NR509/ NR 509 FINAL EXAM GUIDE (LATEST 2026/2027 UPDATE) |ADVANCED HEALTH ASSESSMENT –
HEENT, CARDIAC, RESPIRATORY, ABDOMINAL QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | CHAMBERLAIN UNIVERSITY| GRADED A+
Question 1
A 58-year-old male with a history of hypertension and smoking presents with a 3-day history of a painful red
eye, photophobia, and blurred vision. Examination reveals ciliary flush, a mid-position non-reactive pupil, and a
hazy cornea. Which of the following is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Bacterial conjunctivitis
C. Uveitis
D. Corneal abrasion
🟢 Correct Answer: A. Acute angle-closure glaucoma
🔴 RATIONALE: Acute angle-closure glaucoma presents with a painful red eye, photophobia, blurred vision,
ciliary flush, mid-position fixed pupil, and corneal haze. These findings are classic for an acute glaucoma attack.
Bacterial conjunctivitis typically presents with purulent discharge without corneal haze. Uveitis presents with
photophobia and ciliary flush but not typically a fixed mid-position pupil. Corneal abrasion causes pain,
photophobia, and foreign body sensation, but the pupil is usually normal.
,Question 2
A 32-year-old patient presents with a persistent cough, fever, and shortness of breath. On auscultation, you
hear coarse crackles that clear with coughing. Which of the following is the most likely cause of these crackles?
A. Pneumonia
B. Bronchiectasis
C. Pulmonary edema
D. Atelectasis
🟢 Correct Answer: B. Bronchiectasis
🔴 RATIONALE: Coarse crackles that clear with coughing are characteristic of bronchiectasis. Pneumonia
typically presents with crackles that do not clear with coughing. Pulmonary edema presents with fine, late
inspiratory crackles at the bases. Atelectasis presents with crackles that clear with deep breathing.
Question 3
During a cardiac assessment, you note a split S2 that widens on inspiration and narrows on expiration. This
finding is most consistent with:
A. Atrial septal defect
B. Pulmonic stenosis
C. Physiologic splitting
D. Right bundle branch block
,🟢 Correct Answer: C. Physiologic splitting
🔴 RATIONALE: Physiologic splitting of S2 is a normal finding characterized by widening of the split during
inspiration and narrowing during expiration. Atrial septal defect and right bundle branch block cause a fixed
split that does not vary with respiration. Pulmonic stenosis causes a split that is not typically described as
physiologic.
Question 4
A 45-year-old patient presents with right upper quadrant pain radiating to the shoulder, nausea, and fever. On
abdominal examination, you note guarding and a positive Murphy sign. Which of the following is the most
likely diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Hepatitis
🟢 Correct Answer: B. Acute cholecystitis
🔴 RATIONALE: Acute cholecystitis presents with right upper quadrant pain radiating to the shoulder (referred
pain), nausea, fever, and a positive Murphy sign (inspiratory arrest on palpation of the right upper quadrant).
Acute pancreatitis presents with epigastric pain radiating to the back. Acute appendicitis presents with right
lower quadrant pain. Hepatitis presents with malaise, jaundice, and right upper quadrant discomfort but is less
likely to have a positive Murphy sign.
, Question 5
A 65-year-old female reports hearing loss, tinnitus, and a feeling of fullness in her left ear. Otoscopic
examination reveals a pearly white mass behind the tympanic membrane. Which of the following is the most
likely diagnosis?
A. Otitis media with effusion
B. Cholesteatoma
C. Mastoiditis
D. Otosclerosis
🟢 Correct Answer: B. Cholesteatoma
🔴 RATIONALE: Cholesteatoma is a destructive, non-malignant growth in the middle ear that appears as a
pearly white mass behind the tympanic membrane. It causes hearing loss, tinnitus, and a feeling of fullness.
Otitis media with effusion presents with a dull, retracted tympanic membrane without the pearly white
appearance. Mastoiditis presents with pain and swelling behind the ear. Otosclerosis is a condition of abnormal
bone growth in the middle ear without the pearly white mass.
Question 6
During a respiratory examination, you note increased tactile fremitus and dullness to percussion over the left
lower lobe. These findings are most consistent with:
HEENT, CARDIAC, RESPIRATORY, ABDOMINAL QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | CHAMBERLAIN UNIVERSITY| GRADED A+
Question 1
A 58-year-old male with a history of hypertension and smoking presents with a 3-day history of a painful red
eye, photophobia, and blurred vision. Examination reveals ciliary flush, a mid-position non-reactive pupil, and a
hazy cornea. Which of the following is the most likely diagnosis?
A. Acute angle-closure glaucoma
B. Bacterial conjunctivitis
C. Uveitis
D. Corneal abrasion
🟢 Correct Answer: A. Acute angle-closure glaucoma
🔴 RATIONALE: Acute angle-closure glaucoma presents with a painful red eye, photophobia, blurred vision,
ciliary flush, mid-position fixed pupil, and corneal haze. These findings are classic for an acute glaucoma attack.
Bacterial conjunctivitis typically presents with purulent discharge without corneal haze. Uveitis presents with
photophobia and ciliary flush but not typically a fixed mid-position pupil. Corneal abrasion causes pain,
photophobia, and foreign body sensation, but the pupil is usually normal.
,Question 2
A 32-year-old patient presents with a persistent cough, fever, and shortness of breath. On auscultation, you
hear coarse crackles that clear with coughing. Which of the following is the most likely cause of these crackles?
A. Pneumonia
B. Bronchiectasis
C. Pulmonary edema
D. Atelectasis
🟢 Correct Answer: B. Bronchiectasis
🔴 RATIONALE: Coarse crackles that clear with coughing are characteristic of bronchiectasis. Pneumonia
typically presents with crackles that do not clear with coughing. Pulmonary edema presents with fine, late
inspiratory crackles at the bases. Atelectasis presents with crackles that clear with deep breathing.
Question 3
During a cardiac assessment, you note a split S2 that widens on inspiration and narrows on expiration. This
finding is most consistent with:
A. Atrial septal defect
B. Pulmonic stenosis
C. Physiologic splitting
D. Right bundle branch block
,🟢 Correct Answer: C. Physiologic splitting
🔴 RATIONALE: Physiologic splitting of S2 is a normal finding characterized by widening of the split during
inspiration and narrowing during expiration. Atrial septal defect and right bundle branch block cause a fixed
split that does not vary with respiration. Pulmonic stenosis causes a split that is not typically described as
physiologic.
Question 4
A 45-year-old patient presents with right upper quadrant pain radiating to the shoulder, nausea, and fever. On
abdominal examination, you note guarding and a positive Murphy sign. Which of the following is the most
likely diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute appendicitis
D. Hepatitis
🟢 Correct Answer: B. Acute cholecystitis
🔴 RATIONALE: Acute cholecystitis presents with right upper quadrant pain radiating to the shoulder (referred
pain), nausea, fever, and a positive Murphy sign (inspiratory arrest on palpation of the right upper quadrant).
Acute pancreatitis presents with epigastric pain radiating to the back. Acute appendicitis presents with right
lower quadrant pain. Hepatitis presents with malaise, jaundice, and right upper quadrant discomfort but is less
likely to have a positive Murphy sign.
, Question 5
A 65-year-old female reports hearing loss, tinnitus, and a feeling of fullness in her left ear. Otoscopic
examination reveals a pearly white mass behind the tympanic membrane. Which of the following is the most
likely diagnosis?
A. Otitis media with effusion
B. Cholesteatoma
C. Mastoiditis
D. Otosclerosis
🟢 Correct Answer: B. Cholesteatoma
🔴 RATIONALE: Cholesteatoma is a destructive, non-malignant growth in the middle ear that appears as a
pearly white mass behind the tympanic membrane. It causes hearing loss, tinnitus, and a feeling of fullness.
Otitis media with effusion presents with a dull, retracted tympanic membrane without the pearly white
appearance. Mastoiditis presents with pain and swelling behind the ear. Otosclerosis is a condition of abnormal
bone growth in the middle ear without the pearly white mass.
Question 6
During a respiratory examination, you note increased tactile fremitus and dullness to percussion over the left
lower lobe. These findings are most consistent with:
