2026 ACTUAL EXAM QUESTIONS 1-100 NR-
509 ADVANCED PHYSICAL ASSESSMENT NR
509 MIDTERM AND FINALS EXAMPLIFY
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RATIONALES 2026 Q&A | INSTANT
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Core Domains
1. Interviewing and Health History
2. General Survey, Vital Signs, and Pain
3. Skin, Hair, and Nails
4. HEENT and Neck
5. Respiratory System
6. Cardiovascular and Peripheral Vascular Systems
7. Abdomen and Gastrointestinal System
8. Neurologic System
9. Musculoskeletal System
10. Special Populations and Clinical Reasoning
Introduction
The NR 509 Advanced Physical Assessment Midterm Examination
assesses advanced health history-taking, physical examination
techniques, clinical reasoning, and documentation skills required
of the advanced practice nurse. It evaluates inspection, palpation,
percussion, auscultation, differential diagnosis, and
developmentally appropriate assessment across the lifespan.
,Candidates must recognize normal and abnormal findings,
prioritize patient safety, and apply evidence-based practice.
Multiple-choice and scenario-based items emphasize real-world
clinical application, critical thinking, and safe decision-making in
advanced physical assessment.
1. A nurse practitioner visualizes the tympanic membrane
using an otoscope. The cone of light is seen at the 5
o’clock position in the right ear. Which of the following
does this finding indicate?
text
Otoscopic view:
___________
/ \
| \ / |
| \/ |
| cone of |
| light |
\___________/
A. Perforated tympanic membrane
B. Normal right tympanic membrane
C. Acute otitis media
D. Serous effusion
Correct answer: B
, RATIONALE: A cone of light at the 5 o’clock position in the
right ear is a normal otoscopic finding. It reflects light off the
intact, translucent tympanic membrane. Perforation, otitis media,
and effusion would present with different findings.
2. The nurse practitioner assesses the pupillary light
reflex. When the right eye is stimulated, both pupils
constrict. Which cranial nerves are responsible for this
response?
text
Right eye stimulated:
Right pupil constricts (direct)
Left pupil constricts (consensual)
A. CN I and CN II
B. CN II and CN III
C. CN III and CN IV
D. CN V and CN VII
Correct answer: B
RATIONALE: The afferent limb of the pupillary light reflex is
carried by CN II (optic nerve), and the efferent limb is carried by
CN III (oculomotor nerve). This produces direct and consensual
constriction.
3. During chest expansion assessment, the nurse notes the
right side expands 4 cm and the left side expands 2 cm.
Which condition should the nurse suspect?
text
Anterior chest:
Right expansion = 4 cm
, Left expansion = 2 cm
A. Normal symmetric expansion
B. Left-sided pneumonia or pleural effusion
C. Right-sided pneumothorax
D. Bilateral COPD
Correct answer: B
RATIONALE: Asymmetric chest expansion with decreased
expansion on the left suggests a left-sided pulmonary problem
such as pneumonia, pleural effusion, or atelectasis.
4. The nurse practitioner is documenting abdominal
findings. In which quadrant is the appendix located?
text
RUQ | LUQ
----+----
RLQ | LLQ
A. Right upper quadrant
B. Left upper quadrant
C. Right lower quadrant
D. Left lower quadrant
Correct answer: C
RATIONALE: The appendix is located in the right lower
quadrant (RLQ) at McBurney’s point. Tenderness there may
suggest appendicitis.
5. Which component of the health history is most
important to obtain first during an initial encounter?
A. Review of systems
B. Chief complaint