1
NR 509 Advanced Physical Assessment
Midterm Exam 2025 – Actual
Questions and Verified Answers |
Chamberlain University | Graded A+
1. A nurse practitioner is performing a mental status examination and notes impaired speech
and judgment, with other functions intact. Where is the most likely location of the
problem?
A. Basal ganglia
B. Brainstem
C. Cerebellum
D. Cerebrum
Correct Answer: D
Rationale: The cerebrum, particularly the frontal lobe, is responsible for speech and
judgment. Impairment in these areas with intact other functions suggests a cerebral issue,
not basal ganglia (movement), brainstem (vital functions), or cerebellum (coordination).
2. A 29-year-old patient presents with a tightening headache lasting 5 days, moderate
intensity, and no photophobia or nausea. He works at a computer daily. What is the most
likely diagnosis?
A. Tension headache
B. Analgesic rebound headache
C. Cluster headache
D. Migraine
Correct Answer: A
Rationale: Tension headaches are characterized by bilateral, tightening pain of moderate
intensity, often triggered by stress or prolonged computer use. Lack of
photophobia/nausea rules out migraine, and no medication overuse history excludes
analgesic rebound. Cluster headaches are unilateral and severe.
3. A 50-year-old woman reports the "worst headache of her life" with hypertension (BP
200/110). What is the most likely etiology?
A. Migraine
B. Meningitis
C. Subarachnoid hemorrhage
D. Cluster headache
Correct Answer: C
Rationale: A sudden, severe headache ("worst ever") with elevated blood pressure
suggests subarachnoid hemorrhage, a medical emergency. Migraine and cluster
, 2
headaches are less likely with this presentation, and meningitis typically includes fever
and neck stiffness.
4. Which of the following is a "red flag" for patients presenting with headaches?
A. Phonophobia and photophobia
B. Age over 50
C. Pain over the sinuses
D. Unilateral headache
Correct Answer: B
Rationale: Age over 50 is a red flag for headaches, as it increases the risk of serious
causes like temporal arteritis or brain tumors. Phonophobia/photophobia and unilateral
pain are common in migraines, and sinus pain suggests sinusitis, which is less urgent.
5. A patient presents with a daily headache and funduscopic findings of indistinct disk
edges and absent vein pulsations. What is the most likely diagnosis?
A. Migraine
B. Increased intracranial pressure
C. Detached retina
D. Glaucoma
Correct Answer: B
Rationale: Indistinct disk edges and absent vein pulsations indicate papilledema, a sign
of increased intracranial pressure. Migraine lacks these findings, detached retina affects
vision, and glaucoma causes optic cupping, not papilledema.
6. During a lung assessment, the nurse practitioner elicits a dull percussion note over a lung
lobe. What does this most likely indicate?
A. Normal lung tissue
B. Pneumothorax
C. Consolidation
D. Emphysema
Correct Answer: C
Rationale: A dull percussion note suggests consolidation (e.g., pneumonia), as fluid or
tissue replaces air-filled lung. Normal lung tissue is resonant, pneumothorax is
hyperresonant, and emphysema may produce a hyperresonant note.
7. A 63-year-old male presents with chest pain, shortness of breath, and palpitations. What
is the best course of action?
A. Order a stress test immediately
B. Perform a physical and psychosocial assessment
C. Prescribe antacids for possible GERD
D. Refer for psychiatric evaluation
Correct Answer: B
Rationale: Chest pain, shortness of breath, and palpitations suggest possible cardiac or
pulmonary issues, requiring a comprehensive physical and psychosocial assessment to
rule out serious conditions before assuming non-cardiac causes.
8. A nurse practitioner is assessing new memory in a patient. What is the best method to
evaluate this?
A. Ask about recent meals
B. Perform the four unrelated words test
C. Request a detailed family history
, 3
D. Assess orientation to time and place
Correct Answer: B
Rationale: The four unrelated words test assesses short-term memory by asking the
patient to recall words after a delay. Other options evaluate different cognitive domains
or history, not new memory specifically.
9. A female patient reports consuming 7–8 alcoholic drinks per week but denies
intoxication. What does this indicate?
A. Normal alcohol consumption
B. At-risk drinking
C. Alcohol dependence
D. Social drinking
Correct Answer: B
Rationale: For women, at-risk drinking is defined as more than 7 drinks per week or 3
per occasion, increasing health risks. This exceeds normal consumption but does not
confirm dependence.
10. A 35-year-old female with a history of migraines reports worsening headaches and
nausea at night. She takes oral contraceptives. What is the best next step?
A. Discontinue oral contraceptives
B. Order a brain MRI
C. Prescribe sumatriptan
D. Reassure and monitor symptoms
Correct Answer: B
Rationale: Worsening headaches with nausea in a patient on oral contraceptives raise
concern for serious conditions (e.g., cerebral venous thrombosis). An MRI is warranted to
rule out pathology before adjusting medications or reassuring.
11. A nurse practitioner notes enlarged submental lymph nodes. What area should be
assessed to identify the cause?
A. Thyroid gland
B. Oral cavity
C. Lungs
D. Abdomen
Correct Answer: B
Rationale: Submental lymph nodes drain the oral cavity, lips, and tongue. Assessing the
oral cavity for infections or malignancies is the most relevant next step.
12. A patient presents with a subconjunctival hemorrhage after vomiting. What is the best
treatment?
A. Antibiotic eye drops
B. Observation
C. Surgical drainage
D. Steroid eye drops
Correct Answer: B
Rationale: Subconjunctival hemorrhage is benign, often caused by increased pressure
(e.g., vomiting), and resolves spontaneously. No medications or surgery are needed.
13. During a funduscopic exam, what finding prompts consultation to rule out retinal tears or
detachment?
A. Cotton wool spots
, 4
B. Floaters and flashes
C. Drusen
D. Microaneurysms
Correct Answer: B
Rationale: Floaters and flashes suggest posterior vitreous detachment, which can lead to
retinal tears or detachment, requiring urgent consultation. Other findings are associated
with different conditions (e.g., diabetes, macular degeneration).
14. A patient reports chest pain described as sharp and worse with deep inspiration. What is
the most likely diagnosis?
A. Myocardial infarction
B. Pleuritic pain
C. Esophageal spasm
D. Aortic dissection
Correct Answer: B
Rationale: Sharp chest pain worse with inspiration suggests pleuritic pain, often due to
pleural inflammation (e.g., pneumonia, pleurisy). Myocardial infarction and aortic
dissection are less pleuritic, and esophageal spasm is unrelated to breathing.
15. A nurse practitioner performs the Romberg test. What does a positive result indicate?
A. Peripheral neuropathy
B. Cerebellar dysfunction
C. Muscle weakness
D. Visual impairment
Correct Answer: B
Rationale: A positive Romberg test (swaying or falling with eyes closed) indicates
cerebellar dysfunction or impaired proprioception, as the patient relies on vision for
balance.
16. During a cardiovascular exam, the nurse practitioner hears a third heart sound (S3). What
does this suggest?
A. Heart failure
B. Mitral regurgitation
C. Aortic stenosis
D. Normal finding in adults
Correct Answer: A
Rationale: An S3 heart sound in adults suggests heart failure, indicating rapid ventricular
filling due to fluid overload. It is not typical in healthy adults or specific to valve
disorders.
17. A patient presents with unilateral leg swelling and tenderness. What is the most
appropriate next step?
A. Order a D-dimer test
B. Prescribe antibiotics
C. Apply compression stockings
D. Schedule a follow-up in one week
Correct Answer: A
Rationale: Unilateral leg swelling and tenderness suggest possible deep vein thrombosis
(DVT). A D-dimer test is a non-invasive initial step to assess DVT risk, followed by
imaging if positive.
NR 509 Advanced Physical Assessment
Midterm Exam 2025 – Actual
Questions and Verified Answers |
Chamberlain University | Graded A+
1. A nurse practitioner is performing a mental status examination and notes impaired speech
and judgment, with other functions intact. Where is the most likely location of the
problem?
A. Basal ganglia
B. Brainstem
C. Cerebellum
D. Cerebrum
Correct Answer: D
Rationale: The cerebrum, particularly the frontal lobe, is responsible for speech and
judgment. Impairment in these areas with intact other functions suggests a cerebral issue,
not basal ganglia (movement), brainstem (vital functions), or cerebellum (coordination).
2. A 29-year-old patient presents with a tightening headache lasting 5 days, moderate
intensity, and no photophobia or nausea. He works at a computer daily. What is the most
likely diagnosis?
A. Tension headache
B. Analgesic rebound headache
C. Cluster headache
D. Migraine
Correct Answer: A
Rationale: Tension headaches are characterized by bilateral, tightening pain of moderate
intensity, often triggered by stress or prolonged computer use. Lack of
photophobia/nausea rules out migraine, and no medication overuse history excludes
analgesic rebound. Cluster headaches are unilateral and severe.
3. A 50-year-old woman reports the "worst headache of her life" with hypertension (BP
200/110). What is the most likely etiology?
A. Migraine
B. Meningitis
C. Subarachnoid hemorrhage
D. Cluster headache
Correct Answer: C
Rationale: A sudden, severe headache ("worst ever") with elevated blood pressure
suggests subarachnoid hemorrhage, a medical emergency. Migraine and cluster
, 2
headaches are less likely with this presentation, and meningitis typically includes fever
and neck stiffness.
4. Which of the following is a "red flag" for patients presenting with headaches?
A. Phonophobia and photophobia
B. Age over 50
C. Pain over the sinuses
D. Unilateral headache
Correct Answer: B
Rationale: Age over 50 is a red flag for headaches, as it increases the risk of serious
causes like temporal arteritis or brain tumors. Phonophobia/photophobia and unilateral
pain are common in migraines, and sinus pain suggests sinusitis, which is less urgent.
5. A patient presents with a daily headache and funduscopic findings of indistinct disk
edges and absent vein pulsations. What is the most likely diagnosis?
A. Migraine
B. Increased intracranial pressure
C. Detached retina
D. Glaucoma
Correct Answer: B
Rationale: Indistinct disk edges and absent vein pulsations indicate papilledema, a sign
of increased intracranial pressure. Migraine lacks these findings, detached retina affects
vision, and glaucoma causes optic cupping, not papilledema.
6. During a lung assessment, the nurse practitioner elicits a dull percussion note over a lung
lobe. What does this most likely indicate?
A. Normal lung tissue
B. Pneumothorax
C. Consolidation
D. Emphysema
Correct Answer: C
Rationale: A dull percussion note suggests consolidation (e.g., pneumonia), as fluid or
tissue replaces air-filled lung. Normal lung tissue is resonant, pneumothorax is
hyperresonant, and emphysema may produce a hyperresonant note.
7. A 63-year-old male presents with chest pain, shortness of breath, and palpitations. What
is the best course of action?
A. Order a stress test immediately
B. Perform a physical and psychosocial assessment
C. Prescribe antacids for possible GERD
D. Refer for psychiatric evaluation
Correct Answer: B
Rationale: Chest pain, shortness of breath, and palpitations suggest possible cardiac or
pulmonary issues, requiring a comprehensive physical and psychosocial assessment to
rule out serious conditions before assuming non-cardiac causes.
8. A nurse practitioner is assessing new memory in a patient. What is the best method to
evaluate this?
A. Ask about recent meals
B. Perform the four unrelated words test
C. Request a detailed family history
, 3
D. Assess orientation to time and place
Correct Answer: B
Rationale: The four unrelated words test assesses short-term memory by asking the
patient to recall words after a delay. Other options evaluate different cognitive domains
or history, not new memory specifically.
9. A female patient reports consuming 7–8 alcoholic drinks per week but denies
intoxication. What does this indicate?
A. Normal alcohol consumption
B. At-risk drinking
C. Alcohol dependence
D. Social drinking
Correct Answer: B
Rationale: For women, at-risk drinking is defined as more than 7 drinks per week or 3
per occasion, increasing health risks. This exceeds normal consumption but does not
confirm dependence.
10. A 35-year-old female with a history of migraines reports worsening headaches and
nausea at night. She takes oral contraceptives. What is the best next step?
A. Discontinue oral contraceptives
B. Order a brain MRI
C. Prescribe sumatriptan
D. Reassure and monitor symptoms
Correct Answer: B
Rationale: Worsening headaches with nausea in a patient on oral contraceptives raise
concern for serious conditions (e.g., cerebral venous thrombosis). An MRI is warranted to
rule out pathology before adjusting medications or reassuring.
11. A nurse practitioner notes enlarged submental lymph nodes. What area should be
assessed to identify the cause?
A. Thyroid gland
B. Oral cavity
C. Lungs
D. Abdomen
Correct Answer: B
Rationale: Submental lymph nodes drain the oral cavity, lips, and tongue. Assessing the
oral cavity for infections or malignancies is the most relevant next step.
12. A patient presents with a subconjunctival hemorrhage after vomiting. What is the best
treatment?
A. Antibiotic eye drops
B. Observation
C. Surgical drainage
D. Steroid eye drops
Correct Answer: B
Rationale: Subconjunctival hemorrhage is benign, often caused by increased pressure
(e.g., vomiting), and resolves spontaneously. No medications or surgery are needed.
13. During a funduscopic exam, what finding prompts consultation to rule out retinal tears or
detachment?
A. Cotton wool spots
, 4
B. Floaters and flashes
C. Drusen
D. Microaneurysms
Correct Answer: B
Rationale: Floaters and flashes suggest posterior vitreous detachment, which can lead to
retinal tears or detachment, requiring urgent consultation. Other findings are associated
with different conditions (e.g., diabetes, macular degeneration).
14. A patient reports chest pain described as sharp and worse with deep inspiration. What is
the most likely diagnosis?
A. Myocardial infarction
B. Pleuritic pain
C. Esophageal spasm
D. Aortic dissection
Correct Answer: B
Rationale: Sharp chest pain worse with inspiration suggests pleuritic pain, often due to
pleural inflammation (e.g., pneumonia, pleurisy). Myocardial infarction and aortic
dissection are less pleuritic, and esophageal spasm is unrelated to breathing.
15. A nurse practitioner performs the Romberg test. What does a positive result indicate?
A. Peripheral neuropathy
B. Cerebellar dysfunction
C. Muscle weakness
D. Visual impairment
Correct Answer: B
Rationale: A positive Romberg test (swaying or falling with eyes closed) indicates
cerebellar dysfunction or impaired proprioception, as the patient relies on vision for
balance.
16. During a cardiovascular exam, the nurse practitioner hears a third heart sound (S3). What
does this suggest?
A. Heart failure
B. Mitral regurgitation
C. Aortic stenosis
D. Normal finding in adults
Correct Answer: A
Rationale: An S3 heart sound in adults suggests heart failure, indicating rapid ventricular
filling due to fluid overload. It is not typical in healthy adults or specific to valve
disorders.
17. A patient presents with unilateral leg swelling and tenderness. What is the most
appropriate next step?
A. Order a D-dimer test
B. Prescribe antibiotics
C. Apply compression stockings
D. Schedule a follow-up in one week
Correct Answer: A
Rationale: Unilateral leg swelling and tenderness suggest possible deep vein thrombosis
(DVT). A D-dimer test is a non-invasive initial step to assess DVT risk, followed by
imaging if positive.
