NR509 Advanced Physical Assessment Week 4
Midterm Exam – Verified Solutions
Practice Exam – Version 1 (Questions 1–75)
1. A nurse practitioner is assessing a client who reports difficulty swallowing. Which cranial nerve is
primarily responsible for the gag reflex?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. Both A and B
Correct Answer: D
Rationale: The gag reflex is mediated by both CN IX (sensory) and CN X (motor).
CN IX provides sensation to the posterior pharynx, while CN X provides motor
function to the pharyngeal muscles. CN XII controls tongue movement.
2. During an eye examination, the nurse practitioner notes that the client's pupils constrict when a
light is shone into the opposite eye. This is known as:
A. Direct reflex
B. Consensual reflex
C. Accommodation
D. Convergence
Correct Answer: B
Rationale: The consensual light reflex occurs when shining light into one eye
causes the opposite pupil to constrict. The direct reflex occurs in the same eye.
Accommodation refers to pupil changes when focusing on near objects.
3. A nurse practitioner is assessing a client with suspected carpal tunnel syndrome. Which test is most
specific?
A. Phalen's test
B. Tinel's sign
C. Both A and B
D. McMurray's test
,Correct Answer: C
Rationale: Both Phalen's test (wrist flexion) and Tinel's sign (tapping over the
median nerve) are used to assess carpal tunnel syndrome. McMurray's test
assesses for meniscal tears in the knee.
4. A nurse practitioner is performing a cardiovascular assessment. Which finding is consistent with a
normal S1 heart sound?
A. Closure of the aortic and pulmonic valves
B. Closure of the mitral and tricuspid valves
C. Opening of the mitral and tricuspid valves
D. Closure of the semilunar valves
Correct Answer: B
Rationale: S1 ("lub") is caused by closure of the mitral and tricuspid
(atrioventricular) valves at the beginning of systole. S2 ("dub") is caused by closure
of the aortic and pulmonic (semilunar) valves.
5. A nurse practitioner is assessing a client's skin. Which finding is consistent with psoriasis?
A. Silvery scales on erythematous plaques
B. Honey-colored crusts
C. Vesicles in a dermatomal pattern
D. Annular lesions with central clearing
Correct Answer: A
Rationale: Psoriasis presents with well-demarcated erythematous plaques covered
by silvery scales, commonly on the extensor surfaces. Honey-colored crusts
suggest impetigo. Dermatomal vesicles suggest herpes zoster. Annular lesions
with central clearing suggest tinea corporis.
6. A nurse practitioner is assessing a client with suspected meningitis. Which maneuver involves
flexing the client's neck and observing for involuntary flexion of the hips and knees?
A. Kernig's sign
B. Brudzinski's sign
C. Babinski sign
D. Romberg test
, Correct Answer: B
Rationale: Brudzinski's sign is positive when neck flexion causes involuntary hip
and knee flexion. Kernig's sign is positive when extension of the knee with the hip
flexed causes pain. Babinski assesses for upper motor neuron lesions. Romberg
assesses balance.
7. A nurse practitioner is auscultating lung sounds. Which finding is consistent with consolidation?
A. Crackles
B. Wheezing
C. Bronchial breath sounds in the periphery
D. Pleural friction rub
Correct Answer: C
Rationale: Consolidation (e.g., pneumonia) transmits bronchial breath sounds to
the periphery, where vesicular sounds should normally be heard. Crackles suggest
fluid. Wheezing suggests bronchoconstriction. Pleural friction rub suggests
pleurisy.
8. A nurse practitioner is assessing a client's thyroid gland. Which finding is consistent with
hyperthyroidism?
A. Decreased appetite
B. Weight gain
C. Fine tremor and warm, moist skin
D. Bradycardia
Correct Answer: C
Rationale: Hyperthyroidism presents with a fine tremor, warm/moist skin, weight
loss, tachycardia, and heat intolerance. Weight gain and bradycardia are seen in
hypothyroidism.
9. A nurse practitioner is performing an abdominal assessment. Which sequence is correct?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Inspection, palpation, percussion, auscultation
Midterm Exam – Verified Solutions
Practice Exam – Version 1 (Questions 1–75)
1. A nurse practitioner is assessing a client who reports difficulty swallowing. Which cranial nerve is
primarily responsible for the gag reflex?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. Both A and B
Correct Answer: D
Rationale: The gag reflex is mediated by both CN IX (sensory) and CN X (motor).
CN IX provides sensation to the posterior pharynx, while CN X provides motor
function to the pharyngeal muscles. CN XII controls tongue movement.
2. During an eye examination, the nurse practitioner notes that the client's pupils constrict when a
light is shone into the opposite eye. This is known as:
A. Direct reflex
B. Consensual reflex
C. Accommodation
D. Convergence
Correct Answer: B
Rationale: The consensual light reflex occurs when shining light into one eye
causes the opposite pupil to constrict. The direct reflex occurs in the same eye.
Accommodation refers to pupil changes when focusing on near objects.
3. A nurse practitioner is assessing a client with suspected carpal tunnel syndrome. Which test is most
specific?
A. Phalen's test
B. Tinel's sign
C. Both A and B
D. McMurray's test
,Correct Answer: C
Rationale: Both Phalen's test (wrist flexion) and Tinel's sign (tapping over the
median nerve) are used to assess carpal tunnel syndrome. McMurray's test
assesses for meniscal tears in the knee.
4. A nurse practitioner is performing a cardiovascular assessment. Which finding is consistent with a
normal S1 heart sound?
A. Closure of the aortic and pulmonic valves
B. Closure of the mitral and tricuspid valves
C. Opening of the mitral and tricuspid valves
D. Closure of the semilunar valves
Correct Answer: B
Rationale: S1 ("lub") is caused by closure of the mitral and tricuspid
(atrioventricular) valves at the beginning of systole. S2 ("dub") is caused by closure
of the aortic and pulmonic (semilunar) valves.
5. A nurse practitioner is assessing a client's skin. Which finding is consistent with psoriasis?
A. Silvery scales on erythematous plaques
B. Honey-colored crusts
C. Vesicles in a dermatomal pattern
D. Annular lesions with central clearing
Correct Answer: A
Rationale: Psoriasis presents with well-demarcated erythematous plaques covered
by silvery scales, commonly on the extensor surfaces. Honey-colored crusts
suggest impetigo. Dermatomal vesicles suggest herpes zoster. Annular lesions
with central clearing suggest tinea corporis.
6. A nurse practitioner is assessing a client with suspected meningitis. Which maneuver involves
flexing the client's neck and observing for involuntary flexion of the hips and knees?
A. Kernig's sign
B. Brudzinski's sign
C. Babinski sign
D. Romberg test
, Correct Answer: B
Rationale: Brudzinski's sign is positive when neck flexion causes involuntary hip
and knee flexion. Kernig's sign is positive when extension of the knee with the hip
flexed causes pain. Babinski assesses for upper motor neuron lesions. Romberg
assesses balance.
7. A nurse practitioner is auscultating lung sounds. Which finding is consistent with consolidation?
A. Crackles
B. Wheezing
C. Bronchial breath sounds in the periphery
D. Pleural friction rub
Correct Answer: C
Rationale: Consolidation (e.g., pneumonia) transmits bronchial breath sounds to
the periphery, where vesicular sounds should normally be heard. Crackles suggest
fluid. Wheezing suggests bronchoconstriction. Pleural friction rub suggests
pleurisy.
8. A nurse practitioner is assessing a client's thyroid gland. Which finding is consistent with
hyperthyroidism?
A. Decreased appetite
B. Weight gain
C. Fine tremor and warm, moist skin
D. Bradycardia
Correct Answer: C
Rationale: Hyperthyroidism presents with a fine tremor, warm/moist skin, weight
loss, tachycardia, and heat intolerance. Weight gain and bradycardia are seen in
hypothyroidism.
9. A nurse practitioner is performing an abdominal assessment. Which sequence is correct?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
C. Auscultation, inspection, palpation, percussion
D. Inspection, palpation, percussion, auscultation
