NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 33-year-old nurse presents with a history of weight gain, decreased energy, and
menorrhagia over the past several months. Review of her family history reveals
Hashimoto thyroiditis and hypothyroidism in four female first-degree relatives (her
mother and three sisters). Which of the following skin findings best supports a diagnosis
of clinical hypothyroidism?
a. Discoid rash, alopecia, oral ulcers, and Raynaud phenomenon
b. Warm moist skin, hyperpigmentation, and pretibial myxedema
c. Dry skin, myxedema, alopecia of the eyebrows, and brittle nails
d. Spider angiomas, telangiectasia, palmar erythema, and Terry nails
e. Thickened, taut skin with sclerodactyly and telangiectasia c. Dry skin, myxedema,
alopecia of the eyebrows, and brittle nails
A 74-year-old man is being seen because of a 1-day history of a painful right eye. He also
mentions that he has blurred vision in that eye. He thought something had blown into
his eye, but after flushing it out, the pain and blurred vision remains. What is the best
course of action?
a. Reassure him that pain from a foreign body can remain for a day or two (even after
the foreign body is removed).
b. Perform a vision examination.
c. Perform a complete neurological examination.
d. Refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis,
or acute glaucoma.
e. Check his blood pressure. d. Refer to an ophthalmologist emergently with the
possibility of corneal ulcer, uveitis, or acute glaucoma.
An 87-year-old woman who is generally healthy and cognitively sharp complains to the
clinician of slow loss of vision, with similar problems in both eyes, particularly when she
looks straight ahead. She is having difficulty reading of late. What is a reasonable
response to her?
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,a. "This is a common occurrence with aging and unlikely to have a diagnosis."
b. "This is an unusual occurrence, even among elderly, and may be due to a problem
within the brain (since it is bilateral)."
c. "Are you experiencing depression or stress?"
d. "This may be the onset of macular degeneration, which an ophthalmologist should
confirm."
e. "This is a classic 'floater' and no cause for concern." d. "This may be the onset of
macular degeneration, which an ophthalmologist should confirm."
A 70-year-old man complains of double vision. Which of the following associated
symptoms or signs would be worrying about an underlying neurological problem (as
opposed to pathology in the eye)?
a. Abnormality in extraocular movements on examination
b. Diplopia persisting in the right eye when the left eye is closed
c. An associated conjunctivitis
d. Worsening vision bilaterally on examination
e. Symptoms of flashing lights a. Abnormality in extraocular movements on
examination
An 82-year-old gentleman seems to be speaking loudly during an examination,
suggesting that he may not be hearing well. What is a good question to ask him to help
identify whether or not he has hearing loss?
a. Has he been listening to loud music?
b. How well does he understand people in a noisy environment such as a restaurant?
c. Does he have vertigo?
d. Has he been having an earache?
e. Does he have discharge from his ear? b. How well does he understand people in a
noisy environment such as a restaurant?
A 25-year-old construction worker is complaining of a swishing noise in both ears that
never goes away and has occurred for about 6 months. He is otherwise healthy, is able
to work on his job (operating large, vibrating machinery) without problems, and is not
taking any medications. A complete examination reveals an abnormality. Which of the
following abnormality is most often associated with tinnitus?
a. Bilateral earache
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,b. Wax in both ears
c. Headache
d. Vertigo
e. Mild tremor d. Vertigo
A patient with cystic fibrosis (CF) has been complaining of fullness in his left nasal cavity.
Examination of his nose using an otoscope and a speculum reveals a normal nasal
septum, but a pale, saclike growth of inflamed tissue that is obstructing a large part of
the nasal cavity. What is the most likely diagnosis?
a. Ulcer
b. Viral rhinitis
c. Allergic rhinitis
d. Deviated nasal septum
e. Nasal polyp e. Nasal polyp
1. A 65-year-old overweight male presents at the clinic with hoarseness which has lasted
for around 2 months. He thinks it began along with a cold. He is not feeling badly other
than frequent heartburn, and he has continued to work as a bartender (for the past 30
years), but he is having difficulty being heard and understood because of his hoarse
voice. A diagnosis that is on the differential list includes which of the following?
a. Voice strain from bartending and talking amidst loud ambient noise
b. Viral infection
c. Acid reflux
d. Inhalation of fumes
e. Environmental allergies c. Acid reflux
A 39-year-old architect comes to the clinic for a 2-day history of fever, chills, cough
productive of green sputum, and dyspnea. He has no history of serious illness. His
temperature is 101.2oF. His other vital signs are within normal limits. Late inspiratory
crackles are heard on auscultation over the left lower lung posteriorly. When the
clinician listens over that area and instructs the patient to say "ee," it sounds like "A."
Which of the following would most likely be found on percussion of his lungs?
a. Flatness
b. Hyperresonance
c. Stridor
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, d. Tympany
e. Dullness e. Dullness
A student is practicing the performance of a lung examination on a classmate. Which of
the following is the correct order for performing the components of the lung
examination?
a. Auscultation, inspection, palpation, and percussion
b. Auscultation, percussion, palpation, and inspection
c. Inspection, palpation, percussion, and auscultation
d. Auscultation, inspection, palpation, and percussion
e. Inspection, auscultation, percussion, and palpation
f. Palpation, inspection, auscultation, and percussion c. Inspection, palpation,
percussion, and auscultation
A 14-year-old high school student comes to the clinic for a 3-month history of periodic
dyspnea when playing basketball. It resolves shortly after resting. He has not had fever,
chills, cough, sputum production, or chest pain. He has no history of serious illness.
Based on the boy's history, asthma is suspected. Which of the following sounds heard on
expiration during lung auscultation would be most suggestive of asthma?
a. Mediastinal crunch
b. Pleural rub
c. Rhonchi
d. Wheezes
e. Stridor d. Wheezes
A clinician is percussing the lungs of a patient with chronic obstructive pulmonary
disease to see if they sound hyperresonant. Which of the following is an example of
good technique for percussion?
a. Strike using the tip of the third finger.
b. The proximal interphalangeal joint is the joint that is struck.
c. Put the third and fourth fingers next to each other on the chest.
d. Strike using the finger pad of the fourth finger.
e. The wrist is kept still during percussion. a. Strike using the tip of the third finger.
A 29-year-old waiter comes to the clinic for a 2-month history of a cough. When he
lowers his gown so the clinician can listen to his lungs, the clinician notices a depression
4|Page
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 33-year-old nurse presents with a history of weight gain, decreased energy, and
menorrhagia over the past several months. Review of her family history reveals
Hashimoto thyroiditis and hypothyroidism in four female first-degree relatives (her
mother and three sisters). Which of the following skin findings best supports a diagnosis
of clinical hypothyroidism?
a. Discoid rash, alopecia, oral ulcers, and Raynaud phenomenon
b. Warm moist skin, hyperpigmentation, and pretibial myxedema
c. Dry skin, myxedema, alopecia of the eyebrows, and brittle nails
d. Spider angiomas, telangiectasia, palmar erythema, and Terry nails
e. Thickened, taut skin with sclerodactyly and telangiectasia c. Dry skin, myxedema,
alopecia of the eyebrows, and brittle nails
A 74-year-old man is being seen because of a 1-day history of a painful right eye. He also
mentions that he has blurred vision in that eye. He thought something had blown into
his eye, but after flushing it out, the pain and blurred vision remains. What is the best
course of action?
a. Reassure him that pain from a foreign body can remain for a day or two (even after
the foreign body is removed).
b. Perform a vision examination.
c. Perform a complete neurological examination.
d. Refer to an ophthalmologist emergently with the possibility of corneal ulcer, uveitis,
or acute glaucoma.
e. Check his blood pressure. d. Refer to an ophthalmologist emergently with the
possibility of corneal ulcer, uveitis, or acute glaucoma.
An 87-year-old woman who is generally healthy and cognitively sharp complains to the
clinician of slow loss of vision, with similar problems in both eyes, particularly when she
looks straight ahead. She is having difficulty reading of late. What is a reasonable
response to her?
1|Page
,a. "This is a common occurrence with aging and unlikely to have a diagnosis."
b. "This is an unusual occurrence, even among elderly, and may be due to a problem
within the brain (since it is bilateral)."
c. "Are you experiencing depression or stress?"
d. "This may be the onset of macular degeneration, which an ophthalmologist should
confirm."
e. "This is a classic 'floater' and no cause for concern." d. "This may be the onset of
macular degeneration, which an ophthalmologist should confirm."
A 70-year-old man complains of double vision. Which of the following associated
symptoms or signs would be worrying about an underlying neurological problem (as
opposed to pathology in the eye)?
a. Abnormality in extraocular movements on examination
b. Diplopia persisting in the right eye when the left eye is closed
c. An associated conjunctivitis
d. Worsening vision bilaterally on examination
e. Symptoms of flashing lights a. Abnormality in extraocular movements on
examination
An 82-year-old gentleman seems to be speaking loudly during an examination,
suggesting that he may not be hearing well. What is a good question to ask him to help
identify whether or not he has hearing loss?
a. Has he been listening to loud music?
b. How well does he understand people in a noisy environment such as a restaurant?
c. Does he have vertigo?
d. Has he been having an earache?
e. Does he have discharge from his ear? b. How well does he understand people in a
noisy environment such as a restaurant?
A 25-year-old construction worker is complaining of a swishing noise in both ears that
never goes away and has occurred for about 6 months. He is otherwise healthy, is able
to work on his job (operating large, vibrating machinery) without problems, and is not
taking any medications. A complete examination reveals an abnormality. Which of the
following abnormality is most often associated with tinnitus?
a. Bilateral earache
2|Page
,b. Wax in both ears
c. Headache
d. Vertigo
e. Mild tremor d. Vertigo
A patient with cystic fibrosis (CF) has been complaining of fullness in his left nasal cavity.
Examination of his nose using an otoscope and a speculum reveals a normal nasal
septum, but a pale, saclike growth of inflamed tissue that is obstructing a large part of
the nasal cavity. What is the most likely diagnosis?
a. Ulcer
b. Viral rhinitis
c. Allergic rhinitis
d. Deviated nasal septum
e. Nasal polyp e. Nasal polyp
1. A 65-year-old overweight male presents at the clinic with hoarseness which has lasted
for around 2 months. He thinks it began along with a cold. He is not feeling badly other
than frequent heartburn, and he has continued to work as a bartender (for the past 30
years), but he is having difficulty being heard and understood because of his hoarse
voice. A diagnosis that is on the differential list includes which of the following?
a. Voice strain from bartending and talking amidst loud ambient noise
b. Viral infection
c. Acid reflux
d. Inhalation of fumes
e. Environmental allergies c. Acid reflux
A 39-year-old architect comes to the clinic for a 2-day history of fever, chills, cough
productive of green sputum, and dyspnea. He has no history of serious illness. His
temperature is 101.2oF. His other vital signs are within normal limits. Late inspiratory
crackles are heard on auscultation over the left lower lung posteriorly. When the
clinician listens over that area and instructs the patient to say "ee," it sounds like "A."
Which of the following would most likely be found on percussion of his lungs?
a. Flatness
b. Hyperresonance
c. Stridor
3|Page
, d. Tympany
e. Dullness e. Dullness
A student is practicing the performance of a lung examination on a classmate. Which of
the following is the correct order for performing the components of the lung
examination?
a. Auscultation, inspection, palpation, and percussion
b. Auscultation, percussion, palpation, and inspection
c. Inspection, palpation, percussion, and auscultation
d. Auscultation, inspection, palpation, and percussion
e. Inspection, auscultation, percussion, and palpation
f. Palpation, inspection, auscultation, and percussion c. Inspection, palpation,
percussion, and auscultation
A 14-year-old high school student comes to the clinic for a 3-month history of periodic
dyspnea when playing basketball. It resolves shortly after resting. He has not had fever,
chills, cough, sputum production, or chest pain. He has no history of serious illness.
Based on the boy's history, asthma is suspected. Which of the following sounds heard on
expiration during lung auscultation would be most suggestive of asthma?
a. Mediastinal crunch
b. Pleural rub
c. Rhonchi
d. Wheezes
e. Stridor d. Wheezes
A clinician is percussing the lungs of a patient with chronic obstructive pulmonary
disease to see if they sound hyperresonant. Which of the following is an example of
good technique for percussion?
a. Strike using the tip of the third finger.
b. The proximal interphalangeal joint is the joint that is struck.
c. Put the third and fourth fingers next to each other on the chest.
d. Strike using the finger pad of the fourth finger.
e. The wrist is kept still during percussion. a. Strike using the tip of the third finger.
A 29-year-old waiter comes to the clinic for a 2-month history of a cough. When he
lowers his gown so the clinician can listen to his lungs, the clinician notices a depression
4|Page
