CHAMBERL AIN COLLEGE OF NURSING
School of Nursing · NR 509
NR 509 — Advanced Physical Assessment
Academic Year: 2026/2027
Final Exam · Comprehensive Question Bank
Question 1
A 35-year-old female patient has had migraines for much of her adult life. At her
regular checkup, she is healthy, takes no medications except oral contraceptive pills
(OCPs), exercises, and has a steady job. Her only complaint is that her migraines seem
to have become worse, and, for the past few weeks, she has been waking up at night
with headache and also nausea. Which of the following is the best course of action?
A. Reassure her that this is a common pattern with migraines.
B. Order studies to evaluate potential transient ischemic attacks (TIAs) because she is on
OCPs.
C. Take a further history and perform a very careful neurological examination.
D. Treat her for sinusitis.
E. Prescribe a strong medication for her migraines.
CORRECT ANSWER:
C. Take a further history and perform a very careful neurological examination.
RATIONALE:
The history of nightly awakening and nausea is concerning for increased intracranial
pressure from a tumor or other mass. A careful neurological examination may uncover
deficits.
, Question 2
A 32-year-old male complains of a painless, cystic mass just above his left testicle.
During the physical examination, a strong flashlight is placed behind the scrotum
through the area in question and transillumination is noted. What is the most likely
diagnosis?
A. Direct hernia
B. Indirect hernia
C. Spermatocele
D. Testicular tumor
E. Varicocele
CORRECT ANSWER: C. Spermatocele
RATIONALE:
A spermatocele is a benign, typically painless, movable cystic mass just above the testis that
will typically transilluminate with a strong light source. Direct hernia and indirect hernia are
incorrect as they will typically contain abdominal contents such as bowel that do not
transilluminate.
, Question 3
The clinician is seeing a middle-aged patient who has a diagnosis of lumbar spinal
stenosis. The patient's history is consistent with this diagnosis as he has pain in the
back with walking that improves with rest. Which physical sign(s) are most consistent
with his diagnosis?
A. Hyperreflexia of the lower limb
B. Pelvic tilt or drop
C. Thoracic kyphosis
D. Positive straight-leg raise
E. Flexed forward posture with lower extremity weakness
CORRECT ANSWER: E. Flexed forward posture with lower extremity weakness
RATIONALE:
The physical signs of lumbar spinal stenosis include flexed forward posture and weakness of
the lower extremities.
, Question 4
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast
mass on breast self-examination (BSE) at home. The mass is nontender without skin
changes, erythema, or overlying swelling. She has heard that most breast cancers are
found by patients themselves, and she is very concerned that she may have breast
cancer. Which of the following is true about BSE and self-detection of breast cancer?
A. Most masses that women find at home and bring to a provider's attention turn out to
be malignant.
B. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
C. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
D. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
E. BSE is universally recommended because of very high sensitivity.
CORRECT ANSWER:
B. This patient is more likely to find a fibroadenoma than a cancer on self-
examination.
RATIONALE:
This patient is more likely to find a fibroadenoma than a cancer on self-examination. In this
patient's age range (15-25 years), palpable masses are most likely to be benign
fibroadenomas.
School of Nursing · NR 509
NR 509 — Advanced Physical Assessment
Academic Year: 2026/2027
Final Exam · Comprehensive Question Bank
Question 1
A 35-year-old female patient has had migraines for much of her adult life. At her
regular checkup, she is healthy, takes no medications except oral contraceptive pills
(OCPs), exercises, and has a steady job. Her only complaint is that her migraines seem
to have become worse, and, for the past few weeks, she has been waking up at night
with headache and also nausea. Which of the following is the best course of action?
A. Reassure her that this is a common pattern with migraines.
B. Order studies to evaluate potential transient ischemic attacks (TIAs) because she is on
OCPs.
C. Take a further history and perform a very careful neurological examination.
D. Treat her for sinusitis.
E. Prescribe a strong medication for her migraines.
CORRECT ANSWER:
C. Take a further history and perform a very careful neurological examination.
RATIONALE:
The history of nightly awakening and nausea is concerning for increased intracranial
pressure from a tumor or other mass. A careful neurological examination may uncover
deficits.
, Question 2
A 32-year-old male complains of a painless, cystic mass just above his left testicle.
During the physical examination, a strong flashlight is placed behind the scrotum
through the area in question and transillumination is noted. What is the most likely
diagnosis?
A. Direct hernia
B. Indirect hernia
C. Spermatocele
D. Testicular tumor
E. Varicocele
CORRECT ANSWER: C. Spermatocele
RATIONALE:
A spermatocele is a benign, typically painless, movable cystic mass just above the testis that
will typically transilluminate with a strong light source. Direct hernia and indirect hernia are
incorrect as they will typically contain abdominal contents such as bowel that do not
transilluminate.
, Question 3
The clinician is seeing a middle-aged patient who has a diagnosis of lumbar spinal
stenosis. The patient's history is consistent with this diagnosis as he has pain in the
back with walking that improves with rest. Which physical sign(s) are most consistent
with his diagnosis?
A. Hyperreflexia of the lower limb
B. Pelvic tilt or drop
C. Thoracic kyphosis
D. Positive straight-leg raise
E. Flexed forward posture with lower extremity weakness
CORRECT ANSWER: E. Flexed forward posture with lower extremity weakness
RATIONALE:
The physical signs of lumbar spinal stenosis include flexed forward posture and weakness of
the lower extremities.
, Question 4
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast
mass on breast self-examination (BSE) at home. The mass is nontender without skin
changes, erythema, or overlying swelling. She has heard that most breast cancers are
found by patients themselves, and she is very concerned that she may have breast
cancer. Which of the following is true about BSE and self-detection of breast cancer?
A. Most masses that women find at home and bring to a provider's attention turn out to
be malignant.
B. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
C. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
D. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
E. BSE is universally recommended because of very high sensitivity.
CORRECT ANSWER:
B. This patient is more likely to find a fibroadenoma than a cancer on self-
examination.
RATIONALE:
This patient is more likely to find a fibroadenoma than a cancer on self-examination. In this
patient's age range (15-25 years), palpable masses are most likely to be benign
fibroadenomas.
