NR 509 Advanced Physical Assessment Final Exam
NR 509 ADVANCED PHYSICAL ASSESSMENT FINAL EXAM
NEWEST 2025/2026 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |BRAND NEW
VERSION!!
A 54-year-old female dietician presents for a routine annual examination. On
review of systems, she reports that she has had many breast findings over several
years, including one biopsy with normal pathology. She feels that her breasts have
become far less lumpy since she underwent menopause 3 years ago. Which of the
following is true regarding changes in the breasts with menopause?
a. Transformation of breasts to primarily fatty tissue with menopause decreases
the sensitivity and specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density
after menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to
decrease in the number of lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose
from endogenous and exogenous sources over the lifetime.
e. Mammography performs most poorly in the menopausal and postmenopau
c. Glandular tissue of the breast atrophies with menopause, primarily due to
decrease in the number of lobules.
Rationale: Glandular tissue of the breast atrophies with menopause, primarily
due to a decrease in the number of lobules. The consequent decrease in breast
density makes mammograms ever more useful during the age when breast
cancer incidence starts to rise markedly.
An overweight 26-year-old public servant presents to the Emergency Department
with 12 hours of intense abdominal pain, light-headedness, and a fainting episode
that finally prompted her to seek medical attention. She has a strong family
history of gallstones and is concerned about this possibility. She has not had any
1|Page
, NR 509 Advanced Physical Assessment Final Exam
vomiting or diarrhea. She had a normal bowel movement this morning. Her β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her
last period was 10 weeks ago. Her vital signs at triage are pulse, 118; blood
pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her
pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and
rebound tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and presumed
blood loss as well as gynecological consult for emergent surgery
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a
well visit. Basic labs are performed to screen for diabetes mellitus and
dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all
normal expect for moderate elevations of aspartate aminotransferase, alanine
aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a
mildly elevated total bilirubin. He presents for a follow-up appointment and the
clinician performs an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
2|Page
, NR 509 Advanced Physical Assessment Final Exam
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expirat
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on
expiration
Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular line, would be considered normal on inspiration when the liver is
pushed down into the abdominal cavity on inspiration, but is abnormal on
expiration.
A 63-year-old underweight administrative clerk with a 50-pack-year smoking
history presents with a several month history of recurrent epigastric abdominal
discomfort. She feels fairly well otherwise and denies any nausea, vomiting,
diarrhea, or constipation. She reports that a first cousin died from a ruptured
aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92;
respiratory rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body
mass index is 17.6. On exam, her abdominal aorta is prominent, which is
concerning for an abdominal aortic aneurysm (AAA). Which of the following is her
most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
b. History of smoking
Rationale: History of smoking is her most significant risk factor for an AAA. Male
gender, not female gender, is considered as risk factor. Underweight is not a risk
factor for AAA. Family history of ruptured aneurysm is vague and could be a
cerebral aneurysm. Further, her family history is in a first-degree cousin not a
first-degree relative (biologic parents, siblings, and children). Hypertension could
3|Page
, NR 509 Advanced Physical Assessment Final Exam
contribute to atherosclerosis, which is a risk factor. Further, a diagnosis of
hypertension is not based on one elevated blood pressure reading.
A 76-year-old retired man with a history of prostate cancer and hypertension has
been screened annually for colon cancer using high sensitivity fecal occult blood
testing (FOBT). He presents for follow-up of his hypertension, during which the
clinician scans his chart to ensure he is up to date with his preventive health care.
He has a positive FOBT on one occasion at age 66 years and subsequently went for
a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of colorectal cancer or
adenomatous polyps. What are the U.S. Preventive Services Task Force (USPSTF)
screening recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
a. Do not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most adults
ages 76-85 years, the gain in life years is small compared to colonoscopy risks. It
is advised to discuss individualized risks and benefits with the patient. Annual
FOBT screening may continue until age 80-85 years if benefits to doing so
outweigh risks for the individual patient; however, screening should not be
routinely continued.
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with
a 3-year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks
each episode and is associated with onset of constipation. She describes
infrequent, small hard stool that she finds very difficult to pass. She has tried to
increase dietary fiber and water intake, but usually this is not sufficient and she
resorts to over-the-counter laxatives, which she finds upset her stomach but do
resolve the constipation. Symptoms typically gradually resolve with bowel
4|Page
NR 509 ADVANCED PHYSICAL ASSESSMENT FINAL EXAM
NEWEST 2025/2026 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |BRAND NEW
VERSION!!
A 54-year-old female dietician presents for a routine annual examination. On
review of systems, she reports that she has had many breast findings over several
years, including one biopsy with normal pathology. She feels that her breasts have
become far less lumpy since she underwent menopause 3 years ago. Which of the
following is true regarding changes in the breasts with menopause?
a. Transformation of breasts to primarily fatty tissue with menopause decreases
the sensitivity and specificity of mammograms.
b. Estrogen in hormone replacement therapy (HRT) has no effect on breast density
after menopause.
c. Glandular tissue of the breast atrophies with menopause, primarily due to
decrease in the number of lobules.
d. Breast density has no genetic component and is entirely due to estrogen dose
from endogenous and exogenous sources over the lifetime.
e. Mammography performs most poorly in the menopausal and postmenopau
c. Glandular tissue of the breast atrophies with menopause, primarily due to
decrease in the number of lobules.
Rationale: Glandular tissue of the breast atrophies with menopause, primarily
due to a decrease in the number of lobules. The consequent decrease in breast
density makes mammograms ever more useful during the age when breast
cancer incidence starts to rise markedly.
An overweight 26-year-old public servant presents to the Emergency Department
with 12 hours of intense abdominal pain, light-headedness, and a fainting episode
that finally prompted her to seek medical attention. She has a strong family
history of gallstones and is concerned about this possibility. She has not had any
1|Page
, NR 509 Advanced Physical Assessment Final Exam
vomiting or diarrhea. She had a normal bowel movement this morning. Her β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her
last period was 10 weeks ago. Her vital signs at triage are pulse, 118; blood
pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her
pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and
rebound tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perf
a. Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and findings suggestive of peritoneal
inflammation/irritation strongly suggest a ruptured ectopic pregnancy with
significant intra-abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her hypotension and presumed
blood loss as well as gynecological consult for emergent surgery
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a
well visit. Basic labs are performed to screen for diabetes mellitus and
dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all
normal expect for moderate elevations of aspartate aminotransferase, alanine
aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a
mildly elevated total bilirubin. He presents for a follow-up appointment and the
clinician performs an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
2|Page
, NR 509 Advanced Physical Assessment Final Exam
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expirat
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on
expiration
Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular line, would be considered normal on inspiration when the liver is
pushed down into the abdominal cavity on inspiration, but is abnormal on
expiration.
A 63-year-old underweight administrative clerk with a 50-pack-year smoking
history presents with a several month history of recurrent epigastric abdominal
discomfort. She feels fairly well otherwise and denies any nausea, vomiting,
diarrhea, or constipation. She reports that a first cousin died from a ruptured
aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92;
respiratory rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body
mass index is 17.6. On exam, her abdominal aorta is prominent, which is
concerning for an abdominal aortic aneurysm (AAA). Which of the following is her
most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
b. History of smoking
Rationale: History of smoking is her most significant risk factor for an AAA. Male
gender, not female gender, is considered as risk factor. Underweight is not a risk
factor for AAA. Family history of ruptured aneurysm is vague and could be a
cerebral aneurysm. Further, her family history is in a first-degree cousin not a
first-degree relative (biologic parents, siblings, and children). Hypertension could
3|Page
, NR 509 Advanced Physical Assessment Final Exam
contribute to atherosclerosis, which is a risk factor. Further, a diagnosis of
hypertension is not based on one elevated blood pressure reading.
A 76-year-old retired man with a history of prostate cancer and hypertension has
been screened annually for colon cancer using high sensitivity fecal occult blood
testing (FOBT). He presents for follow-up of his hypertension, during which the
clinician scans his chart to ensure he is up to date with his preventive health care.
He has a positive FOBT on one occasion at age 66 years and subsequently went for
a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of colorectal cancer or
adenomatous polyps. What are the U.S. Preventive Services Task Force (USPSTF)
screening recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
a. Do not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most adults
ages 76-85 years, the gain in life years is small compared to colonoscopy risks. It
is advised to discuss individualized risks and benefits with the patient. Annual
FOBT screening may continue until age 80-85 years if benefits to doing so
outweigh risks for the individual patient; however, screening should not be
routinely continued.
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with
a 3-year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks
each episode and is associated with onset of constipation. She describes
infrequent, small hard stool that she finds very difficult to pass. She has tried to
increase dietary fiber and water intake, but usually this is not sufficient and she
resorts to over-the-counter laxatives, which she finds upset her stomach but do
resolve the constipation. Symptoms typically gradually resolve with bowel
4|Page
