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NR 509 MIDTERM ADVANCED PHYSICAL
ASSESSMENT NEWEST VERSION ACTUAL
QUESTION AND CORRECT DETAILED VERIFIED
ANSWERS FROM VERIFIED SOURCES BY
EXPERT RATED A GRADE.
2026/2027 Frequently Most Tested Questions and
100% Accurate From Past papers | Graded A+ ,
Reviewed and Updated | 100% Guarantee Pass | Latest
Exam and Newest Version!!!
A 70-year-old patient has suspected chronic obstructive pulmonary disease. The
clinician instructs the patient to take a deep breath in, and then with his mouth open,
breathe out as fast and completely as he can. For what is the clinician checking?
a. Bronchophony
b. Egophony
c. Tactile fremitus
d. Forced expiratory time
e. Whispered pectoriloquy
✔️ Correct Answer: D
Rationale:
Forced expiratory time is a simple bedside test used to assess for airway obstruction.
The patient is instructed to take a deep breath and then exhale as rapidly and
completely as possible through an open mouth. A forced expiratory time greater than 6
seconds is suggestive of obstructive airway disease such as COPD. Bronchophony
,(Option A), egophony (Option B), and whispered pectoriloquy (Option E) are tests for
vocal fremitus indicating consolidation. Tactile fremitus (Option C) assesses vibration
transmission through the chest wall.
After examining a patient who is in the hospital for shortness of breath, the clinician
records the following for lung examination: "There is dullness to percussion over the
right lung base. Breath sounds are absent at the right lung base. There are no crackles,
wheezes, or rhonchi. There are no transmitted voice sounds." Which of the following is
the most likely diagnosis?
a. Atelectasis
b. Left-sided heart failure
c. Pneumonia
d. Pneumothorax
e. Chronic obstructive pulmonary disease (COPD)
✔️ Correct Answer: A
Rationale:
Atelectasis (collapse of lung tissue) presents with dullness to percussion, absent breath
sounds, and absent transmitted voice sounds over the affected area. Unlike pneumonia
(Option C), there are no crackles or bronchial breath sounds. Left-sided heart failure
(Option B) would typically present with crackles. Pneumothorax (Option D) would
present with hyperresonance. COPD (Option E) would typically present with
hyperinflation and wheezes.
A 16-year-old boy is brought to the Emergency Department after a motor vehicle
accident for shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a
pneumothorax on the right side. The ED physician decides that a chest tube needs to be
placed in the fourth intercostal space. How does he determine where the fourth
intercostal space is?
a. He finds the suprasternal notch and then moves his finger laterally to the third rib.
The fourth intercostal space is just below the third rib
b. He finds the angle of Louis and then moves laterally to the first rib. He walks down
from there to the fourth intercostal space
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c. He finds the sternal angle and then moves his finger laterally to the second rib. He
then walks down to the second intercostal space, third rib, third intercostal space, fourth
rib and then the fourth intercostal space
d. He finds the clavicle. The second intercostal space is just below
✔️ Correct Answer: C
Rationale:
The fourth intercostal space is located by first identifying the sternal angle (angle of
Louis), which is the junction of the manubrium and body of the sternum at the level of
the second rib. The clinician then moves laterally to the second rib and counts down:
second intercostal space, third rib, third intercostal space, fourth rib, and then the fourth
intercostal space. Option A is incorrect because the suprasternal notch does not directly
lead to rib counting. Option B incorrectly identifies the first rib at the angle of Louis.
Option D is incorrect because the clavicle does not provide reliable rib landmarking.
An elderly patient with a history of smoking two packs of cigarettes a day for 50 years
complains to her physician of progressive shortness of breath. On cardiac examination,
the physician feels the most prominent palpable impulse to be in the xiphoid area. This
is most likely a result of what condition?
a. Aortic stenosis
b. Hypertrophic cardiomyopathy
c. Hypertension
d. Pulmonary hypertension
e. Mitral regurgitation
✔️ Correct Answer: D
Rationale:
A palpable impulse in the xiphoid area suggests right ventricular hypertrophy, which
occurs in pulmonary hypertension (Option D). The patient's history of heavy smoking
and progressive shortness of breath is consistent with COPD, which can lead to
pulmonary hypertension and right ventricular enlargement. Aortic stenosis (Option A)
would produce a systolic ejection murmur at the right upper sternal border.
Hypertrophic cardiomyopathy (Option B) may produce a dynamic outflow obstruction.
Hypertension (Option C) would cause left ventricular hypertrophy with a displaced apical
impulse. Mitral regurgitation (Option E) would produce a holosystolic murmur at the
apex.
, A newborn baby has an embryologic defect affecting the aortic valve. What other
cardiac valve is most likely to be affected?
a. Tricuspid valve
b. Pulmonic valve
c. Mitral valve
d. Pyloric valve
e. Eustachian valve
✔️ Correct Answer: B
Rationale:
The aortic and pulmonic valves are both semilunar valves that develop from the
conotruncal region of the embryonic heart. Embryologic defects affecting the aortic
valve frequently also affect the pulmonic valve (Option B). The tricuspid (Option A) and
mitral (Option C) valves are atrioventricular valves with different embryologic origins.
The pyloric valve (Option D) is not a cardiac valve. The eustachian valve (Option E) is a
remnant of fetal circulation.
A 77-year-old man is experiencing progressive shortness of breath and dizziness. The
patient undergoes cardiac catheterization, and the systolic blood pressure measured in
the left ventricle is 180 mm Hg, while the systolic blood pressure measured in the aorta
is 140 mm Hg. The patient is most likely experiencing symptoms related to what valvular
condition?
a. Aortic insufficiency
b. Mitral stenosis
c. Aortic stenosis
d. Mitral regurgitation
e. Pulmonic stenosis
✔️ Correct Answer: C
Rationale:
The pressure gradient between the left ventricle (180 mm Hg) and the aorta (140 mm
Hg) indicates a 40 mm Hg gradient across the aortic valve, which is diagnostic of aortic
stenosis (Option C). Aortic stenosis causes left ventricular pressure to be significantly
NR 509 MIDTERM ADVANCED PHYSICAL
ASSESSMENT NEWEST VERSION ACTUAL
QUESTION AND CORRECT DETAILED VERIFIED
ANSWERS FROM VERIFIED SOURCES BY
EXPERT RATED A GRADE.
2026/2027 Frequently Most Tested Questions and
100% Accurate From Past papers | Graded A+ ,
Reviewed and Updated | 100% Guarantee Pass | Latest
Exam and Newest Version!!!
A 70-year-old patient has suspected chronic obstructive pulmonary disease. The
clinician instructs the patient to take a deep breath in, and then with his mouth open,
breathe out as fast and completely as he can. For what is the clinician checking?
a. Bronchophony
b. Egophony
c. Tactile fremitus
d. Forced expiratory time
e. Whispered pectoriloquy
✔️ Correct Answer: D
Rationale:
Forced expiratory time is a simple bedside test used to assess for airway obstruction.
The patient is instructed to take a deep breath and then exhale as rapidly and
completely as possible through an open mouth. A forced expiratory time greater than 6
seconds is suggestive of obstructive airway disease such as COPD. Bronchophony
,(Option A), egophony (Option B), and whispered pectoriloquy (Option E) are tests for
vocal fremitus indicating consolidation. Tactile fremitus (Option C) assesses vibration
transmission through the chest wall.
After examining a patient who is in the hospital for shortness of breath, the clinician
records the following for lung examination: "There is dullness to percussion over the
right lung base. Breath sounds are absent at the right lung base. There are no crackles,
wheezes, or rhonchi. There are no transmitted voice sounds." Which of the following is
the most likely diagnosis?
a. Atelectasis
b. Left-sided heart failure
c. Pneumonia
d. Pneumothorax
e. Chronic obstructive pulmonary disease (COPD)
✔️ Correct Answer: A
Rationale:
Atelectasis (collapse of lung tissue) presents with dullness to percussion, absent breath
sounds, and absent transmitted voice sounds over the affected area. Unlike pneumonia
(Option C), there are no crackles or bronchial breath sounds. Left-sided heart failure
(Option B) would typically present with crackles. Pneumothorax (Option D) would
present with hyperresonance. COPD (Option E) would typically present with
hyperinflation and wheezes.
A 16-year-old boy is brought to the Emergency Department after a motor vehicle
accident for shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a
pneumothorax on the right side. The ED physician decides that a chest tube needs to be
placed in the fourth intercostal space. How does he determine where the fourth
intercostal space is?
a. He finds the suprasternal notch and then moves his finger laterally to the third rib.
The fourth intercostal space is just below the third rib
b. He finds the angle of Louis and then moves laterally to the first rib. He walks down
from there to the fourth intercostal space
,-
c. He finds the sternal angle and then moves his finger laterally to the second rib. He
then walks down to the second intercostal space, third rib, third intercostal space, fourth
rib and then the fourth intercostal space
d. He finds the clavicle. The second intercostal space is just below
✔️ Correct Answer: C
Rationale:
The fourth intercostal space is located by first identifying the sternal angle (angle of
Louis), which is the junction of the manubrium and body of the sternum at the level of
the second rib. The clinician then moves laterally to the second rib and counts down:
second intercostal space, third rib, third intercostal space, fourth rib, and then the fourth
intercostal space. Option A is incorrect because the suprasternal notch does not directly
lead to rib counting. Option B incorrectly identifies the first rib at the angle of Louis.
Option D is incorrect because the clavicle does not provide reliable rib landmarking.
An elderly patient with a history of smoking two packs of cigarettes a day for 50 years
complains to her physician of progressive shortness of breath. On cardiac examination,
the physician feels the most prominent palpable impulse to be in the xiphoid area. This
is most likely a result of what condition?
a. Aortic stenosis
b. Hypertrophic cardiomyopathy
c. Hypertension
d. Pulmonary hypertension
e. Mitral regurgitation
✔️ Correct Answer: D
Rationale:
A palpable impulse in the xiphoid area suggests right ventricular hypertrophy, which
occurs in pulmonary hypertension (Option D). The patient's history of heavy smoking
and progressive shortness of breath is consistent with COPD, which can lead to
pulmonary hypertension and right ventricular enlargement. Aortic stenosis (Option A)
would produce a systolic ejection murmur at the right upper sternal border.
Hypertrophic cardiomyopathy (Option B) may produce a dynamic outflow obstruction.
Hypertension (Option C) would cause left ventricular hypertrophy with a displaced apical
impulse. Mitral regurgitation (Option E) would produce a holosystolic murmur at the
apex.
, A newborn baby has an embryologic defect affecting the aortic valve. What other
cardiac valve is most likely to be affected?
a. Tricuspid valve
b. Pulmonic valve
c. Mitral valve
d. Pyloric valve
e. Eustachian valve
✔️ Correct Answer: B
Rationale:
The aortic and pulmonic valves are both semilunar valves that develop from the
conotruncal region of the embryonic heart. Embryologic defects affecting the aortic
valve frequently also affect the pulmonic valve (Option B). The tricuspid (Option A) and
mitral (Option C) valves are atrioventricular valves with different embryologic origins.
The pyloric valve (Option D) is not a cardiac valve. The eustachian valve (Option E) is a
remnant of fetal circulation.
A 77-year-old man is experiencing progressive shortness of breath and dizziness. The
patient undergoes cardiac catheterization, and the systolic blood pressure measured in
the left ventricle is 180 mm Hg, while the systolic blood pressure measured in the aorta
is 140 mm Hg. The patient is most likely experiencing symptoms related to what valvular
condition?
a. Aortic insufficiency
b. Mitral stenosis
c. Aortic stenosis
d. Mitral regurgitation
e. Pulmonic stenosis
✔️ Correct Answer: C
Rationale:
The pressure gradient between the left ventricle (180 mm Hg) and the aorta (140 mm
Hg) indicates a 40 mm Hg gradient across the aortic valve, which is diagnostic of aortic
stenosis (Option C). Aortic stenosis causes left ventricular pressure to be significantly
