NR509 | NR509 Advanced Physical Assessment
Midterm v2 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. A nurse practitioner is assessing a patient using the OLDCART mnemonic for a complaint of
chest pain. Which question best represents the ‘D’ in this mnemonic?
A. Does the pain radiate to your left arm?
B. Does anything make the pain better?
C. What were you doing when the pain started?
D. How long does the pain usually last when it occurs?
Correct Answer: D
Expert Explanation: The ‘D’ in OLDCART stands for Duration, which refers to the length of
time the symptom lasts. Asking how long the pain lasts directly assesses the duration of the
patient’s discomfort. Other components of OLDCART include Onset, Location,
Characteristics, Aggravating/Alleviating factors, Radiation, and Treatment.
2. When performing a skin assessment on a fair-skinned patient, the nurse practitioner notes
a lesion with irregular borders and multiple colors. Which ‘ABCDE’ criteria is the most
concerning for melanoma in this description?
A. Asymmetry
B. Diameter greater than 6mm
C. Color Variation
D. Border Irregularity
Correct Answer: D
Expert Explanation: Border irregularity is a hallmark sign of malignant melanoma where
the edges are notched, ragged, or blurred. While color variation is also mentioned, the
irregular border is a specific prompt for this criterion. Monitoring these changes is vital for
early detection of skin cancers.
3. During a physical exam, the nurse practitioner observes the patient’s thyroid gland. What
is the correct technique for the posterior approach to palpate the thyroid?
A. Stand in front of the patient and push the trachea to the side.
B. Stand behind the patient and use the pads of the fingers to feel for the lobes.
C. Have the patient lie supine and extend the neck fully.
,D. Ask the patient to cough while pressing on the cricoid cartilage.
Correct Answer: B
Expert Explanation: The posterior approach requires the examiner to stand behind the
patient to palpate the thyroid lobes. The patient is usually asked to swallow a sip of water
to help the gland move under the examiner’s fingers. This technique allows for a more
comprehensive assessment of the gland’s size and consistency.
4. Which lymph node is located at the base of the skull posteriorly?
A. Preauricular
B. Submental
C. Supraclavicular
D. Occipital
Correct Answer: D
Expert Explanation: Occipital lymph nodes are located at the base of the skull in the
posterior region. Assessing these nodes is important when a patient presents with scalp
infections or posterior neck pain. Lymph nodes should generally be soft, mobile, and non-
tender in a healthy individual.
5. The nurse practitioner uses a Snellen chart to assess a patient’s vision. The patient’s vision
is recorded as 20/40. What does this measurement indicate?
A. The patient can read 40 lines of the chart from 20 feet away.
B. The patient can see at 40 feet what a normal eye sees at 20 feet.
C. The patient has 40% of normal vision capacity.
D. The patient can see at 20 feet what a normal eye sees at 40 feet.
Correct Answer: D
Expert Explanation: Visual acuity of 20/40 means that the patient can read at 20 feet
what a person with normal vision can read at 40 feet. The first number represents the
distance from the chart, and the second number represents the distance at which a normal
eye could read that line. Higher denominators indicate poorer distance vision.
6. To test for accommodation, the nurse practitioner asks the patient to focus on a distant
object and then on an object held close to the nose. What response is expected?
A. Pupillary constriction and convergence of the eyes.
B. Pupillary dilation and divergence of the eyes.
C. Nystagmus and pupillary dilation.
D. Blinking and tearing.
, Correct Answer: A
Expert Explanation: Accommodation involves the adjustment of the eye for near vision,
resulting in pupillary constriction and convergence of the eyeballs. This test evaluates the
function of the oculomotor nerve (CN III). Lack of this response may indicate neurological
or ocular dysfunction.
7. What is the normal color and appearance of the tympanic membrane during an otoscopic
exam?
A. Amber with bubbles
B. Pearly gray and translucent
C. Bright red and bulging
D. White and opaque
Correct Answer: B
Expert Explanation: A healthy tympanic membrane is pearly gray, translucent, and
reflects light in a cone-shaped pattern. The cone of light is usually visible at the 5 o’clock
position in the right ear and 7 o’clock in the left ear. Redness or bulging often suggests
acute otitis media.
8. The Weber test is used to evaluate for which condition?
A. Lateralization of sound
B. Equilibrium and balance
C. Comparison of air and bone conduction
D. External ear canal patency
Correct Answer: A
Expert Explanation: The Weber test involves placing a vibrating tuning fork on the
midline of the skull to check for lateralization of sound. In normal hearing, the sound is
heard equally in both ears. If the sound is heard better in one ear, it may indicate
conductive or sensorineural hearing loss.
9. During an assessment of the nose, the nurse practitioner notes that the nasal mucosa is
pale, boggy, and bluish. This finding is most consistent with:
A. Allergic rhinitis
B. Acute sinusitis
C. Nasal polyps
D. Cocaine abuse
Correct Answer: A
Midterm v2 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. A nurse practitioner is assessing a patient using the OLDCART mnemonic for a complaint of
chest pain. Which question best represents the ‘D’ in this mnemonic?
A. Does the pain radiate to your left arm?
B. Does anything make the pain better?
C. What were you doing when the pain started?
D. How long does the pain usually last when it occurs?
Correct Answer: D
Expert Explanation: The ‘D’ in OLDCART stands for Duration, which refers to the length of
time the symptom lasts. Asking how long the pain lasts directly assesses the duration of the
patient’s discomfort. Other components of OLDCART include Onset, Location,
Characteristics, Aggravating/Alleviating factors, Radiation, and Treatment.
2. When performing a skin assessment on a fair-skinned patient, the nurse practitioner notes
a lesion with irregular borders and multiple colors. Which ‘ABCDE’ criteria is the most
concerning for melanoma in this description?
A. Asymmetry
B. Diameter greater than 6mm
C. Color Variation
D. Border Irregularity
Correct Answer: D
Expert Explanation: Border irregularity is a hallmark sign of malignant melanoma where
the edges are notched, ragged, or blurred. While color variation is also mentioned, the
irregular border is a specific prompt for this criterion. Monitoring these changes is vital for
early detection of skin cancers.
3. During a physical exam, the nurse practitioner observes the patient’s thyroid gland. What
is the correct technique for the posterior approach to palpate the thyroid?
A. Stand in front of the patient and push the trachea to the side.
B. Stand behind the patient and use the pads of the fingers to feel for the lobes.
C. Have the patient lie supine and extend the neck fully.
,D. Ask the patient to cough while pressing on the cricoid cartilage.
Correct Answer: B
Expert Explanation: The posterior approach requires the examiner to stand behind the
patient to palpate the thyroid lobes. The patient is usually asked to swallow a sip of water
to help the gland move under the examiner’s fingers. This technique allows for a more
comprehensive assessment of the gland’s size and consistency.
4. Which lymph node is located at the base of the skull posteriorly?
A. Preauricular
B. Submental
C. Supraclavicular
D. Occipital
Correct Answer: D
Expert Explanation: Occipital lymph nodes are located at the base of the skull in the
posterior region. Assessing these nodes is important when a patient presents with scalp
infections or posterior neck pain. Lymph nodes should generally be soft, mobile, and non-
tender in a healthy individual.
5. The nurse practitioner uses a Snellen chart to assess a patient’s vision. The patient’s vision
is recorded as 20/40. What does this measurement indicate?
A. The patient can read 40 lines of the chart from 20 feet away.
B. The patient can see at 40 feet what a normal eye sees at 20 feet.
C. The patient has 40% of normal vision capacity.
D. The patient can see at 20 feet what a normal eye sees at 40 feet.
Correct Answer: D
Expert Explanation: Visual acuity of 20/40 means that the patient can read at 20 feet
what a person with normal vision can read at 40 feet. The first number represents the
distance from the chart, and the second number represents the distance at which a normal
eye could read that line. Higher denominators indicate poorer distance vision.
6. To test for accommodation, the nurse practitioner asks the patient to focus on a distant
object and then on an object held close to the nose. What response is expected?
A. Pupillary constriction and convergence of the eyes.
B. Pupillary dilation and divergence of the eyes.
C. Nystagmus and pupillary dilation.
D. Blinking and tearing.
, Correct Answer: A
Expert Explanation: Accommodation involves the adjustment of the eye for near vision,
resulting in pupillary constriction and convergence of the eyeballs. This test evaluates the
function of the oculomotor nerve (CN III). Lack of this response may indicate neurological
or ocular dysfunction.
7. What is the normal color and appearance of the tympanic membrane during an otoscopic
exam?
A. Amber with bubbles
B. Pearly gray and translucent
C. Bright red and bulging
D. White and opaque
Correct Answer: B
Expert Explanation: A healthy tympanic membrane is pearly gray, translucent, and
reflects light in a cone-shaped pattern. The cone of light is usually visible at the 5 o’clock
position in the right ear and 7 o’clock in the left ear. Redness or bulging often suggests
acute otitis media.
8. The Weber test is used to evaluate for which condition?
A. Lateralization of sound
B. Equilibrium and balance
C. Comparison of air and bone conduction
D. External ear canal patency
Correct Answer: A
Expert Explanation: The Weber test involves placing a vibrating tuning fork on the
midline of the skull to check for lateralization of sound. In normal hearing, the sound is
heard equally in both ears. If the sound is heard better in one ear, it may indicate
conductive or sensorineural hearing loss.
9. During an assessment of the nose, the nurse practitioner notes that the nasal mucosa is
pale, boggy, and bluish. This finding is most consistent with:
A. Allergic rhinitis
B. Acute sinusitis
C. Nasal polyps
D. Cocaine abuse
Correct Answer: A
