APEA APEA Clinical Assessment Skills Questions and Answers 2 — Questions and Answers
Question 1: A nurse practitioner performs a Rinne test and finds air conduction is less than bone conduction in the left ear. This indicates which type of hearing loss?
- Conductive hearing loss (Correct answer)
- Sensorineural hearing loss
- Mixed hearing loss
- Central hearing loss
Correct answer: Conductive hearing loss
When bone conduction exceeds air conduction (negative Rinne), a mechanical obstruction to sound transmission in the outer or middle ear is present.
Question 2: During a musculoskeletal exam, the NP notes a positive Phalen test. Which condition does this suggest?
- Carpal tunnel syndrome (Correct answer)
- De Quervain tenosynovitis
- Dupuytren contracture
- Trigger finger
Correct answer: Carpal tunnel syndrome
Phalen's test reproduces paresthesias in the median nerve distribution by maintaining wrist flexion, indicating carpal tunnel syndrome.
Question 3: Which assessment technique is used to evaluate for fluid in the knee joint (ballottement)?
- Patella tap test (Correct answer)
- Valgus stress test
- Anterior drawer test
- Lachman test
Correct answer: Patella tap test
The patella tap test (ballottement) detects knee effusion by compressing the suprapatellar pouch and tapping the patella to feel for fluid displacement.
Question 4: When auscultating heart sounds, which position best accentuates the murmur of mitral stenosis?
- Left lateral decubitus (Correct answer)
- Sitting forward
- Supine
- Standing
Correct answer: Left lateral decubitus
The left lateral decubitus position brings the mitral valve closer to the chest wall and is optimal for hearing the low-pitched diastolic rumble of mitral stenosis.
Question 5: A patient with suspected deep vein thrombosis has a positive Homan sign. Which clinical finding constitutes a positive Homan sign?
- Calf pain with passive dorsiflexion of the foot (Correct answer)
- Edema extending above the knee
- Pitting edema of the lower extremity
- Erythema and warmth over the calf
Correct answer: Calf pain with passive dorsiflexion of the foot
Homan sign is positive when dorsiflexion of the foot causes calf pain, suggesting DVT, though it has low sensitivity and specificity.
Question 6: Which finding on fundoscopic exam indicates increased intracranial pressure?
- Papilledema (Correct answer)
- Cotton wool spots
- Flame hemorrhages
- Microaneurysms
Correct answer: Papilledema
Papilledema is blurring and elevation of the optic disc margins caused by transmission of increased intracranial pressure through the optic nerve sheath.
APEA APEA Clinical Assessment Skills Questions and Answers 2
A nurse practitioner performs a Rinne test and finds air conduction is less than bone conduction in the left ear.
This indicates which type of hearing loss?