NR 509 APEA EXAM (HEENT): ADVANCED PHYSICAL
ASSESSMENT- QUESTIONS AND ANSWERS WITH
RATIONALES LATEST UPDATED
Question 1
The function of the auditory ossicles is to:
a. transmit the light reflex to the light cone.
b. transform sound vibrations into mechanical waves for the inner ear.
c. to capture sound waves from the external ear for transmission into the middle ear.
d. to separate the inner ear from the middle ear.
RATIONALES:
The function of the auditory ossicles is to transform sound vibrations into mechanical
waves for the inner ear
Question 2
A 35-year-old client complains of vertigo accompanied by nausea and vomiting.
Examination reveals bilateral diplopia and an unsteady gait. These symptoms could be
suggestive of:
a. an arrhythmia.
b. a neurological condition.
c. an inner ear infection.
d. orthostatic hypotension.
RATIONALES:
,Vertigo symptoms associated with neurologic conditions include: ataxia, diplopia, and
dysarthria. Symptoms associated with cardiovascular conditions and vertigo include
arrhythmias, orthostatic hypotension, vasovagal stimulation, lightheadedness, weakness, or
presyncope.
Question 3:
A 60-year-old was concerned about a yellowish colored lesion above her right eyelid.
Findings revealed a slightly raised yellowish, well circumscribed plaque along the nasal
area of her right eyelid. This finding is most consistent with:
a. a pinguecula.
b. a chalazion.
c. episcleritis.
d. xanthelasma.
RATIONALES:
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 chalazion is a nontender nodule usually on the underside of the eyelid. Episcleritis is
an ocular inflammation of the episcleral vessels.
Question 4
Assessment of a client's visual acuity resulted in 20/200 using the Snellen eye chart. This
means that:
a. at 200 feet the client can read printed information that a person with normal
vision could read at 20 feet.
b. at 20 feet the client can read printed information that a person with normal vision
could read at 200 feet.
c. the client has normal visual acuity.
, d. the client may not be able to read so he should be tested with the picture or "E" eye
charts.
RATIONALES:
Visual acuity that is corrected to 20/200 constitutes legal blindness. The larger the number
under 20, the worse the visual acuity. If this is a new finding, the client needs
ophthalmologic evaluation.
Question 5
Findings following assessment of a person's left eye gaze include impaired movements
when attempting to look upward, downward, or inward. This condition is most consistent
with:
a. a conjugate gaze.
b. left cranial nerve III (oculomotor) paralysis
c. cranial nerve IV (trochlear) paralysis.
d. cranial nerve VI (abducens) paralysis.
RATIONALES:
With a left cranial nerve III paralysis, upward, downward, or inward movements are
impaired. In conjugate or normal gaze, the normal movement of the two eyes appears
simultaneously in the same direction to bring something into view. With a left cranial nerve
VI paralysis, a person's gaze would include eyes conjugate when looking to the right,
esotropia (one or both eyes turn inward) appears in the left eye when looking straight
ahead, and esotropia is maximum in the left eye when looking to the left. The left eye is
unable to look down when turned inward in a left cranial nerve IV paralysis.
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