NR509 Advanced Physical
Assessment
Week 4 Midterm Exam WITH MUST
KNOW QUESTIONS AND ANSWERS
2026
1. At the start of remote exams, you are required to complete an environmental scan. You will have
three minutes to complete the environmental scan in the practice exam. You will have two minutes to
complete the environmental scan in a graded exam.
To complete the environmental scan:
Use your webcam to slowly scan the entire testing environment including all walls, corners, the
floor, and the ceiling.
Use your webcam to slowly scan the entire desktop or work surface and chair, including the
underside of the desktop or work surface.
If you are using a mouse, mousepad, or keyboard, you must show the top and bottom of each
object.
Currently Selected: A
A. I have correctly completed the environmental scan as required.
B. I have not completed the environmental scan and understand this is considered an academic integrity
violation, and will be investigated per the Student Code of Conduct policy.
2. You begin your graded exam but realize your webcam was not positioned to show the ceiling during
the environmental scan. What is the most appropriate action?
A. Continue with the exam since the walls and desk were shown.
B. Stop the exam, contact technical support, and request a new scan attempt.
C. Proceed and note in the comment section that the ceiling was omitted.
D. Assume it is acceptable because the practice exam allowed three minutes.
3. During the environmental scan, you must show the underside of the work surface. Which of the
following best describes why this is required?
A. To ensure no other electronic devices are present.
,B. To verify the work surface is clean and organized.
C. To prevent the possibility of hidden notes or unauthorized materials.
D. To comply with lighting requirements for the webcam.
4. A student completes the environmental scan in 90 seconds during the graded exam. Which statement
is true?
A. The student must repeat the scan to fill the full two minutes.
B. The student may proceed if all required areas were shown.
C. The exam will automatically fail the student for insufficient scan time.
D. The student must contact the proctor before continuing.
5. Which item must be shown from both the top and bottom during the environmental scan?
A. Chair seat
B. Mousepad
C. Desktop lamp
D. Water bottle
Section 2: General Health Assessment (Questions 6–15)
6. A 45-year-old male presents for a routine physical. He has no complaints. Which of the following is
the most appropriate next step?
A. Begin with a review of systems before taking vital signs.
B. Perform a comprehensive head-to-toe assessment.
C. Conduct a problem-focused assessment based on age and gender.
D. Obtain a thorough health history and then perform a relevant physical exam.
7. When assessing a patient’s mental status, which of the following is the most sensitive indicator of
cognitive impairment?
A. Orientation to person, place, and time
B. Immediate recall of three objects
C. Ability to follow complex commands
D. Subjective report of memory loss
8. A patient presents with a blood pressure of 148/92 mm Hg on two separate visits. The patient has no
known history of hypertension. What is the most appropriate next step?
A. Diagnose hypertension and start lifestyle modification counseling.
B. Order a 24-hour ambulatory blood pressure monitor.
C. Repeat blood pressure in the contralateral arm.
D. Begin antihypertensive therapy immediately.
, 9. Which technique is correct when assessing for jugular venous pressure (JVP)?
A. Position the patient supine with head of bed flat.
B. Measure the vertical distance between the sternal angle and the highest pulsation point.
C. Palpate the internal jugular vein for pulsations.
D. Have the patient perform the Valsalva maneuver during measurement.
10. During inspection of the thorax, you note a lateral curvature of the spine with rotation of the
vertebrae. This finding is consistent with:
A. Kyphosis
B. Lordosis
C. Scoliosis
D. Ankylosing spondylitis
11. A 58-year-old woman reports episodic dizziness when turning her head. On exam, you note
nystagmus and a positive Dix-Hallpike maneuver. What is the most likely diagnosis?
A. Orthostatic hypotension
B. Benign paroxysmal positional vertigo (BPPV)
C. Ménière’s disease
D. Vertebrobasilar insufficiency
12. When auscultating the lungs, you hear a high-pitched, musical sound during expiration. This is most
consistent with:
A. Fine crackles
B. Pleural friction rub
C. Wheezing
D. Stridor
13. A patient reports chest pain that is sharp, pleuritic, and relieved by leaning forward. On exam, you
hear a pericardial friction rub. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
14. The presence of a “split S2” that widens during inspiration is a normal finding in which patient
population?
A. Elderly adults
Assessment
Week 4 Midterm Exam WITH MUST
KNOW QUESTIONS AND ANSWERS
2026
1. At the start of remote exams, you are required to complete an environmental scan. You will have
three minutes to complete the environmental scan in the practice exam. You will have two minutes to
complete the environmental scan in a graded exam.
To complete the environmental scan:
Use your webcam to slowly scan the entire testing environment including all walls, corners, the
floor, and the ceiling.
Use your webcam to slowly scan the entire desktop or work surface and chair, including the
underside of the desktop or work surface.
If you are using a mouse, mousepad, or keyboard, you must show the top and bottom of each
object.
Currently Selected: A
A. I have correctly completed the environmental scan as required.
B. I have not completed the environmental scan and understand this is considered an academic integrity
violation, and will be investigated per the Student Code of Conduct policy.
2. You begin your graded exam but realize your webcam was not positioned to show the ceiling during
the environmental scan. What is the most appropriate action?
A. Continue with the exam since the walls and desk were shown.
B. Stop the exam, contact technical support, and request a new scan attempt.
C. Proceed and note in the comment section that the ceiling was omitted.
D. Assume it is acceptable because the practice exam allowed three minutes.
3. During the environmental scan, you must show the underside of the work surface. Which of the
following best describes why this is required?
A. To ensure no other electronic devices are present.
,B. To verify the work surface is clean and organized.
C. To prevent the possibility of hidden notes or unauthorized materials.
D. To comply with lighting requirements for the webcam.
4. A student completes the environmental scan in 90 seconds during the graded exam. Which statement
is true?
A. The student must repeat the scan to fill the full two minutes.
B. The student may proceed if all required areas were shown.
C. The exam will automatically fail the student for insufficient scan time.
D. The student must contact the proctor before continuing.
5. Which item must be shown from both the top and bottom during the environmental scan?
A. Chair seat
B. Mousepad
C. Desktop lamp
D. Water bottle
Section 2: General Health Assessment (Questions 6–15)
6. A 45-year-old male presents for a routine physical. He has no complaints. Which of the following is
the most appropriate next step?
A. Begin with a review of systems before taking vital signs.
B. Perform a comprehensive head-to-toe assessment.
C. Conduct a problem-focused assessment based on age and gender.
D. Obtain a thorough health history and then perform a relevant physical exam.
7. When assessing a patient’s mental status, which of the following is the most sensitive indicator of
cognitive impairment?
A. Orientation to person, place, and time
B. Immediate recall of three objects
C. Ability to follow complex commands
D. Subjective report of memory loss
8. A patient presents with a blood pressure of 148/92 mm Hg on two separate visits. The patient has no
known history of hypertension. What is the most appropriate next step?
A. Diagnose hypertension and start lifestyle modification counseling.
B. Order a 24-hour ambulatory blood pressure monitor.
C. Repeat blood pressure in the contralateral arm.
D. Begin antihypertensive therapy immediately.
, 9. Which technique is correct when assessing for jugular venous pressure (JVP)?
A. Position the patient supine with head of bed flat.
B. Measure the vertical distance between the sternal angle and the highest pulsation point.
C. Palpate the internal jugular vein for pulsations.
D. Have the patient perform the Valsalva maneuver during measurement.
10. During inspection of the thorax, you note a lateral curvature of the spine with rotation of the
vertebrae. This finding is consistent with:
A. Kyphosis
B. Lordosis
C. Scoliosis
D. Ankylosing spondylitis
11. A 58-year-old woman reports episodic dizziness when turning her head. On exam, you note
nystagmus and a positive Dix-Hallpike maneuver. What is the most likely diagnosis?
A. Orthostatic hypotension
B. Benign paroxysmal positional vertigo (BPPV)
C. Ménière’s disease
D. Vertebrobasilar insufficiency
12. When auscultating the lungs, you hear a high-pitched, musical sound during expiration. This is most
consistent with:
A. Fine crackles
B. Pleural friction rub
C. Wheezing
D. Stridor
13. A patient reports chest pain that is sharp, pleuritic, and relieved by leaning forward. On exam, you
hear a pericardial friction rub. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pulmonary embolism
14. The presence of a “split S2” that widens during inspiration is a normal finding in which patient
population?
A. Elderly adults
