NR509 Advanced Physical Assessment Midterm Exam With Answers (32 Solved Questions)

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NR 509-Advanced Physical AssessmentMidterm Exam1.A mother brings her 2-month-old daughter in for an examination and says, Mydaughter rolled over against the wall, and now I have noticed that she has this spotthat is soft on the top of her head. Is something terribly wrong? The nurses bestresponse would be:A. Perhaps that could be a result of your dietary intake during pregnancy.B. Your baby may have craniosynostosis, a disease of the sutures of the brain.C. That soft spot may be an indication of cretinism or congenital hypothyroidism.D. That soft spot is normal, and actually allows for growth of the brain during thefirst year of your babys life.ANS: D2.Membrane-covered soft spots allow for growth of the brain during the first yearof life. They gradually ossify; the triangular-shaped posterior fontanel is closed by1 to 2 months, and the diamond-shaped anterior fontanel closes between 9 monthsand 2 years.

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The nurse notices that a patients palpebral fissures are not symmetric. Onexamination, the nurse may find that damage has occurred to which cranial nerve(CN)?a. IIIb. Vc. VIId. VIIIANS: CFacial muscles are mediated by CN VII; asymmetry of palpebral fissures may beattributable to damage to CN VII (Bell palsy).3.A patient is unable to differentiate between sharp and dull stimulation to bothsides of her face. The nurse suspects:a. Bell palsy.b. Damage to the trigeminal nerve.c. Frostbite with resultant paresthesia to the cheeks.d. Scleroderma.ANS: BFacial sensations of pain or touch are mediated by CN V, which is the trigeminal

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nerve. Bell palsy is associated with CN VII damage. Frostbite and scleroderma arenot associated with this problem.4.When examining the face of a patient, the nurse is aware that the two pairs ofsalivary glands that are accessible to examination are the ___________ and___________ glands.a. Occipital; submentalb. Parotid; jugulodigastricc. Parotid; submandibulard. Submandibular; occipitalANS: CTwo pairs of salivary glands accessible to examination on the face are the parotidglands, which are in the cheeks over the mandible, anterior to and below the ear;and the submandibular glands, which are beneath the mandible at the angle of thejaw. The parotid glands are normally nonpalpable.5.A patient comes to the clinic complaining of neck and shoulder pain and isunable to turn her head. The nurse suspects damage to CN ______and proceedswith the examination by _____________.a. XI; palpating the anterior and posterior trianglesb. XI; asking the patient to shrug her shoulders against resistance

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c. XII; percussing the sternomastoid and submandibular neck musclesd. XII; assessing for a positive Romberg signANS: BThe major neck muscles are the sternomastoid and the trapezius. They areinnervated by CN XI, the spinal accessory. The innervated muscles assist withhead rotation and head flexion, movement of the shoulders, and extension andturning of the head.6.When examining a patients CN function, the nurse remembers that the musclesin the neck that are innervated by CN XI are the:a. Sternomastoid and trapezius.b. Spinal accessory and omohyoid.c. Trapezius and sternomandibular.d. Sternomandibular and spinal accessory.ANS: AThe major neck muscles are the sternomastoid and the trapezius. They areinnervated by CN XI, the spinal accessory.7.A patient says that she has recently noticed a lump in the front of her neck belowher Adams apple that seems to be getting bigger. During the assessment, thefinding that leads the nurse to suspect that this may not be a cancerous thyroid

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nodule is that the lump (nodule):a. Is tender.b. Is mobile and not hard.c. Disappears when thepatient smiles.d. Is hard and fixed to the surrounding structures.ANS: BPainless, rapidly growing nodules may be cancerous, especially the appearance ofa single nodule in a young person. However, cancerous nodules tend to be hard andfixed to surrounding structures, not mobile.11. The nurse is aware that the four areas in the body where lymph nodes areaccessible are the:a. Head, breasts, groin, and abdomen.b. Arms, breasts, inguinal area, and legs.c. Head and neck, arms, breasts, and axillae.d. Head and neck, arms, inguinal area, and axillae.ANS: DNodes are located throughout the body, but they are accessible to examination onlyin four areas: head and neck, arms, inguinal region, and axillae.

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A mother brings her newborn in for an assessment andasks, Is there somethingwrong with my baby? His head seems so big. Which statement istrueregardingthe relative proportions of the head and trunk of the newborn?a. At birth, the head is one fifth the total length.b. Head circumference should begreater than chest circumference at birth.c. The head size reaches 90% of its final size when the child is 3 years old.d. When the anterior fontanel closes at 2 months, the head will be moreproportioned to the body.ANS: BThe nurse recognizes that during the fetal period, head growth predominates. Headsize is greater than chest circumference at birth, and the head size grows duringchildhood, reaching 90% of its final size when the child is age 6 years.A patient, an 85-year-old woman, is complaining about the fact that the bones inher face have become more noticeable. What explanation should the nurse giveher?a. Diets low in protein and high in carbohydrates may cause enhanced facial bones.b. Bones can become more noticeable if the person does notuse a dermatologicallyapproved moisturizer.c. More noticeable facial bones are probably due to a combination of factors

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