NR509 / NR 509 FINAL EXAM
Latest | Advanced Physical Assessment – Chamberlain University
1. A 67-year-old male presents with a 3-week history of painless cervical lymphadenopathy and a
10-pound weight loss. Which finding would most support a malignant etiology?
A. Lymph node is tender to palpation
B. Lymph node is firm, fixed, and non-tender
C. Lymph node measures 0.5 cm
D. Lymphadenopathy resolves with antibiotics
✔ Correct Answer: B. Lymph node is firm, fixed, and non-tender
2. During funduscopic examination of a hypertensive patient, you observe arteriovenous (AV) nicking.
What does this finding indicate?
A. Normal aging change
B. Chronic hypertensive changes causing arterial wall thickening
C. Diabetic retinopathy
D. Increased intracranial pressure
✔ Correct Answer: B. Chronic hypertensive changes causing arterial wall thickening
3. A patient reports painless, progressive vision loss described as 'looking through a foggy window.'
The most likely diagnosis is:
A. Acute angle-closure glaucoma
B. Retinal detachment
C. Cataract
D. Macular degeneration
✔ Correct Answer: C. Cataract
4. On otoscopic examination, a pearly gray, translucent tympanic membrane with a visible light reflex at
the 5 o'clock position is:
A. Indicative of otitis media
B. Consistent with a normal finding
C. Suggestive of tympanic perforation
D. Associated with cholesteatoma
✔ Correct Answer: B. Consistent with a normal finding
5. A 45-year-old presents with sudden severe eye pain, halos around lights, nausea, and a mid-dilated
fixed pupil. The priority action is:
A. Prescribe eye drops and follow up in 1 week
B. Refer immediately for acute angle-closure glaucoma
C. Perform a visual acuity test and reassure
D. Order an MRI of the orbits
✔ Correct Answer: B. Refer immediately for acute angle-closure glaucoma
6. When performing the Weber test, a patient with right-sided conductive hearing loss will lateralize
sound to which ear?
A. Left ear (unaffected)
B. Both ears equally
C. Right ear (affected)
D. Lateralization depends on frequency
✔ Correct Answer: C. Right ear (affected)
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 1
,7. A 32-year-old woman presents with unilateral facial pain, maxillary tenderness on palpation, and
purulent nasal discharge for 10 days following a URI. The most likely diagnosis is:
A. Allergic rhinitis
B. Acute bacterial rhinosinusitis
C. Dental abscess
D. Trigeminal neuralgia
✔ Correct Answer: B. Acute bacterial rhinosinusitis
8. During a head and neck exam, transillumination of the frontal sinuses reveals no glow bilaterally. This
finding suggests:
A. Normal sinus anatomy
B. Possible sinus congestion or infection
C. Absence of frontal sinuses
D. Deviated nasal septum
✔ Correct Answer: B. Possible sinus congestion or infection
9. Which cranial nerve is being tested when you ask a patient to identify a familiar scent with their eyes
closed?
A. CN II
B. CN V
C. CN I
D. CN VII
✔ Correct Answer: C. CN I
10. A patient presents with a painless white patch on the lateral border of the tongue that cannot be
scraped off. This finding is most consistent with:
A. Oral candidiasis
B. Aphthous ulcer
C. Leukoplakia
D. Lichen planus
✔ Correct Answer: C. Leukoplakia
11. A 28-year-old with a sore throat presents with tonsillar exudates, anterior cervical lymphadenopathy,
fever of 38.9°C, and no cough. Their Centor score is:
A. 1
B. 2
C. 3
D. 4
✔ Correct Answer: D. 4
12. You are assessing extraocular movements and notice the patient's left eye fails to adduct on right
lateral gaze. Which cranial nerve is most likely affected?
A. CN III left
B. CN IV left
C. CN VI right
D. CN III right
✔ Correct Answer: A. CN III left
13. A 70-year-old is noted to have arcus senilis on eye examination. The appropriate clinical response
is:
A. Urgent ophthalmology referral
B. Order fasting lipid panel — this finding is pathologic under age 50
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 2
, C. Document as a normal aging finding in this patient
D. Prescribe lubricating eye drops
✔ Correct Answer: C. Document as a normal aging finding in this patient
14. During thyroid palpation from behind, you note a single 1.5 cm firm, non-tender, non-mobile nodule.
The most appropriate next step is:
A. Reassure the patient and recheck in 12 months
B. Prescribe levothyroxine empirically
C. Order thyroid ultrasound and TSH level
D. Perform fine needle aspiration at bedside
✔ Correct Answer: C. Order thyroid ultrasound and TSH level
15. A 19-year-old presents with fever, severe pharyngitis, exudative tonsillitis, and splenomegaly. The
peripheral smear shows atypical lymphocytes. Which test confirms the diagnosis?
A. Rapid strep test
B. Throat culture
C. Monospot test (heterophile antibody test)
D. CBC with differential only
✔ Correct Answer: C. Monospot test (heterophile antibody test)
16. The Rinne test compares air conduction (AC) to bone conduction (BC). A normal result is:
A. BC > AC
B. AC > BC
C. AC = BC
D. No sound heard in either position
✔ Correct Answer: B. AC > BC
17. A patient presents with sudden unilateral facial drooping involving the forehead, inability to close the
eye, and loss of taste on the anterior tongue. This presentation is most consistent with:
A. Ischemic stroke
B. Bell's palsy (peripheral CN VII palsy)
C. Central facial nerve lesion
D. Trigeminal neuralgia
✔ Correct Answer: B. Bell's palsy (peripheral CN VII palsy)
18. During ophthalmoscopy, you identify flame-shaped hemorrhages and cotton wool spots in a patient
with poorly controlled hypertension. These findings indicate:
A. Background (non-proliferative) diabetic retinopathy
B. Hypertensive retinopathy
C. Central retinal artery occlusion
D. Age-related macular degeneration
✔ Correct Answer: B. Hypertensive retinopathy
19. A 5-year-old child fails a vision screening with a Snellen chart reading of 20/60 in the right eye and
20/20 in the left eye. The most likely diagnosis is:
A. Myopia
B. Astigmatism
C. Amblyopia
D. Strabismus
✔ Correct Answer: C. Amblyopia
20. Which assessment finding best distinguishes hyperthyroidism from a euthyroid goiter?
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 3
Latest | Advanced Physical Assessment – Chamberlain University
1. A 67-year-old male presents with a 3-week history of painless cervical lymphadenopathy and a
10-pound weight loss. Which finding would most support a malignant etiology?
A. Lymph node is tender to palpation
B. Lymph node is firm, fixed, and non-tender
C. Lymph node measures 0.5 cm
D. Lymphadenopathy resolves with antibiotics
✔ Correct Answer: B. Lymph node is firm, fixed, and non-tender
2. During funduscopic examination of a hypertensive patient, you observe arteriovenous (AV) nicking.
What does this finding indicate?
A. Normal aging change
B. Chronic hypertensive changes causing arterial wall thickening
C. Diabetic retinopathy
D. Increased intracranial pressure
✔ Correct Answer: B. Chronic hypertensive changes causing arterial wall thickening
3. A patient reports painless, progressive vision loss described as 'looking through a foggy window.'
The most likely diagnosis is:
A. Acute angle-closure glaucoma
B. Retinal detachment
C. Cataract
D. Macular degeneration
✔ Correct Answer: C. Cataract
4. On otoscopic examination, a pearly gray, translucent tympanic membrane with a visible light reflex at
the 5 o'clock position is:
A. Indicative of otitis media
B. Consistent with a normal finding
C. Suggestive of tympanic perforation
D. Associated with cholesteatoma
✔ Correct Answer: B. Consistent with a normal finding
5. A 45-year-old presents with sudden severe eye pain, halos around lights, nausea, and a mid-dilated
fixed pupil. The priority action is:
A. Prescribe eye drops and follow up in 1 week
B. Refer immediately for acute angle-closure glaucoma
C. Perform a visual acuity test and reassure
D. Order an MRI of the orbits
✔ Correct Answer: B. Refer immediately for acute angle-closure glaucoma
6. When performing the Weber test, a patient with right-sided conductive hearing loss will lateralize
sound to which ear?
A. Left ear (unaffected)
B. Both ears equally
C. Right ear (affected)
D. Lateralization depends on frequency
✔ Correct Answer: C. Right ear (affected)
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 1
,7. A 32-year-old woman presents with unilateral facial pain, maxillary tenderness on palpation, and
purulent nasal discharge for 10 days following a URI. The most likely diagnosis is:
A. Allergic rhinitis
B. Acute bacterial rhinosinusitis
C. Dental abscess
D. Trigeminal neuralgia
✔ Correct Answer: B. Acute bacterial rhinosinusitis
8. During a head and neck exam, transillumination of the frontal sinuses reveals no glow bilaterally. This
finding suggests:
A. Normal sinus anatomy
B. Possible sinus congestion or infection
C. Absence of frontal sinuses
D. Deviated nasal septum
✔ Correct Answer: B. Possible sinus congestion or infection
9. Which cranial nerve is being tested when you ask a patient to identify a familiar scent with their eyes
closed?
A. CN II
B. CN V
C. CN I
D. CN VII
✔ Correct Answer: C. CN I
10. A patient presents with a painless white patch on the lateral border of the tongue that cannot be
scraped off. This finding is most consistent with:
A. Oral candidiasis
B. Aphthous ulcer
C. Leukoplakia
D. Lichen planus
✔ Correct Answer: C. Leukoplakia
11. A 28-year-old with a sore throat presents with tonsillar exudates, anterior cervical lymphadenopathy,
fever of 38.9°C, and no cough. Their Centor score is:
A. 1
B. 2
C. 3
D. 4
✔ Correct Answer: D. 4
12. You are assessing extraocular movements and notice the patient's left eye fails to adduct on right
lateral gaze. Which cranial nerve is most likely affected?
A. CN III left
B. CN IV left
C. CN VI right
D. CN III right
✔ Correct Answer: A. CN III left
13. A 70-year-old is noted to have arcus senilis on eye examination. The appropriate clinical response
is:
A. Urgent ophthalmology referral
B. Order fasting lipid panel — this finding is pathologic under age 50
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 2
, C. Document as a normal aging finding in this patient
D. Prescribe lubricating eye drops
✔ Correct Answer: C. Document as a normal aging finding in this patient
14. During thyroid palpation from behind, you note a single 1.5 cm firm, non-tender, non-mobile nodule.
The most appropriate next step is:
A. Reassure the patient and recheck in 12 months
B. Prescribe levothyroxine empirically
C. Order thyroid ultrasound and TSH level
D. Perform fine needle aspiration at bedside
✔ Correct Answer: C. Order thyroid ultrasound and TSH level
15. A 19-year-old presents with fever, severe pharyngitis, exudative tonsillitis, and splenomegaly. The
peripheral smear shows atypical lymphocytes. Which test confirms the diagnosis?
A. Rapid strep test
B. Throat culture
C. Monospot test (heterophile antibody test)
D. CBC with differential only
✔ Correct Answer: C. Monospot test (heterophile antibody test)
16. The Rinne test compares air conduction (AC) to bone conduction (BC). A normal result is:
A. BC > AC
B. AC > BC
C. AC = BC
D. No sound heard in either position
✔ Correct Answer: B. AC > BC
17. A patient presents with sudden unilateral facial drooping involving the forehead, inability to close the
eye, and loss of taste on the anterior tongue. This presentation is most consistent with:
A. Ischemic stroke
B. Bell's palsy (peripheral CN VII palsy)
C. Central facial nerve lesion
D. Trigeminal neuralgia
✔ Correct Answer: B. Bell's palsy (peripheral CN VII palsy)
18. During ophthalmoscopy, you identify flame-shaped hemorrhages and cotton wool spots in a patient
with poorly controlled hypertension. These findings indicate:
A. Background (non-proliferative) diabetic retinopathy
B. Hypertensive retinopathy
C. Central retinal artery occlusion
D. Age-related macular degeneration
✔ Correct Answer: B. Hypertensive retinopathy
19. A 5-year-old child fails a vision screening with a Snellen chart reading of 20/60 in the right eye and
20/20 in the left eye. The most likely diagnosis is:
A. Myopia
B. Astigmatism
C. Amblyopia
D. Strabismus
✔ Correct Answer: C. Amblyopia
20. Which assessment finding best distinguishes hyperthyroidism from a euthyroid goiter?
NR509 Advanced Physical Assessment — Chamberlain University | Exam Prep 2025/2026 | Page 3
