1
NR 509 ADVANCED PHYSICAL ASSESSMENT MIDTERM EXAM]
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
*Core Domains:
• Comprehensive Health History and Interviewing
• General Survey and Vital Signs
• Skin, Hair, and Nail Assessment
• Head, Eyes, Ears, Nose, and Throat (HEENT)
• Neck, Thyroid, and Lymphatics
• Respiratory and Cardiovascular Assessment
• Abdominal, Genitourinary, and Rectal Assessment
• Musculoskeletal and Neurological Assessment
• Pediatric, Geriatric, and Pregnant Patient Variations
• Clinical Reasoning, Documentation, and Health Promotion*
Introduction:
This comprehensive midterm examination assesses the advanced knowledge,
systematic assessment skills, and clinical reasoning required for graduate nursing
practice. The exam evaluates history-taking, inspection, palpation, percussion, and
auscultation techniques; interpretation of normal and abnormal findings; and
integration of physical assessment data into clinical decision-making. Multiple-
choice and scenario-based questions mirror real patient encounters, requiring
prioritization, accurate documentation, and culturally sensitive communication.
Successful performance confirms readiness to perform advanced health
pg. 1
,2
assessments and to differentiate common, benign, and urgent findings across the
lifespan in primary care and acute settings.
SECTION ONE: QUESTIONS 1–100
1. A 58-year-old man reports shortness of breath that awakens him at night
and is relieved by sitting up. Which term should the nurse document?
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Platypnea
C. Paroxysmal nocturnal dyspnea
RATIONALE: Paroxysmal nocturnal dyspnea (PND) is sudden dyspnea
that occurs during sleep and is relieved by sitting upright, often associated
with left-sided heart failure. Orthopnea is dyspnea when lying flat; dyspnea
on exertion occurs with activity; platypnea is dyspnea relieved by lying
down.
2. During a general survey, the nurse notes a client using pursed-lip breathing,
in a tripod position, and with a barrel-shaped chest. These findings are
most consistent with:
A. Acute appendicitis
B. Chronic obstructive pulmonary disease
C. Myocardial infarction
D. Anxiety attack only
B. Chronic obstructive pulmonary disease
RATIONALE: Barrel chest, pursed-lip breathing, and tripod positioning
are classic signs of COPD, reflecting hyperinflation, air trapping, and
increased work of breathing.
3. Which is the correct sequence for abdominal assessment?
A. Palpation, auscultation, inspection, percussion
B. Inspection, auscultation, percussion, palpation
C. Auscultation, palpation, inspection, percussion
D. Inspection, palpation, percussion, auscultation
pg. 2
,3
B. Inspection, auscultation, percussion, palpation
RATIONALE: The abdominal assessment sequence is inspection,
auscultation, percussion, then palpation. Auscultation before
palpation/percussion prevents alteration of bowel sounds.
4. The nurse asks a client to say “ninety-nine” while auscultating the chest and
notes increased clarity and loudness of the voice. This finding is called:
A. Bronchophony
B. Egophony
C. Whispered pectoriloquy
D. Fremitus
A. Bronchophony
RATIONALE: Bronchophony is increased clarity and loudness of spoken
voice over consolidated lung tissue. Egophony is a change of “E” to “A”;
whispered pectoriloquy is whispered words heard clearly; fremitus is
palpable vibration.
5. A client has a painful, vesicular rash in a unilateral dermatomal distribution
on the trunk. The nurse should suspect:
A. Herpes simplex
B. Cellulitis
C. Herpes zoster (shingles)
D. Contact dermatitis
C. Herpes zoster (shingles)
RATIONALE: Herpes zoster (shingles) presents as a painful or burning
vesicular rash along a dermatome, not crossing the midline, due to
reactivation of varicella-zoster virus. Herpes simplex is usually oral or
genital; cellulitis is diffuse; contact dermatitis is not dermatomal.
6. Which lymph node group is located just anterior to the ear?
A. Posterior auricular
B. Preauricular
C. Submental
D. Supraclavicular
B. Preauricular
RATIONALE: Preauricular lymph nodes are located just in front of the
pg. 3
, 4
ear. Posterior auricular are behind the ear; submental are under the chin;
supraclavicular are above the clavicle and may indicate malignancy if
enlarged.
7. The nurse palpates a client’s radial pulse and notes it is absent on the left
but present on the right. Which assessment should be performed first?
A. Check the left pedal pulse only
B. Measure blood pressure in both arms
C. Auscultate the carotid arteries only
D. Document and discharge
B. Measure blood pressure in both arms
RATIONALE: A decreased or absent radial pulse on one side may
indicate arterial occlusion, dissection, or coarctation. Measuring blood
pressure in both arms is essential to identify a significant discrepancy.
8. Which technique is correct to assess the pupillary light reflex?
A. Shine a light directly into one eye and observe constriction of both pupils
B. Ask the client to focus on a distant object and then on your finger
C. Cover one eye and observe movement of the uncovered eye
D. Use an ophthalmoscope to view the red reflex only
A. Shine a light directly into one eye and observe constriction of both
pupils
RATIONALE: The pupillary light reflex tests direct and consensual
responses: when light is shined in one eye, both the ipsilateral (direct) and
contralateral (consensual) pupils should constrict.
9. A client reports hearing a “whooshing” sound in one ear that is
synchronous with the pulse. The nurse should suspect:
A. Tinnitus
B. Bruit or vascular anomaly
C. Meniere disease
D. Otitis media
B. Bruit or vascular anomaly
RATIONALE: Pulsatile tinnitus—a rhythmic whooshing matching the
heartbeat—may indicate a vascular cause such as carotid stenosis,
pg. 4
NR 509 ADVANCED PHYSICAL ASSESSMENT MIDTERM EXAM]
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
*Core Domains:
• Comprehensive Health History and Interviewing
• General Survey and Vital Signs
• Skin, Hair, and Nail Assessment
• Head, Eyes, Ears, Nose, and Throat (HEENT)
• Neck, Thyroid, and Lymphatics
• Respiratory and Cardiovascular Assessment
• Abdominal, Genitourinary, and Rectal Assessment
• Musculoskeletal and Neurological Assessment
• Pediatric, Geriatric, and Pregnant Patient Variations
• Clinical Reasoning, Documentation, and Health Promotion*
Introduction:
This comprehensive midterm examination assesses the advanced knowledge,
systematic assessment skills, and clinical reasoning required for graduate nursing
practice. The exam evaluates history-taking, inspection, palpation, percussion, and
auscultation techniques; interpretation of normal and abnormal findings; and
integration of physical assessment data into clinical decision-making. Multiple-
choice and scenario-based questions mirror real patient encounters, requiring
prioritization, accurate documentation, and culturally sensitive communication.
Successful performance confirms readiness to perform advanced health
pg. 1
,2
assessments and to differentiate common, benign, and urgent findings across the
lifespan in primary care and acute settings.
SECTION ONE: QUESTIONS 1–100
1. A 58-year-old man reports shortness of breath that awakens him at night
and is relieved by sitting up. Which term should the nurse document?
A. Dyspnea on exertion
B. Orthopnea
C. Paroxysmal nocturnal dyspnea
D. Platypnea
C. Paroxysmal nocturnal dyspnea
RATIONALE: Paroxysmal nocturnal dyspnea (PND) is sudden dyspnea
that occurs during sleep and is relieved by sitting upright, often associated
with left-sided heart failure. Orthopnea is dyspnea when lying flat; dyspnea
on exertion occurs with activity; platypnea is dyspnea relieved by lying
down.
2. During a general survey, the nurse notes a client using pursed-lip breathing,
in a tripod position, and with a barrel-shaped chest. These findings are
most consistent with:
A. Acute appendicitis
B. Chronic obstructive pulmonary disease
C. Myocardial infarction
D. Anxiety attack only
B. Chronic obstructive pulmonary disease
RATIONALE: Barrel chest, pursed-lip breathing, and tripod positioning
are classic signs of COPD, reflecting hyperinflation, air trapping, and
increased work of breathing.
3. Which is the correct sequence for abdominal assessment?
A. Palpation, auscultation, inspection, percussion
B. Inspection, auscultation, percussion, palpation
C. Auscultation, palpation, inspection, percussion
D. Inspection, palpation, percussion, auscultation
pg. 2
,3
B. Inspection, auscultation, percussion, palpation
RATIONALE: The abdominal assessment sequence is inspection,
auscultation, percussion, then palpation. Auscultation before
palpation/percussion prevents alteration of bowel sounds.
4. The nurse asks a client to say “ninety-nine” while auscultating the chest and
notes increased clarity and loudness of the voice. This finding is called:
A. Bronchophony
B. Egophony
C. Whispered pectoriloquy
D. Fremitus
A. Bronchophony
RATIONALE: Bronchophony is increased clarity and loudness of spoken
voice over consolidated lung tissue. Egophony is a change of “E” to “A”;
whispered pectoriloquy is whispered words heard clearly; fremitus is
palpable vibration.
5. A client has a painful, vesicular rash in a unilateral dermatomal distribution
on the trunk. The nurse should suspect:
A. Herpes simplex
B. Cellulitis
C. Herpes zoster (shingles)
D. Contact dermatitis
C. Herpes zoster (shingles)
RATIONALE: Herpes zoster (shingles) presents as a painful or burning
vesicular rash along a dermatome, not crossing the midline, due to
reactivation of varicella-zoster virus. Herpes simplex is usually oral or
genital; cellulitis is diffuse; contact dermatitis is not dermatomal.
6. Which lymph node group is located just anterior to the ear?
A. Posterior auricular
B. Preauricular
C. Submental
D. Supraclavicular
B. Preauricular
RATIONALE: Preauricular lymph nodes are located just in front of the
pg. 3
, 4
ear. Posterior auricular are behind the ear; submental are under the chin;
supraclavicular are above the clavicle and may indicate malignancy if
enlarged.
7. The nurse palpates a client’s radial pulse and notes it is absent on the left
but present on the right. Which assessment should be performed first?
A. Check the left pedal pulse only
B. Measure blood pressure in both arms
C. Auscultate the carotid arteries only
D. Document and discharge
B. Measure blood pressure in both arms
RATIONALE: A decreased or absent radial pulse on one side may
indicate arterial occlusion, dissection, or coarctation. Measuring blood
pressure in both arms is essential to identify a significant discrepancy.
8. Which technique is correct to assess the pupillary light reflex?
A. Shine a light directly into one eye and observe constriction of both pupils
B. Ask the client to focus on a distant object and then on your finger
C. Cover one eye and observe movement of the uncovered eye
D. Use an ophthalmoscope to view the red reflex only
A. Shine a light directly into one eye and observe constriction of both
pupils
RATIONALE: The pupillary light reflex tests direct and consensual
responses: when light is shined in one eye, both the ipsilateral (direct) and
contralateral (consensual) pupils should constrict.
9. A client reports hearing a “whooshing” sound in one ear that is
synchronous with the pulse. The nurse should suspect:
A. Tinnitus
B. Bruit or vascular anomaly
C. Meniere disease
D. Otitis media
B. Bruit or vascular anomaly
RATIONALE: Pulsatile tinnitus—a rhythmic whooshing matching the
heartbeat—may indicate a vascular cause such as carotid stenosis,
pg. 4
