NR509 Advanced Physical Assessment – Final
Exam (2025/2026), Questions and Verified
Answers – Walden University – Complete Exam.
SECTION 1 – ADVANCED HEALTH HISTORY & CLINICAL REASONING .
1. A 29-year-old graduate student presents for “occasional heart racing.” She reports
episodes occur at rest, last 5–10 min, and are accompanied by “tingly hands” and a
sense of doom. She denies chest pain, caffeine, or stimulants. She scores 12/21 on the
GAD-7. Which single follow-up question best clarifies whether further cardiac work-up is
required before initiating psychotherapy?
A. “Do you have a family history of sudden cardiac death?”
B. “Do the episodes wake you from sleep?”
C. “Can you tap your finger to the rhythm of the racing?”
D. “Have you ever fainted during an episode?”
Correct: D
Rationale: Syncope during palpopies strongly predicts malignant arrhythmias (Brugada,
CPVT, WPW) and mandates ECG/event monitor regardless of anxiety score (2025
AHA/ACC/HRS Guideline for Syncope). Family history is useful but less immediate; finger-
tapping cannot distinguish sinus tachycardia from SVT; nocturnal onset is common in
panic.
2. During a motivational-interviewing session, a 55-year-old man with COPD states: “I know
I should quit, but smoking is my only stress relief.” Which clinician response best
demonstrates evocation (MI spirit)?
A. “Have you thought about nicotine patches?”
B. “On a scale of 0–10, how ready are you to quit?”
C. “What were the pros and cons the last time you tried to stop?”
D. “Smoking will only make your COPD worse.”
Correct: C
Rationale: Evocation elicits the patient’s own motivations; exploring previous quit
attempts invites change talk (Miller & Rollnick 2025). Scaling questions are useful but not
evocation; option D is “righting reflex,” undermining autonomy.
3. A 42-year-old woman reports 6 weeks of fatigue, low mood, and weight gain. She
answers “yes” to PHQ-2. Which single PHQ-9 item most increases probability of bipolar
disorder rather than MDD?
, A. Item 9 (self-harm thoughts)
B. Item 4 (fatigue)
C. Item 6 (guilt)
D. Item 8 (psychomotor changes)
Correct: A
Rationale: Item 9 suicidal ideation occurs in both, but combined with atypical fatigue &
weight gain raises suspicion of bipolar II hypomania masked as depression; 2025 APA
guidelines require mood-screen (MDQ) before antidepressant monotherapy.
4. A 68-year-old man with HTN and 40-pack-year history reports nocturnal dyspnea and
ankle swelling. He sleeps on three pillows. Which closed-ended question best
discriminates cardiac vs. pulmonary cause?
A. “Does the shortness of breath wake you from sleep?”
B. “How many flights of stairs can you climb?”
C. “Do you have a cough productive of pink frothy sputum?”
D. “Is the swelling worse at the end of the day?”
Correct: A
Rationale: Paroxysmal nocturnal dyspnea (PND) is cardiac-specific (LVEF failure) vs.
supine nocturnal dyspnea in COPD/asthma; pink sputum is rare, edema timing is non-
specific.
5. A 24-year-old woman describes “sharp chest pain” that improves when she leans
forward and worsens with deep breaths. She had a viral URI last week. Which single
historical feature best supports pericarditis over pleurisy?
A. Pain radiates to trapezius ridge
B. Pain lasts <30 seconds
C. Pain occurs only with exertion
D. Associated palpitations
Correct: A
Rationale: Radiation to trapezius ridge is pathognomonic for pericarditis (phrenic nerve
irritation); pleuritic pain does not radiate there (2025 ESC pericarditis guideline).
6. A 35-year-old veteran reports daily headaches for 3 months, worsening in late
afternoon, and relieved by lying down. He takes ibuprofen 800 mg BID. Which red-flag
question must be asked first?
A. “Any changes in vision?”
B. “Any nausea with the headache?”
C. “Any history of head trauma or blast exposure?”
D. “Any family history of migraine?”
, Correct: C
Rationale: Headache relieved by lying down suggests low-CSF-pressure headache (post-
traumatic CSF leak common in blast-exposed veterans); needs MRI brain & spinal
imaging.
7. A 50-year-old woman with T2DM and BMI 32 reports burning feet for 6 weeks. She
denies alcohol use. Which single question best distinguishes small-fiber neuropathy
from plantar fasciitis?
A. “Is the pain worse first thing in the morning?”
B. “Do you have numbness between the toes?”
C. “Does the burning wake you from sleep?”
D. “Is there swelling in your ankles?”
Correct: C
Rationale: Nocturnal burning not positional is classic small-fiber; plantar fasciitis pain is
worst with first steps and improves with movement.
8. A 30-year-old man reports 3 days of painless gross hematuria at the end of voiding. He
denies trauma or infection. Which single follow-up question best directs you toward
bladder cancer over exercise-induced hematuria?
A. “Do you take any vitamins?”
B. “Do you smoke or vape?”
C. “Do you run long distances?”
D. “Do you have a family history of kidney stones?”
Correct: B
Rationale: Any smoking history in age <50 with painless terminal hematuria mandates
cystoscopy (2025 AUA microhematuria guideline).
9. A 26-year-old woman reports 4 weeks of intermittent bilateral hand swelling and
stiffness lasting 1 hour each morning. She denies rash. Which single question best
discriminates inflammatory arthritis from osteoarthritis?
A. “Does the stiffness last more than 30 minutes?”
B. “Do you have pain in your knees?”
C. “Is the swelling symmetrical?”
D. “Does typing make it worse?”
Correct: A
Rationale: Morning stiffness >30 minutes is the ACR criterion for inflammatory arthritis;
symmetry and joint distribution are supportive but not discriminatory alone.
10. A 45-year-old man reports episodic palpitations lasting 2–3 minutes, accompanied by
diaphoresis and tremor. Symptoms resolve after eating. Which single historical finding
Exam (2025/2026), Questions and Verified
Answers – Walden University – Complete Exam.
SECTION 1 – ADVANCED HEALTH HISTORY & CLINICAL REASONING .
1. A 29-year-old graduate student presents for “occasional heart racing.” She reports
episodes occur at rest, last 5–10 min, and are accompanied by “tingly hands” and a
sense of doom. She denies chest pain, caffeine, or stimulants. She scores 12/21 on the
GAD-7. Which single follow-up question best clarifies whether further cardiac work-up is
required before initiating psychotherapy?
A. “Do you have a family history of sudden cardiac death?”
B. “Do the episodes wake you from sleep?”
C. “Can you tap your finger to the rhythm of the racing?”
D. “Have you ever fainted during an episode?”
Correct: D
Rationale: Syncope during palpopies strongly predicts malignant arrhythmias (Brugada,
CPVT, WPW) and mandates ECG/event monitor regardless of anxiety score (2025
AHA/ACC/HRS Guideline for Syncope). Family history is useful but less immediate; finger-
tapping cannot distinguish sinus tachycardia from SVT; nocturnal onset is common in
panic.
2. During a motivational-interviewing session, a 55-year-old man with COPD states: “I know
I should quit, but smoking is my only stress relief.” Which clinician response best
demonstrates evocation (MI spirit)?
A. “Have you thought about nicotine patches?”
B. “On a scale of 0–10, how ready are you to quit?”
C. “What were the pros and cons the last time you tried to stop?”
D. “Smoking will only make your COPD worse.”
Correct: C
Rationale: Evocation elicits the patient’s own motivations; exploring previous quit
attempts invites change talk (Miller & Rollnick 2025). Scaling questions are useful but not
evocation; option D is “righting reflex,” undermining autonomy.
3. A 42-year-old woman reports 6 weeks of fatigue, low mood, and weight gain. She
answers “yes” to PHQ-2. Which single PHQ-9 item most increases probability of bipolar
disorder rather than MDD?
, A. Item 9 (self-harm thoughts)
B. Item 4 (fatigue)
C. Item 6 (guilt)
D. Item 8 (psychomotor changes)
Correct: A
Rationale: Item 9 suicidal ideation occurs in both, but combined with atypical fatigue &
weight gain raises suspicion of bipolar II hypomania masked as depression; 2025 APA
guidelines require mood-screen (MDQ) before antidepressant monotherapy.
4. A 68-year-old man with HTN and 40-pack-year history reports nocturnal dyspnea and
ankle swelling. He sleeps on three pillows. Which closed-ended question best
discriminates cardiac vs. pulmonary cause?
A. “Does the shortness of breath wake you from sleep?”
B. “How many flights of stairs can you climb?”
C. “Do you have a cough productive of pink frothy sputum?”
D. “Is the swelling worse at the end of the day?”
Correct: A
Rationale: Paroxysmal nocturnal dyspnea (PND) is cardiac-specific (LVEF failure) vs.
supine nocturnal dyspnea in COPD/asthma; pink sputum is rare, edema timing is non-
specific.
5. A 24-year-old woman describes “sharp chest pain” that improves when she leans
forward and worsens with deep breaths. She had a viral URI last week. Which single
historical feature best supports pericarditis over pleurisy?
A. Pain radiates to trapezius ridge
B. Pain lasts <30 seconds
C. Pain occurs only with exertion
D. Associated palpitations
Correct: A
Rationale: Radiation to trapezius ridge is pathognomonic for pericarditis (phrenic nerve
irritation); pleuritic pain does not radiate there (2025 ESC pericarditis guideline).
6. A 35-year-old veteran reports daily headaches for 3 months, worsening in late
afternoon, and relieved by lying down. He takes ibuprofen 800 mg BID. Which red-flag
question must be asked first?
A. “Any changes in vision?”
B. “Any nausea with the headache?”
C. “Any history of head trauma or blast exposure?”
D. “Any family history of migraine?”
, Correct: C
Rationale: Headache relieved by lying down suggests low-CSF-pressure headache (post-
traumatic CSF leak common in blast-exposed veterans); needs MRI brain & spinal
imaging.
7. A 50-year-old woman with T2DM and BMI 32 reports burning feet for 6 weeks. She
denies alcohol use. Which single question best distinguishes small-fiber neuropathy
from plantar fasciitis?
A. “Is the pain worse first thing in the morning?”
B. “Do you have numbness between the toes?”
C. “Does the burning wake you from sleep?”
D. “Is there swelling in your ankles?”
Correct: C
Rationale: Nocturnal burning not positional is classic small-fiber; plantar fasciitis pain is
worst with first steps and improves with movement.
8. A 30-year-old man reports 3 days of painless gross hematuria at the end of voiding. He
denies trauma or infection. Which single follow-up question best directs you toward
bladder cancer over exercise-induced hematuria?
A. “Do you take any vitamins?”
B. “Do you smoke or vape?”
C. “Do you run long distances?”
D. “Do you have a family history of kidney stones?”
Correct: B
Rationale: Any smoking history in age <50 with painless terminal hematuria mandates
cystoscopy (2025 AUA microhematuria guideline).
9. A 26-year-old woman reports 4 weeks of intermittent bilateral hand swelling and
stiffness lasting 1 hour each morning. She denies rash. Which single question best
discriminates inflammatory arthritis from osteoarthritis?
A. “Does the stiffness last more than 30 minutes?”
B. “Do you have pain in your knees?”
C. “Is the swelling symmetrical?”
D. “Does typing make it worse?”
Correct: A
Rationale: Morning stiffness >30 minutes is the ACR criterion for inflammatory arthritis;
symmetry and joint distribution are supportive but not discriminatory alone.
10. A 45-year-old man reports episodic palpitations lasting 2–3 minutes, accompanied by
diaphoresis and tremor. Symptoms resolve after eating. Which single historical finding
