NR509 Final Exam Advanced Physical Assessment (2026) | Verified Q&A +
Rationales | Chamberlain
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 55-year-old patient presents with a chief complaint of "chest pressure."
During auscultation, you hear a high-pitched, scratchy sound at the left lower
sternal border that is loudest when the patient leans forward. This is most likely:
A. Aortic Stenosis
B. Pericardial Friction Rub
C. Mitral Valve Prolapse
D. S3 Gallop
Answer: B. Pericardial Friction Rub
Rationale: A friction rub is characteristic of pericarditis and is best heard with the patient
leaning forward in expiration. It is a scratchy, three-component sound.
2. While performing a respiratory assessment, you hear a muffled, "eee" sound
turn into a nasal "aaa" sound over the right lower lobe. This finding is
documented as:
A. Bronchophony
B. Whispered Pectoriloquy
C. Egophony
D. Tactile Fremitus
Answer: C. Egophony
Rationale: Egophony occurs when sound transmits through consolidated lung tissue (like
pneumonia), altering the sound of the vowel.
3. Which maneuver is used to assess for a torn meniscus in the knee?
,A. Lachman Test
B. McMurray Test
C. Drawer Test
D. Phalen’s Sign
Answer: B. McMurray Test
Rationale: McMurray’s involves rotating the lower leg with the knee flexed; a "click" or
pain indicates a meniscal tear. Lachman and Drawer tests assess the ACL.
4. A positive Rovsing’s sign is characterized by:
A. Pain in the RUQ during inspiration
B. Pain in the RLQ when pressure is applied to the LLQ
C. Pain when the patient drops from their toes to their heels
D. Pain during internal rotation of the right hip
Answer: B. Pain in the RLQ when pressure is applied to the LLQ
Rationale: Rovsing’s sign indicates peritoneal irritation, specifically associated with acute
appendicitis.
5. Which cranial nerve is responsible for the motor function of the tongue?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. CN VII (Facial)
Answer: C. CN XII (Hypoglossal)
Rationale: Testing CN XII involves asking the patient to stick out their tongue; deviation
to one side indicates nerve damage.
6. To differentiate between a "Hordeolum" and a "Chalazion," the practitioner
notes that a Hordeolum is:
A. Chronic and painless
B. Acute and painful
C. Located only on the conjunctiva
D. Associated with vision loss
Answer: B. Acute and painful
Rationale: A hordeolum (stye) is an acute infection of the oil glands; a chalazion is a
non-tender, chronic inflammatory granuloma.
7. A grade IV heart murmur is distinguished by:
,A. Being very faint, heard only with effort
B. Being moderately loud without a thrill
C. Being loud and associated with a palpable thrill
D. Being heard with the stethoscope off the chest
Answer: C. Being loud and associated with a palpable thrill
Rationale: Murmurs are graded I–VI. A thrill (palpable vibration) is first present at Grade
IV.
8. During an abdominal exam, percussing a distended bladder would produce
which sound?
A. Tympany
B. Hyperresonance
C. Dullness
D. Resonance
Answer: C. Dullness
Rationale: Dullness is heard over solid organs or fluid-filled structures (like a full bladder
or an enlarged liver).
9. A "painless" leathery white patch on the lateral border of the tongue that cannot
be scraped off is likely:
A. Oral Candidiasis
B. Leukoplakia
C. Aphthous Ulcer
D. Glossitis
Answer: B. Leukoplakia
Rationale: Leukoplakia is often a premalignant lesion. Candidiasis (Thrush) can be
scraped off, usually revealing a red base.
10. Which test is the most sensitive for identifying an Anterior Cruciate Ligament
(ACL) tear?
A. McMurray Test
B. Lachman Test
C. Bulge Sign
D. Varus Stress Test
Answer: B. Lachman Test
, Rationale: The Lachman test is considered the gold standard for ACL stability, superior
to the Anterior Drawer test.
11. A 70-year-old patient reports a sudden, "curtain-like" loss of vision in the right
eye. There is no pain. This is likely:
A. Acute Angle-Closure Glaucoma
B. Retinal Detachment
C. Cataracts
D. Macular Degeneration
Answer: B. Retinal Detachment
Rationale: Retinal detachment is a painless emergency often described as a curtain or
shadow falling across the field of vision.
12. When testing Cranial Nerve V (Trigeminal), the practitioner should assess:
A. Facial symmetry during a smile
B. Sensation to the face and strength of the masseter muscle
C. The gag reflex
D. Hearing acuity
Answer: B. Sensation to the face and strength of the masseter muscle
Rationale: CN V has both sensory (face) and motor (mastication/clenching teeth)
components.
13. A "Positive Murphy’s Sign" is indicative of:
A. Acute Appendicitis
B. Acute Cholecystitis
C. Splenomegaly
D. Nephrolithiasis
Answer: B. Acute Cholecystitis
Rationale: Pain and inspiratory arrest during palpation of the gallbladder (RUQ) indicates
cholecystitis.
14. Tactile fremitus is decreased in which of the following conditions?
A. Pneumonia
B. Pleural Effusion
C. Lung Tumor
D. Bronchitis
Answer: B. Pleural Effusion
Rationales | Chamberlain
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 55-year-old patient presents with a chief complaint of "chest pressure."
During auscultation, you hear a high-pitched, scratchy sound at the left lower
sternal border that is loudest when the patient leans forward. This is most likely:
A. Aortic Stenosis
B. Pericardial Friction Rub
C. Mitral Valve Prolapse
D. S3 Gallop
Answer: B. Pericardial Friction Rub
Rationale: A friction rub is characteristic of pericarditis and is best heard with the patient
leaning forward in expiration. It is a scratchy, three-component sound.
2. While performing a respiratory assessment, you hear a muffled, "eee" sound
turn into a nasal "aaa" sound over the right lower lobe. This finding is
documented as:
A. Bronchophony
B. Whispered Pectoriloquy
C. Egophony
D. Tactile Fremitus
Answer: C. Egophony
Rationale: Egophony occurs when sound transmits through consolidated lung tissue (like
pneumonia), altering the sound of the vowel.
3. Which maneuver is used to assess for a torn meniscus in the knee?
,A. Lachman Test
B. McMurray Test
C. Drawer Test
D. Phalen’s Sign
Answer: B. McMurray Test
Rationale: McMurray’s involves rotating the lower leg with the knee flexed; a "click" or
pain indicates a meniscal tear. Lachman and Drawer tests assess the ACL.
4. A positive Rovsing’s sign is characterized by:
A. Pain in the RUQ during inspiration
B. Pain in the RLQ when pressure is applied to the LLQ
C. Pain when the patient drops from their toes to their heels
D. Pain during internal rotation of the right hip
Answer: B. Pain in the RLQ when pressure is applied to the LLQ
Rationale: Rovsing’s sign indicates peritoneal irritation, specifically associated with acute
appendicitis.
5. Which cranial nerve is responsible for the motor function of the tongue?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. CN VII (Facial)
Answer: C. CN XII (Hypoglossal)
Rationale: Testing CN XII involves asking the patient to stick out their tongue; deviation
to one side indicates nerve damage.
6. To differentiate between a "Hordeolum" and a "Chalazion," the practitioner
notes that a Hordeolum is:
A. Chronic and painless
B. Acute and painful
C. Located only on the conjunctiva
D. Associated with vision loss
Answer: B. Acute and painful
Rationale: A hordeolum (stye) is an acute infection of the oil glands; a chalazion is a
non-tender, chronic inflammatory granuloma.
7. A grade IV heart murmur is distinguished by:
,A. Being very faint, heard only with effort
B. Being moderately loud without a thrill
C. Being loud and associated with a palpable thrill
D. Being heard with the stethoscope off the chest
Answer: C. Being loud and associated with a palpable thrill
Rationale: Murmurs are graded I–VI. A thrill (palpable vibration) is first present at Grade
IV.
8. During an abdominal exam, percussing a distended bladder would produce
which sound?
A. Tympany
B. Hyperresonance
C. Dullness
D. Resonance
Answer: C. Dullness
Rationale: Dullness is heard over solid organs or fluid-filled structures (like a full bladder
or an enlarged liver).
9. A "painless" leathery white patch on the lateral border of the tongue that cannot
be scraped off is likely:
A. Oral Candidiasis
B. Leukoplakia
C. Aphthous Ulcer
D. Glossitis
Answer: B. Leukoplakia
Rationale: Leukoplakia is often a premalignant lesion. Candidiasis (Thrush) can be
scraped off, usually revealing a red base.
10. Which test is the most sensitive for identifying an Anterior Cruciate Ligament
(ACL) tear?
A. McMurray Test
B. Lachman Test
C. Bulge Sign
D. Varus Stress Test
Answer: B. Lachman Test
, Rationale: The Lachman test is considered the gold standard for ACL stability, superior
to the Anterior Drawer test.
11. A 70-year-old patient reports a sudden, "curtain-like" loss of vision in the right
eye. There is no pain. This is likely:
A. Acute Angle-Closure Glaucoma
B. Retinal Detachment
C. Cataracts
D. Macular Degeneration
Answer: B. Retinal Detachment
Rationale: Retinal detachment is a painless emergency often described as a curtain or
shadow falling across the field of vision.
12. When testing Cranial Nerve V (Trigeminal), the practitioner should assess:
A. Facial symmetry during a smile
B. Sensation to the face and strength of the masseter muscle
C. The gag reflex
D. Hearing acuity
Answer: B. Sensation to the face and strength of the masseter muscle
Rationale: CN V has both sensory (face) and motor (mastication/clenching teeth)
components.
13. A "Positive Murphy’s Sign" is indicative of:
A. Acute Appendicitis
B. Acute Cholecystitis
C. Splenomegaly
D. Nephrolithiasis
Answer: B. Acute Cholecystitis
Rationale: Pain and inspiratory arrest during palpation of the gallbladder (RUQ) indicates
cholecystitis.
14. Tactile fremitus is decreased in which of the following conditions?
A. Pneumonia
B. Pleural Effusion
C. Lung Tumor
D. Bronchitis
Answer: B. Pleural Effusion
