NR509 Week 8 Final Exam 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+
Questions 1–20 (General & HEENT)
1. A 45-year-old patient reports a “pulsing” sound in the left ear that matches
her heartbeat. On otoscopy, the tympanic membrane is normal. What is the
most likely finding on further assessment?
A. Cerumen impaction against the eardrum
B. Patulous eustachian tube
C. Vascular bruit audible over the temporal area
D. Sensorineural hearing loss at 4000 Hz
Rationale: Pulsatile tinnitus suggests a vascular cause (e.g., arteriovenous
malformation, glomus tumor, or carotid bruit). Cerumen impaction and
patulous eustachian tube cause non-pulsatile tinnitus. Isolated high-frequency
loss is typical of noise damage, not pulsatile.
,2. During a funduscopic exam, you note sharp optic disc margins, a cup-to-disc
ratio of 0.3, and arteriovenous nicking. What is the most likely diagnosis?
A. Papilledema
B. Glaucoma
C. Hypertensive retinopathy
D. Optic atrophy
Rationale: AV nicking is characteristic of chronic hypertension. Papilledema
shows blurred disc margins; glaucoma has enlarged cup-to-disc ratio (>0.5);
optic atrophy shows pallor.
3. A 60-year-old with diabetes reports progressive hoarseness and throat
clearing. On mirror laryngoscopy, you see a whitish plaque on one vocal cord
that does not wipe off. What should you suspect?
A. Laryngopharyngeal reflux
B. Leukoplakia with possible dysplasia
C. Vocal cord nodule
D. Acute laryngitis
Rationale: A non-removable white plaque on a vocal cord in an older patient
(especially with smoking history) raises concern for leukoplakia, which can be
premalignant. Reflux and nodules are usually bilateral; laryngitis shows
erythema, not plaque.
4. To assess for facial nerve (CN VII) motor function, you ask the patient to:
A. Smile, puff out cheeks, and close eyes tightly
B. Stick out tongue and move it side to side
C. Shrug shoulders against resistance
D. Follow a finger through the six cardinal gaze positions
Rationale: CN VII controls muscles of facial expression. Tongue is CN XII;
shoulder shrug is CN XI; gaze is CN III, IV, VI.
5. A patient presents with acute conjunctival injection, purulent discharge, and
matted eyelids. The cornea is clear, and vision is normal. Most likely
,pathogen?
A. Adenovirus
B. Neisseria gonorrhoeae
C. Chlamydia trachomatis
D. Allergic reaction
Rationale: Purulent discharge suggests bacterial conjunctivitis. Gonococcal
conjunctivitis is hyperacute with profuse pus. Adenovirus is watery discharge;
chlamydia has chronic mild discharge with follicles; allergy has itching and
tearing.
6. You palpate the thyroid gland and feel a firm, fixed, painless nodule in the
right lobe. The patient has no other symptoms. Which associated finding
would most increase concern for malignancy?
A. Cervical lymphadenopathy
B. Low TSH level
C. Positive thyroglobulin antibodies
D. Family history of Hashimoto’s thyroiditis
Rationale: Firm, fixed nodule with regional lymphadenopathy is suspicious for
thyroid cancer. Low TSH suggests hyperfunctioning nodule (usually benign).
Autoimmune markers and Hashimoto’s are not directly linked to cancer.
7. During a hearing test, the patient cannot hear the tuning fork placed on the
mastoid process after it is moved in front of the ear canal. This indicates:
A. Normal finding
B. Conductive hearing loss
C. Sensorineural hearing loss
D. Mixed hearing loss
Rationale: The Rinne test compares air conduction (AC) to bone conduction
(BC). Normal: AC > BC (patient hears fork at ear canal after mastoid). If BC >
AC, it’s conductive loss.
, 8. An infant’s head circumference is at the 95th percentile, and the anterior
fontanelle is bulging. The infant is lethargic and vomiting. The most
appropriate next step is:
A. Reassure parents and follow up in 1 month
B. Emergent neuroimaging
C. Prescribe antiemetics
D. Check head circumference weekly
Rationale: Bulging fontanelle + macrocephaly + lethargy suggests increased
intracranial pressure (hydrocephalus, meningitis, mass). Needs immediate
imaging.
9. Which cranial nerve is tested by asking the patient to say “ah” and
observing uvula deviation?
A. CN IX (glossopharyngeal)
B. CN X (vagus)
C. CN XI (accessory)
D. CN XII (hypoglossal)
Rationale: CN X (vagus) motor to palate and pharynx. Uvula deviates away
from the side of a vagal lesion. CN IX is sensory (gag afferent).
10. On ophthalmoscopy, you see “copper wiring” and “arteriovenous nicking”
in a patient with known hypertension. The most likely associated finding on
cardiac exam is:
A. Sustained PMI displaced to the left
B. Opening snap
C. Pericardial friction rub
D. Fixed split S2
Rationale: Hypertensive retinopathy indicates end-organ damage; chronic
pressure overload leads to left ventricular hypertrophy (sustained, displaced
PMI). Opening snap = mitral stenosis; friction rub = pericarditis; fixed split S2
= ASD.
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+
Questions 1–20 (General & HEENT)
1. A 45-year-old patient reports a “pulsing” sound in the left ear that matches
her heartbeat. On otoscopy, the tympanic membrane is normal. What is the
most likely finding on further assessment?
A. Cerumen impaction against the eardrum
B. Patulous eustachian tube
C. Vascular bruit audible over the temporal area
D. Sensorineural hearing loss at 4000 Hz
Rationale: Pulsatile tinnitus suggests a vascular cause (e.g., arteriovenous
malformation, glomus tumor, or carotid bruit). Cerumen impaction and
patulous eustachian tube cause non-pulsatile tinnitus. Isolated high-frequency
loss is typical of noise damage, not pulsatile.
,2. During a funduscopic exam, you note sharp optic disc margins, a cup-to-disc
ratio of 0.3, and arteriovenous nicking. What is the most likely diagnosis?
A. Papilledema
B. Glaucoma
C. Hypertensive retinopathy
D. Optic atrophy
Rationale: AV nicking is characteristic of chronic hypertension. Papilledema
shows blurred disc margins; glaucoma has enlarged cup-to-disc ratio (>0.5);
optic atrophy shows pallor.
3. A 60-year-old with diabetes reports progressive hoarseness and throat
clearing. On mirror laryngoscopy, you see a whitish plaque on one vocal cord
that does not wipe off. What should you suspect?
A. Laryngopharyngeal reflux
B. Leukoplakia with possible dysplasia
C. Vocal cord nodule
D. Acute laryngitis
Rationale: A non-removable white plaque on a vocal cord in an older patient
(especially with smoking history) raises concern for leukoplakia, which can be
premalignant. Reflux and nodules are usually bilateral; laryngitis shows
erythema, not plaque.
4. To assess for facial nerve (CN VII) motor function, you ask the patient to:
A. Smile, puff out cheeks, and close eyes tightly
B. Stick out tongue and move it side to side
C. Shrug shoulders against resistance
D. Follow a finger through the six cardinal gaze positions
Rationale: CN VII controls muscles of facial expression. Tongue is CN XII;
shoulder shrug is CN XI; gaze is CN III, IV, VI.
5. A patient presents with acute conjunctival injection, purulent discharge, and
matted eyelids. The cornea is clear, and vision is normal. Most likely
,pathogen?
A. Adenovirus
B. Neisseria gonorrhoeae
C. Chlamydia trachomatis
D. Allergic reaction
Rationale: Purulent discharge suggests bacterial conjunctivitis. Gonococcal
conjunctivitis is hyperacute with profuse pus. Adenovirus is watery discharge;
chlamydia has chronic mild discharge with follicles; allergy has itching and
tearing.
6. You palpate the thyroid gland and feel a firm, fixed, painless nodule in the
right lobe. The patient has no other symptoms. Which associated finding
would most increase concern for malignancy?
A. Cervical lymphadenopathy
B. Low TSH level
C. Positive thyroglobulin antibodies
D. Family history of Hashimoto’s thyroiditis
Rationale: Firm, fixed nodule with regional lymphadenopathy is suspicious for
thyroid cancer. Low TSH suggests hyperfunctioning nodule (usually benign).
Autoimmune markers and Hashimoto’s are not directly linked to cancer.
7. During a hearing test, the patient cannot hear the tuning fork placed on the
mastoid process after it is moved in front of the ear canal. This indicates:
A. Normal finding
B. Conductive hearing loss
C. Sensorineural hearing loss
D. Mixed hearing loss
Rationale: The Rinne test compares air conduction (AC) to bone conduction
(BC). Normal: AC > BC (patient hears fork at ear canal after mastoid). If BC >
AC, it’s conductive loss.
, 8. An infant’s head circumference is at the 95th percentile, and the anterior
fontanelle is bulging. The infant is lethargic and vomiting. The most
appropriate next step is:
A. Reassure parents and follow up in 1 month
B. Emergent neuroimaging
C. Prescribe antiemetics
D. Check head circumference weekly
Rationale: Bulging fontanelle + macrocephaly + lethargy suggests increased
intracranial pressure (hydrocephalus, meningitis, mass). Needs immediate
imaging.
9. Which cranial nerve is tested by asking the patient to say “ah” and
observing uvula deviation?
A. CN IX (glossopharyngeal)
B. CN X (vagus)
C. CN XI (accessory)
D. CN XII (hypoglossal)
Rationale: CN X (vagus) motor to palate and pharynx. Uvula deviates away
from the side of a vagal lesion. CN IX is sensory (gag afferent).
10. On ophthalmoscopy, you see “copper wiring” and “arteriovenous nicking”
in a patient with known hypertension. The most likely associated finding on
cardiac exam is:
A. Sustained PMI displaced to the left
B. Opening snap
C. Pericardial friction rub
D. Fixed split S2
Rationale: Hypertensive retinopathy indicates end-organ damage; chronic
pressure overload leads to left ventricular hypertrophy (sustained, displaced
PMI). Opening snap = mitral stenosis; friction rub = pericarditis; fixed split S2
= ASD.
