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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+
NR-509 Advanced Physical Assessment — 100 Comprehensive Practice
Questions
Important note: These are original, rigorously researched practice/study
questions covering NR-509 core competencies. These practice questions are
designed to be harder than the real exam so you're fully prepared.
DOMAIN 1: HEAD, EYES, EARS, NOSE & THROAT (HEENT)
Q1. A 58-year-old patient presents with sudden onset of painless monocular
vision loss described as "a curtain coming down." Which of the following is the
MOST likely diagnosis?
• A) Central retinal artery occlusion
• B) Retinal detachment
• C) Acute angle-closure glaucoma
• D) Vitreous hemorrhage
✅ Answer: B — Retinal detachment Rationale: The classic "curtain or shadow"
description with painless monocular vision loss is pathognomonic for retinal
detachment. Central retinal artery occlusion presents as sudden, complete,
painless vision loss without the curtain description. Acute angle-closure glaucoma
is painful with halos around lights.
pg. 1
,2
Q2. During fundoscopic examination of a hypertensive patient, you observe
arteriovenous (AV) nicking. This finding indicates:
• A) Increased venous pressure causing arterial compression
• B) Arterial wall thickening compressing the underlying vein at crossing
points
• C) Neovascularization secondary to retinal ischemia
• D) Early diabetic retinopathy
✅ Answer: B — Arterial wall thickening compressing the underlying vein
Rationale: AV nicking (nipping) occurs when thickened arteriolar walls compress
the underlying venous wall at crossing points, a hallmark of chronic hypertension.
This is grade II Keith-Wagener-Barker classification.
Q3. A patient complains of ear pain. On otoscopy, you find a red, bulging
tympanic membrane with loss of the light reflex and absent bony landmarks. The
MOST appropriate diagnosis is:
• A) Otitis media with effusion
• B) Acute otitis media
• C) Bullous myringitis
• D) Tympanosclerosis
✅ Answer: B — Acute otitis media Rationale: Acute otitis media presents with
bulging, erythematous TM, loss of light reflex, obliteration of bony landmarks, and
pain. Otitis media with effusion has a retracted amber TM with visible air-fluid
levels. Bullous myringitis shows hemorrhagic blebs on the TM.
Q4. Weber test lateralizes to the RIGHT ear, and Rinne test shows BC > AC in the
RIGHT ear. These findings are MOST consistent with:
• A) Sensorineural hearing loss in the left ear
• B) Conductive hearing loss in the right ear
pg. 2
,3
• C) Mixed hearing loss bilaterally
• D) Presbycusis
✅ Answer: B — Conductive hearing loss in the right ear Rationale: In
conductive hearing loss, Weber lateralizes to the AFFECTED ear (sound conducted
better through bone to the diseased side). Rinne shows BC > AC on the affected
side (normal is AC > BC). Both findings point to right conductive hearing loss.
Q5. A 45-year-old presents with facial pain over the cheeks worse with bending
forward, purulent nasal discharge, and fever for 10 days after a URI. The
transillumination of the sinuses shows absent light transmission bilaterally. The
MOST likely diagnosis is:
• A) Allergic rhinitis
• B) Acute bacterial rhinosinusitis
• C) Nasal polyps
• D) Frontal sinusitis
✅ Answer: B — Acute bacterial rhinosinusitis Rationale: Bacterial sinusitis
criteria include: symptoms ≥10 days, purulent discharge, facial pain/pressure,
fever. Transillumination absence indicates fluid. The cheek location indicates
maxillary sinusitis. Frontal sinusitis would present with forehead pain.
Q6. On thyroid palpation, you note a single, firm, non-tender nodule that does
NOT move with swallowing. This finding MOST suggests:
• A) Simple thyroid cyst
• B) Hashimoto's thyroiditis
• C) Malignancy or fixed mass
• D) Multinodular goiter
pg. 3
, 4
✅ Answer: C — Malignancy or fixed mass Rationale: Normal thyroid tissue and
benign nodules rise with swallowing because they're attached to the
larynx/trachea. Failure to move with swallowing suggests fixation to surrounding
structures, raising concern for malignancy.
Q7. You assess a patient with a deviated uvula pointing to the LEFT. This is MOST
consistent with:
• A) Left-sided peritonsillar abscess
• B) Right-sided peritonsillar abscess
• C) Left CN X palsy
• D) Bilateral tonsillar hypertrophy
✅ Answer: B — Right-sided peritonsillar abscess Rationale: A peritonsillar
abscess pushes the uvula away from the affected side. If the abscess is on the
right, the uvula deviates to the left. CN X palsy causes uvula deviation to the
OPPOSITE (intact) side when soft palate rises.
Q8. Which of the following is the EARLIEST sign of increased intracranial pressure
(ICP) on fundoscopic exam?
• A) Retinal hemorrhages
• B) Loss of venous pulsations
• C) Papilledema with blurred disc margins
• D) Cotton-wool spots
✅ Answer: B — Loss of venous pulsations Rationale: Spontaneous venous
pulsations are normally present in 80% of people. Loss of venous pulsations is the
earliest sign of elevated ICP. Frank papilledema (blurred disc margins, disc
elevation) occurs later as ICP rises further.
pg. 4
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+
NR-509 Advanced Physical Assessment — 100 Comprehensive Practice
Questions
Important note: These are original, rigorously researched practice/study
questions covering NR-509 core competencies. These practice questions are
designed to be harder than the real exam so you're fully prepared.
DOMAIN 1: HEAD, EYES, EARS, NOSE & THROAT (HEENT)
Q1. A 58-year-old patient presents with sudden onset of painless monocular
vision loss described as "a curtain coming down." Which of the following is the
MOST likely diagnosis?
• A) Central retinal artery occlusion
• B) Retinal detachment
• C) Acute angle-closure glaucoma
• D) Vitreous hemorrhage
✅ Answer: B — Retinal detachment Rationale: The classic "curtain or shadow"
description with painless monocular vision loss is pathognomonic for retinal
detachment. Central retinal artery occlusion presents as sudden, complete,
painless vision loss without the curtain description. Acute angle-closure glaucoma
is painful with halos around lights.
pg. 1
,2
Q2. During fundoscopic examination of a hypertensive patient, you observe
arteriovenous (AV) nicking. This finding indicates:
• A) Increased venous pressure causing arterial compression
• B) Arterial wall thickening compressing the underlying vein at crossing
points
• C) Neovascularization secondary to retinal ischemia
• D) Early diabetic retinopathy
✅ Answer: B — Arterial wall thickening compressing the underlying vein
Rationale: AV nicking (nipping) occurs when thickened arteriolar walls compress
the underlying venous wall at crossing points, a hallmark of chronic hypertension.
This is grade II Keith-Wagener-Barker classification.
Q3. A patient complains of ear pain. On otoscopy, you find a red, bulging
tympanic membrane with loss of the light reflex and absent bony landmarks. The
MOST appropriate diagnosis is:
• A) Otitis media with effusion
• B) Acute otitis media
• C) Bullous myringitis
• D) Tympanosclerosis
✅ Answer: B — Acute otitis media Rationale: Acute otitis media presents with
bulging, erythematous TM, loss of light reflex, obliteration of bony landmarks, and
pain. Otitis media with effusion has a retracted amber TM with visible air-fluid
levels. Bullous myringitis shows hemorrhagic blebs on the TM.
Q4. Weber test lateralizes to the RIGHT ear, and Rinne test shows BC > AC in the
RIGHT ear. These findings are MOST consistent with:
• A) Sensorineural hearing loss in the left ear
• B) Conductive hearing loss in the right ear
pg. 2
,3
• C) Mixed hearing loss bilaterally
• D) Presbycusis
✅ Answer: B — Conductive hearing loss in the right ear Rationale: In
conductive hearing loss, Weber lateralizes to the AFFECTED ear (sound conducted
better through bone to the diseased side). Rinne shows BC > AC on the affected
side (normal is AC > BC). Both findings point to right conductive hearing loss.
Q5. A 45-year-old presents with facial pain over the cheeks worse with bending
forward, purulent nasal discharge, and fever for 10 days after a URI. The
transillumination of the sinuses shows absent light transmission bilaterally. The
MOST likely diagnosis is:
• A) Allergic rhinitis
• B) Acute bacterial rhinosinusitis
• C) Nasal polyps
• D) Frontal sinusitis
✅ Answer: B — Acute bacterial rhinosinusitis Rationale: Bacterial sinusitis
criteria include: symptoms ≥10 days, purulent discharge, facial pain/pressure,
fever. Transillumination absence indicates fluid. The cheek location indicates
maxillary sinusitis. Frontal sinusitis would present with forehead pain.
Q6. On thyroid palpation, you note a single, firm, non-tender nodule that does
NOT move with swallowing. This finding MOST suggests:
• A) Simple thyroid cyst
• B) Hashimoto's thyroiditis
• C) Malignancy or fixed mass
• D) Multinodular goiter
pg. 3
, 4
✅ Answer: C — Malignancy or fixed mass Rationale: Normal thyroid tissue and
benign nodules rise with swallowing because they're attached to the
larynx/trachea. Failure to move with swallowing suggests fixation to surrounding
structures, raising concern for malignancy.
Q7. You assess a patient with a deviated uvula pointing to the LEFT. This is MOST
consistent with:
• A) Left-sided peritonsillar abscess
• B) Right-sided peritonsillar abscess
• C) Left CN X palsy
• D) Bilateral tonsillar hypertrophy
✅ Answer: B — Right-sided peritonsillar abscess Rationale: A peritonsillar
abscess pushes the uvula away from the affected side. If the abscess is on the
right, the uvula deviates to the left. CN X palsy causes uvula deviation to the
OPPOSITE (intact) side when soft palate rises.
Q8. Which of the following is the EARLIEST sign of increased intracranial pressure
(ICP) on fundoscopic exam?
• A) Retinal hemorrhages
• B) Loss of venous pulsations
• C) Papilledema with blurred disc margins
• D) Cotton-wool spots
✅ Answer: B — Loss of venous pulsations Rationale: Spontaneous venous
pulsations are normally present in 80% of people. Loss of venous pulsations is the
earliest sign of elevated ICP. Frank papilledema (blurred disc margins, disc
elevation) occurs later as ICP rises further.
pg. 4
