NR 509 Advanced Physical Assessment Final Examination
Package, Chamberlain University College of Nursing,
2026/2027 – 200-Question NGN-Aligned Examination with
Verified Answers and Rationales
**1. The function of the auditory ossicles is to:**
a) transmit the light reflex to the light cone.
b) transform sound vibrations into mechanical waves for the inner ear.
c) capture sound waves from the external ear for transmission into the middle ear.
d) separate the inner ear from the middle ear.
**Answer:** b) transform sound vibrations into mechanical waves for the inner ear.
**Rationale:** The auditory ossicles (malleus, incus, and stapes) form a chain across the middle
ear, transmitting and amplifying sound vibrations from the tympanic membrane to the oval window of
the inner ear.
**2. A 60-year-old patient is concerned about a yellowish-colored lesion above her right eyelid. Findings
reveal a slightly raised, yellowish, well-circumscribed plaque along the nasal area of her right eyelid. This
finding is most consistent with:**
a) a pinguecula.
b) a chalazion.
c) episcleritis.
d) xanthelasma.
**Answer:** d) xanthelasma.
**Rationale:** Xanthelasma are slightly raised, yellowish, well-circumscribed plaques appearing
along the nasal area of one or both eyelids. They are often associated with lipid disorders. A pinguecula
is a nodule on the bulbar conjunctiva, a chalazion is a nontender eyelid nodule, and episcleritis is
inflammation of the episcleral vessels.
, **3. Assessment of a patient's visual acuity results in 20/200 using the Snellen eye chart. This means
that:**
a) at 200 feet the patient can read what a person with normal vision could read at 20 feet.
b) at 20 feet the patient can read what a person with normal vision could read at 200 feet.
c) the patient has normal visual acuity.
d) the patient may not be able to read so should be tested with picture or "E" charts.
**Answer:** b) at 20 feet the patient can read what a person with normal vision could read at 200 feet.
**Rationale:** The Snellen chart numerator indicates the testing distance (20 feet), and the
denominator indicates the distance at which a normal eye could read that line. 20/200 vision means the
patient sees at 20 feet what a normal person sees at 200 feet and constitutes legal blindness.
**4. Findings following assessment of a person's left eye gaze include impaired movements when
attempting to look upward, downward, or inward. This condition is most consistent with:**
a) a conjugate gaze.
b) left cranial nerve III (oculomotor) paralysis.
c) cranial nerve IV (trochlear) paralysis.
d) cranial nerve VI (abducens) paralysis.
**Answer:** b) left cranial nerve III (oculomotor) paralysis.
**Rationale:** Cranial nerve III (oculomotor nerve) innervates the superior rectus (upward gaze),
inferior rectus (downward gaze), and medial rectus (inward gaze). Paralysis results in impaired
movement in these directions, often with ptosis and a dilated pupil.
**5. When inspecting the neck for the thyroid gland, slightly tilt the patient's head back, and using
tangential lighting directed downward from the tip of the patient's chin, inspect the:**
a) region above the thyroid cartilage.
b) region below the cricoid cartilage.
c) area along the sternomastoid border.
Package, Chamberlain University College of Nursing,
2026/2027 – 200-Question NGN-Aligned Examination with
Verified Answers and Rationales
**1. The function of the auditory ossicles is to:**
a) transmit the light reflex to the light cone.
b) transform sound vibrations into mechanical waves for the inner ear.
c) capture sound waves from the external ear for transmission into the middle ear.
d) separate the inner ear from the middle ear.
**Answer:** b) transform sound vibrations into mechanical waves for the inner ear.
**Rationale:** The auditory ossicles (malleus, incus, and stapes) form a chain across the middle
ear, transmitting and amplifying sound vibrations from the tympanic membrane to the oval window of
the inner ear.
**2. A 60-year-old patient is concerned about a yellowish-colored lesion above her right eyelid. Findings
reveal a slightly raised, yellowish, well-circumscribed plaque along the nasal area of her right eyelid. This
finding is most consistent with:**
a) a pinguecula.
b) a chalazion.
c) episcleritis.
d) xanthelasma.
**Answer:** d) xanthelasma.
**Rationale:** Xanthelasma are slightly raised, yellowish, well-circumscribed plaques appearing
along the nasal area of one or both eyelids. They are often associated with lipid disorders. A pinguecula
is a nodule on the bulbar conjunctiva, a chalazion is a nontender eyelid nodule, and episcleritis is
inflammation of the episcleral vessels.
, **3. Assessment of a patient's visual acuity results in 20/200 using the Snellen eye chart. This means
that:**
a) at 200 feet the patient can read what a person with normal vision could read at 20 feet.
b) at 20 feet the patient can read what a person with normal vision could read at 200 feet.
c) the patient has normal visual acuity.
d) the patient may not be able to read so should be tested with picture or "E" charts.
**Answer:** b) at 20 feet the patient can read what a person with normal vision could read at 200 feet.
**Rationale:** The Snellen chart numerator indicates the testing distance (20 feet), and the
denominator indicates the distance at which a normal eye could read that line. 20/200 vision means the
patient sees at 20 feet what a normal person sees at 200 feet and constitutes legal blindness.
**4. Findings following assessment of a person's left eye gaze include impaired movements when
attempting to look upward, downward, or inward. This condition is most consistent with:**
a) a conjugate gaze.
b) left cranial nerve III (oculomotor) paralysis.
c) cranial nerve IV (trochlear) paralysis.
d) cranial nerve VI (abducens) paralysis.
**Answer:** b) left cranial nerve III (oculomotor) paralysis.
**Rationale:** Cranial nerve III (oculomotor nerve) innervates the superior rectus (upward gaze),
inferior rectus (downward gaze), and medial rectus (inward gaze). Paralysis results in impaired
movement in these directions, often with ptosis and a dilated pupil.
**5. When inspecting the neck for the thyroid gland, slightly tilt the patient's head back, and using
tangential lighting directed downward from the tip of the patient's chin, inspect the:**
a) region above the thyroid cartilage.
b) region below the cricoid cartilage.
c) area along the sternomastoid border.
