NUR 612
EXAM I
(Advanced Health Assessment)
100% Exam-Focused | High-Yield | Scenario-Based
✔ Advanced, exam-style multiple-choice questions
✔ Select-All-That-Apply (SATA) questions
✔ Clinical scenario-based decision-making
✔ Pathophysiology-driven physical assessment integration
✔ Diagnostic reasoning and prioritization
✔ Board-style wording aligned with graduate nursing exams
✔ Clear, concise, exam-ready rationales
✔ No filler, no repetition, no outdated content
,A 54-year-old male presents with a progressive, productive cough worsening over three months and
recent unintentional weight loss. During the chest examination, you note tactile fremitus is increased
over the right upper lobe and bronchophony is present. Percussion over this area reveals dullness.
Which underlying condition is most consistent with these findings?
A) Lobar pneumonia
B) Spontaneous pneumothorax
C) Chronic obstructive pulmonary disease (COPD)
D) Pleural effusion
Correct Answer: A) Lobar pneumonia
Explanation / Rationale:
Increased tactile fremitus, bronchophony, and dullness to percussion indicate lung consolidation or
solidification, which is the hallmark of lobar pneumonia. Pneumothorax and COPD typically present
with decreased fremitus and hyperresonance, while pleural effusion causes dullness but decreased
fremitus due to fluid blocking sound transmission.
A 72-year-old female with a history of hypertension presents with sudden onset of severe chest pain
radiating to her back. On physical examination, you note a diastolic murmur heard best at the left
sternal border and a significant discrepancy in blood pressure (>20 mmHg) between the right and left
arms. Which diagnostic intervention is the priority?
A) Computed Tomography (CT) Angiography of the chest
B) Exercise stress test
C) 12-lead Electrocardiogram (ECG)
D) Transthoracic echocardiogram
Correct Answer: A) Computed Tomography (CT) Angiography of the chest
Explanation / Rationale:
The presentation is classic for an acute aortic dissection, and CT Angiography is the gold standard for
immediate visualization to confirm the diagnosis. While ECG is important to rule out myocardial
infarction, it will not definitively diagnose a dissection. An echocardiogram may be useful but lacks the
speed and sensitivity of CT in an acute emergency setting.
,You are assessing a 45-year-old patient with suspected jaundice. Which of the following physical
examination findings would best distinguish conjugated hyperbilirubinemia from unconjugated
hyperbilirubinemia?
A) Yellowish discoloration of the sclera
B) Dark-colored urine
C) Presence of scleral icterus
D) Diffuse pruritus
Correct Answer: B) Dark-colored urine
Explanation / Rationale:
Conjugated bilirubin is water-soluble and excreted by the kidneys, leading to darkening of the urine
(bilirubinuria), whereas unconjugated bilirubin is not water-soluble and does not affect urine color.
Scleral icterus and yellow skin discoloration occur in both types. Pruritus is associated with cholestasis
and conjugated bilirubin deposition but is less specific than urine color changes.
During a cardiovascular assessment, a 30-year-old female exhibits a fixed split S2 heart sound. This
auscultatory finding is most characteristic of which cardiac condition?
A) Atrial septal defect (ASD)
B) Ventricular septal defect (VSD)
C) Aortic stenosis
D) Mitral valve prolapse
Correct Answer: A) Atrial septal defect (ASD)
Explanation / Rationale:
A fixed split S2 occurs because the volume overload in the right ventricle delays pulmonic valve closure
regardless of respiration, a pathognomonic sign of an ASD. A VSD typically causes a holosystolic
murmur rather than a fixed split. Aortic stenosis and mitral valve prolapse produce different murmurs
and do not typically cause fixed splitting of S2.
, A 60-year-old patient presents with complaints of difficulty swallowing both solids and liquids over
the past six months. He reports regurgitation of undigested food and occasional coughing at night.
Which motor disorder of the esophagus is the most likely diagnosis?
A) Achalasia
B) Esophageal spasm
C) Peptic stricture
D) Schatzki ring
Correct Answer: A) Achalasia
Explanation / Rationale:
Achalasia presents with dysphagia to both solids and liquids (progressive) and regurgitation of bland,
undigested food due to impaired lower esophageal sphincter relaxation. Esophageal spasms typically
cause intermittent chest pain and dysphagia, while strictures and rings usually cause dysphagia
primarily to solids. Nocturnal cough suggests aspiration from retained esophageal contents.
A 25-year-old female presents with acute onset of right lower quadrant (RLQ) pain. Upon palpation of
the left lower quadrant (LLQ), the patient reports increased pain in the RLQ. This positive sign is
known as:
A) Rovsing’s sign
B) Murphy’s sign
C) McBurney’s point tenderness
D) Psoas sign
Correct Answer: A) Rovsing’s sign
Explanation / Rationale:
Rovsing’s sign is positive when palpation of the LLQ causes pain in the RLQ, suggesting peritoneal
irritation in the RLQ, often associated with appendicitis. Murphy’s sign is specific for cholecystitis.
McBurney's point tenderness is direct tenderness in the RLQ, and the psoas sign suggests retrocecal
appendix irritation.
EXAM I
(Advanced Health Assessment)
100% Exam-Focused | High-Yield | Scenario-Based
✔ Advanced, exam-style multiple-choice questions
✔ Select-All-That-Apply (SATA) questions
✔ Clinical scenario-based decision-making
✔ Pathophysiology-driven physical assessment integration
✔ Diagnostic reasoning and prioritization
✔ Board-style wording aligned with graduate nursing exams
✔ Clear, concise, exam-ready rationales
✔ No filler, no repetition, no outdated content
,A 54-year-old male presents with a progressive, productive cough worsening over three months and
recent unintentional weight loss. During the chest examination, you note tactile fremitus is increased
over the right upper lobe and bronchophony is present. Percussion over this area reveals dullness.
Which underlying condition is most consistent with these findings?
A) Lobar pneumonia
B) Spontaneous pneumothorax
C) Chronic obstructive pulmonary disease (COPD)
D) Pleural effusion
Correct Answer: A) Lobar pneumonia
Explanation / Rationale:
Increased tactile fremitus, bronchophony, and dullness to percussion indicate lung consolidation or
solidification, which is the hallmark of lobar pneumonia. Pneumothorax and COPD typically present
with decreased fremitus and hyperresonance, while pleural effusion causes dullness but decreased
fremitus due to fluid blocking sound transmission.
A 72-year-old female with a history of hypertension presents with sudden onset of severe chest pain
radiating to her back. On physical examination, you note a diastolic murmur heard best at the left
sternal border and a significant discrepancy in blood pressure (>20 mmHg) between the right and left
arms. Which diagnostic intervention is the priority?
A) Computed Tomography (CT) Angiography of the chest
B) Exercise stress test
C) 12-lead Electrocardiogram (ECG)
D) Transthoracic echocardiogram
Correct Answer: A) Computed Tomography (CT) Angiography of the chest
Explanation / Rationale:
The presentation is classic for an acute aortic dissection, and CT Angiography is the gold standard for
immediate visualization to confirm the diagnosis. While ECG is important to rule out myocardial
infarction, it will not definitively diagnose a dissection. An echocardiogram may be useful but lacks the
speed and sensitivity of CT in an acute emergency setting.
,You are assessing a 45-year-old patient with suspected jaundice. Which of the following physical
examination findings would best distinguish conjugated hyperbilirubinemia from unconjugated
hyperbilirubinemia?
A) Yellowish discoloration of the sclera
B) Dark-colored urine
C) Presence of scleral icterus
D) Diffuse pruritus
Correct Answer: B) Dark-colored urine
Explanation / Rationale:
Conjugated bilirubin is water-soluble and excreted by the kidneys, leading to darkening of the urine
(bilirubinuria), whereas unconjugated bilirubin is not water-soluble and does not affect urine color.
Scleral icterus and yellow skin discoloration occur in both types. Pruritus is associated with cholestasis
and conjugated bilirubin deposition but is less specific than urine color changes.
During a cardiovascular assessment, a 30-year-old female exhibits a fixed split S2 heart sound. This
auscultatory finding is most characteristic of which cardiac condition?
A) Atrial septal defect (ASD)
B) Ventricular septal defect (VSD)
C) Aortic stenosis
D) Mitral valve prolapse
Correct Answer: A) Atrial septal defect (ASD)
Explanation / Rationale:
A fixed split S2 occurs because the volume overload in the right ventricle delays pulmonic valve closure
regardless of respiration, a pathognomonic sign of an ASD. A VSD typically causes a holosystolic
murmur rather than a fixed split. Aortic stenosis and mitral valve prolapse produce different murmurs
and do not typically cause fixed splitting of S2.
, A 60-year-old patient presents with complaints of difficulty swallowing both solids and liquids over
the past six months. He reports regurgitation of undigested food and occasional coughing at night.
Which motor disorder of the esophagus is the most likely diagnosis?
A) Achalasia
B) Esophageal spasm
C) Peptic stricture
D) Schatzki ring
Correct Answer: A) Achalasia
Explanation / Rationale:
Achalasia presents with dysphagia to both solids and liquids (progressive) and regurgitation of bland,
undigested food due to impaired lower esophageal sphincter relaxation. Esophageal spasms typically
cause intermittent chest pain and dysphagia, while strictures and rings usually cause dysphagia
primarily to solids. Nocturnal cough suggests aspiration from retained esophageal contents.
A 25-year-old female presents with acute onset of right lower quadrant (RLQ) pain. Upon palpation of
the left lower quadrant (LLQ), the patient reports increased pain in the RLQ. This positive sign is
known as:
A) Rovsing’s sign
B) Murphy’s sign
C) McBurney’s point tenderness
D) Psoas sign
Correct Answer: A) Rovsing’s sign
Explanation / Rationale:
Rovsing’s sign is positive when palpation of the LLQ causes pain in the RLQ, suggesting peritoneal
irritation in the RLQ, often associated with appendicitis. Murphy’s sign is specific for cholecystitis.
McBurney's point tenderness is direct tenderness in the RLQ, and the psoas sign suggests retrocecal
appendix irritation.
