NR 509 ADVANCED PHYSICAL
ASSESSMENT PRACTICE EXAM
QUESTIONS WITH VERIFIED ANSWERS
(LATEST 2026/ 2027)- CHAMBERLAIN
1. When assessing for the presence of a pleural effusion, which tactile fremitus finding would
the nurse practitioner expect to encounter over the affected area?
A. Increased tactile fremitus
B. Normal tactile fremitus
C. Decreased to absent tactile fremitus
D. Rhonchal fremitus
Answer: C
Conceptual Explanation: Tactile fremitus is decreased or absent in a pleural effusion
because the fluid in the pleural space acts as a barrier that prevents the transmission of
sound vibrations from the lungs to the chest wall.
2. A patient presents with a ‘blowing’ holosystolic murmur heard best at the apex that
radiates to the left axilla. Which valvular disorder is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
,C. Mitral Stenosis
D. Tricuspid Regurgitation
Answer: B
Conceptual Explanation: Mitral regurgitation is characterized by a holosystolic murmur
heard best at the apex, radiating to the axilla, often described as blowing in quality.
3. During an abdominal assessment, the practitioner performs the Murphy sign. A positive
result is most indicative of which condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenic Rupture
D. Nephrolithiasis
Answer: A
Conceptual Explanation: A positive Murphy sign (sharp pain and inspiratory arrest upon
palpation of the gallbladder area) is a classic finding for acute cholecystitis.
4. A 65-year-old male reports a sudden, painless loss of vision in his right eye described as a
‘curtain being pulled down.’ What is the most likely diagnosis?
A. Acute Angle-Closure Glaucoma
B. Retinal Detachment
C. Macular Degeneration
, D. Cataracts
Answer: B
Conceptual Explanation: Painless, sudden vision loss often described as a curtain or
shadow falling is characteristic of retinal detachment.
5. Which cranial nerve is being assessed when the practitioner asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN XI (Spinal Accessory)
Answer: D
Conceptual Explanation: The Spinal Accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles, responsible for shoulder shrugging.
6. In a patient with suspected meningitis, the practitioner flexes the patient’s neck and
observes for involuntary flexion of the hips and knees. This is known as:
A. Kernig’s sign
B. Babinski’s sign
C. Brudzinski’s sign
D. Lhermitte’s sign
ASSESSMENT PRACTICE EXAM
QUESTIONS WITH VERIFIED ANSWERS
(LATEST 2026/ 2027)- CHAMBERLAIN
1. When assessing for the presence of a pleural effusion, which tactile fremitus finding would
the nurse practitioner expect to encounter over the affected area?
A. Increased tactile fremitus
B. Normal tactile fremitus
C. Decreased to absent tactile fremitus
D. Rhonchal fremitus
Answer: C
Conceptual Explanation: Tactile fremitus is decreased or absent in a pleural effusion
because the fluid in the pleural space acts as a barrier that prevents the transmission of
sound vibrations from the lungs to the chest wall.
2. A patient presents with a ‘blowing’ holosystolic murmur heard best at the apex that
radiates to the left axilla. Which valvular disorder is most likely?
A. Aortic Stenosis
B. Mitral Regurgitation
,C. Mitral Stenosis
D. Tricuspid Regurgitation
Answer: B
Conceptual Explanation: Mitral regurgitation is characterized by a holosystolic murmur
heard best at the apex, radiating to the axilla, often described as blowing in quality.
3. During an abdominal assessment, the practitioner performs the Murphy sign. A positive
result is most indicative of which condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenic Rupture
D. Nephrolithiasis
Answer: A
Conceptual Explanation: A positive Murphy sign (sharp pain and inspiratory arrest upon
palpation of the gallbladder area) is a classic finding for acute cholecystitis.
4. A 65-year-old male reports a sudden, painless loss of vision in his right eye described as a
‘curtain being pulled down.’ What is the most likely diagnosis?
A. Acute Angle-Closure Glaucoma
B. Retinal Detachment
C. Macular Degeneration
, D. Cataracts
Answer: B
Conceptual Explanation: Painless, sudden vision loss often described as a curtain or
shadow falling is characteristic of retinal detachment.
5. Which cranial nerve is being assessed when the practitioner asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN XI (Spinal Accessory)
Answer: D
Conceptual Explanation: The Spinal Accessory nerve (CN XI) innervates the trapezius and
sternocleidomastoid muscles, responsible for shoulder shrugging.
6. In a patient with suspected meningitis, the practitioner flexes the patient’s neck and
observes for involuntary flexion of the hips and knees. This is known as:
A. Kernig’s sign
B. Babinski’s sign
C. Brudzinski’s sign
D. Lhermitte’s sign
