NR 509 FINAL EXAM ACTUAL EXAM ADVANCED PHYSICAL
ASSESSMENT COMPLETE 300 QUESTIONS AND VERIFIED
CORRECT SOLUTIONS LATEST 2024-2025
Jim is a 60-year-old man who presents with vomiting. He denies seeing any blood with
emesis, which has been occurring for 2 days. He does note a dark, granular substance
resembling the coffee left in the filter after brewing. What do you suspect?
A) Bleeding from a diverticulum
B) Bleeding from a peptic ulcer
C) Bleeding from a colon cancer
D) Bleeding from cholecystitis
B) Bleeding from a peptic ulcer ?
You are palpating the abdomen and feel a small mass. Which of the following would you do
next?
A) Ultrasound
B) Examination with the abdominal muscles tensed
C) Surgery referral
D) Determine size by percussion
B) Examination with the abdominal muscles tensed ?
Dawn is a 55-year-old woman who comes in today for her yearly wellness examination. You
carefully perform the rectal examination in the lithotomy position and feel a mass against the
bowel wall which is firm and immobile. Which of the following is most likely?
-Rectal cancer
-Valve of Houston
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-Anal Fissure
-Hemorrhoid
?-Rectal cancer
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
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
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?
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a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
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 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?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
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
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diverticuli were found on colonoscopy. He has no first-degree relatives with a history of
colorectal cancer or adenomatous polyps. What are the U.S. Preventive Services Task Force
(USPSTF) screening recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year
history of recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is
associated with onset of constipation. She describes infrequent, small hard stool that she
finds very difficult to pass. She has tried to increase dietary fiber and water intake, but usually
this is not sufficient and she resorts to over-the-counter laxatives, which she finds upset her
stomach but do resolve the constipation. Symptoms typically gradually resolve with bowel
movements. Which of the following is the most likely physiological mechanism for her
constipation?
a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
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