CHAMBERL AIN COLLEGE OF NURSING
School of Nursing · NR 509
NR 509 — Advanced Physical Assessment
Academic Year: 2026/2027
Midterm Exam · Comprehensive Question
Bank
, Question 1
A 62-year-old retired college professor presents for routine physical examination.
After the patient has been reading a novel in the waiting room for ~20 minutes, the
technician records his blood pressure in both arms using an automated device. The
technician notes a 20-mm Hg difference in systolic blood pressure between the right
and left arms; he repeats the readings 10 minutes later and records the same
asymmetrical systolic blood pressure. Which of the following is true regarding this
physical finding?
A. An arm-to-arm difference of up to 20 mm Hg in systolic blood pressure is considered
the upper limits of normal.
B. The difference is likely secondary to white coat hypertension and should be followed
up with three subsequent monthly readings to confirm.
C. The patient should undergo ambulatory blood pressure monitoring in both arms for
24 hours to confirm conflicting measurements in the office.
D. This finding is clearly abnormal and requires immediate evaluation for possible
cardiovascular emergency.
E. A difference of 20 mm Hg is normal and requires no further evaluation.
CORRECT ANSWER:
D. This finding is clearly abnormal and requires immediate evaluation for possible
cardiovascular emergency.
RATIONALE:
A systolic blood pressure difference of >10-15 mm Hg between arms is abnormal and may
indicate subclavian artery stenosis, aortic dissection, or other vascular pathology. A 20-mm
Hg difference is significant and requires immediate evaluation.
, Question 2
A 65-year-old overweight male presents at the clinic with hoarseness which has
lasted for around 2 months. He thinks it began along with a cold. He is not feeling
badly other than frequent heartburn, and he has continued to work as a bartender
(for the past 30 years), but he is having difficulty being heard and understood
because of his hoarse voice. A diagnosis that is on the differential list includes which
of the following?
A. Voice strain from bartending and talking amidst loud ambient noise
B. Viral infection
C. Acid reflux
D. Inhalation of fumes
E. Environmental allergies
CORRECT ANSWER: C. Acid reflux
RATIONALE:
Hoarseness lasting more than 2 weeks, especially with a history of frequent heartburn,
suggests acid reflux (laryngopharyngeal reflux). The patient's occupation as a bartender
may contribute to voice strain, but the heartburn is a key clue.
, Question 3
A 53-year-old caterer comes to the clinic for a routine examination. She has type 2
diabetes mellitus, which is well controlled on medication. Her history from her last
visit reveals that she smoked one pack of cigarettes a day at that time. The 5 As
Model is a useful approach to take with trying to help patients to quit smoking. What
is the 5 As Model?
A. Admonish, action, available, assess, alleviating factors
B. Agitate, assist, alleviating factors, able, action
C. Affable, associated manifestations, ask, admonish, available
D. Ask, advise, assess, assist, arrange
E. Arrange, aggravating factors, action, attitude, able
CORRECT ANSWER: D. Ask, advise, assess, assist, arrange
RATIONALE:
The 5 As Model for smoking cessation is: Ask about tobacco use, Advise to quit, Assess
willingness to quit, Assist in quitting, and Arrange follow-up. This evidence-based approach
helps clinicians guide patients through the quitting process.
School of Nursing · NR 509
NR 509 — Advanced Physical Assessment
Academic Year: 2026/2027
Midterm Exam · Comprehensive Question
Bank
, Question 1
A 62-year-old retired college professor presents for routine physical examination.
After the patient has been reading a novel in the waiting room for ~20 minutes, the
technician records his blood pressure in both arms using an automated device. The
technician notes a 20-mm Hg difference in systolic blood pressure between the right
and left arms; he repeats the readings 10 minutes later and records the same
asymmetrical systolic blood pressure. Which of the following is true regarding this
physical finding?
A. An arm-to-arm difference of up to 20 mm Hg in systolic blood pressure is considered
the upper limits of normal.
B. The difference is likely secondary to white coat hypertension and should be followed
up with three subsequent monthly readings to confirm.
C. The patient should undergo ambulatory blood pressure monitoring in both arms for
24 hours to confirm conflicting measurements in the office.
D. This finding is clearly abnormal and requires immediate evaluation for possible
cardiovascular emergency.
E. A difference of 20 mm Hg is normal and requires no further evaluation.
CORRECT ANSWER:
D. This finding is clearly abnormal and requires immediate evaluation for possible
cardiovascular emergency.
RATIONALE:
A systolic blood pressure difference of >10-15 mm Hg between arms is abnormal and may
indicate subclavian artery stenosis, aortic dissection, or other vascular pathology. A 20-mm
Hg difference is significant and requires immediate evaluation.
, Question 2
A 65-year-old overweight male presents at the clinic with hoarseness which has
lasted for around 2 months. He thinks it began along with a cold. He is not feeling
badly other than frequent heartburn, and he has continued to work as a bartender
(for the past 30 years), but he is having difficulty being heard and understood
because of his hoarse voice. A diagnosis that is on the differential list includes which
of the following?
A. Voice strain from bartending and talking amidst loud ambient noise
B. Viral infection
C. Acid reflux
D. Inhalation of fumes
E. Environmental allergies
CORRECT ANSWER: C. Acid reflux
RATIONALE:
Hoarseness lasting more than 2 weeks, especially with a history of frequent heartburn,
suggests acid reflux (laryngopharyngeal reflux). The patient's occupation as a bartender
may contribute to voice strain, but the heartburn is a key clue.
, Question 3
A 53-year-old caterer comes to the clinic for a routine examination. She has type 2
diabetes mellitus, which is well controlled on medication. Her history from her last
visit reveals that she smoked one pack of cigarettes a day at that time. The 5 As
Model is a useful approach to take with trying to help patients to quit smoking. What
is the 5 As Model?
A. Admonish, action, available, assess, alleviating factors
B. Agitate, assist, alleviating factors, able, action
C. Affable, associated manifestations, ask, admonish, available
D. Ask, advise, assess, assist, arrange
E. Arrange, aggravating factors, action, attitude, able
CORRECT ANSWER: D. Ask, advise, assess, assist, arrange
RATIONALE:
The 5 As Model for smoking cessation is: Ask about tobacco use, Advise to quit, Assess
willingness to quit, Assist in quitting, and Arrange follow-up. This evidence-based approach
helps clinicians guide patients through the quitting process.
