NR509 / NR 509 Final Exam (Latest 2024 / 2025): Advanced Physical Assessment – Chamberlain
NR-509 Advanced Physical Assessment
Final Exam
The NP is conducting a physical assessment on a woman in her 26th week of
pregnancy. Which of the examination finding is worrisome for a potential,
emergent condition?
Correct Answer:
facial edema
An 11-month-old infant male is accompanied to the clinic by his father. The
father is concerned about the skin rash on this son’s arms represented in
this image. Family history is significant for a 4-year-old sibling with atopic
dermatitis and asthma. Which of the following is the best documentation of
the integument findings?
Correct Answer:
Erythematous, patches and plaques involving the extensor surfaces of the
bilateral antecubital fossa. Mild, secondary excoriations present with serous
exudate. No streaking. Scant purulent drainage
The NP assesses for the Moro Reflex as part of an infant routine physical
examination. The NP should suspect a neurologic disease if the reflex has
not disappeared by what specific timeframe?
Correct Answer:
16 weeks (4 months)
A mother brings her 15-day-old female infant to the outpatient clinic for
evaluation of a rash that appeared suddenly after visiting family in Florida. It
is August and the house did not have air conditioning. The infant is afebrile,
eating and drinking well, and does not appear to be in distress. The physical
assessment findings are represented in this image. Based on the history and
examination findings, what is the likely etiology? ADA Description: Infant
with a red, facial rash.
Correct Answer:
miliaria rubra
A 2-month-old female is accompanied by her parents for her first visit to the
practice. When reviewing the hospital medical records of her birth, the NP
notes documentation regarding significantly edematous hands and feet
present at birth. Upon physical examination of the infant, the NP finds skin
folds that run along the sides of the neck down to the shoulders. Which of
the following should be assessed and monitored by the NP and parents
related to these findings? Select all that apply
Correct Answer:
The infant’s growth chart with concern for height and length.
The infant’s ability to properly latch during breastfeeding.
The infant’s fluid gain or loss.
The NP is observing a female pediatric patient during a routine physical. She
can jump in place and balance on one foot. She speaks in full sentences and
her mother states that she can feed herself. Based on your observations and
the history, determine her developmental age
4 years
The NP is observing
Correct Answer:
3 years
The NP is observing a full-term infant male. He can pull to a stand, use
“mama” and “dada” specifically, and indicates his wants by vocalization and
pointing. Based on your observations, determine his developmental age.
Correct Answer:
8 months
A 48-year-old female presents to the clinic with complaints of heavy vaginal
discharge and severe itching for 1 week. On visualization of the vulva, a
thick, white, curdy discharge is seen at the introitus. On speculum
examination, there is a copious amount of this discharge. The pH of the
discharge is 4.1 and the KOH whiff test is negative, with no unusual smell.
Wet prep shows budding hyphae. Which of the following is the most accurate
interpretation of these findings?
Correct Answer:
These findings suggest candida vaginitis
A 42-year-old female presents to the office for her annual well-woman
examination. She has a history of fibrocystic breast changes since her mid20s, so she did not report any new issues except that her right breast feels
“heavier” than usual. After a careful history and physical examination, the
NP documents the following breast findings: Breasts pendulous with diffuse
fibrocystic changes. Single firm 1 × 1 cm mass, mobile, and nontender, with
overlying peau d’orange appearance in the right breast, upper outer
quadrant at 11 o’clock, 2 cm from the nipple. Which of the following is the
most accurate interpretation of these findings?
Correct Answer:
cancer
A 35-year-old male presents to the clinic for a routine physical examination.
His only complaint is a feeling of heaviness in his scrotum. He denies injury
or trauma. After conducting a history and physical, the NP documents the
following genitourinary (GU) findings: Uncircumcised penis; prepuce easily
retractable. No penile discharge or lesions. No scrotal swelling or
discoloration. Testes descended bilaterally; right testicle smooth; 1 × 1 cm
firm, fixed, nontender, nodule on the left lateral testicle. Epididymis
nontender. No inguinal or femoral hernias. Negative CVA tenderness. Which
of the following is the most accurate interpretation of these findings?
Correct Answer:
testicular cancer
A 34-year-old female presents to the office with left elbow pain following
rigorous training for a tennis match. Tenderness is noted with palpation in
the area on the image marked by the red circle. What correlative diagnosis
does this assessment finding indicate? ADA Description: Left elbow with
emphasis on the small, tuberculated eminence, curved a little forward, about
1 cm from the joint.
Correct Answer:
lateral epicondylitis
A 24-year-old male presents to the office for evaluation of a lump under his
left nipple. He reports no other symptoms, denies trauma or injury, and
reports no known family history of a first-degree relative with breast cancer.
On examination, the NP notes a firm, 2-cm mass under his areola. What is
the most likely etiology for these findings?
Correct Answer:
breast tissue
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A 35-year-old female with a history of migraines presents to the clinic with worsening symptoms for the past few weeks. She reports waking up at night with headaches and nausea. Her only medication history is oral contraceptive pills (OCPs). Otherwise, she states she is healthy. Which of the following actions if taken by the NP is the best next step?
Take a further history and perform a very careful neurological exam
A grandmother is accompanying her 9-year-old granddaughter during a routine physical examination. She asks you privately if her granddaughter has started puberty yet. During the examination, the NP notes asymmetric projection of the areola and nipple of the right chest to form a secondary mound above the level of the breast. The left breast is underdeveloped. These assessment findings are consistent with which Tanner Stage of development?
Primary prevention is defined as which of the following?
Interventions designed to prevent disease
Target blood pressure should be </= 150/90 mmHg but notes that if treatment results in SBP <140 and is “well tolerated and without adverse effects to health or quality of live, treatment does not need to be adjusted.”
In those aged 80 or older, blood pressure targets of 140 to <150/70 to 80 appear optimal for notable reductions in stroke, cardiovascular events, and all-cause mortality.
Have the parent facilitate the exam (e.g., removing clothes, holding the child on lap).
“It often takes the baby more than 30 minutes to finish a bottle.”
global aphasia — Wernicke aphasia
Do you have any aura prior to the headaches?
The patient reports fever, night sweats, and thinks she lost weight.
When grading muscle strength on a scale of 1 to 5, a grade of 3 indicates which of the following?
Active movement against gravity
Which musculoskeletal disorder is paired correctly with the associated systemic manifestations?
Lyme disease and expanding erythematous targetoid patch in early illness
Swelling of the synovial tissue in joints and tendon sheaths.
Flexed forward posture with lower extremity weakness
What is the action(s) of the erector spinae muscle group?
A 17-year-old male presents to the clinic for a follow-up appointment. He fractured his left arm 8 weeks ago and remains in a cast. Upon inspection, the NP finds that his shoulder heights are unequal and there is winging of the scapula. The NP suspects contralateral weakness and muscle wasting as the etiology for the winged scapula. Which of the following physical assessment maneuvers should the NP perform to confirm the suspension?
Compare the strength of the trapezius muscles
Which of the following statements is true regarding prostate cancer screening?
Setting normal cut-offs for prostate-specific antigen (PSA) testing relies on balancing
A 53-year-old African American male presents for discussion of his prostate cancer risk and possible screening for this disease. His father was diagnosed at age 82 years with prostate cancer but died recently at age 87 years from a myocardial infarction before the disease progressed. Family history also reveals that his mother died of ovarian cancer when he was age 10 years, and two of his maternal aunts had breast cancer. Which of the following is true about prostate cancer risk for this patient and subsequent screening?
A 34-year-old female presents to primary care for follow-up regarding anal pain with defecation. A recent referral to GI for anoscopic examination revealed anal fissures that appear to be her source of pain. In addition, today she reports that she has developed episodic abdominal discomfort and sores in her mouth. Which of the following underlying conditions is the NP most likely to find?
A 45-year-old female presents to the primary care clinic. She complains of recently experiencing a change in the patterns of her bowel movements. Her PMH is significant for bleeding ulcers as well as Crohn’s disease. Her family medical history includes a maternal aunt who died of colon cancer at age 49 years. Which of the following historical elements would be most concerning for colon cancer in this patient?
recent onset of small-caliber stools
A 67-year-old female presents to the office for an annual check-up. She retired as a police captain at age 66. Now she enjoys gardening and water aerobics several days a week. She states, “staying active keeps me limber”. After a careful history and physical examination, the NP documents the following musculoskeletal system findings: Full range of motion in all joints. Hands with Heberden nodes at the DIP joints, Bouchard nodes at PIP joints. Mild pain with flexion, extension, and rotation of both hips. Full range of motion in the knees, with moderate crepitus. No effusion but bony enlargement along the tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first MTP joints. Which of the following is the most accurate interpretation of these findings?
These findings suggest osteoarthritis
A 50-year-old male presents to the office for a routine physical examination. He has no complaints. His PMH is significant for non-alcoholic fatty liver disease and high cholesterol for which he is taking fenofibrate. On the social history intake form, he reported consuming 8 ounces of malt liquor daily for 20 years. After a careful history and physical examination, the NP documents the following nervous system findings: Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Oriented to person, place, and time. Speech is fluent, follows commands. Detailed cognitive testing deferred. Cranial Nerves: I—not tested; II through XII intact. Motor: Normal muscle bulk and tone. Strength 5/5 throughout. No pronator drift. Cerebellar—Rapid alternating movements (RAMs), finger-to-nose (F→N), heel-to-shin (H→S) intact. Gait with normal stance and stride. Sensory: Pinprick, light touch, position, and vibration intact. Romberg— maintains balance with eyes closed. Reflexes: 2+ and symmetric with plantar reflexes downgoing. Which of the following is the most accurate interpretation of these findings?
These findings suggest no abdnormalities
A 74-year-old man presents to the clinic for a scheduled annual examination. He has a history of hypertension and diabetes, both controlled with medication. He denies any complaints. The NP performed a fundoscopic examination. Identify the abnormal assessment findings in this image. ADA Description: Accumulations of axoplasmic debris within adjacent bundles of unmyelinated ganglion cell axons of the retina.
A 66-year-old female presents to the office for a focused visit to discuss hypertension management strategies. During the interview, the patient asks the NP if she could be screened today for cervical cancer/HPV. Review of her medical record reveals she was screened at ages 57, 60, and 63, with no abnormal findings, and no history of cancer. What is the best action the NP should take regarding the patient’s request for screening?
Of the following statements, which is true regarding the human papillomavirus (HPV) vaccine?
The vaccine can protect against anogenital lesions
Raised friable or lobed lesions
An 18-year-old female presents to the clinic complaining of a thick and yellow vaginal discharge along with recent pelvic pain. Her history is significant for pelvic inflammatory disease (PID). During the speculum examination, the NP would expect to find purulent discharge in the following area(s) which is consistent with the diagnosis of PID?
A 23-year-old female presents to the clinic. She has decided to discontinue using condoms and would like a different birth control option. Her last pelvic exam was 2 years ago when she had a negative Pap smear and STI screening. Her LMP was 2 days ago, and she is still spotting. She last had sex with her boyfriend 1 week ago. Condoms were used. The NP elects to postpone her speculum exam during this office encounter. What is the best evidence-based rationale for the decision to postpone her exam?
A 45-year-old female presents to the clinic for heavy periods and pelvic pain during her menses. She reached menarche at age 13 years and has had regular periods except during her pregnancies. She is a G4P3013 and does not use birth control as her husband has had a vasectomy. She states this has been going on for about a year but seems to be getting worse. Her LMP was 1 week ago. On a bimanual exam, a large midline mass halfway to the umbilicus is palpated. Each adnexal area is nonpalpable. Her rectal exam is normal. Her body mass index (BMI) is 27. Which of the following is the most likely interpretation of these findings?
These findings suggest uterine fibroids
A 48-year-old female presents to the clinic with complaints of heavy vaginal discharge and severe itching for 1 week. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination, there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. Which of the following is the most accurate interpretation of these findings?
These findings suggest candida vaginitis
A 30-year-old female presents to the clinic with complaints of a bad-smelling vaginal discharge with some mild itching for about 3 weeks. She denies pain with urination or with sexual intercourse. She also reports that the smell increased after intercourse and during her period last week. After a careful history and physical assessment, the NP documents the following pelvic and anorectal examination findings: Bilateral shotty inguinal adenopathy. External genitalia without erythema or lesions. Vaginal mucosa and cervix coated with thin white homogeneous discharge with a mild fishy odor. After swabbing the cervix, no discharge is visible in the cervical os. Uterus midline; no adnexal masses. Rectal vault without masses. Stool brown and negative for fecal blood. pH of vaginal discharge >4.5. Which of the following is the most accurate interpretation of these findings?
These findings suggest bacterial vaginosis
What are the most predominant risk factors for prostate cancer?
Which assessment finding would be most suggestive of a diagnosis of biliary colic?
Associated right shoulder pain
Pressing down onto the abdomen firmly and quickly withdrawals the hand produces pain
A 76-year-old female presents to the office for an annual physical. Upon reviewing her history, she had a positive FOBT on one occasion at age 66 years. Subsequent colonoscopy revealed internal hemorrhoids and sigmoid diverticuli only. She has no firstdegree relatives with a history of colorectal cancer or adenomatous polyps. What is the U.S. Preventive Services Task Force (USPSTF) screening recommendation for this particular patient?
A 30-year-old male is admitted to the hospital for abdominal pain. He reports steady, aching pain that began suddenly around his naval and now involves the lower abdomen. He also reports a decreased appetite with nausea but no vomiting. After a careful history and physical examination, the NP documents the following abdominal findings: The abdomen is flat, firm, and rigid, with increased tenderness and guarding in the right lower quadrant. No bowel sounds heard. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA tenderness. Psoas sign positive. Blumberg sign positive. Which of the following is the most accurate interpretation of these findings?
These findings suggest acute peritonitis
The NP conducted a physical assessment on a 79-year-old male who lives independently in subsidized housing. The documentation for the Head, Eyes, Ears, Nose, Throat (HEENT) findings are as follows: Scalp without lesions. Skull NC/AT. Conjunctiva pink, sclera muddy. Pupils 2 mm constricting to 1 mm, round, regular, equally reactive to light and accommodation. Extraocular movements intact. Disc margins sharp, without hemorrhages or exudates. Mild arteriolar narrowing. TMs with good cone of light. Weber midline. AC > BC. Nasal mucosa erythematous, septum deviated to the right, turbinates mildly enlarged. No sinus tenderness. Oral mucosa pink. Dentition fair. Caries present. Tongue midline, slight beefy redness. Pharynx is mildly erythematous with cobblestoning. Which of the following is the most accurate interpretation of the findings?
The patient has chronic allergies
The staff NP in a nursing home is conducting a physical assessment on an 84-year-old male resident who is pleasant, active, and cooperative. The skin findings in this image are observed during the examination. The staff and patient deny any known injury or trauma. The NP should document these findings as consistent with which of the following?
ADA Description: Extensor surface of the right forearm with emphasis on well-demarcated vividly purple macules and patches
An 80-year-old woman who lives alone at home presents with concerns about maintaining her independent living status. She continues to drive and care for herself and her pet dog but reports two falls over the past 4 months. During one fall, she struck her head, causing a contusion over the right eye. She attributes these episodes to environmental factors. Once she tripped over a rug, and once she misjudged the depth of the curb while crossing the street. Which of the following would be the best approach to this patient?
Perform a comprehensive assessment of fall risk and plan preventive interventions
Concerning alcohol consumption in older adults, which of the following is true?
A 25-year-old female presents to the clinic after a positive home pregnancy test. She confides in you that her live-in, male partner has been verbally threatening her. She denies interest in involving law enforcement. Additionally, she reports that she has a 3- year-old daughter who lives in the home. What is the appropriate next step by the NP?
A 42-year-old female is at 39-weeks gestation. She reports no major issues except swelling in her feet and shortness of breath which she assumed is normal for pregnancy. On exam, the NP notes a diastolic murmur. Which of the following is true about her presentation and the appropriate next step by the NP?
an internal cervical os closed to the width of a fingertip
a bluish hue to the cervix
A 20-year-old female presents to the clinic with symptoms of fatigue, nausea, and an increase in urination. She is sexually active, and her male partner uses condoms occasionally. A urine pregnancy test is positive. Her last menstrual period was 3 months ago (6/20/2021). Using the Naegele rule, what is the estimated date of delivery (EDD, or due date)?
An 11-month-old infant male is accompanied to the clinic by his father. The father is concerned about the skin rash on this son’s arms represented in this image. Family history is significant for a 4-year-old sibling with atopic dermatitis and asthma. Which of the following is the best documentation of the integument findings?
A mother brings her 15-day-old female infant to the outpatient clinic for evaluation of a rash that appeared suddenly after visiting family in Florida. It is August and the house did not have air conditioning. The infant is afebrile, eating and drinking well, and does not appear to be in distress. The physical assessment findings are represented in this image. Based on the history and examination findings, what is the likely etiology.
ADA Description: Infant with a red, facial rash.
A 2-month-old female is accompanied by her parents for her first visit to the practice. When reviewing the hospital medical records of her birth, the NP notes documentation regarding significantly edematous hands and feet present at birth. Upon physical examination of the infant, the NP finds skin folds that run along the sides of the neck down to the shoulders. Which of the following should be assessed and monitored by the NP and parents related to these findings? Select all that apply.
A 25-year-old male presents to the clinic with a complaint of severe rectal pain during defecation. The pain is so severe he waits several days before having a bowel movement. He has a history of ulcerative colitis (UC). He also reports being in an active sexual new relationship with a male partner. After conducting a history and physical exam, the NP documents the following anorectal findings: Perirectal area inflamed; no ulcerations, open sores, fissures, or verruca. Scant, whiteyellow, mucoid, rectal discharge noted. Unable to examine external sphincter, rectal vault, or prostate because of spasm of the external sphincter and marked inflammation and tenderness of anal canal. Which of the following is the most accurate interpretation of these findings?
These findings suggest infectious proctitis
Which muscle(s) are being assessed during active rotation of the neck?
A 26-year-old female presents to the Emergency Department with intense abdominal pain for 6 hours, light-headedness, and a fainting episode that finally prompted her to seek medical attention. She has a history of gallstones and is concerned that she is having another gallbladder attack. She denies nausea and vomiting, and her last normal bowel movement was this morning. She reports that her LMP was 10 weeks ago. Vital signs: pulse 118; blood pressure, 86/68; respiratory rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. A β-human chorionic gonadotropin (β-hCG) blood test is pending. The NP performs an abdominal exam prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. Which of the following is the most likely etiology for these assessment findings?
A 24-year-old male presents to the office for evaluation of a lump under his left nipple. He reports no other symptoms, denies trauma or injury, and reports no known family history of a first-degree relative with breast cancer. On examination, the NP notes a firm, 2-cm mass under his areola. What is the most likely etiology for these findings?
A 34-year-old female arrives at the clinic for a prenatal, second-trimester appointment. During the interview, her behavior is concerning for intoxication, and she smells of alcohol and cigarettes. She reveals a history of intravenous drug use “10-years ago”. How should the NP counsel this patient? Select all that apply
If a pregnant patient does not intend to quit tobacco, cutting down is still considered beneficial to the pregnancy and should be encouraged.
Pregnant women are not routinely screened for hepatitis C, but this test should be added to the panel of prenatal blood tests for patients with a history of intravenous drug use
A 27-year-old female presents to the outpatient clinic with acute abdominal pain and uterine bleeding. Her last menstrual period was 6-weeks ago. She and her husband have been trying to conceive for almost one year. On physical examination, the NP palpates an ill-defined, adnexal mass in the left lower quadrant. The urine pregnancy test results are pending. Based on the history and examination findings, what is the most likely etiology?
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