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,NR 509 – Advanced Physical Assessment Final Exam
Chamberlain University | Practice Questions 2026
Section 1: Clinical Reasoning, Documentation & the Nursing Process
(Q1–Q12)
Q1. A patient presents with a 2-day history of productive cough, fever
of 38.5°C, and pleuritic chest pain. On examination, you note dullness
to percussion and increased tactile fremitus over the right lower lobe.
These findings are most consistent with:
A. Pleural effusion
B. Consolidation (e.g., pneumonia)
C. Pneumothorax
D. Atelectasis
Answer: B
Rationale: Dullness to percussion and increased tactile fremitus together
indicate consolidation, as seen in pneumonia. Pleural effusion also causes
dullness but decreases tactile fremitus. Pneumothorax causes
hyperresonance and decreased fremitus. Atelectasis may cause dullness
but typically decreases fremitus.
Q2. A 65-year-old male with a history of heart failure presents with
worsening dyspnea. On examination, you note an S3 gallop and
bilateral crackles at the lung bases. Which of the following best
describes the S3 gallop?
A. It is best heard with the diaphragm at the base of the heart.
B. It is best heard with the bell at the apex.
C. It is a high-pitched sound heard during systole.
D. It indicates normal aging in older adults.
, Answer: B
Rationale: An S3 gallop is a low-pitched diastolic sound best heard with
the bell at the apex (mitral area). It is abnormal in adults and suggests
ventricular volume overload or heart failure.
Q3. A 30-year-old female presents with a 3-week history of fatigue and
pallor. On examination, you note pale conjunctivae and a systolic flow
murmur. Which laboratory test is most appropriate to order first?
A. Serum ferritin
B. Complete blood count (CBC)
C. Erythropoietin level
D. Bone marrow biopsy
Answer: B
Rationale: The CBC is the initial test for suspected anemia and will reveal
hemoglobin/hematocrit levels. Ferritin and other studies follow based on
the CBC results.
Q4. A nurse practitioner is documenting a SOAP note. Which section
includes the patient's reported symptoms and history?
A. Subjective
B. Objective
C. Assessment
D. Plan
Answer: A
Rationale: The Subjective section includes the patient's reported
symptoms, history, and concerns. Objective includes examination findings.
Assessment is the differential diagnosis. Plan is the management strategy.
Q5. A 45-year-old male presents with a painless, firm nodule on the
thyroid gland. Which finding is most concerning for malignancy?
A. Smooth, mobile nodule
,NR 509 – Advanced Physical Assessment Final Exam
Chamberlain University | Practice Questions 2026
Section 1: Clinical Reasoning, Documentation & the Nursing Process
(Q1–Q12)
Q1. A patient presents with a 2-day history of productive cough, fever
of 38.5°C, and pleuritic chest pain. On examination, you note dullness
to percussion and increased tactile fremitus over the right lower lobe.
These findings are most consistent with:
A. Pleural effusion
B. Consolidation (e.g., pneumonia)
C. Pneumothorax
D. Atelectasis
Answer: B
Rationale: Dullness to percussion and increased tactile fremitus together
indicate consolidation, as seen in pneumonia. Pleural effusion also causes
dullness but decreases tactile fremitus. Pneumothorax causes
hyperresonance and decreased fremitus. Atelectasis may cause dullness
but typically decreases fremitus.
Q2. A 65-year-old male with a history of heart failure presents with
worsening dyspnea. On examination, you note an S3 gallop and
bilateral crackles at the lung bases. Which of the following best
describes the S3 gallop?
A. It is best heard with the diaphragm at the base of the heart.
B. It is best heard with the bell at the apex.
C. It is a high-pitched sound heard during systole.
D. It indicates normal aging in older adults.
, Answer: B
Rationale: An S3 gallop is a low-pitched diastolic sound best heard with
the bell at the apex (mitral area). It is abnormal in adults and suggests
ventricular volume overload or heart failure.
Q3. A 30-year-old female presents with a 3-week history of fatigue and
pallor. On examination, you note pale conjunctivae and a systolic flow
murmur. Which laboratory test is most appropriate to order first?
A. Serum ferritin
B. Complete blood count (CBC)
C. Erythropoietin level
D. Bone marrow biopsy
Answer: B
Rationale: The CBC is the initial test for suspected anemia and will reveal
hemoglobin/hematocrit levels. Ferritin and other studies follow based on
the CBC results.
Q4. A nurse practitioner is documenting a SOAP note. Which section
includes the patient's reported symptoms and history?
A. Subjective
B. Objective
C. Assessment
D. Plan
Answer: A
Rationale: The Subjective section includes the patient's reported
symptoms, history, and concerns. Objective includes examination findings.
Assessment is the differential diagnosis. Plan is the management strategy.
Q5. A 45-year-old male presents with a painless, firm nodule on the
thyroid gland. Which finding is most concerning for malignancy?
A. Smooth, mobile nodule
