Academic Year 2026–2027 NR 509 Advanced
Physical Assessment | 190+ Practice Questions &
Verified Answers | Latest Study Guide, Test Bank,
Practice Exam, Comprehensive Review & Exam
Prep | NR 509 Advanced Physical Assessment,
Health History, Comprehensive Health Assessment,
Physical Examination, Clinical Interview, Head-to-
Toe Assessment, Mental Status Examination,
Cardiovascular Assessment, Respiratory
Assessment, Neurological Assessment, Abdominal
Assessment, Musculoskeletal Assessment &
Diagnostic Reasoning
Question 1: A 55-year-old male with a 40-pack-year smoking history presents
with a chronic cough and hoarseness. During the respiratory examination, you
note a unilateral diaphragmatic paralysis on the left side. Which of the
following anatomical landmarks is most critical for accurately assessing
diaphragmatic excursion during percussion?
A. The sternal angle
B. The costophrenic angle
C. The xiphoid process
D. The angle of Louis
CORRECT ANSWER: B. The costophrenic angle
Rationale: Diaphragmatic excursion is assessed by percussing the descent of the
diaphragm during inspiration and expiration. The key landmark is the costophrenic
angle (the angle between the ribs and the diaphragm), where the change from resonant
to dull percussion notes indicates the position of the diaphragm. A decrease in excursion
suggests phrenic nerve palsy, pleural effusion, or diaphragmatic weakness.
Question 2: In a patient presenting with acute onset of severe, tearing chest
pain radiating to the back, which physical examination finding is most specific
for aortic dissection?
A. Hypertension in the right arm and hypotension in the left arm
B. A prominent P2 and a right ventricular heave
C. A mid-systolic click followed by a late systolic murmur
D. A pericardial friction rub
CORRECT ANSWER: A. Hypertension in the right arm and hypotension in the
left arm
Rationale: Aortic dissection can compromise the ostium of the subclavian artery, leading
to differential blood pressures between the arms. A significant difference in systolic
blood pressure (often > 20 mmHg) between the right and left arms is a classic and
,highly concerning sign. The other options are more consistent with aortic stenosis,
pulmonary hypertension, and pericarditis, respectively.
Question 3: When performing a cardiovascular examination on a patient with
suspected mitral stenosis, the characteristic opening snap is best heard at
which location using the bell of the stethoscope?
A. The aortic area (right second intercostal space)
B. The pulmonic area (left second intercostal space)
C. The tricuspid area (left lower sternal border)
D. The apex of the heart
CORRECT ANSWER: D. The apex of the heart
Rationale: The opening snap of mitral stenosis is best heard at the apex of the heart,
which overlies the left ventricle and corresponds to the mitral valve area. It is a high-
frequency sound that occurs shortly after S2 and is best heard with the diaphragm, but
the location is the apex. It indicates a pliable but stenotic mitral valve.
Question 4: A 68-year-old female presents with progressive dyspnea on
exertion and a dry cough. On auscultation, you hear fine, late-inspiratory
crackles that are most prominent at the lung bases. Which of the following is
the most likely diagnosis?
A. Chronic bronchitis
B. Pulmonary edema secondary to left-sided heart failure
C. Idiopathic pulmonary fibrosis
D. Atelectasis
CORRECT ANSWER: C. Idiopathic pulmonary fibrosis
Rationale: Fine, late-inspiratory crackles (Velcro crackles) that are persistent and
prominent at the lung bases are a hallmark of interstitial lung diseases such as idiopathic
pulmonary fibrosis. These crackles are produced by the sudden opening of stiff, fibrotic
airways during inspiration.
Question 5: During an abdominal examination, you elicit a positive Murphy's
sign. This sign is elicited by having the patient inhale while you palpate the
right subcostal area. A positive sign is indicative of:
A. Acute appendicitis
B. Acute pancreatitis
C. Acute cholecystitis
D. Gastric ulcer
CORRECT ANSWER: C. Acute cholecystitis
Rationale: Murphy's sign is a classic test for acute cholecystitis. The examiner palpates
the right upper quadrant at the costal margin. The patient is asked to take a deep breath.
,If pain causes the patient to abruptly stop inhaling (inspiratory arrest), the test is
positive, indicating inflammation of the gallbladder.
Question 6: A 45-year-old male presents with a palpable, pulsatile mass in the
periumbilical region. He is overweight and has a history of hypertension and
atherosclerosis. Which of the following is the most appropriate immediate
action?
A. Perform a deep palpation to define the margins of the mass
B. Auscultate the mass for a bruit
C. Obtain a computed tomography (CT) scan of the abdomen
D. Refer the patient for an ultrasound
CORRECT ANSWER: B. Auscultate the mass for a bruit
Rationale: In a patient with a suspected abdominal aortic aneurysm (AAA), pulsatile
masses should not be vigorously palpated due to the risk of rupture. The safest and most
appropriate initial step after inspection is to auscultate the mass. A systolic bruit may be
heard over an AAA due to turbulent blood flow, though its absence does not rule it out.
Question 7: In assessing a patient's peripheral vascular system, you note that
the dorsalis pedis pulse is absent but the posterior tibial pulse is strong. The
most likely cause is:
A. Femoral artery occlusion
B. Aortic stenosis
C. Popliteal artery occlusion
D. Anatomic variation
CORRECT ANSWER: D. Anatomic variation
Rationale: The dorsalis pedis artery is congenitally absent in about 10% of the
population. The presence of other palpable pedal pulses (like the posterior tibial) with
intact skin color and temperature suggests that the absence of the dorsalis pedis pulse is
an anatomical variation rather than a pathological occlusion.
Question 8: A patient with a history of heart failure is found to have jugular
venous distention (JVD) with the patient sitting at a 45-degree angle. The top
of the venous pulsations is 8 cm above the sternal angle. What is the
approximate jugular venous pressure (JVP)?
A. 5 cm H₂O
B. 8 cm H₂O
C. 13 cm H₂O
D. 20 cm H₂O
CORRECT ANSWER: C. 13 cm H₂O
Rationale: The JVP is estimated by adding the vertical height of the jugular venous
column (in cm) above the sternal angle to a standard value of 5 cm H₂O (which
, represents the distance from the sternal angle to the right atrium). In this case, 8 cm + 5
cm = 13 cm H₂O. A normal JVP is generally < 9 cm H₂O.
Question 9: A 72-year-old male presents with a painless, non-tender, rubbery,
and fixed mass in the left supraclavicular region (Virchow's node). The most
appropriate next step is to evaluate for:
A. Pulmonary tuberculosis
B. Lymphoma
C. Metastatic malignancy, likely from the gastrointestinal tract or thorax
D. Benign reactive lymphadenopathy
CORRECT ANSWER: C. Metastatic malignancy, likely from the gastrointestinal
tract or thorax
Rationale: A left supraclavicular node (Virchow's node) is a classic sign of metastatic
spread, often from abdominal or thoracic malignancies. It is not typically a primary sign
of TB (which is more common in cervical nodes) or isolated lymphoma without other
findings. A fixed, rubbery, non-tender node raises immediate suspicion for metastasis.
Question 10: When testing for lower motor neuron facial nerve (CN VII) palsy,
such as in Bell's palsy, the patient will be unable to:
A. Shrug their shoulders against resistance
B. Wrinkle their forehead on the affected side
C. Turn their head to the contralateral side
D. Swallow effectively
CORRECT ANSWER: B. Wrinkle their forehead on the affected side
Rationale: Bell's palsy is a lower motor neuron (LMN) lesion. The facial nerve innervates
the forehead muscles. In an LMN lesion, the entire half of the face is affected, including
the forehead. The inability to wrinkle the forehead is a key distinguishing feature from
an upper motor neuron (UMN) lesion (e.g., stroke), which spares the forehead due to
bilateral cortical innervation.
Question 11: A patient is found to have a positive Tinel's sign over the volar
aspect of the wrist. This finding is consistent with:
A. Ulnar nerve entrapment at the elbow
B. Median nerve entrapment at the carpal tunnel
C. Radial nerve palsy
D. Cervical radiculopathy
CORRECT ANSWER: B. Median nerve entrapment at the carpal tunnel
Rationale: Tinel's sign is performed by percussing over the median nerve at the wrist. A
positive sign (tingling or paresthesia in the median nerve distribution of the hand)
indicates nerve irritation or regeneration and is a classic finding in carpal tunnel
syndrome, where the median nerve is compressed.
Physical Assessment | 190+ Practice Questions &
Verified Answers | Latest Study Guide, Test Bank,
Practice Exam, Comprehensive Review & Exam
Prep | NR 509 Advanced Physical Assessment,
Health History, Comprehensive Health Assessment,
Physical Examination, Clinical Interview, Head-to-
Toe Assessment, Mental Status Examination,
Cardiovascular Assessment, Respiratory
Assessment, Neurological Assessment, Abdominal
Assessment, Musculoskeletal Assessment &
Diagnostic Reasoning
Question 1: A 55-year-old male with a 40-pack-year smoking history presents
with a chronic cough and hoarseness. During the respiratory examination, you
note a unilateral diaphragmatic paralysis on the left side. Which of the
following anatomical landmarks is most critical for accurately assessing
diaphragmatic excursion during percussion?
A. The sternal angle
B. The costophrenic angle
C. The xiphoid process
D. The angle of Louis
CORRECT ANSWER: B. The costophrenic angle
Rationale: Diaphragmatic excursion is assessed by percussing the descent of the
diaphragm during inspiration and expiration. The key landmark is the costophrenic
angle (the angle between the ribs and the diaphragm), where the change from resonant
to dull percussion notes indicates the position of the diaphragm. A decrease in excursion
suggests phrenic nerve palsy, pleural effusion, or diaphragmatic weakness.
Question 2: In a patient presenting with acute onset of severe, tearing chest
pain radiating to the back, which physical examination finding is most specific
for aortic dissection?
A. Hypertension in the right arm and hypotension in the left arm
B. A prominent P2 and a right ventricular heave
C. A mid-systolic click followed by a late systolic murmur
D. A pericardial friction rub
CORRECT ANSWER: A. Hypertension in the right arm and hypotension in the
left arm
Rationale: Aortic dissection can compromise the ostium of the subclavian artery, leading
to differential blood pressures between the arms. A significant difference in systolic
blood pressure (often > 20 mmHg) between the right and left arms is a classic and
,highly concerning sign. The other options are more consistent with aortic stenosis,
pulmonary hypertension, and pericarditis, respectively.
Question 3: When performing a cardiovascular examination on a patient with
suspected mitral stenosis, the characteristic opening snap is best heard at
which location using the bell of the stethoscope?
A. The aortic area (right second intercostal space)
B. The pulmonic area (left second intercostal space)
C. The tricuspid area (left lower sternal border)
D. The apex of the heart
CORRECT ANSWER: D. The apex of the heart
Rationale: The opening snap of mitral stenosis is best heard at the apex of the heart,
which overlies the left ventricle and corresponds to the mitral valve area. It is a high-
frequency sound that occurs shortly after S2 and is best heard with the diaphragm, but
the location is the apex. It indicates a pliable but stenotic mitral valve.
Question 4: A 68-year-old female presents with progressive dyspnea on
exertion and a dry cough. On auscultation, you hear fine, late-inspiratory
crackles that are most prominent at the lung bases. Which of the following is
the most likely diagnosis?
A. Chronic bronchitis
B. Pulmonary edema secondary to left-sided heart failure
C. Idiopathic pulmonary fibrosis
D. Atelectasis
CORRECT ANSWER: C. Idiopathic pulmonary fibrosis
Rationale: Fine, late-inspiratory crackles (Velcro crackles) that are persistent and
prominent at the lung bases are a hallmark of interstitial lung diseases such as idiopathic
pulmonary fibrosis. These crackles are produced by the sudden opening of stiff, fibrotic
airways during inspiration.
Question 5: During an abdominal examination, you elicit a positive Murphy's
sign. This sign is elicited by having the patient inhale while you palpate the
right subcostal area. A positive sign is indicative of:
A. Acute appendicitis
B. Acute pancreatitis
C. Acute cholecystitis
D. Gastric ulcer
CORRECT ANSWER: C. Acute cholecystitis
Rationale: Murphy's sign is a classic test for acute cholecystitis. The examiner palpates
the right upper quadrant at the costal margin. The patient is asked to take a deep breath.
,If pain causes the patient to abruptly stop inhaling (inspiratory arrest), the test is
positive, indicating inflammation of the gallbladder.
Question 6: A 45-year-old male presents with a palpable, pulsatile mass in the
periumbilical region. He is overweight and has a history of hypertension and
atherosclerosis. Which of the following is the most appropriate immediate
action?
A. Perform a deep palpation to define the margins of the mass
B. Auscultate the mass for a bruit
C. Obtain a computed tomography (CT) scan of the abdomen
D. Refer the patient for an ultrasound
CORRECT ANSWER: B. Auscultate the mass for a bruit
Rationale: In a patient with a suspected abdominal aortic aneurysm (AAA), pulsatile
masses should not be vigorously palpated due to the risk of rupture. The safest and most
appropriate initial step after inspection is to auscultate the mass. A systolic bruit may be
heard over an AAA due to turbulent blood flow, though its absence does not rule it out.
Question 7: In assessing a patient's peripheral vascular system, you note that
the dorsalis pedis pulse is absent but the posterior tibial pulse is strong. The
most likely cause is:
A. Femoral artery occlusion
B. Aortic stenosis
C. Popliteal artery occlusion
D. Anatomic variation
CORRECT ANSWER: D. Anatomic variation
Rationale: The dorsalis pedis artery is congenitally absent in about 10% of the
population. The presence of other palpable pedal pulses (like the posterior tibial) with
intact skin color and temperature suggests that the absence of the dorsalis pedis pulse is
an anatomical variation rather than a pathological occlusion.
Question 8: A patient with a history of heart failure is found to have jugular
venous distention (JVD) with the patient sitting at a 45-degree angle. The top
of the venous pulsations is 8 cm above the sternal angle. What is the
approximate jugular venous pressure (JVP)?
A. 5 cm H₂O
B. 8 cm H₂O
C. 13 cm H₂O
D. 20 cm H₂O
CORRECT ANSWER: C. 13 cm H₂O
Rationale: The JVP is estimated by adding the vertical height of the jugular venous
column (in cm) above the sternal angle to a standard value of 5 cm H₂O (which
, represents the distance from the sternal angle to the right atrium). In this case, 8 cm + 5
cm = 13 cm H₂O. A normal JVP is generally < 9 cm H₂O.
Question 9: A 72-year-old male presents with a painless, non-tender, rubbery,
and fixed mass in the left supraclavicular region (Virchow's node). The most
appropriate next step is to evaluate for:
A. Pulmonary tuberculosis
B. Lymphoma
C. Metastatic malignancy, likely from the gastrointestinal tract or thorax
D. Benign reactive lymphadenopathy
CORRECT ANSWER: C. Metastatic malignancy, likely from the gastrointestinal
tract or thorax
Rationale: A left supraclavicular node (Virchow's node) is a classic sign of metastatic
spread, often from abdominal or thoracic malignancies. It is not typically a primary sign
of TB (which is more common in cervical nodes) or isolated lymphoma without other
findings. A fixed, rubbery, non-tender node raises immediate suspicion for metastasis.
Question 10: When testing for lower motor neuron facial nerve (CN VII) palsy,
such as in Bell's palsy, the patient will be unable to:
A. Shrug their shoulders against resistance
B. Wrinkle their forehead on the affected side
C. Turn their head to the contralateral side
D. Swallow effectively
CORRECT ANSWER: B. Wrinkle their forehead on the affected side
Rationale: Bell's palsy is a lower motor neuron (LMN) lesion. The facial nerve innervates
the forehead muscles. In an LMN lesion, the entire half of the face is affected, including
the forehead. The inability to wrinkle the forehead is a key distinguishing feature from
an upper motor neuron (UMN) lesion (e.g., stroke), which spares the forehead due to
bilateral cortical innervation.
Question 11: A patient is found to have a positive Tinel's sign over the volar
aspect of the wrist. This finding is consistent with:
A. Ulnar nerve entrapment at the elbow
B. Median nerve entrapment at the carpal tunnel
C. Radial nerve palsy
D. Cervical radiculopathy
CORRECT ANSWER: B. Median nerve entrapment at the carpal tunnel
Rationale: Tinel's sign is performed by percussing over the median nerve at the wrist. A
positive sign (tingling or paresthesia in the median nerve distribution of the hand)
indicates nerve irritation or regeneration and is a classic finding in carpal tunnel
syndrome, where the median nerve is compressed.
