NR509 Actual FINAL EXAM REVIEW: Advanced
Physical Assessment | Practice Questions with
Complete Solutions
Section 1: Assessment Foundations & Documentation (Questions 1-10)
Q1:
A 45-year-old Hispanic female with limited English proficiency presents for diabetes
follow-up. She avoids eye contact with you and provides brief responses to questions
despite an interpreter being present. She accepts the interpreter but remains withdrawn.
Which response demonstrates culturally competent advanced assessment?
A. Ask the interpreter to speak louder because the patient seems hard of hearing
B. Recognize that silence and limited eye contact may signify respect for authority in
some Hispanic cultures
C. Insist on direct eye contact to establish therapeutic rapport
D. Discontinue sensitive questioning to avoid causing discomfort
,Answer: B
Solution:
Key Findings: Limited English proficiency, avoided eye contact, minimal verbal
response, interpreter utilized correctly.
Clinical Reasoning: In many collectivist and hierarchical cultures, avoiding direct eye
contact with healthcare providers (authority figures) is a sign of deference and respect,
not disinterest or depression. The advanced practice nurse must interpret behavior
through a cultural lens rather than imposing Western norms of assertive communication.
Why Not: Option A pathologizes behavior as sensory deficit. Option C imposes
ethnocentric standards that may damage trust. Option D compromises clinical data
collection; cultural competence requires adapting communication style, not abandoning
essential assessment components.
Takeaway: Cultural humility requires distinguishing between psychopathology (e.g.,
depression causing withdrawal) and culturally normative communication patterns.
Always validate with the patient via interpreter when uncertain.
Q2:
A 78-year-old male who lives alone is referred to your clinic after a fall. His daughter
expresses concern that he may no longer be safe living independently.
,Which is the most appropriate initial standardized tool to assess his ability to perform
self-care tasks?
A. Patient Health Questionnaire-9 (PHQ-9)
B. Katz Index of Activities of Daily Living
C. Mini-Mental State Examination (MMSE)
D. CAGE Questionnaire
Answer: B
Solution:
Key Findings: Elderly patient, recent fall, concern regarding independent living safety.
Clinical Reasoning: The Katz ADL Index evaluates six fundamental functions: bathing,
dressing, toileting, transferring, continence, and feeding—essential determinants for
baseline independent living. The Lawton IADL Scale would assess complex
instrumental tasks (cooking, finances) but Katz is the primary screen for basic functional
status.
Why Not: PHQ-9 (A) screens for depression severity. MMSE (C) assesses cognitive
impairment. CAGE (D) screens for alcohol use disorder. While falls may correlate with
these, the specific question regarding functional ability for independent living requires
an ADL assessment.
, Takeaway: Comprehensive geriatric assessment always includes ADL/IADL evaluation
to determine safety, eligibility for home services, and rehabilitation needs.
Q3:
During history-taking, a 32-year-old with chest pain states: "It feels like an elephant
sitting on my chest, 8 out of 10, radiating to my left jaw and arm, worse when I walk
upstairs." You document: "Patient reports chest pain."
This documentation represents which error?
A. Recording subjective data in the objective section
B. Failure to document using the OLDCART framework with direct quotations
C. Inclusion of diagnostic conclusion in the subjective section
D. Violation of HIPAA minimum necessary standard
Answer: B
Solution:
Key Findings: Classic acute coronary syndrome description ("elephant sitting,"
exertional worsening, radiation) documented generically without qualifying
characteristics.
Physical Assessment | Practice Questions with
Complete Solutions
Section 1: Assessment Foundations & Documentation (Questions 1-10)
Q1:
A 45-year-old Hispanic female with limited English proficiency presents for diabetes
follow-up. She avoids eye contact with you and provides brief responses to questions
despite an interpreter being present. She accepts the interpreter but remains withdrawn.
Which response demonstrates culturally competent advanced assessment?
A. Ask the interpreter to speak louder because the patient seems hard of hearing
B. Recognize that silence and limited eye contact may signify respect for authority in
some Hispanic cultures
C. Insist on direct eye contact to establish therapeutic rapport
D. Discontinue sensitive questioning to avoid causing discomfort
,Answer: B
Solution:
Key Findings: Limited English proficiency, avoided eye contact, minimal verbal
response, interpreter utilized correctly.
Clinical Reasoning: In many collectivist and hierarchical cultures, avoiding direct eye
contact with healthcare providers (authority figures) is a sign of deference and respect,
not disinterest or depression. The advanced practice nurse must interpret behavior
through a cultural lens rather than imposing Western norms of assertive communication.
Why Not: Option A pathologizes behavior as sensory deficit. Option C imposes
ethnocentric standards that may damage trust. Option D compromises clinical data
collection; cultural competence requires adapting communication style, not abandoning
essential assessment components.
Takeaway: Cultural humility requires distinguishing between psychopathology (e.g.,
depression causing withdrawal) and culturally normative communication patterns.
Always validate with the patient via interpreter when uncertain.
Q2:
A 78-year-old male who lives alone is referred to your clinic after a fall. His daughter
expresses concern that he may no longer be safe living independently.
,Which is the most appropriate initial standardized tool to assess his ability to perform
self-care tasks?
A. Patient Health Questionnaire-9 (PHQ-9)
B. Katz Index of Activities of Daily Living
C. Mini-Mental State Examination (MMSE)
D. CAGE Questionnaire
Answer: B
Solution:
Key Findings: Elderly patient, recent fall, concern regarding independent living safety.
Clinical Reasoning: The Katz ADL Index evaluates six fundamental functions: bathing,
dressing, toileting, transferring, continence, and feeding—essential determinants for
baseline independent living. The Lawton IADL Scale would assess complex
instrumental tasks (cooking, finances) but Katz is the primary screen for basic functional
status.
Why Not: PHQ-9 (A) screens for depression severity. MMSE (C) assesses cognitive
impairment. CAGE (D) screens for alcohol use disorder. While falls may correlate with
these, the specific question regarding functional ability for independent living requires
an ADL assessment.
, Takeaway: Comprehensive geriatric assessment always includes ADL/IADL evaluation
to determine safety, eligibility for home services, and rehabilitation needs.
Q3:
During history-taking, a 32-year-old with chest pain states: "It feels like an elephant
sitting on my chest, 8 out of 10, radiating to my left jaw and arm, worse when I walk
upstairs." You document: "Patient reports chest pain."
This documentation represents which error?
A. Recording subjective data in the objective section
B. Failure to document using the OLDCART framework with direct quotations
C. Inclusion of diagnostic conclusion in the subjective section
D. Violation of HIPAA minimum necessary standard
Answer: B
Solution:
Key Findings: Classic acute coronary syndrome description ("elephant sitting,"
exertional worsening, radiation) documented generically without qualifying
characteristics.
