Medical Terminology, Exams of Nursing

Download Medical Terminology and more Exams Nursing in PDF only on Docsity! 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 1 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. 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 2 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 5 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? 6 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: 7 pyelonephritis Explanation: Because the kidney lies directly under the costovertebral angle, tenderness over this area would be related to renal issues such as renal stones or pyelonephritis. 25.A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state Explanation: A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. 26.A flat affect can be an identifiable finding in an older adult who has: depression Explanation: Flat affect occurs in depression, Parkinson’s disease, or Alzheimer’s disease. 27.Pain and crepitus over the patella suggests: roughening of the patellar undersurface Explanation: Pain and crepitus over the patella suggests roughening of the patellar undersurface that articulates with the femur. Tenderness over the patellar tendon or inability to extend the knee suggests a partial or complete tear of the patellar tendon. A degenerative patella produces pain with compression and patellar movement during quadriceps contraction. Swelling above and adjacent to the patella suggest synovial thickening or effusion of the knee joint. 28.A child with a heart murmur audible at the lower left sternal border would be suggestive of: ventricular septal defect Explanation: This type murmur is not considered a normal finding in children. The murmur 10 associated with a ventricular septal defect is audible at the lower left sternal border. A child with a heart murmur located at the midsternum or upper right sternal border and associated with a click could be suggestive of aortic valve stenosis. A murmur located at the upper left sternal border with a prominent ejection click in early systole could be suggestive of pulmonary valve stenosis. 29.In order to visualize the opening of Stensen's duct, examine the: 11 buccal mucosa opposite the second molar Explanation: The largest salivary gland is the parotid gland and it lies within the cheeks in front of the ear extending from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to an opening on the buccal mucosa opposite the second molar. If blood comes out through Stensen's duct when it is palpated, this could suggest parotid cancer. If pus is expelled, it suggests suppurative parotitis. With mumps, the orifice of the Stensen duct appears erythematous and enlarged. The submandibular gland is the size of a walnut. It lies beneath the mandible at the angle of the jaw. Wharton's duct runs up and forward to the floor of the mouth and opens at either side of the frenulum. The smallest, the almond-shaped sublingual gland, lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue. 30.Hyperalgesia refers to: increased sensitivity to pain Explanation: Analgesia refers to absence of pain sensation; hypalgesia to decreased sensitivity to pain; hyperalgesia to increased sensitivity; and anesthesia to absence of touch sensation. 31.The part of the brain that maintains homeostasis is the: hypothalamus Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. 32.A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: obtain cognitive and functional assessment Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical 12 epispadias Explanation: With inspection of the male infant's penis, the urethral orifice appears on the dorsal surface of the glans. This finding is consistent with epispadias. A chordee refers to the fixed downward bowing of the penis. With inspection of the male infant's penis, the urethral orifice appears on the ventral surface of the glans. This finding is consistent with hypospadias. Cryptorchidism is a term used to describe undescended testicles in a male. 38.The nurse practitioner should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on which of the following statement: 15 A majority of children go into remission and remain symptom free when treatment is completed Explanation: The majority of children diagnosed with the most common form of leukemia, acute lymphoblastic leukemia, go into remission and remain symptom free when treatment is complete and will have an 85% disease free survival rate. With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. The research statement is true, but it does not address the parent's concern. About 95% of children achieve remission within the first month of chemotherapy. 39.To assess for strabismus in a child, use the: cover-uncover test Explanation: The cover-uncover test assesses coordination of eye muscle movement when one eye is covered. It is always assessed bilaterally. Strabismus is identified when the covered eye is found to deviate from its forward focus. Snellen eye chart assesses visual acuity; ophthalmoscope is used to visually assess the fundus of the eye. Pupillary reaction tests the ability of the eyes to react to light and accommodate. 40.While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? Cranial Nerve V (CN V) Explanation: Touching the cornea and assessing for a reflex assesses cranial nerve V. (sensory) 41.When examining the foot of a patient, the nurse practitioner notes tenderness of the posterior medial malleolus. This could be suggestive of: tibial tendinitis Explanation: Tenderness along the posterior medial malleolus suggests posterior tibial tendinitis. Bone spurs may be present on the calcaneus as bony projections and may cause numbness, tenderness, or pain. Localized tenderness on examination of the ankle joint could be suggestive of arthritis, infection of the ankle, or ligamentous injury. Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis. 16 42.Upon examination of the vagina, the entire anterior vaginal wall, together with the bladder and urethra create a bulge. This condition is most consistent with a: 17 Conjunctivitis is diagnosed by observation of a discharge from the eyes and erythema of the conjunctiva. Amblyopia is diagnosed by visual assessment and testing by an optometrist or ophthalmologist. 47.If fetal movement cannot be perceived after 24 weeks gestation, all of the following may be considered except: normal finding Explanation: If fetal movement cannot be perceived after 24 weeks, consider error in calculating gestational age, fetal death or severe morbidity, or false pregnancy. Confirm fetal health and gestational age with an ultrasound. 48.To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and: palpate upward to just lateral to the pubic tubercles Explanation: To palpate an indirect inguinal hernia in a woman, have her stand and palpate in the labia majora and upward to just lateral to the pubic tubercles. 49.Bilateral exophthalmos suggests: Grave's disease Explanation: Exophthalmos is an abnormal protrusion of the eye. When it presents bilaterally, it is suggestive of Grave's disease, a form of hyperthyroidism. Unilateral exophthalmos may be due to Grave's disease or to a tumor or inflammation of the orbit. Hashimoto's thyroiditis, hypothyroidism, and goiter do not present with exophthalmos. 50.If regular uterine contractions occur prior to 37 weeks gestation, this could be: preterm labor Explanation: Before 37 weeks, regular uterine contractions with or without pain and bleeding are abnormal, suggesting preterm labor. 51.A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write is termed: global aphasia Explanation: 20 With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word- finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With Wernicke's aphasia, speech is fluent, often rapid, 21 voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. 52.When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion of the knee is known as the: bulge sign Explanation: When examining the knee, a fluid wave on the medial side between the patella and the femur is noted. This positive sign for effusion is known as the bulge sign. A positive balloon sign in the knee is the presence of a palpable fluid wave with a returning fluid wave into suprapatellar pouch. Balloting the patella occurs by compressing the suprapatellar pouch and pushing the patella sharply against the femur, causing fluid to return to the suprapatellar pouch. McMurray's test checks for tears in the medial menis 53.Which nerve runs from the spine through the neck, the axilla, and into the arm? Brachial plexus Explanation: The brachial plexus is a network of nerve fibers that runs from the spine through the neck, the axilla, and into the arm. This network of nerves passes through the cervico-axillary canal to reach the axilla and innervates brachium (upper arm), antebrachium (forearm), and hand. The radial nerve originates in the axilla and travels down the arm in a shallow depression (radial groove) on the surface of the humerus. The median nerve is located on the ventral forearm and is just medial to the brachial artery in the antecubital fossa. The ulnar nerve runs posteriorly in the ulnar groove between the medial epicondyle and the olecranon process. 54.When upper motor neuron systems are damaged below the crossover of its tracts in the medulla, motor impairment develops on the same side. This term is: ipsilateral Explanation: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is contralateral. In damage below the crossover, motor impairment would occur on 22 The top of the uterus (fundus) is palpated to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or buttocks (Breech) of the fetus is in the fundus, then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie. If the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back , then the head is extended and the fetus is in face presentation. 61.Which of the following substances is found in the urine of a child suspected of having post streptococcal glomerulonephritis? 25 Blood and protein Explanation: With post streptococcal (strep) glomerulonephritis, a child may have a history of a recent strep infection (pharyngitis or impetigo). Proteinuria is secondary to altered glomerular structure and functioning. Gross hematuria causes the urine to be tea- colored. Bacteria, white blood cells and mucus can be seen with urinary tract infections. Glucose and ketones present in the urine may be associated with diabetes. 62.When describing muscle strength, the term quadriplegia means: inability to move all four extremities Explanation: Quadriplegia means inability to move or paralysis of all four limbs. Hemiparesis refers to weakness of one half of the body. Impaired strength is called weakness, or paresis. Absence of strength is called paralysis, or plegia. 63.Which of the following screening tests for hearing loss can detect both sensorineural and conductive hearing loss? Weber Test Explanation: The Weber hearing screening test can detect unilateral conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss). 64.A female patient presents with a gray, thin, malodorous (fishy) vaginal discharge. These symptoms are most consistent with: bacterial vaginosis Explanation: The discharge associated with bacterial vaginosis can be gray or white, thin, malodorous, and not usually profuse. The odor is usually fishy. Trichomonas vaginalis causes trichomonal vaginitis. Presenting symptoms include a profuse, yellowish, green vaginal discharge that is malodorous. Candidal vaginitis produces a white and curd-like thin discharge that is rarely malodorous. The discharge associated with gonorrhea is usually thick and bloody. 26 65.The classic signs of a basilar skull fracture include hemotympanum and: CSF leak from nose and ears Explanation: Signs of a basilar skull fracture are battle's sign, raccoon eyes, rhinorrhea, otorrhea and hemotympanum (blood in the tympanic cavity). Intracranial hematoma is associated with a general skull fracture. Pain in the occipital region is associated with occipital fracture. Bilateral retinal hemorrhages are associated with shaken baby syndrome. 66.Respiratory effort in the neonate is initiated at birth as a result of: 27 border, and is typically both systolic and diastolic, though only the systolic component may be audible. 71.Part of the nutritional assessment includes anthropometric measurements. These measurements include all of the following except: height and weight: blood pressure, pulse, and respiration: mass index (BMI): basal metabolic rate (BMR). Explanation: Anthropometric measurements are a set of noninvasive, quantitative techniques for determining an individual's body fat composition by measuring, recording, and analyzing specific dimensions of the body: height, weight, BMI, BMR, distribution of body fat, and skin fold thickness. Vital signs are considered physiologic measurements. 72.Cognitive and language development between twelve years and adulthood, follows which one of Piaget's stages of development? Formal operational stage Explanation: Cognitive and language development between twelve years and adulthood, follows the formal operational stage of Piaget's stages of development. 73.If a newborn develops a cephalohematoma, the newborn is at an increased risk for: jaundice Explanation: Cephalohematomas are characterized by bleeding between the bone and the periosteum. Because of breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. They do not increase the risk for infections. Caput succedaneum is an edematous area on the head from pressure against the cervix. Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas. 74.A 40 year old male complains of right flank pain. His temperature is 102° F. These symptoms may be characteristic of: acute pyelonephritis Explanation: Kidney pain in the flank area and groin that is accompanied by fever and chills is consistent with acute pyelonephritis. Renal or ureteral colic usually presents with a 30 sudden onset of pain in the flank area, abdomen, or groin. Chills and fever do not generally accompany urinary calculi. In men, painful urination without frequency or urgency suggests urethritis. Acute prostatitis presents with frequency, urgency, and dysuria. 75.When examining a patient with atopic dermatitis, there is a thickening and roughening of the skin with increased visibility of the normal skin furrows. This condition is termed: lichenification Explanation: 31 Lichenification is defined as the thickening and roughening of the skin with increased visibility of the normal skin furrows (numerous grooves of variable depth on the surface of the epidermis). Atrophy is thinning of the skin with loss of normal skin furrows. Excoriation of the skin is an abrasion or scratch mark. The burrow of a scabies lesion includes small papules, pustules, lichenified areas and excoriations. 76.When eliciting deep tendon reflexes in the biceps, the nurse practitioner notes an abnormal reflex in the right biceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. 77.A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is: A tremor Explanation: A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. 78.The nurse practitioner instructs the patient to move his ear to his shoulder. This maneuver assesses: lateral bending Explanation: Looking over one shoulder and then the other would be assessing rotation of the neck and having the patient bring his ear to his shoulder would be assessing lateral bending of the neck. Assessing neck extension would be having the patient look upward at the ceiling. Bringing the chin to the chest would be assessing flexion of 32 proteinuria or end-organ damage. Primary hypertension, formerly known as essential hypertension, is a disorder which is associated with elevated blood pressure and an unidentifiable cause. 83.The lateral collateral ligament of the knee: connects the lateral femoral epicondyle and the head of the fibula Explanation: The lateral collateral ligament (LCL) connects the lateral femoral epicondyle and the head of the fibula. The anterior cruciate ligament (ACL) crosses obliquely from the anterior medial tibia to the lateral femoral condyle, preventing the tibia from sliding forward on the femur. The posterior cruciate ligament (PCL) crosses from the posterior tibia and lateral meniscus to the medial 35 femoral condyle, preventing the tibia from slipping backward on the femur. The medial and lateral menisci are fibrocartilaginous discs that cushion the action of the femur on the tibia. 84.Which of the following procedures should NOT be performed in a comatose patient? Dilate the pupils Explanation: When assessing a comatose patient, the nurse practitioner should not dilate the eyes because pupillary reaction is the single most important clue to the underlying cause of the coma: structural or metabolic. The other procedures can be performed on a comatose patient. 85.Where the head of the humerus articulates with the shallow glenoid fossa of the scapula is known as the: glenohumeral joint Explanation: The glenohumeral joint is where the head of the humerus articulates with the shallow glenoid fossa of the scapula. This joint is deeply situated and not normally palpable. The acromioclavicular joint lies at the lateral end of the clavicle and articulates with the acromion process of the scapula. The convex medial end of the clavicle articulates with the concave hollow in the upper sternum to form the sternoclavicular joint. There is no manubrium joint; it is the broad upper part of the sternum. 86.The axioscapular group of muscles: pulls the shoulder backward Explanation: The axioscapular group pulls the shoulder backward and rotates the scapula. The scapulohumeral group of muscles rotates the shoulder laterally, including the rotator cuff, and depresses and rotates the head of the humerus. The axiohumeral group produces internal rotation of the shoulder. The serratus anterior draws the shoulder blade forward. 87.The ankle is a hinge formed by the tibia, fibula, and the: talus Explanation: The ankle is a hinge formed by the tibia, fibula, and the talus. The tibia and fibula act as a mortise, stabilizing the joint while bracing the talus like an 36 inverted cup. 88.The maxillary sinuses: surround the nasal cavity Explanation: The paranasal sinuses include the maxillary, frontal, ethmoidal, and sphenoidal sinuses. The maxillary sinuses are located around the nasal cavity. The ethmoidal sinuses are between the eyes and the frontal sinuses are located above the eyes. The sphenoidal sinuses lie just behind the ethmoidal sinuses. 89.The dorsiflexors muscles in the foot include the: 37 femoral vein Explanation: The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of the deep venous system below the inguinal ligament. 95.When discussing the musculoskeletal system, all of the following statements related to articular structure disease are true except which one? Articular disease is usually due to stiffness or pain Explanation: Articular disease typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion due either to stiffness or to pain. Extra-articular disease typically involves selected regions of the joint and types of movement. 96.Signs and symptoms associated with diabetic gastroparesis may include all of the following except: vomiting of undigested food: weight loss: diarrhea: erratic glucose levels. Explanation: Diabetic gastroparesis occurs as a result of damage to the vagus nerve (controls the movement of food through the digestive system). Signs and symptoms associated with diabetic gastroparesis may include vomiting of undigested food, weight loss, erratic glucose levels, and gastroesophageal reflux. Diarrhea is not associated with diabetic gastroparesis or vagus nerve disorders since the vagus nerve innervates the stomach. 97.The portion of the umbilicus in a newborn that is covered with a firm gelatinous substance and dries up within two weeks of birth is known as: the umbilicus amniotic Explanation: The umbilicus amniotic refers to the amniotic portion of the umbilical cord which is covered with a firm gelatinous substance. This portion dries up and falls out within two weeks of birth. The portion of the umbilicus in a newborn that is covered with skin and retracts to become flush with the abdominal wall, is known as the umbilicus cutis. An umbilical hernia in infants is a defect in the abdominal wall which can measure up to six centimeters. An umbilical granuloma reflects 40 granulation tissue at the base of the navel formed during the healing process. 98.A patient was recently diagnosed with gluten intolerance and needs instructions on what foods to eat. The patient should be told that a gluten restricted diet includes: corn Explanation: A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye). Corn and rice, and soybean products are allowed but processed foods are not. 41 99.When percussing a protuberant abdomen, tympany is audible. This is consistent with all of the following conditions except: intestinal obstruction: increased intestinal gas production: a large solid tumor: a paralytic ileus. Explanation: A protuberant abdomen that is tympanic throughout when percussed can suggest intestinal obstruction, increased gas production, or a paralytic ileus. A solid mass gives a dull sound on percussion. 100. The Glasgow coma scale assesses: motor response Explanation: Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glasgow Coma Scale was designed and should be used to assess the depth and duration of coma and impaired consciousness. This scale helps to gauge the impact of a wide variety of conditions such as acute brain injury due to traumatic and/or vascular injuries or infections, metabolic disorders such as hepatic or renal failure, hypoglycemia, or diabetic ketoacidosis. Cranial nerve, auditory, and pupillary responses are not included in the come scale assessment. 101. Women who wear high-heeled shoes with narrow toe boxes are at risk of developing all of the following forefoot abnormalities except: Achilles tendinitis Explanation: Women who wear high-heeled shoes with narrow toe boxes are at risk of developing hallux valgus, metatarsalgia, and Morton's neuroma. Achilles tendinitis more commonly occurs in runners and affects the posterior foot as opposed to the forefoot. 102. One maneuver used to assess coordination is to observe the patient: walking heel-to-toe in a straight line Explanation: To assess coordination, observe the patient’s performance in rapid alternating movements, point- to-point movements, gait and other related body movements, standing in specified ways. Walking heel-to-toe would be an example of observing the patient's gait. Dorsiflexion would be assessing the patient's joint function. Squeezing the examiner's fingers would be one way to assess hand grasp. Counting has nothing 42 involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. 107. To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular movements in an infant, the nurse practitioner would: observe how well the infant tracks the nurse practitioner's face Explanation: To assess the oculomotor, trochlear, and abducens nerves (CN III, IV, & VI) for extraocular 45 movements in an infant, the nurse practitioner would observe how well the infant tracks the nurse practitioner's face. 108. In infants, the palmar grasp reflex ceases after : 4 months Explanation: In infants, the palmar grasp reflex ceases after 4 months. Persistence beyond this time suggests pyramidal tract dysfunction. 109. A patient experienced a neck injury yesterday and presents to the nurse practitioner with aching paracervical pain and stiffness. Other complaints include dizziness, malaise, and fatigue. These findings may be associated with: neck pain with whiplash Explanation: In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder, lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. 110. Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: motor nerve fibers Explanation: The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. 111. At what age should an infant begin to say consonant sounds? Six months 46 Explanation: A six-month-old infant should be able achieve these tasks: look at self in the mirror, respond to his own name, begin to say consonant sounds, begin to pass things from one hand to another, roll over in both directions, know familiar faces, and begin to know if someone is a stranger. 112. Genu varum refers to: bow leggedness Explanation: The term genu valgum refers to knock knees and genu varum refers to bow leggedness. Talipes 47 spinal cord Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. 118. The Weber test uses a tuning fork to test hearing. The frequency range closest to that of conversational speech would be one with a frequency of: 512 Hz Explanation: The Weber hearing test screens for unilateral conductive hearing loss with a tuning fork. The tuning fork is measured in frequencies of 256 Hz or 512 Hz. These frequencies fall within the range of conversational speech. The ideal frequency for the Weber test is 256 Hz. A frequency of 512 Hz is the ideal frequency for the Rinne hearing test. 119. The nurse practitioner holds the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. This maneuver assesses the: placing and stepping reflexes Explanation: The placing or stepping reflex (formerly known as the dancing reflex) is assessed by holding the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine curves toward the stimulus. To elicit the positive support reflex, hold the infant around the trunk, lower the infant until the feet touch a flat surface. Hips, knees, ankles extend and the infant stands up, partially bearing weight. 120. Which of the following findings in a preschooler would indicate the need for further evaluation? Responds to facial expressions and gestures rather than to verbal explanations Explanation: A child who responds to facial expressions and gestures rather than to verbal 50 explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler. 121. Decreased spinal mobility in the lumbar region could be suggestive of: osteoarthritis Explanation: Decreased spinal mobility in the lumbar region could be suggestive of osteoarthritis or ankylosing spondylitis. Dupuytren's contracture affects the hands. Torticollis would present a lateral deviation and rotation of the head. Kyphosis affects the thoracic spine. 51 122. An inward turning of the lower lid margin is called: entropion Explanation: Entropion is more common in the elderly and occurs when the lower lid margin turns inward. When this irritates the conjunctiva and the lower cornea. Ectropion occurs when the lower lid turns outward and exposes the palpebral conjunctiva. Ptosis is a drooping of the upper eyelid. An epicanthal fold is a vertical fold of skin that lies over the medial canthus of the eye. 123. Restrictions of internal and external rotation of the hip are sensitive indicators of: arthritis Explanation: Restrictions of internal and external rotation of the hip are sensitive indicators of arthritis. Lumbar lordosis, scoliosis, and kyphosis do not generally affect internal or external rotation of the hip. 124. The cervical opening or shortening noted during a bimanual examination prior to 37 weeks gestation, may indicate: preterm labor Explanation: The cervical opening or shortening noted during a bimanual examination prior to 37 weeks, may indicate preterm labor. 125. An adolescent visits the nurse practitioner for a sports participation physical. The nurse practitioner instructs the adolescent to stand erect with his arms at his sides. The nurse practitioner stands behind the adolescent and observes his spine and hip. This maneuver assesses for: leg-length discrepancy Explanation: This maneuver assesses for leg-length discrepancy or asymmetry from scoliosis. 126. The part of the peripheral nervous system that controls involuntary actions is known as the: autonomic nervous system Explanation: The autonomic nervous system is part of the peripheral nervous system and generates autonomic reflex responses and consists of the sympathetic and 52 and softer expiratory phase. They are normally heard over the hilar region (center of the lungs near the heart). Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx. 130. A child sustained a "full-thickness" burn injury. This type injury involves tissue destruction down to the: subcutaneous tissue Explanation: A full-thickness burn involves all skin layers, including the epidermis, dermis, and the 55 subcutaneous tissue and fat. Muscles and tendons may be involved. A superficial thickness burn involves the epidermis only. A superficial partial thickness burn involves the epidermis and the dermis. A deep thickness burn involves the entire layer of dermis, and is more severe than a superficial partial thickness burn. 131. 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? Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line Explanation: The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line would be if the child had situs inversus or dextrocardia. 132. After attempting to elicit the Moro reflex in a newborn, the nurse practitioner identifies absence of movement of the left arm. The next assessment would be to: examine the clavicle Explanation: A positive Moro reflex occurs when both arms are extended. If this response is not elicited bilaterally, the nurse practitioner should assess the clavicle. If the clavicle is fractured, the Moro response will be demonstrated on the unaffected side only. Babinski reflex assesses for neurological abnormalities. Gallant reflex is checked while the infant is prone and assesses for trunk incurvation. Ortolani maneuver assesses for congenital hip dysplasia. 133. Raised or flat, deep purple colored lesions noted in the mouth may be suggestive of: Kaposi's sarcoma Explanation: Kaposi's sarcoma (a low-grade vascular tumor associated with human herpes virus 8), is associated with flat or raised deep purple colored lesions of the mouth. Approximately one third of patients with Kaposi’s sarcoma have lesions in the oral cavity. Other sites that could be affected include the gastrointestinal tract and the lungs. Koplik's spots are frequently seen in the early stage of measles (roseola) and appear as small white specks that resemble grains of salt on a red background on the buccal mucosa. Torus palatinus develops as a bony growth in the hard palate and is common in adults. Fordyce spots or granules appear as 56 yellow spots in the buccal mucosa or on the lips. They are considered normal sebaceous glands. 134. 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: xanthelasma Explanation: Slightly raised, yellowish, well-circumscribed plaques appearing along the nasal area of one or both eyelids are consistent with lipid disorders and called xanthelasma. Pinguecula refer to harmless, yellowish, triangular nodules in the bulbar conjunctiva on either side of the iris. A 57 craniosynostosis Explanation: Craniosynostosis is defined as the premature closing of the sutures in young children. When this occurs, a bony ridge can be felt along the suture line. This is not a normal finding since the sutures usually fuse between 12 and 18 months. Hydrocephalus refers to fluid on the brain and would appear as an enlarged head with sutures remaining open. Opisthotonos is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position. This abnormal posturing is an extrapyramidal effect and is caused by spasm of the axial muscles along the spinal column. 140. A decrease in the degree of density in a bone that results in fragile bones is referred to as: osteoporosis Explanation: Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis leads to abnormally porous bone that is compressible, like a sponge. Osteopenia is a condition of bone that makes it slightly less dense than normal bone, but not as severe as in osteoporosis. Osteomyelitis refers to an infection in the bone. Osteoarthritis is a term used to describe degenerative joint disease. 141. Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed: intermittent claudication Explanation: Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud's disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. 142. A patient presents with a fiery red, slightly raised 2 cm lesion on the upper truck that blanches when pressure is applied. The body of the lesion is surrounded by erythema and radiating legs. This is most likely: a spider angioma 60 Explanation: A spider angioma is fiery red, slightly raised and surrounded by erythema and radiating legs that blanch with pressure. These are usually seen in patients with liver disease, pregnancy, vitamin B deficiency, and sometimes patients with no disease. The spider vein is blue. Cherry angiomas are bright or ruby red and increase in size and number as one ages. Petechiae are deep red or reddish purple and are seen when blood is outside the vessels. This suggests a bleeding disorder or injury to the skin. 143. A cartilage-like articulation between the pubic bones is known as the: 61 pubic symphysis Explanation: The pubic symphysis is a cartilage-like articulation between the pubic bones. The anterior superior iliac spine is the area where the iliac crest terminates anteriorly on the ilium. A long curved bone along the uppermost part of the ilium is known as the iliac crest. The superior ramus of pubis are the pubic bones that help form the obturator foramen. 144. Warning signs of peripheral artery disease may include all of the following except: aching or numbness that limits walking: non-healing lesions of the legs: .abdominal pain after meals with weight loss: persistent cough Explanation: Patients with peripheral artery disease (PAD) may not experience any symptoms or may experience a variety of symptoms that indicate ischemia. Some warning signs of peripheral artery disease include: fatigue, aching, numbness, pain that limits walking, or poorly healing lesions on the legs. The nurse practitioner should conduct a thorough assessment and review of symptoms to detect early warning signs and differentiate nonatherosclerotic and nonvascular conditions. PAD is a treatable condition. When recognized early and appropriately managed, complications that can lead to limb loss can be minimized. 145. 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: pericardial friction rub Explanation: Cardiovascular sounds that extend beyond one phase of the cardiac cycle are considered continuous murmurs. Pericardial friction rubs usually produces a scratchy, scraping sound with a high pitch. They are heard best with the diaphragm and are associated with friction from cardiac movement in the pericardial sac. If they are heard in atrial systole and ventricular systole and diastole, then the diagnosis is made. Venous hums are benign sounds resulting from turbulence in the jugular veins. They can produce a humming or roaring sound and are heard best with the bell of the stethoscope during diastole. Venous hums are common in children and may be present in patients who have anemia or hyperthyroidism. The murmur of a patent ductus arteriosus produces a harsh, machine-like sound and is loudest during late systole. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole. 62 quiet and wispy during the inspiratory phase followed by a short, almost silent expiratory phase. These breath sounds are considered: vesicular Explanation: The three normal breath sounds are vesicular, bronchovesicular, and bronchial. Vesicular breath sounds consist of a quiet, wispy inspiratory phase followed by a short, almost silent expiratory phase. They are heard over the periphery of the lung field. Bronchial breath sounds consist of a full inspiratory and expiratory phase with the inspiratory phase usually being louder. They are normally heard over the trachea and larynx. Bronchovesicular breath sounds consist of a full inspiratory phase with a shortened and softer expiratory phase. They are normally heard over the 65 hilar region. Crackles are adventitious sounds heard in the lungs and may be due to abnormalities in the lungs. 151. Fasciculations in atrophic muscles suggest: a lower motor neuron disease Explanation: Fasciculations are small muscle twitches and can be found in any muscle of the body. Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles, this may suggest a lower motor neuron disease. They are not seen in central or peripheral nervous system disease or rheumatoid arthritis. 152. To test the thumb for flexion, ask the patient to: move his thumb across his palm and touch the base of the fifth finger Explanation: 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. Touching the thumb to each of the other fingers tests opposition. Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. Moving the thumb back to its neutral position assesses adduction. 153. When a patient complains of joint pain as progressing from one joint to another, the examiner should consider this pattern of involvement as migratory. This type of involvement would most likely be observed in a patient who has: rheumatic fever Explanation: A migratory pattern would involve migrating pain from joint to joint or steadily spreading from one joint to multiple joints. Examples of this type of joint pain migration is seen in patients who have rheumatic fever or gonococcal arthritis. Gout usually involves one joint and typically affects the first toe. Bursitis is consistent with extra-articular pain that occurs in inflammatory conditions. Osteomyelitis usually presents suddenly with a swollen joint and pain. This is more commonly seen in children. 154. During late adolescence, achievements are marked by: moral thinking 66 Explanation: During the late adolescence, achievements are marked by moral thinking 155. By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as: the straight-leg raise Explanation: 67 Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. 162. The structure that creates a channel for the spinal nerve roots is known as the: intervertebral foramen Explanation: The intervertebral foramen creates a channel for the spinal nerve roots. The vertebral foramen encloses the spinal cord. The transverse foramen creates a channel for the vertebral artery. 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. 163. Retraction of the nipple and areola suggest: an underlying breast mass Explanation: Retraction of the nipple and areola suggest an underlying breast mass. This is not normal and never found in association with cystic breast disease or fibroadenoma. 164. If a patient presents with non-midline lumbar back pain, the nurse practitioner should assess for: muscle strain Explanation: For midline back pain, assess for musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, and, rarely, epidural abscess. Muscle strain, sacroiliitis, trochanteric bursitis, sciatica, and hip arthritis is suggestive of non-midline back pain. Pyelonephritis and renal stones may also be suggestive of non-midline back pain. 165. On examination of the foot, the nurse practitioner notes acute inflammation of the first metatarsophalangeal joint. This finding could be consistent with: gout Explanation: Acute inflammation of the first metatarsophalangeal joint suggests gout. 70 166. When assessing a normal 5-year-old, the last site to assess would be the: throat Explanation: The throat and mouth are considered invasive sites and should be performed last. 167. The palpation technique used to assess respiratory expansion of the chest is placing the hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand medially and grasping a small fold of skin between the thumbs. Then: 71 ask the patient to take a deep breathe and note any delay in expansion during inhalation Explanation: To assess the respiratory expansion of the chest, the examiner places his hands on the eight or tenth ribs posteriorly with the thumbs close to the vertebrae, slides the hand medially and grasps a small fold of skin between the thumbs then asks the patient to take a deep breath. The thumbs should move evenly away from the vertebrae during inspiration and there should be no delay in expansion. 168. When assessing the skin, it is noted to be thickened, taut, and shiny in appearance. This could be associated with: scleroderma Explanation: Scleroderma appears as skin that is thickened, taut, and shiny in appearance. Psoriasis presents as silvery, scaly papules or plaques, mainly on the extensor surfaces of the skin. In patients who have hyperthyroidism, the skin has a velvety appearance and is usually warm to touch. Skin that appears very dry, rough, and cool to touch can be associated with hypothyroidism. 169. The semimembranous bursa of the knee lies: on the posterior and medial surface of the knee Explanation: The large semimembranosus bursa lies on the posterior and medial surfaces of the knee. The prepatellar bursa lies between the patella and the overlying skin. The suprapatellar pouch of the knee lies upward and deep to the quadriceps muscle. The anserine bursa lies 1-2 inches below the knee joint on the medial surface. 170. To test the supraspinatus, anterior and lateral deltoid, and pectoralis major, the nurse practitioner would have the patient perform which shoulder movement. Abduction Explanation: To test the supraspinatus, anterior and lateral deltoid, and pectoralis major, the nurse practitioner would have the patient abduct his arm. 171. The term used to refer to skin that is peeling is: exfoliation Explanation: 72 spondylolisthesis Explanation: The forward slippage of one vertebrae resulting in spinal cord compression is referred to as spondylolisthesis. 75 177. When auscultating breath sounds in a patient who has left sided heart failure, the breath sounds are: vesicular with late inspiratory crackles in the dependent portions of the lungs and resonant on percussion Explanation: A patient with left sided heart failure experiences increased pressure in the pulmonary veins causing congestion and interstitial edema. The breath sounds are vesicular with late inspiratory crackles in the dependent portions of the lungs and are resonant on percussion. Consolidation in the lungs produces bronchial breath sounds with late inspiratory crackles over the involved area and is dull on percussion. A normal lung has vesicular breath sounds without adventitious sounds and is resonant on percussion. Chronic obstructive lung disease produces decreased breath sounds with some audible wheezes and is hyperresonant on percussion. 178. 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? 7 Explanation: APGAR stands for: Activity, Pulse, Grimace, Appearance, and Respiration. It is an objective score of the condition of a baby immediately after birth and is determined by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs receives 0, 1, or 2 points. An Apgar score of 10 means an infant is in the best possible condition. The Apgar score is done routinely 60 seconds after the birth of the infant. A child with a score of 0 to 3 needs immediate resuscitation. The Apgar score is often repeated 5 minutes after birth, and in the event of a difficult resuscitation. The Apgar score may be done again at 10, 15, and 20 minutes. This infant's score is 7: He receives a 1 for respiration, 2 for heart rate, 1 for grimace, 1 for color, and 2 for activity. Scores 7 and greater are generally considered to be normal. 179. A patient complains of severe epigastric pain that radiates to the posterior trunk and entire abdomen. This type of pain can be suggestive of: 76 acute pancreatitis Explanation: Acute pancreatitis is inflammation of the pancreas. The pain is poorly localized in the abdomen, therefore, can be epigastric and may radiate to the posterior trunk. Biliary colic, sudden obstruction of the cystic or common bile ducts by a gallstone is characterized by pain in the epigastric or right upper quadrant and may radiate to the right scapula or shoulder. Pain in the periumbilical area that radiates to the right lower quadrant is usually seen in patients who have appendicitis. Stomach cancer may presents with pain in the patient's epigastric area. 77 back to its neutral position Explanation: Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm and then back to its neutral position assesses adduction. 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. Touching the thumb to each of the other fingers tests opposition. Placing the fingers and thumbs in the neutral position with the palm up and moving the thumb anteriorly away from the palm assesses abduction. 185. A patient complains of an unpleasant abdominal fullness after a light meal. This complaint may be consistent with: diabetic gastroparesis Explanation: Complaints of an unpleasant abdominal fullness after a light or moderate meal, or the inability to eat a full meal is often seen in patients with diabetic gastroparesis, gastric outlet obstruction, gastric cancer, early satiety in hepatitis, or those taking anticholinergic medications. 186. Which technique would be least effective in gaining the cooperation of a toddler during a physical exam? Tell the child that another child the same age was not afraid Explanation: Telling the child that another child the same age was not afraid would not be an effective technique as a toddler is unable to process that concept. The other choices are appropriate techniques. 187. While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a: cranial nerve disorder Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. 80 188. Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation of the head. This condition is suggestive of: torticollis Explanation: Contracture of the sternocleidomastoid muscle could result in lateral deviation and rotation of the head. This condition is suggestive of torticollis. 189. If a patient describes his stool as thin and "pencil-like", this could be associated with: 81 a lesion in the sigmoid colon Explanation: Thin, pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid colon. Constipation produces hard, dry stool. In the presence of hemorrhoids, the stool may appear blood streaked. Crohn's disease may present with blood, mucus, or pus in the stool. 190.When evaluating the six cardinal directions of gaze, a loss of conjugate movements is noted when the patient looks to his left. This finding could be consistent with damage to which cranial nerve? Nerve IV (CN IV) Explanation: To evaluate the extraocular movements in the six cardinal directions of gaze, the examiner should look for loss of conjugate movements in any of the six directions. If there is discongruent gaze, this could be suggestive of damage to cranial nerves CN III, IV, and VI - Oculomotor, Trochlear, and Abducens nerves. 191. With Duchenne muscular dystrophy: include a waddling gait, lordosis and presence of Gower's sign Explanation: Duchenne muscular dystrophy (DMD) is an X-link inherited recessive disorder and is passed from mother to male offspring. DMD is a congenital disorder with symptoms appearing during the 2nd and 3rd year of life. Tremors, hypertonicity and seizures are more consistent with cerebral palsy. Waddling gait, lordosis and Gower's maneuver are signs of DMD. Gower's sign is classic for DMD. The patient has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. 192. o estimate the expected date of delivery (EDD) using Naegele's rule, if the last menses was March 3, 2014, the EDD would be: December 10, 2014 Explanation: The expected date of delivery is 40 weeks from the first date of the LMP. Using Naegele’s rule, the EDD can be estimated by taking the LMP, adding 7 days, subtracting 3 months, and adding 1 year. 193. Adventitious breath sounds, such as crackles, are: popping, frying sounds, may be low or high-pitched and usually heard on 82 Functional impairment Explanation: Functional impairment is a health condition in which the normal function of a part of the body is less than full capacity. One of the defining characteristics of functional impairment is that the reduction in physical or mental capacity is sufficient to interfere with managing day-to-day tasks. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. In the older adult, it is defined as a geriatric syndrome or condition occurring as a temporary state of confusion and may be the first 85 clue to infection or problems with medications. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. A multifactorial geriatric condition or syndrome characterized by an age-related lack of adaptive physiological capacity occurring in the absence of identifiable illness is known as frailty. 199. If urethritis or inflammation of the paraurethral glands is suspected in a female patient, the index finger should be inserted into the vagina and: milk the urethra gently from the inside outward Explanation: If urethritis or inflammation of the paraurethral glands is suspected, the examiner should insert the index finger into the vagina and milk the urethra gently from inside outward. Note any discharge from or about the urethral meatus. If present, it should be cultured. 200. When palpating the carotid pulse, it is important to: position the patient in the lying or sitting positions Explanation: The carotid artery should be palpated gently and while the patient is sitting or lying down. The patient's chin should be elevated to allow easy palpation and yet not enough to tighten the neck muscles. Stimulating its baroreceptors with low palpation can provoke severe bradycardia or cause cardiac arrest in some sensitive persons. Also, carotid arteries should never be palpated at the same time. This may limit blood flow to the head, possibly leading to fainting or cerebral ischemia. A carotid pulse is palpable between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage 201. 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: spermatocele of the epididymis Explanation: A painless, movable cystic mass just above the testicle suggests a spermatocele or an epididymal cyst. Both transilluminate and are difficult to distinguish clinically. An acutely inflamed epididymis is tender and swollen and may be difficult to distinguish from the testicle. Additionally, the scrotum may be reddened and the vas deferens inflamed. 86 Coexisting urinary tract infection, or prostatitis, supports the diagnosis. Varicocele refers to varicose veins of the spermatic cord, usually found on the left. It feels like a soft “bag of worms" upon palpation of the scrotum. Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is retracted upward in the scrotum. The scrotum becomes red and edematous. There is no associated urinary infection. 202. During pregnancy, a patient's fundal height measured 26 centimeters. This would suggest that the gestational age was: 87 the eye especially near the nose. A pinguecula refers to a harmless yellowish triangular nodule noted in the bulbar conjunctiva on either side of the iris. This finding may be seen in aging or in patients who are exposed chronically to dust. 207. When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient: unarousable with eyes closed Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. 208. When performing an examination of the rectal area, a linear tear at the anal opening was observed. This could be indicative of: .an anal fissure Explanation: A linear crack or tear suggests an anal fissure from large, hard stools, inflammatory bowel disease, or sexually transmitted diseases. 209. When examining the prostate gland the examiner should inform the patient that this procedure may: prompt an urge to urinate Explanation: When examining the prostate gland on a male patient, the examiner should inform the patient that this procedure may prompt an urge to urinate but reassure him that he will not void on himself. 210. When administering ear drops to a 6-year-old, the pinna should be pulled: upward and back Explanation: To examine the ears of an infant it is usually necessary to pull the auricle backward and downward. In the older child, the external ear is pulled backward and upward. 90 211. A patient who is being evaluated for frequent headaches, mentions that the headache worsens with coughing, sneezing, or when changing positions. Increasing pain with these maneuvers may be suggestive of: a brain tumor Explanation: If coughing, sneezing, or changing positions increases the pain associated with the headache, sinusitis or a brain tumor may be considered. Migraines may present with symptoms of nausea 91 and vomiting. Brain tumors and subarachnoid hemorrhages can also present with nausea and vomiting. 212. When assessing the knee, the examiner instructs the patient to sit and swing his lower leg away from midline. This motion would assess knee: external rotation Explanation: Instructing the patient to swing his leg away from his midline while sitting assesses external rotation of the knee. Having the patient straighten his leg assesses extension of the knee. The examiner instructs the patient to bend his knee. This maneuver assesses knee flexion. Internal rotation of the knee is elicited by having the patient swing his lower leg toward the midline while sitting. 213. By five years of age, the child is: perform a somersault Explanation: By five years of age, the child is able to perform several of the following tasks: perform a somersault, hop and skip, swing and climb, use the toilet without assistance in cleaning self, and stand on one foot at least 10 seconds. The other choices are consistent with the physical development of a 6 year-old. 214. A condition that involves optic nerve damage and visual field changes is termed: glaucoma Explanation: Glaucoma is a leading cause of blindness in the United States. Glaucoma is a condition that produces optic nerve damage and visual field changes. The risk of glaucoma increases with age but can occur in anyone in any age-group. Retinoblastoma is a rapidly developing tumor and is the most common malignant tumor of the eye in children. A cataract is an opacity of the lens and may be seen through the pupil. Pterygium is a triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea and may interfere with vision but does not cause blindness. 215. Vasculitis on the extremities and an erythematous to salmon-colored rash over the trunk are skin lesions that may be attributed to: rheumatoid arthritis 92 appropriate for sports injuries, but heat application should not be an immediate action. While rest is important after a sprain, early mobility hastens recovery. 219. The vertebral column angles sharply posteriorly and becomes immovable at the: lumbosacral junction Explanation: The vertebral column angles sharply posteriorly and becomes immovable at the lumbosacral junction. The intervertebral discs cushion movement between vertebrae and allow the vertebral 95 column to curve, flex, and bend. The coccyx is the final segment of the vertebral column and serves as an attachment for various tendons, muscles, and ligaments. It also supports weight while sitting. The sacroiliac joint overlays the posterior superior iliac spine. 220. When auscultating heart sounds in a newborn, if a louder than normal pulmonic component (P2) is audible, suspect: pulmonary hypertension Explanation: The aortic (A2), or first component of the second sound at the base, is normally louder than the pulmonic (P2), or second component. A louder than normal pulmonic component, particularly when louder than the aortic sound, suggests pulmonary hypertension. 221. The nurse practitioner places an infant lying supine on the exam table, and turns the head to one side, holding the jaw over the shoulder. The arms and legs on the side to which the head is turned extend, while the opposite arm and leg flex. This maneuver assesses: the asymmetric tonic neck reflex Explanation: The maneuver described assesses the asymmetric tonic neck reflex. Moro or startle reflex assesses arm abduction and extension, open hands, and flexed legs in response to a loud noise. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine should curve toward the stimulus. 222. When performing a rectal exam, a reddish, moist, protruding mass is noted at the anal opening. This finding is most likely a(n): a prolapsed internal hemorrhoid Explanation: Internal hemorrhoids are enlargements of the normal vascular cushions located above the pectinate line. They are not usually visible but may become visible if prolapse occurs after defecation. They would appear in the anal canal as reddish, moist, protruding masses. External hemorrhoids are dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. They present as 96 tender, swollen, bluish, ovoid masses at the anal margin. A tender, purulent, reddened mass palpated in the rectum would be consistent with an anal abscess, especially in the presence of fever and chills. Rectal polyps are typically located in the rectum and ,if palpable, feel soft to touch. 223. A chancre is defined as a: painless ulceration Explanation: A chancre is defined as a painless ulceration formed during the primary stages of syphilis. A group of scattered small vesicles is associated with genital herpes. Papules appearing in many 97