NR 509 (ADVANCED PHYSICAL ASSESSMENT)
FINAL EXAM PRACTICE —
COMPREHENSIVE 2026/2027 UPDATE EXAM
QUESTIONS 100% WITH CORRECT ANSWERS AND
RATIOALES
Which technique is most appropriate when assessing the thyroid gland?
A. Percuss the thyroid while the patient swallows
B. Auscultate the thyroid before palpation
C. Inspect and palpate the thyroid while the patient swallows
D. Palpate the thyroid only with the patient supine
Correct Answer: C. Inspect and palpate the thyroid while the patient swallows
✓
Rationale: Having the patient swallow causes the thyroid gland to move
superiorly, making enlargement or nodules easier to identify. The examiner should
inspect the neck for asymmetry or visible enlargement and then palpate the
thyroid while the patient swallows. Auscultation may be useful when
hyperthyroidism is suspected because a bruit can occur with increased vascularity,
but it is not the primary technique for routine thyroid assessment.
During examination of the cranial nerves, which finding would suggest
dysfunction of cranial nerve VII?
A. Inability to shrug the shoulders
B. Loss of facial symmetry when smiling
C. Difficulty protruding the tongue
D. Loss of sensation over the forehead
Correct Answer: B. Loss of facial symmetry when smiling ✓
Page 1 of 72
, Rationale: Cranial nerve VII, the facial nerve, controls the muscles of facial
expression. Weakness may be demonstrated by an asymmetric smile, inability to
close one eye tightly, decreased forehead movement, or flattening of the
nasolabial fold. Shoulder shrugging primarily evaluates cranial nerve XI, tongue
movement evaluates cranial nerve XII, and facial sensation is primarily mediated
by cranial nerve V.
A patient reports chest pain that occurs predictably with exertion and resolves
after resting. How should the clinician initially characterize this symptom?
A. Pleuritic chest pain
B. Typical angina
C. Pericardial pain
D. Esophageal spasm
Correct Answer: B. Typical angina ✓
Rationale: Chest discomfort that is consistently precipitated by exertion or
emotional stress and relieved by rest is characteristic of stable or typical angina. A
careful history should still assess location, quality, radiation, severity, duration,
associated symptoms, and precipitating or relieving factors. Physical examination
and cardiovascular risk assessment are important because ischemic heart disease
can present atypically, especially in older adults and patients with certain
comorbidities.
Which percussion note is normally expected over healthy lung tissue?
A. Dullness
B. Flatness
C. Resonance
D. Hyperresonance
Correct Answer: C. Resonance ✓
Page 2 of 72
, Rationale: Normal lung tissue containing air produces a resonant percussion
note. Dullness may occur over areas of consolidation, pleural fluid, or other tissue
replacing normal aerated lung. Hyperresonance can occur when there is excessive
air, such as with emphysema or pneumothorax. Percussion is therefore useful for
identifying changes in the density of underlying thoracic structures.
When assessing a patient's jugular venous pressure, where should the head of
the bed generally be positioned?
A. Completely flat
B. Approximately 30–45 degrees
C. 90 degrees
D. Trendelenburg position
Correct Answer: B. Approximately 30–45 degrees ✓
Rationale: Jugular venous pressure is commonly assessed with the patient
positioned at approximately 30–45 degrees, adjusting the angle as necessary to
visualize the venous pulsation. The examiner estimates the vertical height of the
jugular venous column above the sternal angle. An elevated JVP can indicate
increased right-sided cardiac filling pressure and may occur with conditions such
as right-sided heart failure, fluid overload, or constrictive pericardial disease.
Which finding is most consistent with a peripheral arterial disorder?
A. Warm skin with bounding pulses
B. Bilateral dependent edema
C. Cool extremity with diminished pulses
D. Brown pigmentation around the ankles
Correct Answer: C. Cool extremity with diminished pulses ✓
Rationale: Peripheral arterial disease commonly produces diminished or
absent pulses, cool skin, delayed capillary refill, pallor with elevation, and
Page 3 of 72
, dependent rubor. Venous disease more commonly causes edema, warmth, and
skin changes such as hemosiderin deposition and brown pigmentation around the
ankles. Comparing both extremities is important because asymmetry may provide
valuable diagnostic information.
Which lymph nodes are most appropriately palpated when evaluating a patient
with a suspected scalp infection?
A. Epitrochlear nodes
B. Occipital nodes
C. Inguinal nodes
D. Supraclavicular nodes
Correct Answer: B. Occipital nodes ✓
Rationale: Occipital lymph nodes drain portions of the posterior scalp and
may enlarge in response to infections involving that region. Lymph node
assessment should follow the expected drainage patterns of the suspected
pathology. The clinician should evaluate size, consistency, mobility, tenderness,
and symmetry. Tender, soft, mobile nodes often suggest an acute inflammatory
process, whereas hard, fixed, or irregular nodes may require further investigation.
Which finding during a cardiovascular examination is most concerning for heart
failure?
A. Physiologic splitting of S2
B. S3 gallop in an older adult
C. Normal peripheral pulses
D. Soft systolic murmur
Correct Answer: B. S3 gallop in an older adult ✓
Rationale: An S3 may be physiologic in children, young adults, and sometimes
pregnant patients, but a new S3 in an older adult is generally concerning for
Page 4 of 72
FINAL EXAM PRACTICE —
COMPREHENSIVE 2026/2027 UPDATE EXAM
QUESTIONS 100% WITH CORRECT ANSWERS AND
RATIOALES
Which technique is most appropriate when assessing the thyroid gland?
A. Percuss the thyroid while the patient swallows
B. Auscultate the thyroid before palpation
C. Inspect and palpate the thyroid while the patient swallows
D. Palpate the thyroid only with the patient supine
Correct Answer: C. Inspect and palpate the thyroid while the patient swallows
✓
Rationale: Having the patient swallow causes the thyroid gland to move
superiorly, making enlargement or nodules easier to identify. The examiner should
inspect the neck for asymmetry or visible enlargement and then palpate the
thyroid while the patient swallows. Auscultation may be useful when
hyperthyroidism is suspected because a bruit can occur with increased vascularity,
but it is not the primary technique for routine thyroid assessment.
During examination of the cranial nerves, which finding would suggest
dysfunction of cranial nerve VII?
A. Inability to shrug the shoulders
B. Loss of facial symmetry when smiling
C. Difficulty protruding the tongue
D. Loss of sensation over the forehead
Correct Answer: B. Loss of facial symmetry when smiling ✓
Page 1 of 72
, Rationale: Cranial nerve VII, the facial nerve, controls the muscles of facial
expression. Weakness may be demonstrated by an asymmetric smile, inability to
close one eye tightly, decreased forehead movement, or flattening of the
nasolabial fold. Shoulder shrugging primarily evaluates cranial nerve XI, tongue
movement evaluates cranial nerve XII, and facial sensation is primarily mediated
by cranial nerve V.
A patient reports chest pain that occurs predictably with exertion and resolves
after resting. How should the clinician initially characterize this symptom?
A. Pleuritic chest pain
B. Typical angina
C. Pericardial pain
D. Esophageal spasm
Correct Answer: B. Typical angina ✓
Rationale: Chest discomfort that is consistently precipitated by exertion or
emotional stress and relieved by rest is characteristic of stable or typical angina. A
careful history should still assess location, quality, radiation, severity, duration,
associated symptoms, and precipitating or relieving factors. Physical examination
and cardiovascular risk assessment are important because ischemic heart disease
can present atypically, especially in older adults and patients with certain
comorbidities.
Which percussion note is normally expected over healthy lung tissue?
A. Dullness
B. Flatness
C. Resonance
D. Hyperresonance
Correct Answer: C. Resonance ✓
Page 2 of 72
, Rationale: Normal lung tissue containing air produces a resonant percussion
note. Dullness may occur over areas of consolidation, pleural fluid, or other tissue
replacing normal aerated lung. Hyperresonance can occur when there is excessive
air, such as with emphysema or pneumothorax. Percussion is therefore useful for
identifying changes in the density of underlying thoracic structures.
When assessing a patient's jugular venous pressure, where should the head of
the bed generally be positioned?
A. Completely flat
B. Approximately 30–45 degrees
C. 90 degrees
D. Trendelenburg position
Correct Answer: B. Approximately 30–45 degrees ✓
Rationale: Jugular venous pressure is commonly assessed with the patient
positioned at approximately 30–45 degrees, adjusting the angle as necessary to
visualize the venous pulsation. The examiner estimates the vertical height of the
jugular venous column above the sternal angle. An elevated JVP can indicate
increased right-sided cardiac filling pressure and may occur with conditions such
as right-sided heart failure, fluid overload, or constrictive pericardial disease.
Which finding is most consistent with a peripheral arterial disorder?
A. Warm skin with bounding pulses
B. Bilateral dependent edema
C. Cool extremity with diminished pulses
D. Brown pigmentation around the ankles
Correct Answer: C. Cool extremity with diminished pulses ✓
Rationale: Peripheral arterial disease commonly produces diminished or
absent pulses, cool skin, delayed capillary refill, pallor with elevation, and
Page 3 of 72
, dependent rubor. Venous disease more commonly causes edema, warmth, and
skin changes such as hemosiderin deposition and brown pigmentation around the
ankles. Comparing both extremities is important because asymmetry may provide
valuable diagnostic information.
Which lymph nodes are most appropriately palpated when evaluating a patient
with a suspected scalp infection?
A. Epitrochlear nodes
B. Occipital nodes
C. Inguinal nodes
D. Supraclavicular nodes
Correct Answer: B. Occipital nodes ✓
Rationale: Occipital lymph nodes drain portions of the posterior scalp and
may enlarge in response to infections involving that region. Lymph node
assessment should follow the expected drainage patterns of the suspected
pathology. The clinician should evaluate size, consistency, mobility, tenderness,
and symmetry. Tender, soft, mobile nodes often suggest an acute inflammatory
process, whereas hard, fixed, or irregular nodes may require further investigation.
Which finding during a cardiovascular examination is most concerning for heart
failure?
A. Physiologic splitting of S2
B. S3 gallop in an older adult
C. Normal peripheral pulses
D. Soft systolic murmur
Correct Answer: B. S3 gallop in an older adult ✓
Rationale: An S3 may be physiologic in children, young adults, and sometimes
pregnant patients, but a new S3 in an older adult is generally concerning for
Page 4 of 72
