NR 509 Advanced Physical Assessment
Midterm Exam 2025| Chamberlain
University| Actual Exam Questions and
Correct Answers
Question 1: Which of the following statements best describes a differential diagnosis list?
A) A list of all possible symptoms a patient might experience
B) A prioritized list of potential diagnoses based on clinical findings
C) A definitive diagnosis confirmed by diagnostic tests
D) A list of treatments for a specific condition
Correct Answer: B) A prioritized list of potential diagnoses based on clinical findings
Explanation: A differential diagnosis list includes possible diagnoses ranked by likelihood based
on history, physical exam, and clinical reasoning. It is not a symptom list, definitive diagnosis, or
treatment plan.
Question 2: A 66-year-old female presents to the primary care office with complaints of jaw
pain, fatigue, and nausea for the last 48 hours. What course of action is appropriate in the
treatment of this patient?
A) Prescribe antibiotics for possible infection
B) Order a CT scan of the jaw
C) Perform a thorough cardiac evaluation
D) Recommend rest and over-the-counter pain relief
Correct Answer: C) Perform a thorough cardiac evaluation
Explanation: Jaw pain, fatigue, and nausea in a 66-year-old female raise concern for atypical
myocardial infarction, especially in women. A cardiac evaluation (e.g., ECG, troponins) is
urgent. Antibiotics, CT, or rest are inappropriate without ruling out cardiac causes.
Question 3: In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may
be indicative of what? (Select all that apply)
,A) Heart failure
B) Mitral regurgitation
C) Normal aging
D) Ventricular overload
Correct Answers: A, D
Explanation:
A) An S3 heart sound in adults over 40 often indicates heart failure due to fluid overload.
D) Ventricular overload (e.g., from hypertension or cardiomyopathy) can also cause an S3.
B) Mitral regurgitation is associated with murmurs, not S3.
C) S3 is normal in young people but pathological in adults over 40.
Question 4: A 72-year-old male is admitted to intensive care from the Emergency Room for
chest pain. After the history and physical examination, the NP documents: JVP 5 cm above the
sternal angle at 50°, brisk carotid upstrokes, left carotid bruit, diffuse PMI (3 cm) at the anterior
axillary line in the fifth/sixth intercostal spaces, soft S1/S2, S3 at apex, high-pitched 2/6
holosystolic murmur at apex radiating to axilla. Which of the following possible diagnoses is
based on the accurate interpretation of the assessment findings?
A) Aortic stenosis
B) Mitral regurgitation
C) Pulmonary hypertension
D) Pericarditis
Correct Answer: B) Mitral regurgitation
Explanation: The holosystolic murmur at the apex radiating to the axilla, S3, and diffuse PMI
suggest mitral regurgitation. Elevated JVP and carotid bruit indicate possible heart failure or
atherosclerosis. Aortic stenosis causes a systolic ejection murmur, pulmonary hypertension
affects the right heart, and pericarditis causes a friction rub.
Question 5: A 76-year-old male presents for a routine physical. The NP documents: Decreased
elasticity with multiple lentiginous macules on sun-exposed skin, multiple discrete, brown,
,stuck-on, non-indurated, verrucous plaques on the back and abdomen (1–2 cm). Which of the
following is the most accurate interpretation of these findings?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Melanoma
Correct Answer: B) Seborrheic keratosis
Explanation: Brown, stuck-on, verrucous plaques are characteristic of seborrheic keratosis, a
benign condition in older adults. Lentiginous macules are age-related. Actinic keratosis is scaly,
basal cell carcinoma is pearly, and melanoma is asymmetrical with irregular borders.
Question 6: A 14-year-old male presents with his grandmother for a sore throat, afebrile, denies
cough. NP findings: Oral mucosa pink, dental caries, tongue midline, erythematous
pharynx/uvula, enlarged bilateral tonsils, no exudates; trachea midline, thyroid normal,
submandibular/anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery, mobile; no other
lymphadenopathy. Which of the following is the most accurate interpretation of the findings?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Tonsillar abscess
D) Mononucleosis
Correct Answer: A) Viral pharyngitis
Explanation: Afebrile status, no cough, erythematous pharynx, enlarged tonsils without
exudates, and tender lymph nodes suggest viral pharyngitis. Streptococcal pharyngitis typically
has exudates and fever, abscess causes unilateral swelling, and mononucleosis includes systemic
symptoms.
Question 7: The NP is assuming care for a 56-year-old female in long-term care, seated in a
wheelchair. Mental status findings: Appears sad and fatigued, wrinkled clothes, slow/mumbled
speech, coherent thought, limited insight, oriented to person/place/time, accurate but delayed
digit span/serial 7s/calculations, good clock drawing. Which of the following is the most
accurate interpretation of the findings?
A) Normal aging
B) Depression
, C) Dementia
D) Delirium
Correct Answer: B) Depression
Explanation: Sadness, fatigue, slow speech, and limited insight suggest depression. Orientation
and accurate cognitive tasks (despite delays) rule out dementia or delirium. These findings are
not typical of normal aging.
Question 8: The NP performs a physical assessment on a 74-year-old male with shortness of
breath, 20 pack-year smoking history, uses two inhalers daily (medication unknown). The
documentation for respiratory findings is missing. Which of the following is the most accurate
interpretation of the likely findings?
A) Wheezes and hyperresonance
B) Crackles and dullness
C) Normal breath sounds
D) Absent breath sounds
Correct Answer: A) Wheezes and hyperresonance
Explanation: Given the smoking history and likely COPD, wheezes (from airway obstruction)
and hyperresonance (from air trapping) are expected. Crackles/dullness suggest pneumonia,
normal sounds are unlikely, and absent sounds indicate severe obstruction or pneumothorax.
Question 9: A 28-year-old female presents for an annual physical. The NP evaluates cranial
nerves (CNs) while assessing the eyes. Findings are shown in an image (eyes looking right and
left). Damage or inflammation of which cranial nerve(s) is suggested?
A) CN II
B) CN III, IV, VI
C) CN V
D) CN VII
Correct Answer: B) CN III, IV, VI
Explanation: Eye movement (right and left) is controlled by cranial nerves III (oculomotor), IV
(trochlear), and VI (abducens). Abnormal movement suggests damage to these nerves. CN II
affects vision, V sensation, and VII facial movement.
Midterm Exam 2025| Chamberlain
University| Actual Exam Questions and
Correct Answers
Question 1: Which of the following statements best describes a differential diagnosis list?
A) A list of all possible symptoms a patient might experience
B) A prioritized list of potential diagnoses based on clinical findings
C) A definitive diagnosis confirmed by diagnostic tests
D) A list of treatments for a specific condition
Correct Answer: B) A prioritized list of potential diagnoses based on clinical findings
Explanation: A differential diagnosis list includes possible diagnoses ranked by likelihood based
on history, physical exam, and clinical reasoning. It is not a symptom list, definitive diagnosis, or
treatment plan.
Question 2: A 66-year-old female presents to the primary care office with complaints of jaw
pain, fatigue, and nausea for the last 48 hours. What course of action is appropriate in the
treatment of this patient?
A) Prescribe antibiotics for possible infection
B) Order a CT scan of the jaw
C) Perform a thorough cardiac evaluation
D) Recommend rest and over-the-counter pain relief
Correct Answer: C) Perform a thorough cardiac evaluation
Explanation: Jaw pain, fatigue, and nausea in a 66-year-old female raise concern for atypical
myocardial infarction, especially in women. A cardiac evaluation (e.g., ECG, troponins) is
urgent. Antibiotics, CT, or rest are inappropriate without ruling out cardiac causes.
Question 3: In an adult over the age of 40, an S3 assessment finding on cardiac auscultation may
be indicative of what? (Select all that apply)
,A) Heart failure
B) Mitral regurgitation
C) Normal aging
D) Ventricular overload
Correct Answers: A, D
Explanation:
A) An S3 heart sound in adults over 40 often indicates heart failure due to fluid overload.
D) Ventricular overload (e.g., from hypertension or cardiomyopathy) can also cause an S3.
B) Mitral regurgitation is associated with murmurs, not S3.
C) S3 is normal in young people but pathological in adults over 40.
Question 4: A 72-year-old male is admitted to intensive care from the Emergency Room for
chest pain. After the history and physical examination, the NP documents: JVP 5 cm above the
sternal angle at 50°, brisk carotid upstrokes, left carotid bruit, diffuse PMI (3 cm) at the anterior
axillary line in the fifth/sixth intercostal spaces, soft S1/S2, S3 at apex, high-pitched 2/6
holosystolic murmur at apex radiating to axilla. Which of the following possible diagnoses is
based on the accurate interpretation of the assessment findings?
A) Aortic stenosis
B) Mitral regurgitation
C) Pulmonary hypertension
D) Pericarditis
Correct Answer: B) Mitral regurgitation
Explanation: The holosystolic murmur at the apex radiating to the axilla, S3, and diffuse PMI
suggest mitral regurgitation. Elevated JVP and carotid bruit indicate possible heart failure or
atherosclerosis. Aortic stenosis causes a systolic ejection murmur, pulmonary hypertension
affects the right heart, and pericarditis causes a friction rub.
Question 5: A 76-year-old male presents for a routine physical. The NP documents: Decreased
elasticity with multiple lentiginous macules on sun-exposed skin, multiple discrete, brown,
,stuck-on, non-indurated, verrucous plaques on the back and abdomen (1–2 cm). Which of the
following is the most accurate interpretation of these findings?
A) Actinic keratosis
B) Seborrheic keratosis
C) Basal cell carcinoma
D) Melanoma
Correct Answer: B) Seborrheic keratosis
Explanation: Brown, stuck-on, verrucous plaques are characteristic of seborrheic keratosis, a
benign condition in older adults. Lentiginous macules are age-related. Actinic keratosis is scaly,
basal cell carcinoma is pearly, and melanoma is asymmetrical with irregular borders.
Question 6: A 14-year-old male presents with his grandmother for a sore throat, afebrile, denies
cough. NP findings: Oral mucosa pink, dental caries, tongue midline, erythematous
pharynx/uvula, enlarged bilateral tonsils, no exudates; trachea midline, thyroid normal,
submandibular/anterior cervical lymph nodes tender, 1 cm × 1 cm, rubbery, mobile; no other
lymphadenopathy. Which of the following is the most accurate interpretation of the findings?
A) Viral pharyngitis
B) Streptococcal pharyngitis
C) Tonsillar abscess
D) Mononucleosis
Correct Answer: A) Viral pharyngitis
Explanation: Afebrile status, no cough, erythematous pharynx, enlarged tonsils without
exudates, and tender lymph nodes suggest viral pharyngitis. Streptococcal pharyngitis typically
has exudates and fever, abscess causes unilateral swelling, and mononucleosis includes systemic
symptoms.
Question 7: The NP is assuming care for a 56-year-old female in long-term care, seated in a
wheelchair. Mental status findings: Appears sad and fatigued, wrinkled clothes, slow/mumbled
speech, coherent thought, limited insight, oriented to person/place/time, accurate but delayed
digit span/serial 7s/calculations, good clock drawing. Which of the following is the most
accurate interpretation of the findings?
A) Normal aging
B) Depression
, C) Dementia
D) Delirium
Correct Answer: B) Depression
Explanation: Sadness, fatigue, slow speech, and limited insight suggest depression. Orientation
and accurate cognitive tasks (despite delays) rule out dementia or delirium. These findings are
not typical of normal aging.
Question 8: The NP performs a physical assessment on a 74-year-old male with shortness of
breath, 20 pack-year smoking history, uses two inhalers daily (medication unknown). The
documentation for respiratory findings is missing. Which of the following is the most accurate
interpretation of the likely findings?
A) Wheezes and hyperresonance
B) Crackles and dullness
C) Normal breath sounds
D) Absent breath sounds
Correct Answer: A) Wheezes and hyperresonance
Explanation: Given the smoking history and likely COPD, wheezes (from airway obstruction)
and hyperresonance (from air trapping) are expected. Crackles/dullness suggest pneumonia,
normal sounds are unlikely, and absent sounds indicate severe obstruction or pneumothorax.
Question 9: A 28-year-old female presents for an annual physical. The NP evaluates cranial
nerves (CNs) while assessing the eyes. Findings are shown in an image (eyes looking right and
left). Damage or inflammation of which cranial nerve(s) is suggested?
A) CN II
B) CN III, IV, VI
C) CN V
D) CN VII
Correct Answer: B) CN III, IV, VI
Explanation: Eye movement (right and left) is controlled by cranial nerves III (oculomotor), IV
(trochlear), and VI (abducens). Abnormal movement suggests damage to these nerves. CN II
affects vision, V sensation, and VII facial movement.
