NR 509 1
NR 509 ADVANCED PHYSICAL ASSESSMENT |
CHAMBERLAIN COLLEGE OF NURSING | ACADEMIC
YEAR 2026/2027 | FINAL COMPREHENSIVE EXAMINATION
| STUDY GUIDE | LATEST UPDATE | PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW
Table of Contents
1. Clinical Reasoning, Health History, and Documentation
2. Skin, Hair, and Nails Assessment
3. Head, Eyes, Ears, Nose, and Throat (HEENT) Assessment
4. Cardiovascular System Assessment
5. Respiratory System Assessment
6. Abdominal and Gastrointestinal Assessment
7. Musculoskeletal System Assessment
8. Neurological System Assessment
9. Reproductive Health and Pregnancy Assessment
10. Aging Adult, Cultural Competence, and Health Promotion
, NR 509 2
Question 1: You are beginning the examination of the skin on a 25-year-old teacher. You have
previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair
loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and
texture of the skin of a patient with hypothyroidism?
A. Moist and smooth
B. Moist and rough
C. Dry and smooth
D. Dry and rough
Correct Answer: D. Dry and rough
Hypothyroidism reduces metabolic rate, cutaneous blood flow, and sweating, resulting in skin
that is dry, rough, cool, and pale. Myxedema (non-pitting edema) may also be present. Moist
skin suggests hyperthyroidism or normal thermoregulation.
Question 2: Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic
lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on
the rash, it doesn't blanch. What would you tell her regarding her rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
D. It should not cause any concern.
Correct Answer: A. It is likely to be related to her lupus.
A non-blanching rash (petechiae or purpura) in a patient with SLE suggests vasculitis or
thrombocytopenia, both of which can be associated with lupus. This finding warrants further
evaluation and should not be dismissed as a benign allergic reaction.
Question 3: A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease before the age of 50, but this individual was not tested
for BRCA1 and BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s
and had radiation to the chest. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient?
A. No agency recommends breast MRI for a patient such as this one, who has moderately but
not extraordinary risk factors for breast cancer.
B. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
, NR 509 3
MRI for patients with such risk factors.
C. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense
of markedly decreased specificity.
D. This patient should be screened annually with breast MRI due to her history of chest
radiation and family history.
Correct Answer: D. This patient should be screened annually with breast MRI due to
her history of chest radiation and family history.
According to ACS guidelines, women with a history of chest radiation between ages 10 and
30, a BRCA mutation, or a strong family history of breast cancer should receive annual
breast MRI screening. This patient meets criteria based on her prior chest radiation for
lymphoma and family history, placing her at high risk.
Question 4: What is the first technique used in a physical assessment?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: B. Inspection
Inspection is always the first step in physical assessment, involving visual observation to
gather data before any hands-on techniques. It requires careful observation and can provide
critical data about a patient's condition before proceeding to palpation, percussion, or
auscultation.
Question 5: Which part of the hand is best for assessing skin temperature?
A. Fingertips
B. Dorsum of the hand
C. Palm
D. Base of the thumb
Correct Answer: B. Dorsum of the hand
The dorsum (back) of the hand is most sensitive to temperature changes, making it ideal for
assessing skin temperature. The fingertips are best for fine tactile discrimination, while the
palm is used for vibration and position sense.
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Question 6: A 58-year-old male presents with a chief complaint of "chest pressure." He
describes it as a dull ache that started 2 hours ago while raking leaves. Which component of
the HPI is represented by "raking leaves"?
A. Location
B. Context
C. Associated factors
D. Timing
Correct Answer: B. Context
Context refers to the activity or situation the patient was engaged in when the symptom
began. "Raking leaves" provides the environmental or situational context, not the timing
(duration) or associated factors (other symptoms).
Question 7: You are using the "OLDCARTS" mnemonic to gather HPI data. A patient tells
you their abdominal pain is "sharp and stabbing." Which part of OLDCARTS does this
describe?
A. Onset
B. Location
C. Character
D. Timing
Correct Answer: C. Character
Character describes the quality or sensation of the symptom (e.g., sharp, dull, burning,
stabbing). Onset refers to when the symptom began, location to where it is felt, and timing to
frequency and duration.
Question 8: A 72-year-old patient is asked about their medical history but cannot recall the
names of their medications. What is the most appropriate next step?
A. Skip this section and document "non-contributory."
B. Ask the patient to bring all prescription bottles to the next visit.
C. Ask the patient to call their pharmacy for a list while in the office.
D. Document the history as "unknown" and proceed.
Correct Answer: C. Ask the patient to call their pharmacy for a list while in the office.
Accurate medication reconciliation is critical for patient safety. The best immediate step is to
obtain the list from the pharmacy during the visit to ensure accuracy and completeness.
Waiting until the next visit delays important clinical decision-making.
NR 509 ADVANCED PHYSICAL ASSESSMENT |
CHAMBERLAIN COLLEGE OF NURSING | ACADEMIC
YEAR 2026/2027 | FINAL COMPREHENSIVE EXAMINATION
| STUDY GUIDE | LATEST UPDATE | PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW
Table of Contents
1. Clinical Reasoning, Health History, and Documentation
2. Skin, Hair, and Nails Assessment
3. Head, Eyes, Ears, Nose, and Throat (HEENT) Assessment
4. Cardiovascular System Assessment
5. Respiratory System Assessment
6. Abdominal and Gastrointestinal Assessment
7. Musculoskeletal System Assessment
8. Neurological System Assessment
9. Reproductive Health and Pregnancy Assessment
10. Aging Adult, Cultural Competence, and Health Promotion
, NR 509 2
Question 1: You are beginning the examination of the skin on a 25-year-old teacher. You have
previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair
loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and
texture of the skin of a patient with hypothyroidism?
A. Moist and smooth
B. Moist and rough
C. Dry and smooth
D. Dry and rough
Correct Answer: D. Dry and rough
Hypothyroidism reduces metabolic rate, cutaneous blood flow, and sweating, resulting in skin
that is dry, rough, cool, and pale. Myxedema (non-pitting edema) may also be present. Moist
skin suggests hyperthyroidism or normal thermoregulation.
Question 2: Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic
lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on
the rash, it doesn't blanch. What would you tell her regarding her rash?
A. It is likely to be related to her lupus.
B. It is likely to be related to an exposure to a chemical.
C. It is likely to be related to an allergic reaction.
D. It should not cause any concern.
Correct Answer: A. It is likely to be related to her lupus.
A non-blanching rash (petechiae or purpura) in a patient with SLE suggests vasculitis or
thrombocytopenia, both of which can be associated with lupus. This finding warrants further
evaluation and should not be dismissed as a benign allergic reaction.
Question 3: A 68-year-old former paleontologist presents to clinic with concerns about her
breast cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease before the age of 50, but this individual was not tested
for BRCA1 and BRCA2 genes. In addition, the patient suffered from lymphoma in her 20s
and had radiation to the chest. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient?
A. No agency recommends breast MRI for a patient such as this one, who has moderately but
not extraordinary risk factors for breast cancer.
B. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
, NR 509 3
MRI for patients with such risk factors.
C. Regardless of recommendations, the high sensitivity of breast MRI comes at the expense
of markedly decreased specificity.
D. This patient should be screened annually with breast MRI due to her history of chest
radiation and family history.
Correct Answer: D. This patient should be screened annually with breast MRI due to
her history of chest radiation and family history.
According to ACS guidelines, women with a history of chest radiation between ages 10 and
30, a BRCA mutation, or a strong family history of breast cancer should receive annual
breast MRI screening. This patient meets criteria based on her prior chest radiation for
lymphoma and family history, placing her at high risk.
Question 4: What is the first technique used in a physical assessment?
A. Palpation
B. Inspection
C. Percussion
D. Auscultation
Correct Answer: B. Inspection
Inspection is always the first step in physical assessment, involving visual observation to
gather data before any hands-on techniques. It requires careful observation and can provide
critical data about a patient's condition before proceeding to palpation, percussion, or
auscultation.
Question 5: Which part of the hand is best for assessing skin temperature?
A. Fingertips
B. Dorsum of the hand
C. Palm
D. Base of the thumb
Correct Answer: B. Dorsum of the hand
The dorsum (back) of the hand is most sensitive to temperature changes, making it ideal for
assessing skin temperature. The fingertips are best for fine tactile discrimination, while the
palm is used for vibration and position sense.
, NR 509 4
Question 6: A 58-year-old male presents with a chief complaint of "chest pressure." He
describes it as a dull ache that started 2 hours ago while raking leaves. Which component of
the HPI is represented by "raking leaves"?
A. Location
B. Context
C. Associated factors
D. Timing
Correct Answer: B. Context
Context refers to the activity or situation the patient was engaged in when the symptom
began. "Raking leaves" provides the environmental or situational context, not the timing
(duration) or associated factors (other symptoms).
Question 7: You are using the "OLDCARTS" mnemonic to gather HPI data. A patient tells
you their abdominal pain is "sharp and stabbing." Which part of OLDCARTS does this
describe?
A. Onset
B. Location
C. Character
D. Timing
Correct Answer: C. Character
Character describes the quality or sensation of the symptom (e.g., sharp, dull, burning,
stabbing). Onset refers to when the symptom began, location to where it is felt, and timing to
frequency and duration.
Question 8: A 72-year-old patient is asked about their medical history but cannot recall the
names of their medications. What is the most appropriate next step?
A. Skip this section and document "non-contributory."
B. Ask the patient to bring all prescription bottles to the next visit.
C. Ask the patient to call their pharmacy for a list while in the office.
D. Document the history as "unknown" and proceed.
Correct Answer: C. Ask the patient to call their pharmacy for a list while in the office.
Accurate medication reconciliation is critical for patient safety. The best immediate step is to
obtain the list from the pharmacy during the visit to ensure accuracy and completeness.
Waiting until the next visit delays important clinical decision-making.
