NR 509 ADVANCED PHYSICAL ASSESSMENT MIDTERM
EXAM – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
1. A 45-year-old patient presents with a chief complaint of "fatigue." Which of the following is the
most appropriate initial open-ended question?
A) "How long have you been feeling tired?"
B) "Tell me more about your fatigue."
C) "Do you feel tired all the time?"
D) "Is your fatigue worse in the morning or evening?"
Answer: B
Rationale: An open-ended question like "Tell me more about your fatigue" invites the patient to describe
their experience in their own words, facilitating a comprehensive history. The other options are closed-
ended and may limit the patient's response.
2. When performing a mental status examination, which of the following is assessed by asking the
patient to spell "world" backwards?
A) Attention and calculation
B) Memory
C) Orientation
D) Language
Answer: A
Rationale: Spelling "world" backwards tests attention and calculation, part of the cognitive assessment.
Memory is tested by recall, orientation by questions about time/place/person, and language by naming or
repetition.
3. A patient has a blood pressure of 150/90 mmHg. According to the American Heart Association, this
is classified as:
A) Normal
,B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
Rationale: Stage 1 hypertension is defined as systolic 130-139 or diastolic 80-89 mmHg. However, 150/90 is
actually Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Wait, the AHA guidelines: Normal <120/80,
Elevated 120-129/<80, Stage 1 130-139 or 80-89, Stage 2 ≥140 or ≥90. So 150/90 is Stage 2. Correction:
Answer should be D. But let's double-check: 150/90: systolic 150 ≥140, diastolic 90 ≥90, so Stage 2. So
answer D. I'll set answer D. Rationale: Stage 2 hypertension is systolic ≥140 or diastolic ≥90.
4. Which of the following is the correct technique for auscultating the lungs?
A) Listen over the anterior chest only
B) Listen over the posterior chest only
C) Listen over both anterior and posterior chest, comparing sides
D) Listen only at the bases
Answer: C
Rationale: A complete lung exam requires listening over both anterior and posterior chest fields, comparing
symmetrical areas to detect abnormalities.
5. A patient presents with a chief complaint of chest pain. Which of the following questions is most
important to ask first?
A) "Does the pain radiate to your arm?"
B) "What were you doing when the pain started?"
C) "On a scale of 1 to 10, how would you rate your pain?"
D) "Have you ever had this pain before?"
Answer: B
Rationale: Understanding the onset and context of chest pain helps differentiate between cardiac,
pulmonary, musculoskeletal, and other causes. The other questions are also important but the precipitating
event is key.
6. When assessing a patient's skin, which of the following findings is most concerning for melanoma?
A) A symmetrical, uniform brown macule
B) A lesion with irregular borders and multiple colors
2
,C) A raised, flesh-colored nodule
D) A scaly, silvery plaque
Answer: B
Rationale: The ABCDE criteria for melanoma include Asymmetry, Border irregularity, Color variation,
Diameter >6mm, and Evolution. Irregular borders and multiple colors are classic warning signs.
7. A 65-year-old patient has a positive Romberg test. This indicates:
A) Cerebellar dysfunction
B) Peripheral neuropathy
C) Vestibular dysfunction
D) All of the above
Answer: D
Rationale: A positive Romberg test (increased sway or fall when eyes closed) indicates sensory ataxia, which
can be due to peripheral neuropathy, vestibular dysfunction, or cerebellar disease. It tests proprioception
and vestibular function.
8. Which of the following is the correct order of the abdominal examination?
A) Inspection, palpation, percussion, auscultation
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Palpation, percussion, auscultation, inspection
Answer: B
Rationale: The correct order is Inspection, Auscultation, Percussion, Palpation. Auscultation is done before
percussion and palpation because these can alter bowel sounds.
9. A patient has a positive Murphy's sign. This is associated with:
A) Appendicitis
B) Cholecystitis
C) Pancreatitis
D) Diverticulitis
Answer: B
Rationale: Murphy's sign is pain on inspiration when the examiner's hand is placed under the right costal
margin. It is a classic sign of acute cholecystitis.
3
, 10. When assessing a patient's cranial nerves, which nerve is tested by asking the patient to shrug
their shoulders?
A) Cranial nerve IX (glossopharyngeal)
B) Cranial nerve X (vagus)
C) Cranial nerve XI (accessory)
D) Cranial nerve XII (hypoglossal)
Answer: C
Rationale: The accessory nerve (CN XI) innervates the sternocleidomastoid and trapezius muscles.
Shrugging shoulders tests the trapezius.
11. A patient presents with a sudden onset of severe headache, described as "the worst headache of
my life." This is most concerning for:
A) Migraine
B) Tension headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C
Rationale: A sudden, severe "thunderclap" headache is a red flag for subarachnoid hemorrhage. Immediate
evaluation is required.
12. Which of the following is a normal finding when percussing the chest?
A) Dullness over the lung fields
B) Hyperresonance over the lung fields
C) Resonance over the lung fields
D) Tympany over the lung fields
Answer: C
Rationale: Normal lung percussion is resonant. Dullness may indicate consolidation or effusion;
hyperresonance may indicate COPD or pneumothorax; tympany is heard over the stomach.
13. A patient has a blood pressure of 120/80 mmHg in the right arm and 100/70 mmHg in the left
arm. This difference is most consistent with:
4
EXAM – QUESTIONS AND ANSWERS | VERIFIED AND
WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
1. A 45-year-old patient presents with a chief complaint of "fatigue." Which of the following is the
most appropriate initial open-ended question?
A) "How long have you been feeling tired?"
B) "Tell me more about your fatigue."
C) "Do you feel tired all the time?"
D) "Is your fatigue worse in the morning or evening?"
Answer: B
Rationale: An open-ended question like "Tell me more about your fatigue" invites the patient to describe
their experience in their own words, facilitating a comprehensive history. The other options are closed-
ended and may limit the patient's response.
2. When performing a mental status examination, which of the following is assessed by asking the
patient to spell "world" backwards?
A) Attention and calculation
B) Memory
C) Orientation
D) Language
Answer: A
Rationale: Spelling "world" backwards tests attention and calculation, part of the cognitive assessment.
Memory is tested by recall, orientation by questions about time/place/person, and language by naming or
repetition.
3. A patient has a blood pressure of 150/90 mmHg. According to the American Heart Association, this
is classified as:
A) Normal
,B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
Rationale: Stage 1 hypertension is defined as systolic 130-139 or diastolic 80-89 mmHg. However, 150/90 is
actually Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Wait, the AHA guidelines: Normal <120/80,
Elevated 120-129/<80, Stage 1 130-139 or 80-89, Stage 2 ≥140 or ≥90. So 150/90 is Stage 2. Correction:
Answer should be D. But let's double-check: 150/90: systolic 150 ≥140, diastolic 90 ≥90, so Stage 2. So
answer D. I'll set answer D. Rationale: Stage 2 hypertension is systolic ≥140 or diastolic ≥90.
4. Which of the following is the correct technique for auscultating the lungs?
A) Listen over the anterior chest only
B) Listen over the posterior chest only
C) Listen over both anterior and posterior chest, comparing sides
D) Listen only at the bases
Answer: C
Rationale: A complete lung exam requires listening over both anterior and posterior chest fields, comparing
symmetrical areas to detect abnormalities.
5. A patient presents with a chief complaint of chest pain. Which of the following questions is most
important to ask first?
A) "Does the pain radiate to your arm?"
B) "What were you doing when the pain started?"
C) "On a scale of 1 to 10, how would you rate your pain?"
D) "Have you ever had this pain before?"
Answer: B
Rationale: Understanding the onset and context of chest pain helps differentiate between cardiac,
pulmonary, musculoskeletal, and other causes. The other questions are also important but the precipitating
event is key.
6. When assessing a patient's skin, which of the following findings is most concerning for melanoma?
A) A symmetrical, uniform brown macule
B) A lesion with irregular borders and multiple colors
2
,C) A raised, flesh-colored nodule
D) A scaly, silvery plaque
Answer: B
Rationale: The ABCDE criteria for melanoma include Asymmetry, Border irregularity, Color variation,
Diameter >6mm, and Evolution. Irregular borders and multiple colors are classic warning signs.
7. A 65-year-old patient has a positive Romberg test. This indicates:
A) Cerebellar dysfunction
B) Peripheral neuropathy
C) Vestibular dysfunction
D) All of the above
Answer: D
Rationale: A positive Romberg test (increased sway or fall when eyes closed) indicates sensory ataxia, which
can be due to peripheral neuropathy, vestibular dysfunction, or cerebellar disease. It tests proprioception
and vestibular function.
8. Which of the following is the correct order of the abdominal examination?
A) Inspection, palpation, percussion, auscultation
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Palpation, percussion, auscultation, inspection
Answer: B
Rationale: The correct order is Inspection, Auscultation, Percussion, Palpation. Auscultation is done before
percussion and palpation because these can alter bowel sounds.
9. A patient has a positive Murphy's sign. This is associated with:
A) Appendicitis
B) Cholecystitis
C) Pancreatitis
D) Diverticulitis
Answer: B
Rationale: Murphy's sign is pain on inspiration when the examiner's hand is placed under the right costal
margin. It is a classic sign of acute cholecystitis.
3
, 10. When assessing a patient's cranial nerves, which nerve is tested by asking the patient to shrug
their shoulders?
A) Cranial nerve IX (glossopharyngeal)
B) Cranial nerve X (vagus)
C) Cranial nerve XI (accessory)
D) Cranial nerve XII (hypoglossal)
Answer: C
Rationale: The accessory nerve (CN XI) innervates the sternocleidomastoid and trapezius muscles.
Shrugging shoulders tests the trapezius.
11. A patient presents with a sudden onset of severe headache, described as "the worst headache of
my life." This is most concerning for:
A) Migraine
B) Tension headache
C) Subarachnoid hemorrhage
D) Cluster headache
Answer: C
Rationale: A sudden, severe "thunderclap" headache is a red flag for subarachnoid hemorrhage. Immediate
evaluation is required.
12. Which of the following is a normal finding when percussing the chest?
A) Dullness over the lung fields
B) Hyperresonance over the lung fields
C) Resonance over the lung fields
D) Tympany over the lung fields
Answer: C
Rationale: Normal lung percussion is resonant. Dullness may indicate consolidation or effusion;
hyperresonance may indicate COPD or pneumothorax; tympany is heard over the stomach.
13. A patient has a blood pressure of 120/80 mmHg in the right arm and 100/70 mmHg in the left
arm. This difference is most consistent with:
4
