NR 509 ADVANCED PHYSICAL ASSESSMENT |
CHAMBERLAIN COLLEGE OF NURSING | ACADEMIC YEAR
2026/2027 | 150
Core Domains
Health History and Interviewing
Physical Examination Techniques
Head, Eyes, Ears, Nose, and Throat
Cardiovascular and Respiratory Systems
Abdominal and Gastrointestinal Systems
Neurologic and Musculoskeletal Systems
Skin, Hair, and Nails
Special Populations and Cultural Competence
Documentation and Clinical Reasoning
Ethics, Legal, and Professional Standards
Introduction
This examination assesses advanced physical assessment knowledge and
clinical decision-making for graduate nursing practice. It evaluates
interviewing, inspection, palpation, percussion, and auscultation skills
across body systems. Multiple-choice and scenario-based items test real-
world application, diagnostic reasoning, and documentation. Emphasis is
placed on cultural sensitivity, ethical practice, and regulatory compliance.
The exam prepares candidates to perform comprehensive assessments
and communicate findings accurately in diverse clinical settings.
SECTION ONE: QUESTIONS 1–150
1. A patient reports a sudden onset of severe, tearing chest pain
radiating to the back. Which assessment finding is most concerning?
A. Blood pressure 150/90 mmHg
B. Pulse 110 beats/min
C. Unequal radial pulses
D. Respiratory rate 22 breaths/min
, C. Unequal radial pulses
RATIONALE: Unequal pulses suggest aortic dissection, a life-
threatening emergency requiring immediate intervention.
2. During auscultation of the lungs, a nurse hears fine crackles at the
bases. This finding is most consistent with:
A. Asthma
B. Pulmonary edema
C. Pneumonia
D. Pleural effusion
B. Pulmonary edema
RATIONALE: Fine crackles at the bases are classic for fluid in the
alveoli, often due to heart failure or pulmonary edema.
3. Which technique is used to assess for tactile fremitus?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
B. Palpation
RATIONALE: Tactile fremitus is assessed by palpating the chest while
the patient speaks, feeling for vibrations.
4. A patient has a positive Babinski sign. This indicates:
A. Normal finding in adults
B. Upper motor neuron lesion
C. Lower motor neuron lesion
D. Peripheral nerve damage
B. Upper motor neuron lesion
RATIONALE: A positive Babinski sign (dorsiflexion of the great toe)
indicates corticospinal tract damage in adults.
, 5. When assessing the abdomen, the correct order of techniques is:
A. Inspection, palpation, percussion, auscultation
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
RATIONALE: Auscultation precedes palpation and percussion to avoid
altering bowel sounds.
6. A patient has a blood pressure of 160/100 mmHg in the right arm and
130/80 mmHg in the left arm. This finding suggests:
A. Normal variation
B. Aortic stenosis
C. Peripheral vascular disease
D. Coarctation of the aorta
D. Coarctation of the aorta
RATIONALE: A significant difference between arms (>20 mmHg)
suggests coarctation or arterial obstruction.
7. Which cranial nerve is assessed by asking the patient to shrug their
shoulders?
A. CN IX
B. CN X
C. CN XI
D. CN XII
C. CN XI
RATIONALE: CN XI (spinal accessory) innervates the trapezius and
sternocleidomastoid muscles, controlling shoulder shrug.
8. A nurse is assessing a patient with suspected meningitis. Which
finding is most indicative?
, A. Positive Kernig sign
B. Positive Babinski sign
C. Positive Romberg sign
D. Positive Phalen sign
A. Positive Kernig sign
RATIONALE: Kernig sign (resistance to knee extension) indicates
meningeal irritation.
9. During a skin assessment, a nurse notes a non-blanching, purplish
lesion. This is best documented as:
A. Petechiae
B. Ecchymosis
C. Purpura
D. Telangiectasia
C. Purpura
RATIONALE: Purpura is a non-blanching, purplish lesion >3 mm, often
due to bleeding under the skin.
10. A patient has a positive Homans sign. This may indicate:
A. Appendicitis
B. Deep vein thrombosis
C. Cholecystitis
D. Peritonitis
B. Deep vein thrombosis
RATIONALE: Homans sign (calf pain with dorsiflexion) is a classic,
though non-specific, sign of DVT.
11. The correct technique for auscultating the mitral valve is to
place the stethoscope at the:
A. Second right intercostal space
B. Second left intercostal space
CHAMBERLAIN COLLEGE OF NURSING | ACADEMIC YEAR
2026/2027 | 150
Core Domains
Health History and Interviewing
Physical Examination Techniques
Head, Eyes, Ears, Nose, and Throat
Cardiovascular and Respiratory Systems
Abdominal and Gastrointestinal Systems
Neurologic and Musculoskeletal Systems
Skin, Hair, and Nails
Special Populations and Cultural Competence
Documentation and Clinical Reasoning
Ethics, Legal, and Professional Standards
Introduction
This examination assesses advanced physical assessment knowledge and
clinical decision-making for graduate nursing practice. It evaluates
interviewing, inspection, palpation, percussion, and auscultation skills
across body systems. Multiple-choice and scenario-based items test real-
world application, diagnostic reasoning, and documentation. Emphasis is
placed on cultural sensitivity, ethical practice, and regulatory compliance.
The exam prepares candidates to perform comprehensive assessments
and communicate findings accurately in diverse clinical settings.
SECTION ONE: QUESTIONS 1–150
1. A patient reports a sudden onset of severe, tearing chest pain
radiating to the back. Which assessment finding is most concerning?
A. Blood pressure 150/90 mmHg
B. Pulse 110 beats/min
C. Unequal radial pulses
D. Respiratory rate 22 breaths/min
, C. Unequal radial pulses
RATIONALE: Unequal pulses suggest aortic dissection, a life-
threatening emergency requiring immediate intervention.
2. During auscultation of the lungs, a nurse hears fine crackles at the
bases. This finding is most consistent with:
A. Asthma
B. Pulmonary edema
C. Pneumonia
D. Pleural effusion
B. Pulmonary edema
RATIONALE: Fine crackles at the bases are classic for fluid in the
alveoli, often due to heart failure or pulmonary edema.
3. Which technique is used to assess for tactile fremitus?
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
B. Palpation
RATIONALE: Tactile fremitus is assessed by palpating the chest while
the patient speaks, feeling for vibrations.
4. A patient has a positive Babinski sign. This indicates:
A. Normal finding in adults
B. Upper motor neuron lesion
C. Lower motor neuron lesion
D. Peripheral nerve damage
B. Upper motor neuron lesion
RATIONALE: A positive Babinski sign (dorsiflexion of the great toe)
indicates corticospinal tract damage in adults.
, 5. When assessing the abdomen, the correct order of techniques is:
A. Inspection, palpation, percussion, auscultation
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
RATIONALE: Auscultation precedes palpation and percussion to avoid
altering bowel sounds.
6. A patient has a blood pressure of 160/100 mmHg in the right arm and
130/80 mmHg in the left arm. This finding suggests:
A. Normal variation
B. Aortic stenosis
C. Peripheral vascular disease
D. Coarctation of the aorta
D. Coarctation of the aorta
RATIONALE: A significant difference between arms (>20 mmHg)
suggests coarctation or arterial obstruction.
7. Which cranial nerve is assessed by asking the patient to shrug their
shoulders?
A. CN IX
B. CN X
C. CN XI
D. CN XII
C. CN XI
RATIONALE: CN XI (spinal accessory) innervates the trapezius and
sternocleidomastoid muscles, controlling shoulder shrug.
8. A nurse is assessing a patient with suspected meningitis. Which
finding is most indicative?
, A. Positive Kernig sign
B. Positive Babinski sign
C. Positive Romberg sign
D. Positive Phalen sign
A. Positive Kernig sign
RATIONALE: Kernig sign (resistance to knee extension) indicates
meningeal irritation.
9. During a skin assessment, a nurse notes a non-blanching, purplish
lesion. This is best documented as:
A. Petechiae
B. Ecchymosis
C. Purpura
D. Telangiectasia
C. Purpura
RATIONALE: Purpura is a non-blanching, purplish lesion >3 mm, often
due to bleeding under the skin.
10. A patient has a positive Homans sign. This may indicate:
A. Appendicitis
B. Deep vein thrombosis
C. Cholecystitis
D. Peritonitis
B. Deep vein thrombosis
RATIONALE: Homans sign (calf pain with dorsiflexion) is a classic,
though non-specific, sign of DVT.
11. The correct technique for auscultating the mitral valve is to
place the stethoscope at the:
A. Second right intercostal space
B. Second left intercostal space
