NR509 Advanced Physical
Assessment Final Exam Practice
Question Bank (Latest 2026/2027
Edition) –
EXAM
1. A 35-year-old female with a history of migraines presents
with worsening symptoms. She reports waking up at night
with headaches and nausea. Her only medication is oral
contraceptive pills (OCPs). What is the best next step?
Answer: Take a further history and perform a very careful
neurological exam.
Rationale: New-onset "nocturnal" headaches and nausea are
red flags for increased intracranial pressure (ICP) or
secondary causes like stroke, especially in patients using oral
contraceptives which increase thrombotic risk.
2. What is the definition of primary prevention?
Answer: Interventions designed to prevent disease.
Rationale: Primary prevention aims to remove the causes of
disease before it occurs (e.g., immunizations, lifestyle
counseling).
3. According to the USPSTF, what is the recommendation for
breast cancer screening in average-risk women?
, Answer: Mammography is recommended every 2 years for
women aged 50–74.
Rationale: Evidence is insufficient for screening women 75
and older, and biennial screening is the standard for the 50–
74 age group.
4. According to JNC8, what is the target blood pressure for
adults aged 60 and older?
Answer: Target BP should be ≤ 150/90 mmHg.
Rationale: JNC8 relaxed targets for the elderly to balance
stroke reduction against the risk of falls and adverse effects
from overtreatment.
5. A grandmother asks you privately if her 9-year-old
granddaughter has started puberty. During examination, you
note asymmetric projection of the areola and nipple of the
right chest to form a secondary mound above the level of the
breast. The left breast is underdeveloped. What Tanner Stage
is this?
Answer: Tanner Stage IV.
Rationale: Stage IV is defined by the projection of the areola
and nipple to form a secondary mound above the level of the
breast.
6. What is a useful strategy when examining young children
between the ages of 1 and 4?
Answer: Have the parent facilitate the exam (e.g., removing
clothes, holding the child on the lap).
, Rationale: Parental presence and involvement reduce anxiety
and increase cooperation in young children during the
physical examination.
7. What is the function of the auditory ossicles?
Answer: To transform sound vibrations into mechanical
waves for the inner ear.
Rationale: The auditory ossicles (malleus, incus, stapes)
transmit and amplify sound vibrations from the tympanic
membrane to the oval window of the inner ear.
8. A patient complains of vertigo accompanied by nausea and
vomiting. Examination reveals bilateral diplopia and an
unsteady gait. What is the most likely cause?
Answer: A neurological condition.
Rationale: Vertigo with neurologic findings such as diplopia,
ataxia, and dysarthria suggests a central (neurological) cause
rather than peripheral inner ear pathology. Cardiovascular
causes typically present with lightheadedness, weakness, or
presyncope.
9. What is the term for being farsighted?
Answer: Hyperopia.
Rationale: Hyperopia (farsightedness) occurs when light
focuses behind the retina, making near objects appear
blurred while distant objects are seen more clearly.
10. In order to visualize the opening of Stensen's duct, where
should you examine?
, Answer: The buccal mucosa opposite the second upper
molar.
Rationale: Stensen's duct (parotid duct) opens into the oral
cavity on the buccal mucosa opposite the second upper
molar.
HEENT (Head, Eyes, Ears, Nose, Throat)
11. A 60-year-old patient is concerned about a yellowish-
colored lesion above her right eyelid. Findings reveal a
slightly raised yellowish, well-circumscribed plaque along the
nasal area of her right eyelid. What is this finding most
consistent with?
Answer: Xanthelasma.
Rationale: Xanthelasma are yellowish, well-circumscribed
plaques that appear on the eyelids, typically near the inner
canthus. They are often associated with hyperlipidemia.
12. Findings following assessment of a person's left eye gaze
include impaired movements when attempting to look
upward, downward, or inward. What condition is this most
consistent with?
Answer: Left cranial nerve III (oculomotor) paralysis.
Rationale: CN III innervates the medial rectus (adduction),
superior rectus (elevation), inferior rectus (depression), and
inferior oblique (elevation). Paralysis results in impaired
upward, downward, and inward gaze.
Assessment Final Exam Practice
Question Bank (Latest 2026/2027
Edition) –
EXAM
1. A 35-year-old female with a history of migraines presents
with worsening symptoms. She reports waking up at night
with headaches and nausea. Her only medication is oral
contraceptive pills (OCPs). What is the best next step?
Answer: Take a further history and perform a very careful
neurological exam.
Rationale: New-onset "nocturnal" headaches and nausea are
red flags for increased intracranial pressure (ICP) or
secondary causes like stroke, especially in patients using oral
contraceptives which increase thrombotic risk.
2. What is the definition of primary prevention?
Answer: Interventions designed to prevent disease.
Rationale: Primary prevention aims to remove the causes of
disease before it occurs (e.g., immunizations, lifestyle
counseling).
3. According to the USPSTF, what is the recommendation for
breast cancer screening in average-risk women?
, Answer: Mammography is recommended every 2 years for
women aged 50–74.
Rationale: Evidence is insufficient for screening women 75
and older, and biennial screening is the standard for the 50–
74 age group.
4. According to JNC8, what is the target blood pressure for
adults aged 60 and older?
Answer: Target BP should be ≤ 150/90 mmHg.
Rationale: JNC8 relaxed targets for the elderly to balance
stroke reduction against the risk of falls and adverse effects
from overtreatment.
5. A grandmother asks you privately if her 9-year-old
granddaughter has started puberty. During examination, you
note asymmetric projection of the areola and nipple of the
right chest to form a secondary mound above the level of the
breast. The left breast is underdeveloped. What Tanner Stage
is this?
Answer: Tanner Stage IV.
Rationale: Stage IV is defined by the projection of the areola
and nipple to form a secondary mound above the level of the
breast.
6. What is a useful strategy when examining young children
between the ages of 1 and 4?
Answer: Have the parent facilitate the exam (e.g., removing
clothes, holding the child on the lap).
, Rationale: Parental presence and involvement reduce anxiety
and increase cooperation in young children during the
physical examination.
7. What is the function of the auditory ossicles?
Answer: To transform sound vibrations into mechanical
waves for the inner ear.
Rationale: The auditory ossicles (malleus, incus, stapes)
transmit and amplify sound vibrations from the tympanic
membrane to the oval window of the inner ear.
8. A patient complains of vertigo accompanied by nausea and
vomiting. Examination reveals bilateral diplopia and an
unsteady gait. What is the most likely cause?
Answer: A neurological condition.
Rationale: Vertigo with neurologic findings such as diplopia,
ataxia, and dysarthria suggests a central (neurological) cause
rather than peripheral inner ear pathology. Cardiovascular
causes typically present with lightheadedness, weakness, or
presyncope.
9. What is the term for being farsighted?
Answer: Hyperopia.
Rationale: Hyperopia (farsightedness) occurs when light
focuses behind the retina, making near objects appear
blurred while distant objects are seen more clearly.
10. In order to visualize the opening of Stensen's duct, where
should you examine?
, Answer: The buccal mucosa opposite the second upper
molar.
Rationale: Stensen's duct (parotid duct) opens into the oral
cavity on the buccal mucosa opposite the second upper
molar.
HEENT (Head, Eyes, Ears, Nose, Throat)
11. A 60-year-old patient is concerned about a yellowish-
colored lesion above her right eyelid. Findings reveal a
slightly raised yellowish, well-circumscribed plaque along the
nasal area of her right eyelid. What is this finding most
consistent with?
Answer: Xanthelasma.
Rationale: Xanthelasma are yellowish, well-circumscribed
plaques that appear on the eyelids, typically near the inner
canthus. They are often associated with hyperlipidemia.
12. Findings following assessment of a person's left eye gaze
include impaired movements when attempting to look
upward, downward, or inward. What condition is this most
consistent with?
Answer: Left cranial nerve III (oculomotor) paralysis.
Rationale: CN III innervates the medial rectus (adduction),
superior rectus (elevation), inferior rectus (depression), and
inferior oblique (elevation). Paralysis results in impaired
upward, downward, and inward gaze.
