NR509 Week 8 Final Exam Due 1st March 2026
Complete Actual Exam Questions 1- 100 NR-509
Advanced Physical Assessment NR 509 Midterm and
Finals Examplify Online Proctored Exam Questions and
Answers | 100% Pass Guaranteed | Graded A+
Section 1: Headache & Neurology (Questions 1-6)
Question 1
A 28-year-old female presents with a 3-month history of episodic headaches. She
describes a unilateral, throbbing pain that lasts 6-12 hours. She reports seeing
"sparkles and zigzag lines" for 20 minutes before the pain begins. During the
headache, she has nausea and avoids light. What is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Medication overuse headache
*Rationale: The presence of visual aura (sparkles, zigzag lines) preceding a
unilateral, throbbing headache associated with nausea and photophobia meets
ICHD-3 diagnostic criteria for migraine with aura. Tension headaches are bilateral
and non-throbbing. Cluster headaches have autonomic features. Medication
overuse requires frequent analgesic use.*
Question 2
A 45-year-old male reports awakening from sleep with a severe, generalized
headache. He denies prior headache history. Vitals are normal. Which "red flag"
feature is most concerning for a secondary headache disorder?
,A. Headache lasting 4 hours
B. Awakening from sleep due to headache
C. Associated mild nausea
D. Bilateral location
Rationale: Headaches that awaken a patient from sleep are a red flag for
increased intracranial pressure or a space-occupying lesion. Duration, mild
nausea, and bilateral location are common in primary headache disorders like
migraine or tension headache.
Question 3
A 62-year-old female with a history of hypertension presents with a sudden-onset,
severe "thunderclap" headache described as "the worst headache of my life."
Neurologic exam is non-focal. What is the most appropriate next step?
A. Prescribe sumatriptan and follow up in 2 weeks
B. Obtain non-contrast head CT
C. Immediate non-contrast head CT followed by lumbar puncture if CT negative
D. Administer IV fluids and observe for 4 hours
Rationale: Thunderclap headache is a red flag for subarachnoid hemorrhage. Non-
contrast head CT is the initial study of choice. If CT is negative, lumbar puncture is
required to detect xanthochromia or blood in the CSF. This cannot be managed
expectantly or with migraine therapies.
Question 4
A 35-year-old female with migraine with aura is taking combined oral
contraceptives (COCs). She asks about her stroke risk. What is the most
appropriate recommendation?
A. Continue COCs as the risk is negligible
B. Switch to a higher dose estrogen pill
, C. Discontinue COCs and switch to progesterone-only contraception
D. Add low-dose aspirin for stroke prevention
*Rationale: The combination of migraine with aura and combined oral
contraceptives increases the risk of ischemic stroke (OR 2-4). Progesterone-only
methods do not carry this risk. Aspirin is not indicated for primary prevention in
this setting.*
Question 5
A 70-year-old male with a 60-pack-year smoking history presents with new-onset
headache and tenderness over his left temple. He reports jaw pain while chewing.
ESR is 95 mm/hr. What is the most likely diagnosis?
A. Migraine without aura
B. Giant cell arteritis (temporal arteritis)
C. Trigeminal neuralgia
D. Tension-type headache
Rationale: The combination of new headache in an older adult, jaw claudication,
temporal tenderness, and markedly elevated ESR is classic for giant cell arteritis.
This is an emergency due to risk of blindness; high-dose corticosteroids are
required immediately.
Question 6
A 55-year-old female presents with a daily, non-throbbing, "band-like" headache
for 6 months. She takes over-the-counter analgesics nearly every day. What is the
most likely diagnosis?
A. Chronic migraine
B. Medication overuse headache
C. Cluster headache
D. Trigeminal autonomic cephalalgia
Complete Actual Exam Questions 1- 100 NR-509
Advanced Physical Assessment NR 509 Midterm and
Finals Examplify Online Proctored Exam Questions and
Answers | 100% Pass Guaranteed | Graded A+
Section 1: Headache & Neurology (Questions 1-6)
Question 1
A 28-year-old female presents with a 3-month history of episodic headaches. She
describes a unilateral, throbbing pain that lasts 6-12 hours. She reports seeing
"sparkles and zigzag lines" for 20 minutes before the pain begins. During the
headache, she has nausea and avoids light. What is the most likely diagnosis?
A. Tension-type headache
B. Cluster headache
C. Migraine with aura
D. Medication overuse headache
*Rationale: The presence of visual aura (sparkles, zigzag lines) preceding a
unilateral, throbbing headache associated with nausea and photophobia meets
ICHD-3 diagnostic criteria for migraine with aura. Tension headaches are bilateral
and non-throbbing. Cluster headaches have autonomic features. Medication
overuse requires frequent analgesic use.*
Question 2
A 45-year-old male reports awakening from sleep with a severe, generalized
headache. He denies prior headache history. Vitals are normal. Which "red flag"
feature is most concerning for a secondary headache disorder?
,A. Headache lasting 4 hours
B. Awakening from sleep due to headache
C. Associated mild nausea
D. Bilateral location
Rationale: Headaches that awaken a patient from sleep are a red flag for
increased intracranial pressure or a space-occupying lesion. Duration, mild
nausea, and bilateral location are common in primary headache disorders like
migraine or tension headache.
Question 3
A 62-year-old female with a history of hypertension presents with a sudden-onset,
severe "thunderclap" headache described as "the worst headache of my life."
Neurologic exam is non-focal. What is the most appropriate next step?
A. Prescribe sumatriptan and follow up in 2 weeks
B. Obtain non-contrast head CT
C. Immediate non-contrast head CT followed by lumbar puncture if CT negative
D. Administer IV fluids and observe for 4 hours
Rationale: Thunderclap headache is a red flag for subarachnoid hemorrhage. Non-
contrast head CT is the initial study of choice. If CT is negative, lumbar puncture is
required to detect xanthochromia or blood in the CSF. This cannot be managed
expectantly or with migraine therapies.
Question 4
A 35-year-old female with migraine with aura is taking combined oral
contraceptives (COCs). She asks about her stroke risk. What is the most
appropriate recommendation?
A. Continue COCs as the risk is negligible
B. Switch to a higher dose estrogen pill
, C. Discontinue COCs and switch to progesterone-only contraception
D. Add low-dose aspirin for stroke prevention
*Rationale: The combination of migraine with aura and combined oral
contraceptives increases the risk of ischemic stroke (OR 2-4). Progesterone-only
methods do not carry this risk. Aspirin is not indicated for primary prevention in
this setting.*
Question 5
A 70-year-old male with a 60-pack-year smoking history presents with new-onset
headache and tenderness over his left temple. He reports jaw pain while chewing.
ESR is 95 mm/hr. What is the most likely diagnosis?
A. Migraine without aura
B. Giant cell arteritis (temporal arteritis)
C. Trigeminal neuralgia
D. Tension-type headache
Rationale: The combination of new headache in an older adult, jaw claudication,
temporal tenderness, and markedly elevated ESR is classic for giant cell arteritis.
This is an emergency due to risk of blindness; high-dose corticosteroids are
required immediately.
Question 6
A 55-year-old female presents with a daily, non-throbbing, "band-like" headache
for 6 months. She takes over-the-counter analgesics nearly every day. What is the
most likely diagnosis?
A. Chronic migraine
B. Medication overuse headache
C. Cluster headache
D. Trigeminal autonomic cephalalgia
