palpable on DRE. This demarcation is known as the dentate or pectinate line.
A 34-year-old female reports anal pain with defecation. She notes incidentally to this complaint that she has
developed episodic abdominal discomfort and sores in her mouth. Anoscopic examination reveals anal fissures
that appear to be her source of pain. Which of the following underlying conditions is the clinician most likely to
find?
a. Inflammatory bowel disease (IBD)
b. Lymphogranuloma venereum
c. Human papillomavirus (HPV)
d. Gonorrhea cervicitis
e. Primary syphilis
a. Inflammatory bowel disease (IBD)
Rationale: Anal fissures are associated with the underlying condition of Crohn disease, which is one of
the two IBDs (the other is ulcerative colitis). Anal fissures may have no underlying cause, although
constipation is a common and benign condition that may lead to this problem.
b.
A 53-year-old African American advertising agent 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 risk and screening for prostate cancer?
a. The incidence of prostate cancer does not rise until age >65 years, thus this patient needs no screening at this
time.
b. Prostate cancer is always an aggressive neoplasm, thus the risks of overdiagnosis with screening is
outweighed by the benefits of early case-finding.
P 4
NUR 509 - FNP ADULTS FINAL EXAM 2 PREP
NEWEST 2026/2027 ACTUAL EXAM COMPLETE
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALE
A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a rectal
examination, stating that, "Some trainee once did that and it hurt badly." Which of the following is true about
the innervation of the anus and rectum that may explain this patient's experience of discomfort?
a. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves,
making the rectum the most likely source of this patient's discomfort.
b. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral nerves,
making the anus the most likely source of this patient's discomfort.
c. Proximal to the dentate line, the lower gastrointestinal tract is innervated primarily by somatosensory nerves,
P 1
, • NUR 509 09/07/2026
making the proximal reach of the examination the most likely site of this patient's pain.
d. The anal canal has a rich somatosensory innervation,
d. The anal canal has a rich somatosensory innervation, making poorly directed examinations painful in this area.
Rationale: The anal canal is characterized by somatosensory innervation, whereas the rectum has little such
nerve supply. Thus, the patient's discomfort likely occurred due to the stretch of the anal canal rather than
disruption of the more proximal rectal mucosa.
A 54-year-old male with a strong family history of breast and prostate cancer presents to his primary care
provider to discuss prostate screening. His father died at age 73 years from prostate cancer that was not
detected on routine digital rectal examinations (DREs), and he would like to minimize his chance of a similar
occurrence. Which of the following is true regarding the anatomy and screening of the prostate by DRE?
a. All three lobes of the prostate are palpable on DRE.
b. The seminal vesicles are palpable distal to the prostate on DRE.
c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE.
d. The median sulcus divides the lateral lobes from the median lobe and is palpable on DRE.
e. A prostate of 5 cm diameter without palpable nodes or masses represents a normal prostate examination.
c. The median lobe of the prostate is located anterior to the urethra and is not palpable on DRE.
Rationale: Due to its location at the anterior aspect of the urethra, the median lobe of the prostate is not
palpable on DRE, nor are small tumors in this area
A third-year medical student rotating on the internal medicine service performs a digital rectal examination
(DRE) on a 56-year-old female patient. The patient has been admitted for suspicion of a myocardial infarction,
and confirmation that there is no blood in the stool is required before anticoagulation can be started. The
student reports that the fecal occult blood test was negative but notes that he palpated a structure through the
anterior rectum that he could not identify. The attending physician confirms normal anatomy and reviews with
the student that the most likely identity of the structure palpable is which of the following?
a. Sacrum
b. Pectinate line
c. Uterine fundus
d. Prostate
e. Cervix
P 2
, • NUR 509 09/07/2026
e. Cervix
Rationale: The cervix is often palpable through the anterior rectal wall on DRE of female patients.
A 45-year-old female executive reports to her primary care provider that she has recently experienced a change
in the patterns of her bowel movements. She expresses a great concern as her family history includes a maternal
aunt who died of colon cancer at age 49 years; her mother has had colonoscopies every 3 years with numerous
adenomatous polyps removed. Which of the following historical elements would be the most concerning for
colon cancer in this patient?
a. Long-term history of hemorrhoids
b. Recent history of black, tarry stools
c. Remote history of anal pruritus
d. New-onset anal fissures
e. Recent onset of small-caliber stools
e. Recent onset of small-caliber stools
Rationale: Small-caliber stools may be caused by narrowing of the colon due to a mass. Colonoscopy should be
performed to rule out such pathology, especially in a patient with such a notable family history.
A 49-year-old customer service representative presents to his gastroenterologist for follow-up of his long-
standing inflammatory bowel disease (IBD). He was diagnosed with ulcerative colitis (UC) at age 37 years and
has had irregular care for this condition since then. His sole colonoscopy was done at the time of diagnosis 12
years ago. His only relevant family history is of prostate cancer in his father; his mother and sisters are healthy.
Which of the following is true about recommended screening for colon cancer in this patient?
a. The patient should begin screening for colon cancer 10 years prior to the age of onset of his father's prostate
cancer.
b. The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer.
c. The patient is due for routine age-based colon cancer screening by colonoscopy regardless of his risk factors.
d. The patient has a reassuring family history and t
b. The patient should undergo colonoscopy for his bowel condition, which confers risk of colon cancer.
Rationale: The two forms of IBD (UC and Crohn disease) increase the risk of colon cancer and do warrant
increased screening at shortened intervals. The patient should begin screening for colon cancer 10 years prior to
the age of onset of his father's prostate cancer is incorrect because family history of breast, ovarian, or colon
cancer increases an individual's risk of colon cancer, whereas family history of prostate cancer alone does not
increase an individual's risk of colon cancer and thus does not indicate increased screening. (Of note, prostate
cancer may rarely be a manifestation of the BRCA genetic mutation that would put this patient at higher risk for
P 3
, • NUR 509 09/07/2026
many types cancer, but this would usually be accompanied by a family history of many cancers, especially breast
and ovarian cancer in the female line.)
A 49-year-old male with well-controlled HIV undergoes a proctoscopic examination as routine screening for anal
cancer. The patient is asymptomatic and specifically denies complaints of frequent urination (frequency), large
volume of urination (polyuria), or repeated urination at night (nocturia). Under direct visualization, the clinician
observes a clear, circumferential demarcation of proximal versus distal tissue. This demarcation was not palpable
on digital rectal examination (DRE) prior to proctoscopy. What is the most likely origin of this finding?
a. Pathological constriction of the anal canal
b. Normal anatomy of the mucosal surface
c. Carcinoma
d. Valve of Houston
e. External anal sphincter
b. Normal anatomy of the mucosal surface
Rationale: The circumferential border between the anal canal and rectum is visible on proctoscopic examination
but is not palpable on DRE. This demarcation is known as the dentate or pectinate line.
A 34-year-old female reports anal pain with defecation. She notes incidentally to this complaint that she has
developed episodic abdominal discomfort and sores in her mouth. Anoscopic examination reveals anal fissures
that appear to be her source of pain. Which of the following underlying conditions is the clinician most likely to
find?
a. Inflammatory bowel disease (IBD)
b. Lymphogranuloma venereum
c. Human papillomavirus (HPV)
d. Gonorrhea cervicitis
e. Primary syphilis
a. Inflammatory bowel disease (IBD)
Rationale: Anal fissures are associated with the underlying condition of Crohn disease, which is one of
the two IBDs (the other is ulcerative colitis). Anal fissures may have no underlying cause, although
constipation is a common and benign condition that may lead to this problem.
b.
A 53-year-old African American advertising agent 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 risk and screening for prostate cancer?
a. The incidence of prostate cancer does not rise until age >65 years, thus this patient needs no screening at this
time.
b. Prostate cancer is always an aggressive neoplasm, thus the risks of overdiagnosis with screening is
outweighed by the benefits of early case-finding.
P 4
