NR-509 – Advanced Physical Assessment Develops
advanced examination skills, diagnostic reasoning,
clinical interpretation, patient assessment techniques,
and healthcare decision-making.
1. A 68-year-old male presents for a routine examination. His blood pressure
is 148/92 mm Hg in the right arm and 142/88 mm Hg in the left arm. Which of
the following is the most appropriate next step?
A. Diagnose hypertension and start medication.
B. Repeat BP in both arms after 5 minutes of rest; if persistent, evaluate for
subclavian stenosis or aortic dissection.
C. Assume it is a normal variant because the difference is <10 mm Hg.
D. Order a carotid ultrasound immediately.
Correct Answer: B
Rationale: A persistent inter-arm BP difference >10-15 mm Hg may indicate
subclavian artery stenosis or aortic dissection. Repeat measurement is needed; if
confirmed, further vascular evaluation is indicated.
2. A 45-year-old female has a heart rate of 52 bpm, regular, and reports no
symptoms. She runs marathons. The nurse practitioner should:
A. Diagnose bradycardia and order a pacemaker.
B. Recognize this as normal for an athletic individual and document.
C. Immediately start atropine.
D. Order a thyroid panel and echocardiogram.
Correct Answer: B
Rationale: Resting bradycardia (40-60 bpm) is common in well-conditioned
athletes and is a normal physiological adaptation. No intervention is needed
without symptoms.
3. Which of the following is the most accurate method to assess for orthostatic
hypotension?
A. Measure BP once while lying, then immediately upon standing.
B. Measure BP after lying supine for 5 minutes, then after standing at 1 and 3
minutes.
C. Measure BP only after the patient exercises.
,D. Measure BP in sitting position then after lying down.
Correct Answer: B
Rationale: Orthostatic hypotension is defined as a drop in SBP ≥20 mm Hg or
DBP ≥10 mm Hg within 3 minutes of standing after 5 minutes supine. Repeated
measurements are essential.
4. A patient has a pulse oximetry reading of 92% on room air. He has no
respiratory symptoms. Which of the following is the best next step?
A. Immediately apply oxygen.
B. Compare to baseline and consider causes (e.g., anemia, hypoventilation, or early
lung disease); repeat on a different finger.
C. Disregard as a machine error.
D. Order a chest x-ray without further assessment.
Correct Answer: B
Rationale: SpO2 92% is borderline low. The clinician should verify by using a
different site, check waveform, and correlate with history and physical exam.
Asymptomatic hypoxia may indicate early disease.
5. A 72-year-old male has a temperature of 38.8°C (101.8°F) by oral
thermometer. He reports feeling cold and has chills. The nurse practitioner
suspects bacteremia. Which of the following is the most appropriate next
step?
A. Give acetaminophen and wait.
B. Draw blood cultures and start empiric antibiotics after cultures (per sepsis
protocol).
C. Repeat temperature with a tympanic thermometer.
D. Schedule a follow-up in 2 weeks.
Correct Answer: B
Rationale: Fever with chills in an older adult raises concern for serious infection.
Blood cultures should be obtained before antibiotics, but antibiotics should not be
delayed unnecessarily. However, the correct sequence is cultures then antibiotics.
6. A patient’s respiratory rate is documented as 18 breaths per minute by
counting for 15 seconds and multiplying by 4. To increase accuracy, the best
method is:
A. Count for 60 seconds, preferably without the patient’s awareness.
B. Count for 10 seconds and multiply by 6.
C. Use a pulse oximeter respiratory rate.
, D. Rely on patient self-report.
Correct Answer: A
Rationale: Counting for 60 seconds increases accuracy, especially in detecting
irregularities. Awareness often changes breathing rate; observing without
announcing improves reliability.
7. A 30-year-old pregnant woman at 28 weeks gestation has blood pressure
110/70 mm Hg supine and 95/60 mm Hg sitting. She feels lightheaded. This is
most likely due to:
A. Preeclampsia.
B. Supine hypotension syndrome (compression of vena cava by uterus).
C. Hyperthyroidism.
D. Anemia.
Correct Answer: B
Rationale: Supine hypotensive syndrome occurs when the gravid uterus
compresses the inferior vena cava, reducing preload. Symptoms improve with left
lateral positioning.
8. A patient has a body mass index (BMI) of 34 kg/m² and a waist
circumference of 102 cm (40 inches). According to current guidelines, this
indicates:
A. Normal weight.
B. Overweight, but no increased risk.
C. Class I obesity with increased cardiovascular risk (waist circumference >40 in
men).
D. Underweight.
Correct Answer: C
Rationale: BMI 30-34.9 = Class I obesity. Waist circumference >102 cm (40 in) in
men or >88 cm (35 in) in women indicates central obesity, which adds metabolic
risk.
9. Which of the following is the most reliable method to assess body
temperature in a patient with suspected hyperthermia and rigors?
A. Axillary thermometer.
B. Temporal artery thermometer.
C. Oral thermometer after cold drink.
D. Rectal or bladder thermometer (core temperature).
Correct Answer: D
advanced examination skills, diagnostic reasoning,
clinical interpretation, patient assessment techniques,
and healthcare decision-making.
1. A 68-year-old male presents for a routine examination. His blood pressure
is 148/92 mm Hg in the right arm and 142/88 mm Hg in the left arm. Which of
the following is the most appropriate next step?
A. Diagnose hypertension and start medication.
B. Repeat BP in both arms after 5 minutes of rest; if persistent, evaluate for
subclavian stenosis or aortic dissection.
C. Assume it is a normal variant because the difference is <10 mm Hg.
D. Order a carotid ultrasound immediately.
Correct Answer: B
Rationale: A persistent inter-arm BP difference >10-15 mm Hg may indicate
subclavian artery stenosis or aortic dissection. Repeat measurement is needed; if
confirmed, further vascular evaluation is indicated.
2. A 45-year-old female has a heart rate of 52 bpm, regular, and reports no
symptoms. She runs marathons. The nurse practitioner should:
A. Diagnose bradycardia and order a pacemaker.
B. Recognize this as normal for an athletic individual and document.
C. Immediately start atropine.
D. Order a thyroid panel and echocardiogram.
Correct Answer: B
Rationale: Resting bradycardia (40-60 bpm) is common in well-conditioned
athletes and is a normal physiological adaptation. No intervention is needed
without symptoms.
3. Which of the following is the most accurate method to assess for orthostatic
hypotension?
A. Measure BP once while lying, then immediately upon standing.
B. Measure BP after lying supine for 5 minutes, then after standing at 1 and 3
minutes.
C. Measure BP only after the patient exercises.
,D. Measure BP in sitting position then after lying down.
Correct Answer: B
Rationale: Orthostatic hypotension is defined as a drop in SBP ≥20 mm Hg or
DBP ≥10 mm Hg within 3 minutes of standing after 5 minutes supine. Repeated
measurements are essential.
4. A patient has a pulse oximetry reading of 92% on room air. He has no
respiratory symptoms. Which of the following is the best next step?
A. Immediately apply oxygen.
B. Compare to baseline and consider causes (e.g., anemia, hypoventilation, or early
lung disease); repeat on a different finger.
C. Disregard as a machine error.
D. Order a chest x-ray without further assessment.
Correct Answer: B
Rationale: SpO2 92% is borderline low. The clinician should verify by using a
different site, check waveform, and correlate with history and physical exam.
Asymptomatic hypoxia may indicate early disease.
5. A 72-year-old male has a temperature of 38.8°C (101.8°F) by oral
thermometer. He reports feeling cold and has chills. The nurse practitioner
suspects bacteremia. Which of the following is the most appropriate next
step?
A. Give acetaminophen and wait.
B. Draw blood cultures and start empiric antibiotics after cultures (per sepsis
protocol).
C. Repeat temperature with a tympanic thermometer.
D. Schedule a follow-up in 2 weeks.
Correct Answer: B
Rationale: Fever with chills in an older adult raises concern for serious infection.
Blood cultures should be obtained before antibiotics, but antibiotics should not be
delayed unnecessarily. However, the correct sequence is cultures then antibiotics.
6. A patient’s respiratory rate is documented as 18 breaths per minute by
counting for 15 seconds and multiplying by 4. To increase accuracy, the best
method is:
A. Count for 60 seconds, preferably without the patient’s awareness.
B. Count for 10 seconds and multiply by 6.
C. Use a pulse oximeter respiratory rate.
, D. Rely on patient self-report.
Correct Answer: A
Rationale: Counting for 60 seconds increases accuracy, especially in detecting
irregularities. Awareness often changes breathing rate; observing without
announcing improves reliability.
7. A 30-year-old pregnant woman at 28 weeks gestation has blood pressure
110/70 mm Hg supine and 95/60 mm Hg sitting. She feels lightheaded. This is
most likely due to:
A. Preeclampsia.
B. Supine hypotension syndrome (compression of vena cava by uterus).
C. Hyperthyroidism.
D. Anemia.
Correct Answer: B
Rationale: Supine hypotensive syndrome occurs when the gravid uterus
compresses the inferior vena cava, reducing preload. Symptoms improve with left
lateral positioning.
8. A patient has a body mass index (BMI) of 34 kg/m² and a waist
circumference of 102 cm (40 inches). According to current guidelines, this
indicates:
A. Normal weight.
B. Overweight, but no increased risk.
C. Class I obesity with increased cardiovascular risk (waist circumference >40 in
men).
D. Underweight.
Correct Answer: C
Rationale: BMI 30-34.9 = Class I obesity. Waist circumference >102 cm (40 in) in
men or >88 cm (35 in) in women indicates central obesity, which adds metabolic
risk.
9. Which of the following is the most reliable method to assess body
temperature in a patient with suspected hyperthermia and rigors?
A. Axillary thermometer.
B. Temporal artery thermometer.
C. Oral thermometer after cold drink.
D. Rectal or bladder thermometer (core temperature).
Correct Answer: D
