NR 509 FINAL 2024-2025 Exam WITH 200
Questions AND ANSWERS
A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the
past few weeks. She reports waking up at night with headaches and nausea. Her only medication history
is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if
taken by the NP is the best next step - ANSWER>>>>Take a further history and perform a very careful
neurological exam
A grandmother is accompanying her 9-year-old granddaughter during a routine physical examination.
She asks you privately if her granddaughter has started puberty yet. During the examination, the NP
notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound
above the level of the breast. The left breast is underdeveloped. These assessment findings are
consistent with which Tanner Stage of development - ANSWER>>>>IV
Primary prevention is defined as which of the following? - ANSWER>>>>Interventions designed to
prevent disease
Based on the U.S. Preventive Services Task Force (USPSTF) recommendations, which of the following
statements is true about screening for breast cancer in average-risk women? -
ANSWER>>>>Mammography is recommended every 2 years for women aged 50-74 with insufficient
evidence for screening women over the age of 75.
Which of the following statements is true regarding recommendations by the eighth Joint National
Committee (JNC8) for adults aged 60 and older? Select all that apply. - ANSWER>>>>Target blood
pressure should be
Which of the following is a useful strategy when examining young children between the ages of 1 and 4 -
ANSWER>>>>Have the parent facilitate the exam (e.g., removing clothes, holding the child on lap).
The NP is completing the review of systems on a 4-month-old female during a routine encounter. Which
statement from the parent may indicate a cardiac problem in the infant and require a more thorough
subjective history - ANSWER>>>>"It often takes the baby more than 30 minutes to finish a bottle."
A 16-year-old male presents to the clinic with a history of a congenital right upper eyelid drooping as
represented in this image. He has no complaints and denies injury or trauma. Which cranial nerve (CN) is
involved in this condition? - ANSWER>>>>Patient with eyelid drooping-CNIII
Which cranial nerve (CN) innervates the muscles of the pharynx and provides sensory fibers to portions
of the tympanic membrane, auditory canal, pharynx, and the posterior third of the tongue? -
ANSWER>>>>CN IX
The NP should suspect injury to which cranial nerve (CN) if a patient presents with complaints of
photosensitivity and uneven pupils after being struck in the eye with a baseball? - ANSWER>>>>CN III
,Which of the following statements is true regarding risks and rapid recognition of suspected stroke?
Select all that apply - ANSWER>>>>Obesity doubles the risk of stroke even without associated glucose
intolerance Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke
The combination of both receptive and expressive aphasia is a characteristic of which type of speech
disorder - ANSWER>>>>global aphasia
The NP is assessing a 42-year-old female who presents to the clinic with recurring headaches. What is an
effective question to ask the patient? - ANSWER>>>>Do you have any aura prior to the headaches?
A 55-year-old female presents to the clinic with a headache. During the interview, which of the following
symptoms should prompt the NP to be concerned and investigate further - ANSWER>>>>The patient
reports fever, night sweats, and thinks she lost weight.
When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following? -
ANSWER>>>>Active movement against gravity
Which musculoskeletal disorder is paired correctly with the associated systemic manifestations? -
ANSWER>>>>Lyme disease and expanding erythematous targetoid patch in early illness
A 62-year-old female has a diagnosis of rheumatoid arthritis (RA). Which of the following are expected
assessment findings consistent with the diagnosis? - ANSWER>>>>Swelling of the synovial tissue in
joints and tendon sheaths.
A 58-year-old male complains of pain in his knees, hips, hands, wrists, neck, and lower back. Based on
the joints involved, the NP suspects that the patient most likely has which condition -
ANSWER>>>>Osteoarthritis
A 55-year-old male has a diagnosis of lumbar spinal stenosis. Which sign should the NP expect to find on
examination that is most consistent with the diagnosis - ANSWER>>>>Flexed forward posture with
lower extremity weakness
What is the action(s) of the erector spinae muscle group? - ANSWER>>>>Extension of the spine
A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8 weeks
ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are unequal and there
is winging of the scapula. The NP suspects contralateral weakness and muscle wasting as the etiology for
the winged scapula. Which of the following physical assessment maneuvers should the NP perform to
confirm the suspension? - ANSWER>>>>Compare the strength of the trapezius muscles
A 31-year-old female presents to the clinic with a worsening stiff, painful neck. On inspection, the
patient's head is laterally deviated toward the shoulder and rotated. Given this specific physical
assessment finding, what condition should the NP suspect as a differential diagnosis? -
ANSWER>>>>Torticollis
During an evaluation of an athletic 30-year-old female, the NP conducts an active range of motion
evaluation at the neck. All of the following muscles are being assessed when the patient is asked to
extend, flex, and rotate the neck, EXCEPT - ANSWER>>>>Sacrospinalis
, A 58-year-old male complains of lower back pain for many years. He denies a recent injury. On
examination, the NP finds that the patient has tenderness to palpation over the sacroiliac joint. Which of
the following conditions is most consistent with this physical sign? - ANSWER>>>>ankylosing
spondylitis
Which of the following statements is true regarding prostate cancer screening? - ANSWER>>>>Setting
normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing
A 53-year-old African American male presents for discussion of his prostate cancer risk and possible
screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died
recently at age 87 years from a myocardial infarction before the disease progressed. Family history also
reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts
had breast cancer. Which of the following is true about prostate cancer risk for this patient and
subsequent screening - ANSWER>>>>This patient is at an elevated risk of prostate cancer due to his
family history; thus, screening modalities should be discussed between the patient and provider
A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A
recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of
pain. In addition, today she reports that she has developed episodic abdominal discomfort and sores in
her mouth. Which of the following underlying conditions is the NP most likely to find -
ANSWER>>>>Inflammatory bowel disease
A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a
change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well as
Crohn's disease. Her family medical history includes a maternal aunt who died of colon cancer at age 49
years. Which of the following historical elements would be most concerning for colon cancer in this
patient? - ANSWER>>>>recent onset of small-caliber stools
A 67-year-old female presents to the office for an annual check-up. She retired as a police captain at age
66. Now she enjoys gardening and water aerobics several days a week. She states, "staying active keeps
me limber". After a careful history and physical examination, the NP documents the following
musculoskeletal system findings: Full range of motion in all joints. Hands with Heberden nodes at the
DIP joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and rotation of both hips. Full
range of motion in the knees, with moderate crepitus. No effusion but bony enlargement along the
tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first MTP joints. Which of the
following is the most accurate interpretation of these findings? - ANSWER>>>>These findings suggest
osteoarthritis
A 50-year-old male presents to the office for a routine physical examination. He has no complaints. His
PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is taking
fenofibrate. On the social history intake form, he reported consuming 8 ounces of malt liquor daily for
20 years. After a careful history and physical examination, the NP documents the following nervous
system findings: Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Oriented to
person, place, and time. Speech is fluent, follows commands. Detailed cognitive testing deferred. Cranial
Nerves: I—not tested; II through XII intact. Motor: Normal muscle bulk and tone. Strength 5/5
throughout. No pronator drift. Cerebellar—Rapid alternating movements (RAMs), finger-to-nose (F→N),
