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A 43-year-old woman is at the clinic for a routine examination. She reports that she has had a breast lump in her right breast for years. Recently, it has begun to change in consistency and is becoming harder. She reports that 5 years ago her medical provider evaluated the lump and determined that it “was nothing to worry about.” Your examination validates the presence of a mass in the right upper outer portion of the right breast. It is fixed, hard, nontender, with borders that are not well defined. The advanced practice nurse’s recommendation to her is:

A 65 year old female patient who works part-time cleaning houses presents to the clinic with a gradual onset of right shoulder pain and difficulty moving her right shoulder.  She has tenderness over the SITS muscle insertions (supraspinatus, infraspinatus, Teres minor, Subscapularis muscles) and an inability to abduct her right arm above her shoulder level.  Which of the following most likely causes this presentation upon physical exam?

A successful 15-year-old student-athlete’s mother brings him in today because he no longer studies, works out, or sees his friends.  This has gone on for a month and a half.  His parent agrees to let you speak with the patient alone in the room. What should you do next?

The nurse is palpating the prostate gland through the rectum. Which of the following indicates an abnormal finding if found on exam?

While performing the otoscopic examination of a 3-year-old boy who has been pulling on his left ear, the advanced practice provider finds that his left tympanic membrane is bright red, bulging and that the light reflex is not visible. You perform pneumatic otoscopy and find there is diminished movement of the tympanic membrane The advanced practice provider interprets these findings to indicate:

The Advanced Practice nurse is evaluating the vision of an infant at birth.  What do you expect to find?

A 25-year-old woman comes to the emergency department with a sudden fever of 101° F and abdominal pain. Upon examination, the APRN notices that she has rigid, board like lower abdominal musculature. When the APRN tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. The APRN knows that these signs and symptoms are suggestive of:

 A young woman undergoes cranial nerve testing.  On touching the soft palate, her uvula deviates to the left.  Which cranial nerve is responsible?

The Advanced Practice Nurse is examining a patient’s retina with an ophthalmoscope. Which finding is considered normal?

During the assessment of a six-week-old infant, the NP notes bulging fontanelles. The NP is concerned with which condition?