NR509 ADVANCED PHYSICAL ASSESSMENT EXAM NEWEST
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 32-year-old male complains of a painless, cystic mass just above his left testicle. During
the physical examination, a strong flashlight is placed behind the scrotum through the
area in question and transillumination is noted. What is the most likely diagnosis?
a. Direct hernia
b. Indirect hernia
c. Spermatocele
d. Testicular tumor
e. Varicocele c. Spermatocele
A 25-year-old graduate student presents to the clinic complaining of scrotal pain, which
has been increasing over the past 2 days. He is sexually active and has had unprotected
intercourse with multiple partners in the past couple of weeks. On examination, some
mild to moderate swelling of the scrotum on the right and tenderness with palpation of
the right testicle are notes. What is the most likely diagnosis?
a. Acute epididymitis
b. Hydrocele
c. Primary syphilis
d. Spermatocele
e. Testicular cancer a. Acute epididymitis
A 32-year-old elementary teacher requests a workup for infertility. He and his wife have
been trying to conceive for the last 2 years. He reports that his wife has been evaluated
and does not appear to have any infertility issues. The overall examination does not
reveal any significant abnormalities. He is of average height and weight and has normal
secondary sex characteristics of the genitalia. Of the following, which would be most
likely be abnormal and causing male infertility?
a. 5α-Dihydrotestosterone
b. 5α-Reductase
c. Follicle-stimulating hormone (FSH)
1|Page
,d. Luteinizing hormone (LH)
e. Thyroid-stimulating hormone (TSH) c. Follicle-stimulating hormone (FSH)
While performing a physical examination on male patients, it is possible to palpate
multiple structures in relation to the inguinal canal and related hernias. Which of the
following is not palpable during an external examination of the abdominal wall or
inguinal region?
a. External inguinal ring
b. Internal inguinal ring
c. Pubic tubercle
d. Anterior superior iliac spine
e. Direct inguinal hernia b. Internal inguinal ring
A 20-year-old college student presents for his annual physical examination. He recently
became sexually active and is inquiring about the best means of preventing sexually
transmitted infections (STIs). Of the following, which would be the most effective means
of prevention?
a. Early withdrawal
b. Male condoms
c. Spermicides
d. Diaphragms
e. Cervical caps b. Male condoms
A 21-year-old college student presents to the student health clinic for a full physical
examination. He is generally healthy; however, he reports that he has had sexual
intercourse with multiple partners in the past couple of months. He noticed a small
lesion on the shaft of his penis a few days ago. While performing the examination, he
unwillingly achieves an erection. How should the clinician proceed at this point?
a. Stop the examination immediately.
b. Have him return to see another provider.
c. Explain this is a normal response and finish the examination.
d. Tell him the examination cannot proceed until the erection subsides.
e. Assume that he is malingering. c. Explain this is a normal response and finish the
examination.
2|Page
,A 45-year-old driver's education instructor presents to the clinic for heavy periods and
pelvic pain during her menses. She reached menarche at age 13 years and has had
regular periods except during her pregnancies. She is a G4P3013 and does not use birth
control as her husband has had a vasectomy. She states this has been going on for about
a year but seems to be getting worse. Her last period was 1 week ago. On bimanual
exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is
nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. What is the
best explanation for her physical finding?
a. Large colonic stool
b. Ovarian mass
c. Fibroids
d. 4-Month pregnancy
e. Bartholin gland enlargement c. Fibroids
A 32-year-old G0 woman comes for evaluation on why she and her husband have been
unable to get pregnant. Her husband has been married before and has two other
children, ages 7 and 4 years. The patient relates she began her periods at age 12 and has
been fairly regular ever since. She began oral contraceptive pills from when she got
married until last year, when she began to try for a pregnancy.
Before this she had regular cycles for 10 years. She has had a history of five prior
partners. She relates she was once treated for a severe genital infection when she was in
college. Based on this patient's history, what is the best explanation for her infertility?
a. Prior pelvic inflammatory disease (PID)
b. Prior Bartholin gland infection
c. Prior herpes infection
d. Metabolic disorder with subsequent hormonal irregularities leading to anovulation
e. Secondary amenorrhea a. Prior pelvic inflammatory disease (PID)
A 24-year-old retail clerk presents to the clinic for an annual exam. Her last Pap was 3
years ago and was normal. She is a G0 and is currently not sexually active although she
has had two lifetime partners. She is on oral contraceptive pills for cycle control and has
no medical problems. Based on guidelines, the clinician proceeds to perform a Pap
smear and places the speculum. There are two layers of cells, squamous and columnar.
Where is the most important area to obtain cells for a Pap smear?
3|Page
, a. Zona reticularis
b. Transformation zone
c. Squamous zone
d. Columnar zone
e. Linea nigra b. Transformation zone
A 35-year-old grade school teacher presents for her annual exam. Her last Pap smear
was 4 years ago and normal. She is a G1P1 with a 6-year-old child. She has had four
lifetime partners but only one partner in the last 12 years. Otherwise she has no
complaints. A speculum exam is done followed by a bimanual examination during which
a rectovaginal mass is palpated. Which of the following exam findings would be most
reassuring that this is not a colonic mass?
a. No cervical motion tenderness
b. No pus from the os
c. The mass dents with digital pressure
d. Both adnexa are nontender
e. The perineum has no lesions c. The mass dents with digital pressure
A 21-year-old college student presents for her first annual exam. She has been sexually
active for 1 year and has had two partners. She is not aware of having had any sexually
transmitted diseases (STIs).
She is using condoms for birth control and STI prevention but admits to not always using
them regularly. Her last menses was 2 weeks ago. On speculum exam, an unusual
appearance is noted, which is diagnosed as warts. What is the best description for these
lesions?
a. Several shallow ulcers with a red base
b. Translucent nodules
c. Raised friable or lobed lesions
d. Bright red, soft lesion arising from the cervical canal
e. Strawberry cervix (small red granular spots or petechiae) c. Raised friable or lobed
lesions
A 23-year-old female comes to the clinic to discuss her birth control options. Although
she has been sexually active since age 16 years, she has been with one partner for the
last year. She has decided to discontinue condoms and would like a different birth
control option. She has not had a pelvic exam for 2 years. She had a normal Pap smear
4|Page
2025/2026 COMPLETE QUESTIONS AND CORRECT D, Exams of
Nursing
A 32-year-old male complains of a painless, cystic mass just above his left testicle. During
the physical examination, a strong flashlight is placed behind the scrotum through the
area in question and transillumination is noted. What is the most likely diagnosis?
a. Direct hernia
b. Indirect hernia
c. Spermatocele
d. Testicular tumor
e. Varicocele c. Spermatocele
A 25-year-old graduate student presents to the clinic complaining of scrotal pain, which
has been increasing over the past 2 days. He is sexually active and has had unprotected
intercourse with multiple partners in the past couple of weeks. On examination, some
mild to moderate swelling of the scrotum on the right and tenderness with palpation of
the right testicle are notes. What is the most likely diagnosis?
a. Acute epididymitis
b. Hydrocele
c. Primary syphilis
d. Spermatocele
e. Testicular cancer a. Acute epididymitis
A 32-year-old elementary teacher requests a workup for infertility. He and his wife have
been trying to conceive for the last 2 years. He reports that his wife has been evaluated
and does not appear to have any infertility issues. The overall examination does not
reveal any significant abnormalities. He is of average height and weight and has normal
secondary sex characteristics of the genitalia. Of the following, which would be most
likely be abnormal and causing male infertility?
a. 5α-Dihydrotestosterone
b. 5α-Reductase
c. Follicle-stimulating hormone (FSH)
1|Page
,d. Luteinizing hormone (LH)
e. Thyroid-stimulating hormone (TSH) c. Follicle-stimulating hormone (FSH)
While performing a physical examination on male patients, it is possible to palpate
multiple structures in relation to the inguinal canal and related hernias. Which of the
following is not palpable during an external examination of the abdominal wall or
inguinal region?
a. External inguinal ring
b. Internal inguinal ring
c. Pubic tubercle
d. Anterior superior iliac spine
e. Direct inguinal hernia b. Internal inguinal ring
A 20-year-old college student presents for his annual physical examination. He recently
became sexually active and is inquiring about the best means of preventing sexually
transmitted infections (STIs). Of the following, which would be the most effective means
of prevention?
a. Early withdrawal
b. Male condoms
c. Spermicides
d. Diaphragms
e. Cervical caps b. Male condoms
A 21-year-old college student presents to the student health clinic for a full physical
examination. He is generally healthy; however, he reports that he has had sexual
intercourse with multiple partners in the past couple of months. He noticed a small
lesion on the shaft of his penis a few days ago. While performing the examination, he
unwillingly achieves an erection. How should the clinician proceed at this point?
a. Stop the examination immediately.
b. Have him return to see another provider.
c. Explain this is a normal response and finish the examination.
d. Tell him the examination cannot proceed until the erection subsides.
e. Assume that he is malingering. c. Explain this is a normal response and finish the
examination.
2|Page
,A 45-year-old driver's education instructor presents to the clinic for heavy periods and
pelvic pain during her menses. She reached menarche at age 13 years and has had
regular periods except during her pregnancies. She is a G4P3013 and does not use birth
control as her husband has had a vasectomy. She states this has been going on for about
a year but seems to be getting worse. Her last period was 1 week ago. On bimanual
exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is
nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. What is the
best explanation for her physical finding?
a. Large colonic stool
b. Ovarian mass
c. Fibroids
d. 4-Month pregnancy
e. Bartholin gland enlargement c. Fibroids
A 32-year-old G0 woman comes for evaluation on why she and her husband have been
unable to get pregnant. Her husband has been married before and has two other
children, ages 7 and 4 years. The patient relates she began her periods at age 12 and has
been fairly regular ever since. She began oral contraceptive pills from when she got
married until last year, when she began to try for a pregnancy.
Before this she had regular cycles for 10 years. She has had a history of five prior
partners. She relates she was once treated for a severe genital infection when she was in
college. Based on this patient's history, what is the best explanation for her infertility?
a. Prior pelvic inflammatory disease (PID)
b. Prior Bartholin gland infection
c. Prior herpes infection
d. Metabolic disorder with subsequent hormonal irregularities leading to anovulation
e. Secondary amenorrhea a. Prior pelvic inflammatory disease (PID)
A 24-year-old retail clerk presents to the clinic for an annual exam. Her last Pap was 3
years ago and was normal. She is a G0 and is currently not sexually active although she
has had two lifetime partners. She is on oral contraceptive pills for cycle control and has
no medical problems. Based on guidelines, the clinician proceeds to perform a Pap
smear and places the speculum. There are two layers of cells, squamous and columnar.
Where is the most important area to obtain cells for a Pap smear?
3|Page
, a. Zona reticularis
b. Transformation zone
c. Squamous zone
d. Columnar zone
e. Linea nigra b. Transformation zone
A 35-year-old grade school teacher presents for her annual exam. Her last Pap smear
was 4 years ago and normal. She is a G1P1 with a 6-year-old child. She has had four
lifetime partners but only one partner in the last 12 years. Otherwise she has no
complaints. A speculum exam is done followed by a bimanual examination during which
a rectovaginal mass is palpated. Which of the following exam findings would be most
reassuring that this is not a colonic mass?
a. No cervical motion tenderness
b. No pus from the os
c. The mass dents with digital pressure
d. Both adnexa are nontender
e. The perineum has no lesions c. The mass dents with digital pressure
A 21-year-old college student presents for her first annual exam. She has been sexually
active for 1 year and has had two partners. She is not aware of having had any sexually
transmitted diseases (STIs).
She is using condoms for birth control and STI prevention but admits to not always using
them regularly. Her last menses was 2 weeks ago. On speculum exam, an unusual
appearance is noted, which is diagnosed as warts. What is the best description for these
lesions?
a. Several shallow ulcers with a red base
b. Translucent nodules
c. Raised friable or lobed lesions
d. Bright red, soft lesion arising from the cervical canal
e. Strawberry cervix (small red granular spots or petechiae) c. Raised friable or lobed
lesions
A 23-year-old female comes to the clinic to discuss her birth control options. Although
she has been sexually active since age 16 years, she has been with one partner for the
last year. She has decided to discontinue condoms and would like a different birth
control option. She has not had a pelvic exam for 2 years. She had a normal Pap smear
4|Page
