1|Page
NR 509 FINAL EXAM ADVANCED PHYSICAL ASSESSMENT CHAMBERLAIN COLLEGE OF
NURSING 2024 ACTUAL EXAM WITH RATIONALES COMPLETE 100 QUESTIONS WITH
DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS) ALREADY GRADED A+
An overweight 26-year-old public servant presents to the
Emergency Department with 12 hours of intense abdominal
pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong
family history of gallstones and is concerned about this
possibility. She has not had any vomiting or diarrhea. She
had a normal bowel movement this morning. Her β-human
chorionic gonadotropin (β-hCG) is positive at triage. She
reports that her last period was 10 weeks ago. Her vital
signs at triage are pulse, 118; blood pressure, 86/68;
respiratory rate, 20/min; oxygen saturation, 99%; and
temperature, 37.3ºC orally. The clinician performs an
abdominal exam prior to her pelvic exam and, on palpation
of her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
,2|Page
b. Acute cholecystitis
c. Ruptured appendix
d. Perf - CORRECT ANSWER >>>>a. Ruptured tubal (or
ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope,
tachycardia, hypotension, positive β-hCG, and findings
suggestive of peritoneal inflammation/irritation strongly
suggest a ruptured ectopic pregnancy with significant intra-
abdominal bleeding leading to peritoneal signs. This case is
emergent and requires immediate treatment of her
hypotension and presumed blood loss as well as
gynecological consult for emergent surgery
A 63-year-old janitor with a history of adenomatous colonic
polyps presents for a well visit. Basic labs are performed to
screen for diabetes mellitus and dyslipidemia. Electrolytes
and liver enzymes were also measured. His labs are all
normal expect for moderate elevations of aspartate
aminotransferase, alanine aminotransferase, γ-glutamyl
transferase, and alkaline phosphatase as well as a mildly
elevated total bilirubin. He presents for a follow-up
appointment and the clinician performs an abdominal exam
to assess his liver. Which of the following findings would be
most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
,3|Page
c. Dullness to percussion over a span of 11 cm at the
midclavicular line
d. Dullness to percussion over a span of 8 cm at the
midsternal line
e. Liver palpable 3 cm below the right costal margin, mid
clavicular line, on expirat - CORRECT ANSWER >>>>e. Liver
palpable 3 cm below the right costal margin, mid clavicular
line, on expiration
Rationale: The liver being palpable 3 cm below the right
costal margin, midclavicular line, would be considered
normal on inspiration when the liver is pushed down into
the abdominal cavity on inspiration, but is abnormal on
expiration.
A 63-year-old underweight administrative clerk with a 50-
pack-year smoking history presents with a several month
history of recurrent epigastric abdominal discomfort. She
feels fairly well otherwise and denies any nausea, vomiting,
diarrhea, or constipation. She reports that a first cousin died
from a ruptured aneurysm at age 68 years. Her vital signs
are pulse, 86; blood pressure, 148/92; respiratory rate, 16;
oxygen saturation, 95%; and temperature, 36.2ºC. Her body
mass index is 17.6. On exam, her abdominal aorta is
prominent, which is concerning for an abdominal aortic
aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA?
, 4|Page
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension - CORRECT ANSWER >>>>b. History of
smoking
Rationale: History of smoking is her most significant risk
factor for an AAA. Male gender, not female gender, is
considered as risk factor. Underweight is not a risk factor for
AAA. Family history of ruptured aneurysm is vague and
could be a cerebral aneurysm. Further, her family history is
in a first-degree cousin not a first-degree relative (biologic
parents, siblings, and children). Hypertension could
contribute to atherosclerosis, which is a risk factor. Further,
a diagnosis of hypertension is not based on one elevated
blood pressure reading.
A 76-year-old retired man with a history of prostate cancer
and hypertension has been screened annually for colon
cancer using high sensitivity fecal occult blood testing
(FOBT). He presents for follow-up of his hypertension,
during which the clinician scans his chart to ensure he is up
to date with his preventive health care. He has a positive
FOBT on one occasion at age 66 years and subsequently
went for a colonoscopy. Internal hemorrhoids and sigmoid
diverticuli were found on colonoscopy. He has no first-
