NR509 Advanced Physical Assessment Midterm Exam
Review 2025/2026 - 100 Questions & Rated A Answers
for Chamberlain College
A 58-year-old male with COPD presents with increased dyspnea. You auscultate the
right lower lobe posteriorly and hear discontinuous, popping sounds that do not clear
with coughing. Which finding best describes this sound?
1. A) Wheezes indicating bronchospasm
B) Crackles (rales) suggesting atelectasis or early pneumonia
C) Pleural friction rub from pleuritis
D) Stridor caused by upper-airway obstruction
Answer: B
Rationale: Discontinuous, non-musical popping sounds = crackles/rales, often heard in
atelectasis, pneumonia, or interstitial fluid (Bates’). Wheezes are continuous musical
sounds; stridor is inspiratory and cervical; a rub is grating and synchronous with
respiration.
During ophthalmoscopy on a 42-year-old hypertensive woman, you note that the nasal
border of the optic disc is blurred and the cup-to-disc ratio appears 0.6. Your next action
is:
2. A) Document normal variant and proceed
B) Repeat with undilated exam after asking about glaucoma history
C) Perform pupillary dilation for a full disc evaluation and refer for glaucoma
work-up
D) Check confrontational fields only
Answer: C
Rationale: Cup-to-disc ratio ≥ 0.5 and blurred margins raise suspicion of glaucomatous
atrophy; dilation allows stereo-view of disc contour and is standard before referral
(AAO). Documenting as normal (A) misses pathology.
,A 3-week-old infant is brought in with poor feeding. You palpate the anterior fontanelle
and find it depressed 2 mm below the surrounding cranium when the baby is quiet. You
should:
3. A) Reassure parent that this is normal in newborns
B) Assess hydration status and review feeding history
C) Immediately refer for cranial ultrasound
D) Measure head circumference monthly
Answer: B
Rationale: A mildly sunken fontanelle often signals dehydration before other signs
appear (Bates). Reassurance (A) is unsafe; immediate imaging (C) is not indicated
without additional neurologic signs.
While performing a Whispered Voice Test on a 67-year-old man, he repeats only 3 of 6
words correctly at 2 ft. This finding correlates best with:
4. A) Conductive hearing loss requiring tympanometry
B) Sensorineural loss consistent with presbycusis
C) Normal age-related decrement
D) Cerumen impaction until proven otherwise
Answer: B
Rationale: Failure on whisper test suggests high-frequency loss typical of presbycusis
(sensorineural). Tympanometry (A) is for conductive etiology but not first assumption;
cerumen (D) would need otoscopic proof.
A 30-year-old woman describes chest pain that increases with deep inspiration and is
reproducible with palpation of the 4th costochondral junction. You should next:
5. A) Order troponin to rule out MI
B) Perform chest X-ray to exclude fracture
C) Instruct patient to flex and extend neck to elicit CVA tenderness
D) Palpate for Tietze syndrome swelling and observe for warmth
Answer: D
,Rationale: Reproducible pain at costochondral junction indicates costochondritis; Tietze
adds localized swelling/warmth. Flexing neck (C) is for meningitis; troponin (A)
unnecessary without cardiac features.
When grading pitting edema on the left ankle, you note a 5 mm pit that rebounds in 25
seconds. Grade this:
6. A) 1+
B) 2+
C) 3+
D) 4+
Answer: C
Rationale: 3+ = 5–6 mm depth, rebound 10–30 s; 4+ requires >6 mm and >30 s or
persistent (Bates).
A 55-year-old diabetic has a monofilament 5.07 nylon test. He cannot feel the filament
at the 1st, 3rd, and 5th metatarsal heads. Your documentation should state:
7. A) Diminished light touch; continue annual testing
B) Protective sensation absent; high risk for ulceration
C) Peripheral neuropathy confirmed; start gabapentin
D) Vibratory sense deficit; obtain MRI spine
Answer: B
Rationale: Inability to feel 5.07 filament = loss of protective sensation, predictive of foot
ulcers (ADA). Gabapentin (C) treats pain, not screening; no imaging needed (D).
During cardiac auscultation at the apex with the bell, you hear a low-pitched sound just
before S1. It disappears when you press firmly. This is:
8. A) S3 gallop indicating heart failure
B) S4 gallop associated with stiff LV
C) Split S1 from RBBB
D) Mitral valve opening snap
Answer: B
, Rationale: S4 is presystolic, low-pitched, best heard with bell light pressure; firm
pressure obliterates it. S3 occurs after S2; opening snap is high-pitched and earlier.
When evaluating a 70-year-old for dizziness, you perform the Dix-Hallpike maneuver.
After rapid supine head turn to the right, upbeat nystagmus appears after 5 seconds
and fatigues within 30 s. This supports:
9. A) Central vertigo; order MRI
B) Right posterior canal BPPV
C) Orthostatic hypotension
D) Vestibular neuritis
Answer: B
Rationale: Latent, direction-fixed, fatigable nystagmus with Dix-Hallpike is
pathognomonic for posterior canal BPPV. Upbeat/torsional nystagmus aligns with
canalolithiasis.
A 26-year-old woman has a 2 cm mobile, rubbery, non-tender breast mass. You palpate
edges that slip under your fingers. Next best step:
10. A) Reassure fibroadenoma; repeat exam in 1 year
B) Order diagnostic mammogram
C) Schedule ultrasound in 2 weeks
D) Proceed to core biopsy same day
Answer: C
Rationale: Classic fibroadenoma in young woman: ultrasound is imaging of choice (<30
y) to confirm solid vs cystic; mammography (B) less sensitive in dense tissue. Biopsy
(D) only after imaging.
On inspection of the palate of a 4-year-old, you note a translucent, glistening, 1 cm
midline swelling that blanches with pressure. The child is afebrile. Diagnosis?
11. A) Mucocele
B) Epstein pearl
C) Nasoalveolar cyst
D) Hand-foot-mouth vesicle
Review 2025/2026 - 100 Questions & Rated A Answers
for Chamberlain College
A 58-year-old male with COPD presents with increased dyspnea. You auscultate the
right lower lobe posteriorly and hear discontinuous, popping sounds that do not clear
with coughing. Which finding best describes this sound?
1. A) Wheezes indicating bronchospasm
B) Crackles (rales) suggesting atelectasis or early pneumonia
C) Pleural friction rub from pleuritis
D) Stridor caused by upper-airway obstruction
Answer: B
Rationale: Discontinuous, non-musical popping sounds = crackles/rales, often heard in
atelectasis, pneumonia, or interstitial fluid (Bates’). Wheezes are continuous musical
sounds; stridor is inspiratory and cervical; a rub is grating and synchronous with
respiration.
During ophthalmoscopy on a 42-year-old hypertensive woman, you note that the nasal
border of the optic disc is blurred and the cup-to-disc ratio appears 0.6. Your next action
is:
2. A) Document normal variant and proceed
B) Repeat with undilated exam after asking about glaucoma history
C) Perform pupillary dilation for a full disc evaluation and refer for glaucoma
work-up
D) Check confrontational fields only
Answer: C
Rationale: Cup-to-disc ratio ≥ 0.5 and blurred margins raise suspicion of glaucomatous
atrophy; dilation allows stereo-view of disc contour and is standard before referral
(AAO). Documenting as normal (A) misses pathology.
,A 3-week-old infant is brought in with poor feeding. You palpate the anterior fontanelle
and find it depressed 2 mm below the surrounding cranium when the baby is quiet. You
should:
3. A) Reassure parent that this is normal in newborns
B) Assess hydration status and review feeding history
C) Immediately refer for cranial ultrasound
D) Measure head circumference monthly
Answer: B
Rationale: A mildly sunken fontanelle often signals dehydration before other signs
appear (Bates). Reassurance (A) is unsafe; immediate imaging (C) is not indicated
without additional neurologic signs.
While performing a Whispered Voice Test on a 67-year-old man, he repeats only 3 of 6
words correctly at 2 ft. This finding correlates best with:
4. A) Conductive hearing loss requiring tympanometry
B) Sensorineural loss consistent with presbycusis
C) Normal age-related decrement
D) Cerumen impaction until proven otherwise
Answer: B
Rationale: Failure on whisper test suggests high-frequency loss typical of presbycusis
(sensorineural). Tympanometry (A) is for conductive etiology but not first assumption;
cerumen (D) would need otoscopic proof.
A 30-year-old woman describes chest pain that increases with deep inspiration and is
reproducible with palpation of the 4th costochondral junction. You should next:
5. A) Order troponin to rule out MI
B) Perform chest X-ray to exclude fracture
C) Instruct patient to flex and extend neck to elicit CVA tenderness
D) Palpate for Tietze syndrome swelling and observe for warmth
Answer: D
,Rationale: Reproducible pain at costochondral junction indicates costochondritis; Tietze
adds localized swelling/warmth. Flexing neck (C) is for meningitis; troponin (A)
unnecessary without cardiac features.
When grading pitting edema on the left ankle, you note a 5 mm pit that rebounds in 25
seconds. Grade this:
6. A) 1+
B) 2+
C) 3+
D) 4+
Answer: C
Rationale: 3+ = 5–6 mm depth, rebound 10–30 s; 4+ requires >6 mm and >30 s or
persistent (Bates).
A 55-year-old diabetic has a monofilament 5.07 nylon test. He cannot feel the filament
at the 1st, 3rd, and 5th metatarsal heads. Your documentation should state:
7. A) Diminished light touch; continue annual testing
B) Protective sensation absent; high risk for ulceration
C) Peripheral neuropathy confirmed; start gabapentin
D) Vibratory sense deficit; obtain MRI spine
Answer: B
Rationale: Inability to feel 5.07 filament = loss of protective sensation, predictive of foot
ulcers (ADA). Gabapentin (C) treats pain, not screening; no imaging needed (D).
During cardiac auscultation at the apex with the bell, you hear a low-pitched sound just
before S1. It disappears when you press firmly. This is:
8. A) S3 gallop indicating heart failure
B) S4 gallop associated with stiff LV
C) Split S1 from RBBB
D) Mitral valve opening snap
Answer: B
, Rationale: S4 is presystolic, low-pitched, best heard with bell light pressure; firm
pressure obliterates it. S3 occurs after S2; opening snap is high-pitched and earlier.
When evaluating a 70-year-old for dizziness, you perform the Dix-Hallpike maneuver.
After rapid supine head turn to the right, upbeat nystagmus appears after 5 seconds
and fatigues within 30 s. This supports:
9. A) Central vertigo; order MRI
B) Right posterior canal BPPV
C) Orthostatic hypotension
D) Vestibular neuritis
Answer: B
Rationale: Latent, direction-fixed, fatigable nystagmus with Dix-Hallpike is
pathognomonic for posterior canal BPPV. Upbeat/torsional nystagmus aligns with
canalolithiasis.
A 26-year-old woman has a 2 cm mobile, rubbery, non-tender breast mass. You palpate
edges that slip under your fingers. Next best step:
10. A) Reassure fibroadenoma; repeat exam in 1 year
B) Order diagnostic mammogram
C) Schedule ultrasound in 2 weeks
D) Proceed to core biopsy same day
Answer: C
Rationale: Classic fibroadenoma in young woman: ultrasound is imaging of choice (<30
y) to confirm solid vs cystic; mammography (B) less sensitive in dense tissue. Biopsy
(D) only after imaging.
On inspection of the palate of a 4-year-old, you note a translucent, glistening, 1 cm
midline swelling that blanches with pressure. The child is afebrile. Diagnosis?
11. A) Mucocele
B) Epstein pearl
C) Nasoalveolar cyst
D) Hand-foot-mouth vesicle
