ANSWERS NR-509 ADVANCED PHYSICAL ASSESSMENT | CHAMBERLAIN UNIVERSITY || A+
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A 35-year-old female with a history of migraines presents with worsening symptoms for
the past few weeks. She reports waking up at night with headaches and nausea. Her only
medication is oral contraceptive pills (OCPs). Otherwise healthy. What is the best next
step?
A. Prescribe a triptan immediately
B. Order a CT scan without further evaluation
C. Take a further history and perform a very careful neurological exam
D. Discontinue all medications immediately
Answer: C
Rationale:
Worsening headaches with night awakening and nausea are red flag symptoms requiring
evaluation for secondary causes (e.g., intracranial pathology, increased intracranial
pressure). However, the first step is not imaging or treatment escalation, but a focused
history and full neurological exam to identify focal deficits, papilledema, or other warning
signs. Imaging is guided by exam findings. OCP use also raises concern for thrombotic risk,
making careful assessment essential.
A 9-year-old girl shows asymmetric breast development with one breast forming a
secondary mound above the areola. What Tanner stage is this?
A. Tanner II
B. Tanner III
C. Tanner IV
D. Tanner V
Answer: C
Rationale:
Tanner Stage IV is characterized by areola and nipple forming a secondary mound above
the breast contour, with separation of the areola from the breast. Stage II is breast bud
development, Stage III is further enlargement without full separation, and Stage V is mature
adult breast contour.
Primary prevention is defined as:
,A. Treating disease after diagnosis
B. Screening for early disease
C. Interventions designed to prevent disease
D. Rehabilitation after illness
Answer: C
Rationale:
Primary prevention aims to prevent disease before it occurs, such as vaccination, smoking
cessation, and health education. Secondary prevention is screening, and tertiary prevention
is rehabilitation and disease management.
USPSTF recommendation for breast cancer screening in average-risk women:
A. Annual mammography starting at age 40
B. Mammography every 2 years for women aged 50–74
C. No screening after age 60
D. MRI screening for all women
Answer: B
Rationale:
The U.S. Preventive Services Task Force recommends biennial mammography for women
aged 50–74. Screening for women 40–49 is individualized, and evidence is insufficient for
routine screening after 75.
JNC8 recommendation for adults aged 60 and older:
A. Target BP <130/80
B. Target BP ≤150/90 unless tolerated lower values
C. No treatment is recommended
D. Only treat if BP >180/110
Answer: B
Rationale:
JNC8 recommends a goal of ≤150/90 mmHg for adults ≥60, but if patients are already well
controlled below 140 systolic without adverse effects, treatment should not be adjusted
upward. Lower targets may be acceptable if tolerated.
Useful strategy when examining children aged 1–4:
,A. Perform exam without caregiver present
B. Restrain child immediately
C. Have parent assist with exam
D. Avoid physical exam
Answer: C
Rationale:
Toddlers and preschoolers are often anxious; having the parent assist improves
cooperation, reduces fear, and increases exam accuracy.
Infant who takes >30 minutes to finish a bottle—concern for:
A. Normal feeding behavior
B. Cardiac problem
C. Gastroesophageal reflux only
D. Neurological delay only
Answer: B
Rationale:
Prolonged feeding time may indicate fatigue due to cardiac disease (e.g., heart failure,
congenital defects). Infants with cardiac issues tire easily during feeding due to increased
metabolic demand.
Cranial nerve involved in ptosis (drooping eyelid):
A. CN II
B. CN III
C. CN V
D. CN VII
Answer: B
Rationale:
CN III (oculomotor nerve) controls levator palpebrae superioris, which elevates the eyelid.
Injury causes ptosis, pupil abnormalities, and eye movement deficits.
Cranial nerve providing sensory to pharynx and posterior tongue:
A. CN V
B. CN VII
, C. CN IX
D. CN X
Answer: C
Rationale:
CN IX (glossopharyngeal) provides sensory input to the posterior third of the tongue,
pharynx, and part of the ear, and contributes to swallowing reflexes.
Injury causing photosensitivity and uneven pupils after eye trauma:
A. CN II
B. CN III
C. CN IV
D. CN VI
Answer: B
Rationale:
CN III controls pupillary constriction (parasympathetic fibers). Injury causes dilated pupil
(mydriasis), anisocoria, and abnormal light response.
Leading stroke risk factor:
A. Smoking
B. Hypertension
C. Diabetes
D. Obesity
Answer: B
Rationale:
Hypertension is the strongest modifiable risk factor for both ischemic and hemorrhagic
stroke due to chronic vascular damage and increased vessel rupture risk.
Global aphasia is characterized by:
A. Motor deficits only
B. Receptive deficits only
C. Both expressive and receptive language impairment
D. Memory loss only
Answer: C