NR 509 Final Exam / NR509 Final Exam (New 2022):
Advanced Physical Assessment : Chamberlain
College of Nursing (Complete Answers- 100%
Score)
1. A 58-year-old male presents with chest pressure radiating to the jaw and left arm. He is
diaphoretic and nauseated. What is the priority action?
A) Obtain a detailed cardiac history
B) Activate emergency medical services (EMS)
C) Administer sublingual nitroglycerin
D) Order a stat electrocardiogram
Correct Answer: B
Rationale: Acute chest pain with radiation, diaphoresis, and nausea is concerning for acute
coronary syndrome. Immediate activation of EMS is the priority to ensure rapid transport to
emergency care. In-office interventions should not delay EMS.
2. When performing a comprehensive health history, which component is typically assessed
immediately after the chief complaint?
A) Family history
B) History of present illness (HPI)
C) Past medical history
D) Review of systems
Correct Answer: B
Rationale: The HPI expands on the chief complaint using the OLDCARTS framework. It
guides the remainder of the history and physical exam.
3. A patient presents with pleuritic chest pain. The examiner hears a friction-like sound that
persists when the patient briefly holds their breath. Which interpretation is most appropriate?
A) The finding is most consistent with a pleural friction rub
B) The finding is most consistent with a pericardial friction rub
,C) The sound represents bronchovesicular breath sounds
D) The sound represents an S3 gallop
Correct Answer: B
Rationale: A pericardial friction rub may persist when respiration is suspended, helping
distinguish it from a pleural friction rub.
4. Which approach produces the most clinically useful medication history?
A) Record prescription drug names only and omit dose and frequency
B) Exclude supplements because they cannot interact with medications
C) Record prescription drugs, nonprescription products, vitamins, herbals, doses, schedules,
adherence, allergies, and reaction details
D) List allergies without describing the reaction
Correct Answer: C
Rationale: Accurate reconciliation includes every substance the patient takes and how it is
taken. Dose, timing, adherence, and reaction details reveal interaction risk, therapeutic gaps,
and intolerance versus true allergy.
5. A patient reports that a parent had coronary artery disease. Which follow-up information is
most important for cardiovascular risk interpretation?
A) The affected relative's degree of relation and age when disease began
B) The relative's favorite food
C) Whether the relative preferred morning appointments
D) The color of the relative's home
Correct Answer: A
Rationale: Premature disease in a first-degree relative carries more risk significance than
disease beginning late in a distant relative. Recording diagnosis, relationship, and age at onset
makes family history clinically interpretable.
6. During an initial adult visit, which opening question is most likely to identify the patient's
agenda without prematurely narrowing the history?
A) What concerns brought you in today?
B) Is the only concern your blood pressure?
,C) Your chest pain is from stress, correct?
D) You do not have any serious symptoms, do you?
Correct Answer: A
Rationale: An open invitation allows the patient to describe priorities in personal words and
reduces clinician anchoring. Focused questions can follow after the full agenda and urgent
symptoms are identified.
7. A 45-year-old patient reports episodic palpitations. Which component of the history is most
critical to assess?
A) Family history of diabetes
B) Use of caffeine, alcohol, or stimulants
C) Previous surgical history
D) Immunization status
Correct Answer: B
Rationale: Palpitations are commonly triggered by stimulants (caffeine, nicotine,
decongestants), alcohol, and illicit drugs (cocaine, methamphetamine). Identifying triggers
guides management.
8. A patient reports a 10-pound unintentional weight loss over 2 months. Which follow-up
question is most important?
A) "Have you been dieting?"
B) "Do you have a fever, night sweats, or fatigue?"
C) "Did you change your exercise routine?"
D) "Are you taking any herbal supplements?"
Correct Answer: B
Rationale: Unintentional weight loss plus constitutional symptoms (fever, night sweats,
fatigue) raises concern for malignancy, chronic infection (TB, HIV), or inflammatory disease
(rheumatologic).
9. Which of the following is included in the history of present illness (HPI)?
A) Childhood illnesses
B) Onset, setting, and symptoms prompting the visit
, C) Past surgical history
D) Family medical history
Correct Answer: B
Rationale: The HPI details the onset, duration, and characteristics of symptoms leading to
the visit. Past surgical history is part of PMH; family history is separate.
10. A patient reports intermittent epigastric discomfort. Which question best clarifies the onset
component of symptom analysis?
A) "Do you believe all abdominal pain is dangerous?"
B) "What were you doing when it began, and did it start suddenly or gradually?"
C) "Which pharmacy fills your prescriptions?"
D) "How many siblings do you have?"
Correct Answer: B
Rationale: Onset includes the circumstances, speed, and first occurrence of a symptom.
Establishing chronology helps distinguish abrupt vascular or obstructive events from gradually
evolving inflammatory or functional processes.
11. Which component is included in a health history under adult illnesses?
A) Childhood vaccinations only
B) Medical, surgical, OB/GYN, psychiatric
C) Family history of allergies
D) Current medications only
Correct Answer: B
Rationale: Adult illnesses in the health history include medical, surgical, OB/GYN, and
psychiatric conditions.
12. A grandmother accompanies her 9-year-old granddaughter during a routine physical
examination. She asks privately if her granddaughter has started puberty yet. The NP notes
asymmetric projection of the areola and nipple of the right chest to form a secondary mound
above the level of the breast. The left breast is underdeveloped. These findings are consistent
with which Tanner Stage?
Advanced Physical Assessment : Chamberlain
College of Nursing (Complete Answers- 100%
Score)
1. A 58-year-old male presents with chest pressure radiating to the jaw and left arm. He is
diaphoretic and nauseated. What is the priority action?
A) Obtain a detailed cardiac history
B) Activate emergency medical services (EMS)
C) Administer sublingual nitroglycerin
D) Order a stat electrocardiogram
Correct Answer: B
Rationale: Acute chest pain with radiation, diaphoresis, and nausea is concerning for acute
coronary syndrome. Immediate activation of EMS is the priority to ensure rapid transport to
emergency care. In-office interventions should not delay EMS.
2. When performing a comprehensive health history, which component is typically assessed
immediately after the chief complaint?
A) Family history
B) History of present illness (HPI)
C) Past medical history
D) Review of systems
Correct Answer: B
Rationale: The HPI expands on the chief complaint using the OLDCARTS framework. It
guides the remainder of the history and physical exam.
3. A patient presents with pleuritic chest pain. The examiner hears a friction-like sound that
persists when the patient briefly holds their breath. Which interpretation is most appropriate?
A) The finding is most consistent with a pleural friction rub
B) The finding is most consistent with a pericardial friction rub
,C) The sound represents bronchovesicular breath sounds
D) The sound represents an S3 gallop
Correct Answer: B
Rationale: A pericardial friction rub may persist when respiration is suspended, helping
distinguish it from a pleural friction rub.
4. Which approach produces the most clinically useful medication history?
A) Record prescription drug names only and omit dose and frequency
B) Exclude supplements because they cannot interact with medications
C) Record prescription drugs, nonprescription products, vitamins, herbals, doses, schedules,
adherence, allergies, and reaction details
D) List allergies without describing the reaction
Correct Answer: C
Rationale: Accurate reconciliation includes every substance the patient takes and how it is
taken. Dose, timing, adherence, and reaction details reveal interaction risk, therapeutic gaps,
and intolerance versus true allergy.
5. A patient reports that a parent had coronary artery disease. Which follow-up information is
most important for cardiovascular risk interpretation?
A) The affected relative's degree of relation and age when disease began
B) The relative's favorite food
C) Whether the relative preferred morning appointments
D) The color of the relative's home
Correct Answer: A
Rationale: Premature disease in a first-degree relative carries more risk significance than
disease beginning late in a distant relative. Recording diagnosis, relationship, and age at onset
makes family history clinically interpretable.
6. During an initial adult visit, which opening question is most likely to identify the patient's
agenda without prematurely narrowing the history?
A) What concerns brought you in today?
B) Is the only concern your blood pressure?
,C) Your chest pain is from stress, correct?
D) You do not have any serious symptoms, do you?
Correct Answer: A
Rationale: An open invitation allows the patient to describe priorities in personal words and
reduces clinician anchoring. Focused questions can follow after the full agenda and urgent
symptoms are identified.
7. A 45-year-old patient reports episodic palpitations. Which component of the history is most
critical to assess?
A) Family history of diabetes
B) Use of caffeine, alcohol, or stimulants
C) Previous surgical history
D) Immunization status
Correct Answer: B
Rationale: Palpitations are commonly triggered by stimulants (caffeine, nicotine,
decongestants), alcohol, and illicit drugs (cocaine, methamphetamine). Identifying triggers
guides management.
8. A patient reports a 10-pound unintentional weight loss over 2 months. Which follow-up
question is most important?
A) "Have you been dieting?"
B) "Do you have a fever, night sweats, or fatigue?"
C) "Did you change your exercise routine?"
D) "Are you taking any herbal supplements?"
Correct Answer: B
Rationale: Unintentional weight loss plus constitutional symptoms (fever, night sweats,
fatigue) raises concern for malignancy, chronic infection (TB, HIV), or inflammatory disease
(rheumatologic).
9. Which of the following is included in the history of present illness (HPI)?
A) Childhood illnesses
B) Onset, setting, and symptoms prompting the visit
, C) Past surgical history
D) Family medical history
Correct Answer: B
Rationale: The HPI details the onset, duration, and characteristics of symptoms leading to
the visit. Past surgical history is part of PMH; family history is separate.
10. A patient reports intermittent epigastric discomfort. Which question best clarifies the onset
component of symptom analysis?
A) "Do you believe all abdominal pain is dangerous?"
B) "What were you doing when it began, and did it start suddenly or gradually?"
C) "Which pharmacy fills your prescriptions?"
D) "How many siblings do you have?"
Correct Answer: B
Rationale: Onset includes the circumstances, speed, and first occurrence of a symptom.
Establishing chronology helps distinguish abrupt vascular or obstructive events from gradually
evolving inflammatory or functional processes.
11. Which component is included in a health history under adult illnesses?
A) Childhood vaccinations only
B) Medical, surgical, OB/GYN, psychiatric
C) Family history of allergies
D) Current medications only
Correct Answer: B
Rationale: Adult illnesses in the health history include medical, surgical, OB/GYN, and
psychiatric conditions.
12. A grandmother accompanies her 9-year-old granddaughter during a routine physical
examination. She asks privately if her granddaughter has started puberty yet. The NP notes
asymmetric projection of the areola and nipple of the right chest to form a secondary mound
above the level of the breast. The left breast is underdeveloped. These findings are consistent
with which Tanner Stage?
