NR 509 Advanced Physical Assessment Final Exam |
Questions and verified Answers | 2026/27 Updates |
100% Pass Guarantee | Chamberlain
SECTION 1: NEUROLOGICAL ASSESSMENT
1. 35-year-old female with a history of migraines presents to the clinic with
worsening symptoms for the past few weeks. She reports waking up at night with
headaches and nausea. Her only medication history is oral contraceptive pills
(OCPs). Otherwise, she states she is healthy. Which of the following actions if
taken by the NP is the best next step?
• A) Order an immediate MRI of the brain
• B) Prescribe a stronger migraine medication
• C) Discontinue oral contraceptive pills immediately
• D) Take a further history and perform a very careful neurological exam
Correct Answer: D
Expert Rationale: Worsening headaches with nocturnal awakening and nausea in a
patient on OCPs raises concern for increased intracranial pressure or secondary
headache disorders. The OCPs increase the risk of venous sinus thrombosis, which can
present with new or worsening headaches. Before ordering expensive imaging or
changing medications, a thorough history (including detailed headache characteristics,
medication review, and associated symptoms) and careful neurological examination
(including fundoscopy to assess for papilledema) are essential. This systematic approach
allows the NP to determine the urgency and necessity of further diagnostic testing.
Option A (MRI) is premature without initial clinical assessment. Option B is inappropriate
without determining the underlying etiology. Option C is not warranted without further
evidence.
,2. A grandmother is accompanying her 9-year-old granddaughter during a routine
physical examination. She asks you privately if her granddaughter has started
puberty yet. During the examination, the NP notes 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. These assessment findings are
consistent with which Tanner Stage of development?
• A) Tanner Stage II
• B) Tanner Stage III
• C) Tanner Stage IV
• D) Tanner Stage V
Correct Answer: C
Expert Rationale: Tanner Stage IV is characterized by projection of the areola and
nipple to form a secondary mound above the level of the breast, while the overall breast
contour continues to develop. The key feature here is the asymmetric
projection forming a secondary mound, which is the hallmark of Stage IV. Stage II
shows breast bud formation with elevation of breast and papilla as a small mound with
enlargement of the areolar diameter. Stage III shows further enlargement and elevation
of breast and areola with no separation of their contours. Stage V shows projection of
the nipple only, with the areola recessing to the general breast contour. Asymmetric
breast development is common during puberty and typically resolves within 6-12
months; however, the Tanner staging should be based on the more developed breast.
3. Primary prevention is defined as which of the following?
• A) Interventions designed to prevent disease
• B) Early detection and treatment of disease
• C) Rehabilitation and restoration of function
• D) Interventions to reduce complications of existing disease
Correct Answer: A
Expert Rationale: Primary prevention refers to interventions designed to prevent the
onset of disease before it occurs. This includes health promotion activities such as
vaccination, lifestyle modifications, health education, and environmental interventions.
Option B describes secondary prevention (screening and early detection). Option C
describes tertiary prevention (rehabilitation). Option D also describes tertiary
,prevention. Understanding this hierarchy is fundamental to population health and
preventive medicine.
4. Based on the U.S. Preventive Services Task Force (USPSTF) recommendations,
which of the following statements is true about screening for breast cancer in
average-risk women?
• A) Mammography is recommended annually for all women aged 40 and older
• B) Mammography is recommended every 2 years for women aged 50-74 with
insufficient evidence for screening women over the age of 75
• C) Mammography is not recommended for any women over age 75
• D) Clinical breast examination is recommended annually for all women over age
40
Correct Answer: B
Expert Rationale: The USPSTF recommends biennial screening mammography for
women aged 50 to 74 years (Grade B recommendation). For women aged 40 to 49
years, the decision to start screening should be individualized (Grade C). For women
aged 75 years and older, the current evidence is insufficient to assess the balance of
benefits and harms (Grade I statement). Option A is incorrect because the
recommendation is biennial, not annual, and starts at 50. Option C is incorrect because
the USPSTF finds insufficient evidence, not a recommendation against screening. Option
D is incorrect because the USPSTF does not recommend clinical breast examination for
screening.
5. Which of the following statements is true regarding recommendations by the
eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all
that apply.
• A) Target blood pressure should be < 150/90 mmHg
• B) If treatment results in SBP < 140 and is well tolerated without adverse effects,
treatment does not need to be adjusted
• C) All patients aged 60 and older should be treated to a target of < 140/90
mmHg
, • D) In those aged 80 or older, blood pressure targets of 140 to < 150/70 to 80
appear optimal for notable reductions in stroke, cardiovascular events, and all-
cause mortality
Correct Answers: A, B, D
Expert Rationale: JNC8 recommendations for adults aged 60 years and older include:
Target BP < 150/90 mmHg (Option A). However, if treatment results in SBP < 140 and is
well tolerated without adverse effects, treatment does not need to be adjusted (Option
B). For those aged 80 years and older, blood pressure targets of 140 to < 150/70 to 80
appear optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality (Option D). Option C is incorrect because JNC8 does not recommend a
universal target of < 140/90 for all patients aged 60 and older; the target is < 150/90 for
the general population in this age group.
6. Which of the following is a useful strategy when examining young children
between the ages of 1 and 4?
• A) Examine the child in a supine position on the examination table
• B) Have the parent facilitate the exam (e.g., removing clothes, holding the child
on lap)
• C) Ask the child to sit still and follow instructions
• D) Perform the examination as quickly as possible without parental involvement
Correct Answer: B
Expert Rationale: For young children aged 1-4 years, parental involvement is crucial for
a successful examination. Having parents remove clothing, hold the child on their lap,
and provide comfort and distraction helps reduce anxiety and facilitates a cooperative
environment. This age group is often fearful of strangers and may be uncooperative if
approached directly by the provider. Option A is less effective as young children may
feel restrained and become more anxious. Option C is unrealistic because children in
this age range have limited ability to follow complex instructions. Option D is
inappropriate as parental presence and involvement are essential for building trust and
ensuring safety.
Questions and verified Answers | 2026/27 Updates |
100% Pass Guarantee | Chamberlain
SECTION 1: NEUROLOGICAL ASSESSMENT
1. 35-year-old female with a history of migraines presents to the clinic with
worsening symptoms for the past few weeks. She reports waking up at night with
headaches and nausea. Her only medication history is oral contraceptive pills
(OCPs). Otherwise, she states she is healthy. Which of the following actions if
taken by the NP is the best next step?
• A) Order an immediate MRI of the brain
• B) Prescribe a stronger migraine medication
• C) Discontinue oral contraceptive pills immediately
• D) Take a further history and perform a very careful neurological exam
Correct Answer: D
Expert Rationale: Worsening headaches with nocturnal awakening and nausea in a
patient on OCPs raises concern for increased intracranial pressure or secondary
headache disorders. The OCPs increase the risk of venous sinus thrombosis, which can
present with new or worsening headaches. Before ordering expensive imaging or
changing medications, a thorough history (including detailed headache characteristics,
medication review, and associated symptoms) and careful neurological examination
(including fundoscopy to assess for papilledema) are essential. This systematic approach
allows the NP to determine the urgency and necessity of further diagnostic testing.
Option A (MRI) is premature without initial clinical assessment. Option B is inappropriate
without determining the underlying etiology. Option C is not warranted without further
evidence.
,2. A grandmother is accompanying her 9-year-old granddaughter during a routine
physical examination. She asks you privately if her granddaughter has started
puberty yet. During the examination, the NP notes 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. These assessment findings are
consistent with which Tanner Stage of development?
• A) Tanner Stage II
• B) Tanner Stage III
• C) Tanner Stage IV
• D) Tanner Stage V
Correct Answer: C
Expert Rationale: Tanner Stage IV is characterized by projection of the areola and
nipple to form a secondary mound above the level of the breast, while the overall breast
contour continues to develop. The key feature here is the asymmetric
projection forming a secondary mound, which is the hallmark of Stage IV. Stage II
shows breast bud formation with elevation of breast and papilla as a small mound with
enlargement of the areolar diameter. Stage III shows further enlargement and elevation
of breast and areola with no separation of their contours. Stage V shows projection of
the nipple only, with the areola recessing to the general breast contour. Asymmetric
breast development is common during puberty and typically resolves within 6-12
months; however, the Tanner staging should be based on the more developed breast.
3. Primary prevention is defined as which of the following?
• A) Interventions designed to prevent disease
• B) Early detection and treatment of disease
• C) Rehabilitation and restoration of function
• D) Interventions to reduce complications of existing disease
Correct Answer: A
Expert Rationale: Primary prevention refers to interventions designed to prevent the
onset of disease before it occurs. This includes health promotion activities such as
vaccination, lifestyle modifications, health education, and environmental interventions.
Option B describes secondary prevention (screening and early detection). Option C
describes tertiary prevention (rehabilitation). Option D also describes tertiary
,prevention. Understanding this hierarchy is fundamental to population health and
preventive medicine.
4. Based on the U.S. Preventive Services Task Force (USPSTF) recommendations,
which of the following statements is true about screening for breast cancer in
average-risk women?
• A) Mammography is recommended annually for all women aged 40 and older
• B) Mammography is recommended every 2 years for women aged 50-74 with
insufficient evidence for screening women over the age of 75
• C) Mammography is not recommended for any women over age 75
• D) Clinical breast examination is recommended annually for all women over age
40
Correct Answer: B
Expert Rationale: The USPSTF recommends biennial screening mammography for
women aged 50 to 74 years (Grade B recommendation). For women aged 40 to 49
years, the decision to start screening should be individualized (Grade C). For women
aged 75 years and older, the current evidence is insufficient to assess the balance of
benefits and harms (Grade I statement). Option A is incorrect because the
recommendation is biennial, not annual, and starts at 50. Option C is incorrect because
the USPSTF finds insufficient evidence, not a recommendation against screening. Option
D is incorrect because the USPSTF does not recommend clinical breast examination for
screening.
5. Which of the following statements is true regarding recommendations by the
eighth Joint National Committee (JNC8) for adults aged 60 and older? Select all
that apply.
• A) Target blood pressure should be < 150/90 mmHg
• B) If treatment results in SBP < 140 and is well tolerated without adverse effects,
treatment does not need to be adjusted
• C) All patients aged 60 and older should be treated to a target of < 140/90
mmHg
, • D) In those aged 80 or older, blood pressure targets of 140 to < 150/70 to 80
appear optimal for notable reductions in stroke, cardiovascular events, and all-
cause mortality
Correct Answers: A, B, D
Expert Rationale: JNC8 recommendations for adults aged 60 years and older include:
Target BP < 150/90 mmHg (Option A). However, if treatment results in SBP < 140 and is
well tolerated without adverse effects, treatment does not need to be adjusted (Option
B). For those aged 80 years and older, blood pressure targets of 140 to < 150/70 to 80
appear optimal for notable reductions in stroke, cardiovascular events, and all-cause
mortality (Option D). Option C is incorrect because JNC8 does not recommend a
universal target of < 140/90 for all patients aged 60 and older; the target is < 150/90 for
the general population in this age group.
6. Which of the following is a useful strategy when examining young children
between the ages of 1 and 4?
• A) Examine the child in a supine position on the examination table
• B) Have the parent facilitate the exam (e.g., removing clothes, holding the child
on lap)
• C) Ask the child to sit still and follow instructions
• D) Perform the examination as quickly as possible without parental involvement
Correct Answer: B
Expert Rationale: For young children aged 1-4 years, parental involvement is crucial for
a successful examination. Having parents remove clothing, hold the child on their lap,
and provide comfort and distraction helps reduce anxiety and facilitates a cooperative
environment. This age group is often fearful of strangers and may be uncooperative if
approached directly by the provider. Option A is less effective as young children may
feel restrained and become more anxious. Option C is unrealistic because children in
this age range have limited ability to follow complex instructions. Option D is
inappropriate as parental presence and involvement are essential for building trust and
ensuring safety.
