NR509 WEEK 8 FINAL EXAM DUE COMPLETE
ACTUAL EXAM -200 NR-509 ADVANCED PHYSICAL
ASSESSMENT NR 509 MIDTERM AND FINALS
EXAMLIFY ONLINE PROCTORED EXAM.PDF - 140
Questions with Answers
Page 1
,Q1. A patient presents with acute-onset severe headache, nuchal rigidity, and
photophobia. Kernig's sign is positive. Which of the following additional findings
would most strongly support a diagnosis of subarachnoid hemorrhage rather than
bacterial meningitis?
A. Fever and leukocytosis
B. CT showing hyperdense material in the basal cisterns
C. CSF glucose < 40 mg/dL
D. Positive Brudzinski's sign
Correct Answer: B. CT showing hyperdense material in the basal cisterns
Rationale: Subarachnoid hemorrhage is characterized by blood in the subarachnoid
space, which appears hyperdense on non-contrast CT. Bacterial meningitis typically shows
CSF hypoglycorrhachia and inflammatory signs, not hyperdense cisterns.
Why Wrong:
A - Fever and leukocytosis are more indicative of infection, such as meningitis.
C - Low CSF glucose is a hallmark of bacterial meningitis, not SAH.
D - Brudzinski's sign is a meningeal irritation sign seen in both conditions, not
specific for SAH.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination and History Taking,
13th ed., Ch. 17
Q2. Which of the following best describes the mechanism by which the Valsalva
maneuver aids in the differentiation of systolic murmurs?
A. It increases left ventricular preload, augmenting murmurs of aortic stenosis.
B. It decreases venous return, reducing the intensity of most murmurs except
hypertrophic cardiomyopathy.
C. It increases intrathoracic pressure, causing a transient increase in cardiac output.
D. It selectively increases right-sided heart sounds, making pulmonary stenosis louder.
Correct Answer: B. It decreases venous return, reducing the intensity of most
murmurs except hypertrophic cardiomyopathy.
Rationale: The Valsalva maneuver increases intrathoracic pressure, reducing venous
return and thus preload. Most murmurs (e.g., aortic stenosis, mitral regurgitation) become
softer, but hypertrophic cardiomyopathy's murmur becomes louder due to decreased
preload exacerbating the outflow obstruction.
Why Wrong:
A - Valsalva decreases, not increases, preload.
C - Cardiac output transiently decreases during the strain phase.
D - Right-sided murmurs may transiently change but not specifically increase
pulmonary stenosis.
Page 2
,Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 15
Q3. A patient presents with unilateral leg swelling, pain, and a positive Homan's sign.
Which of the following findings on physical examination would most increase the
pretest probability of deep vein thrombosis?
A. Pitting edema confined to the affected limb
B. Palpable cord along the deep venous system
C. Dilated superficial collateral veins
D. Tenderness along the femoral triangle
Correct Answer: C. Dilated superficial collateral veins
Rationale: Dilated superficial collateral veins are a specific sign of DVT, reflecting
venous obstruction and alternative venous drainage. Homan's sign is not reliable. The
Wells score includes active cancer, paralysis, recent immobilization, and tenderness, but
collateral veins are more specific than edema or tenderness.
Why Wrong:
A - Pitting edema is common but nonspecific, occurring in many conditions.
B - A palpable cord is a late sign and not as specific as collateral veins.
D - Tenderness is subjective and low specificity.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 12
Q4. Which of the following electrocardiographic findings is most characteristic of
hyperkalemia and should prompt immediate intervention?
A. Prolonged PR interval
B. Peaked T waves
C. ST-segment depression
D. U waves
Correct Answer: B. Peaked T waves
Rationale: Peaked T waves are the earliest and most characteristic ECG change in
hyperkalemia, resulting from altered repolarization. This is a critical finding that can
progress to ventricular fibrillation. Other changes include widened QRS and loss of P
waves.
Why Wrong:
A - Prolonged PR interval can occur but is not specific or early.
C - ST depression is seen in ischemia and other conditions.
D - U waves are more typical of hypokalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 23
Q5. In a patient with chronic obstructive pulmonary disease, which of the following
physical examination findings is most indicative of the development of cor
Page 3
, pulmonale?
A. Barrel chest
B. Clubbing of the fingers
C. Prominent right ventricular heave
D. Prolonged expiratory phase
Correct Answer: C. Prominent right ventricular heave
Rationale: Cor pulmonale is right ventricular hypertrophy and failure due to pulmonary
hypertension. A right ventricular heave is a sign of right ventricular enlargement,
reflecting chronic pressure overload. Barrel chest and prolonged expiration are typical of
COPD but not specific to cor pulmonale.
Why Wrong:
A - Barrel chest is a structural change of hyperinflation.
B - Clubbing is not typical of COPD unless there is associated lung cancer.
D - Prolonged expiration indicates airflow obstruction.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 14
Q6. Which of the following is the most appropriate next step when a patient presents
with acute vision loss and the funduscopic examination reveals a pale retina with a
cherry-red spot at the macula?
A. Immediate referral to ophthalmology for possible central retinal artery occlusion
B. Order an MRI of the brain to rule out multiple sclerosis
C. Check blood glucose for suspected diabetic retinopathy
D. Begin oral corticosteroids for suspected optic neuritis
Correct Answer: A. Immediate referral to ophthalmology for possible central retinal
artery occlusion
Rationale: A pale retina with a cherry-red spot is classic for central retinal artery
occlusion, an emergency requiring immediate intervention. The cherry-red spot is the
normal choroidal circulation at the macula contrasting with the pale ischemic retina.
Why Wrong:
B - MRI is not the priority; CRAO is a vascular emergency.
C - Diabetic retinopathy does not present with cherry-red spot.
D - Optic neuritis typically causes pain with eye movement and no cherry-red spot.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 9
Q7. A patient presents with a palpable purpura on the lower extremities, abdominal
pain, and arthralgias. Which of the following findings would best confirm the
suspected diagnosis of IgA vasculitis?
A. Positive antinuclear antibody
Page 4
ACTUAL EXAM -200 NR-509 ADVANCED PHYSICAL
ASSESSMENT NR 509 MIDTERM AND FINALS
EXAMLIFY ONLINE PROCTORED EXAM.PDF - 140
Questions with Answers
Page 1
,Q1. A patient presents with acute-onset severe headache, nuchal rigidity, and
photophobia. Kernig's sign is positive. Which of the following additional findings
would most strongly support a diagnosis of subarachnoid hemorrhage rather than
bacterial meningitis?
A. Fever and leukocytosis
B. CT showing hyperdense material in the basal cisterns
C. CSF glucose < 40 mg/dL
D. Positive Brudzinski's sign
Correct Answer: B. CT showing hyperdense material in the basal cisterns
Rationale: Subarachnoid hemorrhage is characterized by blood in the subarachnoid
space, which appears hyperdense on non-contrast CT. Bacterial meningitis typically shows
CSF hypoglycorrhachia and inflammatory signs, not hyperdense cisterns.
Why Wrong:
A - Fever and leukocytosis are more indicative of infection, such as meningitis.
C - Low CSF glucose is a hallmark of bacterial meningitis, not SAH.
D - Brudzinski's sign is a meningeal irritation sign seen in both conditions, not
specific for SAH.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination and History Taking,
13th ed., Ch. 17
Q2. Which of the following best describes the mechanism by which the Valsalva
maneuver aids in the differentiation of systolic murmurs?
A. It increases left ventricular preload, augmenting murmurs of aortic stenosis.
B. It decreases venous return, reducing the intensity of most murmurs except
hypertrophic cardiomyopathy.
C. It increases intrathoracic pressure, causing a transient increase in cardiac output.
D. It selectively increases right-sided heart sounds, making pulmonary stenosis louder.
Correct Answer: B. It decreases venous return, reducing the intensity of most
murmurs except hypertrophic cardiomyopathy.
Rationale: The Valsalva maneuver increases intrathoracic pressure, reducing venous
return and thus preload. Most murmurs (e.g., aortic stenosis, mitral regurgitation) become
softer, but hypertrophic cardiomyopathy's murmur becomes louder due to decreased
preload exacerbating the outflow obstruction.
Why Wrong:
A - Valsalva decreases, not increases, preload.
C - Cardiac output transiently decreases during the strain phase.
D - Right-sided murmurs may transiently change but not specifically increase
pulmonary stenosis.
Page 2
,Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 15
Q3. A patient presents with unilateral leg swelling, pain, and a positive Homan's sign.
Which of the following findings on physical examination would most increase the
pretest probability of deep vein thrombosis?
A. Pitting edema confined to the affected limb
B. Palpable cord along the deep venous system
C. Dilated superficial collateral veins
D. Tenderness along the femoral triangle
Correct Answer: C. Dilated superficial collateral veins
Rationale: Dilated superficial collateral veins are a specific sign of DVT, reflecting
venous obstruction and alternative venous drainage. Homan's sign is not reliable. The
Wells score includes active cancer, paralysis, recent immobilization, and tenderness, but
collateral veins are more specific than edema or tenderness.
Why Wrong:
A - Pitting edema is common but nonspecific, occurring in many conditions.
B - A palpable cord is a late sign and not as specific as collateral veins.
D - Tenderness is subjective and low specificity.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 12
Q4. Which of the following electrocardiographic findings is most characteristic of
hyperkalemia and should prompt immediate intervention?
A. Prolonged PR interval
B. Peaked T waves
C. ST-segment depression
D. U waves
Correct Answer: B. Peaked T waves
Rationale: Peaked T waves are the earliest and most characteristic ECG change in
hyperkalemia, resulting from altered repolarization. This is a critical finding that can
progress to ventricular fibrillation. Other changes include widened QRS and loss of P
waves.
Why Wrong:
A - Prolonged PR interval can occur but is not specific or early.
C - ST depression is seen in ischemia and other conditions.
D - U waves are more typical of hypokalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 23
Q5. In a patient with chronic obstructive pulmonary disease, which of the following
physical examination findings is most indicative of the development of cor
Page 3
, pulmonale?
A. Barrel chest
B. Clubbing of the fingers
C. Prominent right ventricular heave
D. Prolonged expiratory phase
Correct Answer: C. Prominent right ventricular heave
Rationale: Cor pulmonale is right ventricular hypertrophy and failure due to pulmonary
hypertension. A right ventricular heave is a sign of right ventricular enlargement,
reflecting chronic pressure overload. Barrel chest and prolonged expiration are typical of
COPD but not specific to cor pulmonale.
Why Wrong:
A - Barrel chest is a structural change of hyperinflation.
B - Clubbing is not typical of COPD unless there is associated lung cancer.
D - Prolonged expiration indicates airflow obstruction.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 14
Q6. Which of the following is the most appropriate next step when a patient presents
with acute vision loss and the funduscopic examination reveals a pale retina with a
cherry-red spot at the macula?
A. Immediate referral to ophthalmology for possible central retinal artery occlusion
B. Order an MRI of the brain to rule out multiple sclerosis
C. Check blood glucose for suspected diabetic retinopathy
D. Begin oral corticosteroids for suspected optic neuritis
Correct Answer: A. Immediate referral to ophthalmology for possible central retinal
artery occlusion
Rationale: A pale retina with a cherry-red spot is classic for central retinal artery
occlusion, an emergency requiring immediate intervention. The cherry-red spot is the
normal choroidal circulation at the macula contrasting with the pale ischemic retina.
Why Wrong:
B - MRI is not the priority; CRAO is a vascular emergency.
C - Diabetic retinopathy does not present with cherry-red spot.
D - Optic neuritis typically causes pain with eye movement and no cherry-red spot.
Reference: Bickley, L. (2024). Bates' Guide to Physical Examination, 13th ed., Ch. 9
Q7. A patient presents with a palpable purpura on the lower extremities, abdominal
pain, and arthralgias. Which of the following findings would best confirm the
suspected diagnosis of IgA vasculitis?
A. Positive antinuclear antibody
Page 4
