NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST 2025/2026
COMPLETE QUESTIONS AND CORRECT D, Exams of Nursing
A 62-year-old smoker complains of "coughing up small amounts of blood," so you
consider hemoptysis. Which of the following should you also consider?
A) Intestinal bleeding
B) Hematoma of the nasal septum
C) Epistaxis
D) Bruising of the tongue C) Epistaxis
When you suspect hemoptysis, you must consider other etiologies for bleeding.
Commonly, epistaxis can mimic this as well as bleeding from the gastrointestinal tract.
The other
answers, although they involve bleeding, are contained or distant from the pharynx.
Which of the following occurs in respiratory distress?
A) Speaking in sentences of 10-20 words
B) Skin between the ribs moves inward with inspiration
C) Neck muscles are relaxed
D) Patient torso leans posteriorly B) Skin between the ribs moves inward with
inspiration
This description is consistent with retractions that occur with respiratory distress. Other
features include speaking in short sentences, use of accessory muscles, leaning forward
to gain mechanical advantage for the diaphragm, and pursed lip breathing, in which the
patient
exhales against his lips, which are pressed together.
Which of the following is consistent with good percussion technique?
A) Allow all of the fingers to touch the chest while performing percussion.
B) Maintain a stiff wrist and hand.
C) Leave the plexor finger on the pleximeter after each strike.
D) Strike the pleximeter over the distal interphalangeal joint. D) Strike the pleximeter
over the distal interphalangeal joint
1|Page
,Percussion takes practice to master. Most struggle initially with keeping the wrist and
hand relaxed. Other challenges include removing the plexor quickly and keeping the
other
fingers off the chest wall.
Which of the following percussion notes would you obtain over the gastric bubble?
A) Resonance
B) Tympany
C) Hyperresonance
D) Flatness B) Tympany
The gastric bubble produces one of the longest percussion notes. A patient with
COPD may have hyperresonance over his chest, while a normal person would have
resonance.
Dullness is heard over a normal liver, and flatness is heard if one percusses a large
muscle.
Which of the following conditions would produce a hyperresonant percussion note?
A) Large pneumothorax
B) Lobar pneumonia
C) Pleural effusion
D) Empyema A) Large pneumothorax
There is a great deal of free air in the chest with a large pneumothorax, which
produces a hyperresonant note. The other three conditions produce dullness by
dampening the
percussion note with fluid.
Which lung sound possesses the characteristics of being louder and higher in pitch, with
a short silence between inspiration and expiration and with expiration being longer than
inspiration?
A) Bronchovesicular
B) Vesicular
C) Bronchial
2|Page
,D) Tracheal C) Bronchial
A patient complains of shortness of breath for the past few days. On examination, you
note late inspiratory crackles in the lower third of the chest that were not present a
week ago.
What is the most likely explanation for these?
A) Asthma
B) COPD
C) Bronchiectasis
D) Heart failure D) Heart failure
The timing of crackles within inspiration provides important clues. These late
inspiratory crackles that appeared suddenly would be most consistent with heart failure.
COPD
and asthma usually produce early inspiratory crackles. Bronchiectasis, as seen in cystic
fibrosis, classically produces mid-inspiratory crackles, but this is not always reliable.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure A) Bronchitis
Adventitious sounds that clear with cough are usually consistent with bronchitis or
atelectasis. The other conditions would not be associated with findings that cleared with
a cough.
A patient with longstanding COPD was told by another practitioner that his liver was
enlarged and this needed to be assessed. Which of the following would be reasonable to
do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver B) Measure the span of the liver
3|Page
, In this patient, measuring the span of the liver saved the patient an involved workup,
because it was normal. His history of COPD is consistent with flattening of the
diaphragms, which pushed the liver edge down while the actual size of the liver
remained the same. Percussing the lower border of the liver alone caused this referral,
because it was assumed that
the liver was enlarged.
You are at your family reunion playing football when your uncle takes a hit to his right
lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a
very
remote area. What would your next step be?
A) Call a medevac helicopter
B) Drive him to the city (4 hours away)
C) Press on his sternum and spine simultaneously
D) Examine him for tenderness over the injured area C) Press on his sternum and spine
simultaneously
The area involved in the injury will of course be tender. If you press in an area
remote to the injury, but over the same bone which may be involved, you can produce
tenderness
at the site of injury. This would indicate that there may be a fracture at the lateral ribs.
You are performing a thorough cardiac examination. Which of the following chambers of
the heart can you assess by palpation?
A) Left atrium
B) Right atrium
C) Right ventricle
D) Sinus node C) Right ventricle
The right ventricle occupies most of the anterior cardiac surface and is easily
accessible to palpation.
What is responsible for the inspiratory splitting of S2?
A) Closure of aortic, then pulmonic valves
4|Page
COMPLETE QUESTIONS AND CORRECT D, Exams of Nursing
A 62-year-old smoker complains of "coughing up small amounts of blood," so you
consider hemoptysis. Which of the following should you also consider?
A) Intestinal bleeding
B) Hematoma of the nasal septum
C) Epistaxis
D) Bruising of the tongue C) Epistaxis
When you suspect hemoptysis, you must consider other etiologies for bleeding.
Commonly, epistaxis can mimic this as well as bleeding from the gastrointestinal tract.
The other
answers, although they involve bleeding, are contained or distant from the pharynx.
Which of the following occurs in respiratory distress?
A) Speaking in sentences of 10-20 words
B) Skin between the ribs moves inward with inspiration
C) Neck muscles are relaxed
D) Patient torso leans posteriorly B) Skin between the ribs moves inward with
inspiration
This description is consistent with retractions that occur with respiratory distress. Other
features include speaking in short sentences, use of accessory muscles, leaning forward
to gain mechanical advantage for the diaphragm, and pursed lip breathing, in which the
patient
exhales against his lips, which are pressed together.
Which of the following is consistent with good percussion technique?
A) Allow all of the fingers to touch the chest while performing percussion.
B) Maintain a stiff wrist and hand.
C) Leave the plexor finger on the pleximeter after each strike.
D) Strike the pleximeter over the distal interphalangeal joint. D) Strike the pleximeter
over the distal interphalangeal joint
1|Page
,Percussion takes practice to master. Most struggle initially with keeping the wrist and
hand relaxed. Other challenges include removing the plexor quickly and keeping the
other
fingers off the chest wall.
Which of the following percussion notes would you obtain over the gastric bubble?
A) Resonance
B) Tympany
C) Hyperresonance
D) Flatness B) Tympany
The gastric bubble produces one of the longest percussion notes. A patient with
COPD may have hyperresonance over his chest, while a normal person would have
resonance.
Dullness is heard over a normal liver, and flatness is heard if one percusses a large
muscle.
Which of the following conditions would produce a hyperresonant percussion note?
A) Large pneumothorax
B) Lobar pneumonia
C) Pleural effusion
D) Empyema A) Large pneumothorax
There is a great deal of free air in the chest with a large pneumothorax, which
produces a hyperresonant note. The other three conditions produce dullness by
dampening the
percussion note with fluid.
Which lung sound possesses the characteristics of being louder and higher in pitch, with
a short silence between inspiration and expiration and with expiration being longer than
inspiration?
A) Bronchovesicular
B) Vesicular
C) Bronchial
2|Page
,D) Tracheal C) Bronchial
A patient complains of shortness of breath for the past few days. On examination, you
note late inspiratory crackles in the lower third of the chest that were not present a
week ago.
What is the most likely explanation for these?
A) Asthma
B) COPD
C) Bronchiectasis
D) Heart failure D) Heart failure
The timing of crackles within inspiration provides important clues. These late
inspiratory crackles that appeared suddenly would be most consistent with heart failure.
COPD
and asthma usually produce early inspiratory crackles. Bronchiectasis, as seen in cystic
fibrosis, classically produces mid-inspiratory crackles, but this is not always reliable.
When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely
etiology?
A) Bronchitis
B) Simple asthma
C) Cystic fibrosis
D) Heart failure A) Bronchitis
Adventitious sounds that clear with cough are usually consistent with bronchitis or
atelectasis. The other conditions would not be associated with findings that cleared with
a cough.
A patient with longstanding COPD was told by another practitioner that his liver was
enlarged and this needed to be assessed. Which of the following would be reasonable to
do next?
A) Percuss the lower border of the liver
B) Measure the span of the liver
C) Order a hepatitis panel
D) Obtain an ultrasound of the liver B) Measure the span of the liver
3|Page
, In this patient, measuring the span of the liver saved the patient an involved workup,
because it was normal. His history of COPD is consistent with flattening of the
diaphragms, which pushed the liver edge down while the actual size of the liver
remained the same. Percussing the lower border of the liver alone caused this referral,
because it was assumed that
the liver was enlarged.
You are at your family reunion playing football when your uncle takes a hit to his right
lateral thorax and is in pain. He asks you if you think he has a rib fracture. You are in a
very
remote area. What would your next step be?
A) Call a medevac helicopter
B) Drive him to the city (4 hours away)
C) Press on his sternum and spine simultaneously
D) Examine him for tenderness over the injured area C) Press on his sternum and spine
simultaneously
The area involved in the injury will of course be tender. If you press in an area
remote to the injury, but over the same bone which may be involved, you can produce
tenderness
at the site of injury. This would indicate that there may be a fracture at the lateral ribs.
You are performing a thorough cardiac examination. Which of the following chambers of
the heart can you assess by palpation?
A) Left atrium
B) Right atrium
C) Right ventricle
D) Sinus node C) Right ventricle
The right ventricle occupies most of the anterior cardiac surface and is easily
accessible to palpation.
What is responsible for the inspiratory splitting of S2?
A) Closure of aortic, then pulmonic valves
4|Page
