NR509 Week 4 Midterm Exam 2026 | --- --- --- --- --- --- ---
Advanced Physical Assessment Practice Test --- --- --- --- ---
Instructions: This 200-question practice test is designed to assess your
--- --- --- --- --- --- --- --- --- ---
knowledge of advanced physical assessment techniques, clinical reasoning, and
--- --- --- --- --- --- --- --- ---
differential diagnosis. Select the best answer for each question. Detailed
--- --- --- --- --- --- --- --- --- ---
rationales are provided for each answer to enhance your learning.
--- --- --- --- --- --- --- --- --- ---
--
-
Section 1: General Assessment & Health History (Questions 1-25)
--- --- --- --- --- --- --- --- ---
1. A 72-year-old male presents for a routine physical. He states he has been
--- --- --- --- --- --- --- --- --- --- --- --- ---
feeling more tired than usual and has lost 10 pounds unintentionally over
--- --- --- --- --- --- --- --- --- --- --- ---
the last 6 months. What is the MOST important initial step in the
--- --- --- --- --- --- --- --- --- --- --- --- ---
assessment process? --- ---
a) Order a complete blood count and comprehensive metabolic panel.
--- --- --- --- --- --- --- --- ---
b) Perform a thorough cardiovascular and respiratory exam. --- --- --- --- --- --- ---
c) Conduct a detailed health history, including a review of systems and --- --- --- --- --- --- --- --- --- --- ---
functional assessment. --- ---
d) Refer the patient to a dietician for nutritional counseling.
--- --- --- --- --- --- --- --- ---
Answer: c) Conduct a detailed health history, including a review of systems
--- --- --- --- --- --- --- --- --- --- --- ---
and functional assessment.
--- --- ---
Rationale: The initial step in any assessment is a comprehensive health history.
--- --- --- --- --- --- --- --- --- --- --- ---
The patient's symptoms (fatigue, weight loss) are constitutional and could be
--- --- --- --- --- --- --- --- --- --- ---
related to a multitude of systems. The history will guide the focused physical
--- --- --- --- --- --- --- --- --- --- --- --- ---
exam and diagnostic testing. Option A is premature, option B is a component of
--- --- --- --- --- --- --- --- --- --- --- --- --- -
the exam but not the first step, and option D is a potential intervention, not an
-- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
assessment step. --- ---
2. When performing a cultural assessment, which question BEST reflects the
--- --- --- --- --- --- --- --- --- -
concept of "cultural humility"?
-- --- --- --- ---
a) "What is your country of origin?" --- --- --- --- --- ---
b) "Do you have any special beliefs about health and illness?"
--- --- --- --- --- --- --- --- --- ---
, c) "How can I best work with you to understand your health concerns
--- --- --- --- --- --- --- --- --- --- --- ---
and preferences?" --- ---
d) "Do you use any alternative or traditional medicines?"
--- --- --- --- --- --- --- ---
Answer: c) "How can I best work with you to understand your health
--- --- --- --- --- --- --- --- --- --- --- --- ---
concerns and preferences?"
--- --- ---
Rationale: Cultural humility is an ongoing process of self-reflection and
--- --- --- --- --- --- --- --- --- ---
selfcritique, combined with a willingness to learn from others. It moves beyond
--- --- --- --- --- --- --- --- --- --- --- ---
asking a static list of questions to a collaborative partnership. Option C directly
--- --- --- --- --- --- --- --- --- --- --- --- ---
invites the patient to guide the clinician on how to provide the best care,
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
embodying humility. Options A, B, and D are important questions but do not
--- --- --- --- --- --- --- --- --- --- --- --- ---
capture the dynamic, collaborative nature of cultural humility.
--- --- --- --- --- --- --- ---
3. A patient with a known history of hypertension reports occasional
--- --- --- --- --- --- --- --- --- ---
dizziness when standing up quickly. Which component of the health
--- --- --- --- --- --- --- --- --- ---
history is MOST relevant? --- --- --- ---
a) Past medical history --- --- ---
b) Family history --- ---
c) Review of systems (ROS) --- --- --- ---
d) Functional assessment --- ---
Answer: c) Review of systems (ROS)
--- --- --- --- --- ---
Rationale: The ROS is a systematic inventory of body systems obtained
--- --- --- --- --- --- --- --- --- --- ---
through a series of questions. Dizziness upon standing (orthostasis) is a
--- --- --- --- --- --- --- --- --- --- ---
symptom related to the cardiovascular and/or neurologic systems and should be
--- --- --- --- --- --- --- --- --- --- ---
documented in the ROS. Past medical history documents previous diagnoses,
--- --- --- --- --- --- --- --- --- ---
family history is about relatives, and functional assessment focuses on activities
--- --- --- --- --- --- --- --- --- --- ---
of daily living.
--- --- ---
4. The "PQRST" mnemonic is used to evaluate a patient's symptom. What
--- --- --- --- --- --- --- --- --- --- ---
does the "P" stand for? a) Pain scale
--- --- --- --- --- --- --- ---
b) Precipitating/Palliating factors --- ---
c) Previous episodes --- ---
d) Pattern ---
Answer: b) Precipitating/Palliating factors
--- --- --- ---
Rationale: The PQRST mnemonic stands for:
--- --- --- --- --- ---
, o P: Provocative/Palliative (What brings it on? What makes it better
--- --- --- --- --- --- --- --- --- ---
or worse?)--- --- o---Q:---Quality/Quantity---(What---does---it---feel---like?---How---
severe is it?) --- --- --- o---R:---Region/Radiation---(Where---is---it?---Does---it---spread?)---
o---S:---Severity---Scale---(On---a---scale---of---0-10...)---
o T: Timing (When did it start? How long does it last? How often
--- --- --- --- --- --- --- --- --- --- --- --- ---
does it occur?) --- --- ---
5. During the health history, a patient reports that they are a "social
--- --- --- --- --- --- --- --- --- --- --- ---
drinker." Which of the following is the BEST follow-up question to
--- --- --- --- --- --- --- --- --- --- ---
quantify their alcohol intake? --- --- --- ---
a) "Do you ever drink more than you planned to?"
--- --- --- --- --- --- --- --- ---
b) "How many days a week do you drink, and how many drinks do you
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
typically have on those days?" --- --- --- --- ---
c) "Do you ever feel you should cut down on your drinking?"
--- --- --- --- --- --- --- --- --- --- ---
d) "Have you ever had a drink first thing in the morning to steady your
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
nerves?" ---
Answer: b) "How many days a week do you drink, and how many drinks
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
do you typically have on those days?"
--- --- --- --- --- --- ---
Rationale: The term "social drinker" is vague. To quantify intake, the clinician
--- --- --- --- --- --- --- --- --- --- --- ---
must ask for a specific number of days per week and the average number of
--- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
drinks per occasion. This allows for risk stratification (e.g., heavy drinking,
--- --- --- --- --- --- --- --- --- --- ---
binge drinking). Options A, C, and D are questions from the CAGE or AUDIT
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
screening tools, which are used to identify alcohol use disorder, but do not
--- --- --- --- --- --- --- --- --- --- --- --- ---
quantify intake. --- ---
6. A patient's chief complaint is "chest pain." Which of the following
--- --- --- --- --- --- --- --- --- --- ---
questions would be MOST useful in differentiating cardiac from non-
--- --- --- --- --- --- --- --- ---
cardiac pain? a) "Is the pain sharp or dull?" --- --- --- --- --- --- --- --- ---
b) "Does the pain radiate to your jaw or left arm?" --- --- --- --- --- --- --- --- --- ---
c) "What were you doing when the pain started, and what makes it better
--- --- --- --- --- --- --- --- --- --- --- --- ---
or worse?" --- ---
d) "Rate your pain on a scale of 0 to 10." --- --- --- --- --- --- --- --- --- ---
Answer: c) "What were you doing when the pain started, and what makes
--- --- --- --- --- --- --- --- --- --- --- --- ---
it better or worse?"
--- --- --- ---
, Rationale: The P (Provocative/Palliative) and T (Timing) of the PQRST
--- --- --- --- --- --- --- --- --- ---
mnemonic are crucial for differentiating types of chest pain. Cardiac pain is
--- --- --- --- --- --- --- --- --- --- --- ---
often provoked by exertion or stress and relieved by rest or nitroglycerin.
--- --- --- --- --- --- --- --- --- --- --- ---
Pleuritic pain is worsened by breathing or coughing. Musculoskeletal pain is
--- --- --- --- --- --- --- --- --- --- ---
reproducible with palpation or movement. While radiation (B) and quality (A)
--- --- --- --- --- --- --- --- --- --- ---
are helpful, the provocative/palliative factors are the most differentiating.
--- --- --- --- --- --- --- --- ---
7. The Review of Systems is best described as:
--- --- --- --- --- --- --- ---
a) A physical examination of all major organ systems.
--- --- --- --- --- --- --- ---
b) A comprehensive list of all medications the patient is taking.
--- --- --- --- --- --- --- --- --- ---
c) A series of questions asked to identify any symptoms the patient may
--- --- --- --- --- --- --- --- --- --- --- ---
be experiencing. --- ---
d) A summary of the patient's past medical and surgical history.
--- --- --- --- --- --- --- --- --- ---
Answer: c) A series of questions asked to identify any symptoms the
--- --- --- --- --- --- --- --- --- --- --- ---
patient may be experiencing. --- --- --- ---
Rationale: The ROS is a subjective inventory of symptoms (what the patient
--- --- --- --- --- --- --- --- --- --- --- ---
feels/experiences), not objective signs found on physical exam (A). It is distinct --- --- --- --- --- --- --- --- --- --- --- ---
from the history of present illness, past medical history (D), and medication list
--- --- --- --- --- --- --- --- --- --- --- --- ---
(B). ---
8. When assessing a patient's functional status, which of the following is the
--- --- --- --- --- --- --- --- --- --- --- -
priority area to evaluate?
-- --- --- --- ---
a) The ability to manage personal finances. --- --- --- --- --- ---
b) The ability to perform Instrumental Activities of Daily Living
--- --- --- --- --- --- --- --- ---
(IADLs). ---
c) The patient's highest level of education. --- --- --- --- --- ---
d) The patient's occupational history. --- --- --- ---
Answer: b) The ability to perform Instrumental Activities of Daily Living
--- --- --- --- --- --- --- --- --- --- ---
(IADLs). ---
Rationale: Functional assessment evaluates a person's ability to perform
--- --- --- --- --- --- --- --- ---
activities of daily living (ADLs) and instrumental ADLs (IADLs). IADLs
--- --- --- --- --- --- --- --- --- ---
(managing money, shopping, phone use, transportation, preparing meals,
--- --- --- --- --- --- --- ---
housework, managing medications) are a key part of this assessment, especially
--- --- --- --- --- --- --- --- --- --- ---
in identifying early functional decline. While A is an IADL, B is the broadest
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
Advanced Physical Assessment Practice Test --- --- --- --- ---
Instructions: This 200-question practice test is designed to assess your
--- --- --- --- --- --- --- --- --- ---
knowledge of advanced physical assessment techniques, clinical reasoning, and
--- --- --- --- --- --- --- --- ---
differential diagnosis. Select the best answer for each question. Detailed
--- --- --- --- --- --- --- --- --- ---
rationales are provided for each answer to enhance your learning.
--- --- --- --- --- --- --- --- --- ---
--
-
Section 1: General Assessment & Health History (Questions 1-25)
--- --- --- --- --- --- --- --- ---
1. A 72-year-old male presents for a routine physical. He states he has been
--- --- --- --- --- --- --- --- --- --- --- --- ---
feeling more tired than usual and has lost 10 pounds unintentionally over
--- --- --- --- --- --- --- --- --- --- --- ---
the last 6 months. What is the MOST important initial step in the
--- --- --- --- --- --- --- --- --- --- --- --- ---
assessment process? --- ---
a) Order a complete blood count and comprehensive metabolic panel.
--- --- --- --- --- --- --- --- ---
b) Perform a thorough cardiovascular and respiratory exam. --- --- --- --- --- --- ---
c) Conduct a detailed health history, including a review of systems and --- --- --- --- --- --- --- --- --- --- ---
functional assessment. --- ---
d) Refer the patient to a dietician for nutritional counseling.
--- --- --- --- --- --- --- --- ---
Answer: c) Conduct a detailed health history, including a review of systems
--- --- --- --- --- --- --- --- --- --- --- ---
and functional assessment.
--- --- ---
Rationale: The initial step in any assessment is a comprehensive health history.
--- --- --- --- --- --- --- --- --- --- --- ---
The patient's symptoms (fatigue, weight loss) are constitutional and could be
--- --- --- --- --- --- --- --- --- --- ---
related to a multitude of systems. The history will guide the focused physical
--- --- --- --- --- --- --- --- --- --- --- --- ---
exam and diagnostic testing. Option A is premature, option B is a component of
--- --- --- --- --- --- --- --- --- --- --- --- --- -
the exam but not the first step, and option D is a potential intervention, not an
-- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
assessment step. --- ---
2. When performing a cultural assessment, which question BEST reflects the
--- --- --- --- --- --- --- --- --- -
concept of "cultural humility"?
-- --- --- --- ---
a) "What is your country of origin?" --- --- --- --- --- ---
b) "Do you have any special beliefs about health and illness?"
--- --- --- --- --- --- --- --- --- ---
, c) "How can I best work with you to understand your health concerns
--- --- --- --- --- --- --- --- --- --- --- ---
and preferences?" --- ---
d) "Do you use any alternative or traditional medicines?"
--- --- --- --- --- --- --- ---
Answer: c) "How can I best work with you to understand your health
--- --- --- --- --- --- --- --- --- --- --- --- ---
concerns and preferences?"
--- --- ---
Rationale: Cultural humility is an ongoing process of self-reflection and
--- --- --- --- --- --- --- --- --- ---
selfcritique, combined with a willingness to learn from others. It moves beyond
--- --- --- --- --- --- --- --- --- --- --- ---
asking a static list of questions to a collaborative partnership. Option C directly
--- --- --- --- --- --- --- --- --- --- --- --- ---
invites the patient to guide the clinician on how to provide the best care,
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
embodying humility. Options A, B, and D are important questions but do not
--- --- --- --- --- --- --- --- --- --- --- --- ---
capture the dynamic, collaborative nature of cultural humility.
--- --- --- --- --- --- --- ---
3. A patient with a known history of hypertension reports occasional
--- --- --- --- --- --- --- --- --- ---
dizziness when standing up quickly. Which component of the health
--- --- --- --- --- --- --- --- --- ---
history is MOST relevant? --- --- --- ---
a) Past medical history --- --- ---
b) Family history --- ---
c) Review of systems (ROS) --- --- --- ---
d) Functional assessment --- ---
Answer: c) Review of systems (ROS)
--- --- --- --- --- ---
Rationale: The ROS is a systematic inventory of body systems obtained
--- --- --- --- --- --- --- --- --- --- ---
through a series of questions. Dizziness upon standing (orthostasis) is a
--- --- --- --- --- --- --- --- --- --- ---
symptom related to the cardiovascular and/or neurologic systems and should be
--- --- --- --- --- --- --- --- --- --- ---
documented in the ROS. Past medical history documents previous diagnoses,
--- --- --- --- --- --- --- --- --- ---
family history is about relatives, and functional assessment focuses on activities
--- --- --- --- --- --- --- --- --- --- ---
of daily living.
--- --- ---
4. The "PQRST" mnemonic is used to evaluate a patient's symptom. What
--- --- --- --- --- --- --- --- --- --- ---
does the "P" stand for? a) Pain scale
--- --- --- --- --- --- --- ---
b) Precipitating/Palliating factors --- ---
c) Previous episodes --- ---
d) Pattern ---
Answer: b) Precipitating/Palliating factors
--- --- --- ---
Rationale: The PQRST mnemonic stands for:
--- --- --- --- --- ---
, o P: Provocative/Palliative (What brings it on? What makes it better
--- --- --- --- --- --- --- --- --- ---
or worse?)--- --- o---Q:---Quality/Quantity---(What---does---it---feel---like?---How---
severe is it?) --- --- --- o---R:---Region/Radiation---(Where---is---it?---Does---it---spread?)---
o---S:---Severity---Scale---(On---a---scale---of---0-10...)---
o T: Timing (When did it start? How long does it last? How often
--- --- --- --- --- --- --- --- --- --- --- --- ---
does it occur?) --- --- ---
5. During the health history, a patient reports that they are a "social
--- --- --- --- --- --- --- --- --- --- --- ---
drinker." Which of the following is the BEST follow-up question to
--- --- --- --- --- --- --- --- --- --- ---
quantify their alcohol intake? --- --- --- ---
a) "Do you ever drink more than you planned to?"
--- --- --- --- --- --- --- --- ---
b) "How many days a week do you drink, and how many drinks do you
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
typically have on those days?" --- --- --- --- ---
c) "Do you ever feel you should cut down on your drinking?"
--- --- --- --- --- --- --- --- --- --- ---
d) "Have you ever had a drink first thing in the morning to steady your
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
nerves?" ---
Answer: b) "How many days a week do you drink, and how many drinks
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
do you typically have on those days?"
--- --- --- --- --- --- ---
Rationale: The term "social drinker" is vague. To quantify intake, the clinician
--- --- --- --- --- --- --- --- --- --- --- ---
must ask for a specific number of days per week and the average number of
--- --- --- --- --- --- --- --- --- --- --- --- --- --- ---
drinks per occasion. This allows for risk stratification (e.g., heavy drinking,
--- --- --- --- --- --- --- --- --- --- ---
binge drinking). Options A, C, and D are questions from the CAGE or AUDIT
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
screening tools, which are used to identify alcohol use disorder, but do not
--- --- --- --- --- --- --- --- --- --- --- --- ---
quantify intake. --- ---
6. A patient's chief complaint is "chest pain." Which of the following
--- --- --- --- --- --- --- --- --- --- ---
questions would be MOST useful in differentiating cardiac from non-
--- --- --- --- --- --- --- --- ---
cardiac pain? a) "Is the pain sharp or dull?" --- --- --- --- --- --- --- --- ---
b) "Does the pain radiate to your jaw or left arm?" --- --- --- --- --- --- --- --- --- ---
c) "What were you doing when the pain started, and what makes it better
--- --- --- --- --- --- --- --- --- --- --- --- ---
or worse?" --- ---
d) "Rate your pain on a scale of 0 to 10." --- --- --- --- --- --- --- --- --- ---
Answer: c) "What were you doing when the pain started, and what makes
--- --- --- --- --- --- --- --- --- --- --- --- ---
it better or worse?"
--- --- --- ---
, Rationale: The P (Provocative/Palliative) and T (Timing) of the PQRST
--- --- --- --- --- --- --- --- --- ---
mnemonic are crucial for differentiating types of chest pain. Cardiac pain is
--- --- --- --- --- --- --- --- --- --- --- ---
often provoked by exertion or stress and relieved by rest or nitroglycerin.
--- --- --- --- --- --- --- --- --- --- --- ---
Pleuritic pain is worsened by breathing or coughing. Musculoskeletal pain is
--- --- --- --- --- --- --- --- --- --- ---
reproducible with palpation or movement. While radiation (B) and quality (A)
--- --- --- --- --- --- --- --- --- --- ---
are helpful, the provocative/palliative factors are the most differentiating.
--- --- --- --- --- --- --- --- ---
7. The Review of Systems is best described as:
--- --- --- --- --- --- --- ---
a) A physical examination of all major organ systems.
--- --- --- --- --- --- --- ---
b) A comprehensive list of all medications the patient is taking.
--- --- --- --- --- --- --- --- --- ---
c) A series of questions asked to identify any symptoms the patient may
--- --- --- --- --- --- --- --- --- --- --- ---
be experiencing. --- ---
d) A summary of the patient's past medical and surgical history.
--- --- --- --- --- --- --- --- --- ---
Answer: c) A series of questions asked to identify any symptoms the
--- --- --- --- --- --- --- --- --- --- --- ---
patient may be experiencing. --- --- --- ---
Rationale: The ROS is a subjective inventory of symptoms (what the patient
--- --- --- --- --- --- --- --- --- --- --- ---
feels/experiences), not objective signs found on physical exam (A). It is distinct --- --- --- --- --- --- --- --- --- --- --- ---
from the history of present illness, past medical history (D), and medication list
--- --- --- --- --- --- --- --- --- --- --- --- ---
(B). ---
8. When assessing a patient's functional status, which of the following is the
--- --- --- --- --- --- --- --- --- --- --- -
priority area to evaluate?
-- --- --- --- ---
a) The ability to manage personal finances. --- --- --- --- --- ---
b) The ability to perform Instrumental Activities of Daily Living
--- --- --- --- --- --- --- --- ---
(IADLs). ---
c) The patient's highest level of education. --- --- --- --- --- ---
d) The patient's occupational history. --- --- --- ---
Answer: b) The ability to perform Instrumental Activities of Daily Living
--- --- --- --- --- --- --- --- --- --- ---
(IADLs). ---
Rationale: Functional assessment evaluates a person's ability to perform
--- --- --- --- --- --- --- --- ---
activities of daily living (ADLs) and instrumental ADLs (IADLs). IADLs
--- --- --- --- --- --- --- --- --- ---
(managing money, shopping, phone use, transportation, preparing meals,
--- --- --- --- --- --- --- ---
housework, managing medications) are a key part of this assessment, especially
--- --- --- --- --- --- --- --- --- --- ---
in identifying early functional decline. While A is an IADL, B is the broadest
--- --- --- --- --- --- --- --- --- --- --- --- --- ---
