R 509 / NR509 ADVANCED
N
PHYSICAL ASSESSMENT FINAL
EXAM QUIZ BANK 2021-2022 |
Questions & Answers | Highly Rated |
Chamberlain College | Pass
Guaranteed - A+ Graded
ART A: MULTIPLE CHOICE (Q1–100)
P
Q1 (Health History – Interviewing Technique):
A 42-year-old patient presents with vague abdominal discomfort. During the history-taking
interview, the advanced practice nurse asks, "Can you describe what the pain feels like and
when it started?" This questioning technique is best described as:
A. Closed-ended questioning
B. Leading questioning
C. Open-ended questioning
D. Confrontational questioning
[CORRECT] C
Rationale: Open-ended questioning encourages patients to describe symptoms in their own
words, yielding richer clinical data; closed-ended questions (A) limit responses to yes/no or
specific facts and are better suited for clarifying details later; leading questions (B) suggest
answers and may bias the patient's response, compromising history accuracy; this technique is
foundational to therapeutic communication and patient-centered care in advanced practice.
Q2 (Health History – OLDCARTS):
When documenting the history of present illness (HPI) for a patient with chest pain, the
advanced practice nurse uses the OLDCARTS mnemonic. The "R" in OLDCARTS specifically
refers to:
A. Recurrence
B. Radiation
C. Reproducibility
D. Relief
[CORRECT] B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating
factors, Radiation, Timing, and Severity; radiation (B) identifies whether pain spreads to other
, reas, which is critical for differentiating cardiac from musculoskeletal chest pain; while relief (D)
a
and reproducibility (C) are important clinical features, they are captured under
aggravating/alleviating factors in the standard mnemonic.
Q3 (Health History – Cultural Competence):
A 65-year-old Vietnamese-American patient avoids eye contact during the interview. The most
appropriate advanced practice response is:
A. Directly ask the patient to make eye contact to establish rapport
B. Recognize this may reflect cultural respect and continue the interview without judgment
C. Document that the patient is depressed and administer a PHQ-9
D. Immediately request a professional interpreter
[CORRECT] B
Rationale: In many Asian cultures, avoiding eye contact with authority figures demonstrates
respect rather than depression or evasiveness; imposing Western norms (A) undermines
cultural competence and therapeutic alliance; depression screening (C) without additional
supporting evidence is premature and potentially stereotyping; an interpreter (D) is unnecessary
if the patient communicates effectively in English.
Q4 (Health History – Health Literacy):
The advanced practice nurse suspects limited health literacy when a patient with diabetes
repeatedly demonstrates inability to:
A. Name their current medications
B. Explain the purpose of metformin in simple terms
C. Recall the exact date of their last HbA1c test
D. State their physician's full name
[CORRECT] B
Rationale: The inability to explain medication purpose in plain language (teach-back method) is
a sensitive indicator of limited health literacy; while medication recall (A) may indicate
adherence issues, it does not specifically assess comprehension; exact date recall (C) and
physician naming (D) test memory rather than functional health literacy, which is the capacity to
understand and act on health information.
Q5 (Health History – Substance Use Screening):
During a routine wellness visit, the advanced practice nurse screens for alcohol misuse using
the AUDIT-C. A positive screen in a male patient is indicated by a score of:
A. ≥ 2 points
B. ≥ 3 points
C. ≥ 4 points
D. ≥ 5 points
[CORRECT] C
Rationale: The AUDIT-C uses a cutoff of ≥4 for men and ≥3 for women to identify hazardous
drinking or active alcohol use disorders; the lower threshold for women (B) reflects increased
biological vulnerability to alcohol-related harm; scores ≥2 (A) are too sensitive and would
generate excessive false positives; ≥5 (D) would miss significant at-risk drinking in male
patients.
Q6 (Health History – Emergency Red Flags):
Which finding during a focused history requires immediate emergency department referral?
, . Sudden onset "thunderclap" headache described as "worst headache of my life"
A
B. Intermittent chest pain relieved by rest over the past 2 weeks
C. Gradual onset dyspnea on exertion over 3 months
D. Chronic low back pain unchanged for 6 months
[CORRECT] A
Rationale: A thunderclap headache is the hallmark presentation of subarachnoid hemorrhage, a
neurosurgical emergency requiring immediate CT imaging and intervention; stable angina (B)
warrants urgent but not emergent evaluation; progressive dyspnea (C) requires diagnostic
workup but allows for outpatient management; chronic stable back pain (D) does not indicate
acute pathology.
Q7 (Mental Status – Appearance):
During the mental status examination, the advanced practice nurse notes the patient wears a
winter coat in a 78°F room and has multiple layers of mismatched clothing. This finding primarily
assesses which MSE component?
A. Insight
B. Judgment
C. Appearance
D. Affect
[CORRECT] C
Rationale: Appearance encompasses dress, grooming, hygiene, and body habitus, with
inappropriate clothing for environmental temperature suggesting potential cognitive impairment,
psychosis, or self-neglect; insight (A) refers to awareness of illness, judgment (B) to
decision-making capacity, and affect (D) to the observable expression of emotional state—none
are primarily assessed by clothing choices.
Q8 (Mental Status – Speech):
A patient demonstrates rapid, continuous speech that jumps between unrelated topics. The
advanced practice nurse documents this as:
A. Pressured speech
B. Flight of ideas
C. Circumstantiality
D. Tangentiality
[CORRECT] B
Rationale: Flight of ideas describes accelerated speech with abrupt shifts between loosely
connected topics, characteristic of mania; pressured speech (A) refers to rapid speech that is
difficult to interrupt but may remain on one topic; circumstantiality (C) involves indirect speech
that eventually reaches the point; tangentiality (D) diverges completely from the original topic
without returning.
Q9 (Mental Status – Cognitive Screening):
A 70-year-old patient scores 24/30 on the MMSE. The advanced practice nurse correctly
interprets this as:
A. Normal cognition
B. Mild cognitive impairment
C. Moderate cognitive impairment
D. Severe cognitive impairment
, [CORRECT] B
Rationale: MMSE scores of 24-30 indicate mild cognitive impairment (education-adjusted), with
24-26 often representing mild impairment in college-educated individuals; scores 18-23 suggest
moderate impairment (C), 10-17 moderate-severe, and <10 severe (D); normal cognition (A)
typically requires scores ≥27, though norms vary by education level.
Q10 (Mental Status – Depression Screening):
The PHQ-2 is used as an initial depression screen. A positive screen requires the patient to
report problems with which domains over the past 2 weeks?
A. Sleep and appetite
B. Anhedonia and depressed mood
C. Concentration and psychomotor changes
D. Fatigue and guilt
[CORRECT] B
Rationale: The PHQ-2 screens for anhedonia (little interest or pleasure in doing things) and
depressed mood (feeling down, depressed, or hopeless), the two cardinal symptoms of major
depression; a positive screen on either item (score ≥3) triggers full PHQ-9 administration;
sleep/appetite (A), concentration/psychomotor (C), and fatigue/guilt (D) are assessed in the full
PHQ-9 but not the two-item screen.
Q11 (Head/Neck – Eye Exam – Visual Fields):
The advanced practice nurse performs confrontation visual field testing. The patient fails to see
the examiner's fingers in the temporal field of the right eye. This finding suggests a lesion of the:
A. Right optic nerve
B. Left optic tract
C. Right temporal retina
D. Left occipital cortex
[CORRECT] D
Rationale: Temporal visual field loss in the right eye (right homonymous hemianopia) localizes
to the left occipital cortex, as temporal retinal fibers project to the nasal visual field and cross at
the chiasm; right optic nerve lesion (A) would cause complete monocular vision loss; left optic
tract lesion (B) causes left homonymous hemianopia; right temporal retina (C) would affect
nasal visual field, not temporal.
Q12 (Head/Neck – Eye Exam – Pupils):
During pupillary examination, the advanced practice nurse observes that shining a light in the
right eye causes constriction of both pupils, but shining light in the left eye causes only left pupil
constriction. This indicates:
A. Left direct and consensual reflex intact
B. Right afferent pupillary defect (Marcus Gunn pupil)
C. Left efferent pupillary defect
D. Bilateral Argyll Robertson pupils
[CORRECT] C
Rationale: Intact direct reflex in the left eye with absent consensual response in the right eye
indicates a left efferent (motor) defect, as the afferent signal from the left eye reaches both
pretectal nuclei but cannot exit to the right pupil; a right afferent defect (B) would show poor
N
PHYSICAL ASSESSMENT FINAL
EXAM QUIZ BANK 2021-2022 |
Questions & Answers | Highly Rated |
Chamberlain College | Pass
Guaranteed - A+ Graded
ART A: MULTIPLE CHOICE (Q1–100)
P
Q1 (Health History – Interviewing Technique):
A 42-year-old patient presents with vague abdominal discomfort. During the history-taking
interview, the advanced practice nurse asks, "Can you describe what the pain feels like and
when it started?" This questioning technique is best described as:
A. Closed-ended questioning
B. Leading questioning
C. Open-ended questioning
D. Confrontational questioning
[CORRECT] C
Rationale: Open-ended questioning encourages patients to describe symptoms in their own
words, yielding richer clinical data; closed-ended questions (A) limit responses to yes/no or
specific facts and are better suited for clarifying details later; leading questions (B) suggest
answers and may bias the patient's response, compromising history accuracy; this technique is
foundational to therapeutic communication and patient-centered care in advanced practice.
Q2 (Health History – OLDCARTS):
When documenting the history of present illness (HPI) for a patient with chest pain, the
advanced practice nurse uses the OLDCARTS mnemonic. The "R" in OLDCARTS specifically
refers to:
A. Recurrence
B. Radiation
C. Reproducibility
D. Relief
[CORRECT] B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating/Alleviating
factors, Radiation, Timing, and Severity; radiation (B) identifies whether pain spreads to other
, reas, which is critical for differentiating cardiac from musculoskeletal chest pain; while relief (D)
a
and reproducibility (C) are important clinical features, they are captured under
aggravating/alleviating factors in the standard mnemonic.
Q3 (Health History – Cultural Competence):
A 65-year-old Vietnamese-American patient avoids eye contact during the interview. The most
appropriate advanced practice response is:
A. Directly ask the patient to make eye contact to establish rapport
B. Recognize this may reflect cultural respect and continue the interview without judgment
C. Document that the patient is depressed and administer a PHQ-9
D. Immediately request a professional interpreter
[CORRECT] B
Rationale: In many Asian cultures, avoiding eye contact with authority figures demonstrates
respect rather than depression or evasiveness; imposing Western norms (A) undermines
cultural competence and therapeutic alliance; depression screening (C) without additional
supporting evidence is premature and potentially stereotyping; an interpreter (D) is unnecessary
if the patient communicates effectively in English.
Q4 (Health History – Health Literacy):
The advanced practice nurse suspects limited health literacy when a patient with diabetes
repeatedly demonstrates inability to:
A. Name their current medications
B. Explain the purpose of metformin in simple terms
C. Recall the exact date of their last HbA1c test
D. State their physician's full name
[CORRECT] B
Rationale: The inability to explain medication purpose in plain language (teach-back method) is
a sensitive indicator of limited health literacy; while medication recall (A) may indicate
adherence issues, it does not specifically assess comprehension; exact date recall (C) and
physician naming (D) test memory rather than functional health literacy, which is the capacity to
understand and act on health information.
Q5 (Health History – Substance Use Screening):
During a routine wellness visit, the advanced practice nurse screens for alcohol misuse using
the AUDIT-C. A positive screen in a male patient is indicated by a score of:
A. ≥ 2 points
B. ≥ 3 points
C. ≥ 4 points
D. ≥ 5 points
[CORRECT] C
Rationale: The AUDIT-C uses a cutoff of ≥4 for men and ≥3 for women to identify hazardous
drinking or active alcohol use disorders; the lower threshold for women (B) reflects increased
biological vulnerability to alcohol-related harm; scores ≥2 (A) are too sensitive and would
generate excessive false positives; ≥5 (D) would miss significant at-risk drinking in male
patients.
Q6 (Health History – Emergency Red Flags):
Which finding during a focused history requires immediate emergency department referral?
, . Sudden onset "thunderclap" headache described as "worst headache of my life"
A
B. Intermittent chest pain relieved by rest over the past 2 weeks
C. Gradual onset dyspnea on exertion over 3 months
D. Chronic low back pain unchanged for 6 months
[CORRECT] A
Rationale: A thunderclap headache is the hallmark presentation of subarachnoid hemorrhage, a
neurosurgical emergency requiring immediate CT imaging and intervention; stable angina (B)
warrants urgent but not emergent evaluation; progressive dyspnea (C) requires diagnostic
workup but allows for outpatient management; chronic stable back pain (D) does not indicate
acute pathology.
Q7 (Mental Status – Appearance):
During the mental status examination, the advanced practice nurse notes the patient wears a
winter coat in a 78°F room and has multiple layers of mismatched clothing. This finding primarily
assesses which MSE component?
A. Insight
B. Judgment
C. Appearance
D. Affect
[CORRECT] C
Rationale: Appearance encompasses dress, grooming, hygiene, and body habitus, with
inappropriate clothing for environmental temperature suggesting potential cognitive impairment,
psychosis, or self-neglect; insight (A) refers to awareness of illness, judgment (B) to
decision-making capacity, and affect (D) to the observable expression of emotional state—none
are primarily assessed by clothing choices.
Q8 (Mental Status – Speech):
A patient demonstrates rapid, continuous speech that jumps between unrelated topics. The
advanced practice nurse documents this as:
A. Pressured speech
B. Flight of ideas
C. Circumstantiality
D. Tangentiality
[CORRECT] B
Rationale: Flight of ideas describes accelerated speech with abrupt shifts between loosely
connected topics, characteristic of mania; pressured speech (A) refers to rapid speech that is
difficult to interrupt but may remain on one topic; circumstantiality (C) involves indirect speech
that eventually reaches the point; tangentiality (D) diverges completely from the original topic
without returning.
Q9 (Mental Status – Cognitive Screening):
A 70-year-old patient scores 24/30 on the MMSE. The advanced practice nurse correctly
interprets this as:
A. Normal cognition
B. Mild cognitive impairment
C. Moderate cognitive impairment
D. Severe cognitive impairment
, [CORRECT] B
Rationale: MMSE scores of 24-30 indicate mild cognitive impairment (education-adjusted), with
24-26 often representing mild impairment in college-educated individuals; scores 18-23 suggest
moderate impairment (C), 10-17 moderate-severe, and <10 severe (D); normal cognition (A)
typically requires scores ≥27, though norms vary by education level.
Q10 (Mental Status – Depression Screening):
The PHQ-2 is used as an initial depression screen. A positive screen requires the patient to
report problems with which domains over the past 2 weeks?
A. Sleep and appetite
B. Anhedonia and depressed mood
C. Concentration and psychomotor changes
D. Fatigue and guilt
[CORRECT] B
Rationale: The PHQ-2 screens for anhedonia (little interest or pleasure in doing things) and
depressed mood (feeling down, depressed, or hopeless), the two cardinal symptoms of major
depression; a positive screen on either item (score ≥3) triggers full PHQ-9 administration;
sleep/appetite (A), concentration/psychomotor (C), and fatigue/guilt (D) are assessed in the full
PHQ-9 but not the two-item screen.
Q11 (Head/Neck – Eye Exam – Visual Fields):
The advanced practice nurse performs confrontation visual field testing. The patient fails to see
the examiner's fingers in the temporal field of the right eye. This finding suggests a lesion of the:
A. Right optic nerve
B. Left optic tract
C. Right temporal retina
D. Left occipital cortex
[CORRECT] D
Rationale: Temporal visual field loss in the right eye (right homonymous hemianopia) localizes
to the left occipital cortex, as temporal retinal fibers project to the nasal visual field and cross at
the chiasm; right optic nerve lesion (A) would cause complete monocular vision loss; left optic
tract lesion (B) causes left homonymous hemianopia; right temporal retina (C) would affect
nasal visual field, not temporal.
Q12 (Head/Neck – Eye Exam – Pupils):
During pupillary examination, the advanced practice nurse observes that shining a light in the
right eye causes constriction of both pupils, but shining light in the left eye causes only left pupil
constriction. This indicates:
A. Left direct and consensual reflex intact
B. Right afferent pupillary defect (Marcus Gunn pupil)
C. Left efferent pupillary defect
D. Bilateral Argyll Robertson pupils
[CORRECT] C
Rationale: Intact direct reflex in the left eye with absent consensual response in the right eye
indicates a left efferent (motor) defect, as the afferent signal from the left eye reaches both
pretectal nuclei but cannot exit to the right pupil; a right afferent defect (B) would show poor
