NR509/ NR 509 Final Exam Study Guide
(Latest 2026/2027 Update) | Complete Exam
Questions with Verified Answers and
Detailed Rationales | Advanced Health
Assessment – HEENT, Cardiac, Respiratory
1. A 35-year-old G0P0 woman presents with bilateral nipple discharge that started
several weeks ago. The discharge is consistent with breast milk without blood or
pus. Screening labs show normal CBC, metabolic panel, TSH, and HCG. Further labs
are pending. What is the most likely diagnosis?
A) Breast cancer
B) Galactorrhea due to prolactinoma
C) Mastitis
D) Fibrocystic breast changes
Answer: B
Rationale: Prolactinoma is a pituitary tumor that secretes prolactin, causing production of
breast milk (galactorrhea) and can suppress menstruation. The negative HCG rules out
pregnancy, and the absence of inflammatory signs makes mastitis and cancer less likely .
2. A 22-year-old student presents with a nontender, rubbery, mobile breast mass
found on self-examination. There are no skin changes, erythema, or swelling. She
is concerned about breast cancer. What is true about breast self-examination (BSE)
in this patient?
A) Most masses found by women at home turn out to be malignant
B) This patient is more likely to find a fibroadenoma than cancer
C) The most likely mass she would find is an abscess from mastitis
D) BSE is universally recommended due to high sensitivity and specificity
,Answer: B
Rationale: Palpable fibroadenomas are most commonly found in women aged 15-25.
Breast cancer is rare in this age group, and the described mass is classic for fibroadenoma
.
3. A 68-year-old patient with a strong family history of breast cancer (mother
diagnosed in her 50s, cousin diagnosed before age 50), history of chest radiation
for lymphoma in her 20s, and several years of hormone replacement therapy has
had multiple abnormal mammograms with benign biopsies. Regarding MRI
screening:
A) No agency recommends breast MRI for patients with only moderate risk factors
B) USPSTF recommends against MRI screening for such risk factors
C) High sensitivity of breast MRI comes at the expense of decreased specificity
D) Breast MRI is the sole recommended screening modality for women with chest
radiation history
Answer: C
Rationale: Breast MRI has high sensitivity but lower specificity, meaning it detects many
findings that are not cancer (false positives). This patient has an extraordinary risk profile,
including family history, chest radiation, and dense breast tissue .
4. A 66-year-old patient on long-term estrogen therapy has a firm, rubbery,
nontender right supraclavicular lymph node. She denies breast lumps, fevers, or
night sweats. What is true about this presentation?
A) Supraclavicular lymphadenopathy is benign in this location
B) Metastatic breast cancer cells may spread directly to supraclavicular nodes without
axillary involvement
C) This finding is most consistent with an infectious process
D) No further workup is needed as it is likely reactive
Answer: B
Rationale: Supraclavicular lymph nodes are considered malignant until proven otherwise.
Metastatic breast cancer can spread directly to infraclavicular and supraclavicular nodes
,without first affecting axillary nodes. This warrants urgent breast imaging and possible
biopsy .
5. A 44-year-old presents with a breast mass. Her partner noticed it 2 days ago.
What is the most appropriate next step?
A) Reassure the patient and schedule routine mammogram
B) Order diagnostic breast imaging and consider biopsy
C) Prescribe antibiotics for possible mastitis
D) Schedule follow-up in 6 months
Answer: B
Rationale: Any new breast mass in a woman over 40 requires diagnostic imaging
(mammogram and/or ultrasound). The absence of inflammatory signs makes mastitis less
likely, and the age warrants prompt evaluation .
SECTION 2: ABDOMINAL ASSESSMENT
31. A patient is asked to take a deep breath and stops inspiring due to right upper
quadrant pain during deep palpation. This finding is positive for which sign?
A) McBurney's sign
B) Rovsing's sign
C) Murphy's sign
D) Psoas sign
Answer: C
Rationale: Murphy's sign is elicited by palpating the right upper quadrant during
inspiration. Inspiratory arrest due to pain indicates acute cholecystitis .
32. A patient presents with right lower quadrant pain. The clinician raises the
patient's right leg while supine and asks them to push down against the
examiner's hand. Pain in the right lower quadrant suggests which sign?
, A) Rovsing sign
B) Obturator sign
C) Psoas sign
D) Murphy's sign
Answer: C
Rationale: The psoas sign is elicited by asking the patient to raise the right thigh against
the examiner's hand or by extending the right leg while the patient lies on the left side.
Pain indicates irritation of the psoas muscle, often caused by a retrocecal or retroileal
appendix .
33. A patient presents with right upper quadrant pain radiating to the right
shoulder, nausea, and vomiting after a high-fat meal. On exam, deep palpation of
the RUQ causes inspiratory arrest. This presentation is most consistent with:
A) Acute pancreatitis
B) Acute appendicitis
C) Acute cholecystitis
D) Gastritis
Answer: C
Rationale: Right upper quadrant pain radiating to the right shoulder or back after a fatty
meal, combined with Murphy's sign (inspiratory arrest on palpation), is classic for acute
cholecystitis. The right shoulder pain is referred pain from phrenic nerve irritation .
34. A 30-year-old presents with acute onset of severe lower abdominal pain,
dysuria, and fever. On exam, the patient has cervical motion tenderness and
adnexal tenderness. Which diagnosis is most likely?
A) Appendicitis
B) Pelvic inflammatory disease (PID)
C) Ovarian cyst rupture
D) Urinary tract infection
Answer: B
Rationale: Cervical motion tenderness (chandelier sign) and adnexal tenderness are classic
(Latest 2026/2027 Update) | Complete Exam
Questions with Verified Answers and
Detailed Rationales | Advanced Health
Assessment – HEENT, Cardiac, Respiratory
1. A 35-year-old G0P0 woman presents with bilateral nipple discharge that started
several weeks ago. The discharge is consistent with breast milk without blood or
pus. Screening labs show normal CBC, metabolic panel, TSH, and HCG. Further labs
are pending. What is the most likely diagnosis?
A) Breast cancer
B) Galactorrhea due to prolactinoma
C) Mastitis
D) Fibrocystic breast changes
Answer: B
Rationale: Prolactinoma is a pituitary tumor that secretes prolactin, causing production of
breast milk (galactorrhea) and can suppress menstruation. The negative HCG rules out
pregnancy, and the absence of inflammatory signs makes mastitis and cancer less likely .
2. A 22-year-old student presents with a nontender, rubbery, mobile breast mass
found on self-examination. There are no skin changes, erythema, or swelling. She
is concerned about breast cancer. What is true about breast self-examination (BSE)
in this patient?
A) Most masses found by women at home turn out to be malignant
B) This patient is more likely to find a fibroadenoma than cancer
C) The most likely mass she would find is an abscess from mastitis
D) BSE is universally recommended due to high sensitivity and specificity
,Answer: B
Rationale: Palpable fibroadenomas are most commonly found in women aged 15-25.
Breast cancer is rare in this age group, and the described mass is classic for fibroadenoma
.
3. A 68-year-old patient with a strong family history of breast cancer (mother
diagnosed in her 50s, cousin diagnosed before age 50), history of chest radiation
for lymphoma in her 20s, and several years of hormone replacement therapy has
had multiple abnormal mammograms with benign biopsies. Regarding MRI
screening:
A) No agency recommends breast MRI for patients with only moderate risk factors
B) USPSTF recommends against MRI screening for such risk factors
C) High sensitivity of breast MRI comes at the expense of decreased specificity
D) Breast MRI is the sole recommended screening modality for women with chest
radiation history
Answer: C
Rationale: Breast MRI has high sensitivity but lower specificity, meaning it detects many
findings that are not cancer (false positives). This patient has an extraordinary risk profile,
including family history, chest radiation, and dense breast tissue .
4. A 66-year-old patient on long-term estrogen therapy has a firm, rubbery,
nontender right supraclavicular lymph node. She denies breast lumps, fevers, or
night sweats. What is true about this presentation?
A) Supraclavicular lymphadenopathy is benign in this location
B) Metastatic breast cancer cells may spread directly to supraclavicular nodes without
axillary involvement
C) This finding is most consistent with an infectious process
D) No further workup is needed as it is likely reactive
Answer: B
Rationale: Supraclavicular lymph nodes are considered malignant until proven otherwise.
Metastatic breast cancer can spread directly to infraclavicular and supraclavicular nodes
,without first affecting axillary nodes. This warrants urgent breast imaging and possible
biopsy .
5. A 44-year-old presents with a breast mass. Her partner noticed it 2 days ago.
What is the most appropriate next step?
A) Reassure the patient and schedule routine mammogram
B) Order diagnostic breast imaging and consider biopsy
C) Prescribe antibiotics for possible mastitis
D) Schedule follow-up in 6 months
Answer: B
Rationale: Any new breast mass in a woman over 40 requires diagnostic imaging
(mammogram and/or ultrasound). The absence of inflammatory signs makes mastitis less
likely, and the age warrants prompt evaluation .
SECTION 2: ABDOMINAL ASSESSMENT
31. A patient is asked to take a deep breath and stops inspiring due to right upper
quadrant pain during deep palpation. This finding is positive for which sign?
A) McBurney's sign
B) Rovsing's sign
C) Murphy's sign
D) Psoas sign
Answer: C
Rationale: Murphy's sign is elicited by palpating the right upper quadrant during
inspiration. Inspiratory arrest due to pain indicates acute cholecystitis .
32. A patient presents with right lower quadrant pain. The clinician raises the
patient's right leg while supine and asks them to push down against the
examiner's hand. Pain in the right lower quadrant suggests which sign?
, A) Rovsing sign
B) Obturator sign
C) Psoas sign
D) Murphy's sign
Answer: C
Rationale: The psoas sign is elicited by asking the patient to raise the right thigh against
the examiner's hand or by extending the right leg while the patient lies on the left side.
Pain indicates irritation of the psoas muscle, often caused by a retrocecal or retroileal
appendix .
33. A patient presents with right upper quadrant pain radiating to the right
shoulder, nausea, and vomiting after a high-fat meal. On exam, deep palpation of
the RUQ causes inspiratory arrest. This presentation is most consistent with:
A) Acute pancreatitis
B) Acute appendicitis
C) Acute cholecystitis
D) Gastritis
Answer: C
Rationale: Right upper quadrant pain radiating to the right shoulder or back after a fatty
meal, combined with Murphy's sign (inspiratory arrest on palpation), is classic for acute
cholecystitis. The right shoulder pain is referred pain from phrenic nerve irritation .
34. A 30-year-old presents with acute onset of severe lower abdominal pain,
dysuria, and fever. On exam, the patient has cervical motion tenderness and
adnexal tenderness. Which diagnosis is most likely?
A) Appendicitis
B) Pelvic inflammatory disease (PID)
C) Ovarian cyst rupture
D) Urinary tract infection
Answer: B
Rationale: Cervical motion tenderness (chandelier sign) and adnexal tenderness are classic
