NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in
various locations. Each lesion lasts for many minutes. What most likely accounts for this
rash?
A) Insect bites
B) Urticaria, or hives
C) Psoriasis
D) Purpura B) Urticaria, or hives
This is a typical case of urticaria. The most unusual aspect of this condition is that
the lesions "move" from place to place. This would be distinctly unusual for the other
causes listed.
Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few
flat red and purple lesions, about 6 cm in diameter, on the ulnar aspect of her forearms
but nowhere else. She doesn't mention them. They are tender when you examine them.
What should you do?
A) Conclude that these are lesions she has had for a long time.
B) Wait for her to mention them before asking further questions.
C) Ask how she acquired them.
D) Conduct the visit as usual for the patient. C) Ask how she acquired them.
These are consistent with ecchymoses, or bruises. It is important to ask about
antiplatelet medications such as aspirin, trauma history, and history of blood disorders in
the patient and her family. Because of the different ages of the bruises and the isolation
of them to the ulnar forearms, these may be a result of abuse or other violence. It is
your duty to investigate the cause of these lesions.
A middle-aged man comes in because he has noticed multiple small, blood-red, raised
1|Page
,lesions over his anterior chest and abdomen for the past several months. They are not
painful and he has not noted any bleeding or bruising. He is concerned this may be
consistent with a dangerous condition. What should you do?
A) Reassure him that there is nothing to worry about.
B) Do laboratory work to check for platelet problems.
C) Obtain an extensive history regarding blood problems and bleeding disorders.
D) Do a skin biopsy in the office. A) Reassure him that there is nothing to worry about.
These represent cherry angiomas, which are very common, benign lesions. Further
workup such as laboratory work, skin biopsy, or even further questions are not
necessary at this time. It would be wise to ask the patient to report any changes in any
of his skin lesions, and tell him that you would need to see him at that time.
A 38-year-old accountant comes to your clinic for evaluation of a headache. The
throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to
10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has
had headaches like this in the past, usually less than one per week, but not as severe.
She does not know of any inciting factors. There has been no change in the frequency of
her headaches. She usually takes an over-the-counter analgesic and this results in
resolution of the headache. Based on this description, what is the most likely diagnosis
of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound B) Migraine
This is a description of a common migraine (no aura). Distinctive features of a migraine
include phonophobia and photophobia, nausea, resolution with sleep, and unilateral
distribution. Only some of these features may be present.
A 29-year-old computer programmer comes to your office for evaluation of a headache.
The tightening sensation is located all over the head and is of moderate intensity. It used
to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea.
He spends several hours each day at a computer monitor/keyboard. He has tried over-
2|Page
,the-counter medication; it has dulled the pain but not taken it away. Based on this
description, what is your most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound A) Tension
This is a description of a typical tension headache.
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea A) Scotomas
Scotomas are specks in the vision or areas where the patient cannot see; therefore, this
is a common/concerning symptom of the eye.
A 49-year-old administrative assistant comes to your office for evaluation of dizziness.
You elicit the information that the dizziness is a spinning sensation of sudden onset,
worse with head position changes. The episodes last a few seconds and then go away,
and they are accompanied by intense nausea. She has vomited one time. She denies
tinnitus. You perform a physical examination of the head and neck and note that the
patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is
normal. Based on this description, what is the most likely
diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma A) Benign positional vertigo
This is a classic description of benign positional vertigo. The vertigo is episodic,
3|Page
, lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also,
there is no tinnitus or sensorineural hearing loss as occurs in Ménière's disease and
acoustic neuroma.
A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The
first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea
with vomiting; the episode resolved spontaneously. He has had five episodes in the past
1.5 weeks. He does note some tinnitus that comes and goes. Upon physical examination,
you note that he has a normal gait. The Weber localizes to the right side and the air
conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based
on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma C) Ménière's disease
Ménière's disease is characterized by sudden onset of vertiginous episodes that last
several hours to a day or more, then spontaneously resolve; the episodes then recur. On
physical examination, sensorineural hearing loss is present. The patient does complain of
tinnitus.
A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is
not
on any medications and does not take herbs or supplements. She has no chronic medical
conditions. She does not smoke or drink alcohol. She walks into the examination room
with slow
movements and shuffling steps. She has decreased facial mobility and a blunt
expression, without any changes in hair distribution on her face. Based on this
description, what is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease D) Parkinson's disease
This is a typical description for a patient with Parkinson's disease. Facial mobility is
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2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in
various locations. Each lesion lasts for many minutes. What most likely accounts for this
rash?
A) Insect bites
B) Urticaria, or hives
C) Psoriasis
D) Purpura B) Urticaria, or hives
This is a typical case of urticaria. The most unusual aspect of this condition is that
the lesions "move" from place to place. This would be distinctly unusual for the other
causes listed.
Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few
flat red and purple lesions, about 6 cm in diameter, on the ulnar aspect of her forearms
but nowhere else. She doesn't mention them. They are tender when you examine them.
What should you do?
A) Conclude that these are lesions she has had for a long time.
B) Wait for her to mention them before asking further questions.
C) Ask how she acquired them.
D) Conduct the visit as usual for the patient. C) Ask how she acquired them.
These are consistent with ecchymoses, or bruises. It is important to ask about
antiplatelet medications such as aspirin, trauma history, and history of blood disorders in
the patient and her family. Because of the different ages of the bruises and the isolation
of them to the ulnar forearms, these may be a result of abuse or other violence. It is
your duty to investigate the cause of these lesions.
A middle-aged man comes in because he has noticed multiple small, blood-red, raised
1|Page
,lesions over his anterior chest and abdomen for the past several months. They are not
painful and he has not noted any bleeding or bruising. He is concerned this may be
consistent with a dangerous condition. What should you do?
A) Reassure him that there is nothing to worry about.
B) Do laboratory work to check for platelet problems.
C) Obtain an extensive history regarding blood problems and bleeding disorders.
D) Do a skin biopsy in the office. A) Reassure him that there is nothing to worry about.
These represent cherry angiomas, which are very common, benign lesions. Further
workup such as laboratory work, skin biopsy, or even further questions are not
necessary at this time. It would be wise to ask the patient to report any changes in any
of his skin lesions, and tell him that you would need to see him at that time.
A 38-year-old accountant comes to your clinic for evaluation of a headache. The
throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to
10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has
had headaches like this in the past, usually less than one per week, but not as severe.
She does not know of any inciting factors. There has been no change in the frequency of
her headaches. She usually takes an over-the-counter analgesic and this results in
resolution of the headache. Based on this description, what is the most likely diagnosis
of the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound B) Migraine
This is a description of a common migraine (no aura). Distinctive features of a migraine
include phonophobia and photophobia, nausea, resolution with sleep, and unilateral
distribution. Only some of these features may be present.
A 29-year-old computer programmer comes to your office for evaluation of a headache.
The tightening sensation is located all over the head and is of moderate intensity. It used
to last minutes, but this time it has lasted for 5 days. He denies photophobia and nausea.
He spends several hours each day at a computer monitor/keyboard. He has tried over-
2|Page
,the-counter medication; it has dulled the pain but not taken it away. Based on this
description, what is your most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound A) Tension
This is a description of a typical tension headache.
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea A) Scotomas
Scotomas are specks in the vision or areas where the patient cannot see; therefore, this
is a common/concerning symptom of the eye.
A 49-year-old administrative assistant comes to your office for evaluation of dizziness.
You elicit the information that the dizziness is a spinning sensation of sudden onset,
worse with head position changes. The episodes last a few seconds and then go away,
and they are accompanied by intense nausea. She has vomited one time. She denies
tinnitus. You perform a physical examination of the head and neck and note that the
patient's hearing is intact to Weber and Rinne and that there is nystagmus. Her gait is
normal. Based on this description, what is the most likely
diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma A) Benign positional vertigo
This is a classic description of benign positional vertigo. The vertigo is episodic,
3|Page
, lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also,
there is no tinnitus or sensorineural hearing loss as occurs in Ménière's disease and
acoustic neuroma.
A 55-year-old bank teller comes to your office for persistent episodes of dizziness. The
first episode started suddenly and lasted 3 to 4 hours. He experienced a lot of nausea
with vomiting; the episode resolved spontaneously. He has had five episodes in the past
1.5 weeks. He does note some tinnitus that comes and goes. Upon physical examination,
you note that he has a normal gait. The Weber localizes to the right side and the air
conduction is equal to the bone conduction in the right ear. Nystagmus is present. Based
on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma C) Ménière's disease
Ménière's disease is characterized by sudden onset of vertiginous episodes that last
several hours to a day or more, then spontaneously resolve; the episodes then recur. On
physical examination, sensorineural hearing loss is present. The patient does complain of
tinnitus.
A 73-year-old nurse comes to your office for evaluation of new onset of tremors. She is
not
on any medications and does not take herbs or supplements. She has no chronic medical
conditions. She does not smoke or drink alcohol. She walks into the examination room
with slow
movements and shuffling steps. She has decreased facial mobility and a blunt
expression, without any changes in hair distribution on her face. Based on this
description, what is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease D) Parkinson's disease
This is a typical description for a patient with Parkinson's disease. Facial mobility is
4|Page
