NR 509 FINAL PRACTICE QUESTIONS WITH 100%
VERIFIED ANSWERS STUDY GUIDE EXAM
[GRADED A+]
NEW!
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right side.
The lymph node is nontender and feels firm and rubbery. She denies any localized or
systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking
conjugated estrogen tablets for 9 years since menopause, though she has not taken
progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years.
Which of the following is true about this presentation of lymphadenopathy? - Ans✔✔-
Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclvaicular nodes without first causing notable changes in the axillary nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A
rubbery, mobile, nontender mass is palpated in the right breast as described by the patient,
which is consistent with a firbroadenoma. In describing the location of the mass, the
examiner notes that it is 3 cm proximal to and 3 cm to the left of the nipple. Which of the
following would be the most appropriate way to report this finding? - Ans✔✔-rubbery, mobile,
contender mass located in the right breast, in the 10:30 position from the nipple.
A 54-year-old female dietician presents for a routine annual examination. On review of
systems, she reports that she has had many breast findings over several years, including
one biopsy with normal pathology. She feels that her breasts have become far less lumpy
since she underwent menopause 3 years ago. Which of the following is true regarding
changes in the breasts with menopause? - Ans✔✔-Glandular tissue of the breast atrophies
with menopause, primarily due to a decrease in the number of lobules.
An overweight 26-year-old public servant presents to the Emergency Department with 12
hours of intense abdominal pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family history of gallstones and is
concerned about this possibility. She has not had any vomiting or diarrhea. She had a
normal bowel movement this morning. Her β-human chorionic gonadotropin (β-hCG) is
positive at triage. She reports that her last period was 10 weeks ago. Her vital signs at triage
are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her pelvic
,exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness.
What is the most likely diagnosis? - Ans✔✔-Ruptured tubal (or ectopic) pregnancy
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit.
Basic labs are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and
liver enzymes were also measured. His labs are all normal expect for moderate elevations of
aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, and alkaline
phosphatase as well as a mildly elevated total bilirubin. He presents for a follow-up
appointment and the clinician performs an abdominal exam to assess his liver. Which of the
following findings would be most consistent with hepatomegaly? - Ans✔✔-Liver palpable 3
cm below the right costal margin, mid clavicular line, on expiration.
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents
with a several month history of recurrent epigastric abdominal discomfort. She feels fairly
well otherwise and denies any nausea, vomiting, diarrhea, or constipation. She reports that a
first cousin died from a ruptured aneurysm at age 68 years. Her vital signs are pulse, 86;
blood pressure, 148/92; respiratory rate, 16; oxygen saturation, 95%; and temperature,
36.2ºC. Her body mass index is 17.6. On exam, her abdominal aorta is prominent, which is
concerning for an abdominal aortic aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA? - Ans✔✔-History of Smoking
A 76-year-old retired man with a history of prostate cancer and hypertension has been
screened annually for colon cancer using high sensitivity fecal occult blood testing (FOBT).
He presents for follow-up of his hypertension, during which the clinician scans his chart to
ensure he is up to date with his preventive health care. He has a positive FOBT on one
occasion at age 66 years and subsequently went for a colonoscopy. Internal hemorrhoids
and sigmoid diverticuli were found on colonoscopy. He has no first-degree relatives with a
history of colorectal cancer or adenomatous polyps. What are the U.S. Preventive Services
Task Force (USPSTF) screening recommendations for this patient? - Ans✔✔-Do no screen
routinely.
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year
history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and
is associated with onset of constipation. She describes infrequent, small hard stool that she
finds very difficult to pass. She has tried to increase dietary fiber and water intake, but
usually this is not sufficient and she resorts to over-the-counter laxatives, which she finds
upset her stomach but do resolve the constipation. Symptoms typically gradually resolve
with bowel movements. Which of the following is the most likely physiological mechanism for
her constipation? - Ans✔✔-Functional change in bowel movement.
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis and
bronchiectasis that is associated with a rare congenital condition called Kartagener
syndrome. The preceptor notes that she has situs inversus and asks for a physical exam.
Which of the following descriptions best fits with findings on the abdominal exam? - Ans✔✔-
, Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper
quadrant
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-
day history of severe abdominal pain. The emergency physician suspects appendicitis and
general surgery is consulted. The resident believes the patient has signs of peritonitis on
exam. Which of the following physical exam findings supports peritonitis? - Ans✔✔-Pressing
down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the
last 10 months. He presents with a 4-month history of increasing weakness, recurrent
epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight
loss of 18 lb over 4 months. What is the mechanism of his most likely diagnosis? - Ans✔✔-
fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine
clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on its
own after a few hours. Her last episode was prolonged lasting 6 hours, and she is frustrated
that she has had to leave or miss work on three separate occasions. She would like a
diagnosis and the problem fixed. Which symptoms or signs would be most suggestive of a
diagnosis of biliary colic? - Ans✔✔-Associated right shoulder pain
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes
presents for his yearly physical examination and complains of progressively worsening
erectile dysfunction (ED). While counseling him, the clinician mentions that multiple
processes must take place to achieve an erection. Which of the following structures would
be most affected by vascular deficiencies related to his preexisting medical conditions and is
likely contributing to his symptoms? - Ans✔✔-Corpora Cavernosa
A 29-year-old graduate student states that he is able to achieve an erection and ejaculate
during sexual intercourse; however, he does not experience any pleasurable sensation of
orgasm. He is otherwise healthy and is not on any medications. What is the most likely
cause of his problem? - Ans✔✔-Psychogenic
Multiple processes must take place in order for a male to sustain an erection. Various cues
stimulate sympathetic outflow from higher brain centers to the T11-L2 levels of the spinal
cord and parasympathetic outflow from S2 to S4 reflex arcs. Local vasodilatation within the
penis erectile tissue results from increased levels of which of the following? - Ans✔✔-Nitric
oxide (NO) and cyclic guanosine monophosphate (cGMP)
