NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
NR509 / NR-509: ADVANCED PHYSICAL ASSESSMENT
MIDTERM EXAM (LATEST, 2026/2027) CHAMBERLAIN
Chamberlain University | College of Nursing | Graduate Nursing Program
Aligned with NR 509 Course Syllabus, AACN Essentials of Master's Education, and Advanced Physical Assessment
Competencies (2026/2027 Edition)
Total Questions: 120 Multiple Choice (4 options, single best answer)
Cognitive Mix: 20% Recall / 50% Application / 30% Analysis
Item Style: 75% Scenario-Based / 25% Direct Knowledge
Time Allotted: 3 hours (180 minutes)
Passing Score: 75% (90 of 120 correct)
Alignment: Chamberlain NR 509 Syllabus, AACN Essentials (2026/2027 Edition)
Instructions to the Candidate: Read each question stem carefully. Select the single best answer from options
A through D. Many items present clinical scenarios requiring interpretation of assessment data, prioritization,
or application of advanced physical assessment principles consistent with the AACN Essentials and
Chamberlain NR 509 course outcomes. Rationales are provided beneath each item for self-evaluation and
clinical reasoning reinforcement.
Section 1: Advanced Health History & Interviewing
15 questions covering comprehensive history, OLDCARTS/PQRST, motivational interviewing, cultural
competence, health literacy, telehealth assessment, SOAP documentation, and clinical reasoning frameworks.
Q1: The mnemonic OLDCARTS is used by the advanced practice nurse (APN) to systematically explore the history
of present illness. Which option correctly identifies all components of OLDCARTS?
A. Origin, Location, Duration, Character, Aggravating, Relieving, Timing, Severity
B. Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity *[CORRECT]*
C. Onset, Location, Disease, Character, Aggravating, Relieving, Treatment, Severity
D. Onset, Location, Duration, Characteristics, Aggravating, Relieving, Treatment, Symptoms
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, and
Severity. Option A substitutes Disease for Duration and Treatment for Timing; option C substitutes Treatment for Timing
and Symptoms for Severity; option D substitutes Origin for Onset. The NR 509 curriculum reinforces OLDCARTS (or
PQRST) as the structural backbone of every comprehensive HPI to ensure complete, reproducible, and clinically useful
documentation.
Q2: A 54-year-old male presents to the clinic with chest pain. Using the PQRST mnemonic, which question by the
APN best assesses the R (region/radiation) component?
A. On a scale of 0 to 10, how severe is the pain?
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,NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
B. Does the pain travel anywhere else in your body? *[CORRECT]*
C. When did the pain start?
D. What does the pain feel like?
Correct Answer: B
Rationale: The R in PQRST stands for Region/Radiation; asking whether the pain travels assesses radiation (e.g., chest pain
radiating to the left arm or jaw in acute coronary syndrome). Option A assesses onset (provocation/timing), option C
assesses quality, and option D assesses severity. The NR 509 curriculum requires PQRST alongside OLDCARTS so that no
dimension of the chief complaint is missed, particularly in high-stakes cardiopulmonary and abdominal scenarios.
Q3: An APN is conducting a motivational interview with a patient who has poorly controlled type 2 diabetes. The
patient states, I know I should test my blood sugar, but I just can't seem to do it regularly. Which response by the
APN best reflects the technique of reflective listening?
A. It sounds like you understand the importance of testing, but you're finding it difficult to make it a
regular habit. *[CORRECT]*
B. Why don't you try setting an alarm on your phone to remind you to test?
C. You need to test your blood sugar at least twice a day to manage your diabetes properly.
D. If you don't test regularly, your A1C will continue to rise and you may need insulin.
Correct Answer: A
Rationale: Reflective listening in motivational interviewing restates the patient's statement in the APN's own words to
confirm understanding, reduce resistance, and elicit further change talk. Option A is directive advice, option C is a closed
suggestion that offers solutions prematurely, and option D uses fear-based reasoning inconsistent with the spirit of
motivational interviewing. The AACN Essentials emphasize patient-centered communication that strengthens the therapeutic
alliance and supports self-management.
Q4: Which mnemonic, recommended by the U.S. Department of Health and Human Services, guides culturally
competent health interviews through Listen, Explain, Acknowledge, Recommend, and Negotiate?
A. LEARN *[CORRECT]*
B. SBAR
C. PQRST
D. OLDCARTS
Correct Answer: A
Rationale: The LEARN mnemonic (Listen, Explain, Acknowledge, Recommend, Negotiate) was developed by Berlin and
Fowkes and is endorsed by the U.S. DHHS as a framework for cross-cultural communication. OLDCARTS structures the
HPI, PQRST structures pain assessment, and SBAR standardizes clinical handoffs. The NR 509 curriculum integrates
LEARN with the culturally and linguistically appropriate services (CLAS) standards to reduce disparities in advanced
physical assessment.
Q5: A 67-year-old patient is newly prescribed warfarin for atrial fibrillation. The APN plans to use the teach-back
method to assess health literacy. Which statement by the APN best demonstrates teach-back technique?
A. Have you ever taken a blood thinner before?
B. Are there any side effects you would like me to explain?
C. To make sure I explained things clearly, please tell me in your own words how you will take this
medication at home. *[CORRECT]*
D. Do you understand how to take your warfarin?
Correct Answer: C
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,NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
Rationale: Teach-back places responsibility for clarity on the clinician and asks the patient to repeat information in their
own words rather than answer yes/no questions. Option A and D are closed questions that allow patients to mask
non-understanding; option C is a medication-history question. NR 509 documentation standards and the Agency for
Healthcare Research and Quality (AHRQ) recommend universal teach-back for high-risk medications such as warfarin,
insulin, and digoxin.
Q6: The APN is conducting a telehealth assessment for a 72-year-old patient with new-onset dyspnea. The video
connection is poor, the patient's face is only partially visible, and no auxiliary equipment (stethoscope, pulse
oximeter) is available in the home. Which action best demonstrates clinical reasoning in the telehealth context?
A. Ask the patient to take their own vital signs and email them later, then end the visit.
B. Proceed with history-taking only, document a normal exam, and recommend routine follow-up in 6 months.
C. Recognize the assessment limitation, ask the patient to reposition for better visualization, and arrange
an in-person evaluation given the high-risk presentation. *[CORRECT]*
D. Document the visit as a complete physical assessment and prescribe a diuretic based on the chief complaint.
Correct Answer: C
Rationale: Telehealth cannot substitute for cardiopulmonary auscultation, and new dyspnea in a 72-year-old is a red-flag
presentation requiring hands-on evaluation. The APN must acknowledge technology limitations and escalate to in-person
care rather than document an unverifiable normal exam. Option A and D are unsafe and constitute documentation fraud;
option C is incomplete and abandons the patient mid-encounter. AACN Essentials Domain 7 requires APNs to apply clinical
judgment in matching the modality to the acuity of the presenting problem.
Q7: An APN documents the following SOAP note: S: Pt c/o knee pain. O: Knee swollen, tender to palpation. A:
Osteoarthritis. P: NSAIDs PRN. Which component of this SOAP note is most deficient according to NR 509
documentation standards?
A. The plan section lacks the objective data.
B. The objective section lacks the assessment section.
C. The assessment section lacks the plan.
D. The subjective section lacks the patient's quote and OLDCARTS detail. *[CORRECT]*
Correct Answer: D
Rationale: The subjective section is incomplete because it omits OLDCARTS detail (onset, location, duration, character,
aggravating/relieving factors, timing, severity), relevant past history, and patient quotes. Option B and D are structurally
impossible (a section cannot lack itself), and option C confuses sections. NR 509 reinforces that the HPI must support
medical decision-making and that the subjective narrative is the foundation of subsequent objective findings and assessment.
Q8: An APN begins a new patient interview. The patient states, I'm here because my stomach hurts. Which response
best elicits a complete chief complaint using open-ended follow-up?
A. Tell me more about the pain in your stomach and when it started. *[CORRECT]*
B. On a scale of 0 to 10, how would you rate the pain?
C. Is the pain sharp or dull?
D. Does the pain radiate to your back?
Correct Answer: A
Rationale: Open-ended questions invite the patient to describe the symptom in their own words and reveal onset, character,
and context. Option A, C, and D are all closed-ended questions that narrow the response prematurely and may bias the
patient. NR 509 emphasizes beginning with broad open-ended probes, then funneling to specific closed-ended questions only
after the patient's narrative has been heard.
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Q9: An APN is taking a family history from a 42-year-old female patient. The patient reports that her mother died at
age 58 of breast cancer and her maternal aunt died at age 60 of ovarian cancer. Which action by the APN reflects
appropriate clinical reasoning based on this family history?
A. Document the family history and recommend routine screening beginning at age 50.
B. Recognize the hereditary cancer pattern and recommend earlier genetic counseling and screening.
*[CORRECT]*
C. Reassure the patient that family history does not affect personal cancer risk.
D. Recommend a prophylactic mastectomy without further evaluation.
Correct Answer: B
Rationale: Two first-degree relatives with breast or ovarian cancer at young ages raises suspicion for BRCA1/2 mutations
warranting earlier referral to genetic counseling and enhanced screening per USPSTF and NCCN guidelines. Option A
misses the red flag and delays screening; option C is factually incorrect; option D is premature without confirmatory testing.
NR 509 reinforces that the family history is a primary screening tool and a powerful predictor of risk that must trigger
appropriate cascade referrals.
Q10: Which sequence represents the correct standard order of the comprehensive health history interview?
A. Review of systems, chief complaint, HPI, family history, social history, past medical history
B. Chief complaint, HPI, past medical history, family history, personal/social history, review of systems
*[CORRECT]*
C. Past medical history, chief complaint, HPI, social history, family history, review of systems
D. Chief complaint, review of systems, family history, HPI, past medical history, social history
Correct Answer: B
Rationale: The standard comprehensive history proceeds from chief complaint and HPI, through past medical history
(including medications, allergies, immunizations), family history, personal/social history, and finally the review of systems.
The order reflects clinical reasoning: anchor on the present concern, then build context around it. The other options place
ROS or social history out of sequence, disrupting the natural flow that NR 509 reinforces for organized documentation.
Q11: During a comprehensive interview, the patient pauses, looks down tearfully, and is silent when discussing the
recent death of her husband. Which response by the APN best demonstrates therapeutic communication and
nonverbal awareness?
A. Why are you so upset? It has been several months.
B. I notice this is difficult for you. Take your time; I'm here when you're ready to continue.
*[CORRECT]*
C. I can see you are upset; let's move on to the next section so we can finish.
D. Don't cry. We don't need to talk about that today.
Correct Answer: B
Rationale: Therapeutic communication acknowledges nonverbal cues, allows silence, and signals presence without forcing
premature disclosure. Option A prioritizes efficiency over rapport and dismisses the emotional cue; option C is dismissive
and blocks the patient; option D judges the patient's grief. The AACN Essentials and NR 509 patient-centered interviewing
competencies require APNs to recognize nonverbal cues and respond with empathy rather than task-focused deflection.
Q12: A 16-year-old female presents alone requesting contraception. The APN establishes the patient's capacity for
confidential care. According to professional and ethical standards for adolescent care, which action is most
appropriate?
Confidential - For Graduate Nursing Education Use Page 4
NR509 / NR-509: ADVANCED PHYSICAL ASSESSMENT
MIDTERM EXAM (LATEST, 2026/2027) CHAMBERLAIN
Chamberlain University | College of Nursing | Graduate Nursing Program
Aligned with NR 509 Course Syllabus, AACN Essentials of Master's Education, and Advanced Physical Assessment
Competencies (2026/2027 Edition)
Total Questions: 120 Multiple Choice (4 options, single best answer)
Cognitive Mix: 20% Recall / 50% Application / 30% Analysis
Item Style: 75% Scenario-Based / 25% Direct Knowledge
Time Allotted: 3 hours (180 minutes)
Passing Score: 75% (90 of 120 correct)
Alignment: Chamberlain NR 509 Syllabus, AACN Essentials (2026/2027 Edition)
Instructions to the Candidate: Read each question stem carefully. Select the single best answer from options
A through D. Many items present clinical scenarios requiring interpretation of assessment data, prioritization,
or application of advanced physical assessment principles consistent with the AACN Essentials and
Chamberlain NR 509 course outcomes. Rationales are provided beneath each item for self-evaluation and
clinical reasoning reinforcement.
Section 1: Advanced Health History & Interviewing
15 questions covering comprehensive history, OLDCARTS/PQRST, motivational interviewing, cultural
competence, health literacy, telehealth assessment, SOAP documentation, and clinical reasoning frameworks.
Q1: The mnemonic OLDCARTS is used by the advanced practice nurse (APN) to systematically explore the history
of present illness. Which option correctly identifies all components of OLDCARTS?
A. Origin, Location, Duration, Character, Aggravating, Relieving, Timing, Severity
B. Onset, Location, Duration, Character, Aggravating, Relieving, Timing, Severity *[CORRECT]*
C. Onset, Location, Disease, Character, Aggravating, Relieving, Treatment, Severity
D. Onset, Location, Duration, Characteristics, Aggravating, Relieving, Treatment, Symptoms
Correct Answer: B
Rationale: OLDCARTS stands for Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, and
Severity. Option A substitutes Disease for Duration and Treatment for Timing; option C substitutes Treatment for Timing
and Symptoms for Severity; option D substitutes Origin for Onset. The NR 509 curriculum reinforces OLDCARTS (or
PQRST) as the structural backbone of every comprehensive HPI to ensure complete, reproducible, and clinically useful
documentation.
Q2: A 54-year-old male presents to the clinic with chest pain. Using the PQRST mnemonic, which question by the
APN best assesses the R (region/radiation) component?
A. On a scale of 0 to 10, how severe is the pain?
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,NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
B. Does the pain travel anywhere else in your body? *[CORRECT]*
C. When did the pain start?
D. What does the pain feel like?
Correct Answer: B
Rationale: The R in PQRST stands for Region/Radiation; asking whether the pain travels assesses radiation (e.g., chest pain
radiating to the left arm or jaw in acute coronary syndrome). Option A assesses onset (provocation/timing), option C
assesses quality, and option D assesses severity. The NR 509 curriculum requires PQRST alongside OLDCARTS so that no
dimension of the chief complaint is missed, particularly in high-stakes cardiopulmonary and abdominal scenarios.
Q3: An APN is conducting a motivational interview with a patient who has poorly controlled type 2 diabetes. The
patient states, I know I should test my blood sugar, but I just can't seem to do it regularly. Which response by the
APN best reflects the technique of reflective listening?
A. It sounds like you understand the importance of testing, but you're finding it difficult to make it a
regular habit. *[CORRECT]*
B. Why don't you try setting an alarm on your phone to remind you to test?
C. You need to test your blood sugar at least twice a day to manage your diabetes properly.
D. If you don't test regularly, your A1C will continue to rise and you may need insulin.
Correct Answer: A
Rationale: Reflective listening in motivational interviewing restates the patient's statement in the APN's own words to
confirm understanding, reduce resistance, and elicit further change talk. Option A is directive advice, option C is a closed
suggestion that offers solutions prematurely, and option D uses fear-based reasoning inconsistent with the spirit of
motivational interviewing. The AACN Essentials emphasize patient-centered communication that strengthens the therapeutic
alliance and supports self-management.
Q4: Which mnemonic, recommended by the U.S. Department of Health and Human Services, guides culturally
competent health interviews through Listen, Explain, Acknowledge, Recommend, and Negotiate?
A. LEARN *[CORRECT]*
B. SBAR
C. PQRST
D. OLDCARTS
Correct Answer: A
Rationale: The LEARN mnemonic (Listen, Explain, Acknowledge, Recommend, Negotiate) was developed by Berlin and
Fowkes and is endorsed by the U.S. DHHS as a framework for cross-cultural communication. OLDCARTS structures the
HPI, PQRST structures pain assessment, and SBAR standardizes clinical handoffs. The NR 509 curriculum integrates
LEARN with the culturally and linguistically appropriate services (CLAS) standards to reduce disparities in advanced
physical assessment.
Q5: A 67-year-old patient is newly prescribed warfarin for atrial fibrillation. The APN plans to use the teach-back
method to assess health literacy. Which statement by the APN best demonstrates teach-back technique?
A. Have you ever taken a blood thinner before?
B. Are there any side effects you would like me to explain?
C. To make sure I explained things clearly, please tell me in your own words how you will take this
medication at home. *[CORRECT]*
D. Do you understand how to take your warfarin?
Correct Answer: C
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,NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
Rationale: Teach-back places responsibility for clarity on the clinician and asks the patient to repeat information in their
own words rather than answer yes/no questions. Option A and D are closed questions that allow patients to mask
non-understanding; option C is a medication-history question. NR 509 documentation standards and the Agency for
Healthcare Research and Quality (AHRQ) recommend universal teach-back for high-risk medications such as warfarin,
insulin, and digoxin.
Q6: The APN is conducting a telehealth assessment for a 72-year-old patient with new-onset dyspnea. The video
connection is poor, the patient's face is only partially visible, and no auxiliary equipment (stethoscope, pulse
oximeter) is available in the home. Which action best demonstrates clinical reasoning in the telehealth context?
A. Ask the patient to take their own vital signs and email them later, then end the visit.
B. Proceed with history-taking only, document a normal exam, and recommend routine follow-up in 6 months.
C. Recognize the assessment limitation, ask the patient to reposition for better visualization, and arrange
an in-person evaluation given the high-risk presentation. *[CORRECT]*
D. Document the visit as a complete physical assessment and prescribe a diuretic based on the chief complaint.
Correct Answer: C
Rationale: Telehealth cannot substitute for cardiopulmonary auscultation, and new dyspnea in a 72-year-old is a red-flag
presentation requiring hands-on evaluation. The APN must acknowledge technology limitations and escalate to in-person
care rather than document an unverifiable normal exam. Option A and D are unsafe and constitute documentation fraud;
option C is incomplete and abandons the patient mid-encounter. AACN Essentials Domain 7 requires APNs to apply clinical
judgment in matching the modality to the acuity of the presenting problem.
Q7: An APN documents the following SOAP note: S: Pt c/o knee pain. O: Knee swollen, tender to palpation. A:
Osteoarthritis. P: NSAIDs PRN. Which component of this SOAP note is most deficient according to NR 509
documentation standards?
A. The plan section lacks the objective data.
B. The objective section lacks the assessment section.
C. The assessment section lacks the plan.
D. The subjective section lacks the patient's quote and OLDCARTS detail. *[CORRECT]*
Correct Answer: D
Rationale: The subjective section is incomplete because it omits OLDCARTS detail (onset, location, duration, character,
aggravating/relieving factors, timing, severity), relevant past history, and patient quotes. Option B and D are structurally
impossible (a section cannot lack itself), and option C confuses sections. NR 509 reinforces that the HPI must support
medical decision-making and that the subjective narrative is the foundation of subsequent objective findings and assessment.
Q8: An APN begins a new patient interview. The patient states, I'm here because my stomach hurts. Which response
best elicits a complete chief complaint using open-ended follow-up?
A. Tell me more about the pain in your stomach and when it started. *[CORRECT]*
B. On a scale of 0 to 10, how would you rate the pain?
C. Is the pain sharp or dull?
D. Does the pain radiate to your back?
Correct Answer: A
Rationale: Open-ended questions invite the patient to describe the symptom in their own words and reveal onset, character,
and context. Option A, C, and D are all closed-ended questions that narrow the response prematurely and may bias the
patient. NR 509 emphasizes beginning with broad open-ended probes, then funneling to specific closed-ended questions only
after the patient's narrative has been heard.
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, NR 509 Advanced Physical Assessment Midterm Exam (2026/2027) Chamberlain University
Q9: An APN is taking a family history from a 42-year-old female patient. The patient reports that her mother died at
age 58 of breast cancer and her maternal aunt died at age 60 of ovarian cancer. Which action by the APN reflects
appropriate clinical reasoning based on this family history?
A. Document the family history and recommend routine screening beginning at age 50.
B. Recognize the hereditary cancer pattern and recommend earlier genetic counseling and screening.
*[CORRECT]*
C. Reassure the patient that family history does not affect personal cancer risk.
D. Recommend a prophylactic mastectomy without further evaluation.
Correct Answer: B
Rationale: Two first-degree relatives with breast or ovarian cancer at young ages raises suspicion for BRCA1/2 mutations
warranting earlier referral to genetic counseling and enhanced screening per USPSTF and NCCN guidelines. Option A
misses the red flag and delays screening; option C is factually incorrect; option D is premature without confirmatory testing.
NR 509 reinforces that the family history is a primary screening tool and a powerful predictor of risk that must trigger
appropriate cascade referrals.
Q10: Which sequence represents the correct standard order of the comprehensive health history interview?
A. Review of systems, chief complaint, HPI, family history, social history, past medical history
B. Chief complaint, HPI, past medical history, family history, personal/social history, review of systems
*[CORRECT]*
C. Past medical history, chief complaint, HPI, social history, family history, review of systems
D. Chief complaint, review of systems, family history, HPI, past medical history, social history
Correct Answer: B
Rationale: The standard comprehensive history proceeds from chief complaint and HPI, through past medical history
(including medications, allergies, immunizations), family history, personal/social history, and finally the review of systems.
The order reflects clinical reasoning: anchor on the present concern, then build context around it. The other options place
ROS or social history out of sequence, disrupting the natural flow that NR 509 reinforces for organized documentation.
Q11: During a comprehensive interview, the patient pauses, looks down tearfully, and is silent when discussing the
recent death of her husband. Which response by the APN best demonstrates therapeutic communication and
nonverbal awareness?
A. Why are you so upset? It has been several months.
B. I notice this is difficult for you. Take your time; I'm here when you're ready to continue.
*[CORRECT]*
C. I can see you are upset; let's move on to the next section so we can finish.
D. Don't cry. We don't need to talk about that today.
Correct Answer: B
Rationale: Therapeutic communication acknowledges nonverbal cues, allows silence, and signals presence without forcing
premature disclosure. Option A prioritizes efficiency over rapport and dismisses the emotional cue; option C is dismissive
and blocks the patient; option D judges the patient's grief. The AACN Essentials and NR 509 patient-centered interviewing
competencies require APNs to recognize nonverbal cues and respond with empathy rather than task-focused deflection.
Q12: A 16-year-old female presents alone requesting contraception. The APN establishes the patient's capacity for
confidential care. According to professional and ethical standards for adolescent care, which action is most
appropriate?
Confidential - For Graduate Nursing Education Use Page 4
