FINAL PRACTICE EXAM
NR509
Advanced Physical
Assessment
200-Question Final Practice Exam
Mixed-topic multiple-choice practice covering health history, examination techniques,
system-focused assessment, normal vs abnormal findings, clinical reasoning, special tests, and
documentation.
200 A-D 200
Practice Questions Multiple Choice Explained Answers
Original study and revision material • Clean print-ready format
PassPoint Pro
Page 1 of 51
,PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
How to Use This Final Review
Study approach
Work through each item without looking at the answer. Then compare your reasoning with the explanation, especially the
examination sequence, interpretation of abnormal findings, and urgency/red-flag logic.
Coverage
History and general survey; skin; HEENT; thorax/lungs; cardiovascular and peripheral vascular; abdomen; musculoskeletal;
neurologic; GU/reproductive; pregnancy; pediatrics; older-adult assessment.
Practice Questions
History
1. A patient reports chest discomfort that began while climbing stairs. Which interpretation or assessment action is
most appropriate?
A. Ask only whether the pain is sharp or dull
B. Defer symptom questions until after the physical exam
C. Use OPQRST to characterize onset, provocation/palliation, quality, region/radiation, severity, and timing.
D. Begin with a full family history before characterizing the pain
Answer: C. Use OPQRST to characterize onset, provocation/palliation, quality, region/radiation, severity, and timing.
Explanation: A structured symptom analysis prevents important details from being missed. OPQRST organizes the symptom history
before narrowing the differential. It also supports clear documentation and safer clinical reasoning. The other options either misidentify
the finding, use the wrong examination technique, or delay an appropriate focused assessment.
2. While completing a history assessment, you note the following: During the general survey, a patient appears pale,
diaphoretic, and short of breath at rest. What is the best next conclusion?
A. Ask the patient to return when symptoms resolve
B. Document the appearance as normal because the patient is awake
C. Treat the appearance as potentially unstable and obtain focused vital signs and cardiopulmonary assessment promptly.
D. Complete a routine review of systems first
Answer: C. Treat the appearance as potentially unstable and obtain focused vital signs and cardiopulmonary assessment
promptly.
Explanation: General appearance can reveal acuity before a detailed examination begins. Pallor, diaphoresis, and dyspnea at rest are
abnormal and may signal cardiopulmonary compromise. Focused assessment and vital signs should not be delayed. The other options
either misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
Vitals
3. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
becomes dizzy after standing and the blood pressure falls significantly.
A. Assess for orthostatic hypotension using supine and standing blood pressure and pulse measurements.
B. Diagnose hypertension from the standing value
C. Repeat only the seated blood pressure
D. Check temperature before repeating any blood pressure
Answer: A. Assess for orthostatic hypotension using supine and standing blood pressure and pulse measurements.
Explanation: Postural symptoms with a pressure drop suggest orthostatic hypotension. Comparing position-related blood pressure and
pulse changes helps establish the pattern. The finding should be interpreted with hydration status, medications, bleeding risk, and
Page 2
,PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
autonomic causes in mind. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
Skin
4. A clinician documents: "A pigmented lesion is asymmetric with an irregular border and several colors." Which
statement should be added to make the assessment most clinically appropriate?
A. Assume color variation is normal in all nevi
B. Classify it as a benign nevus because pigmentation is expected
C. Use the Braden scale to classify melanoma risk
D. Apply the ABCDE approach and consider the lesion suspicious for melanoma.
Answer: D. Apply the ABCDE approach and consider the lesion suspicious for melanoma.
Explanation: Asymmetry, border irregularity, color variation, larger diameter, and evolution are classic melanoma warning features. No
single feature confirms malignancy, but multiple features increase concern. Suspicious lesions require timely diagnostic evaluation. The
other options either misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
5. A patient has a nonblanchable area of intact erythematous skin over the sacrum. Which interpretation or
assessment action is most appropriate?
A. Unstageable pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Recognize this as a stage 1 pressure injury finding.
Answer: D. Recognize this as a stage 1 pressure injury finding.
Explanation: Stage 1 pressure injury is intact skin with nonblanchable erythema. Stage 2 involves partial-thickness skin loss, while deeper
stages involve greater tissue loss. Correct staging depends on the deepest visible tissue damage. The other options either misidentify the
finding, use the wrong examination technique, or delay an appropriate focused assessment.
6. While completing a skin assessment, you note the following: An older adult has decreased skin turgor over the hand
but moist mucous membranes and stable vital signs. What is the best next conclusion?
A. Assume dehydration is impossible in older adults
B. Diagnose severe dehydration from hand turgor alone
C. Use only capillary refill to assess hydration
D. Interpret hand turgor cautiously because age-related loss of elasticity can mimic dehydration.
Answer: D. Interpret hand turgor cautiously because age-related loss of elasticity can mimic dehydration.
Explanation: Skin elasticity decreases with aging, so turgor over the hand is less reliable in older adults. Hydration assessment should
integrate mucous membranes, orthostatic symptoms, intake, output, vital signs, and overall context. A single skin finding should not
determine hydration status. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
HEENT
7. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
cannot read the expected line on a distance vision chart.
A. Test both eyes together and document one value
B. Document visual acuity for each eye separately with the corrective-lens status.
C. Use the whisper test to quantify acuity
D. Record only that vision is abnormal
Answer: B. Document visual acuity for each eye separately with the corrective-lens status.
Explanation: Distance acuity should be measured and documented eye by eye, with both eyes tested as appropriate. Corrective lenses
should be noted because they affect interpretation. Specific acuity values are more useful than vague labels. The other options either
Page 3
, PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
8. A clinician documents: "When testing hearing, the Weber test lateralizes to the right ear and Rinne shows bone
conduction longer than air conduction on the right." Which statement should be added to make the assessment most
clinically appropriate?
A. Right-sided sensorineural hearing loss
B. Left-sided conductive hearing loss
C. Normal hearing bilaterally
D. Interpret the pattern as right-sided conductive hearing loss.
Answer: D. Interpret the pattern as right-sided conductive hearing loss.
Explanation: In conductive hearing loss, Weber tends to lateralize to the affected ear and Rinne can show bone conduction greater than
air conduction. Sensorineural loss typically lateralizes Weber to the better ear while air conduction remains greater than bone conduction.
The tests are screening tools and do not replace formal audiometry. The other options either misidentify the finding, use the wrong
examination technique, or delay an appropriate focused assessment.
9. An adult needs otoscopic examination. Which interpretation or assessment action is most appropriate?
A. Pull the auricle up and back to help straighten the ear canal.
B. Pull the tragus forward only
C. Pull the auricle down and back
D. Insert the otoscope without manipulating the auricle
Answer: A. Pull the auricle up and back to help straighten the ear canal.
Explanation: For most adults and older children, the pinna is pulled up and back to align the canal. In young children, the direction differs
because of canal anatomy. Proper positioning improves visualization and reduces discomfort. The other options either misidentify the
finding, use the wrong examination technique, or delay an appropriate focused assessment.
10. While completing a heent assessment, you note the following: Fundoscopic examination reveals blurred optic-disc
margins with loss of the normal cup. What is the best next conclusion?
A. Interpret it as uncomplicated presbyopia
B. Recognize papilledema as a concerning finding that can reflect increased intracranial pressure.
C. Document the finding as a normal optic disc
D. Treat it as a normal aging change
Answer: B. Recognize papilledema as a concerning finding that can reflect increased intracranial pressure.
Explanation: Papilledema refers to optic-disc swelling, classically associated with raised intracranial pressure. Blurred disc margins are
not a normal fundoscopic finding. The clinical context determines urgency, especially when headache, vomiting, focal deficits, or altered
mental status are present. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
11. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
has a diffusely enlarged thyroid without tenderness.
A. Auscultate every thyroid before palpation regardless of size
B. Inspect and palpate the thyroid while the patient swallows, noting size, symmetry, nodules, and tenderness.
C. Palpate only from the anterior position and avoid swallowing
D. Percuss the thyroid before inspection
Answer: B. Inspect and palpate the thyroid while the patient swallows, noting size, symmetry, nodules, and tenderness.
Explanation: Thyroid assessment includes inspection and palpation, often while the patient swallows because the gland rises with
deglutition. Size, consistency, symmetry, nodules, and tenderness are important. Auscultation is most useful when the gland is enlarged
or hypervascular. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate focused
assessment.
Lungs
Page 4
NR509
Advanced Physical
Assessment
200-Question Final Practice Exam
Mixed-topic multiple-choice practice covering health history, examination techniques,
system-focused assessment, normal vs abnormal findings, clinical reasoning, special tests, and
documentation.
200 A-D 200
Practice Questions Multiple Choice Explained Answers
Original study and revision material • Clean print-ready format
PassPoint Pro
Page 1 of 51
,PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
How to Use This Final Review
Study approach
Work through each item without looking at the answer. Then compare your reasoning with the explanation, especially the
examination sequence, interpretation of abnormal findings, and urgency/red-flag logic.
Coverage
History and general survey; skin; HEENT; thorax/lungs; cardiovascular and peripheral vascular; abdomen; musculoskeletal;
neurologic; GU/reproductive; pregnancy; pediatrics; older-adult assessment.
Practice Questions
History
1. A patient reports chest discomfort that began while climbing stairs. Which interpretation or assessment action is
most appropriate?
A. Ask only whether the pain is sharp or dull
B. Defer symptom questions until after the physical exam
C. Use OPQRST to characterize onset, provocation/palliation, quality, region/radiation, severity, and timing.
D. Begin with a full family history before characterizing the pain
Answer: C. Use OPQRST to characterize onset, provocation/palliation, quality, region/radiation, severity, and timing.
Explanation: A structured symptom analysis prevents important details from being missed. OPQRST organizes the symptom history
before narrowing the differential. It also supports clear documentation and safer clinical reasoning. The other options either misidentify
the finding, use the wrong examination technique, or delay an appropriate focused assessment.
2. While completing a history assessment, you note the following: During the general survey, a patient appears pale,
diaphoretic, and short of breath at rest. What is the best next conclusion?
A. Ask the patient to return when symptoms resolve
B. Document the appearance as normal because the patient is awake
C. Treat the appearance as potentially unstable and obtain focused vital signs and cardiopulmonary assessment promptly.
D. Complete a routine review of systems first
Answer: C. Treat the appearance as potentially unstable and obtain focused vital signs and cardiopulmonary assessment
promptly.
Explanation: General appearance can reveal acuity before a detailed examination begins. Pallor, diaphoresis, and dyspnea at rest are
abnormal and may signal cardiopulmonary compromise. Focused assessment and vital signs should not be delayed. The other options
either misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
Vitals
3. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
becomes dizzy after standing and the blood pressure falls significantly.
A. Assess for orthostatic hypotension using supine and standing blood pressure and pulse measurements.
B. Diagnose hypertension from the standing value
C. Repeat only the seated blood pressure
D. Check temperature before repeating any blood pressure
Answer: A. Assess for orthostatic hypotension using supine and standing blood pressure and pulse measurements.
Explanation: Postural symptoms with a pressure drop suggest orthostatic hypotension. Comparing position-related blood pressure and
pulse changes helps establish the pattern. The finding should be interpreted with hydration status, medications, bleeding risk, and
Page 2
,PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
autonomic causes in mind. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
Skin
4. A clinician documents: "A pigmented lesion is asymmetric with an irregular border and several colors." Which
statement should be added to make the assessment most clinically appropriate?
A. Assume color variation is normal in all nevi
B. Classify it as a benign nevus because pigmentation is expected
C. Use the Braden scale to classify melanoma risk
D. Apply the ABCDE approach and consider the lesion suspicious for melanoma.
Answer: D. Apply the ABCDE approach and consider the lesion suspicious for melanoma.
Explanation: Asymmetry, border irregularity, color variation, larger diameter, and evolution are classic melanoma warning features. No
single feature confirms malignancy, but multiple features increase concern. Suspicious lesions require timely diagnostic evaluation. The
other options either misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
5. A patient has a nonblanchable area of intact erythematous skin over the sacrum. Which interpretation or
assessment action is most appropriate?
A. Unstageable pressure injury
B. Stage 2 pressure injury
C. Stage 3 pressure injury
D. Recognize this as a stage 1 pressure injury finding.
Answer: D. Recognize this as a stage 1 pressure injury finding.
Explanation: Stage 1 pressure injury is intact skin with nonblanchable erythema. Stage 2 involves partial-thickness skin loss, while deeper
stages involve greater tissue loss. Correct staging depends on the deepest visible tissue damage. The other options either misidentify the
finding, use the wrong examination technique, or delay an appropriate focused assessment.
6. While completing a skin assessment, you note the following: An older adult has decreased skin turgor over the hand
but moist mucous membranes and stable vital signs. What is the best next conclusion?
A. Assume dehydration is impossible in older adults
B. Diagnose severe dehydration from hand turgor alone
C. Use only capillary refill to assess hydration
D. Interpret hand turgor cautiously because age-related loss of elasticity can mimic dehydration.
Answer: D. Interpret hand turgor cautiously because age-related loss of elasticity can mimic dehydration.
Explanation: Skin elasticity decreases with aging, so turgor over the hand is less reliable in older adults. Hydration assessment should
integrate mucous membranes, orthostatic symptoms, intake, output, vital signs, and overall context. A single skin finding should not
determine hydration status. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
HEENT
7. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
cannot read the expected line on a distance vision chart.
A. Test both eyes together and document one value
B. Document visual acuity for each eye separately with the corrective-lens status.
C. Use the whisper test to quantify acuity
D. Record only that vision is abnormal
Answer: B. Document visual acuity for each eye separately with the corrective-lens status.
Explanation: Distance acuity should be measured and documented eye by eye, with both eyes tested as appropriate. Corrective lenses
should be noted because they affect interpretation. Specific acuity values are more useful than vague labels. The other options either
Page 3
, PASSPOINT PRO | NR509 ADVANCED PHYSICAL ASSESSMENT
misidentify the finding, use the wrong examination technique, or delay an appropriate focused assessment.
8. A clinician documents: "When testing hearing, the Weber test lateralizes to the right ear and Rinne shows bone
conduction longer than air conduction on the right." Which statement should be added to make the assessment most
clinically appropriate?
A. Right-sided sensorineural hearing loss
B. Left-sided conductive hearing loss
C. Normal hearing bilaterally
D. Interpret the pattern as right-sided conductive hearing loss.
Answer: D. Interpret the pattern as right-sided conductive hearing loss.
Explanation: In conductive hearing loss, Weber tends to lateralize to the affected ear and Rinne can show bone conduction greater than
air conduction. Sensorineural loss typically lateralizes Weber to the better ear while air conduction remains greater than bone conduction.
The tests are screening tools and do not replace formal audiometry. The other options either misidentify the finding, use the wrong
examination technique, or delay an appropriate focused assessment.
9. An adult needs otoscopic examination. Which interpretation or assessment action is most appropriate?
A. Pull the auricle up and back to help straighten the ear canal.
B. Pull the tragus forward only
C. Pull the auricle down and back
D. Insert the otoscope without manipulating the auricle
Answer: A. Pull the auricle up and back to help straighten the ear canal.
Explanation: For most adults and older children, the pinna is pulled up and back to align the canal. In young children, the direction differs
because of canal anatomy. Proper positioning improves visualization and reduces discomfort. The other options either misidentify the
finding, use the wrong examination technique, or delay an appropriate focused assessment.
10. While completing a heent assessment, you note the following: Fundoscopic examination reveals blurred optic-disc
margins with loss of the normal cup. What is the best next conclusion?
A. Interpret it as uncomplicated presbyopia
B. Recognize papilledema as a concerning finding that can reflect increased intracranial pressure.
C. Document the finding as a normal optic disc
D. Treat it as a normal aging change
Answer: B. Recognize papilledema as a concerning finding that can reflect increased intracranial pressure.
Explanation: Papilledema refers to optic-disc swelling, classically associated with raised intracranial pressure. Blurred disc margins are
not a normal fundoscopic finding. The clinical context determines urgency, especially when headache, vomiting, focal deficits, or altered
mental status are present. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate
focused assessment.
11. Which response best demonstrates correct advanced physical-assessment reasoning for this finding: A patient
has a diffusely enlarged thyroid without tenderness.
A. Auscultate every thyroid before palpation regardless of size
B. Inspect and palpate the thyroid while the patient swallows, noting size, symmetry, nodules, and tenderness.
C. Palpate only from the anterior position and avoid swallowing
D. Percuss the thyroid before inspection
Answer: B. Inspect and palpate the thyroid while the patient swallows, noting size, symmetry, nodules, and tenderness.
Explanation: Thyroid assessment includes inspection and palpation, often while the patient swallows because the gland rises with
deglutition. Size, consistency, symmetry, nodules, and tenderness are important. Auscultation is most useful when the gland is enlarged
or hypervascular. The other options either misidentify the finding, use the wrong examination technique, or delay an appropriate focused
assessment.
Lungs
Page 4
