Midterml Exam:l NRl 509/l NR509l (NEWl
2026/l 2027l Update)l Advancedl Physicall
Assessmentl Guide|l Questionsl &l Answersl
|l Gradel A|l 100%l Correctl (Verifiedl
Solutions)l -Chamberlain
QUESTION
Keyl Componentsl ofl thel thoraxl andl lungl exam
Answer:
Surveyl respirationl (rate,l rhythm,l depth,l effortl ofl breathing,l signsl ofl respiratoryl distress).
Examinel thel anteriorl andl posteriorl chest:
Inspectl thel chestl (deformities,l musclel retraction,l lag).
Palpatel thel chestl (tenderness,l bruising,l sinusl tracts,l respiratoryl expansion,l fremitus).
Percussl thel chestl (flat,l dull,l resonant,l hyperresonantl orl tympanitic).
Auscultatel thel chestl (breathl sounds,l adventitious,l transmittedl voicel sounds).
QUESTION
Respiratoryl survey
Answer:
abnormalitiesl includel bradypnea,l tachypnea,l hyperventilation,l cheyne-stokesl breathing,l
andl ataxicl breathing
delayedl expirationl occursl inl COPD
,QUESTION
Signsl ofl respiratoryl distress
Answer:
Cyanosisl inl thel lips,l tonguel andl orall mucosal signalsl hypoxia
pallorl andl sweatingl (diaphoresis)l ACSl andl HF
Clubbingl ofl thel nailsl occursl inl bronchietctasis,l congentiall heartl disease,l pulmonaryl
fibrosis,l cysticl fibrosis,l lungl abscess,l andl malignancy.
accessoryl musclel usel canl signall ^l ventiatoryl requirementsl d/tl airwaysl rorl parenchymall
lungl diseasel orl respiratoryl musclel fatigue.l
laterall displacementl ofl thel tracheal occursl inl pneuomothorax,l pleurall effusion,l andl
atelectasis.
QUESTION
Posteriorl Chestl Assessment
Answer:
Asymmetricl expansionl occursl inl largel pleurall effusions
Retractionl occursl inl severel asthma,l COPD,l andl upperl airwayl obstruction.l
Unilaterall impairmentl orl laggingl suggestsl pleurall diseasel froml asbestosisl orl silicosis,l
phrenicl nervel damage,l orl trauma
QUESTION
Palpationl ofl thel chest
Answer:
intercostall tendernessl canl developl overl inflamedl pleurae,l costall cartilagel tendernessl inl
costochondritis.
tenderness,l bruisingl andl bonyl "stepl off"l arel commonl overl al fxl rib.
,crepitusl mayl bel palpalel inl thel overtl fxl andl arthriticl joints
crepitusl andl chestl walll edemal arel seenl inl mediastinitis
QUESTION
Tactilel Fremitus
Answer:
decreasedl orl absentl whenl thel voicel isl higherl pitchedl orl softl orl whenl thel transmissionl
ofl vibrationsl froml thel larynxl tol thel surfacel ofl thel chestl isl impededl byl al thickl chestl
wall,l anl obstructedl bronchus,l COPD,l pleurall effusion,l fibrosis,l pneumol orl inflitratingl
tumor.
QUESTION
Chestl Percussion
Answer:
Dullnessl replacesl resonancel whenl fluidl orl solidl tissuel replacesl air-containingl lungl orl
occupiesl thel pleurall spacel beneathl yourl percussingl fingers.
suchl asl >l lobarl pneumonitisl inl whichl hel alveolil arel filledl withl fluidl andl bloodl cellsl
andl pleurall accumulationsl ofl serousl fluidl (pleurall effusion)l andl bloodl orl empyema.l
Dullnessl makesl pneumonial andl pleurall effusionl 3l tol 4l timesl morel likely.
Generalizedl hyperresonancel isl commonl overl thel hyperinflatedl lungsl ofl COPDl orl
asthma.l
Unilaterall hyperresonancel suggestl largel pneumol orl air
QUESTION
Ausculatationl lungs
Answer:
, breathl soundsl mayl bel decreasedl whenl airl flowl isl decreasedl (Obstructivel lungl diseasel
orl respiratoryl musclel weakness)l orl whenl thel transmissionl ofl soundl isl poorl (l pleurall
effusion,l pneumol orl COPD)
al gapl suggestl bronchiall breathl sounds
QUESTION
Lungl Sounds
Answer:
cracklesl canl arisel forml abnormalitiesl ofl thel lungl parenchymal (l pneumonia,l interstitiall
lungl disease,l pulmonaryl fibrosis,l atelectasis,l HF)
wheezesl arisel inl thel narrowedl airwaysl ofl asthma,l COPDl andl bronchitisl
ronchil -l soundl froml secretionsl inl largel airwaysl thatl mayl changel withl coughing
finel latel inspiratoryl cracklesl thatl persistl froml breathl tol breathl andl suggestl abnormall
lungl tissue
cracklesl ofl HFl arel bestl heardl inl thel posteriorl inferiorl lungl fieldsl
silentl chestl =l clinicall emergency
stridorl &l laryngeall soundsl arel thel loudestl overl thel neck
truel wheezesl andl rhonchil arel faintl orl absentl overl thel next
QUESTION
Anteriorl Chestl Asessement
Answer:
Abnormall retractionl occursl inl severel asthma,l COPDl andl upperl airwayl obstruction
lagl occursl inl underlyingl diseasesl ofl thel lungl orl pleura
2026/l 2027l Update)l Advancedl Physicall
Assessmentl Guide|l Questionsl &l Answersl
|l Gradel A|l 100%l Correctl (Verifiedl
Solutions)l -Chamberlain
QUESTION
Keyl Componentsl ofl thel thoraxl andl lungl exam
Answer:
Surveyl respirationl (rate,l rhythm,l depth,l effortl ofl breathing,l signsl ofl respiratoryl distress).
Examinel thel anteriorl andl posteriorl chest:
Inspectl thel chestl (deformities,l musclel retraction,l lag).
Palpatel thel chestl (tenderness,l bruising,l sinusl tracts,l respiratoryl expansion,l fremitus).
Percussl thel chestl (flat,l dull,l resonant,l hyperresonantl orl tympanitic).
Auscultatel thel chestl (breathl sounds,l adventitious,l transmittedl voicel sounds).
QUESTION
Respiratoryl survey
Answer:
abnormalitiesl includel bradypnea,l tachypnea,l hyperventilation,l cheyne-stokesl breathing,l
andl ataxicl breathing
delayedl expirationl occursl inl COPD
,QUESTION
Signsl ofl respiratoryl distress
Answer:
Cyanosisl inl thel lips,l tonguel andl orall mucosal signalsl hypoxia
pallorl andl sweatingl (diaphoresis)l ACSl andl HF
Clubbingl ofl thel nailsl occursl inl bronchietctasis,l congentiall heartl disease,l pulmonaryl
fibrosis,l cysticl fibrosis,l lungl abscess,l andl malignancy.
accessoryl musclel usel canl signall ^l ventiatoryl requirementsl d/tl airwaysl rorl parenchymall
lungl diseasel orl respiratoryl musclel fatigue.l
laterall displacementl ofl thel tracheal occursl inl pneuomothorax,l pleurall effusion,l andl
atelectasis.
QUESTION
Posteriorl Chestl Assessment
Answer:
Asymmetricl expansionl occursl inl largel pleurall effusions
Retractionl occursl inl severel asthma,l COPD,l andl upperl airwayl obstruction.l
Unilaterall impairmentl orl laggingl suggestsl pleurall diseasel froml asbestosisl orl silicosis,l
phrenicl nervel damage,l orl trauma
QUESTION
Palpationl ofl thel chest
Answer:
intercostall tendernessl canl developl overl inflamedl pleurae,l costall cartilagel tendernessl inl
costochondritis.
tenderness,l bruisingl andl bonyl "stepl off"l arel commonl overl al fxl rib.
,crepitusl mayl bel palpalel inl thel overtl fxl andl arthriticl joints
crepitusl andl chestl walll edemal arel seenl inl mediastinitis
QUESTION
Tactilel Fremitus
Answer:
decreasedl orl absentl whenl thel voicel isl higherl pitchedl orl softl orl whenl thel transmissionl
ofl vibrationsl froml thel larynxl tol thel surfacel ofl thel chestl isl impededl byl al thickl chestl
wall,l anl obstructedl bronchus,l COPD,l pleurall effusion,l fibrosis,l pneumol orl inflitratingl
tumor.
QUESTION
Chestl Percussion
Answer:
Dullnessl replacesl resonancel whenl fluidl orl solidl tissuel replacesl air-containingl lungl orl
occupiesl thel pleurall spacel beneathl yourl percussingl fingers.
suchl asl >l lobarl pneumonitisl inl whichl hel alveolil arel filledl withl fluidl andl bloodl cellsl
andl pleurall accumulationsl ofl serousl fluidl (pleurall effusion)l andl bloodl orl empyema.l
Dullnessl makesl pneumonial andl pleurall effusionl 3l tol 4l timesl morel likely.
Generalizedl hyperresonancel isl commonl overl thel hyperinflatedl lungsl ofl COPDl orl
asthma.l
Unilaterall hyperresonancel suggestl largel pneumol orl air
QUESTION
Ausculatationl lungs
Answer:
, breathl soundsl mayl bel decreasedl whenl airl flowl isl decreasedl (Obstructivel lungl diseasel
orl respiratoryl musclel weakness)l orl whenl thel transmissionl ofl soundl isl poorl (l pleurall
effusion,l pneumol orl COPD)
al gapl suggestl bronchiall breathl sounds
QUESTION
Lungl Sounds
Answer:
cracklesl canl arisel forml abnormalitiesl ofl thel lungl parenchymal (l pneumonia,l interstitiall
lungl disease,l pulmonaryl fibrosis,l atelectasis,l HF)
wheezesl arisel inl thel narrowedl airwaysl ofl asthma,l COPDl andl bronchitisl
ronchil -l soundl froml secretionsl inl largel airwaysl thatl mayl changel withl coughing
finel latel inspiratoryl cracklesl thatl persistl froml breathl tol breathl andl suggestl abnormall
lungl tissue
cracklesl ofl HFl arel bestl heardl inl thel posteriorl inferiorl lungl fieldsl
silentl chestl =l clinicall emergency
stridorl &l laryngeall soundsl arel thel loudestl overl thel neck
truel wheezesl andl rhonchil arel faintl orl absentl overl thel next
QUESTION
Anteriorl Chestl Asessement
Answer:
Abnormall retractionl occursl inl severel asthma,l COPDl andl upperl airwayl obstruction
lagl occursl inl underlyingl diseasesl ofl thel lungl orl pleura
