NR509 Week 8 Final Exam Due 22nd December
2025 Complete Actual Exam Questions 1- 100
NR-509 Advanced Physical Assessment NR 509
Midterm and Finals Examplify Online Proctored
Exam Questions and Answers | 100% Pass
Guaranteed | Graded A+
Section 1: Abdominal Assessment (Questions 1-20)
Question 1
An overweight 26-year-old public servant presents to the Emergency
Department with 12 hours of intense abdominal pain, light-headedness,
and a fainting episode. She has a strong family history of gallstones. Her
β-hCG is positive. Her last menstrual period was 10 weeks ago. Vital
signs: pulse 118, BP 86/68, RR 20. On abdominal exam, the clinician
finds involuntary rigidity and rebound tenderness. What is the most likely
diagnosis?
,,answer,,,,: Ruptured tubal (ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and peritoneal signs strongly suggest a
ruptured ectopic pregnancy with significant intra-abdominal bleeding.
This is an emergency requiring immediate gynecologic consultation.
Although acute cholecystitis and appendicitis are possibilities, the
positive pregnancy test and unstable vital signs make ruptured ectopic
pregnancy most likely.
,Question 2
A 63-year-old janitor with a history of adenomatous colonic polyps
presents for a well visit. Labs show moderate elevations of AST, ALT,
GGT, alkaline phosphatase, and mildly elevated total bilirubin. The
clinician performs an abdominal exam to assess his liver. Which finding
would be most consistent with hepatomegaly?
,,answer,,,,: Liver palpable 3 cm below the right costal margin,
midclavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin on
expiration is abnormal (normal liver is not palpable on expiration).
Findings supporting hepatomegaly are more convincing if, by percussion,
the liver span is >12 cm at the midclavicular line. Normal liver span is 6-
12 cm at the midclavicular line.
Question 3
A 63-year-old underweight administrative clerk with a 50-pack-year
smoking history presents with recurrent epigastric abdominal
discomfort. She reports a first cousin died from a ruptured aneurysm at
age 68. Vital signs: pulse 86, BP 148/92, BMI 17.6. On exam, her
abdominal aorta is prominent, concerning for an abdominal aortic
aneurysm (AAA). What is her most significant risk factor for AAA?
,,answer,,,,: History of smoking
Rationale: Smoking history is the most significant risk factor for
abdominal aortic aneurysm. Male gender (not female) is also a risk
factor. Underweight is not a risk factor. Family history of ruptured
,aneurysm in a first cousin (not first-degree relative) is less significant.
Hypertension may contribute but requires more than one elevated
reading for diagnosis.
Question 4
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using high-
sensitivity FOBT. He had one positive FOBT at age 66 followed by
colonoscopy that found internal hemorrhoids and sigmoid diverticuli. He
has no first-degree relatives with colorectal cancer. What are the USPSTF
screening recommendations for this patient?
,,answer,,,,: Do not screen routinely
Rationale: The USPSTF recommends against routine screening for adults
ages 76-85 years because the gain in life years is small compared to
colonoscopy risks. Screening should be individualized based on overall
health and prior screening history. A life expectancy >7 years is generally
needed for screening to be beneficial.
Question 5
An otherwise healthy 31-year-old accountant presents with a 3-year
history of recurrent crampy abdominal pain lasting 1-2 weeks per
episode, associated with onset of constipation. She describes
infrequent, small, hard stools. Increased dietary fiber and water are
insufficient, requiring OTC laxatives. Symptoms resolve with bowel
movements. What is the most likely physiological mechanism for her
constipation?
, ,,answer,,,,: Functional change in bowel movement
Rationale: The symptoms are characteristic of irritable bowel syndrome
(IBS), specifically constipation-predominant type. IBS involves functional
changes in bowel motility without structural abnormality. The chronic,
recurrent pattern with symptom relief after defecation is classic for IBS.
Question 6
A 23-year-old woman with Kartagener syndrome (chronic sinusitis,
bronchiectasis, situs inversus) comes to the clinic. The preceptor notes
she has situs inversus. Which abdominal exam findings would be
expected?
,,answer,,,,: Tympany to percussion in the right upper quadrant, dullness
to percussion of the left upper quadrant
Rationale: Situs inversus is associated with Kartagener syndrome.
Organs are reversed: the stomach and gastric air bubble (tympany) are on
the right, and liver dullness is on the left. This is the opposite of normal
anatomy.
Question 7
An otherwise healthy 28-year-old lawyer presents with a 1-day history of
severe abdominal pain. The emergency physician suspects appendicitis.
The resident believes the patient has signs of peritonitis on exam. Which
physical exam finding supports peritonitis?
,,answer,,,,: Pressing down onto the abdomen firmly and slowly and
withdrawing the hand quickly produces pain
2025 Complete Actual Exam Questions 1- 100
NR-509 Advanced Physical Assessment NR 509
Midterm and Finals Examplify Online Proctored
Exam Questions and Answers | 100% Pass
Guaranteed | Graded A+
Section 1: Abdominal Assessment (Questions 1-20)
Question 1
An overweight 26-year-old public servant presents to the Emergency
Department with 12 hours of intense abdominal pain, light-headedness,
and a fainting episode. She has a strong family history of gallstones. Her
β-hCG is positive. Her last menstrual period was 10 weeks ago. Vital
signs: pulse 118, BP 86/68, RR 20. On abdominal exam, the clinician
finds involuntary rigidity and rebound tenderness. What is the most likely
diagnosis?
,,answer,,,,: Ruptured tubal (ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and peritoneal signs strongly suggest a
ruptured ectopic pregnancy with significant intra-abdominal bleeding.
This is an emergency requiring immediate gynecologic consultation.
Although acute cholecystitis and appendicitis are possibilities, the
positive pregnancy test and unstable vital signs make ruptured ectopic
pregnancy most likely.
,Question 2
A 63-year-old janitor with a history of adenomatous colonic polyps
presents for a well visit. Labs show moderate elevations of AST, ALT,
GGT, alkaline phosphatase, and mildly elevated total bilirubin. The
clinician performs an abdominal exam to assess his liver. Which finding
would be most consistent with hepatomegaly?
,,answer,,,,: Liver palpable 3 cm below the right costal margin,
midclavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin on
expiration is abnormal (normal liver is not palpable on expiration).
Findings supporting hepatomegaly are more convincing if, by percussion,
the liver span is >12 cm at the midclavicular line. Normal liver span is 6-
12 cm at the midclavicular line.
Question 3
A 63-year-old underweight administrative clerk with a 50-pack-year
smoking history presents with recurrent epigastric abdominal
discomfort. She reports a first cousin died from a ruptured aneurysm at
age 68. Vital signs: pulse 86, BP 148/92, BMI 17.6. On exam, her
abdominal aorta is prominent, concerning for an abdominal aortic
aneurysm (AAA). What is her most significant risk factor for AAA?
,,answer,,,,: History of smoking
Rationale: Smoking history is the most significant risk factor for
abdominal aortic aneurysm. Male gender (not female) is also a risk
factor. Underweight is not a risk factor. Family history of ruptured
,aneurysm in a first cousin (not first-degree relative) is less significant.
Hypertension may contribute but requires more than one elevated
reading for diagnosis.
Question 4
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using high-
sensitivity FOBT. He had one positive FOBT at age 66 followed by
colonoscopy that found internal hemorrhoids and sigmoid diverticuli. He
has no first-degree relatives with colorectal cancer. What are the USPSTF
screening recommendations for this patient?
,,answer,,,,: Do not screen routinely
Rationale: The USPSTF recommends against routine screening for adults
ages 76-85 years because the gain in life years is small compared to
colonoscopy risks. Screening should be individualized based on overall
health and prior screening history. A life expectancy >7 years is generally
needed for screening to be beneficial.
Question 5
An otherwise healthy 31-year-old accountant presents with a 3-year
history of recurrent crampy abdominal pain lasting 1-2 weeks per
episode, associated with onset of constipation. She describes
infrequent, small, hard stools. Increased dietary fiber and water are
insufficient, requiring OTC laxatives. Symptoms resolve with bowel
movements. What is the most likely physiological mechanism for her
constipation?
, ,,answer,,,,: Functional change in bowel movement
Rationale: The symptoms are characteristic of irritable bowel syndrome
(IBS), specifically constipation-predominant type. IBS involves functional
changes in bowel motility without structural abnormality. The chronic,
recurrent pattern with symptom relief after defecation is classic for IBS.
Question 6
A 23-year-old woman with Kartagener syndrome (chronic sinusitis,
bronchiectasis, situs inversus) comes to the clinic. The preceptor notes
she has situs inversus. Which abdominal exam findings would be
expected?
,,answer,,,,: Tympany to percussion in the right upper quadrant, dullness
to percussion of the left upper quadrant
Rationale: Situs inversus is associated with Kartagener syndrome.
Organs are reversed: the stomach and gastric air bubble (tympany) are on
the right, and liver dullness is on the left. This is the opposite of normal
anatomy.
Question 7
An otherwise healthy 28-year-old lawyer presents with a 1-day history of
severe abdominal pain. The emergency physician suspects appendicitis.
The resident believes the patient has signs of peritonitis on exam. Which
physical exam finding supports peritonitis?
,,answer,,,,: Pressing down onto the abdomen firmly and slowly and
withdrawing the hand quickly produces pain
