NR509 | NR509 Advanced Physical Assessment
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. During a health history, a patient describes their pain as ‘dull and achy’ in the right upper
quadrant. This type of information is classified as which of the following?
A. Objective data
B. Physical examination finding
C. Subjective data
D. Clinical diagnosis
Correct Answer: C
Expert Explanation: Subjective data consists of information provided by the patient,
including their feelings, perceptions, and descriptions of symptoms. This differs from
objective data, which are measurable signs observed by the clinician during a physical
exam. Understanding this distinction is fundamental for accurate documentation and
clinical reasoning in advanced practice nursing.
2. When assessing a patient using the CAGE questionnaire, which of the following questions
pertains to the ‘E’ in the acronym?
A. Have you ever felt you should cut down on your drinking?
B. Have you ever had a drink first thing in the morning to steady your nerves?
C. Have you ever felt bad or guilty about your drinking?
D. Have people annoyed you by criticizing your drinking?
Correct Answer: B
Expert Explanation: The ‘E’ in CAGE stands for ‘Eye-opener,’ which asks if the patient
needs a drink first thing in the morning to steady nerves or get rid of a hangover. This tool
is specifically designed to screen for potential alcohol use disorder in a clinical setting. Each
positive response increases the clinical suspicion of alcohol dependency or abuse.
3. A 45-year-old patient presents with a suspicious skin lesion. Which ‘ABCDE’ criteria for
melanoma refers to a lesion having jagged or blurred edges?
A. Asymmetry
B. Color variation
C. Border irregularity
,D. Diameter
Correct Answer: C
Expert Explanation: Border irregularity refers to edges that are ragged, notched, or
blurred, which is a key warning sign for melanoma. Clinicians use the ABCDE mnemonic to
systematically evaluate pigmented lesions for malignancy. A positive finding in any of these
categories warrants further investigation, such as a biopsy.
4. During a lung examination, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which condition?
A. Pneumothorax
B. Pleural effusion
C. Chronic obstructive pulmonary disease
D. Lobar pneumonia
Correct Answer: D
Expert Explanation: Increased tactile fremitus occurs when there is consolidation in the
lung tissue, such as in lobar pneumonia, which transmits vibrations more effectively.
Conversely, conditions like pneumothorax or pleural effusion decrease or absent vibrations
because they displace the lung from the chest wall. Accurate palpation of fremitus helps the
provider localize pathology within the thoracic cavity.
5. Which heart sound is produced by the closure of the mitral and tricuspid valves and marks
the beginning of systole?
A. S3
B. S2
C. S1
D. S4
Correct Answer: C
Expert Explanation: The S1 heart sound, often described as ‘lub,’ signifies the closure of
the atrioventricular valves at the onset of ventricular contraction. It is typically heard
loudest at the apex of the heart using the diaphragm of the stethoscope. Distinguishing S1
from S2 is essential for timing murmurs and other extra heart sounds during cardiac
auscultation.
6. When performing the Weber test, a patient reports that the sound is heard better in the
right ear. This lateralization to the impaired ear suggests which type of hearing loss?
A. Sensineural hearing loss in the right ear
B. Conductive hearing loss in the right ear
, C. Normal hearing in both ears
D. Sensorineural hearing loss in the left ear
Correct Answer: B
Expert Explanation: In the Weber test, sound lateralizing to the ‘bad’ ear suggests
conductive hearing loss because the ear is not distracted by ambient noise. If the sound
lateralizes to the ‘good’ ear, it suggests sensorineural loss in the opposite ear. This test
must be used in conjunction with the Rinne test to differentiate hearing pathologies
accurately.
7. A patient exhibits pain when the clinician performs internal rotation of the right hip with
the knee flexed. This is known as which sign?
A. Psoas sign
B. Obturator sign
C. Rovsing sign
D. Murphy sign
Correct Answer: B
Expert Explanation: The Obturator sign involves internal rotation of the flexed hip, which
can irritate an inflamed appendix located in the pelvis. It is one of several physical exam
maneuvers used to assess for acute appendicitis. A positive result is indicated by the
elicitation of hypogastric pain during the maneuver.
8. Which cranial nerve is responsible for the gag reflex and the movement of the soft palate?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve IX (Glossopharyngeal)
Correct Answer: D
Expert Explanation: The Glossopharyngeal nerve (CN IX) provides sensory innervation to
the posterior third of the tongue and is part of the motor arc for the gag reflex. It works
closely with the Vagus nerve (CN X) to ensure proper swallowing and airway protection.
Assessment of these nerves is vital in patients with neurological deficits or dysphagia.
9. During a funduscopic examination, the provider observes the optic disc. Which of the
following is considered a normal finding?
A. Papilledema with blurred margins
B. A yellowish-orange to creamy pink color
Midterm v3 | Questions with Correct Answers and
Expert Explanation for Each Question |
Chamberlain
1. During a health history, a patient describes their pain as ‘dull and achy’ in the right upper
quadrant. This type of information is classified as which of the following?
A. Objective data
B. Physical examination finding
C. Subjective data
D. Clinical diagnosis
Correct Answer: C
Expert Explanation: Subjective data consists of information provided by the patient,
including their feelings, perceptions, and descriptions of symptoms. This differs from
objective data, which are measurable signs observed by the clinician during a physical
exam. Understanding this distinction is fundamental for accurate documentation and
clinical reasoning in advanced practice nursing.
2. When assessing a patient using the CAGE questionnaire, which of the following questions
pertains to the ‘E’ in the acronym?
A. Have you ever felt you should cut down on your drinking?
B. Have you ever had a drink first thing in the morning to steady your nerves?
C. Have you ever felt bad or guilty about your drinking?
D. Have people annoyed you by criticizing your drinking?
Correct Answer: B
Expert Explanation: The ‘E’ in CAGE stands for ‘Eye-opener,’ which asks if the patient
needs a drink first thing in the morning to steady nerves or get rid of a hangover. This tool
is specifically designed to screen for potential alcohol use disorder in a clinical setting. Each
positive response increases the clinical suspicion of alcohol dependency or abuse.
3. A 45-year-old patient presents with a suspicious skin lesion. Which ‘ABCDE’ criteria for
melanoma refers to a lesion having jagged or blurred edges?
A. Asymmetry
B. Color variation
C. Border irregularity
,D. Diameter
Correct Answer: C
Expert Explanation: Border irregularity refers to edges that are ragged, notched, or
blurred, which is a key warning sign for melanoma. Clinicians use the ABCDE mnemonic to
systematically evaluate pigmented lesions for malignancy. A positive finding in any of these
categories warrants further investigation, such as a biopsy.
4. During a lung examination, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which condition?
A. Pneumothorax
B. Pleural effusion
C. Chronic obstructive pulmonary disease
D. Lobar pneumonia
Correct Answer: D
Expert Explanation: Increased tactile fremitus occurs when there is consolidation in the
lung tissue, such as in lobar pneumonia, which transmits vibrations more effectively.
Conversely, conditions like pneumothorax or pleural effusion decrease or absent vibrations
because they displace the lung from the chest wall. Accurate palpation of fremitus helps the
provider localize pathology within the thoracic cavity.
5. Which heart sound is produced by the closure of the mitral and tricuspid valves and marks
the beginning of systole?
A. S3
B. S2
C. S1
D. S4
Correct Answer: C
Expert Explanation: The S1 heart sound, often described as ‘lub,’ signifies the closure of
the atrioventricular valves at the onset of ventricular contraction. It is typically heard
loudest at the apex of the heart using the diaphragm of the stethoscope. Distinguishing S1
from S2 is essential for timing murmurs and other extra heart sounds during cardiac
auscultation.
6. When performing the Weber test, a patient reports that the sound is heard better in the
right ear. This lateralization to the impaired ear suggests which type of hearing loss?
A. Sensineural hearing loss in the right ear
B. Conductive hearing loss in the right ear
, C. Normal hearing in both ears
D. Sensorineural hearing loss in the left ear
Correct Answer: B
Expert Explanation: In the Weber test, sound lateralizing to the ‘bad’ ear suggests
conductive hearing loss because the ear is not distracted by ambient noise. If the sound
lateralizes to the ‘good’ ear, it suggests sensorineural loss in the opposite ear. This test
must be used in conjunction with the Rinne test to differentiate hearing pathologies
accurately.
7. A patient exhibits pain when the clinician performs internal rotation of the right hip with
the knee flexed. This is known as which sign?
A. Psoas sign
B. Obturator sign
C. Rovsing sign
D. Murphy sign
Correct Answer: B
Expert Explanation: The Obturator sign involves internal rotation of the flexed hip, which
can irritate an inflamed appendix located in the pelvis. It is one of several physical exam
maneuvers used to assess for acute appendicitis. A positive result is indicated by the
elicitation of hypogastric pain during the maneuver.
8. Which cranial nerve is responsible for the gag reflex and the movement of the soft palate?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve IX (Glossopharyngeal)
Correct Answer: D
Expert Explanation: The Glossopharyngeal nerve (CN IX) provides sensory innervation to
the posterior third of the tongue and is part of the motor arc for the gag reflex. It works
closely with the Vagus nerve (CN X) to ensure proper swallowing and airway protection.
Assessment of these nerves is vital in patients with neurological deficits or dysphagia.
9. During a funduscopic examination, the provider observes the optic disc. Which of the
following is considered a normal finding?
A. Papilledema with blurred margins
B. A yellowish-orange to creamy pink color
