NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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.
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, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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:
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, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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
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, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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:
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Questions-Answers
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.
Downloaded by academic master ()
, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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:
Downloaded by academic master ()
, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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
Downloaded by academic master ()
, NR 603 Week 4 APEA Predictor Exam Study Guide
Questions-Answers
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:
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