NR 509 MIDTERM EXAM – ADVANCED PHYSICAL 3. When assessing a patient for jugular venous distension, which
ASSESSMENT / CHAMBERLAIN ACTUAL EXAM position is recommended?
QUESTIONS AND VERIFIED ANSWERS WITH A. Supine, with head flat
RATIONALES GRADED A+ LATEST B. Sitting upright at 90 degrees
C. Supine, with head elevated 30–45 degrees
D. Standing
1. A 54-year-old patient presents with sudden onset of severe chest pain
Answer: C
radiating to the jaw and left arm. Which initial assessment finding most
Rationale: Elevating the head to 30–45 degrees allows optimal
strongly supports the suspicion of myocardial infarction?
visualization of the jugular veins and helps distinguish JVD from normal
A. Blood pressure of 118/76 mmHg
neck veins.
B. Heart rate of 78 bpm
C. ST-segment elevation on ECG
D. Mild shortness of breath 4. A patient presents with unilateral swelling, warmth, and tenderness of
Answer: C the calf. Which assessment tool is most appropriate to evaluate for deep
Rationale: ST-segment elevation on an ECG is a hallmark sign of acute vein thrombosis (DVT)?
myocardial infarction and is critical for immediate diagnosis and A. Homan’s sign
intervention. Vital signs alone are not diagnostic. B. Peripheral pulse palpation
C. Capillary refill time
D. Allen’s test
2. During auscultation of the lungs, a nurse notes fine, late inspiratory
Answer: A
crackles at the bases bilaterally. The most likely underlying cause is:
Rationale: Homan’s sign (pain in the calf with dorsiflexion of the foot)
A. Asthma
may indicate DVT, but it is not definitive. Further diagnostic imaging
B. Pulmonary edema
(e.g., Doppler ultrasound) is warranted.
C. Chronic bronchitis
D. Pleural effusion
Answer: B
Rationale: Fine, late inspiratory crackles, especially at the lung bases,
suggest fluid accumulation consistent with pulmonary edema.
,5. Which cranial nerve is assessed by asking a patient to smile, frown, Answer: B
and raise their eyebrows? Rationale: Orthostatic vital signs help identify postural hypotension, a
A. CN V – Trigeminal common cause of dizziness in hypertensive patients on medication.
B. CN VII – Facial
C. CN IX – Glossopharyngeal
D. CN XI – Accessory 8. When performing a focused musculoskeletal assessment on the knee,
which finding indicates a positive McMurray test?
Answer: B
A. Decreased passive range of motion
Rationale: The facial nerve (CN VII) controls facial expression
B. Audible click or pop with knee rotation
muscles; testing movements such as smiling and raising eyebrows
C. Tenderness along the medial joint line
assesses its function. D. Swelling of the quadriceps
Answer: B
6. While examining a patient’s abdomen, the nurse notes a bruit over the Rationale: A clicking or popping sensation during the McMurray
epigastric region. This finding is most consistent with: maneuver suggests a meniscal tear in the knee.
A. Liver cirrhosis
B. Renal artery stenosis
C. Abdominal aortic aneurysm 9. A nurse notes that a patient has a blood pressure of 150/92 mmHg and
D. Gastroesophageal reflux disease a heart rate of 104 bpm. Which additional finding would best indicate
possible secondary hypertension?
Answer: C
A. Obesity
Rationale: A systolic bruit over the epigastric area may indicate
B. Epistaxis
turbulent blood flow through an abdominal aortic aneurysm.
C. Abdominal bruit
D. Peripheral edema
7. A 45-year-old patient has a history of hypertension and reports Answer: C
dizziness upon standing. Which assessment is most important? Rationale: An abdominal bruit suggests renovascular causes of
A. Apical heart rate secondary hypertension, whereas obesity and epistaxis are more
B. Orthostatic vital signs associated with primary hypertension or nonspecific signs.
C. Lung auscultation
D. Abdominal palpation
,10. During a neurological exam, a patient demonstrates pronator drift of Answer: A
the right arm. This finding most likely indicates: Rationale: Jaundice with RUQ tenderness is consistent with
A. Cerebellar dysfunction hepatocellular injury or cholestasis; elevated liver enzymes (AST, ALT)
B. Upper motor neuron lesion confirm liver involvement.
C. Peripheral neuropathy
D. Lower motor neuron lesion
13. Which percussion note is expected over a normal adult lung?
Answer: B
A. Dull
Rationale: Pronator drift is a sensitive sign of subtle upper motor
B. Resonant
neuron weakness, often due to a lesion in the corticospinal tract.
C. Tympanic
D. Flat
11. Which assessment technique is best for evaluating tactile fremitus in Answer: B
a patient with suspected pneumonia? Rationale: Normal lung tissue produces a resonant sound upon
A. Palpation of chest wall while patient whispers “ninety-nine” percussion; dullness may indicate consolidation or effusion.
B. Percussion over lung fields
C. Auscultation of breath sounds
D. Observation of chest expansion 14. When assessing a patient’s reflexes, the nurse notes a grade 3+
patellar reflex. This is interpreted as:
Answer: A
A. Absent reflex
Rationale: Tactile fremitus is assessed by palpating vibrations on the
B. Normal
chest wall while the patient vocalizes a phrase; increased fremitus occurs
C. Brisker than average
over areas of consolidation. D. Hyperactive with clonus
Answer: C
12. A patient presents with jaundice, dark urine, and right upper Rationale: A 3+ reflex is brisker than average but not pathologic; grade
quadrant tenderness. Which lab test is most consistent with this 4+ indicates hyperactive reflexes with clonus.
presentation?
A. Elevated AST/ALT
B. Low WBC count
C. Hyperglycemia
D. Elevated creatinine
, 15. Which cardiac auscultation finding is most characteristic of aortic 17. During eye examination, a patient demonstrates a sudden loss of
stenosis? central vision in the left eye. Which assessment tool should the nurse use
A. Mid-diastolic murmur at apex first?
B. Harsh systolic crescendo-decrescendo murmur at right upper sternal A. Confrontation visual field test
border B. Fundoscopic examination
C. Continuous machinery murmur at left infraclavicular area C. Extraocular movements
D. Soft systolic ejection murmur at lower left sternal border D. Pupillary light reflex
Answer: B Answer: B
Rationale: Aortic stenosis produces a systolic crescendo-decrescendo Rationale: Sudden central vision loss warrants fundoscopic examination
murmur heard best at the right upper sternal border radiating to the to assess for retinal detachment, macular degeneration, or vascular
carotid arteries. occlusion.
16. A patient with chronic liver disease presents with spider angiomas 18. A patient presents with tachypnea, accessory muscle use, and
and palmar erythema. These findings are primarily caused by: wheezing. The nurse suspects acute asthma exacerbation. Which
A. Portal hypertension assessment finding most accurately reflects airflow limitation?
B. Hyperbilirubinemia A. Peak expiratory flow rate (PEFR)
C. Estrogen excess due to impaired liver metabolism B. SpO₂
D. Vitamin K deficiency C. Respiratory rate
D. Breath sound symmetry
Answer: C
Rationale: Liver dysfunction impairs estrogen metabolism, leading to Answer: A
vascular changes like spider angiomas and palmar erythema. Rationale: PEFR quantifies airflow obstruction and is essential in
monitoring severity of asthma exacerbation.
ASSESSMENT / CHAMBERLAIN ACTUAL EXAM position is recommended?
QUESTIONS AND VERIFIED ANSWERS WITH A. Supine, with head flat
RATIONALES GRADED A+ LATEST B. Sitting upright at 90 degrees
C. Supine, with head elevated 30–45 degrees
D. Standing
1. A 54-year-old patient presents with sudden onset of severe chest pain
Answer: C
radiating to the jaw and left arm. Which initial assessment finding most
Rationale: Elevating the head to 30–45 degrees allows optimal
strongly supports the suspicion of myocardial infarction?
visualization of the jugular veins and helps distinguish JVD from normal
A. Blood pressure of 118/76 mmHg
neck veins.
B. Heart rate of 78 bpm
C. ST-segment elevation on ECG
D. Mild shortness of breath 4. A patient presents with unilateral swelling, warmth, and tenderness of
Answer: C the calf. Which assessment tool is most appropriate to evaluate for deep
Rationale: ST-segment elevation on an ECG is a hallmark sign of acute vein thrombosis (DVT)?
myocardial infarction and is critical for immediate diagnosis and A. Homan’s sign
intervention. Vital signs alone are not diagnostic. B. Peripheral pulse palpation
C. Capillary refill time
D. Allen’s test
2. During auscultation of the lungs, a nurse notes fine, late inspiratory
Answer: A
crackles at the bases bilaterally. The most likely underlying cause is:
Rationale: Homan’s sign (pain in the calf with dorsiflexion of the foot)
A. Asthma
may indicate DVT, but it is not definitive. Further diagnostic imaging
B. Pulmonary edema
(e.g., Doppler ultrasound) is warranted.
C. Chronic bronchitis
D. Pleural effusion
Answer: B
Rationale: Fine, late inspiratory crackles, especially at the lung bases,
suggest fluid accumulation consistent with pulmonary edema.
,5. Which cranial nerve is assessed by asking a patient to smile, frown, Answer: B
and raise their eyebrows? Rationale: Orthostatic vital signs help identify postural hypotension, a
A. CN V – Trigeminal common cause of dizziness in hypertensive patients on medication.
B. CN VII – Facial
C. CN IX – Glossopharyngeal
D. CN XI – Accessory 8. When performing a focused musculoskeletal assessment on the knee,
which finding indicates a positive McMurray test?
Answer: B
A. Decreased passive range of motion
Rationale: The facial nerve (CN VII) controls facial expression
B. Audible click or pop with knee rotation
muscles; testing movements such as smiling and raising eyebrows
C. Tenderness along the medial joint line
assesses its function. D. Swelling of the quadriceps
Answer: B
6. While examining a patient’s abdomen, the nurse notes a bruit over the Rationale: A clicking or popping sensation during the McMurray
epigastric region. This finding is most consistent with: maneuver suggests a meniscal tear in the knee.
A. Liver cirrhosis
B. Renal artery stenosis
C. Abdominal aortic aneurysm 9. A nurse notes that a patient has a blood pressure of 150/92 mmHg and
D. Gastroesophageal reflux disease a heart rate of 104 bpm. Which additional finding would best indicate
possible secondary hypertension?
Answer: C
A. Obesity
Rationale: A systolic bruit over the epigastric area may indicate
B. Epistaxis
turbulent blood flow through an abdominal aortic aneurysm.
C. Abdominal bruit
D. Peripheral edema
7. A 45-year-old patient has a history of hypertension and reports Answer: C
dizziness upon standing. Which assessment is most important? Rationale: An abdominal bruit suggests renovascular causes of
A. Apical heart rate secondary hypertension, whereas obesity and epistaxis are more
B. Orthostatic vital signs associated with primary hypertension or nonspecific signs.
C. Lung auscultation
D. Abdominal palpation
,10. During a neurological exam, a patient demonstrates pronator drift of Answer: A
the right arm. This finding most likely indicates: Rationale: Jaundice with RUQ tenderness is consistent with
A. Cerebellar dysfunction hepatocellular injury or cholestasis; elevated liver enzymes (AST, ALT)
B. Upper motor neuron lesion confirm liver involvement.
C. Peripheral neuropathy
D. Lower motor neuron lesion
13. Which percussion note is expected over a normal adult lung?
Answer: B
A. Dull
Rationale: Pronator drift is a sensitive sign of subtle upper motor
B. Resonant
neuron weakness, often due to a lesion in the corticospinal tract.
C. Tympanic
D. Flat
11. Which assessment technique is best for evaluating tactile fremitus in Answer: B
a patient with suspected pneumonia? Rationale: Normal lung tissue produces a resonant sound upon
A. Palpation of chest wall while patient whispers “ninety-nine” percussion; dullness may indicate consolidation or effusion.
B. Percussion over lung fields
C. Auscultation of breath sounds
D. Observation of chest expansion 14. When assessing a patient’s reflexes, the nurse notes a grade 3+
patellar reflex. This is interpreted as:
Answer: A
A. Absent reflex
Rationale: Tactile fremitus is assessed by palpating vibrations on the
B. Normal
chest wall while the patient vocalizes a phrase; increased fremitus occurs
C. Brisker than average
over areas of consolidation. D. Hyperactive with clonus
Answer: C
12. A patient presents with jaundice, dark urine, and right upper Rationale: A 3+ reflex is brisker than average but not pathologic; grade
quadrant tenderness. Which lab test is most consistent with this 4+ indicates hyperactive reflexes with clonus.
presentation?
A. Elevated AST/ALT
B. Low WBC count
C. Hyperglycemia
D. Elevated creatinine
, 15. Which cardiac auscultation finding is most characteristic of aortic 17. During eye examination, a patient demonstrates a sudden loss of
stenosis? central vision in the left eye. Which assessment tool should the nurse use
A. Mid-diastolic murmur at apex first?
B. Harsh systolic crescendo-decrescendo murmur at right upper sternal A. Confrontation visual field test
border B. Fundoscopic examination
C. Continuous machinery murmur at left infraclavicular area C. Extraocular movements
D. Soft systolic ejection murmur at lower left sternal border D. Pupillary light reflex
Answer: B Answer: B
Rationale: Aortic stenosis produces a systolic crescendo-decrescendo Rationale: Sudden central vision loss warrants fundoscopic examination
murmur heard best at the right upper sternal border radiating to the to assess for retinal detachment, macular degeneration, or vascular
carotid arteries. occlusion.
16. A patient with chronic liver disease presents with spider angiomas 18. A patient presents with tachypnea, accessory muscle use, and
and palmar erythema. These findings are primarily caused by: wheezing. The nurse suspects acute asthma exacerbation. Which
A. Portal hypertension assessment finding most accurately reflects airflow limitation?
B. Hyperbilirubinemia A. Peak expiratory flow rate (PEFR)
C. Estrogen excess due to impaired liver metabolism B. SpO₂
D. Vitamin K deficiency C. Respiratory rate
D. Breath sound symmetry
Answer: C
Rationale: Liver dysfunction impairs estrogen metabolism, leading to Answer: A
vascular changes like spider angiomas and palmar erythema. Rationale: PEFR quantifies airflow obstruction and is essential in
monitoring severity of asthma exacerbation.
