NR 509 Midterm Exam / NR509 Midterm Exam
(Latest 2020): Advanced Physical Assessment:
Chamberlain College of Nursing (Verified
Answers, Already graded A)
Section I: Clinical Reasoning & The Nursing Process
1. A 58-year-old carpenter presents for his annual physical. The NP notes a systolic murmur on
auscultation. Which statement best explains why the NP does not immediately diagnose
aortic stenosis?
A. Systolic murmurs have high specificity but low sensitivity for aortic stenosis
B. Systolic murmurs have high sensitivity but low specificity for aortic stenosis
C. Systolic murmurs are only present in aortic stenosis
D. Systolic murmurs are always benign
Rationale: Systolic murmurs are common and can be heard in many conditions, including
benign flow murmurs, aortic sclerosis, and aortic stenosis. Their high sensitivity means most
patients with aortic stenosis will have a murmur, but low specificity means many patients
without aortic stenosis also have murmurs. Additional information is needed to differentiate.
2. A 51-year-old moderately overweight professor reports chest pain after tennis matches. A
28-year-old student also reports chest tightness during exams. The clinician recommends
immediate CAD evaluation for the professor but not the student. Which principle explains
this?
A. The professor's symptoms are more severe
B. The student is too young for CAD
C. Positive predictive value of an observation is higher in a group with higher disease
prevalence
D. The professor has better insurance
Rationale: Positive predictive value depends on disease prevalence. In a population with
higher prevalence of CAD (older, overweight males), a positive finding is more likely to represent
true disease. In a low-prevalence population, the same finding is more likely to be a false
positive.
,3. Which of the following is an example of objective data?
A. Patient reports a headache for 3 days
B. Patient states she feels nauseated
C. Patient describes her pain as "sharp"
D. 2.5 cm scar on the right lower forearm
Rationale: Objective data are directly observable and measurable by the examiner. A scar
can be seen and measured. Subjective data include symptoms the patient reports, such as
headache, nausea, and pain description.
4. A 45-year-old forklift driver presents with intense substernal chest pain, pale and
diaphoretic. The PA questions him in detail about his eating habits and digestive history.
Which step of clinical reasoning has the PA failed to follow?
A. Gather complete information
B. Generate a differential diagnosis
C. Give special consideration to potential life-threatening problems
D. Develop a problem list
Rationale: The PA failed to prioritize life-threatening causes. A pale, diaphoretic patient with
substernal chest pain must be evaluated for acute coronary syndrome first. Digestive history can
be explored later, but ruling out life threats takes priority.
5. A test for strep throat yields 150 true positives and 150 false positives. What is the positive
predictive value?
A. 25%
B. 75%
C. 100%
D. 50%
Rationale: PPV = true positives / (true positives + false positives) = 150 / (150 + 150) =
150/300 = 50%.
,6. A test yields 85 true negatives and 15 false negatives. What is the negative predictive
value?
A. 15%
B. 50%
C. 85%
D. 100%
Rationale: NPV = true negatives / (true negatives + false negatives) = 85 / (85 + 15) = 85/100
= 85%.
7. A pulse oximeter consistently reads 25 bpm at rest and 50 bpm while jogging. The
technician questions which aspect of the instrument?
A. Reliability
B. Validity
C. Sensitivity
D. Specificity
Rationale: Validity refers to whether an instrument measures what it is intended to
measure. A pulse oximeter reading 25 bpm at rest is not measuring heart rate accurately.
Reliability would refer to consistency of measurements.
8. A nursing diagnosis is best described as:
A. Identification of the etiology of a disease
B. A pattern of maladaptive coping
C. A clinical judgment about individual, family, or community responses to actual or
potential health problems
D. The patient's perception of their health status
Rationale: Nursing diagnoses focus on human responses to health conditions, not on
disease pathology itself. Medical diagnoses identify disease; nursing diagnoses identify the
patient's response to illness.
9. Which statement best describes a differential diagnosis list?
, A. The final confirmed diagnosis
B. A list of diagnoses that have been ruled out
C. A list of potential/plausible diagnoses that may be causing the signs and symptoms
D. The patient's chief complaint
Rationale: A differential diagnosis is a working list of possible conditions that could explain
the patient's presentation. It guides further testing and clinical reasoning.
10. During a mental status exam, a 70-year-old man scores 22/30 on the MoCA, losing points
on delayed recall and abstraction. Which conclusion is most accurate?
A. Normal cognition
B. Mild cognitive impairment
C. Major neurocognitive disorder
D. Delirium
Rationale: A MoCA score of 22/30 (below the 26 cutoff) with deficits in delayed recall and
abstraction suggests mild cognitive impairment. Major neurocognitive disorder would typically
show more significant functional impairment.
11. Which of the following is an example of subjective data?
A. Decreased range of motion in the left knee
B. Left knee has been swollen and hot for 3 days (patient report)
C. Crepitus palpated in the left knee
D. 2+ pitting edema in the left lower extremity
Rationale: Subjective data are what the patient reports or describes. The patient's report of
swelling and heat duration is subjective. Range of motion, crepitus, and edema are objective
findings determined by the examiner.
12. The nursing process includes which of the following steps?
A. Assessment, diagnosis, outcome identification, planning, implementation, evaluation
B. Assessment, treatment, planning, evaluation, discharge
C. Admission, assessment, diagnosis, treatment, discharge
D. History, physical, diagnosis, prescription, follow-up
(Latest 2020): Advanced Physical Assessment:
Chamberlain College of Nursing (Verified
Answers, Already graded A)
Section I: Clinical Reasoning & The Nursing Process
1. A 58-year-old carpenter presents for his annual physical. The NP notes a systolic murmur on
auscultation. Which statement best explains why the NP does not immediately diagnose
aortic stenosis?
A. Systolic murmurs have high specificity but low sensitivity for aortic stenosis
B. Systolic murmurs have high sensitivity but low specificity for aortic stenosis
C. Systolic murmurs are only present in aortic stenosis
D. Systolic murmurs are always benign
Rationale: Systolic murmurs are common and can be heard in many conditions, including
benign flow murmurs, aortic sclerosis, and aortic stenosis. Their high sensitivity means most
patients with aortic stenosis will have a murmur, but low specificity means many patients
without aortic stenosis also have murmurs. Additional information is needed to differentiate.
2. A 51-year-old moderately overweight professor reports chest pain after tennis matches. A
28-year-old student also reports chest tightness during exams. The clinician recommends
immediate CAD evaluation for the professor but not the student. Which principle explains
this?
A. The professor's symptoms are more severe
B. The student is too young for CAD
C. Positive predictive value of an observation is higher in a group with higher disease
prevalence
D. The professor has better insurance
Rationale: Positive predictive value depends on disease prevalence. In a population with
higher prevalence of CAD (older, overweight males), a positive finding is more likely to represent
true disease. In a low-prevalence population, the same finding is more likely to be a false
positive.
,3. Which of the following is an example of objective data?
A. Patient reports a headache for 3 days
B. Patient states she feels nauseated
C. Patient describes her pain as "sharp"
D. 2.5 cm scar on the right lower forearm
Rationale: Objective data are directly observable and measurable by the examiner. A scar
can be seen and measured. Subjective data include symptoms the patient reports, such as
headache, nausea, and pain description.
4. A 45-year-old forklift driver presents with intense substernal chest pain, pale and
diaphoretic. The PA questions him in detail about his eating habits and digestive history.
Which step of clinical reasoning has the PA failed to follow?
A. Gather complete information
B. Generate a differential diagnosis
C. Give special consideration to potential life-threatening problems
D. Develop a problem list
Rationale: The PA failed to prioritize life-threatening causes. A pale, diaphoretic patient with
substernal chest pain must be evaluated for acute coronary syndrome first. Digestive history can
be explored later, but ruling out life threats takes priority.
5. A test for strep throat yields 150 true positives and 150 false positives. What is the positive
predictive value?
A. 25%
B. 75%
C. 100%
D. 50%
Rationale: PPV = true positives / (true positives + false positives) = 150 / (150 + 150) =
150/300 = 50%.
,6. A test yields 85 true negatives and 15 false negatives. What is the negative predictive
value?
A. 15%
B. 50%
C. 85%
D. 100%
Rationale: NPV = true negatives / (true negatives + false negatives) = 85 / (85 + 15) = 85/100
= 85%.
7. A pulse oximeter consistently reads 25 bpm at rest and 50 bpm while jogging. The
technician questions which aspect of the instrument?
A. Reliability
B. Validity
C. Sensitivity
D. Specificity
Rationale: Validity refers to whether an instrument measures what it is intended to
measure. A pulse oximeter reading 25 bpm at rest is not measuring heart rate accurately.
Reliability would refer to consistency of measurements.
8. A nursing diagnosis is best described as:
A. Identification of the etiology of a disease
B. A pattern of maladaptive coping
C. A clinical judgment about individual, family, or community responses to actual or
potential health problems
D. The patient's perception of their health status
Rationale: Nursing diagnoses focus on human responses to health conditions, not on
disease pathology itself. Medical diagnoses identify disease; nursing diagnoses identify the
patient's response to illness.
9. Which statement best describes a differential diagnosis list?
, A. The final confirmed diagnosis
B. A list of diagnoses that have been ruled out
C. A list of potential/plausible diagnoses that may be causing the signs and symptoms
D. The patient's chief complaint
Rationale: A differential diagnosis is a working list of possible conditions that could explain
the patient's presentation. It guides further testing and clinical reasoning.
10. During a mental status exam, a 70-year-old man scores 22/30 on the MoCA, losing points
on delayed recall and abstraction. Which conclusion is most accurate?
A. Normal cognition
B. Mild cognitive impairment
C. Major neurocognitive disorder
D. Delirium
Rationale: A MoCA score of 22/30 (below the 26 cutoff) with deficits in delayed recall and
abstraction suggests mild cognitive impairment. Major neurocognitive disorder would typically
show more significant functional impairment.
11. Which of the following is an example of subjective data?
A. Decreased range of motion in the left knee
B. Left knee has been swollen and hot for 3 days (patient report)
C. Crepitus palpated in the left knee
D. 2+ pitting edema in the left lower extremity
Rationale: Subjective data are what the patient reports or describes. The patient's report of
swelling and heat duration is subjective. Range of motion, crepitus, and edema are objective
findings determined by the examiner.
12. The nursing process includes which of the following steps?
A. Assessment, diagnosis, outcome identification, planning, implementation, evaluation
B. Assessment, treatment, planning, evaluation, discharge
C. Admission, assessment, diagnosis, treatment, discharge
D. History, physical, diagnosis, prescription, follow-up
