NR 509 MIDTERM EXAM / ADVANCED
PHYSICAL ASSESSMENT EXAM 2024-2025
WITH ACTUAL CORRECT QUESTIONS
AND VERIFIED DETAILED ANSWERS
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SOLUTIONS |ALREADY GRADED
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A clinician is percussing the lungs of a patient with chronic obstructive pulmonary disease to see if they
sound hyperresonant. Which of the following is an example of good technique for percussion?
a. Strike using the tip of the third finger.
b. The proximal interphalangeal joint is the joint that is struck.
c. Put the third and fourth fingers next to each other on the chest.
d. Strike using the finger pad of the fourth finger.
e. The wrist is kept still during percussion.
a. Strike using the tip of the third finger.
A 29-year-old waiter comes to the clinic for a 2-month history of a cough. When he lowers his gown so
the clinician can listen to his lungs, the clinician notices a depression of the lower part of his sternum.
Which of the following best describes the appearance of his chest?
a. Barrel chest
b. Flail chest
c. Pectus excavatum
d. Pigeon chest
e. Thoracic kyphoscoliosis
c. Pectus excavatum
A 13-year-old girl is brought by her mother to the clinic one day before the start of eighth grade because
of a 3-day history of episodes of shortness of breath. When she gets the shortness of breath, she also
notices tingling around her lips. She has no fever, cough, sputum production, or chest pain. She has no
history of serious illness and takes no medications. Vital signs are within normal limits. Cardiac, lung, and
extremity examinations show no abnormalities. Which of the following is the most likely diagnosis?
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,a. Aspiration of a foreign body
b. Anxiety
c. Asthma
d. Left-sided heart failure
e. Pneumonia
b. Anxiety
A 70-year-old patient has suspected chronic obstructive pulmonary disease. The clinician instructs the
patient to take a deep breath in, and then with his mouth open, breathe out as fast and completely as
he can. For what is the clinician checking?
a. Bronchophony
b. Egophony
c. Tactile fremitus
d. Forced expiratory time
e. Whispered pectoriloquy
d. Forced expiratory time
After examining a patient who is in the hospital for shortness of breath, the clinician records the
following for lung examination: "There is dullness to percussion over the right lung base. Breath sounds
are absent at the right lung base. There are no crackles, wheezes, or rhonchi. There are no transmitted
voice sounds." Which of the following is the most likely diagnosis?
a. Atelectasis
b. Left-sided heart failure
c. Pneumonia
d. Pneumothorax
e. Chronic obstructive pulmonary disease (COPD)
a. Atelectasis
A 16-year-old boy is brought to the Emergency Department (ED) after a motor vehicle accident for
shortness of breath for 1 hour. A chest x-ray shows a rib fracture and a pneumothorax on the right side.
The ED physician decides that a chest tube needs to be placed in the fourth intercostal space. How does
he determine where the fourth intercostal space is?
a. He finds the suprasternal notch and then moves his finger laterally to the third rib. The fourth
intercostal space is just below the third rib.
b. He finds the angle of Louis and then moves laterally to the first rib. He walks down from there to the
fourth intercostal space.
c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to
the second
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space.
d. He finds the clavicle. The second intercostal space is just below
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, c. He finds the sternal angle and then moves his finger laterally to the second rib. He then walks down to
the second
intercostal space, third rib, third intercostal space, fourth rib and then the fourth intercostal space
An elderly patient with a history of smoking two packs of cigarettes a day for 50 years complains to her
physician of progressive shortness of breath. On cardiac examination, the physician feels the most
prominent palpable impulse to be in the xiphoid area. This is most likely a result of what condition?
a. Aortic stenosis
b. Hypertrophic cardiomyopathy
c. Hypertension
d. Pulmonary hypertension
e. Mitral regurgitation
d. Pulmonary hypertension
A newborn baby has an embryologic defect affecting the aortic valve. What other cardiac valve is most
likely to be affected?
a. Tricuspid valve
b. Pulmonic valve
c. Mitral valve
d. Pyloric valve
e. Eustachian valve
b. Pulmonic valve
A 77-year-old man is experiencing progressive shortness of breath and dizziness. The patient undergoes
cardiac catheterization, and the systolic blood pressure measured in the left ventricle is 180 mm Hg,
while the systolic blood pressure measured in the aorta is 140 mm Hg. The patient is most likely
experiencing symptoms related to what valvular condition?
a. Aortic insufficiency
b. Mitral stenosis
c. Aortic stenosis
d. Mitral regurgitation
e. Pulmonic stenosis
c. Aortic stenosis
On routine physical examination, a 40-year-old teacher is found to have a single second heart sound.
The most likely explanation for this finding is what?
a. Auscultation occurred during inspiration.
b. The patient has pulmonic stenosis.
c. Auscultation occurred during expiration.
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