Chamberlain College of Nursing | NR 509 Advanced Physical Assessment
NR 509 Advanced Physical Assessment Final
Comprehensive Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 509 Advanced Physical Assessment | University-Level Advanced
Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 509 Advanced Physical Assessment
Final Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This Final Comprehensive Examination contains 100 verified questions designed for university-level
advanced practice nursing students enrolled in NR 509 Advanced Physical Assessment at Chamberlain
College of Nursing. The questions are distributed equally across four core domains: Cardiovascular and
Peripheral Vascular Assessment (25 questions), Respiratory and Thoracic Assessment (25 questions),
Gastrointestinal and Abdominal Assessment (25 questions), and Neurological, Musculoskeletal, and
Integumentary Assessment (25 questions). All content is original and constructed to reinforce the official
NR 509 Final Comprehensive Examination course objectives for actual exam readiness and clinical
diagnostic proficiency, aligned to the 2026/2027 academic year. Each item emphasizes systematic
physical assessment technique, accurate interpretation of clinical findings, and sound diagnostic
reasoning drawn from foundational advanced health assessment methodology.
ACTUAL QUESTIONS
Domain 1: Cardiovascular and Peripheral Vascular Assessment
Question 1. When auscultating the heart in a client with suspected aortic stenosis, which
auscultatory finding is most characteristic of severe disease?
A. A soft, early systolic murmur at the right upper sternal border
B. A high-pitched diastolic decrescendo murmur at the left sternal border
C. A harsh, late-peaking systolic murmur radiating to the carotid arteries
D. A continuous machinery murmur throughout systole and diastole
Correct Answer: C
Rationale: Severe aortic stenosis produces a harsh, crescendo-decrescendo systolic ejection murmur
that peaks late in systole and radiates to the carotids. The later the peak, the more severe the stenosis,
reflecting delayed left ventricular ejection through a critically narrowed valve orifice. This finding is
consistent with advanced physical assessment principles emphasizing murmur timing and radiation.
Question 2. During assessment of jugular venous pressure, the vertical height of the
column of blood above the sternal angle is measured at 5 cm with the client at 45 degrees.
What is the estimated central venous pressure?
A. 10 cm H2O
B. 5 cm H2O
C. 8 cm H2O
D. 13 cm H2O
Correct Answer: A
Rationale: Central venous pressure is estimated by adding the vertical height of the jugular venous
column above the sternal angle to the approximate distance from the right atrium to the sternal angle (5
cm when the client is at 45 degrees). Thus 5 cm + 5 cm = 10 cm H2O. Values above 8–9 cm H2O suggest
elevated right atrial pressure.
Question 3. Which peripheral pulse finding is most consistent with chronic arterial
insufficiency of the lower extremity?
A. Bounding pulse with rapid upstroke
B. Pulsus alternans with alternating strong and weak beats
C. Water-hammer pulse with rapid collapse
D. Diminished or absent dorsalis pedis and posterior tibial pulses
Correct Answer: D
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
, Rationale: Chronic arterial insufficiency reduces antegrade flow, resulting in diminished or absent
distal pulses (dorsalis pedis and posterior tibial). Bounding or water-hammer pulses indicate high
stroke volume or runoff states, while pulsus alternans reflects severe left ventricular dysfunction.
Question 4. A client presents with a mid-systolic click followed by a late systolic murmur at
the apex. Which valvular abnormality is most likely?
A. Aortic stenosis
B. Mitral valve prolapse
C. Tricuspid regurgitation
D. Pulmonic stenosis
Correct Answer: B
Rationale: The mid-systolic click of mitral valve prolapse results from sudden tensing of the redundant
leaflet and chordae as the valve prolapses into the left atrium; the subsequent late systolic murmur
reflects mitral regurgitation that increases as ventricular volume decreases in late systole.
Question 5. When performing the Allen test prior to radial artery puncture, which result
indicates adequate ulnar collateral circulation?
A. Palm flushes within 5–7 seconds after release of ulnar compression
B. Palm remains pale after release of ulnar artery compression
C. Pallor persists for more than 15 seconds after both arteries are released
D. No color change is observed in either hand
Correct Answer: A
Rationale: Adequate ulnar collateral flow is confirmed when the palm flushes within 5–7 seconds after
release of ulnar artery compression while the radial artery remains occluded. Persistent pallor indicates
insufficient collateral circulation and is a contraindication to radial arterial access.
Question 6. Which finding on cardiac auscultation is most suggestive of an atrial septal
defect?
A. Paradoxical splitting of the second heart sound
B. Wide physiologic splitting that varies with respiration
C. Fixed splitting of the second heart sound
D. Single second heart sound without respiratory variation
Correct Answer: C
Rationale: Fixed splitting of S2 occurs in atrial septal defect because the left-to-right shunt equalizes
respiratory variation in right ventricular stroke volume, keeping the aortic and pulmonic components
widely separated throughout the respiratory cycle.
Question 7. Assessment of a client with suspected deep vein thrombosis reveals a positive
Homan sign. How should this finding be interpreted in contemporary clinical assessment?
A. Highly sensitive and specific for acute deep vein thrombosis
B. Low sensitivity and specificity; not recommended as a sole diagnostic indicator
C. Pathognomonic when accompanied by calf tenderness
D. Useful only in clients with a history of prior venous thromboembolism
Correct Answer: B
Rationale: Homan sign (pain on dorsiflexion of the foot) has both low sensitivity and low specificity for
deep vein thrombosis and is no longer recommended as a reliable clinical indicator. Diagnosis relies on
pretest probability scoring, duplex ultrasonography, and D-dimer testing rather than this physical
finding alone.
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
NR 509 Advanced Physical Assessment Final
Comprehensive Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 509 Advanced Physical Assessment | University-Level Advanced
Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 509 Advanced Physical Assessment
Final Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
,INTRODUCTION
This Final Comprehensive Examination contains 100 verified questions designed for university-level
advanced practice nursing students enrolled in NR 509 Advanced Physical Assessment at Chamberlain
College of Nursing. The questions are distributed equally across four core domains: Cardiovascular and
Peripheral Vascular Assessment (25 questions), Respiratory and Thoracic Assessment (25 questions),
Gastrointestinal and Abdominal Assessment (25 questions), and Neurological, Musculoskeletal, and
Integumentary Assessment (25 questions). All content is original and constructed to reinforce the official
NR 509 Final Comprehensive Examination course objectives for actual exam readiness and clinical
diagnostic proficiency, aligned to the 2026/2027 academic year. Each item emphasizes systematic
physical assessment technique, accurate interpretation of clinical findings, and sound diagnostic
reasoning drawn from foundational advanced health assessment methodology.
ACTUAL QUESTIONS
Domain 1: Cardiovascular and Peripheral Vascular Assessment
Question 1. When auscultating the heart in a client with suspected aortic stenosis, which
auscultatory finding is most characteristic of severe disease?
A. A soft, early systolic murmur at the right upper sternal border
B. A high-pitched diastolic decrescendo murmur at the left sternal border
C. A harsh, late-peaking systolic murmur radiating to the carotid arteries
D. A continuous machinery murmur throughout systole and diastole
Correct Answer: C
Rationale: Severe aortic stenosis produces a harsh, crescendo-decrescendo systolic ejection murmur
that peaks late in systole and radiates to the carotids. The later the peak, the more severe the stenosis,
reflecting delayed left ventricular ejection through a critically narrowed valve orifice. This finding is
consistent with advanced physical assessment principles emphasizing murmur timing and radiation.
Question 2. During assessment of jugular venous pressure, the vertical height of the
column of blood above the sternal angle is measured at 5 cm with the client at 45 degrees.
What is the estimated central venous pressure?
A. 10 cm H2O
B. 5 cm H2O
C. 8 cm H2O
D. 13 cm H2O
Correct Answer: A
Rationale: Central venous pressure is estimated by adding the vertical height of the jugular venous
column above the sternal angle to the approximate distance from the right atrium to the sternal angle (5
cm when the client is at 45 degrees). Thus 5 cm + 5 cm = 10 cm H2O. Values above 8–9 cm H2O suggest
elevated right atrial pressure.
Question 3. Which peripheral pulse finding is most consistent with chronic arterial
insufficiency of the lower extremity?
A. Bounding pulse with rapid upstroke
B. Pulsus alternans with alternating strong and weak beats
C. Water-hammer pulse with rapid collapse
D. Diminished or absent dorsalis pedis and posterior tibial pulses
Correct Answer: D
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
, Rationale: Chronic arterial insufficiency reduces antegrade flow, resulting in diminished or absent
distal pulses (dorsalis pedis and posterior tibial). Bounding or water-hammer pulses indicate high
stroke volume or runoff states, while pulsus alternans reflects severe left ventricular dysfunction.
Question 4. A client presents with a mid-systolic click followed by a late systolic murmur at
the apex. Which valvular abnormality is most likely?
A. Aortic stenosis
B. Mitral valve prolapse
C. Tricuspid regurgitation
D. Pulmonic stenosis
Correct Answer: B
Rationale: The mid-systolic click of mitral valve prolapse results from sudden tensing of the redundant
leaflet and chordae as the valve prolapses into the left atrium; the subsequent late systolic murmur
reflects mitral regurgitation that increases as ventricular volume decreases in late systole.
Question 5. When performing the Allen test prior to radial artery puncture, which result
indicates adequate ulnar collateral circulation?
A. Palm flushes within 5–7 seconds after release of ulnar compression
B. Palm remains pale after release of ulnar artery compression
C. Pallor persists for more than 15 seconds after both arteries are released
D. No color change is observed in either hand
Correct Answer: A
Rationale: Adequate ulnar collateral flow is confirmed when the palm flushes within 5–7 seconds after
release of ulnar artery compression while the radial artery remains occluded. Persistent pallor indicates
insufficient collateral circulation and is a contraindication to radial arterial access.
Question 6. Which finding on cardiac auscultation is most suggestive of an atrial septal
defect?
A. Paradoxical splitting of the second heart sound
B. Wide physiologic splitting that varies with respiration
C. Fixed splitting of the second heart sound
D. Single second heart sound without respiratory variation
Correct Answer: C
Rationale: Fixed splitting of S2 occurs in atrial septal defect because the left-to-right shunt equalizes
respiratory variation in right ventricular stroke volume, keeping the aortic and pulmonic components
widely separated throughout the respiratory cycle.
Question 7. Assessment of a client with suspected deep vein thrombosis reveals a positive
Homan sign. How should this finding be interpreted in contemporary clinical assessment?
A. Highly sensitive and specific for acute deep vein thrombosis
B. Low sensitivity and specificity; not recommended as a sole diagnostic indicator
C. Pathognomonic when accompanied by calf tenderness
D. Useful only in clients with a history of prior venous thromboembolism
Correct Answer: B
Rationale: Homan sign (pain on dorsiflexion of the foot) has both low sensitivity and low specificity for
deep vein thrombosis and is no longer recommended as a reliable clinical indicator. Diagnosis relies on
pretest probability scoring, duplex ultrasonography, and D-dimer testing rather than this physical
finding alone.
NR 509 Advanced Physical Assessment Final Comprehensive Examination 2026/2027 | Verified Questions
