NR509 | NR509 Advanced Physical Assessment
Final Exam v1 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 55-year-old patient presents with a complaint of a new, growing mole on their back.
Which of the following physical assessment findings would be most concerning for malignant
melanoma?
A. A symmetrical border with uniform brown pigmentation
B. A diameter of 4 millimeters with a smooth surface
C. An irregular border with color variation and a diameter of 8 millimeters
D. A lesion that has been present for 20 years without change
Correct Answer: C
Expert Explanation: The ABCDE rule is used to screen for melanoma, where ‘B’ stands for
border irregularity and ‘C’ stands for color variation. A diameter greater than 6 millimeters
is also a significant warning sign for malignancy. These findings necessitate further
diagnostic testing such as a biopsy to rule out skin cancer.
2. When performing a respiratory assessment, the nurse practitioner hears low-pitched,
snoring sounds over the bronchi that clear with coughing. How should these be documented?
A. Rhonchi
B. Wheezes
C. Crackles
D. Stridor
Correct Answer: A
Expert Explanation: Rhonchi are continuous, low-pitched sounds that often resemble
snoring and are caused by secretions in the larger airways. They are characteristically
known to clear or change significantly after a patient coughs. This differentiates them from
wheezes, which are high-pitched, and crackles, which are discontinuous sounds.
3. During a cardiac examination, the provider notes a mid-systolic click. This finding is most
commonly associated with which of the following conditions?
A. Mitral valve prolapse
B. Aortic stenosis
C. Mitral regurgitation
,D. Atrial septal defect
Correct Answer: A
Expert Explanation: A mid-systolic click is the hallmark clinical sound associated with
mitral valve prolapse. It occurs as the redundant valve leaflets balloon into the left atrium
during systole. This click may or may not be followed by a late systolic murmur of mitral
regurgitation.
4. To assess for a possible meniscus tear in the knee, which of the following special tests
should the nurse practitioner perform?
A. McMurray test
B. Lachman test
C. Drawer test
D. Bulge sign
Correct Answer: A
Expert Explanation: The McMurray test is specifically designed to evaluate for tears in the
meniscus of the knee joint. During the test, the knee is rotated and extended while the
provider feels for a click or pop. In contrast, the Lachman and Drawer tests are used to
evaluate the integrity of the cruciate ligaments.
5. A patient complains of pain in the right lower quadrant of the abdomen. When the
provider presses deeply on the left lower quadrant, the patient feels pain in the right lower
quadrant. This is known as:
A. Murphy’s sign
B. Obturator sign
C. Psoas sign
D. Rovsing’s sign
Correct Answer: D
Expert Explanation: Rovsing’s sign is considered positive when pressure applied to the
left lower quadrant elicited pain in the right lower quadrant. This suggests peritoneal
irritation and is commonly associated with acute appendicitis. It is one of several clinical
maneuvers used to diagnose abdominal emergencies.
6. When assessing cranial nerve function, the nurse practitioner asks the patient to puff out
their cheeks and show their teeth. Which cranial nerve is being tested?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
, C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: A
Expert Explanation: Cranial Nerve VII, the facial nerve, is responsible for the muscles of
facial expression. By asking the patient to puff out their cheeks or smile, the provider is
checking for symmetry and motor strength. Weakness or asymmetry in these movements
could indicate a central or peripheral nerve lesion, such as Bell’s palsy.
7. A 68-year-old male presents with urinary frequency and a weak stream. During a digital
rectal exam (DRE), the prostate feels enlarged, non-tender, and rubbery. This most likely
indicates:
A. Prostate cancer
B. Prostatitis
C. Prostatic abscess
D. Benign prostatic hyperplasia (BPH)
Correct Answer: D
Expert Explanation: Benign prostatic hyperplasia typically presents as a symmetrically
enlarged, smooth, and firm but rubbery prostate. Prostate cancer is more likely to present
with hard nodules or an irregular shape. Prostatitis would usually involve significant
tenderness and systemic symptoms like fever.
8. In the ‘OLD CARTS’ mnemonic for history taking, what does the ‘D’ represent?
A. Duration
B. Description
C. Diagnosis
D. Degree
Correct Answer: A
Expert Explanation: OLD CARTS is a common mnemonic used to explore the history of a
present illness. The ‘D’ stands for Duration, which refers to how long the symptom has been
present or how long each episode lasts. Understanding the duration helps the clinician
distinguish between acute and chronic conditions.
9. During an eye examination, the nurse practitioner uses the Snellen chart. If a patient’s
vision is recorded as 20/40, what does this mean?
A. The patient can see at 40 feet what a normal person sees at 20 feet
B. The patient can see at 20 feet what a normal person sees at 40 feet
Final Exam v1 | Questions with Correct Answers
and Expert Explanation for Each Question |
Chamberlain
1. A 55-year-old patient presents with a complaint of a new, growing mole on their back.
Which of the following physical assessment findings would be most concerning for malignant
melanoma?
A. A symmetrical border with uniform brown pigmentation
B. A diameter of 4 millimeters with a smooth surface
C. An irregular border with color variation and a diameter of 8 millimeters
D. A lesion that has been present for 20 years without change
Correct Answer: C
Expert Explanation: The ABCDE rule is used to screen for melanoma, where ‘B’ stands for
border irregularity and ‘C’ stands for color variation. A diameter greater than 6 millimeters
is also a significant warning sign for malignancy. These findings necessitate further
diagnostic testing such as a biopsy to rule out skin cancer.
2. When performing a respiratory assessment, the nurse practitioner hears low-pitched,
snoring sounds over the bronchi that clear with coughing. How should these be documented?
A. Rhonchi
B. Wheezes
C. Crackles
D. Stridor
Correct Answer: A
Expert Explanation: Rhonchi are continuous, low-pitched sounds that often resemble
snoring and are caused by secretions in the larger airways. They are characteristically
known to clear or change significantly after a patient coughs. This differentiates them from
wheezes, which are high-pitched, and crackles, which are discontinuous sounds.
3. During a cardiac examination, the provider notes a mid-systolic click. This finding is most
commonly associated with which of the following conditions?
A. Mitral valve prolapse
B. Aortic stenosis
C. Mitral regurgitation
,D. Atrial septal defect
Correct Answer: A
Expert Explanation: A mid-systolic click is the hallmark clinical sound associated with
mitral valve prolapse. It occurs as the redundant valve leaflets balloon into the left atrium
during systole. This click may or may not be followed by a late systolic murmur of mitral
regurgitation.
4. To assess for a possible meniscus tear in the knee, which of the following special tests
should the nurse practitioner perform?
A. McMurray test
B. Lachman test
C. Drawer test
D. Bulge sign
Correct Answer: A
Expert Explanation: The McMurray test is specifically designed to evaluate for tears in the
meniscus of the knee joint. During the test, the knee is rotated and extended while the
provider feels for a click or pop. In contrast, the Lachman and Drawer tests are used to
evaluate the integrity of the cruciate ligaments.
5. A patient complains of pain in the right lower quadrant of the abdomen. When the
provider presses deeply on the left lower quadrant, the patient feels pain in the right lower
quadrant. This is known as:
A. Murphy’s sign
B. Obturator sign
C. Psoas sign
D. Rovsing’s sign
Correct Answer: D
Expert Explanation: Rovsing’s sign is considered positive when pressure applied to the
left lower quadrant elicited pain in the right lower quadrant. This suggests peritoneal
irritation and is commonly associated with acute appendicitis. It is one of several clinical
maneuvers used to diagnose abdominal emergencies.
6. When assessing cranial nerve function, the nurse practitioner asks the patient to puff out
their cheeks and show their teeth. Which cranial nerve is being tested?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
, C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: A
Expert Explanation: Cranial Nerve VII, the facial nerve, is responsible for the muscles of
facial expression. By asking the patient to puff out their cheeks or smile, the provider is
checking for symmetry and motor strength. Weakness or asymmetry in these movements
could indicate a central or peripheral nerve lesion, such as Bell’s palsy.
7. A 68-year-old male presents with urinary frequency and a weak stream. During a digital
rectal exam (DRE), the prostate feels enlarged, non-tender, and rubbery. This most likely
indicates:
A. Prostate cancer
B. Prostatitis
C. Prostatic abscess
D. Benign prostatic hyperplasia (BPH)
Correct Answer: D
Expert Explanation: Benign prostatic hyperplasia typically presents as a symmetrically
enlarged, smooth, and firm but rubbery prostate. Prostate cancer is more likely to present
with hard nodules or an irregular shape. Prostatitis would usually involve significant
tenderness and systemic symptoms like fever.
8. In the ‘OLD CARTS’ mnemonic for history taking, what does the ‘D’ represent?
A. Duration
B. Description
C. Diagnosis
D. Degree
Correct Answer: A
Expert Explanation: OLD CARTS is a common mnemonic used to explore the history of a
present illness. The ‘D’ stands for Duration, which refers to how long the symptom has been
present or how long each episode lasts. Understanding the duration helps the clinician
distinguish between acute and chronic conditions.
9. During an eye examination, the nurse practitioner uses the Snellen chart. If a patient’s
vision is recorded as 20/40, what does this mean?
A. The patient can see at 40 feet what a normal person sees at 20 feet
B. The patient can see at 20 feet what a normal person sees at 40 feet
