NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass
on breast self-examination (BSE) at home. The mass is nontender without skin changes,
erythema, or overlying swelling. She has heard that most breast cancers are found by
patients themselves, and she is very concerned that she may have breast cancer. Which
of the following is true about BSE and self-detection of breast cancer? a. Most
masses that women find at home and bring to a provider's attention turn out to be
malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity and specificity for
finding cancerous lesions.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
A 48-year-old female psychologist presents to clinic with concerns about her breast
cancer risk after an age-matched cousin was recently diagnosed with this disease. This
cousin is the third family member on her father's side in as many years to be diagnosed
with breast cancer, including the patient's own father, who had surgery and subsequent
treatment 3 years ago for breast cancer. The patient has little other knowledge of her
family history, only that her grandparents independently arrived from Eastern Europe
near the end of World War II and were among very few members of their family that
survived the war. The patient has read about testing for the breast cancer genes (BRCA1
and BRCA2) and desires further information about whether this would be appropriate
for her. Which of the following is true about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and should be
discounted in assessing her risk for these genes.
b. Breast cancer in a male relative does not add significant weight to the decision to test
for the BRCA genes in this patient.
1|Page
,c. The BRCAPRO calculator does not add any further clinical information to this patient's
risk for carrying the BRCA gene.
d. This patient carries several risk factors that together justify BRCA testing.
e. Even if this patient is BRCA positive, no changes in screening or treatment are
recommended for patients with this genetic mutation, so the test is not recommended.
d. This patient carries several risk factors that together justify BRCA testing.
A 68-year-old former paleontologist presents to clinic with concerns about her breast
cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease a few years ago before the age of 50 years, but
this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient
suffered from lymphoma in her 20s and had radiation to the chest. She did take
hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her 50s
for persistently dense breasts with subtle findings, but follow-up biopsies never showed
any malignant pathology. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient? a. No agency recommends breast MRI for a
patient such as this one, who has moderately but not extraordinary risk factors for
breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
breasts).
d. Mammograms are not affected by breast density and thus density is not a factor in
choosing MRIs over mammograms in patients such as this individual.
e. History of chest radiation is not a risk factor for breast cancer and is thus not relevant
to deciding whether MRI is appropriate in this patient.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
breasts).
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right
side. The lymph node is nontender and feels firm and rubbery. She denies any localized
2|Page
,or systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking
conjugated estrogen tablets for 9 years since menopause, though she has not taken
progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years.
Which of the following is true about this presentation of lymphadenopathy? a.
Breast cancer always presents with axillary lymphadenopathy because the lymphatics of
the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A
rubbery, mobile, nontender mass is palpated in the right breast as described by the
patient, which is consistent with a firbroadenoma. In describing the location of the mass,
the examiner notes that it is 3 cm proximal to and 3 cm to the left of the nipple. Which
of the following would be the most appropriate way to report this finding? a. "Rubbery,
mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer
quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner
quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from
the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from
the nipple"
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
3|Page
, 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 postmenopausal age
group and should be limited for that reason.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in
the number of lobules.
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 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. Perforated bowel wall
e. Ruptured ovarian cyst
a. Ruptured tubal (or ectopic) pregnancy
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
4|Page
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 22-year-old G0P0 undergraduate student presents to clinic after finding a breast mass
on breast self-examination (BSE) at home. The mass is nontender without skin changes,
erythema, or overlying swelling. She has heard that most breast cancers are found by
patients themselves, and she is very concerned that she may have breast cancer. Which
of the following is true about BSE and self-detection of breast cancer? a. Most
masses that women find at home and bring to a provider's attention turn out to be
malignant.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
c. The most likely breast mass this patient is likely to find in herself is an abscess
complicating underlying mastitis.
d. Because of this patient's age, breast masses should not be pursued with imaging and
diagnosis because the risk of cancer is so low.
e. BSE is universally recommended because of very high sensitivity and specificity for
finding cancerous lesions.
b. This patient is more likely to find a fibroadenoma than a cancer on self-examination.
A 48-year-old female psychologist presents to clinic with concerns about her breast
cancer risk after an age-matched cousin was recently diagnosed with this disease. This
cousin is the third family member on her father's side in as many years to be diagnosed
with breast cancer, including the patient's own father, who had surgery and subsequent
treatment 3 years ago for breast cancer. The patient has little other knowledge of her
family history, only that her grandparents independently arrived from Eastern Europe
near the end of World War II and were among very few members of their family that
survived the war. The patient has read about testing for the breast cancer genes (BRCA1
and BRCA2) and desires further information about whether this would be appropriate
for her. Which of the following is true about this patient's indications for BRCA testing?
a. Her familial lineage is irrelevant to her risk of BRCA genes and should be
discounted in assessing her risk for these genes.
b. Breast cancer in a male relative does not add significant weight to the decision to test
for the BRCA genes in this patient.
1|Page
,c. The BRCAPRO calculator does not add any further clinical information to this patient's
risk for carrying the BRCA gene.
d. This patient carries several risk factors that together justify BRCA testing.
e. Even if this patient is BRCA positive, no changes in screening or treatment are
recommended for patients with this genetic mutation, so the test is not recommended.
d. This patient carries several risk factors that together justify BRCA testing.
A 68-year-old former paleontologist presents to clinic with concerns about her breast
cancer risk. Her mother developed the disease in her 50s and died from it in her 60s. A
younger cousin developed the disease a few years ago before the age of 50 years, but
this individual was not tested for the BRCA1 and BRCA2 genes. In addition, the patient
suffered from lymphoma in her 20s and had radiation to the chest. She did take
hormone replacement therapy for a few years before data emerged that this may
contribute to breast cancer risk. She has had several abnormal mammograms in her 50s
for persistently dense breasts with subtle findings, but follow-up biopsies never showed
any malignant pathology. Which of the following is true regarding magnetic resonance
imaging (MRI) screening of this patient? a. No agency recommends breast MRI for a
patient such as this one, who has moderately but not extraordinary risk factors for
breast cancer.
b. The U.S. Preventive Services Task Force (USPSTF) recommends against screening with
MRI for patients with such risk factors.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
breasts).
d. Mammograms are not affected by breast density and thus density is not a factor in
choosing MRIs over mammograms in patients such as this individual.
e. History of chest radiation is not a risk factor for breast cancer and is thus not relevant
to deciding whether MRI is appropriate in this patient.
c. Regardless of recommendations, the high sensitivity of breast MRI comes at the
expense of markedly decreased specificity (i.e., the ability to rule out disease in healthy
breasts).
A 66-year-old female museum curator presents for a routine annual examination. On
examination, a notably enlarged supraclavicular lymph node is appreciated on the right
side. The lymph node is nontender and feels firm and rubbery. She denies any localized
2|Page
,or systemic symptoms such as breast lumps, fevers, or night sweats. She has been taking
conjugated estrogen tablets for 9 years since menopause, though she has not taken
progestin compounds since she had a hysterectomy for heavy bleeding at age 45 years.
Which of the following is true about this presentation of lymphadenopathy? a.
Breast cancer always presents with axillary lymphadenopathy because the lymphatics of
the breast uniformly drain into the axilla.
b. Supraclavicular nodes are generally considered benign and require no further
evaluation or follow-up.
c. Supraclavicular nodes are found along the anterior edge of the trapezius muscle in the
neck.
d. Firm, rubbery lymph nodes are generally considered to be benign.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
e. Metastatic breast cancer cells may spread directly into the infraclavicular and then
supraclavicular nodes without first causing notable changes in the axillary nodes.
A 24-year-old graphic designer presents to clinic with a concern for a breast mass. A
rubbery, mobile, nontender mass is palpated in the right breast as described by the
patient, which is consistent with a firbroadenoma. In describing the location of the mass,
the examiner notes that it is 3 cm proximal to and 3 cm to the left of the nipple. Which
of the following would be the most appropriate way to report this finding? a. "Rubbery,
mobile, nontender mass located in right breast, in the 10:30 position from the nipple"
b. "Rubbery, mobile, nontender mass located in right breast, in the lower outer
quadrant"
c. "Rubbery, mobile, nontender mass located in right breast, in the upper inner
quadrant"
d. "Rubbery, mobile, nontender mass located in the left breast, upper outer quadrant"
e. "Rubbery, mobile, nontender mass located in right breast, in the 1:30 position from
the nipple"
a. "Rubbery, mobile, nontender mass located in right breast, in the 10:30 position from
the nipple"
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
3|Page
, 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 postmenopausal age
group and should be limited for that reason.
c. Glandular tissue of the breast atrophies with menopause, primarily due to decrease in
the number of lobules.
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 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. Perforated bowel wall
e. Ruptured ovarian cyst
a. Ruptured tubal (or ectopic) pregnancy
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
4|Page
