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NR 509 APEA EXAM – UROLOGY

1:
 In men, painful urination without frequency or urgency suggests:

2: 
A 65-year-old woman complains that when she feels the urge to urinate, she has to go immediately or else she urinates “on herself”. She has become homebound because she wants to stay close to the bathroom. This condition is termed:

Questions with detailed explanations 

3:
 Symptoms of proctitis may include all of the following except:

4: 
A 40 year old male complains of right flank pain. His temperature is 102° F. These symptoms may be characteristic of:

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5: 
A useful mnemonic for elucidating causes of incontinence in the older adult is:

6: 
Which condition usually coexists with epididymitis?

7: 
Which of the following substances is found in the urine of a child suspected of having post streptococcal glomerulonephritis? NR 509 APEA exam – urology.

8: 
A whitish sebaceous secretion that collects between the glans penis and foreskin or in the vulva is……

9: 
A 40 -year-old male states that he felt “something” above his left testis. On examination, a painless cyst is noted above the left testicle. Transillumination is positive. This is consistent with a:

10: 
Undescended testicle(s) in a young male is termed nr 509 apea exam

11: 
When examining the scrotum in a young male child, test the cremasteric reflex by nr 509 apea exam

12: 
Which one of the following patient positions would be least beneficial to examine the genitals of a young female child?

13: 
A 50-year-old male describes difficulty emptying his bladder. On exam, a distended bladder is noted following urination. This finding may be ……

14: 
One cause of proctitis could be related to nr 509 apea exam

15: 
Which one of the following symptoms would be least indicative of acute glomerulonephritis?

16: 
In renal adaptation of the newborn, which one of the following statements is correct? NR 509 APEA exam – urology.

17: 
A 33 year old male presents for examination because of a scrotal complaint. The exam reveals the presence of 2 testicles and palpable tissue resembling a “bag of worms” over the left testicle. When in the supine position with the scrotum elevated, the “bag of worms” disappears. This condition is suggestive of a:

18: 
Benign prostatic hypertrophy begins in the: NR 509 APEA exam – urology.

NR 509 APEA EXAM – WOMEN’S HEALTH

Question 1:
 When palpating the cervix during the bimanual exam, cervical motion tenderness (chandelier sign) is noted. This tenderness could be suggestive of:

Question 2:
 In a female diagnosed with a first-degree uterine prolapse, the cervix:

3: Daughters of women who took Diethylstilbestrol (DES) during pregnancy are at a high risk for developing all of the following abnormalities except:

4: A female patient presents with a profuse, yellowish, green vaginal discharge that is malodorous. This vaginal discharge is most consistent with:

5: The most common causes of sexual problems in females are …..

6: Chronic pelvic pain refers to pain that does not respond to therapy and:

7: In female patients with dyspareunia, superficial pain is most likely related to all of the following except: NR 509 APEA EXAM – WOMEN’S HEALTH.

8: If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and:

9: Upon examination of the vagina, a swollen red ring is noted around the urethral opening. This finding is most consistent with a:

10: When performing a bimanual vaginal exam, a solid, nodular-like lesion is palpated over the right ovary. This finding is most consistent with:

11: Indications for performing a rectovaginal exam include all of the following except to:

12: Examination of a female patient’s right breast reveals a retraction of the nipple and areola. This finding is consistent with: NR 509 APEA EXAM – WOMEN’S HEALTH.

13: To assess pelvic floor muscle strength during the bimanual vaginal exam, have the patient squeeze around the inserted fingers for as long as possible. To consider full strength, snug compression should last for:

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14: Upon examination of the vagina, a tense, hot, very tender abscess with labial swelling is noted. This finding is most consistent with a:

15: A female patient has a history of a retroverted uterus. This condition refers to:

16: 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:

17: Urethritis in a female patient may arise from all of the following organisms except:

18: To palpate the uterus during a bimanual exam, the examiner would lubricate the index and middle fingers of one hand and insert them into the vagina. The other hand would be placed on the abdomen: NR 509 APEA EXAM – WOMEN’S HEALTH.

19: When do the ovaries become non-palpable after menopause?

20: When performing a rectal exam on a female, a hard nodular rectal “shelf” is palpable at the tip of the examiner’s finger. This finding is suggestive of:

21: A twenty-year-old female complains of a milky discharge bilaterally from her breasts. This suggests:

22: A woman complains of infrequent menses with intervals greater than 35 days. This condition is …..

23: The most common cause of acute pelvic pain in women is:

24: When performing a vaginal exam with a speculum, the use of the upper blade as a retractor could expose a:

25: When preparing to perform a pelvic exam in an older female, vaginal atrophy is noted. Due to this finding, the speculum:

26: Upon examination of the cervix, a yellow drainage is visible around the cervical os. This finding is most likely suggestive of: NR 509 APEA EXAM – WOMEN’S HEALTH.

27: When examining the cervix, a bright, red, soft and fragile lesion is noted on the cervical surface. This finding is consistent with:

28: During examination of the vagina, a bulge in the upper two-thirds of the anterior vaginal wall is noted. This symptom is most consistent with a:

29: The most common type of hernia in women is the:

30: A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with:

31: When performing a bimanual vaginal exam, a smooth and rather compressible non-tender lesion is palpated over the right ovary. This finding is most consistent with:

32: When performing the bimanual vaginal exam, a nodule on the anterior uterine surface could suggest a (an):

33: Cessation of the menses for 12 months is ….

34: A woman complains of experiencing uterine bleeding between expected menstrual cycles. This condition is …..

35: A 45-year old female presents to the nurse practitioner with complaints of postcoital bleeding (greater than spotting) unrelated to the menstrual cycle. What is the most likely cause?

36: When performing the bimanual vaginal exam, uterine enlargement is …… This enlargement could suggest: NR 509 APEA EXAM – WOMEN’S HEALTH.

37: In which of the following situations would it be difficult for the examiner to palpate an ovary during the bimanual vaginal exam?

38: Causes of post menopausal bleeding typically include all of the following except:

39: A 35-year-old female presents with complaints of swelling of her right breast. Findings reveal edema of the lower portion of her right breast. The skin appears thickened with enlarged pores. This condition is consistent with:

40: The shiny, pink area located around the cervical os is ….as nr 509 apea exam

41: During a speculum exam of the cervix the speculum is maintain in an open position by:

42: A female patient presents with a white and curd-like thin vaginal discharge. This discharge is most consistent with:

Question 43:
 Upon examination of the vagina, a bulge is …..in the lower posterior wall of the vagina. This finding is most consistent with a:

Question 44:
 Upon examination of the cervix, an irregular cauliflower-like growth was ….around the cervical os. This finding is most suggestive of:

45: Upon examination of the vagina, a small, red, benign tumor is …..at the posterior part of the urethral meatus. This finding is most consistent with a:

46: To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and:

47: An ulcerated vulvar lesion in an elderly woman may indicate nr 509 apea exam

48: Pelvic floor muscle weakness may be due to all of the following except:

49: In a female diagnosed with a third-degree uterine prolapse, the cervix:

50: A woman complains of abnormally heavy and prolonged menstrual periods that occur at regular intervals. This condition is most likely:

51: In a female diagnosed with a second-degree uterine prolapse, the cervix:

52: A woman complains of experiencing frequent menses with intervals of fewer than 21 days. This condition is …..

53: If performed correctly and in a timely fashion, which one of the following is most definitive for the diagnosis of breast cancer? NR 509 APEA EXAM – WOMEN’S HEALTH.

54: Retraction of the nipple and areola suggest:

55: The vaginal mucosa lies in transverse folds ……

56: The most important risk factor for cervical cancer is nr 509 apea exam

57: When performing a bimanual exam of the vagina, the examiner should lubricate the index and middle fingers of a gloved hand. From a standing position, the fingers should be ….into the vagina while exerting pressure primarily:

58: Fixed flattening of the nipple suggests:

59: Chronic pelvic pain may be secondary to all of the above except:

60: When discussing the female anatomy, the introitus is also ….as the nr 509 apea exam

61: When performing a breast exam, a mobile mass becomes fixed when the arm relaxes. This suggests that the mass is:

62: To palpate the right ovary when performing the bimanual vaginal exam, the abdominal hand should be on the right lower quadrant and the pelvic hand needs to be:

63: When performing an examination of the external genitalia of a female patient, a small, firm, round cystic nodule in the labia is …… This lesion is most consistent with:

64: Primary dysmenorrhea results from:

65: The deep red area located around the cervical os is ….as nr 509 apea exam

66: When examining the cervix, a translucent nodule is …..on the cervical surface. This finding is consistent with:

67: To palpate the left ovary when performing the bimanual vaginal exam, the abdominal hand should be on the left lower quadrant and the pelvic hand needs to be:

68: When performing a vaginal exam with a speculum, the use of the lower blade as a retractor during bearing down could expose an anterior wall defect such as a: NR 509 APEA EXAM – WOMEN’S HEALTH

NR 509 APEA EXAM – HEENT

Question 1:
 The function of the auditory ossicles is to:

Question 2:
 A 35-year-old patient complains of vertigo accompanied by nausea and vomiting. Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be suggestive of:

3. A 60-year-old was concerned about a yellowish colored lesion above her right eyelid. Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal area of her right eyelid. This finding is most consistent with:

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4. Assessment of a patient’s visual acuity resulted in 20/200 using the Snellen eye chart. This means that:

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5. Findings following assessment of a person’s left eye gaze include impaired movements when attempting to look upward, downward, or inward. This condition is most consistent with: a conjugate gaze.

6. Findings following assessment of a person’s eye gaze include both eyes moving in the same direction simultaneously. This condition is most consistent with: a conjugate gaze.

7. A patient was diagnosed as being farsighted. The term for this condition is:

8.  buildup of excess fluid around the periphery of the eye orbits is known as:

9. hat connects the middle ear to the nasopharynx? NR 509 APEA EXAM – HEENT.

10. The fleshly projection of the earlobe is known as the:

11.Then examining the pupils, the left pupil is noted to be fixed and dilated to light and near accommodation. This condition may be suggestive of:

12. A deposit of uric acid crystals appearing as hard nodules on the helix or antihelix is termed:

13. n the outer ear, anterior and parallel to the helix, is a curved prominence known as the:

14. On examination of the pupils, both are round but the right pupil appears larger than the left and reacts much slower to light. This condition may be indicative of:

15. A six-year-old complains that something is in her left eye. There is a red raised area of the left lid. There is redness and tenderness of the eye and tearing. These findings are consistent with:

16. Ophthalmoscopic examination of the retina reveals AV tapering. This appears as if the: vein “winds” down on either side of the artery.

17.  A patient presents with complaints of burning, itching, tearing, and some pain in the eye. Findings reveal red, scaly, greasy flakes and thickened, crusted lid margins. This would be suggestive of:

18. Ophthalmoscopic examination of the fundus reveals small, rounded, slightly irregular red spots embedded in the retina. These findings are consistent with: NR 509 APEA EXAM – HEENT.

19. Redness, bleeding, pain, and swelling of the gums is most likely nr 509 apea exam

20. Ophthalmoscopic examination of the retina reveals a normal arteriovenous crossing. This appears as if the:

21. Otosclerosis is an example of a(n):

22.  Which of the following findings in a preschooler would indicate the need for further evaluation?

23. A 50- year-old patient complains of being unable to read the hymnal at church. This describes:

24. The gradual loss of vision with a change in color and size of the optic disc is referred to as:

25. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner’s right hand nr 509 apea exam

26. A 30-year-old patient presents with complaints of seeing double in the right eye. Examination reveals diplopia in the right eye when the left eye is …… This may be suggestive of a:

27. One cause of nasal septum perforation may be:

28. A 30-year-old patient presents with a moderate “aching” in his right eye. Findings reveal a small and irregular shaped right pupil.

29. Sudden bilateral and painless visual loss is rare but can be associated with all the following except:

30. On ophthalmoscopic examination, optic atrophy appears: NR 509 APEA EXAM – HEENT.

31. Ophthalmoscopic examination of the retina reveals AV banking. This appears as if the: vein tapes down on either side of the artery.

32. Causes of sensorineural hearing loss include all of the following except nr 509 apea exam

33. What visual acuity constitutes legal blindness?

34. An example of a cause of conductive hearing loss in children would be:

35. Miosis is a term used to describe:

36.  If a patient complains of seeing flashing lights across the field of vision, this could be: NR 509 APEA EXAM – HEENT

NR 509 APEA EXAM – CARDIO

Question 1:
 The lymphatic ducts drain into the:

Question 2:
 While auscultating the patient’s heart, a medium, soft murmur is audible. It is pansystolic and heard loudest at the apex with radiation to the left axilla. These findings are consistent with:

3:
 Which of the following group of symptoms would be suggestive of an infant experiencing a congenital heart defect associated with a decreased pulmonary blood flow pattern?

4:
 Right atrial pressure can be determined by:

5:
 When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the most appropriate for this child?

6:
 The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from the:

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7:
 The external iliac lymph nodes drain lymphatic fluid from the following areas except the:

8:
 The amplitude of the pulse in a patient in cardiogenic shock would most likely appear:

9:
 When auscultating the heart for aortic insufficiency, ask the patient to:

10:
 The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal ligament and drain lymphatic fluid from all of these areas except:

11:
When auscultating the point of maximal impulse (PMI), apex of the heart, in an adult, the stethoscope is placed at the: NR 509 APEA EXAM – CARDIO.

12:
 Deep cervical lymph nodes drain lymphatic fluid from the:

13:
 Which of the following symptoms would necessitate the need for further evaluation in the newborn?

14:
 Symptoms of acrocyanosis in the newborn include:

15:
 A heart rate of 100-180 beats per minute in an adult is …..

16:
 Tissue ischemia is usually …..when assessing a patient with peripheral artery disease (PAD). What other symptom could be …….?

17:
 When performing a cardiovascular assessment on a healthy 2-year-old child:

18:
 A disparity between the brachial and femoral pulses in a 4-month-old could indicate:

19:
 The right lymph duct drains lymphatic fluid from all the following areas except the:

20
: When auscultating the apex of the heart in an 8-year-old, the bell of the stethoscope should be placed at the:

21:
In order to assess for varicosities in the lower extremities, position the patient: NR 509 APEA EXAM – CARDIO.

22:
 A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with:

23:
 Symptoms of orthostatic hypotension include all of the following except:

24:
 A three-week-old infant presents with a generalized lacy, reticulated blue discoloration of the skin. This is suggestive of:

25:
 The supraclavicular lymph nodes are located:

26:
 In an adult patient, auscultate the sounds arising from the mitral valve by placing the stethoscope:The tonsillar lymph node is located:

27:
 A bruit heard in the epigastric area with both systolic and diastolic components is suggestive of:

28:
 Presence of a heart murmur in a child would be considered organic if the child:

29:
 A patient complaints of a sharp, knifelike pain that begins in the chest and radiates to the tip of the shoulder and to the neck. This type of chest pain is suggestive of:

30:
 In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse (PMI), ask the patient to:

31:
 The preauricular lymph node is located:

32:
 To auscultate the heart sounds arising from the pulmonic valve in an adult patient, place the stethoscope:

33:
 To assess aortic pulsations in patients with carotid obstruction, assess the pulse using the:

34:
 When screening a patient for peripheral arterial disease (PAD), one risk factor would include a history of:

35:
 The preauricular nodes drain lymphatic fluid from the:

36:
 The ankle-brachial index is a screening test used to assess a person’s risk for:

37:
 The internal iliac lymph nodes drain lymphatic fluid from the:

38:
 Causes of orthostatic hypotension in older adults may include all of the following except:

39:
 A 5-year-old child presents with complaints of fever and headache. Examination reveals a heart rate of 157 beats/minute, respiratory rate of 40 breaths/minute, B/P 108/54, and a temperature of 102.6 °F. The increased heart rate is most likely related to:NR 509 APEA EXAM – CARDIO.

40:
 The posterior chest wall and portions of the arms are ……by which group of lymph nodes?

41:
 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:

42:
 A disease that may present as indigestion, but is precipitated by exertion and ….by rest is most likely:

Question 43:
 A patient …..of having chronic venous insufficiency, may present with:

Question 44:
 The great saphenous vein enters the deep venous system by way of the:

45:
 Warning signs of peripheral artery disease may include all of the following except:

46:
 On assessment, which one of the following symptoms would be noted as a compensatory response to chronic hypoxia?

47:
 A patient complains of some pain in the distal portions of her fingers on both hands. She states that it tends to occur more frequently with exposure to cold. These symptoms may be consistent with:

48:
  The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of:

49:
The thoracic lymph duct drains lymphatic fluid from all the following areas except the: NR 509 APEA EXAM – CARDIO.

50:
 When auscultating the heart, the displacement of the point of maximal impulse (PMI) is greater than 10 cm lateral to the midsternal line. This finding is consistent with:

51:
 A sudden, tearing, sharp pain that begins in the chest and radiates to the back or into the neck is usually ……:

52:
 By placing the ball of the examiner’s hand firmly on the chest, the examiner would be checking for:

53:
 Which lymph nodes receive lymphatic fluid from the stomach, duodenum, liver, gallbladder, and pancreas?

54:
 When auscultating the heart of a 55-year-old patient, a loud murmur with a thrill is audible in the right second intercostal space that radiates to the carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the apex. The murmur is heard best with the patient sitting and leaning forward. This finding is consistent with:

55:
 When auscultating heart sounds arising from the aortic valve in an adult patient, place the stethoscope:

56:
 A patient describes chest pain as persistent, sharp, and knife-like. These symptoms are more characteristic of:

57:
 A third heart sound (S3) is audible in a forty-five-year old. This S3 sound may be:

58:
 Enlarged or tender lymph nodes are most often ……:

59:
 A widened pulse pressure greater than or equal to 60 in an older patient is a risk factor for cardiovascular disease, stroke, and:

60:
 Characteristic symptoms of chronic venous insufficiency may include which one of the following?

61:
 Widened pulse pressure (PP) is defined as systolic blood pressure (SBP):

62:
Characteristic symptoms of chronic arterial insufficiency may include which one of the following? NR 509 APEA EXAM – CARDIO.

63:
 Pain or cramping of the legs that occurs during exertion and is ……by rest is ……:

64:
 In older adults, the presence of heart sound S3 suggests:

65:
 To auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope:

66:
 When auscultating the heart of a 50-year-old patient, a soft murmur is audible in the left second and third intercostal spaces and radiates to the left shoulder and neck. Also noted is a crescendo-decrescendo pitch to the murmur. This finding could be consistent with:

67:
 The hemodynamic changes resulting from structural defects in children can lead to heart failure. The most common reason for these changes is related to:

68:
 The posterior auricular lymph nodes drain lymphatic fluid from the:

69:
 While examining the heart, a pansystolic, blowing murmur is audible over the left sternal border with radiation to the right of the sternum. The intensity increased with inspiration. This finding is characteristic of:

70:
 The axillary lymph nodes drain lymphatic fluid from all of the following areas except the:

71:
A patient complains of pain in the arch of the foot sometimes relieved by rest. Occasionally, he experiences intermittent pain in the toes, especially at rest. Exercise aggravates the pain in the arch. History reveals he smokes approximately a half pack of cigarettes per day. These symptoms may be consistent with nr 509 apea exam

72:
 The occipital lymph node is located:

73:
 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:

74:
A twelve-month-old has a history of heart failure related to his congenital heart defect. He is receiving aldactone (Spironolactone), enalapril (Vasotec), furosemide (Lasix), and acetaminophen (Tylenol). The infant’s potassium level is 3.1 meq/l. Which medication is most likely decreasing his potassium level? NR 509 APEA EXAM – CARDIO

75:
 The anterior cervical lymph node chain is located anterior and nr 509 apea exam

76:
 The tonsillar, submandibular, and submental nodes drain the lymphatic fluid from portions of the:

77:
 A condition that usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress may be …….

78:
 The sacral lymph nodes receive lymphatic fluid from all the following except the:

79:
 Children presenting with congenital heart defects that result in right to left shunting would most likely exhibit which of the following symptoms?

80:
 An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true?

81:
 Heart sounds produced by turbulence due to a temporary increase in blood flow in predisposing conditions, such as hyperthyroidism, is ……:

82:
 The four classic structural defects of Tetralogy of Fallot include nr 509 apea exam

83:
 A child presents with fever of 102.5 °F for the past five days. Kawasaki disease is ……if which of the following groups of symptoms is present?

84:
 A finding suggestive of an inflamed lymph node would be one that is:

85:
 The posterior auricular lymph node is located:

86:
 Enlargement of which lymph nodes would be suggestive of metastasis from a thoracic or abdominal malignancy?

87:
 The superior and inferior mesenteric lymph nodes drain lymphatic fluid from the: nr 509 apea exam

88:
A male patient states that he has difficulty breathing when he is lying down but when he sits up, it improves. This is a classic description of: NR 509 APEA EXAM – CARDIO

89:
 Assessment findings in a newborn at birth include: irregular respirations without crying, heart rate of 105 beats/minute, grimaces with reflex stimulation, kicking of both feet, and moving of both arms. The body and face are pink and hands and feet are cyanotic. What is the APGAR score?

90:
 A patient complains of increased pain in the calf muscles and buttocks especially after walking or riding his bicycle. He states that the pain stops after he sits still for about 2-3 minutes. This condition may be ……

91:
 A condition that presents with symptomatic limb ischemia upon exertion is termed:

92:
 Absent or diminished pulses in the wrist could be indicative of: nr 509 apea exam

93:
 In older adults, the presence of heart sound S4 suggests:

94:
 A patient describes chest pain as pressing, squeezing, and tight lasting between 1 and 3 minutes. These symptoms are more characteristic of:

95:
 When auscultating the heart, a scratchy, continuous murmur is audible during atrial systole and ventricular systole and diastole. This finding may be indicative of a:

96:
 The anterior mediastinal lymph nodes drain lymphatic fluid from the nr 509 apea exam

97:
 To assess the murmur of aortic insufficiency, position the patient:

98:
 A pediatric patient presents with erythema marginatum, chorea, and a heart murmur. These symptoms are consistent with:

99:
 When auscultating the heart; S1 sound, is located at the apex of the heart and signifies:

100:
 A patient with cirrhosis develops portal hypertension as indicated by the presence of: nr 509 apea exam

101:
 Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with:

102:
 Why would a newborn with patent ductus arteriosus receive a prostaglandin inhibitor (indomethacin)?

103:
When assessing a 3-year-old African American child, the most likely cause of black, dusky mucous membranes is related to: NR 509 APEA EXAM – CARDIO

NR 509 Week 2 Quiz

A mother brings her two month old daughter in for an examination says “my daughter rolled over against the wall and now I have noticed that she has the spot soft on the top of her head, is there something terribly wrong?” The FNP‘s best response would be:

During percussion the FNP knows that a dull percussion note elicited over a lung lobe. This most likely results from:

The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects Damage to: NR 509 Week 2 Quiz

When examining the face, the FNP is aware that the two pairs of salivary gland‘s that are accessible to examination are the _____ glands

A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The FNP suspects damage to cranial nerve ____ and proceeds with the examination by____

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When examining a patient’s cranial nerve function, the FNP remembers that the muscles in the neck that are innervated by CN XI are the:

The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the _____ gland

A patient says that she has recently noticed a lump in the front of her neck below her “Adams apple” that seems to be getting bigger. During the assessment, the finding that leaves the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:

The FNP notices that the patient’s submental lymph nodes are enlarged. In an effort to identify the cause of the node enlargement, the FNP would assess the patient’s:

The FNP is aware that the four areas in the body were lymph nodes accessible are the: nr 509 week 2 quiz

A 52-year-old patient describes the presence of occasional floaters or spots moving in front of his eyes. The FNP should know that floaters are usually not significant and are caused by:

The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?

A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:

A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next: NR 509 Week 2 Quiz

A patient’s vision is ……as 20/80 in each eye. The FNP interprets this finding to mean that nr 509 week 2 quiz

When performing the corneal light reflex assessment, the FNP notes that the light is …..at 2 o’clock in each eye. The FNP should

The FNP is performing the diagnostic positions test. Normal findings would be which of these results? nr 509 week 2 quiz

During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?

A 60-year-old man is at the clinic for an examination. The FNP suspects that he has ptosis of one eye. How should the FNP check for this?

The FNP is doing an assessment on a 21-year-old patient and notices that his nasal mucosa appears pale gray and swollen. What would be the most appropriate question to ask the patient?

The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?

During an oral assessment of a 30-year-old African-American patient, the FNP notices bluish lips and a dark line along the gingival margin. What would the FNP do in response to these findings

During an assessment of a 20-year-old patient with a three day history of nausea and vomiting the FNP notices dry mucous and deep vertical fissures on the tongue. NR 509 Week 2 Quiz. These findings are reflective of:

The FNP is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate FNP reflects a correct understanding of tactile fremitus?

The FNP student is reviewing physical assessment findings of the HEENT system associated with pregnancy. Which statement by the graduate FNP reflects a correct understanding of expected HEENT changes associated with pregnancy? During pregnancy: NR 509 Week 2 Quiz

NR 509 Week 3 Quiz

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The FNP examined her hand and will expect a fracture if the girl complains:

A patient has been diagnosed with osteoporosis and asked the FNP “what is osteoporosis?” The FNP explains to the patient that osteoporosis is defined as:

Patient states, “I can hear a crunching or grating sound when I kneel”. She also states “that it is very difficult to get out of bed in the morning because of stiffness and pain in my joints”. The FNP should assess for signs of what problem? NR 509 Week 3 Quiz.

When taking the history on a patient with a seizure disorder the FNP assesses whether the patient has an aura. Which of these would be the best question for obtaining this information?

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The FNP is teaching a class on osteoporosis prevention to a group of post menopausal women. A participant shows that she needs more instruction when she states I will:

The FNP is performing a neurological assessment on a 41-year-old woman with a history of diabetes. When testing her ability to feel the vibrations of a tuning fork the FNP notices that the patient is unable to feel vibrations on the great toe or ankle bilaterally, but she is able to feel vibrations on both patella. Given this information what would the FNP suspect?

And 80-year-old woman is visiting the clinic for a check up. She states “I can’t walk as much as I used to”. The FNP is observing from motor dysfunction in her hip and should have her:

The FNP is testing the function of cranial nerve XI. Which of these best describes the response the FNP should expect if the nerve is intact? The patient: NR 509 Week 3 Quiz.

A 50-year-old woman is in a clinic for weakness in her left arm and leg that she noticed for the past week. The FNP should perform which type of neurologic examination?

During the neurological assessment of a healthy 35-year-old patient the FNP asks him to relax his muscles completely. The FNP then moves each extremity through full range of motion. Which of these results would the FNP expect to find?

A woman who is 8 months pregnant comments that she has noticed a change in posture and is having lower back pain. The FNP tells her that during pregnancy women have a posture shift to compensate for the enlarging fetus. This shift and posture is known as

A patient is able to flex his right arm forward without difficulty or pain but is unable to abduct his arm because of pain and muscle spasm’s. The FNP should suspect:

A professional tennis player comes into the clinic complaining of a sore elbow. The FNP will assess for tenderness at the:

The FNP suspect that a patient has carpal tunnel syndrome and wants to perform the Phalens test. To perform this task the FNP should instruct the patient to:

During the history a patient tells the FNP that “it feels like the room is spinning around me”. The FNP would document this as: nr 509 week 3 quiz

The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception the FNP decides to complete the test as quickly as possible. When the FNP applies the sharp point of a pin on his arm several times he is only able to identify these as one very sharp prick. What would be the most accurate explanation for this?

An 85-year-old patient comments during his annual physical that “he seems to be getting shorter as he ages”. The FNP should explain that decrease height occurs with aging because:

A patient is complaining of pain in his joints that is worse in the morning, is better after he has moved around for a while, and then gets worse again if he sits for long periods of time. The FNP should assess for other signs of what problem? NR 509 Week 3 Quiz.

When the FNP asks a 68-year-old patient to stand with feet together and arms at his side with his eyes closed he starts to sway and moves his feet farther apart. The FNP would document this finding as:

During an assessment of the cranial nerves the FNP finds the following asymmetry when the patient smiles or frowns, uneven lifting of eyebrows, sagging of lower eyelids, and escape of air when the FNP presses against the right path cheek. This would indicate dysfunction of which of these cranial nerves? nr 509 week 3 quiz

The FNP is teaching a class on osteoporosis prevention to a group of postmenopausal women which of these actions is the best way to prevent or delay bone loss in this group?

In obtaining a history on a 74 year old patient the FNP notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold thing. With this information what should the FNP‘s response be?

During a history of a 78-year-old man his wife states that “he occasionally has problems with short-term memory loss and confusion. He can’t even remember how to button his shirt”. In doing the assessment of his sensory system which action of the FNP‘s is most appropriate?

While obtaining a history of a 3 month old infant from the mother the FNP asks about the infants ability to suck and grass the mothers finger. What is the FNP assessing? nr 509 week 3 quiz

The FNP is doing an assessment on a 29-year-old woman who visits the clinic complaining of always dropping things and falling down. While testing rapid alternating movements the FNP notices that the woman is unable to pat both her knees. Her response is very slow and she misses frequently. What should the FNP suspect? NR 509 Week 3 Quiz.

NR 509 WEEK 4 QUIZ

A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?

The direction of blood flow through the heart is best described by which of these

In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would

When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are

The sack that surrounds and protects the heart is called the

When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?

The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?

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During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process?

The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?

In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history? NR 509 WEEK 4 QUIZ.

The FNP is assessing the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a____pulse

A patient complains of leg pain that wakes him at night. … states that he has been having problems with his legs. He has pain in his legs when they are … and disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing

During an assessment the FNP uses the profile sign to detect nr 509 week 4 quiz

 … these statements describes the closure of the valves in a normal cardiac cycle?

When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next

A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing

In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. nr 509 week 4 quiz  Which of these findings can … explained by expected hemodynamic changes related to age? NR 509 WEEK 4 QUIZ.

The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?

The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?

A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?

Findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is … 45°. The FNP knows that this finding indicate:

The component of the conduction system referred to as the pacemaker of the heart is the nr 509 week 4 quiz NR 509 WEEK 4 QUIZ.

The FNP is reviewing anatomy and physiology of the heart. Which statement best describes what is … by atrial kick?

A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be

When assessing a patient the FNP notes that the left femoral pulse as diminished 1+/4+. What should the FNP do next? NR 509 WEEK 4 QUIZ.

NR 509 4.1. – NJL, 22, M, African American

Patient Information:

NJL, 22, M, African American, Cigna

S.

CC
: “burning sensation while peeing and peeing constantly”

HPI
:
   Onset: 2 days ago

Location: urethra

Duration: intermittent r/t urination

Characteristics:  burning, frequent urination

Aggravating Factors: urination

Relieving Factors: Tylenol 250 mg

Treatment:  Tylenol 250 mg orally Twice a Day

Current Medications
:
none

Allergies:
 None

PMHx
:  TDaP  06/5/13.  Does not recall any other immunizations.  Denies any major illnesses or surgery.

Soc Hx
:
  Truck driver student, enjoys hanging out with friends and playing sports.  Long-term relationship, one son age 6 month, non-smoker, EtoH 3 drinks/week.  Patient plays basketball 3 days a week. NR 509 4.1. – NJL, 22, M, African American.

Fam Hx
: NJL is the middle child of three. One son, 6 months, healthy.  One sister 34 and one brother 28,  no known health disorders. Father 61, smoker, Obese, Hypertension, Hyperlipidemia. Mother 59, Hypertension, Hyperlipidemia. Maternal Grandmother 75 (deceased), skin cancer. Maternal Grandfather (deceased) alcoholic, diabetic unknown age of death. Paternal Grandmother 86, no health issues. Paternal Grandfather (deceased) diabetic.

ROS
: (Jarvis, 2016)

CONSTITUTIONAL:  Denies any weight loss, fever, chills, weakness or fatigue.

HEENT:

Head: Denies head injury, dizziness, syncope, vertigo, or severe headaches.

Eyes:  Denies any difficulty, eye pain, inflammation, lesions, visual loss, blurred vision, double vision or yellow sclera, glaucoma, cataracts, no corrective lenses.

Ears: Denies hearing loss, earaches, discharge, tinnitus or vertigo NR 509 4.1. – NJL, 22, M, African American

Nose:  Denies epistaxis discharge, sinus pain, obstruction or allergy.

Throat:  Denies mouth pain, bleeding gums, toothache, lesions in mouth, dysphagia.

CARDIOVASCULAR:  Denies cyanosis, chest pain, pressure or discomfort, palpitations or edema, hypertension, anemia. Denies history of murmur, dyspnea with exertion, or coronary artery disease.

PERIPHERAL VASCULAR: Denies pain, numbness, tingling, coldness, discoloration, varicose vein, infection, ulcers or swelling in legs.

RESPIRATORY:  Denies shortness of breath, wheezing, or chest pain with breathing. Nonsmoker. Denies history of lung disease. (Smoker 1pack/week)

MUSCULOSKELETAL: Denies history of arthritis, gout, joint pain, stiffness, swelling, muscle pain, weakness or limitation of motion.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.  Reports no change in bowel or bladder control.

GASTROINTESTINAL: Denies nausea, vomiting or diarrhea. No abdominal pain or blood. Denies history of ulcers, gallbladder disease, appendicitis or colitis. Bowel movement 1/day, soft, brown no pain or bleeding.

GENITOURINARY:  Denies kidney disease, flank, groin or suprapubic pain. No reports of dysuria, frequency, hesitancy or urgency. Denies change to urine color. Denies pain, lesions , lumps or discharge from penis and scrotum. Monogamous 3- year heterosexual relationship with condoms for contraceptive. No other sexual partners reported. Denies any known contact with partners with STIs. (Dysuria, frequency- 8 times/day)

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.  Reports no change in bowel or bladder control.

MUSCULOSKELETAL: Denies history of bone trauma, joint pain, deformity, gout or arthritis.

HEMATOLOGIC:  Reports no history of intravenous drug use, blood transfusions, anemia, bleeding or irregular bruising. NR 509 4.1. – NJL, 22, M, African American.

LYMPHATICS:   No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies polyuria or polydipsia

 

O.

Physical exam
:

Height 177.8 cm (6’0), Weight 77.27 kg (170 lbs.). BMI: 23.1

NJL is a 22-year-old African American male of appropriate weight, who is not currently under the influence of drugs or alcohol who articulates clearly, ambulates without difficulty and appears to be in no distress.

HEENT

HEAD: Normocephalic, symmetrical face no weakness or involuntary movements. No tempromaxillary joint tenderness noted upon palpation.

EYES:  PERRLA. EOM intact, no ptosis, discharge or crusting.  Conjunctivae clear, sclerae white; no lesion or redness. Pupils 3mm brisk reaction.

EARS: No mass, lesions, discharge or tenderness to palpation. Clear canals. Tympanic membrane boggy clear fluid noted, landmarks intact, no perforation NR 509 4.1. – NJL, 22, M, African American.

NOSE: No deformities or tenderness to palpation, mucosa pink, septum midline.

THROAT:  Mucosa and gingivae pink, no lesions. Tongue symmetric and midline. Tonsils present

NECK: Supple with full ROM, no masses, tenderness, lymphadenopathy, no jugular veins distention or carotid bruits.

RESPIRATORY:  All lungs fields clear to auscultation. No wheezing. Chest expansion symmetrical. Tactile fremitus equal bilaterally.

CARDIOVASCULAR:  no abnormal pulsations, no heaves, Apical impulse at 5
th
ICS in left MCL, S1-S2 present, no murmur auscultated

PERIPHEAL: Color appropriate for racial background; No redness, cyanosis, edema, varicosities, or calf tenderness.  Radial, Posterior tibial, Dorsalis pedis pulses palpable 2+ and equal bilaterally.

MUSCULOSKELETAL:  Temporomandibular joint-no slipping or crepitation. Neck- Full range of motion, no pain. Vertebral column- No tenderness, curvature or deformity: full extension, lateral bending and rotation. Arms and legs symmetric bilaterally with full range of motion, no pain or crepitation. Able to maintain flexion against resistance and without tenderness.  Upon inspection of muscles throughout body no atrophy noted. Homologous muscles equal bilaterally in size, strength and tone.

NEUROLOGIC: Appearance behavior speech appropriate. Alert and oriented to person, place, time, with coherent thoughts.  Cranial nerves I-XII intact. Reflexes intact 2+ bilaterally.

GASTROINTESTINAL: Flat, symmetric, bowel sounds present in all four quadrants. No tenderness upon palpation. No masses or organomegaly noted. (Suprapubic tenderness upon palpation)

GENITOURINARY:  Penis-  Circumcised, skin intact without inflammation, lesions or nodules. No phimosis or paraphimos. Urethral meatus centrally located. Pubic hair distribution appropriate without lice or nits. Meatus edge open, pink, smooth and without discharge. No tenderness, nodules or induration palpated on penis shaft. No scrotal edema or inflammation present, slight asymmetry noted-left testicle lower than right testicle. Testes oval, firm, smooth, equal bilaterally and slightly tender to moderate pressure. Smooth nontender spermatic cord. No hernia, tumor, or varicocele present. No hernia or bulge present upon palpation of left and right inguinal canals or while patient is standing or straining down on. Inguinal lymph nodes soft, discrete and movable. Urine pale yellow, pH 7.0, SGravity 1.020, negative protein, glucose, WBCs, RBCs.  (Cloudy yellow urine, pyuria, bacteriuria, slight tenderness upon palpation of inguinal lymph nodes and suprapubic area)

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.  Reports no change in bowel or bladder control.

MUSCULOSKELETAL: Denies history of bone trauma, joint pain, deformity, gout or arthritis.

HEMATOLOGIC:  Reports no history of intravenous drug use, blood transfusions, anemia, bleeding or irregular bruising. NR 509 4.1. – NJL, 22, M, African American.

LYMPHATICS:   No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

 

 

According to Domino & Baldor (2016), urinary tract infections or Cystitis is an infection of the lower urinary tract usually resulting from gram negative enteric bacteria and is characterized urinary frequency, urgency, dysuria, low back pain, hematuria, flank pain, urine dribbling, nausea and vomiting and suprapubic discomfort. General treatment includes hydration, and pain medication/ analgesics as needed.  Occhipinti, Germano, & Maffei (2016) found that a dose of Oximacro, 112 mg BID x 7 days, which contains 36 mg A type cranberry proanthocyanidins was effective in preventing UTIS.  In uncomplicated cystitis a fluoroquinolone or sulfa drug may be used for 7 days while in complicated cystitis a 2-week antibiotic selected from culture and sensitivity results is recommended (Domino& Baldor, 2016).

 

 

Domino, F. J., & Baldor, R. A. (2016).
The 5-minute clinical consult 2017
(25th ed.).

Philadelphia, Pa.: Wolters Kluwer Health/Lippincott Williams & Wilkins

Jarvis, C. (2016).
Physical examination & health assessment
(7th ed.). Retrieved from

http://bookshelf.vitalsource.com
.

Occhipinti, A., Germano, A., & Maffei, M. E. (2016). Prevention of urinary tract infection with   oximacro, A cranberry extract with a high content of a-type proanthocyanidins: A          pre-      clinical double-blind controlled study.
Urology Journal
,
13
(2), 2640-2649. NR 509 4.1. – NJL, 22, M, African American.

NR 509 Wk 3 – SJS 33, F, African American

Patient Information:

S
JS 33, F, African American, Cigna

S.

CC
: “pounding headache”

HPI
:
   Onset: 2 days ago

Location: forehead

Duration: constant

Characteristics:  dulling pain

Aggravating Factors: loud noise and bright lights

Relieving Factors: rest, closing eyes, Tylenol 500 mg

Treatment:  Tylenol 500 mg orally Twice a Day

Current Medications
:
none

Allergies:
 None

PMHx
:  Influenza 09//19/16; TDaP  06/5/15.  Positive Hepatitis B, Varicella and MMR Titers.    Denies any major illnesses or surgery. NR 509 Wk 3 – SJS 33, F, African American.

Soc Hx
:
  Registered Nurse, enjoys shopping, reading and traveling, Married, two children ages 5 & 3, non-smoker, EtoH 2 drinks/week.  Patient runs twice a week

Fam Hx
: SJS is the oldest child of three.  Two brothers no health disorders. Father 61, smoker, Obese, Hypertension, Hyperlipidemia. Mother 59, Hypertension, Hyperlipidemia. Maternal Grandmother 75 (deceased), skin cancer. Maternal Grandfather (deceased) alcoholic, diabetic unknown age of death. Paternal Grandmother 86, no health issues. Paternal Grandfather (deceased) diabetic.

ROS
: (Jarvis, 2016)

CONSTITUTIONAL:  Denies any weight loss, fever, chills, weakness or fatigue.

HEENT:

Head: Denies head injury, dizziness, syncope, vertigo, or severe headaches. (current headache, occurs monthly around menstrual cycle) NR 509 Wk 3 – SJS 33, F, African American.

Eyes:  Denies any difficulty, eye pain, inflammation, lesions, visual loss, blurred vision, double vision or yellow sclera, glaucoma, cataracts, no corrective lenses. (wears glasses)

Ears: Denies hearing loss, earaches, discharge, tinnitus or vertigo

Nose:  Denies epistaxis discharge, sinus pain, obstruction or allergy.

Throat:  Denies mouth pain, bleeding gums, toothache, lesions in mouth, dysphagia.

CARDIOVASCULAR:  Denies cyanosis, chest pain, pressure or discomfort, palpitations or edema, hypertension, anemia. Denies history of murmur, dyspnea with exertion, or coronary artery disease.

PERIPHERAL VASCULAR: Denies pain, numbness, tingling, coldness, discoloration, varicose vein, infection, ulcers or swelling in legs.

RESPIRATORY:  Denies shortness of breath, wheezing, or chest pain with breathing. Nonsmoker. Denies history of lung disease.

MUSCULOSKELETAL: Denies history of arthritis, gout, joint pain, stiffness, swelling, muscle pain, weakness or limitation of motion. NR 509 Wk 3 – SJS 33, F, African American.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.  Reports no change in bowel or bladder control. (Current headache)

O.

Physical exam
:

Height 163 cm (5’3), Weight 68.18 kg (150 lbs.). BMI: 26.6

SJS is a 33-year-old mildly overweight African American female not currently under the influence of drugs or alcohol who articulates clearly, ambulates without difficulty and appears to be in no distress.

HEENT

HEAD: Normocephalic, symmetrical face no weakness or involuntary movements. No tempromaxillary joint tenderness noted upon palpation.

EYES:  PERRLA. EOM intact, no ptosis, discharge or crusting.  Conjunctivae clear, sclerae white; no lesion or redness. Pupils 3mm brisk reaction (Patient states sensitivity to light upon exam)

 

EARS: No mass, lesions, discharge or tenderness to palpation. Clear canals. Tympanic membrane boggy clear fluid noted, landmarks intact, no perforation.

NOSE: No deformities or tenderness to palpation, mucosa pink, septum midline.

THROAT:  Mucosa and gingivae pink, no lesions. Tongue symmetric and midline. Tonsils not present NR 509 Wk 3 – SJS 33, F, African American.

NECK: Supple with full ROM, no masses, tenderness, lymphadenopathy, no jugular veins distention or carotid bruits.

RESPIRATORY:  All lungs fields clear to auscultation. No wheezing. Chest expansion symmetrical. Tactile fremitus equal bilaterally.

CARDIOVASCULAR:  no abnormal pulsations, no heaves, Apical impulse at 5
th
ICS in left MCL, S1-S2 present, no murmur auscultated

EXTREMITIES: Color appropriate for racial background; No redness, cyanosis, edema, varicosities, or calf tenderness.  Radial, Posterior tibial, Dorsalis pedis pulses palpable 2+ and equal bilaterally.

MUSCULOSKELETAL:  Temporomandibular joint-no slipping or crepitation. Neck- Full range of motion, no pain. Vertebral column- No tenderness, curvature or deformity: full extension, lateral bending and rotation. Arms and legs symmetric bilaterally with full range of motion, no pain or crepitation. Able to maintain flexion against resistance and without tenderness.  Upon inspection of muscles throughout body no atrophy noted. Homologous muscles equal bilaterally in size, strength and tone.

NEUROLOGIC: Appearance behavior speech appropriate. Alert and oriented to person, place, time, with coherent thoughts.

Cranial nerve I:  Smell distinction intact

Cranial nerve II: Visual acuity 20/20 in right and left eye. No optic disc atrophy

Cranial nerve III, IV, VI: PERRLA. Extraocular movements intact (Patient states sensitivity to light upon exam) NR 509 Wk 3 – SJS 33, F, African American.

Cranial nerve V:  Jaw strength equal bilaterally, no asymmetry or pain. Equal sensation to light touch bilaterally.

Cranial nerve VII: Facial movements are symmetrical and intact.

Cranial nerve VIII: Normal tone and whisper test positive.

Cranial nerve XI, X: Uvula and soft palate rise in the midline, gag reflex intact, voice smooth.

Cranial nerve XI: Equal size and strength bilaterally against resistance.

Cranial nerve XII: Tongue is midline, no tremors. Speech is clear and distinct,

Cerebellar function intact as tested by RAM, and Finger-to-finger test, finger to nose and heel to shin test. Negative Romberg sign. Positive point location, extinction, two-point discrimination, graphesthesia, stereognoisis of a key and tactile discrimination. Bicep, Triceps, Brachioradialis and quadriceps reflexes intact at 2+ bilaterally. No clonus noted.

 

According to Mitsikostas & Rapoport (2015), migraines are characterized by recurrent, severe attacks of headaches and are often accompanied by other symptoms. Migraines affect approximately 12 % of the general population and affects women three time more than men (Mitsikostas & Rapoport, 2015). General prevention includes lifestyle modifications, stress management, healthy diet, exercise, avoiding precipitants, biofeedback and prophylactic medication for frequent severe attacks (Domino& Baldor, 2016). NR 509 Wk 3 – SJS 33, F, African American.

Domino, F. J., & Baldor, R. A. (2016).
The 5-minute clinical consult 2017
(25th ed.).

Philadelphia, Pa.: Wolters Kluwer Health/Lippincott Williams & Wilkins

Jarvis, C. (2016).
Physical examination & health assessment
(7th ed.). Retrieved from

http://bookshelf.vitalsource.com
.

Mitsikostas, D. D., & Rapoport, A. M. (2015). New players in the preventive treatment of

migraine.
BMC Medicine
,
13
279. doi:10.1186/s12916-015-0522-1 NR 509 Wk 3 – SJS 33, F, African American.

APEA Ortho
.

Question:

A tool for assessing risk factors for osteoporotic fractures is the:

 

DEXA.FRAX.  CorrectBRCA1.HAARM.  Incorrect

 

Explanation:

The FRAX calculator generates fracture risk based on age, body mass index, parental fracture history, use of glucocorticoids, presence of rheumatoid arthritis or secondary osteoporosis, and tobacco and alcohol use. It has been validated for black, Hispanic, and Asian women in the USA and has calculators that are country and continent specific. Duel energy x-ray absorptiometry, DEXA, is the optimal standard for measuring bone density. APEA Ortho. BRAC1 is a gene that can mutate and increase the risk of breast cancer. HAARM is the melanoma risk model.

Question:

Anserine bursitis arises from:

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excessive running.  Correctexcessive kneeling.  Incorrectarthritis.trauma

 

Explanation:

Anserine bursitis arises from excessive running, valgus knee deformity, fibromyalgias, and osteoarthritis. Prepatellar bursitis (“housemaid’s knee”) arises from excessive kneeling. A popliteal or “baker’s” cyst arises from distention of the gastrocnemius semimembranous bursa from underlying arthritis or trauma. APEA Ortho.

Question:

When examining the knee, which of the following symptoms could be indicative of a positive Adduction (Varus) Stress Test?

 

Pain in the lateral joint line  CorrectPain in the medial joint line  IncorrectPain in the anterior joint lineA click along the medial joint line.

 

Explanation:

The Adduction (or Varus) Stress Test is a maneuver that evaluates the function of the lateral collateral ligament. To perform this test, the knee is held in 30 degrees of flexion. With one hand on the medial side of the knee and one hand on the ankle, an adduction force is gently applied. If pain is noted in the lateral joint line, this could be indicative of a lateral collateral ligament tear. When tenderness extends more to the proximal or distal joint line, the collateral ligament may be the cause of pain instead of the meniscus APEA Ortho.

Question:

When assessing the knee, the examiner instructs the patient to straighten his knee. This motion would assess knee:

 

flexion.extension.  Correctinternal rotation.external rotation.

 

Explanation:

Having the patient straighten his leg assesses extension of the knee. The examiner instructs the patient to bend his knee. APEA Ortho. This maneuver assesses knee flexion. Internal rotation of the knee could be elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to swing his leg away from his midline while sitting assesses external rotation of the knee.

Question:

When performing an examination of a tender left finger on an adult, the surrounding tissue reveals warmth, edema, and redness. This finding could be suggestive of:

 

carcinoma.muscular atrophy. synovitis.  Incorrectgouty arthritis.  Correct

 

Explanation:

Redness, warmth, and edema over a tender joint suggest septic or gouty arthritis infection, or possibly rheumatoid arthritis.

Question:

An example of a fibrous joint would be the:

 

vertebral bodies of the spine.skull.   Correctshoulder.  Incorrectpubic symphysis of the pelvis.

 

Explanation:

The skull is an example of the fibrous joint. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints APEA Ortho.

Question:

To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the:

 

lateral joint line of the knee.on either side of the patella.upper edge of the tibial plateau.  Correcttop of the patella.

 

Explanation:

To palpate the medial meniscus, slightly internally rotate the tibia and palpate the medial soft tissue along the upper edge of the tibial plateau. The lateral meniscus is palpated on the lateral joint line by placing the patient’s knee in slight flexion. To palpate the tibiofemoral joint, face the patient’s knee and place the thumbs in the soft-tissue depressions on either side of the patellar tendon.

Question:

A patient complains of a sharp burning pain in the neck and right arm with associated paresthesias and weakness. These symptoms may be associated with:

 

mechanical neck pain.mechanical neck pain with whiplash.cervical radiculopathy.  Correctcervical myelopathy.

 

Explanation:

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. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm and stiffness and tightness in the upper back and shoulder, lasting up to 6 weeks. 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. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities.

Question:

A patient complains of lateral hip pain while pointing near the trochanter. This type of pain could be suggestive of:

 

sciatica.  Incorrectradicular pain.polyarticular arthritis.bursitis.  Correct

 

Explanation:

Lateral hip pain near the greater trochanter suggests trochanteric bursitis. Sciatica symptoms usually include a shooting pain below the knee, commonly in the lateral leg or posterior calf and accompanied by low back pain. Radicular pain refers to pain that radiates along the dermatome of a nerve due to inflammation or irritation of a nerve root, as with sciatica pain. Polyarticular arthritis refers to arthritis involving several joints.

Question:

The muscle of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is known as the:

 

infraspinatus muscle.  Correctpectoralis major. subscapularis muscle.  Incorrectsupraspinatus muscle.

 

Explanation:

One of the muscles of the scapulohumeral group that crosses the glenohumeral joint posteriorly and inserts on the greater tubercle is the infraspinatus muscle. The other one is the teres minor muscle. The pectoralis major muscle is situated on the anterior chest. The muscle that runs above the glenohumeral joint and inserts on the greater tubercle is known as the supraspinatus. The subscapularis muscle originates on the anterior surface of the scapula and crosses the joint anteriorly and inserts on the lesser tubercle.

Question:

Inspection of the hip begins with careful observation of a patient’s gait. A patient’s foot moves forward without bearing weight. This is known as the: APEA Ortho.

 

swing phase of gait.  Correctstance phase of gait.push off phase of gait.heel strike phase of gait.

 

Explanation:

Inspection of the hip begins with careful observation of a patient’s gait. There are 2 phases of gait: stance and swing. The swing phase occurs when the foot moves forward and does not bear weight. The stance phase occurs when the foot is on the ground bearing weight.

Question:

The axioscapular group of muscles:

 

pulls the shoulder backward.  Correctrotates the shoulder laterally.produce internal rotation of the shoulder.  Incorrectdraws the shoulder blade forward.

 

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.

Question:

When assessing the knee, the examiner instructs the patient to sit and swing his lower leg toward midline. This motion assesses knee:

 

flexion.extension.internal rotation.  Correctexternal rotation.

 

Explanation:

Internal rotation of the knee is elicited by having the patient swing his lower leg toward the midline while sitting. Instructing the patient to bend his knee assesses knee flexion. Having the patient straighten his leg assesses extension of the knee. APEA Ortho. Instructing the patient to swing his leg away from his midline while sitting would be a maneuver to assess external rotation of the knee.

Question:

When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of:

 

adduction.  Incorrectabduction.flexion.  Correctextension.

 

Explanation:

When performing a musculoskeletal examination, the nurse practitioner instructs the patient to move his arm in front of his body. This motion of the shoulder girdle would be an example of flexion. Extension occurs when the patient moves his arm behind himself. Abduction occurs when the patient moves his arm away from the body laterally and overhead. Adduction occurs when the patient moves his arm across his body.

Question:

Static stabilizers of the shoulder are referred to as those structures that are:

 

muscular structures of the shoulder girdle.capable of movement. bony structures of the shoulder girdle.  Correctresponsible for stabilizing the humeral head in the glenoid cavity.  Incorrect

 

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.

Question:

To test the thumb for abduction, ask the patient to:

 

move his thumb across his palm and touch the base of the fifth finger.  Incorrectmove his thumb from the base of the fifth finger and then as far away from the palm as possible.touch the thumb to each of the other fingertips. place the fingers and thumbs in the neutral position with the palm up and then move the thumb anteriorly away from the palm.  Correct

 

Explanation:

Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. To test the thumb for flexion, ask the patient to move his thumb to touch the base of the fifth finger. To test extension, ask the patient to move his thumb from the base of the fifth finger, across the palm, and then as far away from the palm as possible. APEA Ortho. Touching the thumb to each of the other fingers tests opposition. Moving the thumb back to its neutral position assesses adduction.

Question:

Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the:

 

medial meniscus.lateral meniscus.  Correctlateral collateral ligament (LCL).  Incorrectposterior cruciate ligament (PCL).

 

Explanation:

Passive flexion, valgus stress, and internal rotation of the lower leg, evaluates the lateral meniscus.

Question:

The nurse practitioner instructs the patient to lie supine, bend his knee, and turn his lower leg and foot away from the midline. This maneuver would assess hip:

 

abductionextension.external rotation.  Incorrectinternal rotation.  Correct

 

Explanation:

To assess for hip internal rotation, the patient would lie supine, bend his knee, and turn his lower leg and foot away from the midline. To assess hip abduction, the patient would lie supine and move his lower leg away from the midline. To assess hip extension, the patient would lie face up, bend his knees, place feet flat on the table, and lift his buttocks off the table. To assess for external rotation of the hip, the patient would lie supine, bend his knee, and turn the lower leg and foot toward the midline. APEA Ortho.

Question:

Children with Legg-Calve Perthes disease should:

 

maintain a diet high in protein, vitamins and minerals.sleep on a firm mattress to prevent contractures.   Incorrectavoid weight bearing on the affected extremity.  Correctbe allowed to play basketball.

 

Explanation:

Legg–Calvé–Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of bone mass and a weakening of the femoral head. APEA Ortho. The bone loss leads to some degree of collapse and deformity of the femoral head and sometimes secondary changes to the shape of the hip socket. The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity so that the risk of developing a severe degenerative arthritis as an adult can be reduced. Diet and sleeping on a firm mattress do not alter the course of the disease. However, avoiding high impact sports such as basketball during treatment is essential since increased weight on the hip will cause further damage.

Question:

The convex medial end of the clavicle that articulates with the concave hollow in the upper sternum is referred to as the:

 

glenohumeral joint.sternoclavicular joint.  Correctacromioclavicular joint.manubrium joint.  Incorrect

 

Explanation:

The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. 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. There is no manubrium joint; it is the broad upper part of the sternum.

Question:

When assessing a patient with complaints consistent with carpal tunnel syndrome, which one of the following symptoms is unlikely?

 

Dropping objectsInability to twist lids off jarsTingling of the first three digits of the handNumbness of the last two digits of the hand  Correct

 

Explanation:

For complaints of dropping objects, inability to twist lids off jars, aching at the wrist or even the forearm, and numbness of the first three digits, consider carpal tunnel syndrome.

Question:

When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in the palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as:

 

de Quervain’s test.Finkelstein’s test.  CorrectTinel’s test.Phalen’s test.

 

Explanation:

When evaluating a patient who complains of thumb pain, the nurse practitioner would test thumb movement by instructing the patient to place his thumb in his palm and then move the wrist toward the midline in ulnar deviation. This maneuver is commonly known as Finkelstein’s test. Tinel’s test assesses for median nerve compression. The examiner would tap lightly over the median nerve of the carpal tunnel. To test Phalen’s sign, the patient would hold his wrists in flexion for 60 seconds while pressing the backs of his hands together to form right angles APEA Ortho.

Question:

Olecranon bursitis may be caused by all of the following except:

 

gout.trauma.frozen shoulder.  Correctosteoarthritis.

 

Explanation:

Olecranon bursitis refers to swelling and inflammation of the olecranon bursa and may result from trauma, gout, or arthritis.

Question:

Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except:

 

hallux valgus.metatarsalgia.Achilles tendinitis.  CorrectMorton’s neuroma.  Incorrect

 

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.

Question:

Upon examination of the foot and ankle, the nurse practitioner notes point tenderness over the posterior aspects of the right malleolus. Additionally, the patient is unable to bear weight after 4 steps. This finding is most consistent with:

 

Achilles tendinitis.  Incorrectan ankle fracture.   Correcta ligamentous injury.rheumatoid arthritis.

 

Explanation:

Point tenderness over the posterior aspects of the right malleolus with an inability to bear weight after 4 steps could be consistent with an ankle fracture. Rheumatoid nodules and tenderness may be associated with Achilles tendinitis. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Tenderness on compression of the foot is an early sign of rheumatoid arthritis.

Question:

The small intrinsic muscles are located:

 

at the anterior surface of the vertebrae. on either side of the midline of the vertebrae.  Incorrectbetween the vertebrae.  Correctin front of the cervical vertebrae.

 

Explanation:

The small intrinsic muscles are located between the vertebrae. Prevertebral muscles run in front of the cervical vertebrae, and they contract generally to flex the neck and bow the head. The paravertebral muscles are located on both sides of the vertebrae and extend downward to the entire spine. Muscles that attach to the anterior surface of the vertebrae include the psoas muscles and the muscles of the abdominal wall. APEA Ortho.

Question:

The nurse practitioner instructs the patient look upward at the ceiling. This maneuver assesses cervical:

 

flexion.extension.  Correctrotation.lateral bending.

 

Explanation:

Assessing neck extension occurs by asking the patient to look upward at the ceiling. Bringing the chin to the chest assesses flexion of the cervical spine. Looking over one shoulder and then the other assesses rotation of the neck. Asking the patient to bring his ear to his shoulder assesses lateral bending of the cervical spine.

Question:

Upon examination of the left shoulder, the patient complains of a dull, aching pain when attempting active or passive range of motion and localized tenderness with external rotation. These symptoms could be suggestive of:

 

a complete rotator cuff tear.adhesive capsulitis.  Correctrotator cuff tendinitis.  Incorrectcalcific tendinitis.

 

Explanation:

Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. It progresses to restriction of active and passive range of motion and tenderness with external rotation. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Reports of sharp “catches” of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain.

Question:

The area at the posterior aspect of the spine lateral to the sacroiliac joint is known as the:

 

posterior superior iliac spine.  Correctischial tuberosity.superior ramus of pubis.pubic symphysis.

 

Explanation:

The posterior superior aspect of the spine lateral to the sacroiliac joint is known as the posterior superior iliac spine. The ischial tuberosity is a large swelling posteriorly on the superior ramus of the ischium. It marks the lateral boundary of the pelvic outlet and bares most of the weight when sitting. The superior ramus of pubis are the pubic bones that help form the obturator foramen. The pubic symphysis is a cartilage-like articulation between the pubic bones.

Question:

Which nerve in the arm runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process?

 

Median nerveUlnar nerve  CorrectRadial nerveBrachial plexus

 

Explanation:

The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. APEA Ortho. 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 brachial plexus runs from the spine through the neck, the axilla, and into the arm.

Question:

When examining the knee, the presence of a palpable fluid wave with the returning fluid wave into the suprapatellar pouch is noted. This positive sign for effusion of the knee is known as the:

 

balloon sign.  Correctbulge sign.  Incorrectballoting sign.McMurray’s sign.

 

Explanation:

A positive balloon sign for effusion in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. 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. Balloting of the patella is tested by compressing the suprapatellar pouch and pushing the patella sharply against the femur. If fluid returns to the suprapatellar pouch, then an effusion of the knee is diagnosed. McMurray’s test checks for tears in the medial meniscus.

Question:

Dynamic stabilizers of the shoulder are referred to as those structures that are:

 

incapable of movement.capable of movement.   Correctbony structures of the shoulder girdle.  Incorrectresponsible for joint stability.

 

Explanation:

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. 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.

Question:

A structural channel beneath the palmar surface of the wrist and proximal hand is known as the:

 

median nerve plexus.carpal tunnel.  Correctcarpal sheath.flexor retinaculum.

 

Explanation:

A structural channel beneath the palmar surface of the wrist and proximal hand is known as the carpal tunnel. The carpal sheath covers the tendons. The flexor retinaculum is the transverse ligament that holds the sheath in place. APEA Ortho.

Question:

When describing muscle strength, the term paraplegia means:

 

impaired strength.absence of strength.paralysis of all four extremities.paralysis of the legs.  Correct

 

Explanation:

Paraplegia means paralysis of the legs. Impaired strength is called weakness, or paresis. Absence of strength is called paralysis, or plegia. Quadriplegia means inability to move or paralysis of all four limbs.

Question:

A patient reports sharp “catches” of pain, grating, and weakness in the right shoulder when lifting the arm overhead. These symptoms could be suggestive of:

 

a complete rotator cuff tear.adhesive capsulitis.rotator cuff tendinitis.  Correctcalcific tendinitis.

 

Explanation:

Reports of sharp “catches” of pain, grating, and weakness in the shoulder when lifting the arm overhead are symptoms suggestive of rotator cuff tendinitis or impingement syndrome. With complete rotator cuff tears, active abduction and forward flexion at the glenohumeral joint are severely impaired. A characteristic shrug of the shoulder is noted with a positive arm drop on the affected side. Adhesive capsulitis, or frozen shoulder, refers to fibrosis of the glenohumeral joint capsule resulting in a dull aching pain in the shoulder. APEA Ortho. It progresses to restriction of active and passive range of motion. Calcific tendinitis involves the supraspinatus tendon and is associated with deposition of calcium salts. This results in disabling attacks of shoulder pain severely limiting motions due to the pain.

Question:

The structure that encloses the spinal cord is known as the:

 

articular process.spinous process.articular facets.vertebral foramen.  Correct

 

Explanation:

The vertebral foramen encloses the spinal cord. The structure that projects from the spinal column posteriorly in the midline is referred to as the spinous process. The articular processes are located on each side of the vertebra at the junction of the pedicles and the laminae, also referred to as the articular facets.

Question:

When examining the patient for wrist adduction, the nurse practitioner instructs the patient with his palms down to:

 

point his fingers toward the ceiling. move his fingers toward the midline.   Correctmove his fingers away from the midline.point his fingers toward the floor.   Incorrect

 

Explanation:

Adduction occurs by moving fingers toward the midline. When examining the patient for wrist flexion, the nurse practitioner instructs the patient to position his palms down and to point his fingers toward the floor. Extension occurs with pointing fingers toward the ceiling. Abduction occurs by having the patient bring his fingers away from the midline.

Question:

An example of a cartilaginous joint would be the:

 

vertebral bodies of the spine.  Correctskull. shoulder.knee.

 

Explanation:

Vertebral bodies of the spine and the pubic symphysis of the pelvis are examples of cartilaginous joints. Examples of synovial joints include the shoulder, knee, hip, wrist, distal radioulnar, elbow, and carpals. The skull is an example of the fibrous joint.

Question:

When grading muscle strength, a five would indicate:

 

no muscular contraction detected.barely detectable trace of contraction.active movement of the body part with gravity eliminated.active movement against full resistance without fatigue APEA Ortho.  Correct

 

Explanation:

A grade of five for muscle strength would indicate active movement against full resistance without fatigue. Zero muscular strength would indicate no muscular contraction was noted on exam. A grade of one indicates a barely detectable trace of contraction noted on exam. For active movement of the body part with gravity eliminated, a grade of two would be noted.

Question:

With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a positive test for a:

 

lateral collateral ligament (LCL) tear.medial collateral ligament (MCL) tear.posterior cruciate ligament (PCL) tear.medial meniscal tear.  Correct

 

Explanation:

With the patient in the dorsal decubitus position, have him slowly extend the knee while maintaining the varus stress and external rotation. If a snap on the medial joint line is palpated, this may indicate a medial meniscal tear or a positive McMurray test. The Adduction (Varus) Stress Test evaluates the function of the lateral collateral ligament, while the Abduction (Valgus) Stress Test evaluates the medial collateral ligament APEA Ortho. To test the posterior cruciate ligament, the posterior drawer sign would be assessed.

Question:

When examining the elbow for range of motion, the nurse practitioner instructs the patient to bend his elbow. This motion is an example of:

 

extension.flexion.  Correctsupination.pronation.

 

Explanation:

Instructing the patient to bend his elbow is an example of flexion. Extension occurs with straightening the elbow. Turning the palms upward demonstrate supination. Turning the palms downward demonstrates pronation.

Question:

The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses:

 

cervical flexion.cervical extension.rotation.lateral bending.  Correct

 

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.

Question:

The nurse practitioner instructs the patient to move his extended fingers so that each touches its nearest finger. This motion assesses the fingers and thumbs for:

 

adduction.  Correctabduction.flexion.  Incorrectextension.

 

Explanation:

Instructing the patient to make a fist with the left hand and to place his left thumb on top of the distal fingers assesses flexion. Extension occurs when the patient is able to completely move the fingers away from the palm and fingers are most distal from the palm. Asking the patient to move the fingers as far apart from each other as possible demonstrates abduction. The fingers must be kept in the same plane. The ability to move the fingers so that each digit touches the finger next to it assesses adduction. The fingers must be kept in the same plane.

Question:

The nurse practitioner would tap lightly over the median nerve in the carpal tunnel to assess:

 

Finkelstein’s test.Tinel’s test.  CorrectPhalen’s test.  Incorrectthumb abduction.

 

Explanation:

The examiner taps lightly over the median nerve in the carpal tunnel to assess Tinel’s sign. A positive Tinel’s test may indicate carpal tunnel syndrome. Asking the patient to point his thumb upward while the examiner applies downward resistance tests thumb abduction. To test thumb movement, instruct the patient to grasp his thumb against his palm and then move his wrist toward the midline in ulnar deviation. This maneuver is commonly known as Finkelstein’s test. To test Phalen’s sign, the patient would hold his wrists in flexion for 60 seconds while pressing the backs of his hands together to form right angles.

Question:

Which one of the following conditions can plantar fasciitis be associated?

 

Achilles tendinitisAn ankle fracture A ligamentous injuryRheumatoid arthritis  Correct

 

Explanation:

Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. This condition can be seen in prolonged standing or heel-strike exercise and also in rheumatoid arthritis, and gout.

Question:

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.  Correctmechanical low back pain.lumbar spinal stenosis.pseudoclaudication pain.  Incorrect

 

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. APEA Ortho. 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.

Question:

Where the head of the humerus articulates with the shallow glenoid fossa of the scapula is known as the:

 

glenohumeral joint.  Correctsternoclavicular joint.acromioclavicular joint.  Incorrectmanubrium 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.

Question:

Which of the following symptoms would be suggestive of lumbar spinal stenosis?

 

Calf wastingThigh pain after 30 seconds of lumbar extension  CorrectAbsent ankle jerkLoss of normal lumbar lordosis

 

Explanation:

Lumbar spinal stenosis arises from hypertrophic degenerative disease of one or more vertebral facets and thickening of the ligamentum flavum, causing narrowing of the spinal canal. Symptoms include posture flexed forward, lower extremity weakness, hyporeflexia, and thigh pain after 30 seconds of lumbar extension. Calf wasting and absent ankle jerk are typically noted in patients with sciatica or disc disease. Loss of the normal lumbar lordosis is a common cause of low back pain.

Question:

When inspecting the face, asymmetry is noted. This finding could be suggestive of:

 

trigeminal neuralgia.temporomandibular joint dysfunction syndrome.  Correcttemporal arthritis.a normal finding.

 

Explanation:

Facial asymmetry can be seen in temporomandibular joint dysfunction syndrome (TMJ).

On ophthalmoscopic examination, optic atrophy appears:

White

APEA Ortho