NR 603 Week 4 APEA Predictor Exam
Review Questions
SECTION I: ADVANCED HEALTH ASSESSMENT & CLINICAL REASONING (Questions 1–15)
Question 1
A 45-year-old female presents with a 2-week history of fatigue, weight gain, cold intolerance,
and constipation. On examination, she has bradycardia, dry skin, and non-pitting edema of the
lower extremities. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing's syndrome
D. Diabetes mellitus
Correct Answer: B. Hypothyroidism
Rationale: The presentation of fatigue, weight gain, cold intolerance, constipation,
bradycardia, dry skin, and non-pitting edema (myxedema) is classic for hypothyroidism.
Hyperthyroidism presents with weight loss, heat intolerance, and tachycardia. Cushing's
syndrome presents with weight gain, hypertension, and hyperglycemia. Diabetes mellitus
typically presents with polyuria, polydipsia, and polyphagia.
Question 2
A patient is unable to identify the smell of an orange. This inability could reflect an abnormality
in which cranial nerve?
A. CN I
B. CN II
C. CN VII
D. CN VIII
Correct Answer: A. CN I
Rationale: Cranial Nerve I is the olfactory nerve responsible for the sense of smell. Cranial
Nerves II and III assess vision and pupillary reaction. Cranial Nerve VII tests facial movement and
taste. Cranial Nerve VIII tests hearing and balance.
,Question 3
A transient ischemic attack (TIA) is best defined as:
A. A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal
ischemia, without acute infarction
B. An infarction of central nervous system tissue that may be symptomatic or silent
C. A sudden loss of consciousness due to cerebral hypoperfusion
D. A reversible ischemic event that always resolves within 1 hour
Correct Answer: A. A transient episode of neurologic dysfunction caused by focal brain,
spinal cord, or retinal ischemia, without acute infarction
Rationale: TIA is now defined as "a transient episode of neurological dysfunction caused by
focal brain, spinal cord, or retinal ischemia, without acute infarction." Ischemic stroke is defined
as an infarction of central nervous system tissue that may be symptomatic or silent. The other
options do not reflect current definitions.
Question 4
The term asteatosis refers to:
A. Skin that is dry, flaky, rough, and often itchy
B. Raised, greasy, velvety lesions
C. Painful vesicular lesions in a dermatomal distribution
D. Thickened, yellowed, deeply furrowed skin from sun exposure
Correct Answer: A. Skin that is dry, flaky, rough, and often itchy
Rationale: Asteatosis is a physiologic change of aging characterized by loss of elastic turgor
and dry, flaky, rough, itchy skin. Seborrheic keratosis appears as raised, greasy lesions. Herpes
zoster presents as painful vesicular lesions in a dermatomal distribution. Sun-damaged skin
appears weather-beaten, thickened, yellowed, and deeply furrowed.
Question 5
The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great
vessels is the:
,A. Pleural cavity
B. Mediastinum
C. Pericardium
D. Visceral pleura
Correct Answer: B. Mediastinum
Rationale: The mediastinum is the middle section of the thoracic cavity containing the
esophagus, trachea, heart, and great vessels. The right and left pleural cavities are on either side
of the mediastinum and contain the lungs. The visceral pleura encloses the lung. The
pericardium surrounds the heart.
Question 6
When examining the conjunctiva and sclera, the examiner should have the patient look upward
and then:
A. Cover one eye while visualizing the other
B. Depress both lower lids with the thumbs, exposing the sclera and conjunctiva
C. Observe for excessive tearing or dryness
D. Check the position of the lids for variations
Correct Answer: B. Depress both lower lids with the thumbs, exposing the sclera and
conjunctiva
Rationale: To expose the conjunctiva and sclera, have the patient look upward and depress
both lower lids with your thumbs. Covering one eye checks visual acuity. Observing for tearing
assesses the lacrimal apparatus. Checking lid position identifies eyelid abnormalities.
Question 7
The preauricular lymph node is located:
A. At the angle of the mandible
B. In front of the ear
C. At the base of the skull posteriorly
D. Superficial to the mastoid process
Correct Answer: B. In front of the ear
, Rationale: The preauricular lymph nodes are located in front of the ear. The tonsillar nodes
are at the angle of the mandible. The occipital nodes are at the base of the skull posteriorly. The
posterior auricular nodes are superficial to the mastoid process.
Question 8
The groove of the metacarpophalangeal joint can be palpated by having the patient:
A. Extend his hand
B. Flex his hand
C. Make a fist
D. Abduct his fingers
Correct Answer: B. Flex his hand
Rationale: The groove of the metacarpophalangeal joints can be palpated by having the
patient flex his hand. Extension, fist-making, and abduction do not optimally expose this groove
for palpation.
Question 9
Tenderness at the costovertebral angle may signify:
A. Cholecystitis
B. Pyelonephritis
C. Appendicitis
D. Pancreatitis
Correct Answer: B. Pyelonephritis
Rationale: Tenderness at the costovertebral angle (CVA tenderness) is a classic sign of
pyelonephritis (kidney infection/inflammation). Cholecystitis presents with right upper quadrant
tenderness. Appendicitis presents with right lower quadrant tenderness. Pancreatitis presents
with epigastric tenderness.
Question 10
Acute cholecystitis typically presents with pain that radiates to the:
Review Questions
SECTION I: ADVANCED HEALTH ASSESSMENT & CLINICAL REASONING (Questions 1–15)
Question 1
A 45-year-old female presents with a 2-week history of fatigue, weight gain, cold intolerance,
and constipation. On examination, she has bradycardia, dry skin, and non-pitting edema of the
lower extremities. What is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing's syndrome
D. Diabetes mellitus
Correct Answer: B. Hypothyroidism
Rationale: The presentation of fatigue, weight gain, cold intolerance, constipation,
bradycardia, dry skin, and non-pitting edema (myxedema) is classic for hypothyroidism.
Hyperthyroidism presents with weight loss, heat intolerance, and tachycardia. Cushing's
syndrome presents with weight gain, hypertension, and hyperglycemia. Diabetes mellitus
typically presents with polyuria, polydipsia, and polyphagia.
Question 2
A patient is unable to identify the smell of an orange. This inability could reflect an abnormality
in which cranial nerve?
A. CN I
B. CN II
C. CN VII
D. CN VIII
Correct Answer: A. CN I
Rationale: Cranial Nerve I is the olfactory nerve responsible for the sense of smell. Cranial
Nerves II and III assess vision and pupillary reaction. Cranial Nerve VII tests facial movement and
taste. Cranial Nerve VIII tests hearing and balance.
,Question 3
A transient ischemic attack (TIA) is best defined as:
A. A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal
ischemia, without acute infarction
B. An infarction of central nervous system tissue that may be symptomatic or silent
C. A sudden loss of consciousness due to cerebral hypoperfusion
D. A reversible ischemic event that always resolves within 1 hour
Correct Answer: A. A transient episode of neurologic dysfunction caused by focal brain,
spinal cord, or retinal ischemia, without acute infarction
Rationale: TIA is now defined as "a transient episode of neurological dysfunction caused by
focal brain, spinal cord, or retinal ischemia, without acute infarction." Ischemic stroke is defined
as an infarction of central nervous system tissue that may be symptomatic or silent. The other
options do not reflect current definitions.
Question 4
The term asteatosis refers to:
A. Skin that is dry, flaky, rough, and often itchy
B. Raised, greasy, velvety lesions
C. Painful vesicular lesions in a dermatomal distribution
D. Thickened, yellowed, deeply furrowed skin from sun exposure
Correct Answer: A. Skin that is dry, flaky, rough, and often itchy
Rationale: Asteatosis is a physiologic change of aging characterized by loss of elastic turgor
and dry, flaky, rough, itchy skin. Seborrheic keratosis appears as raised, greasy lesions. Herpes
zoster presents as painful vesicular lesions in a dermatomal distribution. Sun-damaged skin
appears weather-beaten, thickened, yellowed, and deeply furrowed.
Question 5
The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great
vessels is the:
,A. Pleural cavity
B. Mediastinum
C. Pericardium
D. Visceral pleura
Correct Answer: B. Mediastinum
Rationale: The mediastinum is the middle section of the thoracic cavity containing the
esophagus, trachea, heart, and great vessels. The right and left pleural cavities are on either side
of the mediastinum and contain the lungs. The visceral pleura encloses the lung. The
pericardium surrounds the heart.
Question 6
When examining the conjunctiva and sclera, the examiner should have the patient look upward
and then:
A. Cover one eye while visualizing the other
B. Depress both lower lids with the thumbs, exposing the sclera and conjunctiva
C. Observe for excessive tearing or dryness
D. Check the position of the lids for variations
Correct Answer: B. Depress both lower lids with the thumbs, exposing the sclera and
conjunctiva
Rationale: To expose the conjunctiva and sclera, have the patient look upward and depress
both lower lids with your thumbs. Covering one eye checks visual acuity. Observing for tearing
assesses the lacrimal apparatus. Checking lid position identifies eyelid abnormalities.
Question 7
The preauricular lymph node is located:
A. At the angle of the mandible
B. In front of the ear
C. At the base of the skull posteriorly
D. Superficial to the mastoid process
Correct Answer: B. In front of the ear
, Rationale: The preauricular lymph nodes are located in front of the ear. The tonsillar nodes
are at the angle of the mandible. The occipital nodes are at the base of the skull posteriorly. The
posterior auricular nodes are superficial to the mastoid process.
Question 8
The groove of the metacarpophalangeal joint can be palpated by having the patient:
A. Extend his hand
B. Flex his hand
C. Make a fist
D. Abduct his fingers
Correct Answer: B. Flex his hand
Rationale: The groove of the metacarpophalangeal joints can be palpated by having the
patient flex his hand. Extension, fist-making, and abduction do not optimally expose this groove
for palpation.
Question 9
Tenderness at the costovertebral angle may signify:
A. Cholecystitis
B. Pyelonephritis
C. Appendicitis
D. Pancreatitis
Correct Answer: B. Pyelonephritis
Rationale: Tenderness at the costovertebral angle (CVA tenderness) is a classic sign of
pyelonephritis (kidney infection/inflammation). Cholecystitis presents with right upper quadrant
tenderness. Appendicitis presents with right lower quadrant tenderness. Pancreatitis presents
with epigastric tenderness.
Question 10
Acute cholecystitis typically presents with pain that radiates to the:
