NUR 612 Exam 4

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Free NUR 612 Exam 4 Questions

1.

Which of the following represents the first sign of puberty in girls?

  • Thelarche

  • Menarche

  • Proliferation of lactiferous duct

  • Areolar elevation

Explanation

Correct Answer: A. Thelarche

Explanation of Correct Answer

Thelarche refers to the onset of breast development, which is typically the first physical sign of puberty in girls. It usually occurs between ages 8 and 13 and is driven by estrogen stimulation of the mammary glands. Breast budding is easily noticeable and marks the beginning of pubertal development.


2.

Which item in the patient history is considered a risk factor for cancer of the penis?

  • Circumcised at birth

  • History of condyloma acuminatum infectionsHad congenital hydrocele

  • Had congenital hydrocele

  • History of untreated epispadius

Explanation

Correct Answer: B. History of condyloma acuminatum infections

Explanation of Correct Answer

Condyloma acuminatum is caused by human papillomavirus (HPV), particularly types 16 and 18, which are strongly associated with penile cancer. Chronic HPV infection increases the risk of malignant transformation of penile epithelial cells, making this a significant risk factor.


3.

Which finding indicates a normal cremasteric reflex?

  • Penile erection in response to light touch

  • Descent of testicle into scrotum in response to pressure on abdominal wall

  • Drop of urine appearing at urethral meatus in response to pressing glans

  • Elevation of left testicle and scrotum in response to stroking left inner thigh

Explanation

Correct Answer: D. Elevation of left testicle and scrotum in response to stroking left inner thigh

Explanation of Correct Answer

The cremasteric reflex is elicited by gently stroking the inner thigh. A normal response is contraction of the cremaster muscle, which pulls the testicle and scrotum upward on the same side. This reflex is mediated by the genitofemoral nerve (L1–L2) and helps assess the integrity of the lumbar spinal cord segments.


4.

A patient who has difficulty writing or drawing is most likely to have what condition?

  • Temporal lobe damage

  • Peripheral neuropathy

  • Organic brain syndrome

  • Psychiatric hallucinations

Explanation

Correct Answer: B. Peripheral neuropathy

Explanation of Correct Answer

Peripheral neuropathy affects the peripheral nerves, leading to weakness, numbness, and loss of fine motor control in the hands. Since writing and drawing require precise coordination, patients with neuropathy may struggle due to impaired sensation or muscle weakness. This makes peripheral neuropathy the most likely cause when the primary difficulty lies in motor execution rather than cognitive processing.


5.

Mrs. Pope presents with twitching and burning sensations in her right leg that cause difficulty in walking. Initial suspicion is peripheral neuropathy. The proper diagnosis of peripheral neuropathy begins with a detailed history and physical examination. Which of the following information in her social history may be a cause of her symptoms? Select all that apply.

  • Current occupation

  • Going out to dinner

  • Use of shoes with good support

  • Substance abuse

  • Use of supplements

Explanation

Correct Answers: A. Current occupation, D. Substance abuse, E. Use of supplements

Explanation of Correct Answers

A. Current occupation

Jobs involving repetitive trauma, exposure to toxins, or prolonged standing can contribute to peripheral nerve injury and neuropathy, making occupation an important factor in history-taking.

D. Substance abuse

Alcohol and certain illicit drugs are well-known causes of peripheral neuropathy due to direct neurotoxicity and nutritional deficiencies (especially thiamine).

E. Use of supplements

Overuse of some supplements, such as vitamin B6 (pyridoxine), can cause neuropathy, while deficiencies of other vitamins (B12, folate) may also contribute.


6.

Which of the following hernias occur more often in females and is the least common of all hernias?

  • Indirect

  • Direct

  • Femoral

  • Ventral

Explanation

Correct Answer: C. Femoral

Explanation of Correct Answer

Femoral hernias are rare, making up only about 2–4% of all hernias, and are the least common type overall. They occur more often in females due to the wider bony structure of the female pelvis. Femoral hernias protrude through the femoral canal, just below the inguinal ligament, and have a high risk of strangulation, making recognition and prompt management critical.


7.

A patient with Alzheimer’s disease classically displays which of the following?

  • Alternating periods of mania and stupor

  • Hallucinations and decorticate posturing

  • Disintegration of personality

  • Rapid onset of symptoms

Explanation

Correct Answer: C. Disintegration of personality

Explanation of Correct Answer

Alzheimer’s disease is a progressive neurodegenerative disorder that gradually impairs memory, cognition, behavior, and personality. Over time, patients experience disorientation, loss of judgment, social withdrawal, and disintegration of personality. These changes occur slowly and insidiously, distinguishing Alzheimer’s from other acute or fluctuating neurological conditions.


8.

You examine Mr. Lacosta, a 22-year-old male. CC is penile pain and swelling. On exam you notice a constricting band of tissue directly behind the head of the penis. You diagnose this as:

  • Paraphimosis

  • Hypospadias

  • Orchitis

  • Torsion

Explanation

Correct Answer: A. Paraphimosis

Explanation of Correct Answer

Paraphimosis occurs when the foreskin is retracted behind the glans penis and becomes trapped, forming a constricting band. This leads to penile pain, swelling, and impaired blood flow. It is a urologic emergency because untreated paraphimosis can cause vascular compromise and necrosis of penile tissue.


9.

Which of the following conditions presents nonproliferating lesions and does not affect future cancer risk?

  • Atypical lobular hyperplasia

  • Fat necrosis

  • Radial scar

  • Papilloma

Explanation

Correct Answer:

2. Fat necrosis

Explanation of Correct Answer

Fat necrosis of the breast is a benign, nonproliferative lesion often caused by trauma, surgery, or radiation. It presents as firm nodules that may mimic carcinoma on exam or imaging, but it carries no increased risk of future breast cancer. Histologically, it shows lipid-filled macrophages and calcifications without cellular proliferation.


10.

What type of hernia would you typically see in a 15-year-old male?

  • Femoral

  • Umbilical

  • Direct inguinal

  • Indirect inguinal

Explanation

Correct Answer: D. Indirect inguinal

Explanation of Correct Answer

An indirect inguinal hernia is the most common type seen in children and adolescents, including 15-year-old males. It occurs when abdominal contents protrude through the inguinal canal due to a congenital defect in the processus vaginalis that fails to close. This hernia follows the pathway of the spermatic cord and may extend into the scrotum.


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