NR 509 Advanced Physical Assessment: Questions and Answers

1. A patient tells the FNP that he is very nervous, that he is nauseated, and that he “feels hot”. This type of data would be:
   • Subjective data. Subjective data is information provided by the patient that cannot be observed directly by the practitioner.
2. The patient’s record, laboratory studies, objective data, and subjective data combine to form the:
   • Database. The database includes all the information collected about a patient.
3. The FNP is reviewing information about evidence-based practice. Which statement best reflects evidence-based practice?
   • Evidence-based practice involves using the best available evidence, clinical expertise, and patient preferences to make clinical decisions.
4. A 59-year-old patient tells the FNP that he has ulcerative colitis. He has been having black stools for the last 24 hours. How would the FNP best document his reason for seeking care?
   • The FNP should document it as “Patient reports black stools for the last 24 hours and has a history of ulcerative colitis.”
5. A 29-year-old woman tells the FNP that she has excruciating pain in her back. Which would be an appropriate response by the FNP to the woman’s statement?
   • “Can you describe the pain and its location? What activities or positions make it better or worse?”
6. In recording the childhood illnesses of a patient who denies having had any, which note by the FNP would be most accurate?
   • “Patient denies childhood illnesses.”
7. If a female patient tells the FNP that she has had six pregnancies, with four live births at term and two spontaneous abortions. Her four children are still living. How would the FNP record this information?
   • Gravida 6, Para 4, Abortions 2, Living children 4 (G6P4A2L4).
8. Which of these statements represents subjective data the FNP obtained from the patient regarding the patient’s skin?
   • “Patient reports itching on the arms and legs.”
9. The FNP is obtaining a history for a 30-year-old male patient and is concerned about health promotion activities. Which of these questions would be appropriate to use to assess health promotion activities for this patient?
   • “What type of exercise do you engage in, and how often?”
10. Which statement indicates that the FNP understands the pain experienced by an elderly person?
    • “Older adults may experience pain differently, and they may not report it because they think it’s a normal part of aging.”
11. The FNP is performing a vision examination. Which of these charts is most widely used for visual examination?
    • The Snellen chart.
12. During a complete health assessment, how would the FNP test the patient’s hearing?
    • Perform a whisper test or use an audiometer.
13. The FNP has just completed an examination of a patient’s extra-ocular muscles. When documenting the findings, the FNP should document the assessment of which cranial nerves?
    • Cranial nerves III (Oculomotor), IV (Trochlear), and VI (Abducens).
14. A patient’s uvula rises midline when she says “ahh” and she has a positive gag reflex. The FNP has just tested which cranial nerve?
    • Cranial nerve IX (Glossopharyngeal) and X (Vagus).
15. During an examination, the FNP notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with the successful performance of this action?
    • Cranial nerve XII (Hypoglossal).
16. A patient is unable to shrug her shoulders against the FNP‘s resistant hands. What cranial nerve is involved with successful shoulder shrugging?
    • Cranial nerve XI (Accessory).
17. During an examination, the patient has just successfully completed the finger-to-nose and rapid alternating movements test and is able to run each heel down the opposite shin. The FNP would conclude that the patient’s ___ function is intact.
    • Cerebellar function.
18. A five-year-old child is in the clinic for a checkup. The FNP would expect him to:
    • Achieve age-appropriate developmental milestones, such as following directions, identifying colors, and engaging in imaginative play.
19. When the FNP performs the confrontation test, the FNP has assessed:
    • Peripheral vision.
20. Which of these statements is true regarding the complete physical assessment?
    • It includes a detailed examination of each body system and is typically conducted from head to toe.
21. Which of these statements is true regarding recording of data from the history and physical examination?
    • It should be factual, accurate, and documented in a clear, concise manner.
22. Which of these is included in the assessment of general appearance?
    • Observations about the patient’s level of consciousness, skin color, posture, mobility, and overall hygiene.
23. The FNP is performing a review of symptoms. Which of these questions are appropriate as health promotion questions to ask during this time?
    • “Do you perform regular self-exams for breast or testicular cancer?” “How often do you visit the dentist?”
24. The FNP is incorporating a person’s spiritual values into the health history. Which of these questions illustrates the community portion of the FICA questions?
    • “Are you part of a religious or spiritual community, and how does it support you?”
25. The FNP is preparing to complete a health assessment on a 16-year-old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins?
    • “I would like to speak with your daughter alone for part of the visit to discuss some confidential matters.”
26. A mother brings her two-month-old daughter in for an examination and says, “My daughter rolled over against the wall and now I have noticed that she has a soft spot on the top of her head, is there something terribly wrong?” The FNP’s best response would be:
    • “The soft spot on her head is called the fontanel and is a normal part of her development. It will gradually close as she grows.”
27. During percussion, the FNP knows that a dull percussion note elicited over a lung lobe most likely results from:
    • Fluid or solid tissue replacing air-containing lung tissue, such as in pneumonia, pleural effusion, or a tumor.
28. The patient is unable to differentiate between sharp and dull stimulation to both sides of her face. The FNP suspects damage to:
    • Cranial nerve V (Trigeminal).
29. When examining the face, the FNP is aware that the two pairs of salivary glands that are accessible to examination are the ____ glands:
    • Parotid and submandibular glands.
30. 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 ____:
    • Cranial nerve XI (Accessory) and assesses the patient’s ability to shrug her shoulders and turn her head against resistance.
31. 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:
    • Sternocleidomastoid and trapezius muscles.
32. The patient’s laboratory data reveal an elevated thyroxine level. The FNP would proceed with an examination of the ____ gland:
    • Thyroid.
33. A patient says that she has recently noticed a lump in the front of her neck below her “Adam’s apple” that seems to be getting bigger. During the assessment, the finding that leads the FNP to suspect that this may not be a cancerous thyroid nodule is that the lump:
    • Moves up and down with swallowing, which is characteristic of a thyroid nodule rather than a malignant mass.
34. 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:
    • Mouth and throat for signs of infection or other abnormalities.
35. The FNP is aware that the four areas in the body where lymph nodes are accessible are the:
    • Head and neck, arms, axillae, and inguinal region.
36. 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:
    • Normal aging changes in the vitreous humor of the eye.
37. The FNP is preparing to assess the visual acuity of a 16-year-old patient. How should the FNP proceed?
    • Use the Snellen chart to test distance vision, asking the patient to read the smallest line of letters they can see clearly.
38. A patient’s vision is recorded as 20/30 when the Snellen eye chart is used. The FNP interprets these results to indicate that:
    • The patient can read at 20 feet what a person with normal vision can read at 30 feet.
39. A patient is unable to read even the largest letters on the Snellen chart. The FNP should take which action next:
    • Move the patient closer to the chart until they can see the largest letters, then note the distance at which they can read them.
40. A patient’s vision is reported as 20/80 in each eye. The FNP interprets this finding to mean that:
    • The patient can read at 20 feet what a person with normal vision can read at 80 feet.
41. When performing the corneal light reflex assessment, the FNP notes that the light is reflected at 2 o’clock in each eye. The FNP should:
    • Consider this a normal finding as long as the reflection is symmetrical in both eyes.
42. The FNP is performing the diagnostic positions test. Normal findings would be which of these results?
    • Smooth, coordinated movements of the eyes in all six cardinal positions of gaze.
43. During an assessment of the sclera of an African-American patient, the FNP would consider which of these an expected finding?
    • The presence of small, brown macules or spots on the sclera.
44. 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?
    • Observe the position of the upper eyelid in relation to the pupil; ptosis is indicated if the upper eyelid droops.
45. 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?
    • “Do you have any allergies or frequent nasal congestion?”
46. The FNP is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?
    • Firm pressure but no pain or tenderness.
47. 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?
    • Recognize these as normal variations commonly seen in dark-skinned individuals.
48. During an assessment of a 20-year-old patient with a three-day history of nausea and vomiting, the FNP notices dry mucous membranes and deep vertical fissures on the tongue. These findings are reflective of:
    • Dehydration.
49. 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?
    • “Tactile fremitus is a palpable vibration that is strongest over the trachea and diminishes as you move down the bronchi.”
50. 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:
    • Increased vascularity of the upper respiratory tract can cause nasal stuffiness and epistaxis (nosebleeds).

NR 509 Week 2 Quiz Review

1. What does dullness when percussing lung fields indicate?
   • Dullness typically indicates the presence of fluid or solid tissue, as seen in pneumonia, pleural effusion, or a lung tumor.
2. Facial sensation is controlled by which cranial nerve?
   • Cranial nerve V (Trigeminal).
3. What are the two salivary glands accessible during an exam?
   • The parotid and submandibular glands.
4. What cranial nerve is being tested when a patient shrugs their shoulders?
   • Cranial nerve XI (Accessory).
5. What muscles are involved when testing cranial nerve XI (spinal accessory nerve)?
   • The sternocleidomastoid and trapezius muscles.
6. How to distinguish between malignant and benign lymph nodes?
   • Malignant lymph nodes are usually hard, non-tender, fixed, and irregular in shape, whereas benign nodes are typically softer, tender, movable, and smooth.
7. What to do next if you palpate a submental lymph node?
   • Assess for signs of infection or other abnormalities in the mouth and throat area.
8. Define visual acuity.
   • Visual acuity refers to the clarity or sharpness of vision, usually measured with a Snellen chart.
9. What to do if your patient can’t read the largest number on the Snellen chart?
   • Move the patient closer to the chart until they can see the largest letters, then document the distance at which they can read them.
10. Example of good visual acuity.
    • 20/20 vision, meaning the patient can see at 20 feet what a person with normal vision can see at 20 feet.
11. Example of poor visual acuity.
    • 20/200 vision, meaning the patient can see at 20 feet what a person with normal vision can see at 200 feet.
12. What is involved with the corneal light reflex?
    • Assessing the reflection of light on the cornea to determine eye alignment.
13. Normal variances of sclera.
    • Small brown macules or spots in dark-skinned individuals are normal variations.
14. How to check for ptosis?
    • Observe the position of the upper eyelid in relation to the pupil; ptosis is indicated if the upper eyelid droops.
15. What does ptosis indicate?
    • Ptosis can indicate dysfunction of cranial nerve III (Oculomotor) or other underlying neurological or muscular conditions.

NR 509 Week 3 Quiz Review

1. What piece of equipment can be used to test for peripheral neuropathy?
   • A tuning fork for vibration sensation or a monofilament for tactile sensation.
2. How to test for Romberg sign?
   • Have the patient stand with feet together and eyes closed; a positive Romberg sign is when the patient sways or falls.
3. Diagnosis for a patient with a complaint of the room spinning (vertigo)?
   • Benign paroxysmal positional vertigo (BPPV) or other vestibular disorders.
4. Expected postural changes in pregnancy.
   • Anterior tilt of the pelvis and lordosis to accommodate the growing fetus.
5. What is the Phalen’s test and how to conduct it?
   • The Phalen’s test involves flexing the wrists and pressing the backs of the hands together for 60 seconds to elicit symptoms of carpal tunnel syndrome.
6. What does a positive Phalen’s test indicate?
   • Numbness, tingling, or pain in the fingers, suggesting carpal tunnel syndrome.
7. What is loss of bone density?
   • Osteoporosis, a condition characterized by weak and brittle bones.
8. Disease with joint pain in the morning that improves with movement and worsens with sitting?
   • Rheumatoid arthritis.
9. What is the summation effect and what does it mean?
   • The summation effect occurs when multiple stimuli are perceived as a single, more intense sensation, typically in the context of pain assessment.
10. What are normal findings in passive range of motion (ROM)?
    • Smooth, coordinated movements without pain, resistance, or crepitus.
11. How to evaluate a patient with migraines in regard to aura?
    • Ask the patient if they experience any sensory disturbances, such as visual changes or tingling sensations, before the onset of a migraine.
12. What are abnormal findings of the rotator cuff?
    • Pain, weakness, or limited range of motion in the shoulder, often indicating a tear or inflammation.
13. Type of neuro exam for a patient presenting with one-sided weakness?
    • A comprehensive neurological examination, including motor strength, sensory function, and reflex testing.
14. Common reflexes at various ages?
    • Infant reflexes include the Moro reflex and rooting reflex; in adults, the patellar reflex and Achilles reflex are commonly tested.
15. Tremors that improve with alcohol (ETOH)?
    • Essential tremor.
16. What concerns exist when a patient is slow with rapid alternating movements (RAM)?
    • Possible cerebellar dysfunction.
17. Education for patients on exercises that help prevent osteoporosis?
    • Weight-bearing exercises, such as walking or resistance training, to strengthen bones.
18. What does hip abduction reveal?
    • Strength and integrity of the hip joint and surrounding muscles.
19. What findings should the FNP expect when assessing a 35-year-old man with an infection in his left foot?
    • Redness, swelling, warmth, and possible discharge or pus at the infection site.
20. The direction of blood flow through the heart is best described by which of these:
    • From the body to the right atrium, to the right ventricle, to the lungs, to the left atrium, to the left ventricle, and then to the body.
21. In assessing the carotid arteries of an older patient with cardiovascular disease, the FNP would:
    • Auscultate for bruits and palpate for strength and symmetry of the pulse.
22. 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 aortic and pulmonic valves.
23. The sac that surrounds and protects the heart is called the:
    • Pericardium.
24. When assessing a newborn infant who is five minutes old, the FNP knows that which of these statements would be true?
    • The Apgar score should be assessed to evaluate the infant’s physical condition immediately after birth.
25. The FNP is performing an assessment on an adult. The adult’s vital signs are normal and capillary refill is five seconds. What should the FNP do next?
    • Reassess the capillary refill time, as normal capillary refill should be less than two seconds.
26. During an assessment of an older adult, the FNP should expect to notice which finding as a normal physiologic change associated with the aging process?
    • Decreased skin elasticity and thinning of the epidermis.
27. 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 would the FNP want to have?
    • Information about the infant’s feeding pattern, frequency, and duration, as well as any signs of gastrointestinal issues.
28. In assessing a patient’s major risk factors for heart disease, which would the FNP want to include when taking a history?
    • Family history of heart disease, smoking status, blood pressure, cholesterol levels, physical activity, and diet.
29. The FNP is assessing the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a ____ pulse:
    • Bounding and rapid pulse.
30. A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. His legs are pale when elevated and the pain 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:
    • Peripheral artery disease (PAD).
31. During an assessment, the FNP uses the profile sign to detect:
    • Early clubbing of the fingers.
32. Which of these statements describes the closure of the valves in a normal cardiac cycle?
    • The atrioventricular (mitral and tricuspid) valves close at the beginning of systole, and the semilunar (aortic and pulmonic) valves close at the end of systole.
33. When performing a peripheral vascular assessment on a patient, the FNP is unable to palpate the ulnar pulses. The patient’s skin is warm and capillary refill is normal. The FNP should next:
    • Document the finding and proceed with the assessment, as the ulnar pulse can be difficult to palpate in some individuals.
34. A 67-year-old patient states that he “recently began having 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:
    • Intermittent claudication due to peripheral artery disease (PAD).
35. 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. Which of these findings can be explained by expected hemodynamic changes related to age?
    • The increase in blood pressure and the split S2 can be related to age-related changes in the cardiovascular system.
36. The FNP is examining the lymphatic system of a healthy three-year-old child. Which finding should the FNP expect?
    • Palpable, small, non-tender lymph nodes.
37. The FNP is preparing to perform the modified Allen test. Which is an appropriate reason for this test?
    • To assess the adequacy of collateral circulation before arterial blood sampling or cannulation.
38. A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exams, 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?
    • The decrease in blood pressure is a normal finding during mid-pregnancy due to the effects of progesterone and increased blood volume.
39. Findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pulsations, 5 cm above the sternal angle when the head of his bed is elevated to 45°. The FNP knows that this finding indicates:
    • Right-sided heart failure.

NR 509 Advanced Physical Assessment: Questions and Answers (Continued)

1. During an abdominal assessment, the FNP elicits tenderness on light palpation in the right lower quadrant. The FNP interprets that this finding could indicate a disorder of which of these structures?
   • The appendix, indicating possible appendicitis.
2. A patient has a terrible itch for several months that he has been scratching continuously. On examination, the FNP might expect to find:
   • Lichenification, which is thickened, leathery skin due to chronic scratching or rubbing.
3. The FNP is listening to bowel sounds. Which of these statements is true of bowel sounds?
   • Normal bowel sounds are high-pitched, gurgling, and occur irregularly from 5 to 30 times per minute.
4. A patient is complaining of a sharp pain along the costovertebral angles. The FNP knows that this symptom is most often indicative of:
   • Kidney inflammation, such as pyelonephritis or kidney stones.
5. The FNP notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the FNP would report this as a:
   • Papule.
6. A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The FNP should conduct which of these techniques to assess for this condition?
   • Murphy’s sign, which involves palpating the right upper quadrant and asking the patient to take a deep breath. Pain on inspiration suggests cholecystitis.
7. The FNP just noted from a patient’s medical record that the patient has a lesion that is confluent in nature. On examination, the FNP would expect to find:
   • Lesions that run together, such as those seen in urticaria (hives).
8. During an examination, the FNP finds that a patient has excessive dryness of skin. The best term to describe this condition is:
   • Xerosis.
9. An older patient has been diagnosed with pernicious anemia. The FNP knows that this condition could be related to:
   • A deficiency in intrinsic factor, leading to vitamin B12 malabsorption.
10. A 52-year-old woman has a papule on her nose that has rounded, pearly borders and a central red ulcer. She said she first noticed it several months ago and that it has slowly grown larger. The FNP suspects which condition?
    • Basal cell carcinoma.
11. The FNP is watching a new graduate FNP perform auscultation of a patient’s abdomen. Which statement by the new graduate shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?
    • “Auscultation is performed first to avoid altering the bowel sounds that might occur after percussion and palpation.”
12. A newborn infant is in the clinic for a well-baby check. The FNP observes the infant for the possibility of fluid loss because of which of these factors?
    • Newborns have a higher body surface area to volume ratio, which increases their risk of fluid loss.

NR 509 Week 5 Quiz Review

1. Tenderness in RLQ is concerning for:
   • Appendicitis.
2. Inuit people tend to sweat more on their face than trunk and extremities when exposed to heat:
   • This statement needs context, but in general, sweating patterns can vary based on climate adaptation and individual physiology.
3. A spot on the face with a round pearly border with a central red lesion is concerning for:
   • Basal cell carcinoma.
4. Murphy sign: Positive with deep palpation causes pain on inspiration:
   • This indicates cholecystitis.
5. Why do you auscultate first in abdominal assessment?
   • To avoid altering the bowel sounds that might occur after percussion and palpation.
6. Tympany in the umbilical area:
   • Tympany is the expected sound due to the presence of gas in the intestines.
7. A patient with decreased gastric secretions is at increased risk of:
   • Malabsorption and nutrient deficiencies, particularly of vitamin B12, iron, and calcium.
8. Another name for hyperactive bowels:
   • Borborygmi.
9. Black tarry stool is concerning for:
   • Gastrointestinal bleeding, particularly from the upper GI tract.
10. Lichenification is caused by:
    • Chronic scratching or rubbing of the skin.
11. A papule is:
    • A small, solid, raised lesion less than 1 cm in diameter.
12. Older adults have:
    • Decreased skin turgor, increased skin fragility, and often thinner, drier skin.
13. CVA tenderness:
    • Costovertebral angle tenderness, often indicating kidney inflammation.
14. Confluent lesions:
    • Lesions that run together, such as those seen in urticaria.
15. Dryness of the skin:
    • Xerosis.
16. Newborns are at greater risk of fluid loss:
    • Due to their higher body surface area to volume ratio.
17. High-pitched irregular bowel sounds:
    • Typically indicate increased gastrointestinal activity and can be heard in conditions like gastroenteritis.
18. Changes in hair texture and color of an AA child with Marasmus:
    • Hair may become sparse, dry, and depigmented.
19. How to assess for enlarged organs in the abdominal region:
    • Use of palpation and percussion to determine organ size, tenderness, and consistency.
20. Three sounds heard in percussion:
    • Tympany, dullness, and resonance.

NR 509 Week 5 Quiz

1. A woman has come to the clinic to seek help with a substance-abuse problem. She admits to using cocaine just before arrival. Which of these assessment findings would the FNP expect to find when examining the woman?
   • Tachycardia, hypertension, dilated pupils, and hyperactivity.
2. A 63-year-old Chinese American man enters the office with complaints of chest pain, shortness of breath, and palpitations. Which statement most accurately reflects the FNP’s best course of action?
   • Immediately perform a focused cardiac assessment and consider the possibility of an acute coronary syndrome.
3. The FNP is planning to assess new memory with the patient. The best way for the FNP to do this would be:
   • Ask the patient to remember and recall a list of three unrelated words after a few minutes.
4. During the health history, the FNP asks a female patient “how many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking?
   • “I have more than seven drinks per week or more than three drinks per occasion.”
5. Symptoms such as pain are often influenced by a person’s cultural heritage. Which of the following is a true statement regarding pain?
   • Cultural background can affect how individuals express and cope with pain, and it is important to consider these factors in pain management.
6. The FNP suspects abuse when a 10-year-old child is taken to the urgent care center for a leg injury. The best way to document the history and physical findings is to:
   • Record the child’s and caregiver’s words verbatim, describe the physical findings objectively, and avoid inserting personal opinions.
7. During a mental status assessment, which question by the FNP would best assess a person’s judgment?
   • “What would you do if you found a stamped, addressed envelope on the sidewalk?”
8. The FNP is performing a mental status assessment on a five-year-old girl. Her parents are undergoing a bitter divorce and are worried about the effect it is having on their daughter. Which action or statement might lead the FNP to be concerned about the girl’s mental status?
   • The child appears excessively withdrawn, tearful, or shows a significant change in behavior or performance at school.
9. During a mental status examination, the FNP wants to assess a patient’s affect. The FNP should ask the patient which question?
   • Observe the patient’s facial expressions and ask, “How are you feeling today?”
10. During an examination, the FNP notices a patterned injury on a patient’s back. Which of these would cause such an injury?
    • Injuries that resemble the shape of an object, such as a belt or electrical cord, suggest the possibility of abuse.
11. The FNP is aware that intimate partner violence screening should occur with which situation?
    • During routine health assessments and whenever a patient presents with injuries or conditions that raise suspicions of abuse.
12. Which statement is best for the FNP to use when preparing to administer the Abuse Assessment Screen?
    • “Because violence is so common in many people’s lives, we ask all our patients about it routinely.”
13. The FNP is conducting a class on alcohol and the effects of alcohol on the body. How many standard drinks (each containing 12 g alcohol) per day are associated with increased deaths from cirrhosis, cancers of the mouth, esophagus, and injuries in men?
    • More than two standard drinks per day.
14. A woman who has just discovered that she is pregnant is in the clinic for her first obstetric visit. She asks the FNP how many drinks a day are safe for her baby. The FNP’s best response is:
    • “There is no safe amount of alcohol during pregnancy; it’s best to avoid alcohol entirely.”
15. The FNP is performing the Denver II screen test on a 12-month-old infant during a routine well-child visit. The FNP should tell the infant’s parents that the Denver II:
    • Screens for developmental delays and helps assess the child’s developmental progress in comparison to other children of the same age.
16. Which term refers to a wound produced by tearing or splitting of body tissue usually from blunt impact over a bony surface?
    • Laceration.
17. When reviewing the use of alcohol by older adults, the FNP notes that the older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods of time in the older adult?
    • Decreased liver metabolism and renal function.
18. The FNP is reviewing concepts of cultural aspects of pain. Which statement is true regarding pain?
    • Pain perception and expression can vary widely among different cultural groups, and cultural competence is important in pain management.
19. The FNP is planning to assess a child using a behavioral checklist. This tool is most appropriate for a:
    • School-aged child or adolescent to assess emotional and behavioral functioning.
20. The FNP is assessing orientation in a 79-year-old patient. Which of these responses would lead the FNP to conclude that the patient is oriented?
    • The patient correctly states their name, the current date, and their location.
21. As a mandatory reporter of elder abuse, which of these must be present before an FNP notifies the authorities?
    • Reasonable suspicion or evidence of abuse, neglect, or exploitation.
22. A 30-year-old female patient is describing feelings of hopelessness and depression. She has attempted self-mutilation and has a history of prior suicide attempts. She describes difficulty sleeping at night and has lost 10 pounds in the past month. Which of these statements or questions is the FNP’s best response in this situation?
    • “It sounds like you are going through a very difficult time. Are you thinking about hurting yourself now?”
23. For persons age 12 years and older, which of these illicit substances was one of the most commonly used?
    • Marijuana.
24. Which of these individuals would the FNP consider at highest risk for a suicide attempt?
    • An individual with a history of prior suicide attempts, depression, substance abuse, and a lack of social support.
25. The FNP is assessing a patient who has cirrhosis of the liver secondary to chronic alcohol use. During the physical exam, the FNP looks for cardiac problems associated with chronic heavy use of alcohol such as:
    • Cardiomyopathy and arrhythmias.
26. During an examination of an aging male, the FNP recognizes that normal changes to expect would be:
    • Enlarged prostate, decreased testosterone levels, and reduced muscle mass.
27. During a health history, a 22-year-old woman asks, “Can I get that vaccine for HPV? I have genital warts and I’d like them to go away!” What is the FNP’s best response?
    • “The HPV vaccine is most effective before exposure to the virus, but it can still provide some benefit. Let’s discuss your options.”
28. During a speculum inspection of the vagina, the FNP would expect to see what at the end of the vaginal canal?
    • The cervix.
29. A 62-year-old man is experiencing fever, chills, malaise, urinary frequency and urgency. He also reports urethral discharge and a dull aching pain in the perineal and rectal area. The symptoms are most consistent with:
    • Prostatitis.
30. When performing a genital examination on a 25-year-old man, the FNP notices deeply pigmented, wrinkled scrotal skin with large sebaceous follicles. On the basis of this information, the FNP would:
    • Consider these findings normal.
31. The mother of a 10-year-old boy asks the FNP to discuss the recognition of puberty. The FNP should reply by saying:
    • “Puberty in boys typically begins with testicular enlargement, followed by penile growth and the appearance of pubic hair.”
32. The uterus is usually tilted forward and superior to the bladder. This position is known as:
    • Anteverted and anteflexed.
33. A male patient with possible fertility problems asks the FNP where sperm is produced. The FNP knows that sperm production occurs in:
    • The seminiferous tubules within the testes.
34. A 15-year-old boy is seen in the clinic for complaints of dull pain and pulling in the scrotal area. On examination, the FNP palpates a soft, irregular mass posterior to and above the testes on the left. This mass collapses when the patient is supine and refills when he is upright. This description is consistent with:
    • A varicocele.
35. In performing an assessment of a woman’s axillary lymph system, the FNP should assess which of these nodes?
    • Central, pectoral, subscapular, and lateral nodes.
36. A patient contacts the office and tells the FNP that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the FNP’s best response?
    • “It’s common for breast development to be uneven during puberty. Tenderness and unilateral enlargement can be normal, but we can examine her to be sure.”
37. An 11-year-old girl is in the clinic for a sports physical. The FNP notices that she has begun to develop breasts, and during the conversation the girl reveals that she is worried about her development. Which of these techniques would best assist the young girl in understanding the expected sequence for development? The FNP should:
    • Use the Tanner stages to explain the normal progression of pubertal development.
38. A 54-year-old woman who has just completed menopause is in the clinic today for her yearly physical examination. Which of these statements should the FNP include in patient education? A postmenopausal woman:
    • Should continue regular breast and pelvic exams, and discuss calcium and vitamin D supplementation to reduce the risk of osteoporosis.