NR 509 Final Exam / NR509 Final Exam (New
2021): Advanced Physical Assessment
:Chamberlain College
1. A 35-year-old female with a history of migraines presents with worsening symptoms over the
past few weeks. She reports waking at night with headaches and nausea. Her only medication is
oral contraceptive pills. Which action by the NP is the best next step?
A. Order an MRI of the brain immediately
B. Discontinue the oral contraceptive pills
C. Take a further history and perform a careful neurological exam
D. Prescribe a stronger migraine medication
Rationale: Worsening headaches that wake the patient at night warrant thorough
investigation. OCPs increase cerebrovascular event risk, so a careful neurological exam is
essential to rule out serious pathology. Ordering MRI without assessment is premature;
discontinuing OCPs may be considered later but is not the first step.
2. Primary prevention is defined as which of the following?
A. Interventions designed to prevent disease
B. Early detection and treatment of disease
C. Rehabilitation and restoration of function
D. Screening for early signs of disease
Rationale: Primary prevention includes immunizations and health education to prevent
disease. Secondary prevention involves screening and early detection. Tertiary prevention
focuses on rehabilitation.
3. A grandmother asks privately if her 9-year-old granddaughter has started puberty. The NP
notes asymmetric projection of the areola and nipple of the right chest forming a secondary
mound above the breast. The left breast is underdeveloped. These findings are consistent with
which Tanner Stage?
A. I
B. II
C. III
D. IV
, Rationale: Tanner Stage IV is characterized by projection of the areola and nipple to form a
secondary mound. Stage II shows breast bud elevation; Stage III shows further enlargement
without separation of contours. Asymmetric development is common and usually resolves.
4. Which statement from a parent may indicate a cardiac problem in a 4-month-old infant
requiring more thorough history?
A. "She sleeps through the night now."
B. "It often takes the baby more than 30 minutes to finish a bottle."
C. "She has started rolling over."
D. "She smiles responsively at us."
Rationale: Prolonged feeding times in infants can indicate fatigue from cardiac disease (e.g.,
congestive heart failure). This warrants further investigation.
5. Which of the following is included in a health history under adult illnesses?
A. Childhood vaccinations
B. Medical, surgical, OB/GYN, psychiatric
C. Family history of allergies
D. Current medications only
Rationale: Adult illnesses in the health history include medical, surgical, OB/GYN, and
psychiatric conditions.
6. What is included in the history of present illness (HPI)?
A. Social history
B. Onset, setting, and symptoms prompting the visit
C. Past surgical history
D. Family medical history
Rationale: The HPI details onset, duration, and characteristics of symptoms leading to the
visit.
7. Which anatomical description is most appropriate for a medical record?
A. "Pain near the liver"
B. "Pain in the right upper abdomen"
C. "Pain cranial to the umbilicus in the right hypochondrium"
D. "Pain above the belly button"
, Rationale: Standardized anatomical terminology ensures accurate communication and
comparison. "Right hypochondrium" is a precise anatomical region.
8. A 44-year-old female presents with a breast mass. After workup reveals a benign cyst, what
advice should be given about breast cancer screening?
A. BSE is well evidenced and all agencies agree it should be taught
B. Clinical breast examination is superior to BSE
C. Mammography is recommended every 2 years for women aged 50–74
D. Mammography is recommended every 2 years for women aged 50–74 with insufficient
evidence for screening over age 75
Rationale: USPSTF recommends biennial mammography for average-risk women aged 50–
74. Evidence for screening over 75 is insufficient.
9. A 31-year-old female presents with a stiff, painful neck. Her head is laterally deviated toward
the shoulder and rotated. What condition should the NP suspect?
A. Torticollis
B. Ankylosing spondylitis
C. Osteoarthritis
D. Spondylolisthesis
Rationale: Torticollis presents with lateral deviation and rotation of the head due to spasm
of the sternocleidomastoid muscle.
10. Which of the following statements is true regarding alcohol consumption in older adults?
A. The CAGE screening retains the same sensitivity and specificity as in younger populations
B. Detection of alcohol abuse is higher in older patients
C. Symptoms of alcohol abuse are more overt in older patients
D. Alcohol alone does not cause cognitive impairment in older patients
Rationale: The CAGE screening tool maintains validity across age groups. Detection may
actually be lower in older adults due to less frequent screening.
11. An 80-year-old woman reports two falls in 4 months. She attributes them to environmental
factors. What is the best approach?
A. Advise her to be more careful
B. Advise her to use a walker
C. Reassure her that falls are associated with aging
D. Perform a comprehensive assessment of fall risk and plan preventive interventions
, Rationale: Falls in older adults require comprehensive assessment to identify modifiable risk
factors and prevent future falls. Environmental attribution does not rule out intrinsic causes.
12. Which is a useful strategy when examining young children aged 1–4?
A. Perform the exam in a head-to-toe sequence
B. Have the parent facilitate the exam (e.g., holding the child on lap)
C. Examine the child without the parent present
D. Use complex instructions to assess comprehension
Rationale: Parental facilitation reduces anxiety and improves cooperation in young children.
13. A patient presents with pleuritic chest pain. The examiner hears a friction-like sound that
persists when the patient holds their breath. This finding is most consistent with:
A. Pleural friction rub
B. Pericardial friction rub
C. Bronchovesicular breath sounds
D. S3 gallop
Rationale: A pericardial friction rub persists during breath-holding, distinguishing it from a
pleural friction rub which disappears when respiration is suspended.
14. Which is an effective question to ask a patient presenting with recurring headaches?
A. "Do you have any family history of headaches?"
B. "Do you have any aura prior to the headaches?"
C. "What is your blood type?"
D. "Have you ever had an MRI?"
Rationale: Asking about aura helps differentiate migraine with aura from other headache
types and guides diagnosis.
15. A 75-year-old female presents to a new provider. Which finding on physical exam is
consistent with normal aging rather than cardiovascular disease?
A. Narrowed pulse pressure with increased systolic and diastolic
B. Widened pulse pressure with increased systolic and decreased diastolic
C. Drop in systolic pressure of 25 mm Hg when standing
D. Isolated systolic BP >150 mm Hg
Rationale: Widened pulse pressure with increased systolic (up to 140) and decreased
diastolic is a normal aging change due to arterial stiffening.
2021): Advanced Physical Assessment
:Chamberlain College
1. A 35-year-old female with a history of migraines presents with worsening symptoms over the
past few weeks. She reports waking at night with headaches and nausea. Her only medication is
oral contraceptive pills. Which action by the NP is the best next step?
A. Order an MRI of the brain immediately
B. Discontinue the oral contraceptive pills
C. Take a further history and perform a careful neurological exam
D. Prescribe a stronger migraine medication
Rationale: Worsening headaches that wake the patient at night warrant thorough
investigation. OCPs increase cerebrovascular event risk, so a careful neurological exam is
essential to rule out serious pathology. Ordering MRI without assessment is premature;
discontinuing OCPs may be considered later but is not the first step.
2. Primary prevention is defined as which of the following?
A. Interventions designed to prevent disease
B. Early detection and treatment of disease
C. Rehabilitation and restoration of function
D. Screening for early signs of disease
Rationale: Primary prevention includes immunizations and health education to prevent
disease. Secondary prevention involves screening and early detection. Tertiary prevention
focuses on rehabilitation.
3. A grandmother asks privately if her 9-year-old granddaughter has started puberty. The NP
notes asymmetric projection of the areola and nipple of the right chest forming a secondary
mound above the breast. The left breast is underdeveloped. These findings are consistent with
which Tanner Stage?
A. I
B. II
C. III
D. IV
, Rationale: Tanner Stage IV is characterized by projection of the areola and nipple to form a
secondary mound. Stage II shows breast bud elevation; Stage III shows further enlargement
without separation of contours. Asymmetric development is common and usually resolves.
4. Which statement from a parent may indicate a cardiac problem in a 4-month-old infant
requiring more thorough history?
A. "She sleeps through the night now."
B. "It often takes the baby more than 30 minutes to finish a bottle."
C. "She has started rolling over."
D. "She smiles responsively at us."
Rationale: Prolonged feeding times in infants can indicate fatigue from cardiac disease (e.g.,
congestive heart failure). This warrants further investigation.
5. Which of the following is included in a health history under adult illnesses?
A. Childhood vaccinations
B. Medical, surgical, OB/GYN, psychiatric
C. Family history of allergies
D. Current medications only
Rationale: Adult illnesses in the health history include medical, surgical, OB/GYN, and
psychiatric conditions.
6. What is included in the history of present illness (HPI)?
A. Social history
B. Onset, setting, and symptoms prompting the visit
C. Past surgical history
D. Family medical history
Rationale: The HPI details onset, duration, and characteristics of symptoms leading to the
visit.
7. Which anatomical description is most appropriate for a medical record?
A. "Pain near the liver"
B. "Pain in the right upper abdomen"
C. "Pain cranial to the umbilicus in the right hypochondrium"
D. "Pain above the belly button"
, Rationale: Standardized anatomical terminology ensures accurate communication and
comparison. "Right hypochondrium" is a precise anatomical region.
8. A 44-year-old female presents with a breast mass. After workup reveals a benign cyst, what
advice should be given about breast cancer screening?
A. BSE is well evidenced and all agencies agree it should be taught
B. Clinical breast examination is superior to BSE
C. Mammography is recommended every 2 years for women aged 50–74
D. Mammography is recommended every 2 years for women aged 50–74 with insufficient
evidence for screening over age 75
Rationale: USPSTF recommends biennial mammography for average-risk women aged 50–
74. Evidence for screening over 75 is insufficient.
9. A 31-year-old female presents with a stiff, painful neck. Her head is laterally deviated toward
the shoulder and rotated. What condition should the NP suspect?
A. Torticollis
B. Ankylosing spondylitis
C. Osteoarthritis
D. Spondylolisthesis
Rationale: Torticollis presents with lateral deviation and rotation of the head due to spasm
of the sternocleidomastoid muscle.
10. Which of the following statements is true regarding alcohol consumption in older adults?
A. The CAGE screening retains the same sensitivity and specificity as in younger populations
B. Detection of alcohol abuse is higher in older patients
C. Symptoms of alcohol abuse are more overt in older patients
D. Alcohol alone does not cause cognitive impairment in older patients
Rationale: The CAGE screening tool maintains validity across age groups. Detection may
actually be lower in older adults due to less frequent screening.
11. An 80-year-old woman reports two falls in 4 months. She attributes them to environmental
factors. What is the best approach?
A. Advise her to be more careful
B. Advise her to use a walker
C. Reassure her that falls are associated with aging
D. Perform a comprehensive assessment of fall risk and plan preventive interventions
, Rationale: Falls in older adults require comprehensive assessment to identify modifiable risk
factors and prevent future falls. Environmental attribution does not rule out intrinsic causes.
12. Which is a useful strategy when examining young children aged 1–4?
A. Perform the exam in a head-to-toe sequence
B. Have the parent facilitate the exam (e.g., holding the child on lap)
C. Examine the child without the parent present
D. Use complex instructions to assess comprehension
Rationale: Parental facilitation reduces anxiety and improves cooperation in young children.
13. A patient presents with pleuritic chest pain. The examiner hears a friction-like sound that
persists when the patient holds their breath. This finding is most consistent with:
A. Pleural friction rub
B. Pericardial friction rub
C. Bronchovesicular breath sounds
D. S3 gallop
Rationale: A pericardial friction rub persists during breath-holding, distinguishing it from a
pleural friction rub which disappears when respiration is suspended.
14. Which is an effective question to ask a patient presenting with recurring headaches?
A. "Do you have any family history of headaches?"
B. "Do you have any aura prior to the headaches?"
C. "What is your blood type?"
D. "Have you ever had an MRI?"
Rationale: Asking about aura helps differentiate migraine with aura from other headache
types and guides diagnosis.
15. A 75-year-old female presents to a new provider. Which finding on physical exam is
consistent with normal aging rather than cardiovascular disease?
A. Narrowed pulse pressure with increased systolic and diastolic
B. Widened pulse pressure with increased systolic and decreased diastolic
C. Drop in systolic pressure of 25 mm Hg when standing
D. Isolated systolic BP >150 mm Hg
Rationale: Widened pulse pressure with increased systolic (up to 140) and decreased
diastolic is a normal aging change due to arterial stiffening.
