NR509 Final Exam Advanced Physical Assessment (2026) | Verified Q&A +
Rationales | Chamberlain GRADED A+
Master your NR509 Final with this comprehensive 2026/2027 study guide featuring
verified exam questions and in-depth clinical rationales specifically for Chamberlain
University. This review covers high-yield head-to-toe assessment techniques, including
specialty maneuvers for abdominal pain, heart murmur identification, and cranial nerve
testing. Designed for advanced practice nursing students, it provides the essential
diagnostic pearls and documentation tips needed to achieve an A+ on your final
predictor.
1. A 72-year-old male presents with a sudden onset of "the worst headache of my
life." He has associated photophobia and nuchal rigidity. What is the most likely
diagnosis?
A) Migraine Headache
B) Subarachnoid Hemorrhage
C) Cluster Headache
D) Giant Cell Arteritis
Answer: B) Subarachnoid Hemorrhage
Rationale: A "thunderclap" headache, often described as the "worst headache of life," is
a classic presentation of a subarachnoid hemorrhage, often due to a ruptured aneurysm.
2. Which specialized test is performed by asking the patient to stand with their
feet together and arms at their sides, first with eyes open and then with eyes
closed?
A) McMurray Test
B) Romberg Test
C) Tinel’s Sign
D) Dix-Hallpike Maneuver
Answer: B) Romberg Test
Rationale: This tests cerebellar function and proprioception. Symmetrical swaying or loss
of balance with eyes closed is a positive result.
,3. A patient presents with "tearing" chest pain that radiates to the back between
the scapulae. BP is 180/100 mmHg in the right arm and 140/80 mmHg in the left
arm. This suggests:
A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Spontaneous Pneumothorax
Answer: B) Aortic Dissection
Rationale: Tearing pain and a significant blood pressure differential (>20 mmHg)
between arms are hallmark signs of an aortic dissection.
4. During the physical exam of a 4-week-old infant, you palpate an "olive-shaped
mass" in the upper right quadrant. The parent reports non-bilious projectile
vomiting. This suggests:
A) Intussusception
B) Pyloric Stenosis
C) Hirschsprung's Disease
D) GERD
Answer: B) Pyloric Stenosis
Rationale: The palpable "olive" and projectile vomiting are pathognomonic for
hypertrophic pyloric stenosis.
5. Which heart sound occurs early in diastole and is often associated with fluid
volume overload in conditions like heart failure?
A) S1
B) S2
C) S3
D) S4
Answer: C) S3
Rationale: S3 (ventricular gallop) results from rapid ventricular filling into a dilated or
fluid-filled chamber.
6. A "Positive Phalen’s Maneuver" produces paresthesia in the thumb, index, and
middle fingers. This indicates compression of which nerve?
,A) Ulnar Nerve
B) Radial Nerve
C) Median Nerve
D) Axillary Nerve
Answer: C) Median Nerve
Rationale: This nerve is compressed within the carpal tunnel.
7. A patient presents with "painless" gross hematuria. Which risk factor would
most increase your suspicion of bladder cancer?
A) Alcohol use
B) High-protein diet
C) Cigarette smoking
D) History of UTIs
Answer: C) Cigarette smoking
Rationale: Tobacco use is the leading risk factor for urothelial (bladder) carcinoma.
8. Which cranial nerve is responsible for the motor function of the muscles of
mastication (chewing)?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN XII (Hypoglossal)
Answer: A) CN V (Trigeminal)
9. A "Positive Murphy’s Sign" during abdominal palpation is indicative of:
A) Acute Appendicitis
B) Acute Cholecystitis
C) Splenic Rupture
D) Nephrolithiasis
Answer: B) Acute Cholecystitis
10. When assessing for "Tactile Fremitus," you note increased vibrations over the
right lower lobe. This suggests:
, A) Pneumothorax
B) Pleural Effusion
C) Lung Consolidation (Pneumonia)
D) Emphysema
Answer: C) Lung Consolidation (Pneumonia)
Rationale: Solid or fluid-filled tissue (consolidation) transmits sound vibrations better
than air.
11. "Heberden’s Nodes" are bony enlargements found in which joints?
A) Proximal Interphalangeal (PIP)
B) Distal Interphalangeal (DIP)
C) Metacarpophalangeal (MCP)
D) Wrist
Answer: B) Distal Interphalangeal (DIP)
Rationale: These are classic findings in Osteoarthritis.
12. A patient presents with localized RLQ pain. When you press on the LLQ, the
patient feels pain in the RLQ. This is known as:
A) Psoas Sign
B) Obturator Sign
C) Rovsing’s Sign
D) McBurney’s Sign
Answer: C) Rovsing’s Sign
13. Which murmur is characterized as holosystolic, heard best at the apex, and
radiates to the left axilla?
A) Aortic Stenosis
B) Mitral Regurgitation
C) Mitral Stenosis
D) Tricuspid Regurgitation
Answer: B) Mitral Regurgitation
Rationales | Chamberlain GRADED A+
Master your NR509 Final with this comprehensive 2026/2027 study guide featuring
verified exam questions and in-depth clinical rationales specifically for Chamberlain
University. This review covers high-yield head-to-toe assessment techniques, including
specialty maneuvers for abdominal pain, heart murmur identification, and cranial nerve
testing. Designed for advanced practice nursing students, it provides the essential
diagnostic pearls and documentation tips needed to achieve an A+ on your final
predictor.
1. A 72-year-old male presents with a sudden onset of "the worst headache of my
life." He has associated photophobia and nuchal rigidity. What is the most likely
diagnosis?
A) Migraine Headache
B) Subarachnoid Hemorrhage
C) Cluster Headache
D) Giant Cell Arteritis
Answer: B) Subarachnoid Hemorrhage
Rationale: A "thunderclap" headache, often described as the "worst headache of life," is
a classic presentation of a subarachnoid hemorrhage, often due to a ruptured aneurysm.
2. Which specialized test is performed by asking the patient to stand with their
feet together and arms at their sides, first with eyes open and then with eyes
closed?
A) McMurray Test
B) Romberg Test
C) Tinel’s Sign
D) Dix-Hallpike Maneuver
Answer: B) Romberg Test
Rationale: This tests cerebellar function and proprioception. Symmetrical swaying or loss
of balance with eyes closed is a positive result.
,3. A patient presents with "tearing" chest pain that radiates to the back between
the scapulae. BP is 180/100 mmHg in the right arm and 140/80 mmHg in the left
arm. This suggests:
A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Spontaneous Pneumothorax
Answer: B) Aortic Dissection
Rationale: Tearing pain and a significant blood pressure differential (>20 mmHg)
between arms are hallmark signs of an aortic dissection.
4. During the physical exam of a 4-week-old infant, you palpate an "olive-shaped
mass" in the upper right quadrant. The parent reports non-bilious projectile
vomiting. This suggests:
A) Intussusception
B) Pyloric Stenosis
C) Hirschsprung's Disease
D) GERD
Answer: B) Pyloric Stenosis
Rationale: The palpable "olive" and projectile vomiting are pathognomonic for
hypertrophic pyloric stenosis.
5. Which heart sound occurs early in diastole and is often associated with fluid
volume overload in conditions like heart failure?
A) S1
B) S2
C) S3
D) S4
Answer: C) S3
Rationale: S3 (ventricular gallop) results from rapid ventricular filling into a dilated or
fluid-filled chamber.
6. A "Positive Phalen’s Maneuver" produces paresthesia in the thumb, index, and
middle fingers. This indicates compression of which nerve?
,A) Ulnar Nerve
B) Radial Nerve
C) Median Nerve
D) Axillary Nerve
Answer: C) Median Nerve
Rationale: This nerve is compressed within the carpal tunnel.
7. A patient presents with "painless" gross hematuria. Which risk factor would
most increase your suspicion of bladder cancer?
A) Alcohol use
B) High-protein diet
C) Cigarette smoking
D) History of UTIs
Answer: C) Cigarette smoking
Rationale: Tobacco use is the leading risk factor for urothelial (bladder) carcinoma.
8. Which cranial nerve is responsible for the motor function of the muscles of
mastication (chewing)?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN XII (Hypoglossal)
Answer: A) CN V (Trigeminal)
9. A "Positive Murphy’s Sign" during abdominal palpation is indicative of:
A) Acute Appendicitis
B) Acute Cholecystitis
C) Splenic Rupture
D) Nephrolithiasis
Answer: B) Acute Cholecystitis
10. When assessing for "Tactile Fremitus," you note increased vibrations over the
right lower lobe. This suggests:
, A) Pneumothorax
B) Pleural Effusion
C) Lung Consolidation (Pneumonia)
D) Emphysema
Answer: C) Lung Consolidation (Pneumonia)
Rationale: Solid or fluid-filled tissue (consolidation) transmits sound vibrations better
than air.
11. "Heberden’s Nodes" are bony enlargements found in which joints?
A) Proximal Interphalangeal (PIP)
B) Distal Interphalangeal (DIP)
C) Metacarpophalangeal (MCP)
D) Wrist
Answer: B) Distal Interphalangeal (DIP)
Rationale: These are classic findings in Osteoarthritis.
12. A patient presents with localized RLQ pain. When you press on the LLQ, the
patient feels pain in the RLQ. This is known as:
A) Psoas Sign
B) Obturator Sign
C) Rovsing’s Sign
D) McBurney’s Sign
Answer: C) Rovsing’s Sign
13. Which murmur is characterized as holosystolic, heard best at the apex, and
radiates to the left axilla?
A) Aortic Stenosis
B) Mitral Regurgitation
C) Mitral Stenosis
D) Tricuspid Regurgitation
Answer: B) Mitral Regurgitation
