NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells
the nurse that he has had "a runny nose for a week." When performing the physical
assessment, the nurse notes that the child has nasal flaring and sternal and intercostal
retractions. The nurse's next action should be to:
a.
Assure the mother that these signs are normal symptoms of a cold.
b.
Recognize that these are serious signs, and contact the physician.
c.
Ask the mother if the infant has had trouble with feedings.
d.
Perform a complete cardiac assessment because these signs are probably indicative of
early heart failure. ANS: B
The infant is an obligatory nose breather until the age of 3 months. Normally, no flaring
of the nostrils and no sternal or intercostal retraction occurs. Significant retractions of
the sternum and intercostal muscles and nasal flaring indicate increased inspiratory
effort, as in pneumonia, acute airway obstruction, asthma, and atelectasis; therefore,
immediate referral to the physician is warranted. These signs do not indicate heart
failure, and an assessment of the infant's feeding is not a priority at this time.
19. When assessing the respiratory system of a 4-year-old child, which of these findings
would the nurse expect?
a.
Crepitus palpated at the costochondral junctions
b.
No diaphragmatic excursion as a result of a child's decreased inspiratory volume
c.
Presence of bronchovesicular breath sounds in the peripheral lung fields
d.
Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest
ANS: C
1|Page
,Bronchovesicular breath sounds in the peripheral lung fields of the infant and young
child up to age 5 or 6 years are normal findings. Their thin chest walls with
underdeveloped musculature do not dampen the sound, as do the thicker chest walls of
adults; therefore, breath sounds are loud and harsh.
When inspecting the anterior chest of an adult, the nurse should include which
assessment?
a.
Diaphragmatic excursion
b.
Symmetric chest expansion
c.
Presence of breath sounds
d.
Shape and configuration of the chest wall ANS: D
Inspection of the anterior chest includes shape and configuration of the chest wall;
assessment of the patient's level of consciousness and the patient's skin color and
condition; quality of respirations; presence or absence of retraction and bulging of the
intercostal spaces; and use of accessory muscles. Symmetric chest expansion is assessed
by palpation. Diaphragmatic excursion is assessed by percussion of the posterior chest.
Breath sounds are assessed by auscultation.
The nurse knows that auscultation of fine crackles would most likely be noticed in:
a.
A healthy 5-year-old child.
b.
A pregnant woman.
c.
The immediate newborn period.
d.
Association with a pneumothorax. ANS: C
Fine crackles are commonly heard in the immediate newborn period as a result of the
opening of the airways and a clearing of fluid. Persistent fine crackles would be noticed
with pneumonia, bronchiolitis, or atelectasis.
During an assessment of an adult, the nurse has noted unequal chest expansion and
recognizes that this occurs in which situation?
a.
2|Page
,In an obese patient
b.
When part of the lung is obstructed or collapsed
c.
When bulging of the intercostal spaces is present
d.
When accessory muscles are used to augment respiratory effort ANS: B
Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as
with pneumonia, or when guarding to avoid postoperative incisional pain.
During auscultation of the lungs of an adult patient, the nurse notices the presence of
bronchophony. The nurse should assess for signs of which condition?
a.
Airway obstruction
b.
Emphysema
c.
Pulmonary consolidation
d.
Asthma ANS: C
Pathologic conditions that increase lung density, such as pulmonary consolidation, will
enhance the transmission of voice sounds, such as bronchophony
The nurse is reviewing the characteristics of breath sounds. Which statement about
bronchovesicular breath sounds is true? Bronchovesicular breath sounds are:
a.
Musical in quality.
b.
Usually caused by a pathologic disease.
c.
Expected near the major airways.
d.
Similar to bronchial sounds except shorter in duration. ANS: C
Bronchovesicular breath sounds are heard over major bronchi where fewer alveoli are
located posteriorly—between the scapulae, especially on the right; and anteriorly,
around the upper sternum in the first and second intercostal spaces. The other
responses are not correct.
3|Page
, The nurse is listening to the breath sounds of a patient with severe asthma. Air passing
through narrowed bronchioles would produce which of these adventitious sounds?
a.
Wheezes
b.
Bronchial sounds
c.
Bronchophony
d.
Whispered pectoriloquy ANS: A
Wheezes are caused by air squeezed or compressed through passageways narrowed
almost to closure by collapsing, swelling, secretions, or tumors, such as with acute
asthma or chronic emphysema.
A patient has a long history of chronic obstructive pulmonary disease (COPD). During the
assessment, the nurse will most likely observe which of these?
a.
Unequal chest expansion
b.
Increased tactile fremitus
c.
Atrophied neck and trapezius muscles
d.
Anteroposterior-to-transverse diameter ratio of 1:1 ANS: D
An anteroposterior-to-transverse diameter ratio of 1:1 or barrel chest is observed in
individuals with COPD because of hyperinflation of the lungs. The ribs are more
horizontal, and the chest appears as if held in continuous inspiration. Neck muscles are
hypertrophied from aiding in forced respiration. Chest expansion may be decreased but
symmetric. Decreased tactile fremitus occurs from decreased transmission of vibrations.
A teenage patient comes to the emergency department with complaints of an inability
to breathe and a sharp pain in the left side of his chest. The assessment findings include
cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the
left, hyperresonance on the left, and decreased breath sounds on the left. The nurse
interprets that these assessment findings are consistent with:
a.
Bronchitis.
4|Page
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells
the nurse that he has had "a runny nose for a week." When performing the physical
assessment, the nurse notes that the child has nasal flaring and sternal and intercostal
retractions. The nurse's next action should be to:
a.
Assure the mother that these signs are normal symptoms of a cold.
b.
Recognize that these are serious signs, and contact the physician.
c.
Ask the mother if the infant has had trouble with feedings.
d.
Perform a complete cardiac assessment because these signs are probably indicative of
early heart failure. ANS: B
The infant is an obligatory nose breather until the age of 3 months. Normally, no flaring
of the nostrils and no sternal or intercostal retraction occurs. Significant retractions of
the sternum and intercostal muscles and nasal flaring indicate increased inspiratory
effort, as in pneumonia, acute airway obstruction, asthma, and atelectasis; therefore,
immediate referral to the physician is warranted. These signs do not indicate heart
failure, and an assessment of the infant's feeding is not a priority at this time.
19. When assessing the respiratory system of a 4-year-old child, which of these findings
would the nurse expect?
a.
Crepitus palpated at the costochondral junctions
b.
No diaphragmatic excursion as a result of a child's decreased inspiratory volume
c.
Presence of bronchovesicular breath sounds in the peripheral lung fields
d.
Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest
ANS: C
1|Page
,Bronchovesicular breath sounds in the peripheral lung fields of the infant and young
child up to age 5 or 6 years are normal findings. Their thin chest walls with
underdeveloped musculature do not dampen the sound, as do the thicker chest walls of
adults; therefore, breath sounds are loud and harsh.
When inspecting the anterior chest of an adult, the nurse should include which
assessment?
a.
Diaphragmatic excursion
b.
Symmetric chest expansion
c.
Presence of breath sounds
d.
Shape and configuration of the chest wall ANS: D
Inspection of the anterior chest includes shape and configuration of the chest wall;
assessment of the patient's level of consciousness and the patient's skin color and
condition; quality of respirations; presence or absence of retraction and bulging of the
intercostal spaces; and use of accessory muscles. Symmetric chest expansion is assessed
by palpation. Diaphragmatic excursion is assessed by percussion of the posterior chest.
Breath sounds are assessed by auscultation.
The nurse knows that auscultation of fine crackles would most likely be noticed in:
a.
A healthy 5-year-old child.
b.
A pregnant woman.
c.
The immediate newborn period.
d.
Association with a pneumothorax. ANS: C
Fine crackles are commonly heard in the immediate newborn period as a result of the
opening of the airways and a clearing of fluid. Persistent fine crackles would be noticed
with pneumonia, bronchiolitis, or atelectasis.
During an assessment of an adult, the nurse has noted unequal chest expansion and
recognizes that this occurs in which situation?
a.
2|Page
,In an obese patient
b.
When part of the lung is obstructed or collapsed
c.
When bulging of the intercostal spaces is present
d.
When accessory muscles are used to augment respiratory effort ANS: B
Unequal chest expansion occurs when part of the lung is obstructed or collapsed, as
with pneumonia, or when guarding to avoid postoperative incisional pain.
During auscultation of the lungs of an adult patient, the nurse notices the presence of
bronchophony. The nurse should assess for signs of which condition?
a.
Airway obstruction
b.
Emphysema
c.
Pulmonary consolidation
d.
Asthma ANS: C
Pathologic conditions that increase lung density, such as pulmonary consolidation, will
enhance the transmission of voice sounds, such as bronchophony
The nurse is reviewing the characteristics of breath sounds. Which statement about
bronchovesicular breath sounds is true? Bronchovesicular breath sounds are:
a.
Musical in quality.
b.
Usually caused by a pathologic disease.
c.
Expected near the major airways.
d.
Similar to bronchial sounds except shorter in duration. ANS: C
Bronchovesicular breath sounds are heard over major bronchi where fewer alveoli are
located posteriorly—between the scapulae, especially on the right; and anteriorly,
around the upper sternum in the first and second intercostal spaces. The other
responses are not correct.
3|Page
, The nurse is listening to the breath sounds of a patient with severe asthma. Air passing
through narrowed bronchioles would produce which of these adventitious sounds?
a.
Wheezes
b.
Bronchial sounds
c.
Bronchophony
d.
Whispered pectoriloquy ANS: A
Wheezes are caused by air squeezed or compressed through passageways narrowed
almost to closure by collapsing, swelling, secretions, or tumors, such as with acute
asthma or chronic emphysema.
A patient has a long history of chronic obstructive pulmonary disease (COPD). During the
assessment, the nurse will most likely observe which of these?
a.
Unequal chest expansion
b.
Increased tactile fremitus
c.
Atrophied neck and trapezius muscles
d.
Anteroposterior-to-transverse diameter ratio of 1:1 ANS: D
An anteroposterior-to-transverse diameter ratio of 1:1 or barrel chest is observed in
individuals with COPD because of hyperinflation of the lungs. The ribs are more
horizontal, and the chest appears as if held in continuous inspiration. Neck muscles are
hypertrophied from aiding in forced respiration. Chest expansion may be decreased but
symmetric. Decreased tactile fremitus occurs from decreased transmission of vibrations.
A teenage patient comes to the emergency department with complaints of an inability
to breathe and a sharp pain in the left side of his chest. The assessment findings include
cyanosis, tachypnea, tracheal deviation to the right, decreased tactile fremitus on the
left, hyperresonance on the left, and decreased breath sounds on the left. The nurse
interprets that these assessment findings are consistent with:
a.
Bronchitis.
4|Page
