NR509 / NR 509 FINAL EXAM LATEST ():
ADVANCED PHYSICAL ASSESSMENT QUESTIONS AND
ANSWERS (VERIFIED ANSWERS)/ GRADED A+
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision - answer Ans: D
Rationale: The lens loses its elasticity over time as part of the normal aging process, and the
eye is less able to accommodate and focus on near objects; therefore, the patient will be
expected to have blurring of near vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing
loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying
to him. He admits to lip-reading more. He has a history of noise exposure in his young adult
years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based
on this information, what is the most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds - answer Ans: A
Rationale: Human speech is considered to be a middle-range sound. During the aging
process there is a loss of acuity, starting with high-pitched sounds but extending to the middle
range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination;
he gets up five to six times per night to urinate and has to go at least that often in the daytime.
,He does not feel as if his bladder empties completely; the strength of the urinary stream is
diminished. He denies dysuria or hematuria. This problem has been present for several years
but has worsened over the last 8 months. You palpate his prostate. What is your expected
physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy - answer Ans: C
Rationale: This is the expected physical examination finding in benign prostatic hyperplasia
(BPH).
4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned
about his memory. The patient himself admits to misplacing his keys more often and forgets
what he is supposed to buy from the grocery store and where he has parked the car. He denies
getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died
8 months ago; his three children live in three different states; and he has limited his activities
because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of
beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination
and obtain a total score of 24 out of 28. Based on this information, what is your most likely
diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression - answer Ans: D
Rationale: The patient has symptoms of depression: His wife died, he has no real social support
system, and he has isolated himself from his usual activities. He also drinks a considerable
amount of alcohol on a daily basis, which can further depress his mood. Depression can
masquerade as dementia in the elderly and must be considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a
complete history, perform a thorough physical examination, and order laboratory tests. You
,diagnose her with hyperthyroidism. Based on her age, which of the atypical symptoms of
hyperthyroidism is more likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia - answer Ans: D
Rationale: This is an atypical symptom of hyperthyroidism that is more likely to be seen in the
older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an
ECG (electrocardiogram) because of her history of hypertension. You diagnose a previous
myocardial infarction and ask her if she had any symptoms related to this. Which of the
following symptoms would be more common in this patient's age group for an acute myocardial
infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw - answer Ans: B
Rationale: This is an atypical symptom and more likely to be seen in this patient's age group.
7. An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her
clothes are hanging loosely off her frame and that she has lost 15 pounds. She is unaware of
this. Her husband of 63 years died a few months ago. You ask the patient to complete a Rapid
Screen for Dietary Intake. Which of the following statements is considered to be part of this
rapid screen?
A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time. - answer Ans: C
, Rationale: This is part of the Rapid Screen for Dietary Intake.
8. An 89-year-old retired school principal comes for an annual check-up. She would like to know
whether or not she should undergo a screening colonoscopy. She has never done this before.
Which of the following factors should not be considered when discussing whether she should go
for this screening test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient - answer Ans: D
Rationale: The current age of the patient is not as important as her actual life expectancy and
current health status.
9. Which of the following booster immunizations is recommended in the older adult
population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps - answer Ans: A
Rationale: Older adults who have received the primary series of three tetanus immunizations
should receive the single booster dose of tetanus immunization every 10 years.
10. You are asked to perform a home safety assessment for an 87-year-old retired farmer who
lives by himself. Which of the following is not considered to be an increased risk for falls?
A) Loose electrical cords
B) Slippery or irregular surfaces
C) Chairs at awkward angles
D) Bright lighting - answer Ans: D
ADVANCED PHYSICAL ASSESSMENT QUESTIONS AND
ANSWERS (VERIFIED ANSWERS)/ GRADED A+
1. Which of the following changes are expected in vision as part of the normal aging process?
A) Cataracts
B) Glaucoma
C) Macular degeneration
D) Blurring of near vision - answer Ans: D
Rationale: The lens loses its elasticity over time as part of the normal aging process, and the
eye is less able to accommodate and focus on near objects; therefore, the patient will be
expected to have blurring of near vision.
2. A 72-year-old retired truck driver comes to the clinic with his wife for evaluation of hearing
loss. He has noticed some decreased ability to hear what his wife and grandchildren are saying
to him. He admits to lip-reading more. He has a history of noise exposure in his young adult
years: He worked as a sound engineer at a local arena and had to attend a lot of concerts. Based
on this information, what is the most likely finding regarding his hearing acuity?
A) Loss of acuity for middle-range sounds
B) Increase of acuity for low-range sounds
C) Loss of acuity for high-range sounds
D) Increase of acuity for high-range sounds - answer Ans: A
Rationale: Human speech is considered to be a middle-range sound. During the aging
process there is a loss of acuity, starting with high-pitched sounds but extending to the middle
range and then into the low range.
3. A 79-year-old retired banker comes to your office for evaluation of difficulty with urination;
he gets up five to six times per night to urinate and has to go at least that often in the daytime.
,He does not feel as if his bladder empties completely; the strength of the urinary stream is
diminished. He denies dysuria or hematuria. This problem has been present for several years
but has worsened over the last 8 months. You palpate his prostate. What is your expected
physical examination finding, based on this description?
A) Normal size, smooth
B) Normal size, boggy
C) Enlarged size, smooth
D) Enlarged size, boggy - answer Ans: C
Rationale: This is the expected physical examination finding in benign prostatic hyperplasia
(BPH).
4. A 70-year-old retired auto mechanic comes to your office because his neighbor is concerned
about his memory. The patient himself admits to misplacing his keys more often and forgets
what he is supposed to buy from the grocery store and where he has parked the car. He denies
getting lost in familiar places. Upon further questioning, he states that his wife of 40 years died
8 months ago; his three children live in three different states; and he has limited his activities
because the people he interacted with were "his wife's friends, not his." He drinks a six-pack of
beer daily; he does not smoke or use illicit drugs. You perform a mini-mental state examination
and obtain a total score of 24 out of 28. Based on this information, what is your most likely
diagnosis?
A) Benign forgetfulness
B) Dementia
C) Meningitis
D) Depression - answer Ans: D
Rationale: The patient has symptoms of depression: His wife died, he has no real social support
system, and he has isolated himself from his usual activities. He also drinks a considerable
amount of alcohol on a daily basis, which can further depress his mood. Depression can
masquerade as dementia in the elderly and must be considered in a patient with memory loss.
5. An 85-year-old retired teacher comes to your office for evaluation of weakness. You obtain a
complete history, perform a thorough physical examination, and order laboratory tests. You
,diagnose her with hyperthyroidism. Based on her age, which of the atypical symptoms of
hyperthyroidism is more likely to be seen?
A) Fatigue
B) Weight loss
C) Tachycardia
D) Anorexia - answer Ans: D
Rationale: This is an atypical symptom of hyperthyroidism that is more likely to be seen in the
older patient.
6. A 78-year-old retired seamstress comes to the office for a routine check-up. You obtain an
ECG (electrocardiogram) because of her history of hypertension. You diagnose a previous
myocardial infarction and ask her if she had any symptoms related to this. Which of the
following symptoms would be more common in this patient's age group for an acute myocardial
infarction?
A) Chest pain
B) Syncope
C) Pain radiating into the left arm
D) Pain radiating into the jaw - answer Ans: B
Rationale: This is an atypical symptom and more likely to be seen in this patient's age group.
7. An 88-year-old retired piano teacher comes for evaluation of fatigue. You notice that her
clothes are hanging loosely off her frame and that she has lost 15 pounds. She is unaware of
this. Her husband of 63 years died a few months ago. You ask the patient to complete a Rapid
Screen for Dietary Intake. Which of the following statements is considered to be part of this
rapid screen?
A) I eat more than two meals per day.
B) I drink one glass of alcohol every day.
C) Without wanting to, I have lost or gained 10 pounds in the last 6 months.
D) I eat with at least one other person most of the time. - answer Ans: C
, Rationale: This is part of the Rapid Screen for Dietary Intake.
8. An 89-year-old retired school principal comes for an annual check-up. She would like to know
whether or not she should undergo a screening colonoscopy. She has never done this before.
Which of the following factors should not be considered when discussing whether she should go
for this screening test?
A) Life expectancy
B) Time interval until benefit from screening accrues
C) Patient preference
D) Current age of patient - answer Ans: D
Rationale: The current age of the patient is not as important as her actual life expectancy and
current health status.
9. Which of the following booster immunizations is recommended in the older adult
population?
A) Tetanus
B) Diphtheria
C) Measles
D) Mumps - answer Ans: A
Rationale: Older adults who have received the primary series of three tetanus immunizations
should receive the single booster dose of tetanus immunization every 10 years.
10. You are asked to perform a home safety assessment for an 87-year-old retired farmer who
lives by himself. Which of the following is not considered to be an increased risk for falls?
A) Loose electrical cords
B) Slippery or irregular surfaces
C) Chairs at awkward angles
D) Bright lighting - answer Ans: D
