NR 603 APEA PREDICTOR EXAM QUESTIONS AND ANSWERS WITH EXPLANATIONS

109. A patient experienced a neck injury yesterday and presents to the nurse practitioner with aching paracervical pain and stiffness. Other complaints include dizziness, malaise, and fatigue. These findings may be associated with: neck pain with whiplash Explanation: In patients with mechanical neck pain with whiplash, the paracervical pain and stiffness begins the day after injury and may be accompanied by occipital headaches, dizziness, and malaise. Mechanical neck pain is described as aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, stiffness, and tightness in the upper back and shoulder, lasting up to 6 weeks. With cervical radiculopathy, nerve root compression is the etiology. Symptoms may include sharp burning or tingling pain in the neck and one arm with associated paresthesias. In cervical myelopathy, cervical cord compression, the neck pain is associated with bilateral weakness and paresthesias in both upper and lower extremities. 110. Most peripheral nerves contain afferent and efferent fibers. The term efferent refers to: motor nerve fibers Explanation: The peripheral nervous system includes spinal and peripheral nerves that carry impulses to and from the cord. Spinal nerve fibers co-mingle with similar fibers from other levels in plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. 111.At what age should an infant begin to say consonant sounds? Six months Explanation: A six-month-old infant should be able achieve these tasks: look at self in the mirror, respond to his own name, begin to say consonant sounds, begin to pass things from one hand to another, roll over in both directions, know familiar faces, and begin to know if someone is a stranger. 112. Genu varum refers to: bow leggedness Explanation: The term genu valgum refers to knock knees and genu varum refers to bow leggedness. Talipes equinovarus is the term that describes a clubfoot. Toeing inward or outward of the feet is known as tibial torsion. 113. When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the: posterior portion of the medial meniscus Explanation: When examining the medial and lateral meniscus, a click along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the posterior portion of the medial meniscus. 114. Breastfeeding is contraindicated for an infant diagnosed with which one of the following conditions? Galactosemia Explanation: Galactosemia is the lack of a specific enzyme in the liver that breaks down galactose into glucose. Some infants may inherit a gene that allows for some galactose metabolism. However, if the baby has “classic galactosemia” in which the baby has no galactose metabolizing enzymes, the baby will need to be weaned abruptly, and then fed a lactose free formula. Breast feeding is not contraindicated in the other conditions. 115. In order to examine the tongue, ask the patient to stick out his tongue and with the examiner's right hand: gently pull it to the left side , and inspect the side of the tongue Explanation: In order to examine the tongue, ask the patient stick out his the tongue and with the examiner's right hand, grasp the tip of the tongue with a gauze and gently pull it to the patient's left. Inspect the side of the tongue, then palpate it with the left hand, feeling for any induration. Reverse the procedure for the other side. Inspecting for tongue symmetry checks function of cranial nerve XII, hypoglossal. Stimulating the patient to cough and eliciting the gag reflex do not have anything to do with the tongue examination. 116. The ankle-brachial index is a screening test used to assess a person's risk for: peripheral artery disease Explanation: The ankle-brachial index test is a quick, noninvasive way to check a person's risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system. 117. The central nervous system extends from the medulla into the: spinal cord Explanation: Below the medulla, the central nervous system extends into the elongated spinal cord, encased within the bony vertebral column and terminating at the first or second lumbar vertebra. 118. The Weber test uses a tuning fork to test hearing. The frequency range closest to that of conversational speech would be one with a frequency of: 512 Hz Explanation: The Weber hearing test screens for unilateral conductive hearing loss with a tuning fork. The tuning fork is measured in frequencies of 256 Hz or 512 Hz. These frequencies fall within the range of conversational speech. The ideal frequency for the Weber test is 256 Hz. A frequency of 512 Hz is the ideal frequency for the Rinne hearing test. 119. The nurse practitioner holds the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. This maneuver assesses the: placing and stepping reflexes Explanation: The placing or stepping reflex (formerly known as the dancing reflex) is assessed by holding the infant around the trunk. One sole touches the table. The hip and knee of the foot will flex and the other foot will step forward. Alternating stepping will occur. To elicit the Landau reflex, the infant is suspended prone with one hand, and the infant's head will lift and the spine will straighten. Galant's reflex, or trunk incurvation reflex, is elicited when the infant is supported prone with one hand, and then one side of the back (one centimeter from the midline), is stroked from the shoulder to the buttocks. The spine curves toward the stimulus. To elicit the positive support reflex, hold the infant around the trunk, lower the infant until the feet touch a flat surface. Hips, knees, ankles extend and the infant stands up, partially bearing weight. 120. Which of the following findings in a preschooler would indicate the need for further evaluation? Responds to facial expressions and gestures rather than to verbal explanations Explanation: A child who responds to facial expressions and gestures rather than to verbal explanations is probably expressions rather than verbal clues. These children may have a hearing deficit that needs further evaluation. The other choices are normal behaviors for the preschooler.