NR 509 FINAL EXAM GUIDE (2024/2025)100+
Questions with Verified Answers and Rationales –
Graded A+
This guide covers the core topics tested on the Chamberlain
University NR 509 Advanced Physical Assessment final exam,
including: HEENT, cardiac, respiratory, abdominal,
neurological, musculoskeletal, and advanced assessment
techniques.
SECTION 1: HEENT (Head, Eyes, Ears, Nose, Throat)
Question 1
A 65-year-old patient reports gradual vision loss, difficulty
reading, and trouble driving at night. Fundoscopic exam reveals
a "copper wire" appearance of arteriovenous nicking and
flame-shaped hemorrhages. What is the most likely diagnosis?
• A) Diabetic retinopathy
• B) Hypertensive retinopathy
• C) Age-related macular degeneration
• D) Glaucoma
Correct Answer: B
Rationale: Hypertensive retinopathy findings include
arteriovenous nicking, copper/silver wiring, flame-shaped
,hemorrhages, cotton-wool spots, and papilledema in severe
cases. Diabetic retinopathy has microaneurysms, dot-blot
hemorrhages, and neovascularization. Macular degeneration
affects the macula (drusen). Glaucoma presents with optic disc
cupping.
Clinical Pearl: The Keith-Wagener-Barker classification grades
hypertensive retinopathy from I (mild AV nicking) to IV
(papilledema).
Question 2
A 45-year-old patient reports episodic headaches with
unilateral, periorbital pain that is "sharp" and lasts 15–60
minutes. The eye is red and tearing, and the patient is restless.
This is most consistent with:
• A) Migraine
• B) Tension headache
• C) Cluster headache
• D) Temporal arteritis
Correct Answer: C
Rationale: Cluster headaches are unilateral, severe, periorbital
pain lasting 15–180 minutes, accompanied by ipsilateral
autonomic symptoms (red eye, tearing, nasal congestion,
ptosis, miosis). Patients are restless (not lying still like
,migraine). Migraine is often throbbing, with photophobia and
nausea, lasting 4–72 hours.
Question 3
A 70-year-old patient presents with acute-onset, painless vision
loss in the right eye. Fundoscopic exam shows a pale optic disc
with "boxcarring" of retinal vessels. What is the most likely
diagnosis?
• A) Central retinal artery occlusion (CRAO)
• B) Central retinal vein occlusion (CRVO)
• C) Optic neuritis
• D) Vitreous hemorrhage
Correct Answer: A
Rationale: CRAO presents with acute, painless, monocular
vision loss. Fundus shows cherry-red spot (macula) with
surrounding pale retina, boxcarring (segmentation) of retinal
vessels, and optic disc pallor. CRVO causes disc edema and
diffuse retinal hemorrhages ("blood and thunder").
Question 4
A patient presents with acute ear pain, fever, and hearing loss.
Otoscopic exam reveals a bulging, erythematous tympanic
, membrane with absent landmarks and decreased mobility on
pneumatic otoscopy. What is the most likely diagnosis?
• A) Otitis externa
• B) Acute otitis media (AOM)
• C) Serous otitis media (OME)
• D) Tympanosclerosis
Correct Answer: B
Rationale: AOM presents with bulging, erythematous TM,
decreased or absent mobility, and middle ear effusion. Otitis
externa involves canal erythema and edema; pain with tragus
manipulation. OME (serous) has retracted TM with fluid level
but no acute inflammation. Tympanosclerosis has white
plaques without inflammation.
Clinical Pearl: Pneumatic otoscopy is the gold standard for
assessing TM mobility. Reduced mobility = middle ear effusion.
Question 5
A 50-year-old woman reports a lump in her neck. On palpation,
you feel a firm, nontender, 2 cm nodule in the right thyroid
lobe that moves with swallowing. What is the first step in
evaluation?
• A) Order a thyroid ultrasound
• B) Order a thyroid-stimulating hormone (TSH) level
Questions with Verified Answers and Rationales –
Graded A+
This guide covers the core topics tested on the Chamberlain
University NR 509 Advanced Physical Assessment final exam,
including: HEENT, cardiac, respiratory, abdominal,
neurological, musculoskeletal, and advanced assessment
techniques.
SECTION 1: HEENT (Head, Eyes, Ears, Nose, Throat)
Question 1
A 65-year-old patient reports gradual vision loss, difficulty
reading, and trouble driving at night. Fundoscopic exam reveals
a "copper wire" appearance of arteriovenous nicking and
flame-shaped hemorrhages. What is the most likely diagnosis?
• A) Diabetic retinopathy
• B) Hypertensive retinopathy
• C) Age-related macular degeneration
• D) Glaucoma
Correct Answer: B
Rationale: Hypertensive retinopathy findings include
arteriovenous nicking, copper/silver wiring, flame-shaped
,hemorrhages, cotton-wool spots, and papilledema in severe
cases. Diabetic retinopathy has microaneurysms, dot-blot
hemorrhages, and neovascularization. Macular degeneration
affects the macula (drusen). Glaucoma presents with optic disc
cupping.
Clinical Pearl: The Keith-Wagener-Barker classification grades
hypertensive retinopathy from I (mild AV nicking) to IV
(papilledema).
Question 2
A 45-year-old patient reports episodic headaches with
unilateral, periorbital pain that is "sharp" and lasts 15–60
minutes. The eye is red and tearing, and the patient is restless.
This is most consistent with:
• A) Migraine
• B) Tension headache
• C) Cluster headache
• D) Temporal arteritis
Correct Answer: C
Rationale: Cluster headaches are unilateral, severe, periorbital
pain lasting 15–180 minutes, accompanied by ipsilateral
autonomic symptoms (red eye, tearing, nasal congestion,
ptosis, miosis). Patients are restless (not lying still like
,migraine). Migraine is often throbbing, with photophobia and
nausea, lasting 4–72 hours.
Question 3
A 70-year-old patient presents with acute-onset, painless vision
loss in the right eye. Fundoscopic exam shows a pale optic disc
with "boxcarring" of retinal vessels. What is the most likely
diagnosis?
• A) Central retinal artery occlusion (CRAO)
• B) Central retinal vein occlusion (CRVO)
• C) Optic neuritis
• D) Vitreous hemorrhage
Correct Answer: A
Rationale: CRAO presents with acute, painless, monocular
vision loss. Fundus shows cherry-red spot (macula) with
surrounding pale retina, boxcarring (segmentation) of retinal
vessels, and optic disc pallor. CRVO causes disc edema and
diffuse retinal hemorrhages ("blood and thunder").
Question 4
A patient presents with acute ear pain, fever, and hearing loss.
Otoscopic exam reveals a bulging, erythematous tympanic
, membrane with absent landmarks and decreased mobility on
pneumatic otoscopy. What is the most likely diagnosis?
• A) Otitis externa
• B) Acute otitis media (AOM)
• C) Serous otitis media (OME)
• D) Tympanosclerosis
Correct Answer: B
Rationale: AOM presents with bulging, erythematous TM,
decreased or absent mobility, and middle ear effusion. Otitis
externa involves canal erythema and edema; pain with tragus
manipulation. OME (serous) has retracted TM with fluid level
but no acute inflammation. Tympanosclerosis has white
plaques without inflammation.
Clinical Pearl: Pneumatic otoscopy is the gold standard for
assessing TM mobility. Reduced mobility = middle ear effusion.
Question 5
A 50-year-old woman reports a lump in her neck. On palpation,
you feel a firm, nontender, 2 cm nodule in the right thyroid
lobe that moves with swallowing. What is the first step in
evaluation?
• A) Order a thyroid ultrasound
• B) Order a thyroid-stimulating hormone (TSH) level
