NR 509 Advanced Physical Assessment Final
Exam 2025| Chamberlain University| Actual
Exam Questions and Correct Answers
Question 1: A 35-year-old female with a history of migraines presents with worsening symptoms
for weeks, including nighttime headaches and nausea, taking oral contraceptive pills (OCPs).
What is the NP’s best next step?
A) Prescribe a higher dose of migraine medication
B) Order a brain CT or MRI
C) Discontinue OCPs and reassess
D) Refer to a neurologist immediately
Correct Answer: B) Order a brain CT or MRI
Explanation: Worsening migraines with nighttime awakening and nausea are red flags for a
serious condition (e.g., brain mass or hemorrhage), especially with OCP use, which increases
stroke risk. Imaging is the next step to rule out secondary causes. Adjusting medication,
discontinuing OCPs, or referral without imaging is premature.
Question 2: A grandmother asks privately if her 9-year-old granddaughter has started puberty.
The NP notes asymmetric projection of the right areola and nipple forming a secondary mound,
with an underdeveloped left breast. This is consistent with which Tanner Stage?
A) Tanner Stage 1
B) Tanner Stage 2
C) Tanner Stage 3
D) Tanner Stage 4
Correct Answer: C) Tanner Stage 3
Explanation: Asymmetric projection of the areola and nipple forming a secondary mound above
the breast level indicates Tanner Stage 3 of breast development. Stage 1 is prepubertal, Stage 2 is
breast budding, and Stage 4 involves further breast enlargement.
Question 3: Primary prevention is defined as which of the following?
,A) Early detection of disease through screening
B) Preventing disease before it occurs
C) Treatment to manage chronic conditions
D) Rehabilitation after disease onset
Correct Answer: B) Preventing disease before it occurs
Explanation: Primary prevention aims to prevent disease through measures like vaccinations or
lifestyle changes. Secondary prevention involves screening, tertiary prevention manages chronic
conditions, and rehabilitation is post-disease.
Question 4: Based on USPSTF recommendations, which statement is true about breast cancer
screening in average-risk women?
A) Annual mammography is recommended starting at age 40
B) Biennial mammography is recommended for women aged 50–74
C) Breast self-examination is required monthly
D) Screening is not recommended after age 65
Correct Answer: B) Biennial mammography is recommended for women aged 50–74
Explanation: USPSTF recommends biennial mammography for average-risk women aged 50–
74. Screening may start at 40 based on individual risk, self-examination is not required, and
screening continues past 65 if life expectancy supports it.
Question 5: Which statements are true regarding JNC8 recommendations for adults aged 60 and
older? (Select all that apply)
A) Treat to a BP goal of <150/90 mmHg
B) Initiate treatment at BP ≥140/90 mmHg
C) Use thiazide diuretics or ACE inhibitors as first-line therapy
D) Beta-blockers are preferred for initial treatment
Correct Answers: A, C
Explanation: JNC8 recommends a BP goal of <150/90 mmHg for adults ≥60 and using thiazides
or ACE inhibitors as first-line therapy. Treatment is initiated at ≥150/90 mmHg, not 140/90, and
beta-blockers are not preferred initially.
,Question 6: Which is a useful strategy when examining young children aged 1–4?
A) Perform the exam in a head-to-toe sequence
B) Allow the child to sit on the parent’s lap
C) Use a stethoscope first to reduce anxiety
D) Restrain the child to ensure cooperation
Correct Answer: B) Allow the child to sit on the parent’s lap
Explanation: Allowing a young child to sit on a parent’s lap reduces anxiety and promotes
cooperation. Head-to-toe sequence may overwhelm, stethoscopes can be intimidating, and
restraint increases distress.
Question 7: During a review of systems for a 4-month-old female, which parental statement
indicates a potential cardiac problem requiring further history?
A) “She feeds well and gains weight.”
B) “She gets tired and sweaty during feeds.”
C) “She sleeps through the night.”
D) “She has frequent diaper rashes.”
Correct Answer: B) “She gets tired and sweaty during feeds.”
Explanation: Fatigue and sweating during feeds suggest cardiac issues (e.g., heart failure) due to
increased metabolic demand. Normal feeding, sleeping, or diaper rashes are not cardiac-related.
Question 8: A 16-year-old male has congenital right upper eyelid drooping, no complaints or
trauma. Which cranial nerve is involved?
A) CN III (Oculomotor)
B) CN IV (Trochlear)
C) CN VI (Abducens)
D) CN VII (Facial)
Correct Answer: A) CN III (Oculomotor)
Explanation: Congenital ptosis (eyelid drooping) is often due to CN III dysfunction affecting the
levator palpebrae superioris. CN IV and VI control eye movement, and CN VII affects facial
muscles.
, Question 9: Which cranial nerve innervates pharynx muscles and provides sensory fibers to the
tympanic membrane, auditory canal, pharynx, and posterior third of the tongue?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Correct Answer: C) CN IX (Glossopharyngeal)
Explanation: CN IX innervates pharyngeal muscles (stylopharyngeus) and provides sensory
innervation to the tympanic membrane, auditory canal, pharynx, and posterior tongue. CN X has
broader roles, CN V is facial sensory, and CN VII is facial motor/sensory.
Question 10: The NP suspects injury to which cranial nerve if a patient presents with
photosensitivity and uneven pupils after a baseball strike to the eye?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: B) CN III (Oculomotor)
Explanation: Uneven pupils (anisocoria) and photosensitivity after eye trauma suggest CN III
injury, which controls pupil constriction. CN II affects vision, and CN IV/VI affect eye
movement.
Question 11: Which statement is true regarding risks and rapid recognition of suspected stroke?
A) Stroke risk is not associated with hypertension
B) Facial droop is a key sign for rapid stroke recognition
C) Stroke symptoms always resolve within 24 hours
D) Diabetes is not a risk factor for stroke
Correct Answer: B) Facial droop is a key sign for rapid stroke recognition
Explanation: Facial droop is part of the FAST (Face, Arms, Speech, Time) criteria for stroke
recognition. Hypertension and diabetes are risk factors, and stroke symptoms may persist.
Exam 2025| Chamberlain University| Actual
Exam Questions and Correct Answers
Question 1: A 35-year-old female with a history of migraines presents with worsening symptoms
for weeks, including nighttime headaches and nausea, taking oral contraceptive pills (OCPs).
What is the NP’s best next step?
A) Prescribe a higher dose of migraine medication
B) Order a brain CT or MRI
C) Discontinue OCPs and reassess
D) Refer to a neurologist immediately
Correct Answer: B) Order a brain CT or MRI
Explanation: Worsening migraines with nighttime awakening and nausea are red flags for a
serious condition (e.g., brain mass or hemorrhage), especially with OCP use, which increases
stroke risk. Imaging is the next step to rule out secondary causes. Adjusting medication,
discontinuing OCPs, or referral without imaging is premature.
Question 2: A grandmother asks privately if her 9-year-old granddaughter has started puberty.
The NP notes asymmetric projection of the right areola and nipple forming a secondary mound,
with an underdeveloped left breast. This is consistent with which Tanner Stage?
A) Tanner Stage 1
B) Tanner Stage 2
C) Tanner Stage 3
D) Tanner Stage 4
Correct Answer: C) Tanner Stage 3
Explanation: Asymmetric projection of the areola and nipple forming a secondary mound above
the breast level indicates Tanner Stage 3 of breast development. Stage 1 is prepubertal, Stage 2 is
breast budding, and Stage 4 involves further breast enlargement.
Question 3: Primary prevention is defined as which of the following?
,A) Early detection of disease through screening
B) Preventing disease before it occurs
C) Treatment to manage chronic conditions
D) Rehabilitation after disease onset
Correct Answer: B) Preventing disease before it occurs
Explanation: Primary prevention aims to prevent disease through measures like vaccinations or
lifestyle changes. Secondary prevention involves screening, tertiary prevention manages chronic
conditions, and rehabilitation is post-disease.
Question 4: Based on USPSTF recommendations, which statement is true about breast cancer
screening in average-risk women?
A) Annual mammography is recommended starting at age 40
B) Biennial mammography is recommended for women aged 50–74
C) Breast self-examination is required monthly
D) Screening is not recommended after age 65
Correct Answer: B) Biennial mammography is recommended for women aged 50–74
Explanation: USPSTF recommends biennial mammography for average-risk women aged 50–
74. Screening may start at 40 based on individual risk, self-examination is not required, and
screening continues past 65 if life expectancy supports it.
Question 5: Which statements are true regarding JNC8 recommendations for adults aged 60 and
older? (Select all that apply)
A) Treat to a BP goal of <150/90 mmHg
B) Initiate treatment at BP ≥140/90 mmHg
C) Use thiazide diuretics or ACE inhibitors as first-line therapy
D) Beta-blockers are preferred for initial treatment
Correct Answers: A, C
Explanation: JNC8 recommends a BP goal of <150/90 mmHg for adults ≥60 and using thiazides
or ACE inhibitors as first-line therapy. Treatment is initiated at ≥150/90 mmHg, not 140/90, and
beta-blockers are not preferred initially.
,Question 6: Which is a useful strategy when examining young children aged 1–4?
A) Perform the exam in a head-to-toe sequence
B) Allow the child to sit on the parent’s lap
C) Use a stethoscope first to reduce anxiety
D) Restrain the child to ensure cooperation
Correct Answer: B) Allow the child to sit on the parent’s lap
Explanation: Allowing a young child to sit on a parent’s lap reduces anxiety and promotes
cooperation. Head-to-toe sequence may overwhelm, stethoscopes can be intimidating, and
restraint increases distress.
Question 7: During a review of systems for a 4-month-old female, which parental statement
indicates a potential cardiac problem requiring further history?
A) “She feeds well and gains weight.”
B) “She gets tired and sweaty during feeds.”
C) “She sleeps through the night.”
D) “She has frequent diaper rashes.”
Correct Answer: B) “She gets tired and sweaty during feeds.”
Explanation: Fatigue and sweating during feeds suggest cardiac issues (e.g., heart failure) due to
increased metabolic demand. Normal feeding, sleeping, or diaper rashes are not cardiac-related.
Question 8: A 16-year-old male has congenital right upper eyelid drooping, no complaints or
trauma. Which cranial nerve is involved?
A) CN III (Oculomotor)
B) CN IV (Trochlear)
C) CN VI (Abducens)
D) CN VII (Facial)
Correct Answer: A) CN III (Oculomotor)
Explanation: Congenital ptosis (eyelid drooping) is often due to CN III dysfunction affecting the
levator palpebrae superioris. CN IV and VI control eye movement, and CN VII affects facial
muscles.
, Question 9: Which cranial nerve innervates pharynx muscles and provides sensory fibers to the
tympanic membrane, auditory canal, pharynx, and posterior third of the tongue?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Correct Answer: C) CN IX (Glossopharyngeal)
Explanation: CN IX innervates pharyngeal muscles (stylopharyngeus) and provides sensory
innervation to the tympanic membrane, auditory canal, pharynx, and posterior tongue. CN X has
broader roles, CN V is facial sensory, and CN VII is facial motor/sensory.
Question 10: The NP suspects injury to which cranial nerve if a patient presents with
photosensitivity and uneven pupils after a baseball strike to the eye?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: B) CN III (Oculomotor)
Explanation: Uneven pupils (anisocoria) and photosensitivity after eye trauma suggest CN III
injury, which controls pupil constriction. CN II affects vision, and CN IV/VI affect eye
movement.
Question 11: Which statement is true regarding risks and rapid recognition of suspected stroke?
A) Stroke risk is not associated with hypertension
B) Facial droop is a key sign for rapid stroke recognition
C) Stroke symptoms always resolve within 24 hours
D) Diabetes is not a risk factor for stroke
Correct Answer: B) Facial droop is a key sign for rapid stroke recognition
Explanation: Facial droop is part of the FAST (Face, Arms, Speech, Time) criteria for stroke
recognition. Hypertension and diabetes are risk factors, and stroke symptoms may persist.
