NR 509 ADVANCED PHYSICAL ASSESSMENT EXAM / NR 509
ADVANCED PHYSICAL ASSESSMENT APPROVED FINAL EXAM
2026/2027 PREP QUESTIONS & STUDY GUIDE COMPLETE ACTUAL
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2026 EDITION GUARANTEED SUCCESS A+
(BRAND NEW!) FULL REVISED NR 509 ADVANCED PHYSICAL
ASSESSMENT REAL EXAM
1. A 65-year-old male presents with complaints of chest pressure that radiates to
his left arm. The pain began 30 minutes ago while he was shoveling snow. Which
of the following findings would be most concerning for acute coronary syndrome?
A) Pain that improves with rest
B) Pain that is reproducible with palpation
C) Pain associated with diaphoresis and nausea
D) Pain described as pressure with radiation to the jaw and left arm
E) Pain that worsens with deep inspiration
Correct Answer: D
Rationale: Acute coronary syndrome typically presents with substernal chest
pressure or pain that may radiate to the left arm, jaw, or back. Associated
symptoms include diaphoresis, nausea, and shortness of breath. Pain that
improves with rest suggests stable angina. Reproducible pain with palpation
suggests musculoskeletal origin. Pain worsening with inspiration suggests
pericarditis or pulmonary pathology.
,2. During cardiac auscultation, you hear a high-pitched, blowing diastolic murmur
at the left sternal border. The patient is in the seated position leaning forward. This
finding is most consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Tricuspid stenosis
D) Pulmonary regurgitation
E) Mitral valve prolapse
Correct Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic
decrescendo murmur best heard at the left sternal border (Erb's point) with the
patient leaning forward and in expiration. Mitral stenosis produces a low-
pitched, rumbling diastolic murmur with an opening snap. Tricuspid stenosis
produces a diastolic rumble at the left lower sternal border. Pulmonary
regurgitation produces a diastolic decrescendo murmur at the left upper sternal
border.
3. Which of the following jugular venous pressure (JVP) measurements indicates
right-sided heart failure?
A) JVP less than 3 cm H₂O
B) JVP greater than 4 cm H₂O above the sternal angle
C) JVP equal to 2 cm H₂O
D) JVP measured at the mid-clavicular line
E) Absence of visible jugular venous pulsations
,Correct Answer: B
Rationale: Normal JVP is less than 3-4 cm H₂O above the sternal angle (or 8-9
cm H₂O above the right atrium). Elevated JVP (>4 cm above sternal angle)
indicates increased right atrial pressure, suggesting right-sided heart failure,
constrictive pericarditis, or tricuspid stenosis. Measurement should be taken at
the angle of Louis with the patient at 45 degrees.
4. A 55-year-old female presents with fatigue and dyspnea on exertion. Cardiac
examination reveals a mid-systolic ejection murmur at the right upper sternal
border that radiates to the carotids. The murmur increases with squatting. This
presentation is consistent with:
A) Mitral regurgitation
B) Aortic regurgitation
C) Aortic stenosis
D) Pulmonic stenosis
E) Hypertrophic cardiomyopathy
Correct Answer: C
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic
ejection murmur at the right upper sternal border with radiation to the carotids.
Squatting increases venous return and cardiac output, amplifying the murmur.
Hypertrophic cardiomyopathy produces a similar murmur that decreases with
squatting and increases with Valsalva. Mitral regurgitation produces a
holosystolic murmur at the apex radiating to the axilla.
, 5. When assessing a patient's peripheral pulses, you note diminished dorsalis pedis
pulses bilaterally with capillary refill time of 4 seconds. The most appropriate next
step is:
A) Order immediate vascular surgery consultation
B) Document as normal finding in elderly patients
C) Perform Allen's test
D) Obtain ankle-brachial index (ABI) measurements
E) Start antiplatelet therapy immediately
Correct Answer: D
Rationale: Diminished peripheral pulses with prolonged capillary refill suggest
peripheral arterial disease. Ankle-brachial index (ABI) is the appropriate non-
invasive test to confirm diagnosis. Normal ABI is 0.9-1.3; values <0.9 indicate
PAD. While consultation may be needed, ABI provides objective documentation.
Documentation as normal would be incorrect as this indicates pathology.
6. A patient presents with a "tearing" chest pain that radiates to the back. Blood
pressure is 180/95 mmHg in the right arm and 140/80 mmHg in the left arm. These
findings suggest:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
E) Esophageal rupture
ADVANCED PHYSICAL ASSESSMENT APPROVED FINAL EXAM
2026/2027 PREP QUESTIONS & STUDY GUIDE COMPLETE ACTUAL
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (100% CORRECT VERIFIED SOLUTIONS) LATEST
UPDATED VERSION 2026 EDITION GUARANTEED SUCCESS A+
(BRAND NEW!) FULL REVISED NR 509 ADVANCED PHYSICAL
ASSESSMENT REAL EXAM
1. A 65-year-old male presents with complaints of chest pressure that radiates to
his left arm. The pain began 30 minutes ago while he was shoveling snow. Which
of the following findings would be most concerning for acute coronary syndrome?
A) Pain that improves with rest
B) Pain that is reproducible with palpation
C) Pain associated with diaphoresis and nausea
D) Pain described as pressure with radiation to the jaw and left arm
E) Pain that worsens with deep inspiration
Correct Answer: D
Rationale: Acute coronary syndrome typically presents with substernal chest
pressure or pain that may radiate to the left arm, jaw, or back. Associated
symptoms include diaphoresis, nausea, and shortness of breath. Pain that
improves with rest suggests stable angina. Reproducible pain with palpation
suggests musculoskeletal origin. Pain worsening with inspiration suggests
pericarditis or pulmonary pathology.
,2. During cardiac auscultation, you hear a high-pitched, blowing diastolic murmur
at the left sternal border. The patient is in the seated position leaning forward. This
finding is most consistent with:
A) Mitral stenosis
B) Aortic regurgitation
C) Tricuspid stenosis
D) Pulmonary regurgitation
E) Mitral valve prolapse
Correct Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic
decrescendo murmur best heard at the left sternal border (Erb's point) with the
patient leaning forward and in expiration. Mitral stenosis produces a low-
pitched, rumbling diastolic murmur with an opening snap. Tricuspid stenosis
produces a diastolic rumble at the left lower sternal border. Pulmonary
regurgitation produces a diastolic decrescendo murmur at the left upper sternal
border.
3. Which of the following jugular venous pressure (JVP) measurements indicates
right-sided heart failure?
A) JVP less than 3 cm H₂O
B) JVP greater than 4 cm H₂O above the sternal angle
C) JVP equal to 2 cm H₂O
D) JVP measured at the mid-clavicular line
E) Absence of visible jugular venous pulsations
,Correct Answer: B
Rationale: Normal JVP is less than 3-4 cm H₂O above the sternal angle (or 8-9
cm H₂O above the right atrium). Elevated JVP (>4 cm above sternal angle)
indicates increased right atrial pressure, suggesting right-sided heart failure,
constrictive pericarditis, or tricuspid stenosis. Measurement should be taken at
the angle of Louis with the patient at 45 degrees.
4. A 55-year-old female presents with fatigue and dyspnea on exertion. Cardiac
examination reveals a mid-systolic ejection murmur at the right upper sternal
border that radiates to the carotids. The murmur increases with squatting. This
presentation is consistent with:
A) Mitral regurgitation
B) Aortic regurgitation
C) Aortic stenosis
D) Pulmonic stenosis
E) Hypertrophic cardiomyopathy
Correct Answer: C
Rationale: Aortic stenosis produces a harsh, crescendo-decrescendo systolic
ejection murmur at the right upper sternal border with radiation to the carotids.
Squatting increases venous return and cardiac output, amplifying the murmur.
Hypertrophic cardiomyopathy produces a similar murmur that decreases with
squatting and increases with Valsalva. Mitral regurgitation produces a
holosystolic murmur at the apex radiating to the axilla.
, 5. When assessing a patient's peripheral pulses, you note diminished dorsalis pedis
pulses bilaterally with capillary refill time of 4 seconds. The most appropriate next
step is:
A) Order immediate vascular surgery consultation
B) Document as normal finding in elderly patients
C) Perform Allen's test
D) Obtain ankle-brachial index (ABI) measurements
E) Start antiplatelet therapy immediately
Correct Answer: D
Rationale: Diminished peripheral pulses with prolonged capillary refill suggest
peripheral arterial disease. Ankle-brachial index (ABI) is the appropriate non-
invasive test to confirm diagnosis. Normal ABI is 0.9-1.3; values <0.9 indicate
PAD. While consultation may be needed, ABI provides objective documentation.
Documentation as normal would be incorrect as this indicates pathology.
6. A patient presents with a "tearing" chest pain that radiates to the back. Blood
pressure is 180/95 mmHg in the right arm and 140/80 mmHg in the left arm. These
findings suggest:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
E) Esophageal rupture
