Physical Assessment for FNP Boards: What You Need to Know

Clinical High-Yield · 8 min read · March 17, 2026

Why Physical Assessment Is Tested

The FNP boards test physical assessment not as isolated facts ("what does a S3 heart sound mean?") but as integrated clinical reasoning ("a patient presents with dyspnea and you hear a S3 — what is the most likely diagnosis and what do you do next?").

Understanding physical findings in clinical context is the key.

Cardiovascular Exam Findings

Heart sounds:

  • S1: Closure of mitral and tricuspid valves (beginning of systole)
  • S2: Closure of aortic and pulmonic valves (end of systole)
  • S3 (ventricular gallop): Early diastole — normal in children, sign of heart failure or volume overload in adults
  • S4 (atrial gallop): Late diastole — sign of decreased ventricular compliance (hypertension, CAD)
  • Murmurs: Systolic (between S1 and S2) vs. diastolic (between S2 and S1)

High-yield murmurs:

  • Aortic stenosis: Harsh systolic ejection murmur, right upper sternal border, radiates to carotids
  • Mitral regurgitation: Holosystolic murmur, apex, radiates to axilla
  • Aortic regurgitation: Diastolic decrescendo murmur, left sternal border
  • Mitral stenosis: Diastolic rumble, apex, opening snap

JVD: Elevated jugular venous distension suggests right heart failure or cardiac tamponade

Pulmonary Exam Findings

  • Crackles (rales): Fluid in alveoli — pneumonia, pulmonary edema, fibrosis
  • Wheezes: Airway narrowing — asthma, COPD, foreign body
  • Rhonchi: Secretions in large airways — bronchitis, COPD
  • Stridor: Upper airway obstruction — croup, epiglottitis, foreign body
  • Pleural friction rub: Pleuritis
  • Decreased breath sounds: Pleural effusion, pneumothorax, consolidation

Percussion:

  • Dullness: Consolidation (pneumonia), pleural effusion
  • Hyperresonance: Pneumothorax, emphysema

Abdominal Exam Findings

  • Murphy's sign: Pain on deep palpation RUQ during inspiration — cholecystitis
  • McBurney's point tenderness: Appendicitis
  • Rovsing's sign: RLQ pain with LLQ palpation — appendicitis
  • Psoas sign: RLQ pain with hip extension — appendicitis
  • Obturator sign: RLQ pain with internal rotation of hip — appendicitis
  • Shifting dullness + fluid wave: Ascites

Neurological Exam Findings

  • Kernig's sign: Resistance to knee extension with hip flexed — meningitis
  • Brudzinski's sign: Involuntary knee flexion with neck flexion — meningitis
  • Babinski sign: Upgoing plantar response — upper motor neuron lesion
  • Romberg test: Positive (falls with eyes closed) — proprioception deficit

The Board Approach

For every physical finding, know:

  1. What system it's in
  2. What it indicates (normal vs. abnormal)
  3. What diagnoses it suggests
  4. What the next diagnostic step would be

This framework covers the vast majority of physical assessment questions on the FNP boards.