NR 509 Final Exam / NR509 Final Exam (New
2026/2027): Advanced Physical Assessment:
Chamberlain College of Nursing (100% Verified &
Correct Answers)
Which of the following occurs in respiratory distress?
A) Speaking in sentences of 10-20 words
B) Skin between the ribs moves inward with inspiration
C) Neck muscles are relaxed
D) Patient torso leans posteriorly - Correct AnswerB) Skin between the ribs moves inward with
inspiration
This description is consistent with retractions that occur with respiratory distress. Other
features include speaking in short sentences, use of accessory muscles, leaning forward
to gain mechanical advantage for the diaphragm, and pursed lip breathing, in which the patient
exhales against his lips, which are pressed together.
Which of the following is consistent with good percussion technique?
A) Allow all of the fingers to touch the chest while performing percussion.
B) Maintain a stiff wrist and hand.
C) Leave the plexor finger on the pleximeter after each strike.
D) Strike the pleximeter over the distal interphalangeal joint. - Correct AnswerD) Strike the
pleximeter over the distal interphalangeal joint
Page 1 of 127
,Percussion takes practice to master. Most struggle initially with keeping the wrist and hand
relaxed. Other challenges include removing the plexor quickly and keeping the other
fingers off the chest wall.
Which of the following percussion notes would you obtain over the gastric bubble?
A) Resonance
B) Tympany
C) Hyperresonance
D) Flatness - Correct AnswerB) Tympany
The gastric bubble produces one of the longest percussion notes. A patient with
COPD may have hyperresonance over his chest, while a normal person would have resonance.
Dullness is heard over a normal liver, and flatness is heard if one percusses a large muscle.
Which of the following conditions would produce a hyperresonant percussion note?
A) Large pneumothorax
B) Lobar pneumonia
C) Pleural effusion
D) Empyema - Correct AnswerA) Large pneumothorax
There is a great deal of free air in the chest with a large pneumothorax, which
produces a hyperresonant note. The other three conditions produce dullness by dampening the
percussion note with fluid.
Page 2 of 127
,Which lung sound possesses the characteristics of being louder and higher in pitch, with a short
silence between inspiration and expiration and with expiration being longer than inspiration?
A) Bronchovesicular
B) Vesicular
C) Bronchial
D) Tracheal - Correct AnswerC) Bronchial
A patient complains of shortness of breath for the past few days. On examination, you note late
inspiratory crackles in the lower third of the chest that were not present a week ago.
What is the most likely explanation for these?
A) Asthma
B) COPD
C) Bronchiectasis
D) Heart failure - Correct AnswerD) Heart failure
The timing of crackles within inspiration provides important clues. These late
inspiratory crackles that appeared suddenly would be most consistent with heart failure. COPD
and asthma usually produce early inspiratory crackles. Bronchiectasis, as seen in cystic
fibrosis, classically produces mid-inspiratory crackles, but this is not always reliable.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
A) Bronchitis
B) Simple asthma
Page 3 of 127
, C) Cystic fibrosis
D) Heart failure - Correct AnswerA) Bronchitis
Adventitious sounds that clear with cough are usually consistent with bronchitis or
atelectasis. The other conditions would not be associated with findings that cleared with a
cough.
A patient with longstanding COPD was told by another practitioner that his liver was enlarged
and this needed to be assessed. Which of the following would be reasonable to do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver - Correct AnswerB) Measure the span of the liver
In this patient, measuring the span of the liver saved the patient an involved workup, because it
was normal. His history of COPD is consistent with flattening of the diaphragms, which pushed
the liver edge down while the actual size of the liver remained the same. Percussing the lower
border of the liver alone caused this referral, because it was assumed that
the liver was enlarged.
You are at your family reunion playing football when your uncle takes a hit to his right
lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very
remote area. What would your next step be?
A) Call a medevac helicopter
B) Drive him to the city (4 hours away)
Page 4 of 127
2026/2027): Advanced Physical Assessment:
Chamberlain College of Nursing (100% Verified &
Correct Answers)
Which of the following occurs in respiratory distress?
A) Speaking in sentences of 10-20 words
B) Skin between the ribs moves inward with inspiration
C) Neck muscles are relaxed
D) Patient torso leans posteriorly - Correct AnswerB) Skin between the ribs moves inward with
inspiration
This description is consistent with retractions that occur with respiratory distress. Other
features include speaking in short sentences, use of accessory muscles, leaning forward
to gain mechanical advantage for the diaphragm, and pursed lip breathing, in which the patient
exhales against his lips, which are pressed together.
Which of the following is consistent with good percussion technique?
A) Allow all of the fingers to touch the chest while performing percussion.
B) Maintain a stiff wrist and hand.
C) Leave the plexor finger on the pleximeter after each strike.
D) Strike the pleximeter over the distal interphalangeal joint. - Correct AnswerD) Strike the
pleximeter over the distal interphalangeal joint
Page 1 of 127
,Percussion takes practice to master. Most struggle initially with keeping the wrist and hand
relaxed. Other challenges include removing the plexor quickly and keeping the other
fingers off the chest wall.
Which of the following percussion notes would you obtain over the gastric bubble?
A) Resonance
B) Tympany
C) Hyperresonance
D) Flatness - Correct AnswerB) Tympany
The gastric bubble produces one of the longest percussion notes. A patient with
COPD may have hyperresonance over his chest, while a normal person would have resonance.
Dullness is heard over a normal liver, and flatness is heard if one percusses a large muscle.
Which of the following conditions would produce a hyperresonant percussion note?
A) Large pneumothorax
B) Lobar pneumonia
C) Pleural effusion
D) Empyema - Correct AnswerA) Large pneumothorax
There is a great deal of free air in the chest with a large pneumothorax, which
produces a hyperresonant note. The other three conditions produce dullness by dampening the
percussion note with fluid.
Page 2 of 127
,Which lung sound possesses the characteristics of being louder and higher in pitch, with a short
silence between inspiration and expiration and with expiration being longer than inspiration?
A) Bronchovesicular
B) Vesicular
C) Bronchial
D) Tracheal - Correct AnswerC) Bronchial
A patient complains of shortness of breath for the past few days. On examination, you note late
inspiratory crackles in the lower third of the chest that were not present a week ago.
What is the most likely explanation for these?
A) Asthma
B) COPD
C) Bronchiectasis
D) Heart failure - Correct AnswerD) Heart failure
The timing of crackles within inspiration provides important clues. These late
inspiratory crackles that appeared suddenly would be most consistent with heart failure. COPD
and asthma usually produce early inspiratory crackles. Bronchiectasis, as seen in cystic
fibrosis, classically produces mid-inspiratory crackles, but this is not always reliable.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
A) Bronchitis
B) Simple asthma
Page 3 of 127
, C) Cystic fibrosis
D) Heart failure - Correct AnswerA) Bronchitis
Adventitious sounds that clear with cough are usually consistent with bronchitis or
atelectasis. The other conditions would not be associated with findings that cleared with a
cough.
A patient with longstanding COPD was told by another practitioner that his liver was enlarged
and this needed to be assessed. Which of the following would be reasonable to do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver - Correct AnswerB) Measure the span of the liver
In this patient, measuring the span of the liver saved the patient an involved workup, because it
was normal. His history of COPD is consistent with flattening of the diaphragms, which pushed
the liver edge down while the actual size of the liver remained the same. Percussing the lower
border of the liver alone caused this referral, because it was assumed that
the liver was enlarged.
You are at your family reunion playing football when your uncle takes a hit to his right
lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a very
remote area. What would your next step be?
A) Call a medevac helicopter
B) Drive him to the city (4 hours away)
Page 4 of 127
