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NR509 / NR 509 Final Exam Latest (): Advanced Physical
Assessment Questions and Answers (Verified Answers)
Question 1:
During an adult physical exam, the nurse practitioner notes an S4 heart sound
while auscultating the apex. This finding is most commonly associated with which
condition?
A. Aortic regurgitation
B. Mitral stenosis
C. Left ventricular hypertrophy
D. Atrial septal defect
Correct Answer: C. Left ventricular hypertrophy
Rationale:
An S4 heart sound occurs when blood is forced into a stiff or noncompliant
ventricle during atrial contraction, often due to left ventricular hypertrophy from
chronic hypertension or aortic stenosis. It represents increased resistance to
ventricular filling, not valvular regurgitation or septal defects.
Question 2:
A 50-year-old male presents with shortness of breath and a chronic productive
cough. On exam, the nurse observes barrel chest, diminished breath sounds, and
prolonged expiration. These findings are most consistent with which condition?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Pulmonary fibrosis
D. Bronchitis
Correct Answer: B. Chronic obstructive pulmonary disease (COPD)
Rationale:
COPD is characterized by chronic airflow obstruction, air trapping, and alveolar
wall destruction. The barrel chest and prolonged expiratory phase indicate
, 2
hyperinflation. While asthma may appear similar, it is usually reversible with
bronchodilator therapy, unlike COPD.
Question 3:
While palpating the thyroid gland, the nurse practitioner detects a single, firm, non-
tender nodule. The patient also reports unintentional weight loss and heat
intolerance. What is the most likely diagnosis?
A. Simple goiter
B. Hashimoto’s thyroiditis
C. Thyroid carcinoma
D. Subacute thyroiditis
Correct Answer: C. Thyroid carcinoma
Rationale:
A solitary, firm, non-tender nodule with systemic signs such as weight loss and
hypermetabolism strongly suggests thyroid carcinoma. Hashimoto’s typically
presents as a tender or diffusely enlarged gland, while subacute thyroiditis is
painful and transient.
Question 4:
A nurse practitioner asks a patient to smile, frown, and puff out their cheeks during
a cranial nerve assessment. Which cranial nerve is being tested?
A. CN III
B. CN V
C. CN VII (Facial nerve)
D. CN IX
Correct Answer: C. CN VII (Facial nerve)
Rationale:
These facial movements assess Cranial Nerve VII, which controls muscles of
facial expression. Damage to this nerve can cause facial asymmetry, drooping, or
inability to close the eye on the affected side. CN V instead controls mastication
and facial sensation.
, 3
Question 5:
While percussing the lungs, the nurse hears a dull sound over the right lower lobe.
This finding most likely indicates:
A. Pneumothorax
B. Consolidation from pneumonia
C. Emphysema
D. Normal lung tissue
Correct Answer: B. Consolidation from pneumonia
Rationale:
A dull percussion tone occurs when normal air-filled lung tissue becomes solid or
fluid-filled, as in pneumonia, atelectasis, or effusion. Hyperresonance, on the
other hand, suggests excess air from emphysema or pneumothorax.
Question 6:
When performing an abdominal assessment, which sequence of physical exam
techniques is correct?
A. Inspection, palpation, auscultation, percussion
B. Inspection, percussion, palpation, auscultation
C. Inspection, auscultation, percussion, palpation
D. Auscultation, inspection, palpation, percussion
Correct Answer: C. Inspection, auscultation, percussion, palpation
Rationale:
To avoid altering bowel sounds, the nurse should auscultate before palpating or
percussing. Palpation stimulates peristalsis, which could produce false bowel
sounds, leading to inaccurate assessment findings.
Question 7:
A patient reports shooting pain down the posterior thigh and calf with weakness
during knee flexion. Which spinal nerve root is most likely affected?
A. L3
B. L4
, 4
C. L5
D. S1
Correct Answer: D. S1
Rationale:
The S1 nerve root innervates the posterior leg and controls knee flexion and
ankle plantar flexion. Herniation of the L5-S1 disk frequently compresses this
root, producing characteristic posterior leg pain and weakness.
Question 8:
During a fundoscopic examination, the nurse practitioner observes cotton wool
spots scattered across the retina. What condition is most associated with this
finding?
A. Retinal detachment
B. Hypertensive retinopathy
C. Glaucoma
D. Cataract
Correct Answer: B. Hypertensive retinopathy
Rationale:
Cotton wool spots are microinfarcts of the retinal nerve fiber layer caused by
chronic hypertension or diabetes, indicating vascular damage. Retinal
detachment presents with sudden vision loss or floaters, not cotton wool patches.
Question 9:
A 72-year-old patient presents with bruits over the carotid arteries. What is the
most appropriate next step for the nurse practitioner?
A. Perform light carotid massage
B. Avoid palpation and refer for ultrasound
C. Check jugular venous distention
D. Palpate firmly for pulse amplitude
Correct Answer: B. Avoid palpation and refer for ultrasound
Rationale:
When a carotid bruit is heard, palpation could dislodge a plaque, risking embolic
NR509 / NR 509 Final Exam Latest (): Advanced Physical
Assessment Questions and Answers (Verified Answers)
Question 1:
During an adult physical exam, the nurse practitioner notes an S4 heart sound
while auscultating the apex. This finding is most commonly associated with which
condition?
A. Aortic regurgitation
B. Mitral stenosis
C. Left ventricular hypertrophy
D. Atrial septal defect
Correct Answer: C. Left ventricular hypertrophy
Rationale:
An S4 heart sound occurs when blood is forced into a stiff or noncompliant
ventricle during atrial contraction, often due to left ventricular hypertrophy from
chronic hypertension or aortic stenosis. It represents increased resistance to
ventricular filling, not valvular regurgitation or septal defects.
Question 2:
A 50-year-old male presents with shortness of breath and a chronic productive
cough. On exam, the nurse observes barrel chest, diminished breath sounds, and
prolonged expiration. These findings are most consistent with which condition?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Pulmonary fibrosis
D. Bronchitis
Correct Answer: B. Chronic obstructive pulmonary disease (COPD)
Rationale:
COPD is characterized by chronic airflow obstruction, air trapping, and alveolar
wall destruction. The barrel chest and prolonged expiratory phase indicate
, 2
hyperinflation. While asthma may appear similar, it is usually reversible with
bronchodilator therapy, unlike COPD.
Question 3:
While palpating the thyroid gland, the nurse practitioner detects a single, firm, non-
tender nodule. The patient also reports unintentional weight loss and heat
intolerance. What is the most likely diagnosis?
A. Simple goiter
B. Hashimoto’s thyroiditis
C. Thyroid carcinoma
D. Subacute thyroiditis
Correct Answer: C. Thyroid carcinoma
Rationale:
A solitary, firm, non-tender nodule with systemic signs such as weight loss and
hypermetabolism strongly suggests thyroid carcinoma. Hashimoto’s typically
presents as a tender or diffusely enlarged gland, while subacute thyroiditis is
painful and transient.
Question 4:
A nurse practitioner asks a patient to smile, frown, and puff out their cheeks during
a cranial nerve assessment. Which cranial nerve is being tested?
A. CN III
B. CN V
C. CN VII (Facial nerve)
D. CN IX
Correct Answer: C. CN VII (Facial nerve)
Rationale:
These facial movements assess Cranial Nerve VII, which controls muscles of
facial expression. Damage to this nerve can cause facial asymmetry, drooping, or
inability to close the eye on the affected side. CN V instead controls mastication
and facial sensation.
, 3
Question 5:
While percussing the lungs, the nurse hears a dull sound over the right lower lobe.
This finding most likely indicates:
A. Pneumothorax
B. Consolidation from pneumonia
C. Emphysema
D. Normal lung tissue
Correct Answer: B. Consolidation from pneumonia
Rationale:
A dull percussion tone occurs when normal air-filled lung tissue becomes solid or
fluid-filled, as in pneumonia, atelectasis, or effusion. Hyperresonance, on the
other hand, suggests excess air from emphysema or pneumothorax.
Question 6:
When performing an abdominal assessment, which sequence of physical exam
techniques is correct?
A. Inspection, palpation, auscultation, percussion
B. Inspection, percussion, palpation, auscultation
C. Inspection, auscultation, percussion, palpation
D. Auscultation, inspection, palpation, percussion
Correct Answer: C. Inspection, auscultation, percussion, palpation
Rationale:
To avoid altering bowel sounds, the nurse should auscultate before palpating or
percussing. Palpation stimulates peristalsis, which could produce false bowel
sounds, leading to inaccurate assessment findings.
Question 7:
A patient reports shooting pain down the posterior thigh and calf with weakness
during knee flexion. Which spinal nerve root is most likely affected?
A. L3
B. L4
, 4
C. L5
D. S1
Correct Answer: D. S1
Rationale:
The S1 nerve root innervates the posterior leg and controls knee flexion and
ankle plantar flexion. Herniation of the L5-S1 disk frequently compresses this
root, producing characteristic posterior leg pain and weakness.
Question 8:
During a fundoscopic examination, the nurse practitioner observes cotton wool
spots scattered across the retina. What condition is most associated with this
finding?
A. Retinal detachment
B. Hypertensive retinopathy
C. Glaucoma
D. Cataract
Correct Answer: B. Hypertensive retinopathy
Rationale:
Cotton wool spots are microinfarcts of the retinal nerve fiber layer caused by
chronic hypertension or diabetes, indicating vascular damage. Retinal
detachment presents with sudden vision loss or floaters, not cotton wool patches.
Question 9:
A 72-year-old patient presents with bruits over the carotid arteries. What is the
most appropriate next step for the nurse practitioner?
A. Perform light carotid massage
B. Avoid palpation and refer for ultrasound
C. Check jugular venous distention
D. Palpate firmly for pulse amplitude
Correct Answer: B. Avoid palpation and refer for ultrasound
Rationale:
When a carotid bruit is heard, palpation could dislodge a plaque, risking embolic
