NR 509 MIDTERM EXAM ADVANCED
PHYSICAL ASSESSMENT EXAMINATION
TEST 2026 FULL SOLVED QUESTIONS
AND SOLUTIONS
1. A 55-year-old patient reports "I feel like the room is spinning." This symptom
is best documented as:
A) Presyncope
B) Disequilibrium
C) Vertigo
D) Lightheadedness
Answer: C) Vertigo
,rational,: Vertigo is the illusion of rotational movement, often described as the
room spinning. It indicates vestibular dysfunction (peripheral or central).
Presyncope is a feeling of impending faint, disequilibrium is unsteadiness, and
lightheadedness is a vague nonspecific sensation.
2. The first step in the clinical reasoning process is:
A) Generating hypotheses
B) Gathering data
C) Evaluating outcomes
D) Formulating a plan
Answer: B) Gathering data
,rational,: Clinical reasoning begins with collecting subjective and objective data
(history and physical exam) before analyzing, hypothesizing, planning, and
evaluating.
,3. Which part of the stethoscope is best for hearing high-pitched sounds such
as breath sounds and S1/S2?
A) Bell
B) Diaphragm
C) Tubing
D) Earpieces
Answer: B) Diaphragm
,rational,: The diaphragm is used for high-frequency sounds (breath, bowel, normal
heart sounds). The bell is for low-frequency sounds (bruits, S3, S4, murmurs of
mitral stenosis).
4. A patient presents with pallor, diaphoresis, and cool extremities. These
findings are most consistent with:
A) Increased sympathetic nervous system activity
B) Parasympathetic dominance
C) Anaphylaxis
D) Hyperthyroidism
Answer: A) Increased sympathetic nervous system activity
,rational,: Pallor, diaphoresis, and cool skin result from peripheral vasoconstriction
and sweating triggered by sympathetic activation (e.g., shock, pain, anxiety).
5. When examining the optic disc with an ophthalmoscope, the cup-to-disc
ratio is normally:
A) 0.8
B) 0.5 or less
C) 1.0
D) 0.9
Answer: B) 0.5 or less
,rational,: The physiologic cup occupies less than half the disc diameter; a ratio
>0.5 may indicate glaucomatous cupping.
,6. A patient complains of double vision that resolves when one eye is covered.
This is:
A) Monocular diplopia
B) Binocular diplopia
C) Strabismus
D) Amblyopia
Answer: B) Binocular diplopia
,rational,: Binocular diplopia occurs when eyes are misaligned; covering one eye
eliminates the double image. Monocular diplopia persists with one eye covered and
suggests ocular pathology (cornea, lens).
7. To test cranial nerve XI (spinal accessory), the examiner asks the patient to:
A) Stick out the tongue
B) Smile and show teeth
C) Shrug shoulders and turn head against resistance
D) Follow a moving object with eyes
Answer: C) Shrug shoulders and turn head against resistance
,rational,: CN XI innervates the sternocleidomastoid and trapezius muscles, tested
by shoulder shrug and head rotation against resistance.
8. A thrill palpated over the precordium is:
A) A normal finding in thin individuals
B) A palpable murmur, always abnormal
C) Best felt with the bell
D) Associated with ventricular dilation
Answer: B) A palpable murmur, always abnormal
,rational,: A thrill is a vibratory sensation caused by turbulent blood flow through a
diseased valve or septal defect; it corresponds to a loud murmur (grade ≥4/6).
, 9. The correct order for abdominal assessment is:
A) Inspection, percussion, palpation, auscultation
B) Inspection, auscultation, percussion, palpation
C) Palpation, auscultation, inspection, percussion
D) Auscultation, palpation, percussion, inspection
Answer: B) Inspection, auscultation, percussion, palpation
,rational,: Auscultation follows inspection because palpation and percussion may
alter bowel sounds. The typical sequence is modified for the abdomen.
10. A positive Murphy’s sign is elicited by:
A) Deep palpation in the right upper quadrant during inspiration
B) Percussion over the costovertebral angle
C) Rebound tenderness in the left lower quadrant
D) Palpating the epigastric area while the patient lifts their head
Answer: A) Deep palpation in the right upper quadrant during inspiration
,rational,: Murphy’s sign (pain and inspiratory arrest when the examiner’s fingers
hook under the right costal margin) is suggestive of acute cholecystitis.
11. Which lymph node group is palpated at the angle of the mandible?
A) Preauricular
B) Submental
C) Tonsillar
D) Posterior auricular
Answer: C) Tonsillar
,rational,: Tonsillar nodes are at the angle of the mandible. Submental nodes are
midline behind the chin, preauricular in front of the ear, and posterior auricular over
the mastoid.
12. Bronchovesicular breath sounds heard over the peripheral lung fields
would indicate:
PHYSICAL ASSESSMENT EXAMINATION
TEST 2026 FULL SOLVED QUESTIONS
AND SOLUTIONS
1. A 55-year-old patient reports "I feel like the room is spinning." This symptom
is best documented as:
A) Presyncope
B) Disequilibrium
C) Vertigo
D) Lightheadedness
Answer: C) Vertigo
,rational,: Vertigo is the illusion of rotational movement, often described as the
room spinning. It indicates vestibular dysfunction (peripheral or central).
Presyncope is a feeling of impending faint, disequilibrium is unsteadiness, and
lightheadedness is a vague nonspecific sensation.
2. The first step in the clinical reasoning process is:
A) Generating hypotheses
B) Gathering data
C) Evaluating outcomes
D) Formulating a plan
Answer: B) Gathering data
,rational,: Clinical reasoning begins with collecting subjective and objective data
(history and physical exam) before analyzing, hypothesizing, planning, and
evaluating.
,3. Which part of the stethoscope is best for hearing high-pitched sounds such
as breath sounds and S1/S2?
A) Bell
B) Diaphragm
C) Tubing
D) Earpieces
Answer: B) Diaphragm
,rational,: The diaphragm is used for high-frequency sounds (breath, bowel, normal
heart sounds). The bell is for low-frequency sounds (bruits, S3, S4, murmurs of
mitral stenosis).
4. A patient presents with pallor, diaphoresis, and cool extremities. These
findings are most consistent with:
A) Increased sympathetic nervous system activity
B) Parasympathetic dominance
C) Anaphylaxis
D) Hyperthyroidism
Answer: A) Increased sympathetic nervous system activity
,rational,: Pallor, diaphoresis, and cool skin result from peripheral vasoconstriction
and sweating triggered by sympathetic activation (e.g., shock, pain, anxiety).
5. When examining the optic disc with an ophthalmoscope, the cup-to-disc
ratio is normally:
A) 0.8
B) 0.5 or less
C) 1.0
D) 0.9
Answer: B) 0.5 or less
,rational,: The physiologic cup occupies less than half the disc diameter; a ratio
>0.5 may indicate glaucomatous cupping.
,6. A patient complains of double vision that resolves when one eye is covered.
This is:
A) Monocular diplopia
B) Binocular diplopia
C) Strabismus
D) Amblyopia
Answer: B) Binocular diplopia
,rational,: Binocular diplopia occurs when eyes are misaligned; covering one eye
eliminates the double image. Monocular diplopia persists with one eye covered and
suggests ocular pathology (cornea, lens).
7. To test cranial nerve XI (spinal accessory), the examiner asks the patient to:
A) Stick out the tongue
B) Smile and show teeth
C) Shrug shoulders and turn head against resistance
D) Follow a moving object with eyes
Answer: C) Shrug shoulders and turn head against resistance
,rational,: CN XI innervates the sternocleidomastoid and trapezius muscles, tested
by shoulder shrug and head rotation against resistance.
8. A thrill palpated over the precordium is:
A) A normal finding in thin individuals
B) A palpable murmur, always abnormal
C) Best felt with the bell
D) Associated with ventricular dilation
Answer: B) A palpable murmur, always abnormal
,rational,: A thrill is a vibratory sensation caused by turbulent blood flow through a
diseased valve or septal defect; it corresponds to a loud murmur (grade ≥4/6).
, 9. The correct order for abdominal assessment is:
A) Inspection, percussion, palpation, auscultation
B) Inspection, auscultation, percussion, palpation
C) Palpation, auscultation, inspection, percussion
D) Auscultation, palpation, percussion, inspection
Answer: B) Inspection, auscultation, percussion, palpation
,rational,: Auscultation follows inspection because palpation and percussion may
alter bowel sounds. The typical sequence is modified for the abdomen.
10. A positive Murphy’s sign is elicited by:
A) Deep palpation in the right upper quadrant during inspiration
B) Percussion over the costovertebral angle
C) Rebound tenderness in the left lower quadrant
D) Palpating the epigastric area while the patient lifts their head
Answer: A) Deep palpation in the right upper quadrant during inspiration
,rational,: Murphy’s sign (pain and inspiratory arrest when the examiner’s fingers
hook under the right costal margin) is suggestive of acute cholecystitis.
11. Which lymph node group is palpated at the angle of the mandible?
A) Preauricular
B) Submental
C) Tonsillar
D) Posterior auricular
Answer: C) Tonsillar
,rational,: Tonsillar nodes are at the angle of the mandible. Submental nodes are
midline behind the chin, preauricular in front of the ear, and posterior auricular over
the mastoid.
12. Bronchovesicular breath sounds heard over the peripheral lung fields
would indicate:
