NR 509 Advanced Physical Assessment
(Chamberlain). 100% Complete Accurate
Midterm Exam (2026/2027). – Complete
Question & Answer Actual Exam with
Rationales
1. A patient presents for evaluation of a sharp, aching chest pain which
increases with breathing. Which anatomic area would you localize the
symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
Correct Answer: A) Musculoskeletal
Rationale: Chest pain may be due to a musculoskeletal condition, such as
costochondritis or intercostal muscle cramp. This would be worsened by motion
of the chest wall. Pleuritic chest pain is also a sharp chest pain which increases
with a deep breath. This type of pain can occur with inflammation of the pleura
from pneumonia or other conditions and pulmonary embolus.
2. A patient comes to the emergency room for evaluation of shortness of
breath. To which anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic
Correct Answer: C) Cardiac
Rationale: Cardiac disorders such as congestive heart failure are the most likely
on this list to result in shortness of breath. There are cases within the other
categories which may also result in shortness of breath, such as anemia in the
Nurslink.
,hematologic category, pregnancy in the reproductive category, or sepsis with
UTI in the urinary category.
3. A patient presents for evaluation of a cough. Which of the following
anatomic regions can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine
Correct Answer: C) Cardiac
Rationale: The cardiac system can cause a cough if the patient has congestive
heart failure. This results in fluid buildup in the lungs, which in turn can cause a
cough that produces pink, frothy sputum. A foreign body in the ear may also
cause a cough by stimulating Arnold's branch of the vagus nerve, but this is less
likely to be seen clinically than heart failure.
4. A 22-year-old advertising copywriter presents for evaluation of joint
pain. The pain is new, located in the wrists and fingers bilaterally, with
some subjective fever. The patient denies a rash; she also denies recent
travel or camping activities. She has a family history significant for
rheumatoid arthritis. Based on this information, which of the following
pathologic processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic
Correct Answer: B) Inflammatory
Rationale: The description is most consistent with an inflammatory process,
although all the other etiologies should be considered. Lyme disease is an
infection which commonly causes arthritis, hemophilia is a hematologic
condition which can cause bleeding in the joints, and trauma can obviously
cause joint pain.
Nurslink.
,5. A 47-year-old contractor presents for evaluation of neck pain, which has
been intermittent for several years. He normally takes over-the-counter
medications to ease the pain, but this time they haven't worked as well and
he still has discomfort. He recently wallpapered the entire second floor in
his house, which caused him great discomfort. The pain resolved with rest.
He denies fever, chills, rash, upper respiratory symptoms, trauma, or
injury to the neck. Based on this description, what is the most likely
pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic
Correct Answer: C) Degenerative
Rationale: The description is most consistent with degenerative arthritis in the
neck. The patient has had intermittent symptoms and the questions asked to
elicit pertinent negative and positive findings are negative for infectious,
traumatic, or neoplastic disease.
6. A 15-year-old high school sophomore comes to the clinic for evaluation of
a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear
pain; and nonproductive cough. Which is the most likely pathologic
process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular
Correct Answer: C) Allergic
Rationale: This description is most consistent with allergic rhinitis.
7. A 19-year-old college student presents to the emergency room with fever,
headache, and neck pain/stiffness. She is concerned about the possibility of
Nurslink.
, meningococcal meningitis. Several of her dorm mates have been
vaccinated, but she hasn't been. Which of the following physical
examination descriptions is most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple
with full range of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with
paraspinous muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
tender to palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
supple with full range of motion
Correct Answer: C) Head is normocephalic and atraumatic, fundi with
blurred disc margins, neck tender to palpation, unable to perform range of
motion
Rationale: Blurred disc margins are consistent with papilledema, and neck
tenderness and lack of range of motion are consistent with neck stiffness, which
in this scenario is likely to be caused by meningeal inflammation. Kernig's and
Brudzinski's signs are also helpful in testing for meningeal irritation on exam.
8. A 37-year-old nurse comes for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and
occurs 1 to 2 hours after eating greasy foods. Which one of the following
physical examination descriptions would be most consistent with the
diagnosis of cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly
or masses
B) Abdomen is soft and tender to palpation in the right lower quadrant, without
rebound or guarding
C) Abdomen is soft and tender to palpation in the right upper quadrant with
inspiration, to the point of stopping inspiration, and there is no rebound or
guarding
D) Abdomen is soft and tender to palpation in the mid-epigastric area, without
rebound or guarding
Nurslink.
(Chamberlain). 100% Complete Accurate
Midterm Exam (2026/2027). – Complete
Question & Answer Actual Exam with
Rationales
1. A patient presents for evaluation of a sharp, aching chest pain which
increases with breathing. Which anatomic area would you localize the
symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine
Correct Answer: A) Musculoskeletal
Rationale: Chest pain may be due to a musculoskeletal condition, such as
costochondritis or intercostal muscle cramp. This would be worsened by motion
of the chest wall. Pleuritic chest pain is also a sharp chest pain which increases
with a deep breath. This type of pain can occur with inflammation of the pleura
from pneumonia or other conditions and pulmonary embolus.
2. A patient comes to the emergency room for evaluation of shortness of
breath. To which anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic
Correct Answer: C) Cardiac
Rationale: Cardiac disorders such as congestive heart failure are the most likely
on this list to result in shortness of breath. There are cases within the other
categories which may also result in shortness of breath, such as anemia in the
Nurslink.
,hematologic category, pregnancy in the reproductive category, or sepsis with
UTI in the urinary category.
3. A patient presents for evaluation of a cough. Which of the following
anatomic regions can be responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine
Correct Answer: C) Cardiac
Rationale: The cardiac system can cause a cough if the patient has congestive
heart failure. This results in fluid buildup in the lungs, which in turn can cause a
cough that produces pink, frothy sputum. A foreign body in the ear may also
cause a cough by stimulating Arnold's branch of the vagus nerve, but this is less
likely to be seen clinically than heart failure.
4. A 22-year-old advertising copywriter presents for evaluation of joint
pain. The pain is new, located in the wrists and fingers bilaterally, with
some subjective fever. The patient denies a rash; she also denies recent
travel or camping activities. She has a family history significant for
rheumatoid arthritis. Based on this information, which of the following
pathologic processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic
Correct Answer: B) Inflammatory
Rationale: The description is most consistent with an inflammatory process,
although all the other etiologies should be considered. Lyme disease is an
infection which commonly causes arthritis, hemophilia is a hematologic
condition which can cause bleeding in the joints, and trauma can obviously
cause joint pain.
Nurslink.
,5. A 47-year-old contractor presents for evaluation of neck pain, which has
been intermittent for several years. He normally takes over-the-counter
medications to ease the pain, but this time they haven't worked as well and
he still has discomfort. He recently wallpapered the entire second floor in
his house, which caused him great discomfort. The pain resolved with rest.
He denies fever, chills, rash, upper respiratory symptoms, trauma, or
injury to the neck. Based on this description, what is the most likely
pathologic process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic
Correct Answer: C) Degenerative
Rationale: The description is most consistent with degenerative arthritis in the
neck. The patient has had intermittent symptoms and the questions asked to
elicit pertinent negative and positive findings are negative for infectious,
traumatic, or neoplastic disease.
6. A 15-year-old high school sophomore comes to the clinic for evaluation of
a 3-week history of sneezing; itchy, watery eyes; clear nasal discharge; ear
pain; and nonproductive cough. Which is the most likely pathologic
process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular
Correct Answer: C) Allergic
Rationale: This description is most consistent with allergic rhinitis.
7. A 19-year-old college student presents to the emergency room with fever,
headache, and neck pain/stiffness. She is concerned about the possibility of
Nurslink.
, meningococcal meningitis. Several of her dorm mates have been
vaccinated, but she hasn't been. Which of the following physical
examination descriptions is most consistent with meningitis?
A) Head is normocephalic and atraumatic, fundi with sharp discs, neck supple
with full range of motion
B) Head is normocephalic and atraumatic, fundi with sharp discs, neck with
paraspinous muscle spasm and limited range of motion to the right
C) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
tender to palpation, unable to perform range of motion
D) Head is normocephalic and atraumatic, fundi with blurred disc margins, neck
supple with full range of motion
Correct Answer: C) Head is normocephalic and atraumatic, fundi with
blurred disc margins, neck tender to palpation, unable to perform range of
motion
Rationale: Blurred disc margins are consistent with papilledema, and neck
tenderness and lack of range of motion are consistent with neck stiffness, which
in this scenario is likely to be caused by meningeal inflammation. Kernig's and
Brudzinski's signs are also helpful in testing for meningeal irritation on exam.
8. A 37-year-old nurse comes for evaluation of colicky right upper quadrant
abdominal pain. The pain is associated with nausea and vomiting and
occurs 1 to 2 hours after eating greasy foods. Which one of the following
physical examination descriptions would be most consistent with the
diagnosis of cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly
or masses
B) Abdomen is soft and tender to palpation in the right lower quadrant, without
rebound or guarding
C) Abdomen is soft and tender to palpation in the right upper quadrant with
inspiration, to the point of stopping inspiration, and there is no rebound or
guarding
D) Abdomen is soft and tender to palpation in the mid-epigastric area, without
rebound or guarding
Nurslink.
