Nsg 3370 Maternity Final Exams Study Guide Question and Answers with explanations (NSG3370)

Exam (elaborations) Nsg 3370 Maternity Final Exams Study Guide Question and Answers with explanations (NSG3370) 1. During pregnancy, dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concerns of: peripartum cardiomyopathy Explanation: Dyspnea accompanied by increased respiratory rate, cough, rales, or respiratory distress raises concerns of possible infection, asthma, pulmonary embolus, or peripartum cardiomyopathy. 2. The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the: mediastinum Explanation: The middle section of the thoracic cavity containing the esophagus, trachea, heart, and great vessels is the mediastinum. The right and left pleural cavities, are on either side of the mediastinum and those contain the lungs. The visceral pleura encloses the lung. The pericardium surrounds the heart. 3. A patient is unable to identify the smell of an orange. This inability could reflect an abnormality in cranial nerves: CN I Explanation: Cranial Nerve I is the olfactory nerve responsible for the sense of smell. To test the sense of smell, the examiner presents the patient with familiar and nonirritating odors. A person should normally perceive odor on each side and correctly identify the source. Cranial Nerves II and III assess vision and pupillary reaction. Cranial Nerve VIII tests the hearing and balance. 4. A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction Explanation: 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 “an infarction of central nervous system tissue” that may be symptomatic or silent. The other terms are not related to the new definitions. 5. The term asteatosis refers to: skin that is dry, flaky, rough, and often itchy Explanation: Physiologic changes of aging include loss of elastic turgor, and wrinkling. Skin that appears dry, flaky, rough, and itchy is termed asteatosis. Sun exposure can cause damage to the skin resembling an appearance as weather beaten, thickened, yellowed, and deeply furrowed. Seborrheic keratosis appear as raised, yellowish lesions that feel greasy, velvety, or warty. Painful vesicular lesions in a dermatomal distribution may suggest herpes zoster. Nsg 3370 Maternity Final Exams Study Guide Question and Answers with explanations 6. An enlarged liver with a smooth tender edge may suggest: right-sided heart failure. Explanation: An enlarged liver with a smooth, tender edge suggests inflammation, as in hepatitis, or venous congestion, as in right-sided heart failure. Cirrhosis, hematochromatosis (increased amount of iron in the blood), and lymphoma produce an enlarged liver with a firm, nontender edge. An enlarged liver that is firm or hard and has an irregular edge or surface suggests hepatocellular carcinoma. 7. New onset hypertension with proteinuria or end-organ damage is: preeclampsia Explanation: Chronic hypertension occurs when systolic BP (SBP) 140 mm Hg or diastolic BP (DBP) 90 mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum. Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in the absence of proteinuria. Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage. Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause. 8. The psoas muscle group and muscles of the abdominal wall assist with: flexion Explanation: The psoas muscle group and muscles of the abdominal wall assist with flexion. The deep intrinsic muscles of the back assist with extension. The abdominal muscles and intrinsic muscles of the back assist with rotation. Lateral bending uses the abdominal muscles and intrinsic muscles of the back. 9. "Preterm small for gestational age" (SGA) infants are prone to: hypocalcemia Explanation: "Preterm appropriate for gestational age" (AGA) infants are prone to respiratory distress syndrome, apnea, patent ductus arteriosus with left-to-right shunt, and infection. "Preterm small for gestational age" (SGA) infants are more likely to experience asphyxia, hypoglycemia, and hypocalcemia. 10. Swelling noted 1-2 inches below the knee joint and on the medial surface of the knee would be suggestive of: anserine bursitis Explanation: Swelling 1-2 inches below the knee joint and on the medial surface would be suggestive of anserine bursitis. Swelling over the tibial tubercle suggests infrapatellar bursitis. Swelling over the patella suggests prepatellar bursitis. Semimembranous bursitis would be suggested by swelling on the posterior and medial surface of the knee. 11. A patient states that the only way he can sleep at night is to use several pillows or to sleep upright in a recliner. This sleep pattern is most consistent with: obstructive lung disease Explanation: With obstructive lung disease, the patient experiences orthopnea, dyspnea that occurs when the patient lies down but improves with sitting. Therefore, the patient would use several pillows or sleep upright in a recliner. Orthopnea is seen in obstructive lung disease, mitral stenosis, and heart failure. Paroxysmal nocturnal dyspnea describe episodes of sudden dyspnea that cause the patient to awaken from sleep where the patient must sit up, walk, or stand for it to resolve. Coughing and wheezing may also occur. Angina pectoris commonly creates chest pain or shortness of breath. Jugular venous pressure reflects right atrial pressure and volume status. In cases of cardiac or pulmonary dysfunction, jugular venous pressures usually raise. 12. A positive obturator sign would elicit pain in the: right hypogastric area Explanation: Assessment of the obturator sign is performed by flexing. By flexing the patient's right thigh at the hip with the knees bent, rotating the leg internally at the hip. If this causes increased pain in the right epigastric area, then the obturator sign is positive. Hypogastric pain occurs as the obturator muscle rubs an inflamed appendix. 13. The lateral bone that serves as a strut between the scapula and the sternum is known as the: clavicle Explanation: The lateral bone that serves as a strut between the scapula and the sternum is known as the clavicle. The humerus is the long bone of the upper arm. The acromion process is an extension of the spine of the scapula and located at the highest point of the shoulder. The thick curved extension of the superior border of the scapula is referred to as the coracoid process. 14. When examining the foot of a patient, the nurse practitioner notes focal heel tenderness on palpation of the plantar fascia. This could be suggestive of: plantar fasciitis Explanation: Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. Bone spurs may be present on the calcaneus as bony projections and may cause numbness, tenderness, or pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Tenderness along the posterior medial malleolus suggests posterior tibial tendinitis. 15. When examining the conjunctiva and sclera, have the patient look upward and then: depress both lower lids with your thumbs, exposing the sclera and conjunctiva Explanation: When examining the conjunctiva and the sclera, the best way to expose these structures is to have the patient look upward and depress both lower lids with your thumbs. Covering one eye while visualizing the other eyes checks for visual acuity. Observing for excessive tearing or dryness assesses the lacrimal apparatus. Checking the position of the lids may identify variations and abnormalities in the eyelids. 16. The groove of the metacarpophalangeal joint can be palpated by having the patient: flex his hand Explanation: The groove of the metacarpophalangeal joints can be palpated by having the patient flex his hand. 17. A patient complains of shooting pains below the knee radiating into the lateral leg and calf. This type of low back pain is referred to as: radicular low back pain Explanation: Radicular low back pain, or sciatica, presents with shooting pains below the knee, into the lateral leg or posterior calf. It may be accompanied by paresthesias and/or weakness in the affected leg. Mechanical low back pain often arises from muscle and ligament injuries (~70%) or age-related intervertebral disc or facet disease. Common symptoms include aching pain in the lumbosacral area that radiates to the upper leg. Common risk factors include heavy lifting, poor conditioning, and obesity. Lumbar spinal stenosis or "pseudoclaudication" refers to pain in the back or legs with walking that improves with rest, lumbar flexion, or both. 18. When assessing a 3-month-old for developmental dysplasia of the hips (DDH), which one of the following symptoms would be suspicious of dysplasia? Limitation of abduction of the affected extremity, shortening of the femur and positive Ortolani's sign Explanation: Developmental dysplasia of the hips (DDH) presents with limitation of abduction, shortening of the extremity, as the head of the femur does not fit into the acetabulum, and a positive Ortolani's (it clicks when maneuvered). DDH presents with asymmetry of the gluteal folds. 19. A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis is suspected because the pain radiates to the: right scapula area Explanation: Acute cholecystitis presents with right upper quadrant and upper abdominal pain radiating to the right scapular area. It is usually steady and aching. Pain in the epigastric area could be associated with peptic ulcer or dyspepsia. Cancer of the stomach can present with epigastric pain. Acute mechanical colon obstruction presents with pain in the lower abdomen. 20. The preauricular lymph node is located: in front of the ear Explanation: The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process. 21. Cessation of the menses for 12 months is termed: menopause Explanation: Menopause is defined as cessation of menses for 12 months, progressing through several stages of erratic cyclical bleeding. Oligomenorrhea is infrequent bleeding with menses occurring greater than 35-day intervals, or 4-9 menstrual cycles per year. Menorrhagia refers to excessive or prolonged menstrual flow occurring at regular intervals. Metrorrhagia refers to intermenstrual bleeding. 22. The gastrocnemius and soleus muscles are located by palpating the: posterior surface of the lower leg Explanation: The gastrocnemius and soleus muscles are located by palpating the posterior surface of the lower leg. 23. One cause of nasal septum perforation may be: intranasal use of cocaine Explanation: Perforation of the nasal septum could be caused by trauma, surgery, and intranasal use of cocaine or amphetamines. Nasal polyps obstruct air flow but there is no relationship to nasal septum perforation. Cystic fibrosis or chronic sinusitis are not associated with nasal perforation. 24. Tenderness in the costovertebral angles may signify: pyelonephritis Explanation: Because the kidney lies directly under the costovertebral angle, tenderness over this area would be related to renal issues such as renal stones or pyelonephritis. 25. A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state Explanation: A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. 26. A flat affect can be an identifiable finding in an older adult who has: depression Explanation: Flat affect occurs in depression, Parkinson’s disease, or Alzheimer’s disease. 27. Pain and crepitus over the patella suggests: roughening of the patellar undersurface Explanation: Pain and crepitus over the patella suggests roughening of the patellar undersurface that articulates with the femur. Tenderness over the patellar tendon or inability to extend the knee suggests a partial or complete tear of the patellar tendon. A degenerative patella produces pain with compression and patellar movement during quadriceps contraction. Swelling above and adjacent to the patella suggest synovial thickening or effusion of the knee joint. 28. A child with a heart murmur audible at the lower left sternal border would be suggestive of: ventricular septal defect Explanation: This type murmur is not considered a normal finding in children. The murmur associated with a ventricular septal defect is audible at the lower left sternal border. A child with a heart murmur located at the midsternum or upper right sternal border and associated with a click could be suggestive of aortic valve stenosis. A murmur located at the upper left sternal border with a prominent ejection click in early systole could be suggestive of pulmonary valve stenosis. 29. In order to visualize the opening of Stensen's duct, examine the: buccal mucosa opposite the second molar Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. 30. Hyperalgesia refers to: increased sensitivity to pain Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. 31. The part of the brain that maintains homeostasis is the: hypothalamus Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. 32. A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: obtain cognitive and functional assessment Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment and determining multifactorial fall risks are essential to the preventing future falls. 33. Which one of the following symptoms would be seen in a 39 week gestational age patient who was suspected of having HELLP syndrome? Vomiting, flu - like symptoms, and platelet count 100,000 Explanation: HELLP syndrome is a life-threatening pregnancy complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. Its characteristics: H (hemolysis), EL (elevated liver enzymes) and LP (low platelet count). 34. Flexion contracture of the knee suggests hamstring tightness or: limb paralysis Explanation: Flexion contracture (inability to extend fully) is seen in hamstring tightness or limb paralysis. Swelling over the patella suggests prepatellar bursitis. Stumbling or "giving way" of the knee during the heel strike phase of gait suggests quadriceps weakness or abnormal patellar tracking. 35. A protrusion of the membranes that cover the spine and the spinal cord itself, through a defect in the bony encasement of the vertebral column is known as: a meningomyelocele Explanation: A meningomyelocele is defined as the protrusion of the membranes that cover the spine and the spinal cord itself, through a defect in the bony encasement of the vertebral column. A developmental congenital disorder caused by the incomplete closing of the embryonic neural tube is known as spina bifida. A protrusion of the spinal cord through a defect in the vertebral arch is referred to as a myelocele. An omphalocele is a type of abdominal wall defect in which the intestines, liver, and occasionally other organs remain outside of the abdomen in a sac. 36. Static stabilizers of the shoulder are referred to as those structures that are: bony structures of the shoulder girdle Explanation: Static stabilizers are incapable of movement and include the bony structures of the shoulder girdle, the labrum, the articular capsule, and the glenohumeral ligaments that add to joint stability. Dynamic stabilizers are capable of movement and include the SITS muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis). These muscles move the humerus and compress and stabilize the humeral head within the glenoid cavity. 37. With inspection of the male infant's penis, the urethral orifice appears on the dorsal surface of the glans. This finding is consistent with: epispadias Explanation: With inspection of the male infant's penis, the urethral orifice appears on the dorsal surface of the glans. This finding is consistent with epispadias. A chordee refers to the fixed downward bowing of the penis. With inspection of the male infant's penis, the urethral orifice appears on the ventral surface of the glans. This finding is consistent with hypospadias. Cryptorchidism is a term used to describe undescended testicles in a male. 38. The nurse practitioner should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on which of the following statement: A majority of children go into remission and remain symptom free when treatment is completed Explanation: The majority of children diagnosed with the most common form of leukemia, acute lymphoblastic leukemia, go into remission and remain symptom free when treatment is complete and will have an 85% disease free survival rate. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. The research statement is true, but it does not address the parent's concern. About 95% of children achieve remission within the first month of chemotherapy. 39. To assess for strabismus in a child, use the: cover-uncover test Explanation: The cover-uncover test assesses coordination of eye muscle movement when one eye is covered. It is always assessed bilaterally. Strabismus is identified when the covered eye is found to deviate from its forward focus. Snellen eye chart assesses visual acuity; ophthalmoscope is used to visually assess the fundus of the eye. Pupillary reaction tests the ability of the eyes to react to light and accommodate. 40. While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? Cranial Nerve V (CN V) Explanation: Touching the cornea and assessing for a reflex assesses cranial nerve V. (sensory) 41. When examining the foot of a patient, the nurse practitioner notes tenderness of the posterior medial malleolus. This could be suggestive of: tibial tendinitis Explanation: Tenderness along the posterior medial malleolus suggests posterior tibial tendinitis. Bone spurs may be present on the calcaneus as bony projections and may cause numbness, tenderness, or pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. 42. Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a: cystourethrocele Explanation: When the entire anterior vaginal wall, together with the bladder and urethra, is involved in the bulge, a cystourethrocele is present. A cystocele is a bulge of the upper two-thirds of the anterior vaginal wall and the bladder above it. It results from weakened supporting tissues. A prolapsed urethral mucosa forms a swollen red ring around the urethral meatus. A urethral caruncle is a small, red, benign tumor visible at the posterior part of the urethral meatus. 43. A 3 year-old presents with a history of fever and cough over the past 24 hours. Findings on exam reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40 breaths/minute. Tachypnea in this child is most likely related to the child's febrile state Explanation: In children, heart and respiratory rates will increase with fever. For every degree of fever the respiratory rate will increase 3-4 breaths/minutes and the heart rate will increase 8-10 beats/minute. 44. A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with: Trichomonal vaginitis Explanation: Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. With bacterial vaginosis, the discharge can be gray or white, thin, malodorous (fishy), and not usually profuse. The discharge associated with gonorrhea is usually thick and bloody. 45. When assessing plantar reflexes, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the right foot. Absence of movement of the big toe is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Lumbar 5 and Sacral 1 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. 46. Which disorder of the eye can be detected with the cover-uncover and the Hirschberg test? Strabismus Explanation: Strabismus is misalignment of the eyes and can be assessed using the cover-uncover teats and the Hirschberg test (corneal light reflex). With the cover-uncover test, eye muscle weakness is seen as eye deviation when the eye is uncovered. With Hirschberg's test, an asymmetric light reflex indicates a deviation. Cataracts are visualized by a cloudiness or opacity in the lens. Conjunctivitis is diagnosed by observation of a discharge from the eyes and erythema of the conjunctiva. Amblyopia is diagnosed by visual assessment and testing by an optometrist or ophthalmologist. 47. If fetal movement cannot be perceived after 24 weeks gestation, all of the following may be considered except: normal finding Explanation: If fetal movement cannot be perceived after 24 weeks, consider error in calculating gestational age, fetal death or severe morbidity, or false pregnancy. Confirm fetal health and gestational age with an ultrasound. 48. To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and: palpate upward to just lateral to the pubic tubercles Explanation: To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and upward to just lateral to the pubic tubercles. 49. Bilateral exophthalmos suggests: Grave's disease Explanation: Exophthalmos is an abnormal protrusion of the eye. When it presents bilaterally, it is suggestive of Grave's disease, a form of hyperthyroidism. Unilateral exophthalmos may be due to Grave's disease or to a tumor or inflammation of the orbit. Hashimoto's thyroiditis, hypothyroidism, and goiter do not present with exophthalmos. 50. If regular uterine contractions occur prior to 37 weeks gestation, this could be: preterm labor Explanation: Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor. 51. A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write is termed: global aphasia Explanation: With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. 52. When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion of the knee is known as the: bulge sign Explanation: When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. A positive balloon sign in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. Balloting the patella occurs by compressing the suprapatellar pouch and pushing the patella sharply against the femur, causing fluid to return to the suprapatellar pouch. McMurray's test checks for tears in the medial menis 53. Which nerve runs from the spine through the neck, the axilla, and into the arm? Brachial plexus Explanation: The brachial plexus is a network of nerve fibers that runs from the spine through the neck, the axilla, and into the arm. This network of nerves passes through the cervico-axillary canal to reach the axilla and innervates brachium (upper arm), antebrachium (forearm), and hand. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. 54. When upper motor neuron systems are damaged below the crossover of its tracts in the medulla, motor impairment develops on the same side. This term is: ipsilateral Explanation: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is contralateral. In damage below the crossover, motor impairment would occur on the same side or ipsilateral side. Superficial refers to the outer surface of something. Intermediate is a term used to denote something between two other structures. 55. Symptoms of orthostatic hypotension include all of the following except: syncope: unsteadiness: visual blurring: respiratory rate greater than 30. Explanation: Orthostatic hypotension occurs in 20% of older adults and in up to 50% of frail nursing home residents, especially when they first arise in the morning. Symptoms include lightheadedness, weakness, unsteadiness, visual blurring, and in 20% to 30% of patients, syncope. 56. What is the earliest recognizable clinical manifestation(s) of cystic fibrosis in a child? Clubbing, frequent respiratory infections, and rectal prolapse Explanation: Cystic fibrosis is one of the most common genetic disorders in Caucasian children in the United States and is usually diagnosed at an early age. However, if it is not diagnosed in infancy, some of the symptoms seen in children include: not growing or gaining weight appropriately, frequent lung infections, persistent cough, and wheezing. Other symptoms may also develop in childhood such as: clubbing, rectal prolapse, and polyps in the nose or sinuses. The other choices are not seen in cystic fibrosis. 57. The most effective method to use when assessing visual acuity in young children, is the: E chart. Explanation: The E chart and Snellen charts assess visual acuity but for the young child, but the E chart is more appropriate. The child can tell the examiner which direction the E is pointing. The Snellen test requires that the child be able to identify letters of the alphabet. The most effective method to use when assessing conjugate gaze in young children, is the use of the cover-uncover test and the corneal light reflex test. The Ishihara chart assesses color blindness. 58. An adolescent visits the nurse practitioner for a sports participation physical. The nurse practitioner instructs the adolescent to hold his arms against his lateral upper legs against resistance. This maneuver assesses for: strength of the deltoid muscle Explanation: This maneuver assesses strength of the deltoid muscle. 59. Ptosis of the left eye would be suggestive of damage to which cranial nerve? Cranial Nerve III (CN III) Explanation: Ptosis of the left eye would be suggestive of 3rd nerve palsy (CN III)-Oculomotor nerve. 60. When performing the first Leopold maneuver on a pregnant woman, if the fetal buttocks and head are not easily palpated at the fundus, the fetus is said to be in: transverse lie Explanation: The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie. If the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back , then the head is extended and the fetus is in face presentation. 61. Which of the following substances is found in the urine of a child suspected of having post streptococcal glomerulonephritis? Blood and protein Explanation: With post streptococcal (strep) glomerulonephritis, a child may have a history of a recent strep infection (pharyngitis or impetigo). Proteinuria is secondary to altered glomerular structure and functioning. Gross hematuria causes the urine to be tea-colored. Bacteria, white blood cells and mucus can be seen with urinary tract infections. Glucose and ketones present in the urine may be associated with diabetes. 62. When describing muscle strength, the term quadriplegia means: inability to move all four extremities Explanation: Quadriplegia means inability to move or paralysis of all four limbs. Hemiparesis refers to weakness of one half of the body. Impaired strength is called weakness, or paresis. Absence of strength is called paralysis, or plegia. 63. Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss? Weber Test Explanation: The Weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). 64. A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with: bacterial vaginosis Explanation: The discharge associated with bacterial vaginosis can be gray or white, thin, malodorous, and not usually profuse. The odor is usually fishy. Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. The discharge associated with gonorrhea is usually thick and bloody. 65. The classic signs of a basilar skull fracture include hemotympanum and: CSF leak from nose and ears Explanation: Signs of a basilar skull fracture are battle's sign, raccoon eyes, rhinorrhea, otorrhea and hemotympanum (blood in the tympanic cavity). Intracranial hematoma is associated with a general skull fracture. Pain in the occipital region is associated with occipital fracture. Bilateral retinal hemorrhages are associated with shaken baby syndrome. 66. Respiratory effort in the neonate is initiated at birth as a result of: chemical, thermal, and mechanical factors Explanation: Chemical, thermal, and mechanical factors influence respiration as follows: breathing is initiated by a lack of oxygen and a high level of carbon dioxide in the blood stream. This stimulates the respiratory center in the medulla of the brain. Initiation of respiration is aided by the compression of the chest wall during the birth process, the cool air on the wet face, and the general handling of the body and limbs. A healthy baby cries almost immediately, but he has to breathe to be able to cry. With the first breath, the blood vessels in the lung expand. Spontaneous breathing is now established. Pulmonary venous return to the heart increases. This results in left arterial pressure exceeding right arterial pressure. Right to left shunting through the foramen ovale is reduced. 67. At what age does an infant copy sounds and gestures of others? Nine months Explanation: A normal nine-month infant should display stranger awareness, have a favorite toy, understand no, copy sounds and gestures of others, use fingers to point at things, play peek-a-boo, sit without support, and display the pincer grasp. 68. Stool that appears bloody, mucoid, or with pus, may indicate: Crohn's disease Explanation: Crohn's disease usually presents with blood, mucus, or pus in the stool. Thin, pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid colon. Constipation produces hard, dry stool. In the presence of hemorrhoids, the stool may appear blood streaked. 69. A patient complains of a sore tongue. Findings reveal a smooth and erythematous tongue. This condition is termed: glossitis Explanation: Glossitis is a term used to describe a sore tongue with an erythematous and smooth surface or a general inflammation of the tongue. Gingivitis refers to an inflammation of the gums. Stomatitis describes inflammation of the mouth including the mucous membranes and the lips. Candidiasis refers to a yeast infection of the mouth and presents with yellowish white patchy lesions in the mouth and tongue. 70. During pregnancy, what sound may be auscultated at the second or third intercostal space at the sternal border due to increased blood flow through the vessels? Venous hum Explanation: A venous hum, or continuous mammary souffle that occurs during pregnancy is due to increased blood flow through normal vessels. The mammary souffle is commonly heard during late pregnancy or lactation. It is heard loudest in the second or third intercostal space at the sternal border, and is typically both systolic and diastolic, though only the systolic component may be audible. 71. Part of the nutritional assessment includes anthropometric measurements. These measurements include all of the following except: height and weight: blood pressure, pulse, and respiration: mass index (BMI): basal metabolic rate (BMR). Explanation: Anthropometric measurements are a set of noninvasive, quantitative techniques for determining an individual's body fat composition by measuring, recording, and analyzing specific dimensions of the body: height, weight, BMI, BMR, distribution of body fat, and skin fold thickness. Vital signs are considered physiologic measurements. 72. Cognitive and language development between twelve years and adulthood, follows which one of Piaget's stages of development? Formal operational stage Explanation: Cognitive and language development between twelve years and adulthood, follows the formal operational stage of Piaget's stages of development. 73. If a newborn develops a cephalohematoma, the newborn is at an increased risk for: jaundice Explanation: Cephalohematomas are characterized by bleeding between the bone and the periosteum. Because of breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. They do not increase the risk for infections. Caput succedaneum is an edematous area on the head from pressure against the cervix. Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas. 74. A 40 year old male complains of right flank pain. His temperature is 102° F. These symptoms may be characteristic of: acute pyelonephritis Explanation: Kidney pain in the flank area and groin that is accompanied by fever and chills is consistent with acute pyelonephritis. Renal or ureteral colic usually presents with a sudden onset of pain in the flank area, abdomen, or groin. Chills and fever do not generally accompany urinary calculi. In men, painful urination without frequency or urgency suggests urethritis. Acute prostatitis presents with frequency, urgency, and dysuria. 75. When examining a patient with atopic dermatitis, there is a thickening and roughening of the skin with increased visibility of the normal skin furrows. This condition is termed: lichenification Explanation: Lichenification is defined as the thickening and roughening of the skin with increased visibility of the normal skin furrows (numerous grooves of variable depth on the surface of the epidermis). Atrophy is thinning of the skin with loss of normal skin furrows. Excoriation of the skin is an abrasion or scratch mark. The burrow of a scabies lesion includes small papules, pustules, lichenified areas and excoriations. 76. When eliciting deep tendon reflexes in the biceps, the nurse practitioner notes an abnormal reflex in the right biceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. 77. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is: A tremor Explanation: A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. 78. The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses: lateral bending Explanation: Looking over one shoulder and then the other would be assessing rotation of the neck and having the patient bring his ear to his shoulder would be assessing lateral bending of the neck. Assessing neck extension would be having the patient look upward at the ceiling. Bringing the chin to the chest would be assessing flexion of the neck. 79. A disparity between the brachial and femoral pulses in a 4-month-old could indicate: coarctation of the aorta (COA) Explanation: In coarctation of the aorta (COA), there is a disparity of pulses between the upper and lower extremities due to the narrowing of the descending aorta resulting in decreased blood flow to the lower extremities. The other choices do not present with these findings. 80. A patient presents with chest pain that radiates to the left side of the neck and down the left arm when he chops wood. This type of pain could be suggestive of: angina pectoris Explanation: Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain and tenderness associated with costochondritis worsens with coughing or taking deep breaths. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Any pain in the chest is cardiac until proven otherwise. 81. The Sexual Maturity Rating in girls includes 5 stages. Characteristics of Stage 5 include: coarse, curly hair as in adults covering the pubis and inner thighs Explanation: The Sexual Maturity Rating is also termed, Tanner staging; named after Dr. James Tanner. The stages are characterized by the following findings: Stage 1: (prepubertal): absence of breasts, pubic hair; Stage 2: Long, downy pubic hair near the labia, appearance of breast buds; Stage 3: Dark, coarse, curly hair sparsely over the symphysis pubis, enlargement of breast tissue and areola, with no separation of contours; Stage 4: Pubic hair as in an adult female but not in distribution; areola and nipple form secondary mound above breast tissue; Stage 5: Pubic hair as in adult female with distribution in inner thighs, linea alba; large breasts with single contour. 82. B/P readings greater than 140 mm HG systolic and greater than 90 mm HG diastolic prior to pregnancy, before 20 weeks gestation, or beyond 12 weeks postpartum is: chronic hypertension Explanation: Chronic hypertension occurs when systolic BP (SBP) 140 mm Hg or diastolic BP (DBP) 90 mm Hg documented prior to pregnancy, before 20 weeks, or beyond 12 weeks postpartum. Gestational hypertension refers to elevated blood pressure detected after 20 weeks gestation in the absence of proteinuria. Pre-eclampsia occurs in a woman who was previously normotensive but now has new onset hypertension with either proteinuria or end-organ damage. Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause. 83. The lateral collateral ligament of the knee: connects the lateral femoral epicondyle and the head of the fibula Explanation: The lateral collateral ligament (LCL) connects the lateral femoral epicondyle and the head of the fibula. The anterior cruciate ligament (ACL) crosses obliquely from the anterior medial tibia to the lateral femoral condyle, preventing the tibia from sliding forward on the femur. The posterior cruciate ligament (PCL) crosses from the posterior tibia and lateral meniscus to the medial femoral condyle, preventing the tibia from slipping backward on the femur. The medial and lateral menisci are fibrocartilaginous discs that cushion the action of the femur on the tibia. 84. Which of the following procedures should NOT be performed in a comatose patient? Dilate the pupils Explanation: When assessing a comatose patient, the nurse practitioner should not dilate the eyes because pupillary reaction is the single most important clue to the underlying cause of the coma: structural or metabolic. The other procedures can be performed on a comatose patient. 85. Where the head of the humerus articulates with the shallow glenoid fossa of the scapula is known as the: glenohumeral joint Explanation: The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. There is no manubrium joint; it is the broad upper part of the sternum. 86. The axioscapular group of muscles: pulls the shoulder backward Explanation: The axioscapular group pulls the shoulder backward and rotates the scapula. The scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and depresses and rotates the head of the humerus. The axiohumeral group produces internal rotation of the shoulder. The serratus anterior draws the shoulder blade forward. 87. The ankle is a hinge formed by the tibia, fibula, and the: talus Explanation: The ankle is a hinge formed by the tibia, fibula, and the talus. The tibia and fibula act as a mortise, stabilizing the joint while bracing the talus like an inverted cup. 88. The maxillary sinuses: surround the nasal cavity Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind the ethmoidal sinuses. 89. The dorsiflexors muscles in the foot include the: toe extensors Explanation: The dorsiflexors in the foot include the anterior tibial muscles and the toe extensors. 90. In renal adaptation of the newborn, which one of the following statements is correct? The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte stress Explanation: In the neonate the kidneys are structurally complete but physiologically immature. The glomeruli have an inability to filter and concentrate urine, therefore glucose and amino acids escape and there is decreased ability to remove uric acid crystals which give the reddish appearance to the urine. There is an inability to adapt to fluid and electrolyte stress leading to loss of bicarbonate and poor reabsorption. This puts the neonate at increased risk of metabolic acidosis. The tubules are short/narrow which causes a problem with reabsorption. The nephrons function well within a month. ADH inhibits diuresis and the immature kidney causes an increased risk for dehydration. 91. When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is: attached to the rib or intercostal muscle Explanation: A mobile mass that becomes fixed when the arm relaxes is attached to the ribs and/or intercostal muscles. If fixed when the hand is pressed against the hip, it is attached to the pectoral fascia. This finding is not consistent with cystic breast disease or indicative of nonmalignant masses. 92. An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true? This is a normal exam Explanation: Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake. 93. According to the U.S. Preventive Services Task Force, older adults should be screened for colorectal cancer with high-sensitivity fecal occult blood tests (FOBTs) every: year Explanation: The Task Force recommends screening for colorectal cancer with colonoscopy every 10 years, sigmoidoscopy every 5 years with high-sensitivity fecal occult blood tests (FOBTs) every 3 years, or FOBTs every year beginning age 50 years through age 75 years. Recommends against routine screening for adults ages 76 to 85 years, due to moderate certainty that the net benefit is small. 94. The great saphenous vein enters the deep venous system by way of the: femoral vein Explanation: The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of the deep venous system below the inguinal ligament. 95. When discussing the musculoskeletal system, all of the following statements related to articular structure disease are true except which one? Articular disease is usually due to stiffness or pain Explanation: Articular disease typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion due either to stiffness or to pain. Extra-articular disease typically involves selected regions of the joint and types of movement. 96. Signs and symptoms associated with diabetic gastroparesis may include all of the following except: vomiting of undigested food: weight loss: diarrhea: erratic glucose levels. Explanation: Diabetic gastroparesis occurs as a result of damage to the vagus nerve (controls the movement of food through the digestive system). Signs and symptoms associated with diabetic gastroparesis may include vomiting of undigested food, weight loss, erratic glucose levels, and gastroesophageal reflux. Diarrhea is not associated with diabetic gastroparesis or vagus nerve disorders since the vagus nerve innervates the stomach. 97. The portion of the umbilicus in a newborn that is covered with a firm gelatinous substance and dries up within two weeks of birth is known as: the umbilicus amniotic Explanation: The umbilicus amniotic refers to the amniotic portion of the umbilical cord which is covered with a firm gelatinous substance. This portion dries up and falls out within two weeks of birth. The portion of the umbilicus in a newborn that is covered with skin and retracts to become flush with the abdominal wall, is known as the umbilicus cutis. An umbilical hernia in infants is a defect in the abdominal wall which can measure up to six centimeters. An umbilical granuloma reflects granulation tissue at the base of the navel formed during the healing process. 98. A patient was recently diagnosed with gluten intolerance and needs instructions on what foods to eat. The patient should be told that a gluten restricted diet includes: corn Explanation: A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye). Corn and rice, and soybean products are allowed but processed foods are not. 99. When percussing a protuberant abdomen, tympany is audible. This is consistent with all of the following conditions except: intestinal obstruction: increased intestinal gas production: a large solid tumor: a paralytic ileus. Explanation: A protuberant abdomen that is tympanic throughout when percussed can suggest intestinal obstruction, increased gas production, or a paralytic ileus. A solid mass gives a dull sound on percussion. 100. The Glasgow coma scale assesses: motor response Explanation: Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glasgow Coma Scale was designed and should be used to assess the depth and duration of coma and impaired consciousness. This scale helps to gauge the impact of a wide variety of conditions such as acute brain injury due to traumatic and/or vascular injuries or infections, metabolic disorders such as hepatic or renal failure, hypoglycemia, or diabetic ketoacidosis. Cranial nerve, auditory, and pupillary responses are not included in the come scale assessment. 101. Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except: Achilles tendinitis Explanation: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux valgus, metatarsalgia, and Morton's neuroma. Achilles tendinitis more commonly occurs in runners and affects the posterior foot as opposed to the forefoot. 102. One maneuver used to assess coordination is to observe the patient: walking heel-to-toe in a straight line Explanation: To assess coordination, observe the patient’s performance in rapid alternating movements, pointto- point movements, gait and other related body movements, standing in specified ways. Walking heel-to-toe would be an example of observing the patient's gait. Dorsiflexion would be assessing the patient's joint function. Squeezing the examiner's fingers would be one way to assess hand grasp. Counting has nothing to do with coordination. 103. A small, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow-joint is referred to as the: lateral epicondyle of the humerus Explanation: A small, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow-joint is referred to as the lateral epicondyle of the humerus. 104. Uncontrolled electrical activity in the brain, which may produce minor physical signs, thought disturbances, or disturbed motor activity is: seizure Explanation: A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. 105. A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually associated with: an aortic dissection Explanation: Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Exertional pain can be angina pectoris. Symptoms most often seen with myocardial infarction include a retrosternal type pain that often radiates up to the neck, shoulder, and jaw and down to the ulnar aspect of the left arm. Pain associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents with a sharp knifelike pain. Any pain in the chest is cardiac until proven otherwise. 106. Involuntary movements of the body that involve larger portions of the body, including the trunk resulting in grotesque, twisted postures are suggestive of: dystonic movements Explanation: Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. 107. To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular movements in an infant, the nurse practitioner would: observe how well the infant tracks the nurse practitioner's face Explanation: To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular movements in an infant, the nurse practitioner would observe how well the infant tracks the nurse practitioner's face. 108. In infants, the palmar grasp reflex ceases after : 4 months Explanation: In infants, the palmar grasp reflex ceases after 4 months. Persistence beyond this time suggests pyramidal tract dysfunction. 109. A patient experienced a neck injury yesterday and presents to the nurse practitioner with aching paracervical pain and stiffness. Other complaints include dizziness, malaise, and fatigue. These findings may be associated with: neck pain with whiplash Explanation: In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder, lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. 110. Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: motor nerve fibers Explanation: The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. 111. At what age should an infant begin to say consonant sounds? Six months Explanation: A six-month-old infant should be able achieve these tasks: look at self in the mirror, respond to his own name, begin to say consonant sounds, begin to pass things from one hand to another, roll over in both directions, know familiar faces, and begin to know if someone is a stranger. 112. Genu varum refers to: bow leggedness Explanation: The term genu valgum refers to knock knees and genu varum refers to bow leggedness. Talipes equinovarus is the term that describes a clubfoot. Toeing inward or outward of the feet is known as tibial torsion. 113. When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the: posterior portion of the medial meniscus Explanation: When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the posterior portion of the medial meniscus. 114. Breastfeeding is contraindicated for an infant diagnosed with which one of the following conditions? Galactosemia Explanation: Galactosemia is the lack of a specific enzyme in the liver that breaks down galactose into glucose. Some infants may inherit a gene that allows for some galactose metabolism. However, if the baby has “classic galactosemia” in which the baby has no galactose metabolizing enzymes, the baby will need to be weaned abruptly, and then fed a lactose free formula. Breast feeding is not contraindicated in the other conditions. 115. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner's right hand: gently pull it to the left side , and inspect the side of the tongue Explanation: In order to examine the tongue, ask the patient stick out his the tongue and with the examiner's right hand, grasp the tip of the tongue with a gauze and gently pull it to the patient's left. Inspect the side of the tongue, then palpate it with the left hand, feeling for any induration. Reverse the procedure for the other side. Inspecting for tongue symmetry checks function of cranial nerve XII, hypoglossal. Stimulating the patient to cough and eliciting the gag reflex do not have anything to do with the tongue examination. 116. The ankle-brachial index is a screening test used to assess a person's risk for: peripheral artery disease Explanation: The ankle-brachial index test is a quick, noninvasive way to check a person's risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system. 117. The central nervous system extends from the medulla into the: spinal cord Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. 118. The Weber test uses a tuning fork to test hearing. The frequency range closest to that of conversational speech would be one with a frequency of: 512 Hz Explanation: The Weber hearing test screens for unilateral conductive hearing loss with a tuning fork. The tuning fork is measured in frequencies of 256 Hz or 512 Hz. These frequencies fall within the range of conversational speech. The ideal frequency for the Weber test is 256 Hz. A frequency of 512 Hz is the ideal frequency for the Rinne hearing test. 119. The nurse practitioner holds the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. This maneuver assesses the: placing and stepping reflexes Explanation: The placing or stepping reflex (formerly known as the dancing reflex) is assessed by holding the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine curves toward the stimulus. To elicit the positive support reflex, hold the infant around the trunk, lower the infant until the feet touch a flat surface. Hips, knees, ankles extend and the infant stands up, partially bearing weight. 120. Which of the following findings in a preschooler would indicate the need for further evaluation? Responds to facial expressions and gestures rather than to verbal explanations Explanation: A child who responds to facial expressions and gestures rather than to verbal explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler. 121. Decreased spinal mobility in the lumbar region could be suggestive of: osteoarthritis Explanation: Decreased spinal mobility in the lumbar region could be suggestive of osteoarthritis or ankylosing spondylitis. Dupuytren's contracture affects the hands. Torticollis would present a lateral deviation and rotation of the head. Kyphosis affects the thoracic spine. 122. An inward turning of the lower lid margin is called: entropion Explanation: Entropion is more common in the elderly and occurs when the lower lid margin turns inward. When this irritates the conjunctiva and the lower cornea. Ectropion occurs when th