NR509 WEEK 8 FINAL EXAM DUE 22ND
DECEMBER 2025 COMPLETE ACTUAL EXAM
QUESTIONS 1- 100 UPDATED 6/27/2026 NR-509
ADVANCED PHYSICAL ASSESSMENT NR 509
MIDTERM AND FINALS EXAMPLIFY ONLINE
PROCTORED EXAM QUESTIONS AND ANSWERS
WITH VERIFIED RATIONALES
1. Cardiovascular Assessment
A 68-year-old male presents for a routine physical. During auscultation, you note a
harsh, crescendo-decrescendo systolic murmur, heard best at the second right
intercostal space. The murmur radiates to the carotid arteries. What is the most
likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Hypertrophic cardiomyopathy
Answer: B
Rationale: Aortic stenosis (AS) is characterized by a mid-systolic, crescendo-
decrescendo murmur best heard at the right upper sternal border (2nd right
intercostal space) with radiation to the carotids. Mitral regurgitation is a
holosystolic murmur heard best at the apex radiating to the axilla. Hypertrophic
cardiomyopathy produces a systolic murmur that increases with Valsalva and
decreases with squatting.
2. HEENT Assessment
A patient demonstrates normal pupillary constriction when shifting focus from a
distant object to a near object. What physiological process is being tested?
A) Direct pupillary reflex
B) Consensual pupillary reflex
,C) Accommodation
D) Convergence
Answer: C
Rationale: Accommodation is the triad of pupillary constriction, convergence of
the eyes, and lens thickening that occurs when shifting gaze from a distant to a
near target. The direct pupillary reflex is the constriction of the ipsilateral pupil in
response to light, while the consensual reflex is the constriction of the contralateral
pupil.
3. Musculoskeletal Assessment
You suspect a medial meniscus tear in a patient with acute knee pain. Which
specific physical exam maneuver is most appropriate to assess this?
A) Lachman test
B) McMurray test
C) Anterior drawer test
D) Apley compression test
Answer: B
Rationale: The McMurray test is a specific provocative maneuver used to detect
meniscal tears by producing a palpable or audible click or pain when the knee is
rotated while flexed and extended. Lachman and anterior drawer tests assess
anterior cruciate ligament (ACL) stability. Apley's compression test is another
maneuver that can indicate a meniscal injury.
4. Gastrointestinal Assessment
A 24-year-old female presents with acute right lower quadrant (RLQ) abdominal
pain. On examination, you deeply palpate the left lower quadrant and elicit sudden,
sharp pain in the RLQ. What is the name of this positive sign?
A) Murphy's sign
B) McBurney's sign
C) Rovsing's sign
D) Psoas sign
Answer: C
Rationale: A positive Rovsing's sign is elicited when palpation in the left lower
,quadrant causes pain in the right lower quadrant, suggesting peritoneal
inflammation localized to the appendix. McBurney's sign is tenderness specifically
at McBurney's point. Murphy's sign assesses for acute cholecystitis. The psoas sign
is a different test for appendicitis.
5. Neurological Assessment
During a neurological examination, you ask a patient to close their eyes and
identify a common object, such as a coin or key, placed in their palm. What
cortical sensory function is being assessed?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Barognosis
Answer: B
Rationale: Stereognosis is the ability to perceive the form of an object by touch.
Graphesthesia is the ability to recognize numbers or letters traced on the skin.
Two-point discrimination tests the ability to distinguish two simultaneous
pinpricks on the skin. Barognosis is the ability to perceive weight.
6. Pulmonary Assessment
When assessing tactile fremitus on a patient with right lower lobe lobar
pneumonia, what would you expect to find over the consolidated lung field?
A) Increased tactile fremitus
B) Decreased tactile fremitus
C) Absent tactile fremitus
D) Hyperresonance on percussion
Answer: A
Rationale: Tactile fremitus is increased over areas of lung consolidation (e.g.,
pneumonia) because sound waves are transmitted more efficiently through denser
tissue. It is decreased or absent in conditions like pleural effusion, pneumothorax,
or COPD, which separate the lung from the chest wall with fluid or air.
, 7. Skin & Integumentary Assessment
A 55-year-old construction worker presents with a pearly, translucent papule on his
nose. The lesion has a central ulceration and visible telangiectatic vessels. Which
type of skin malignancy is most consistent with this appearance?
A) Melanoma
B) Squamous cell carcinoma (SCC)
C) Basal cell carcinoma (BCC)
D) Actinic keratosis
Answer: C
Rationale: Basal cell carcinoma (BCC) is the most common skin cancer and
classically presents as a pearly, translucent papule or nodule with telangiectasias,
often with a central depression or ulceration. Squamous cell carcinoma is often a
scaly, crusted plaque or nodule. Melanoma is typically pigmented and follows the
ABCDEs.
8. Peripheral Vascular Assessment
A 42-year-old female reports persistent calf pain that occurs when she walks and
resolves with rest. A Doppler assessment confirms peripheral arterial disease
(PAD). What is the classic term for this symptom?
A) Raynaud's phenomenon
B) Venous claudication
C) Intermittent claudication
D) Rest pain
Answer: C
Rationale: Intermittent claudication is a symptom of PAD characterized by
muscular ischemic pain that is consistently reproduced by a specific amount of
exercise and relieved by a few minutes of rest. Raynaud's is vasospasm in response
to cold or stress. Venous claudication is a dull ache associated with venous
insufficiency, often worse with prolonged standing and relieved by elevation.
9. Neurological Assessment
You elicit a Babinski sign in a 45-year-old male. What does a positive response
indicate, and what does it suggest?
DECEMBER 2025 COMPLETE ACTUAL EXAM
QUESTIONS 1- 100 UPDATED 6/27/2026 NR-509
ADVANCED PHYSICAL ASSESSMENT NR 509
MIDTERM AND FINALS EXAMPLIFY ONLINE
PROCTORED EXAM QUESTIONS AND ANSWERS
WITH VERIFIED RATIONALES
1. Cardiovascular Assessment
A 68-year-old male presents for a routine physical. During auscultation, you note a
harsh, crescendo-decrescendo systolic murmur, heard best at the second right
intercostal space. The murmur radiates to the carotid arteries. What is the most
likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Hypertrophic cardiomyopathy
Answer: B
Rationale: Aortic stenosis (AS) is characterized by a mid-systolic, crescendo-
decrescendo murmur best heard at the right upper sternal border (2nd right
intercostal space) with radiation to the carotids. Mitral regurgitation is a
holosystolic murmur heard best at the apex radiating to the axilla. Hypertrophic
cardiomyopathy produces a systolic murmur that increases with Valsalva and
decreases with squatting.
2. HEENT Assessment
A patient demonstrates normal pupillary constriction when shifting focus from a
distant object to a near object. What physiological process is being tested?
A) Direct pupillary reflex
B) Consensual pupillary reflex
,C) Accommodation
D) Convergence
Answer: C
Rationale: Accommodation is the triad of pupillary constriction, convergence of
the eyes, and lens thickening that occurs when shifting gaze from a distant to a
near target. The direct pupillary reflex is the constriction of the ipsilateral pupil in
response to light, while the consensual reflex is the constriction of the contralateral
pupil.
3. Musculoskeletal Assessment
You suspect a medial meniscus tear in a patient with acute knee pain. Which
specific physical exam maneuver is most appropriate to assess this?
A) Lachman test
B) McMurray test
C) Anterior drawer test
D) Apley compression test
Answer: B
Rationale: The McMurray test is a specific provocative maneuver used to detect
meniscal tears by producing a palpable or audible click or pain when the knee is
rotated while flexed and extended. Lachman and anterior drawer tests assess
anterior cruciate ligament (ACL) stability. Apley's compression test is another
maneuver that can indicate a meniscal injury.
4. Gastrointestinal Assessment
A 24-year-old female presents with acute right lower quadrant (RLQ) abdominal
pain. On examination, you deeply palpate the left lower quadrant and elicit sudden,
sharp pain in the RLQ. What is the name of this positive sign?
A) Murphy's sign
B) McBurney's sign
C) Rovsing's sign
D) Psoas sign
Answer: C
Rationale: A positive Rovsing's sign is elicited when palpation in the left lower
,quadrant causes pain in the right lower quadrant, suggesting peritoneal
inflammation localized to the appendix. McBurney's sign is tenderness specifically
at McBurney's point. Murphy's sign assesses for acute cholecystitis. The psoas sign
is a different test for appendicitis.
5. Neurological Assessment
During a neurological examination, you ask a patient to close their eyes and
identify a common object, such as a coin or key, placed in their palm. What
cortical sensory function is being assessed?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Barognosis
Answer: B
Rationale: Stereognosis is the ability to perceive the form of an object by touch.
Graphesthesia is the ability to recognize numbers or letters traced on the skin.
Two-point discrimination tests the ability to distinguish two simultaneous
pinpricks on the skin. Barognosis is the ability to perceive weight.
6. Pulmonary Assessment
When assessing tactile fremitus on a patient with right lower lobe lobar
pneumonia, what would you expect to find over the consolidated lung field?
A) Increased tactile fremitus
B) Decreased tactile fremitus
C) Absent tactile fremitus
D) Hyperresonance on percussion
Answer: A
Rationale: Tactile fremitus is increased over areas of lung consolidation (e.g.,
pneumonia) because sound waves are transmitted more efficiently through denser
tissue. It is decreased or absent in conditions like pleural effusion, pneumothorax,
or COPD, which separate the lung from the chest wall with fluid or air.
, 7. Skin & Integumentary Assessment
A 55-year-old construction worker presents with a pearly, translucent papule on his
nose. The lesion has a central ulceration and visible telangiectatic vessels. Which
type of skin malignancy is most consistent with this appearance?
A) Melanoma
B) Squamous cell carcinoma (SCC)
C) Basal cell carcinoma (BCC)
D) Actinic keratosis
Answer: C
Rationale: Basal cell carcinoma (BCC) is the most common skin cancer and
classically presents as a pearly, translucent papule or nodule with telangiectasias,
often with a central depression or ulceration. Squamous cell carcinoma is often a
scaly, crusted plaque or nodule. Melanoma is typically pigmented and follows the
ABCDEs.
8. Peripheral Vascular Assessment
A 42-year-old female reports persistent calf pain that occurs when she walks and
resolves with rest. A Doppler assessment confirms peripheral arterial disease
(PAD). What is the classic term for this symptom?
A) Raynaud's phenomenon
B) Venous claudication
C) Intermittent claudication
D) Rest pain
Answer: C
Rationale: Intermittent claudication is a symptom of PAD characterized by
muscular ischemic pain that is consistently reproduced by a specific amount of
exercise and relieved by a few minutes of rest. Raynaud's is vasospasm in response
to cold or stress. Venous claudication is a dull ache associated with venous
insufficiency, often worse with prolonged standing and relieved by elevation.
9. Neurological Assessment
You elicit a Babinski sign in a 45-year-old male. What does a positive response
indicate, and what does it suggest?
