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NR 509 FINAL ACTUAL EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED
1. A 58-year-old male presents with chest pressure that radiates to the
jaw and left arm. He is diaphoretic and nauseated. What is the priority
action?
A) Obtain a detailed cardiac history
B) Activate emergency medical services (EMS)
C) Administer sublingual nitroglycerin
D) Order a stat electrocardiogram
Rationale: Acute chest pain with radiation, diaphoresis, and nausea is
concerning for acute coronary syndrome. Immediate activation of
EMS is the priority for transport to emergency care. In-office
interventions should not delay EMS.
2. When performing a comprehensive health history, which component
is typically assessed immediately after the chief complaint?
A) Family history
B) History of present illness (HPI)
C) Past medical history
D) Review of systems
Rationale: The HPI expands on the chief complaint using the
OLDCARTS (onset, location, duration, characteristics,
aggravating/alleviating factors, timing, severity) framework. It guides
the remainder of the history and physical exam.
3. A 45-year-old female reports fatigue, weight gain, and cold
intolerance. On examination, the thyroid gland is non-palpable. Which
,2|Page
finding would most strongly support hypothyroidism?
A) Exophthalmos
B) Delayed relaxation phase of deep tendon reflexes
C) Thyroid bruit
D) Tachycardia
Rationale: Hypothyroidism causes delayed reflex relaxation ("hung-
up" reflexes). Exophthalmos and bruit indicate hyperthyroidism.
Hypothyroidism typically causes bradycardia, not tachycardia.
4. The correct order of abdominal examination techniques is:
A) Palpation, percussion, auscultation, inspection
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Percussion, palpation, inspection, auscultation
Rationale: Inspection is always first. Auscultation is performed before
percussion and palpation because manipulation can alter bowel
sounds. Percussion then palpation follow.
5. A 72-year-old male reports a new unilateral headache, scalp
tenderness, and jaw pain when chewing. Funduscopic exam reveals pale,
swollen optic discs. Which diagnosis is most likely?
A) Migraine headache
B) Giant cell arteritis (temporal arteritis)
C) Trigeminal neuralgia
D) Acute angle-closure glaucoma
Rationale: Giant cell arteritis presents with headache, scalp
tenderness, jaw claudication, and can cause anterior ischemic optic
neuropathy (pale disc edema). ESR and CRP are elevated. Prompt
steroids prevent blindness.
6. Cranial nerve XI (spinal accessory) is assessed by asking the patient
to:
A) Stick out the tongue
B) Shrug the shoulders against resistance
,3|Page
C) Follow a finger through six cardinal directions
D) Say "ah" and observe the palate
Rationale: CN XI innervates the trapezius and sternocleidomastoid.
Shoulder shrug tests trapezius. CN XII tests tongue movement; CN III,
IV, VI test extraocular movements; CN X tests palate elevation.
7. A 55-year-old male with a 40-pack-year smoking history reports
chronic cough and dyspnea. On auscultation, breath sounds are
diminished with prolonged expiration. What is the most appropriate next
physical exam maneuver?
A) Assess for tactile fremitus
B) Measure forced expiratory time (FET)
C) Perform egophony
D) Palpate for tracheal deviation
Rationale: Prolonged forced expiratory time (>6 seconds) is a bedside
test for obstructive airway disease. Diminished breath sounds and
prolonged expiration are consistent with COPD.
8. The "sniffing position" (neck flexion with head extension) is most
useful for examining which structure?
A) Larynx and upper airway
B) Thyroid gland
C) Carotid arteries
D) Trachea
Rationale: The sniffing position aligns the oral, pharyngeal, and
laryngeal axes for optimal visualization of the upper airway during
laryngoscopy or for assessing airway patency.
9. A 34-year-old female reports dizziness upon standing. Supine BP
120/80, HR 72; standing BP 90/60, HR 108. These findings are
consistent with:
A) Carotid sinus hypersensitivity
B) Orthostatic hypotension
C) Vasovagal syncope
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D) Dehydration only
Rationale: Orthostatic hypotension is a drop in systolic BP ≥20 mmHg
or diastolic ≥10 mmHg within 3 minutes of standing, often with reflex
tachycardia. Many causes (dehydration, autonomic dysfunction,
medications).
10. Heart sound S2 is best heard at which location?
A) Apex (mitral area)
B) Left upper sternal border (pulmonic area) and right upper
sternal border (aortic area)
C) Left lower sternal border (tricuspid area)
D) Xiphoid process
Rationale: S2 (aortic and pulmonic valve closure) is best heard at the
base (2nd intercostal spaces left and right sternal border). The apex is
best for S1 and murmurs.
11. A 28-year-old pregnant patient at 32 weeks gestation reports bilateral
leg swelling. BP 142/92 mmHg, urinalysis 2+ protein. What is the most
likely diagnosis?
A) Physiologic edema of pregnancy
B) Preeclampsia
C) Deep vein thrombosis
D) Heart failure
Rationale: New hypertension after 20 weeks with proteinuria defines
preeclampsia. Physiologic edema does not include hypertension or
proteinuria. DVT is usually unilateral.
12. The Lachman test is used to assess the integrity of which knee
ligament?
A) Medial collateral ligament
B) Anterior cruciate ligament (ACL)
C) Posterior cruciate ligament
D) Lateral collateral ligament
Rationale: Lachman test (anterior translation of tibia on femur with
NR 509 FINAL ACTUAL EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED
1. A 58-year-old male presents with chest pressure that radiates to the
jaw and left arm. He is diaphoretic and nauseated. What is the priority
action?
A) Obtain a detailed cardiac history
B) Activate emergency medical services (EMS)
C) Administer sublingual nitroglycerin
D) Order a stat electrocardiogram
Rationale: Acute chest pain with radiation, diaphoresis, and nausea is
concerning for acute coronary syndrome. Immediate activation of
EMS is the priority for transport to emergency care. In-office
interventions should not delay EMS.
2. When performing a comprehensive health history, which component
is typically assessed immediately after the chief complaint?
A) Family history
B) History of present illness (HPI)
C) Past medical history
D) Review of systems
Rationale: The HPI expands on the chief complaint using the
OLDCARTS (onset, location, duration, characteristics,
aggravating/alleviating factors, timing, severity) framework. It guides
the remainder of the history and physical exam.
3. A 45-year-old female reports fatigue, weight gain, and cold
intolerance. On examination, the thyroid gland is non-palpable. Which
,2|Page
finding would most strongly support hypothyroidism?
A) Exophthalmos
B) Delayed relaxation phase of deep tendon reflexes
C) Thyroid bruit
D) Tachycardia
Rationale: Hypothyroidism causes delayed reflex relaxation ("hung-
up" reflexes). Exophthalmos and bruit indicate hyperthyroidism.
Hypothyroidism typically causes bradycardia, not tachycardia.
4. The correct order of abdominal examination techniques is:
A) Palpation, percussion, auscultation, inspection
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Percussion, palpation, inspection, auscultation
Rationale: Inspection is always first. Auscultation is performed before
percussion and palpation because manipulation can alter bowel
sounds. Percussion then palpation follow.
5. A 72-year-old male reports a new unilateral headache, scalp
tenderness, and jaw pain when chewing. Funduscopic exam reveals pale,
swollen optic discs. Which diagnosis is most likely?
A) Migraine headache
B) Giant cell arteritis (temporal arteritis)
C) Trigeminal neuralgia
D) Acute angle-closure glaucoma
Rationale: Giant cell arteritis presents with headache, scalp
tenderness, jaw claudication, and can cause anterior ischemic optic
neuropathy (pale disc edema). ESR and CRP are elevated. Prompt
steroids prevent blindness.
6. Cranial nerve XI (spinal accessory) is assessed by asking the patient
to:
A) Stick out the tongue
B) Shrug the shoulders against resistance
,3|Page
C) Follow a finger through six cardinal directions
D) Say "ah" and observe the palate
Rationale: CN XI innervates the trapezius and sternocleidomastoid.
Shoulder shrug tests trapezius. CN XII tests tongue movement; CN III,
IV, VI test extraocular movements; CN X tests palate elevation.
7. A 55-year-old male with a 40-pack-year smoking history reports
chronic cough and dyspnea. On auscultation, breath sounds are
diminished with prolonged expiration. What is the most appropriate next
physical exam maneuver?
A) Assess for tactile fremitus
B) Measure forced expiratory time (FET)
C) Perform egophony
D) Palpate for tracheal deviation
Rationale: Prolonged forced expiratory time (>6 seconds) is a bedside
test for obstructive airway disease. Diminished breath sounds and
prolonged expiration are consistent with COPD.
8. The "sniffing position" (neck flexion with head extension) is most
useful for examining which structure?
A) Larynx and upper airway
B) Thyroid gland
C) Carotid arteries
D) Trachea
Rationale: The sniffing position aligns the oral, pharyngeal, and
laryngeal axes for optimal visualization of the upper airway during
laryngoscopy or for assessing airway patency.
9. A 34-year-old female reports dizziness upon standing. Supine BP
120/80, HR 72; standing BP 90/60, HR 108. These findings are
consistent with:
A) Carotid sinus hypersensitivity
B) Orthostatic hypotension
C) Vasovagal syncope
, 4|Page
D) Dehydration only
Rationale: Orthostatic hypotension is a drop in systolic BP ≥20 mmHg
or diastolic ≥10 mmHg within 3 minutes of standing, often with reflex
tachycardia. Many causes (dehydration, autonomic dysfunction,
medications).
10. Heart sound S2 is best heard at which location?
A) Apex (mitral area)
B) Left upper sternal border (pulmonic area) and right upper
sternal border (aortic area)
C) Left lower sternal border (tricuspid area)
D) Xiphoid process
Rationale: S2 (aortic and pulmonic valve closure) is best heard at the
base (2nd intercostal spaces left and right sternal border). The apex is
best for S1 and murmurs.
11. A 28-year-old pregnant patient at 32 weeks gestation reports bilateral
leg swelling. BP 142/92 mmHg, urinalysis 2+ protein. What is the most
likely diagnosis?
A) Physiologic edema of pregnancy
B) Preeclampsia
C) Deep vein thrombosis
D) Heart failure
Rationale: New hypertension after 20 weeks with proteinuria defines
preeclampsia. Physiologic edema does not include hypertension or
proteinuria. DVT is usually unilateral.
12. The Lachman test is used to assess the integrity of which knee
ligament?
A) Medial collateral ligament
B) Anterior cruciate ligament (ACL)
C) Posterior cruciate ligament
D) Lateral collateral ligament
Rationale: Lachman test (anterior translation of tibia on femur with
