NR 509 Final Exam: Advanced Physical Assessment Questions
and Answers.
1. A 14-year-old student comes with her family to the urgent care center, having been
hit in the right eye with a plastic baseball during a family reunion. She complains of a
painful, watery, red right eye and sensitivity to light. She has normal visual acuity in
both eyes, no diplopia, and can open and close her eyes normally. The pupils are
unequal in size, 3 mm in diameter on the left, 5 mm in diameter on the right. Which
cranial nerve (CN) would be implicated as the cause of the photosensitivity complaint
and the pupillary asymmetry?
a. CN II
b. CN III
c. CN IV
d. CN V
e. CN VI
ANSWER: b. CN III
• Rationale: The oculomotor nerve (CN III) controls pupillary constriction. Injury to this
nerve can result in a dilated pupil (mydriasis) on the affected side, leading to impaired
pupillary constriction and a complaint of sensitivity to light (photophobia) due to the
inability to constrict the pupil appropriately. The asymmetry (right pupil larger than left)
points to a right CN III palsy.
2. A 20-year-old college student presents for his annual physical examination. He
recently became sexually active and is inquiring about the best means of preventing
sexually transmitted infections (STIs). Of the following, which would be the most
effective means of prevention?
a. Early withdrawal
b. Male condoms
c. Spermicides
d. Diaphragms
, e. Cervical caps
ANSWER: b. Male condoms
Rationale: The correct and consistent use of male condoms is highly effective in preventing
the transmission of multiple STIs, including HIV, chlamydia, gonorrhea, and HPV. While
abstinence is the most effective method, for sexually active individuals, male condoms
provide the best protection against most STIs.
3. A 17-year-old G1P0 presents at a routine prenatal check. By last menstrual period
(LMP), her gestational age at this visit is 36 weeks, 2 days. A first-trimester ultrasound
confirmed her estimated delivery date. On exam, her fundus measures 31 centimeters.
Ultrasound imaging might reveal which of the following anatomical findings that would
explain this size?
a. Normal size, organs, and amniotic fluid for the gestational age
b. Uterine leiomyomata that restrict fetal development
c. Extra amniotic fluid
d. Renal agenesis of the fetus resulting in intrauterine growth retardation
e. Twin pregnancy
ANSWER: d. Renal agenesis of the fetus resulting in intrauterine growth retardation
Rationale: A fundal height that is more than 4 cm less than the gestational age (36 weeks vs.
31 cm) suggests intrauterine growth restriction or oligohydramnios. Fetal renal agenesis
leads to a lack of amniotic fluid production (oligohydramnios), which results in a small-for-
dates uterus. This condition is also associated with intrauterine growth restriction.
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
• ANSWER: b. This patient is more likely to find a fibroadenoma than a cancer on self-
examination.
• Rationale: In women aged 15-25 years, the most common palpable breast mass is a benign
fibroadenoma. While patients often detect breast cancers themselves, in this age group, the
vast majority of masses are benign.
Questions 4-100 (Additional Questions with Original Options)
5. A 21-year-old college student presents for her first annual exam. She has been
sexually active for 1 year and has had two partners. She is not aware of having had any
sexually transmitted diseases (STIs). She is using condoms for birth control and STI
prevention but admits to not always using them regularly. Her last menses was 2 weeks
ago. On speculum exam, an unusual appearance is noted, which is diagnosed as warts.
What is the best description for these lesions?
• a. Several shallow ulcers with a red base
• b. Translucent nodules
• c. Raised friable or lobed lesions
• d. Bright red, soft lesion arising from the cervical canal
• e. Strawberry cervix (small red granular spots or petechiae)
• ANSWER: c. Raised friable or lobed lesions
• Rationale: Warts, or condylomata acuminata, caused by HPV, appear as raised, fleshy, often
lobed or cauliflower-like lesions. They are typically friable (easily broken).
6. A 21-year-old college student presents to the student health clinic for a full physical
examination. He is generally healthy; however, he reports that he has had sexual
intercourse with multiple partners in the past couple of months. He noticed a small
, lesion on the shaft of his penis a few days ago. While performing the examination, he
unwillingly achieves an erection. How should the clinician proceed at this point?
• a. Stop the examination immediately.
• b. Have him return to see another provider.
• c. Explain this is a normal response and finish the examination.
• d. Tell him the examination cannot proceed until the erection subsides.
• e. Assume that he is malingering.
• ANSWER: c. Explain this is a normal response and finish the examination.
• Rationale: An erection during a genital examination is a normal physiological response and
not a sign of sexual arousal or malingering. The clinician should acknowledge this as a
normal occurrence to reassure the patient and continue the examination in a professional
manner.
7. A 22-year-old G1P0 presents for a routine prenatal visit at 32 weeks' gestational age.
Leopold maneuvers indicate that the fetus is in a transverse lie, with the fetal skull
palpable at the woman's left side. Fetal heart tones are heard at the uterine fundus with
a baseline rate of 140 and beat-to-beat variability noted. Which of the following steps is
appropriate to take at this time?
• a. Schedule a return visit in ~2 weeks.
• b. Admit the patient to labor and delivery for monitoring.
• c. Perform an external version.
• d. Plan for induction of labor at 36 weeks.
• e. Order a stat cesarean section.
• ANSWER: a. Schedule a return visit in ~2 weeks.
• Rationale: At 32 weeks' gestation, the fetus still has room to move, and a transverse lie is
not a concern that requires intervention. Leopold maneuvers are also less accurate before 36
weeks. Normal fetal heart tones and variability are reassuring. Routine prenatal care,
including biweekly visits between 30-36 weeks, is appropriate.
and Answers.
1. A 14-year-old student comes with her family to the urgent care center, having been
hit in the right eye with a plastic baseball during a family reunion. She complains of a
painful, watery, red right eye and sensitivity to light. She has normal visual acuity in
both eyes, no diplopia, and can open and close her eyes normally. The pupils are
unequal in size, 3 mm in diameter on the left, 5 mm in diameter on the right. Which
cranial nerve (CN) would be implicated as the cause of the photosensitivity complaint
and the pupillary asymmetry?
a. CN II
b. CN III
c. CN IV
d. CN V
e. CN VI
ANSWER: b. CN III
• Rationale: The oculomotor nerve (CN III) controls pupillary constriction. Injury to this
nerve can result in a dilated pupil (mydriasis) on the affected side, leading to impaired
pupillary constriction and a complaint of sensitivity to light (photophobia) due to the
inability to constrict the pupil appropriately. The asymmetry (right pupil larger than left)
points to a right CN III palsy.
2. A 20-year-old college student presents for his annual physical examination. He
recently became sexually active and is inquiring about the best means of preventing
sexually transmitted infections (STIs). Of the following, which would be the most
effective means of prevention?
a. Early withdrawal
b. Male condoms
c. Spermicides
d. Diaphragms
, e. Cervical caps
ANSWER: b. Male condoms
Rationale: The correct and consistent use of male condoms is highly effective in preventing
the transmission of multiple STIs, including HIV, chlamydia, gonorrhea, and HPV. While
abstinence is the most effective method, for sexually active individuals, male condoms
provide the best protection against most STIs.
3. A 17-year-old G1P0 presents at a routine prenatal check. By last menstrual period
(LMP), her gestational age at this visit is 36 weeks, 2 days. A first-trimester ultrasound
confirmed her estimated delivery date. On exam, her fundus measures 31 centimeters.
Ultrasound imaging might reveal which of the following anatomical findings that would
explain this size?
a. Normal size, organs, and amniotic fluid for the gestational age
b. Uterine leiomyomata that restrict fetal development
c. Extra amniotic fluid
d. Renal agenesis of the fetus resulting in intrauterine growth retardation
e. Twin pregnancy
ANSWER: d. Renal agenesis of the fetus resulting in intrauterine growth retardation
Rationale: A fundal height that is more than 4 cm less than the gestational age (36 weeks vs.
31 cm) suggests intrauterine growth restriction or oligohydramnios. Fetal renal agenesis
leads to a lack of amniotic fluid production (oligohydramnios), which results in a small-for-
dates uterus. This condition is also associated with intrauterine growth restriction.
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
• ANSWER: b. This patient is more likely to find a fibroadenoma than a cancer on self-
examination.
• Rationale: In women aged 15-25 years, the most common palpable breast mass is a benign
fibroadenoma. While patients often detect breast cancers themselves, in this age group, the
vast majority of masses are benign.
Questions 4-100 (Additional Questions with Original Options)
5. A 21-year-old college student presents for her first annual exam. She has been
sexually active for 1 year and has had two partners. She is not aware of having had any
sexually transmitted diseases (STIs). She is using condoms for birth control and STI
prevention but admits to not always using them regularly. Her last menses was 2 weeks
ago. On speculum exam, an unusual appearance is noted, which is diagnosed as warts.
What is the best description for these lesions?
• a. Several shallow ulcers with a red base
• b. Translucent nodules
• c. Raised friable or lobed lesions
• d. Bright red, soft lesion arising from the cervical canal
• e. Strawberry cervix (small red granular spots or petechiae)
• ANSWER: c. Raised friable or lobed lesions
• Rationale: Warts, or condylomata acuminata, caused by HPV, appear as raised, fleshy, often
lobed or cauliflower-like lesions. They are typically friable (easily broken).
6. A 21-year-old college student presents to the student health clinic for a full physical
examination. He is generally healthy; however, he reports that he has had sexual
intercourse with multiple partners in the past couple of months. He noticed a small
, lesion on the shaft of his penis a few days ago. While performing the examination, he
unwillingly achieves an erection. How should the clinician proceed at this point?
• a. Stop the examination immediately.
• b. Have him return to see another provider.
• c. Explain this is a normal response and finish the examination.
• d. Tell him the examination cannot proceed until the erection subsides.
• e. Assume that he is malingering.
• ANSWER: c. Explain this is a normal response and finish the examination.
• Rationale: An erection during a genital examination is a normal physiological response and
not a sign of sexual arousal or malingering. The clinician should acknowledge this as a
normal occurrence to reassure the patient and continue the examination in a professional
manner.
7. A 22-year-old G1P0 presents for a routine prenatal visit at 32 weeks' gestational age.
Leopold maneuvers indicate that the fetus is in a transverse lie, with the fetal skull
palpable at the woman's left side. Fetal heart tones are heard at the uterine fundus with
a baseline rate of 140 and beat-to-beat variability noted. Which of the following steps is
appropriate to take at this time?
• a. Schedule a return visit in ~2 weeks.
• b. Admit the patient to labor and delivery for monitoring.
• c. Perform an external version.
• d. Plan for induction of labor at 36 weeks.
• e. Order a stat cesarean section.
• ANSWER: a. Schedule a return visit in ~2 weeks.
• Rationale: At 32 weeks' gestation, the fetus still has room to move, and a transverse lie is
not a concern that requires intervention. Leopold maneuvers are also less accurate before 36
weeks. Normal fetal heart tones and variability are reassuring. Routine prenatal care,
including biweekly visits between 30-36 weeks, is appropriate.
