NR509 Week 4 Midterm Exam 2026 | Advanced
Physical Assessment Scenario-Based Practice Test
(100 NCLEX-Style Case Questions with Answers &
Detailed Rationales)
1. A 62-year-old patient presents with shortness of breath when lying flat and reports
needing two pillows to sleep. On assessment, crackles are heard in both lung bases. What is
the most likely condition?
A. Asthma exacerbation
B. Left-sided heart failure
C. Pneumothorax
D. COPD without exacerbation
✔️ Answer: B. Left-sided heart failure
Rationale: Orthopnea and bibasilar crackles indicate pulmonary congestion from left ventricular
failure.
2. A patient arrives after a head injury and becomes increasingly drowsy. Pupils are
unequal, with the right pupil fixed and dilated. What is the priority concern?
A. Anxiety reaction
B. Increased intracranial pressure
C. Migraine headache
D. Dehydration
✔️ Answer: B. Increased intracranial pressure
Rationale: Unequal, non-reactive pupils and declining consciousness suggest brain herniation
risk.
3. During lung assessment, a nurse notes absent breath sounds in the right upper lobe and
tracheal deviation to the left. What is most likely occurring?
A. Pneumonia
B. Pneumothorax
C. Bronchitis
D. Pleural effusion
,✔️ Answer: B. Pneumothorax
Rationale: Air in the pleural space can collapse the lung and shift the trachea.
4. A patient with chronic liver disease presents with abdominal distention and shifting
dullness. What is the most likely cause?
A. Constipation
B. Ascites
C. Bowel obstruction
D. Hernia
✔️ Answer: B. Ascites
Rationale: Fluid accumulation in the peritoneal cavity is common in liver failure.
5. A nurse asks a patient to close their eyes and identify a coin placed in their hand. The
patient cannot identify it. What is this finding called?
A. Astereognosis
B. Aphasia
C. Apraxia
D. Agnosia
✔️ Answer: A. Astereognosis
Rationale: Inability to recognize objects by touch indicates parietal lobe dysfunction.
6. A patient presents with wheezing, chest tightness, and prolonged expiration. What
condition is most likely?
A. Pneumonia
B. Asthma exacerbation
C. Heart failure
D. Pleural effusion
✔️ Answer: B. Asthma exacerbation
Rationale: Wheezing and prolonged expiration indicate bronchoconstriction.
7. During cardiovascular assessment, a nurse hears a blowing holosystolic murmur at the
apex. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
, C. Pulmonary stenosis
D. Pericarditis
✔️ Answer: B. Mitral regurgitation
Rationale: Holosystolic murmur at apex suggests backward flow through mitral valve.
8. A patient is unable to perform rapid alternating hand movements. What does this
indicate?
A. Stroke
B. Cerebellar dysfunction
C. Peripheral neuropathy
D. Muscle strain
✔️ Answer: B. Cerebellar dysfunction
Rationale: Dysdiadochokinesia indicates impaired coordination.
9. A nurse observes jugular venous distention in a patient sitting at 45 degrees. What
condition is most likely?
A. Hypovolemia
B. Right-sided heart failure
C. Dehydration
D. Anxiety
✔️ Answer: B. Right-sided heart failure
Rationale: Elevated venous pressure causes visible neck vein distention.
10. A patient has rebound tenderness in the right lower quadrant. What is the priority
concern?
A. Constipation
B. Appendicitis
C. Gastritis
D. GERD
✔️ Answer: B. Appendicitis
Rationale: Rebound tenderness suggests peritoneal inflammation.
11. A nurse hears stridor in a patient with facial swelling after eating peanuts. What is the
priority action?
Physical Assessment Scenario-Based Practice Test
(100 NCLEX-Style Case Questions with Answers &
Detailed Rationales)
1. A 62-year-old patient presents with shortness of breath when lying flat and reports
needing two pillows to sleep. On assessment, crackles are heard in both lung bases. What is
the most likely condition?
A. Asthma exacerbation
B. Left-sided heart failure
C. Pneumothorax
D. COPD without exacerbation
✔️ Answer: B. Left-sided heart failure
Rationale: Orthopnea and bibasilar crackles indicate pulmonary congestion from left ventricular
failure.
2. A patient arrives after a head injury and becomes increasingly drowsy. Pupils are
unequal, with the right pupil fixed and dilated. What is the priority concern?
A. Anxiety reaction
B. Increased intracranial pressure
C. Migraine headache
D. Dehydration
✔️ Answer: B. Increased intracranial pressure
Rationale: Unequal, non-reactive pupils and declining consciousness suggest brain herniation
risk.
3. During lung assessment, a nurse notes absent breath sounds in the right upper lobe and
tracheal deviation to the left. What is most likely occurring?
A. Pneumonia
B. Pneumothorax
C. Bronchitis
D. Pleural effusion
,✔️ Answer: B. Pneumothorax
Rationale: Air in the pleural space can collapse the lung and shift the trachea.
4. A patient with chronic liver disease presents with abdominal distention and shifting
dullness. What is the most likely cause?
A. Constipation
B. Ascites
C. Bowel obstruction
D. Hernia
✔️ Answer: B. Ascites
Rationale: Fluid accumulation in the peritoneal cavity is common in liver failure.
5. A nurse asks a patient to close their eyes and identify a coin placed in their hand. The
patient cannot identify it. What is this finding called?
A. Astereognosis
B. Aphasia
C. Apraxia
D. Agnosia
✔️ Answer: A. Astereognosis
Rationale: Inability to recognize objects by touch indicates parietal lobe dysfunction.
6. A patient presents with wheezing, chest tightness, and prolonged expiration. What
condition is most likely?
A. Pneumonia
B. Asthma exacerbation
C. Heart failure
D. Pleural effusion
✔️ Answer: B. Asthma exacerbation
Rationale: Wheezing and prolonged expiration indicate bronchoconstriction.
7. During cardiovascular assessment, a nurse hears a blowing holosystolic murmur at the
apex. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
, C. Pulmonary stenosis
D. Pericarditis
✔️ Answer: B. Mitral regurgitation
Rationale: Holosystolic murmur at apex suggests backward flow through mitral valve.
8. A patient is unable to perform rapid alternating hand movements. What does this
indicate?
A. Stroke
B. Cerebellar dysfunction
C. Peripheral neuropathy
D. Muscle strain
✔️ Answer: B. Cerebellar dysfunction
Rationale: Dysdiadochokinesia indicates impaired coordination.
9. A nurse observes jugular venous distention in a patient sitting at 45 degrees. What
condition is most likely?
A. Hypovolemia
B. Right-sided heart failure
C. Dehydration
D. Anxiety
✔️ Answer: B. Right-sided heart failure
Rationale: Elevated venous pressure causes visible neck vein distention.
10. A patient has rebound tenderness in the right lower quadrant. What is the priority
concern?
A. Constipation
B. Appendicitis
C. Gastritis
D. GERD
✔️ Answer: B. Appendicitis
Rationale: Rebound tenderness suggests peritoneal inflammation.
11. A nurse hears stridor in a patient with facial swelling after eating peanuts. What is the
priority action?
