NR 509 / NR509 Advanced Physical Assessment Final Exam Review (Weeks 5-8) | 150+ Verified Q&A with Detailed Rationales | Chamberlain University | 2025/2026 Updated | A+ Graded

Comprehensive final exam review for the NR509 Advanced Physical Assessment course at Chamberlain University, covering Weeks 5 through 8. Updated for the 2025/2026 academic year, this A+ graded resource features 150+ exam-style questions with verified correct answers and detailed rationales, covering all key topics tested on the NR509 Final Exam. The actual exam consists of 100 questions with a 120-minute time limit, is non-cumulative, and delivered via Examplify (online proctored) . Key Topics Covered: Breast & Female Reproductive Assessment Breast Exam: Best performed 5-7 days after the first day of menstruation; inspect for symmetry, contours, and retractions; palpate with patient supine with arm above head using ladder pattern with circular motion at each location Montgomery Glands: Sebaceous glands that secrete a protective lipid substance during lactation Galactorrhea: Milky discharge from the nipple unrelated to normal breastfeeding Mammary Souffle: "Puff of air" (venous hum) heard during pregnancy and lactation Breast Cancer Signs: Redness, peau d'orange (thickening with prominent pores), flattening instead of normal convexity, asymmetry, nipple direction changes, and Paget disease (rash, scaling, ulceration of nipple and areola) Breast Cancer Risk Factors: Increasing age, first-degree family member, BRCA1/BRCA2 mutations, personal history of precancerous breast mass, dense breast tissue, high-dose radiation, and high estrogen levels Abdominal & Gastrointestinal Assessment Appendicitis Signs: McBurney's point tenderness, Rovsing sign (rebound tenderness when palpating LLQ), Psoas sign (flexion of thigh contracts psoas muscle), Obturator sign (flex right thigh, bend knee, rotate leg internally), leukocytosis, high fever, nausea, vomiting Diverticulitis: LLQ pain, rebound tenderness, constipation, leukocytosis, hematochezia Cholecystitis: Intermittent pain caused by obstruction in the bile system; usually related to gallstones; Murphy's sign positive; liver assessment via palpation and percussion IBS (Irritable Bowel Syndrome): Diagnosis of exclusion; intermittent pain for at least 12 weeks over a year, relief with defecation, changes in stool frequency and consistency, mucous in stool, bloating, commonly associated with food intolerances IBD (Inflammatory Bowel Disease): Mucous in stool, bloating, chronic diarrhea, hematochezia, anal fissures; Crohn's: skip lesions/cobblestoning; UC: continuous inflammation; strong family link Colon Cancer: Changes in stool, palpable mass (late stage), pencil-thin stools, hematochezia; (+) Cologuard/fecal tests → colonoscopy Colon Cancer Risk Factors: African American, male, elderly, IBD, family history, inactivity, low-fiber diet, obesity, alcohol, cigarette smoking Hepatitis A: Fecal-oral route, usually not chronic Hepatitis B: Injection, contact with body fluid Hepatitis C: Injection, blood transfusion (most prevalent chronic bloodborne disease) PUD (Peptic Ulcer Disease): Common causes: H. pylori and NSAIDs; pain after meals (2-3 hr delay for duodenal); GERD, hematemesis, melena; treat with PPI, H2RA, antacids Male & Genitourinary Assessment Rectal Exam: Side-lying preferred for elderly/obese; standing bent forward; bear down to pass external sphincter; assess glove for bleeding, discharge, fecal matter; masses: movable = fecal matter, immovable = prostate nodule, hemorrhoid, or fecal matter Prostate Cancer Risk Factors: Higher risk at age 40, increases rapidly after age 50; African American higher incidence and mortality; Agent Orange exposure; high-fat diet; obesity; cigarette smoking; cadmium exposure Primary Screening Test for Prostate Cancer: PSA (Prostate-Specific Antigen) Proctitis Causes: IBD, STIs, trauma, bacterial infections, radiation therapy (especially for prostate cancer treatment) Hernias: Protrusion of a loop of an organ or tissue through an abnormal opening; Femoral hernias are at higher risk for incarceration and strangulation Incarcerated Hernia: Contents cannot be returned to abdominal cavity Strangulated Hernia: Blood supply is compromised Gynecological & Reproductive Assessment Normal Discharge: Clear, white, may have white clumps, not odorous Candidiasis: Thick, white, curdy discharge, not odorous, with pruritus, vaginal soreness, pain with urination, dyspareunia Bacterial Vaginosis (BV): Gray, white, thin discharge, very odorous, worse after intercourse PID (Pelvic Inflammatory Disease): Most common cause of acute pelvic pain; secondary to STDs, ectopic pregnancy, recent IUD insertion Cervical Cancer: Extensive cauliflower-like growth Cervical Cancer Risk Factors: Immunosuppression, long-term OC use, chlamydia infection, precancerous lesions, in utero DES exposure, more than 3 full-term pregnancies Musculoskeletal Assessment Osteoarthritis: Age 60; "wear and tear," degenerative; Heberden nodes (DIP); Bouchard nodes (PIP); wide base stance; pain worse with activity Rheumatoid Arthritis: Tender, painful, stiff, symmetric, ulnar deviation, pain worse at rest, morning stiffness Gout: Uric acid buildup; crystal deposits in joints; erythema; deformities; most common in big toe, distal locations Pseudogout: Calcium crystals (NOT urate) Muscle Strength Rating (0-5 Scale): 0 = no contraction (flaccid); 1 = barely detectable movement; 2 = movement, not against gravity, not against resistance; 3 = movement against gravity, not against resistance; 4 = movement against gravity, some resistance; 5 = full movement with full resistance Special Tests: External rotation resistance test, Empty can test, Midline vs off-midline back pain causes Cauda Equina Syndrome: Low back pain + bowel/bladder incontinence + saddle seat anesthesia (emergency!) Abdominal & Systemic Conditions Barrett's Esophagus: Risk factor for esophageal cancer AAA Risk Factor: History of smoking is most significant risk factor Appendicitis with Peritonitis: Pressing down onto abdomen firmly and slowly, then withdrawing hand quickly produces pain (rebound tenderness) Kartagener Syndrome: Situs inversus → tympany to percussion in RUQ, dullness to percussion of LUQ Functional Constipation: Functional change in bowel movement Documentation & Clinical Reasoning Differential Diagnosis List: A list of potential/plausible diagnoses that may be causing the signs and symptoms JVP Assessment: Decreased in hypovolemic patients (GI bleed, marked dehydration); elevated in hypervolemic patients (CHF, renal failure) USPSTF Colorectal Cancer Screening: Recommendations based on patient risk factors Perfect for Chamberlain University nursing students, graduate nursing students, and healthcare professionals preparing for the NR509 final exam or advanced physical assessment certification. A+ Graded | 2025/2026 Updated |