NR509 | NR509 Advanced Physical Assessment
Exam 2 v1 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. When performing a fundoscopic examination, which of the following is the most
appropriate technique for visualizing the red reflex?
A. Use the small green light setting on the ophthalmoscope from a distance of 3 feet.
B. Place the ophthalmoscope directly against the patient’s cornea while looking through the
aperture.
C. Instruct the patient to look directly into the light source while keeping their eyes closed.
D. Position the ophthalmoscope 15 inches away from the patient and 15 degrees lateral to
the line of vision.
Correct Answer: D
Expert Explanation: The red reflex is elicited by looking through the ophthalmoscope
aperture from about 15 inches away and 15 degrees lateral to the patient’s line of sight.
This allows the light to reflect off the retina and through the pupil, appearing as an orange-
red glow. Absence of this reflex can indicate conditions such as cataracts or retinal
detachment.
2. A patient presents with hearing loss. During the Weber test, the sound lateralizes to the
right ear. During the Rinne test, bone conduction is greater than air conduction (BC > AC) on
the right. What is the most likely diagnosis?
A. Conductive hearing loss in the right ear.
B. Sensorineural hearing loss in the left ear.
C. Normal hearing in both ears.
D. Sensorineural hearing loss in the right ear.
Correct Answer: A
Expert Explanation: In conductive hearing loss, the Weber test lateralizes to the impaired
ear because the room noise is not heard through the external canal, allowing the bone-
conducted vibration to be more prominent. The Rinne test showing BC > AC is a hallmark of
conductive loss where sound bypasses the external/middle ear obstruction through the
bone. If it were sensorineural loss, the sound would lateralize to the ‘good’ ear, and AC
would remain greater than BC.
,3. Which heart sound is often referred to as a ventricular gallop and occurs early in diastole
during rapid ventricular filling?
A. S1
B. S3
C. S2
D. S4
Correct Answer: B
Expert Explanation: The S3 heart sound occurs during the early phase of diastole when
the ventricles are filling rapidly. It is often called a ventricular gallop and can be normal in
children or athletes but may indicate heart failure in older adults. It is best heard at the
apex with the bell of the stethoscope in the left lateral decubitus position.
4. During the respiratory assessment of a patient with suspected lobar pneumonia, which
finding is most consistent with consolidation?
A. Decreased tactile fremitus and hyperresonance on percussion.
B. Increased tactile fremitus and tympany on percussion.
C. Increased tactile fremitus and dullness on percussion.
D. Absent tactile fremitus and resonance on percussion.
Correct Answer: C
Expert Explanation: Consolidation occurs when lung tissue becomes firm as air is
replaced by fluid or exudate, as seen in pneumonia. This denser medium transmits
vibrations better, leading to increased tactile fremitus. Additionally, percussion over fluid-
filled or solid lung tissue produces a dull sound rather than the normal resonant sound of
air-filled lungs.
5. Where is the apical pulse (point of maximal impulse) normally located in a healthy adult?
A. 5th intercostal space, midclavicular line.
B. 2nd intercostal space, right sternal border.
C. 4th intercostal space, midclavicular line.
D. 5th intercostal space, left sternal border.
Correct Answer: A
Expert Explanation: The point of maximal impulse (PMI) is usually found at the 5th
intercostal space at or just medial to the midclavicular line. Displacement of the PMI
laterally or downward can indicate left ventricular hypertrophy or cardiomegaly. The
, clinician should assess the location, diameter, and duration of the apical impulse during the
cardiac exam.
6. Which of the following describes a ‘grade 4’ heart murmur according to the standard
grading scale?
A. Faint and heard only after the listener has ‘tuned in’.
B. Moderately loud with an associated palpable thrill.
C. Loud, but without a palpable thrill.
D. Very loud, heard with the stethoscope off the chest.
Correct Answer: B
Expert Explanation: Heart murmurs are graded from 1 to 6 based on intensity. A grade 4
murmur is characterized as loud and must have a palpable thrill (a vibration felt on the
chest wall). Grades 5 and 6 also have thrills, while grades 1 through 3 do not.
7. During a breast examination, which characteristic of a lump is most concerning for
malignancy?
A. Soft, tender, and mobile mass.
B. Firm, non-tender, and fixed mass with irregular borders.
C. Round, smooth, and highly elastic mass.
D. Painful mass that fluctuates in size with the menstrual cycle.
Correct Answer: B
Expert Explanation: Malignant breast masses are typically firm or hard, non-tender, and
fixed to the underlying skin or fascia, making them difficult to move. They often have
irregular, poorly defined borders. In contrast, benign cysts are usually mobile, smooth, and
may be tender or change with hormones.
8. Which lymph node group is located at the top of the axilla, deep within the axillary hair?
A. Lateral (brachial) nodes.
B. Pectoral (anterior) nodes.
C. Central axillary nodes.
D. Subscapular (posterior) nodes.
Correct Answer: C
Expert Explanation: The central axillary nodes are positioned high in the axilla and
receive lymph from the other three groups of axillary nodes. They are usually the most
palpable nodes during a routine physical exam. Identifying enlargement here is critical for
staging breast cancer or identifying infections.
Exam 2 v1 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. When performing a fundoscopic examination, which of the following is the most
appropriate technique for visualizing the red reflex?
A. Use the small green light setting on the ophthalmoscope from a distance of 3 feet.
B. Place the ophthalmoscope directly against the patient’s cornea while looking through the
aperture.
C. Instruct the patient to look directly into the light source while keeping their eyes closed.
D. Position the ophthalmoscope 15 inches away from the patient and 15 degrees lateral to
the line of vision.
Correct Answer: D
Expert Explanation: The red reflex is elicited by looking through the ophthalmoscope
aperture from about 15 inches away and 15 degrees lateral to the patient’s line of sight.
This allows the light to reflect off the retina and through the pupil, appearing as an orange-
red glow. Absence of this reflex can indicate conditions such as cataracts or retinal
detachment.
2. A patient presents with hearing loss. During the Weber test, the sound lateralizes to the
right ear. During the Rinne test, bone conduction is greater than air conduction (BC > AC) on
the right. What is the most likely diagnosis?
A. Conductive hearing loss in the right ear.
B. Sensorineural hearing loss in the left ear.
C. Normal hearing in both ears.
D. Sensorineural hearing loss in the right ear.
Correct Answer: A
Expert Explanation: In conductive hearing loss, the Weber test lateralizes to the impaired
ear because the room noise is not heard through the external canal, allowing the bone-
conducted vibration to be more prominent. The Rinne test showing BC > AC is a hallmark of
conductive loss where sound bypasses the external/middle ear obstruction through the
bone. If it were sensorineural loss, the sound would lateralize to the ‘good’ ear, and AC
would remain greater than BC.
,3. Which heart sound is often referred to as a ventricular gallop and occurs early in diastole
during rapid ventricular filling?
A. S1
B. S3
C. S2
D. S4
Correct Answer: B
Expert Explanation: The S3 heart sound occurs during the early phase of diastole when
the ventricles are filling rapidly. It is often called a ventricular gallop and can be normal in
children or athletes but may indicate heart failure in older adults. It is best heard at the
apex with the bell of the stethoscope in the left lateral decubitus position.
4. During the respiratory assessment of a patient with suspected lobar pneumonia, which
finding is most consistent with consolidation?
A. Decreased tactile fremitus and hyperresonance on percussion.
B. Increased tactile fremitus and tympany on percussion.
C. Increased tactile fremitus and dullness on percussion.
D. Absent tactile fremitus and resonance on percussion.
Correct Answer: C
Expert Explanation: Consolidation occurs when lung tissue becomes firm as air is
replaced by fluid or exudate, as seen in pneumonia. This denser medium transmits
vibrations better, leading to increased tactile fremitus. Additionally, percussion over fluid-
filled or solid lung tissue produces a dull sound rather than the normal resonant sound of
air-filled lungs.
5. Where is the apical pulse (point of maximal impulse) normally located in a healthy adult?
A. 5th intercostal space, midclavicular line.
B. 2nd intercostal space, right sternal border.
C. 4th intercostal space, midclavicular line.
D. 5th intercostal space, left sternal border.
Correct Answer: A
Expert Explanation: The point of maximal impulse (PMI) is usually found at the 5th
intercostal space at or just medial to the midclavicular line. Displacement of the PMI
laterally or downward can indicate left ventricular hypertrophy or cardiomegaly. The
, clinician should assess the location, diameter, and duration of the apical impulse during the
cardiac exam.
6. Which of the following describes a ‘grade 4’ heart murmur according to the standard
grading scale?
A. Faint and heard only after the listener has ‘tuned in’.
B. Moderately loud with an associated palpable thrill.
C. Loud, but without a palpable thrill.
D. Very loud, heard with the stethoscope off the chest.
Correct Answer: B
Expert Explanation: Heart murmurs are graded from 1 to 6 based on intensity. A grade 4
murmur is characterized as loud and must have a palpable thrill (a vibration felt on the
chest wall). Grades 5 and 6 also have thrills, while grades 1 through 3 do not.
7. During a breast examination, which characteristic of a lump is most concerning for
malignancy?
A. Soft, tender, and mobile mass.
B. Firm, non-tender, and fixed mass with irregular borders.
C. Round, smooth, and highly elastic mass.
D. Painful mass that fluctuates in size with the menstrual cycle.
Correct Answer: B
Expert Explanation: Malignant breast masses are typically firm or hard, non-tender, and
fixed to the underlying skin or fascia, making them difficult to move. They often have
irregular, poorly defined borders. In contrast, benign cysts are usually mobile, smooth, and
may be tender or change with hormones.
8. Which lymph node group is located at the top of the axilla, deep within the axillary hair?
A. Lateral (brachial) nodes.
B. Pectoral (anterior) nodes.
C. Central axillary nodes.
D. Subscapular (posterior) nodes.
Correct Answer: C
Expert Explanation: The central axillary nodes are positioned high in the axilla and
receive lymph from the other three groups of axillary nodes. They are usually the most
palpable nodes during a routine physical exam. Identifying enlargement here is critical for
staging breast cancer or identifying infections.
