.
NR 509 / NR509 Midterm Exam (Latest 2025/
2026 Update) Advanced Physical Assessment
Exam Review | Weeks 5-8
Covered| Questions and Verified Answers
QUESTION
A .39-year-old .architect .comes .to .the .clinic .for .a .2-day .history .of .fever, .chills, .cough
.productive .of .green .sputum, .and .dyspnea. .He .has .no .history
of .serious .illness. .His .temperature .is .101.2ºF. .His .other .vital .signs .are .within .normal .limits. .Late
.inspiratory .crackles .are .heard .on .auscultation .over .the .left .lower .lung .posteriorly. .When .the
clinician .listens .over .that .area .and .instructs .the .patient .to .say ."ee," .it .sounds .like ."A." .Which
.of .the .following .would .most .likely .be .found .on .percussion .of .his .lungs?
Answer:
a. Flatness
b. Hyperresonance .c. .Stridor
d. .Tympany .e. .Dullness
QUESTION
A .student .is .practicing .the .performance .of .a .lung .examination .on .a .classmate. .Which .of .the
.following .is .the .correct .order .for .performing .the .components .of .the .lung .examination?
Answer:
a. Auscultation, .inspection, .palpation, .and .percussion
b. Auscultation, .percussion, .palpation, .and .inspection .c. .Inspection, .palpation, .percussion,
.and .auscultation .d. .Auscultation, .inspection, .palpation, .and .percussion .e. .Inspection,
.auscultation, .percussion, .and .palpation .f. .Palpation, .inspection, .auscultation, .and
.percussion
QUESTION
A .14-year-old .high .school .student .comes .to .the .clinic .for .a .3-month .history .of .periodic
.dyspnea .when .playing .basketball. .It .resolves .shortly .after .resting. .He .has .not .had .fever,
.chills, .cough,
sputum .production, .or .chest .pain. .He .has .no .history .of .serious .illness. .Based .on .the .boy's
.history, .asthma .is .suspected. .Which .of .the .following .sounds .heard .on .expiration .during .lung
.auscultation .would .be .most .suggestive .of .asthma?
Answer:
a. Mediastinal .crunch
b. Pleural .rub .c. .Rhonchi
,.
d. .Wheezes .e. .Stridor
QUESTION
A .clinician .is .percussing .the .lungs .of .a .patient .with .chronic .obstructive .pulmonary .disease .to
.see .if .they .sound .hyperresonant. .Which .of .the .following
is .an .example .of .good .technique .for .percussion?
Answer:
a. Strike .using .the .tip .of .the .third .finger.
b. The .proximal .interphalangeal .joint .is .the .joint .that .is .struck.
c. Put .the .third .and .fourth .fingers .next .to .each .other .on .the .chest. .d. .Strike .using .the .finger
.pad .of .the .fourth .finger.
e. .The .wrist .is .kept .still .during .percussion. .Submit
QUESTION
A .29-year-old .waiter .comes .to .the .clinic .for .a .2-month .history .of .a .cough. .When .he .lowers
.his .gown .so .the .clinician .can .listen .to .his .lungs, .the .clinician .notices .a .depression .of .the
.lower .part .of .his .sternum. .Which .of .the .following .best .describes .the .appearance .of .his
.chest?
Answer:
a. Barrel .chest
b. Flail .chest
c. Pectus .excavatum .d. .Pigeon .chest
e. .Thoracic .kyphoscoliosis
QUESTION
A .13-year-old .girl .is .brought .by .her .mother .to .the .clinic .one .day .before
the .start .of .eighth .grade .because .of .a .3-day .history .of .episodes .of .shortness .of .breath. .When
.she .gets .the .shortness .of .breath, .she .also .notices .tingling .around .her .lips. .She .has .no .fever,
.cough,
sputum .production, .or .chest .pain. .She .has .no .history .of .serious .illness .and .takes .no .medications.
Vital .signs .are .within .normal .limits. .Cardiac, .lung, .and .extremity .examinations .show
.no .abnormalities. .Which .of .the .following .is .the .most .likely .diagnosis?
Answer:
a. Aspiration .of .a .foreign .body
b. Anxiety .c. .Asthma
d. .Left-sided .heart .failure .e. .Pneumonia
,.
QUESTION
A .70-year-old .patient .has .suspected .chronic .obstructive .pulmonary .dis- .ease. .The .clinician
instructs .the .patient .to .take .a .deep .breath .in, .and .then .with .his .mouth .open, .breathe .out .as
.fast .and .completely .as .he .can. .For .what .is .the .clinician .checking?
Answer:
a. Bronchophony
b. Egophony
c. Tactile .fremitus
d. Forced .expiratory .time .e. .Whispered .pectoriloquy
QUESTION
After .examining .a .patient .who .is .in .the .hospital .for .shortness .of .breath, .the .clinician .records .the
.following .for .lung .examination
Answer:
"There .is .dullness
to .percussion .over .the .right .lung .base. .Breath .sounds .are .absent .at .the .right .lung .base. .There
.are .no .crackles, .wheezes, .or .rhonchi. .There .are .no .trans-
mitted .voice .sounds." .Which .of .the .following .is .the .most .likely .diagnosis?
Answer:
a. Atelectasis
b. Left-sided .heart .failure .c. .Pneumonia
d. Pneumothorax
e. Chronic .obstructive .pulmonary .disease .(COPD)
QUESTION
A .16-year-old .boy .is .brought .to .the .Emergency .Department .(ED) .after .a .motor .vehicle
.accident .for .shortness .of .breath .for .1 .hour. .A .chest .x-ray .shows .a .rib .fracture .and .a
.pneumothorax .on .the .right .side. .The .ED .physician .decides .that .a .chest .tube .needs .to .be
.placed .in .the .fourth .intercostal .space. .How .does .he .determine .where .the .fourth .intercostal
.space .is?
Answer:
a. He .finds .the .suprasternal .notch .and .then .moves .his .finger .laterally .to .the .third .rib. .The
.fourth .intercostal .space .is .just .below .the .third .rib.
b. He .finds .the .angle .of .Louis .and .then .moves .laterally .to .the .first .rib. .He .walks .down .from
.there .to .the .fourth .intercostal .space.
c. He .finds .the .sternal .angle .and .then .moves .his .finger .laterally .to .the .second .rib. .He .then
.walks .down .to .the .second .intercostal .space, .third .rib, .third .intercostal .space, .fourth .rib .and
.then .the .fourth .intercostal .space.
, .
d. He .finds .the .clavicle. .The .second .intercostal .space .is .just .below .the .clavicle. .He .then
.walks .down .to .third .rib, .third .intercostal .space, .fourth .rib, .and .then .the .fourth .intercostal
.space.
e. He .finds .the .angle .of .Louis .and .then .moves .his .finger .laterally .to .the .third .rib. .The
.fourth .intercostal .space .is .just .below .the .third .rib.
QUESTION
An .elderly .patient .with .a .history .of .smoking .two .packs .of .cigarettes .a .day .for .50 .years
.complains .to .her .physician .of .progressive .shortness .of .breath. .On .cardiac .examination, .the
.physician .feels
the .most .prominent .palpable .impulse .to .be .in .the .xiphoid .area. .This .is .most .likely .a .result .of
.what .condition?
Answer:
a. Aortic .stenosis
b. Hypertrophic .cardiomyopathy .c. .Hypertension
d. .Pulmonary .hypertension .e. .Mitral .regurgitation
QUESTION
A .newborn .baby .has .an .embryologic .defect .affecting .the .aortic .valve. .What .other .cardiac
.valve .is .most .likely .to .be .affected?
Answer:
a. Tricuspid .valve
b. Pulmonic .valve .c. .Mitral .valve
d. Pyloric .valve
e. Eustachian .valve
QUESTION
A .77-year-old .man .is .experiencing .progressive .shortness .of .breath .and .dizziness. .The .patient
undergoes .cardiac .catheterization, .and .the .systolic .blood .pressure .measured .in .the .left
.ventricle .is .180 .mm .Hg, .while .the .systolic .blood .pressure .measured .in .the .aorta .is .140 .mm
.Hg. .The
patient .is .most .likely .experiencing .symptoms .related .to .what .valvular .condition?
Answer:
a. Aortic .insufficiency
b. Mitral .stenosis .c. .Aortic .stenosis
d. .Mitral .regurgitation .e. .Pulmonic .stenosis
NR 509 / NR509 Midterm Exam (Latest 2025/
2026 Update) Advanced Physical Assessment
Exam Review | Weeks 5-8
Covered| Questions and Verified Answers
QUESTION
A .39-year-old .architect .comes .to .the .clinic .for .a .2-day .history .of .fever, .chills, .cough
.productive .of .green .sputum, .and .dyspnea. .He .has .no .history
of .serious .illness. .His .temperature .is .101.2ºF. .His .other .vital .signs .are .within .normal .limits. .Late
.inspiratory .crackles .are .heard .on .auscultation .over .the .left .lower .lung .posteriorly. .When .the
clinician .listens .over .that .area .and .instructs .the .patient .to .say ."ee," .it .sounds .like ."A." .Which
.of .the .following .would .most .likely .be .found .on .percussion .of .his .lungs?
Answer:
a. Flatness
b. Hyperresonance .c. .Stridor
d. .Tympany .e. .Dullness
QUESTION
A .student .is .practicing .the .performance .of .a .lung .examination .on .a .classmate. .Which .of .the
.following .is .the .correct .order .for .performing .the .components .of .the .lung .examination?
Answer:
a. Auscultation, .inspection, .palpation, .and .percussion
b. Auscultation, .percussion, .palpation, .and .inspection .c. .Inspection, .palpation, .percussion,
.and .auscultation .d. .Auscultation, .inspection, .palpation, .and .percussion .e. .Inspection,
.auscultation, .percussion, .and .palpation .f. .Palpation, .inspection, .auscultation, .and
.percussion
QUESTION
A .14-year-old .high .school .student .comes .to .the .clinic .for .a .3-month .history .of .periodic
.dyspnea .when .playing .basketball. .It .resolves .shortly .after .resting. .He .has .not .had .fever,
.chills, .cough,
sputum .production, .or .chest .pain. .He .has .no .history .of .serious .illness. .Based .on .the .boy's
.history, .asthma .is .suspected. .Which .of .the .following .sounds .heard .on .expiration .during .lung
.auscultation .would .be .most .suggestive .of .asthma?
Answer:
a. Mediastinal .crunch
b. Pleural .rub .c. .Rhonchi
,.
d. .Wheezes .e. .Stridor
QUESTION
A .clinician .is .percussing .the .lungs .of .a .patient .with .chronic .obstructive .pulmonary .disease .to
.see .if .they .sound .hyperresonant. .Which .of .the .following
is .an .example .of .good .technique .for .percussion?
Answer:
a. Strike .using .the .tip .of .the .third .finger.
b. The .proximal .interphalangeal .joint .is .the .joint .that .is .struck.
c. Put .the .third .and .fourth .fingers .next .to .each .other .on .the .chest. .d. .Strike .using .the .finger
.pad .of .the .fourth .finger.
e. .The .wrist .is .kept .still .during .percussion. .Submit
QUESTION
A .29-year-old .waiter .comes .to .the .clinic .for .a .2-month .history .of .a .cough. .When .he .lowers
.his .gown .so .the .clinician .can .listen .to .his .lungs, .the .clinician .notices .a .depression .of .the
.lower .part .of .his .sternum. .Which .of .the .following .best .describes .the .appearance .of .his
.chest?
Answer:
a. Barrel .chest
b. Flail .chest
c. Pectus .excavatum .d. .Pigeon .chest
e. .Thoracic .kyphoscoliosis
QUESTION
A .13-year-old .girl .is .brought .by .her .mother .to .the .clinic .one .day .before
the .start .of .eighth .grade .because .of .a .3-day .history .of .episodes .of .shortness .of .breath. .When
.she .gets .the .shortness .of .breath, .she .also .notices .tingling .around .her .lips. .She .has .no .fever,
.cough,
sputum .production, .or .chest .pain. .She .has .no .history .of .serious .illness .and .takes .no .medications.
Vital .signs .are .within .normal .limits. .Cardiac, .lung, .and .extremity .examinations .show
.no .abnormalities. .Which .of .the .following .is .the .most .likely .diagnosis?
Answer:
a. Aspiration .of .a .foreign .body
b. Anxiety .c. .Asthma
d. .Left-sided .heart .failure .e. .Pneumonia
,.
QUESTION
A .70-year-old .patient .has .suspected .chronic .obstructive .pulmonary .dis- .ease. .The .clinician
instructs .the .patient .to .take .a .deep .breath .in, .and .then .with .his .mouth .open, .breathe .out .as
.fast .and .completely .as .he .can. .For .what .is .the .clinician .checking?
Answer:
a. Bronchophony
b. Egophony
c. Tactile .fremitus
d. Forced .expiratory .time .e. .Whispered .pectoriloquy
QUESTION
After .examining .a .patient .who .is .in .the .hospital .for .shortness .of .breath, .the .clinician .records .the
.following .for .lung .examination
Answer:
"There .is .dullness
to .percussion .over .the .right .lung .base. .Breath .sounds .are .absent .at .the .right .lung .base. .There
.are .no .crackles, .wheezes, .or .rhonchi. .There .are .no .trans-
mitted .voice .sounds." .Which .of .the .following .is .the .most .likely .diagnosis?
Answer:
a. Atelectasis
b. Left-sided .heart .failure .c. .Pneumonia
d. Pneumothorax
e. Chronic .obstructive .pulmonary .disease .(COPD)
QUESTION
A .16-year-old .boy .is .brought .to .the .Emergency .Department .(ED) .after .a .motor .vehicle
.accident .for .shortness .of .breath .for .1 .hour. .A .chest .x-ray .shows .a .rib .fracture .and .a
.pneumothorax .on .the .right .side. .The .ED .physician .decides .that .a .chest .tube .needs .to .be
.placed .in .the .fourth .intercostal .space. .How .does .he .determine .where .the .fourth .intercostal
.space .is?
Answer:
a. He .finds .the .suprasternal .notch .and .then .moves .his .finger .laterally .to .the .third .rib. .The
.fourth .intercostal .space .is .just .below .the .third .rib.
b. He .finds .the .angle .of .Louis .and .then .moves .laterally .to .the .first .rib. .He .walks .down .from
.there .to .the .fourth .intercostal .space.
c. He .finds .the .sternal .angle .and .then .moves .his .finger .laterally .to .the .second .rib. .He .then
.walks .down .to .the .second .intercostal .space, .third .rib, .third .intercostal .space, .fourth .rib .and
.then .the .fourth .intercostal .space.
, .
d. He .finds .the .clavicle. .The .second .intercostal .space .is .just .below .the .clavicle. .He .then
.walks .down .to .third .rib, .third .intercostal .space, .fourth .rib, .and .then .the .fourth .intercostal
.space.
e. He .finds .the .angle .of .Louis .and .then .moves .his .finger .laterally .to .the .third .rib. .The
.fourth .intercostal .space .is .just .below .the .third .rib.
QUESTION
An .elderly .patient .with .a .history .of .smoking .two .packs .of .cigarettes .a .day .for .50 .years
.complains .to .her .physician .of .progressive .shortness .of .breath. .On .cardiac .examination, .the
.physician .feels
the .most .prominent .palpable .impulse .to .be .in .the .xiphoid .area. .This .is .most .likely .a .result .of
.what .condition?
Answer:
a. Aortic .stenosis
b. Hypertrophic .cardiomyopathy .c. .Hypertension
d. .Pulmonary .hypertension .e. .Mitral .regurgitation
QUESTION
A .newborn .baby .has .an .embryologic .defect .affecting .the .aortic .valve. .What .other .cardiac
.valve .is .most .likely .to .be .affected?
Answer:
a. Tricuspid .valve
b. Pulmonic .valve .c. .Mitral .valve
d. Pyloric .valve
e. Eustachian .valve
QUESTION
A .77-year-old .man .is .experiencing .progressive .shortness .of .breath .and .dizziness. .The .patient
undergoes .cardiac .catheterization, .and .the .systolic .blood .pressure .measured .in .the .left
.ventricle .is .180 .mm .Hg, .while .the .systolic .blood .pressure .measured .in .the .aorta .is .140 .mm
.Hg. .The
patient .is .most .likely .experiencing .symptoms .related .to .what .valvular .condition?
Answer:
a. Aortic .insufficiency
b. Mitral .stenosis .c. .Aortic .stenosis
d. .Mitral .regurgitation .e. .Pulmonic .stenosis
