San Diego State University (SDSU)
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50 Questions with Verified Answers and Detailed Rationales
Q1. A nurse is preparing to palpate a patient's thyroid gland and positions the patient
slightly forward with the neck flexed. This positioning is intended to:
A. Relax the sternocleidomastoid muscles
B. Increase blood flow to the thyroid
C. Decrease the patient's anxiety
D. Improve visualization of the trachea
Correct Answer: A
Flexing the neck slightly forward relaxes the sternocleidomastoid muscles, making the
thyroid gland more accessible to palpation from behind the patient. This position does
not increase blood flow, reduce anxiety specifically, or improve tracheal visualization; it
is purely an anatomical maneuver to facilitate gland examination.
Q2. During a skin assessment, the nurse notes a 5 mm pearly papule with telangiectasia
and a rolled border on the patient's nose. This lesion is most consistent with:
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Melanoma
D. Seborrheic keratosis
Correct Answer: B
Basal cell carcinoma classically presents as a pearly papule with surface telangiectasia
and a rolled, translucent border, most commonly on sun-exposed areas such as the face.
Squamous cell carcinoma appears as a scaly, erythematous patch or nodule, melano ma
demonstrates asymmetry and color variation, and seborrheic keratosis has a waxy,
"stuck-on" appearance without telangiectasia.
,Q3. A nurse is auscultating the heart and hears a loud, harsh holosystolic murmur at the
apex that radiates to the axilla. The nurse recognizes this as most consistent with:
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonic regurgitation
Correct Answer: B
Mitral regurgitation produces a holosystolic (pansystolic) murmur best heard at the
apex with radiation to the axilla, caused by backward blood flow into the left atrium
during systole. Aortic stenosis is a crescendo-decrescendo systolic murmur at the right
second intercostal space, tricuspid stenosis is a diastolic murmur at the lower left sternal
border, and pulmonic regurgitation is a diastolic murmur at the left sternal border.
Q4. During a neurological assessment, the nurse tests the patient's graphesthesia by
writing a number on the palm while the patient's eyes are closed. The inability to
identify the number indicates a lesion in the:
A. Primary motor cortex
B. Parietal lobe sensory association area
C. Temporal lobe
D. Occipital lobe
Correct Answer: B
Graphesthesia requires intact sensory input and cortical integration in the parietal lobe
sensory association area; inability to recognize written numbers indicates cortical
sensory loss (astereognosis). The primary motor cortex controls voluntary movement ,
the temporal lobe processes auditory information and memory, and the occipital lobe is
responsible for visual processing.
Q5. A nurse is assessing a patient's abdomen and notes a positive psoas sign, indicated
by pain when the patient extends the right hip against resistance. This finding is most
consistent with:
A. Cholecystitis
B. Appendicitis
C. Pancreatitis
D. Diverticulitis
, Correct Answer: B
The psoas sign indicates irritation of the iliopsoas muscle by an inflamed retrocecal
appendix, as the psoas muscle lies posterior to the appendix. Cholecystitis causes
Murphy's sign, pancreatitis produces epigastric pain with Cullen's or Grey Turner's
signs, and diverticulitis typically affects the sigmoid colon causing left lower quadrant
pain without psoas involvement.
Q6. During a musculoskeletal assessment, the nurse performs the McMurray test by
flexing the patient's knee and rotating the tibia while extending the knee. A palpable or
audible click indicates:
A. Anterior cruciate ligament tear
B. Meniscal tear
C. Medial collateral ligament sprain
D. Patellar tendonitis
Correct Answer: B
The McMurray test specifically evaluates the menisci; a click or pop during knee flexion,
rotation, and extension indicates a torn meniscus being caught between the femoral
condyles. ACL tears are assessed by the Lachman and anterior drawer tests, MCL
injuries by valgus stress testing, and patellar tendonitis by resisted knee extension and
palpation of the inferior patellar pole.
Q7. A nurse is inspecting a patient's sclera and notes a yellow-green discoloration. The
nurse understands that this finding indicates:
A. Hyperbilirubinemia from liver disease
B. Carotenemia from excessive beta-carotene intake
C. Subconjunctival hemorrhage
D. Normal variant in dark-skinned individuals
Correct Answer: A
Yellow-green discoloration of the sclera (icterus) indicates hyperbilirubinemia from
liver disease, hemolysis, or biliary obstruction, as bilirubin deposits in elastic tissues.
Carotenemia causes yellowing of the skin but spares the sclera, subconjunctival
hemorrhage presents as a bright red patch, and scleral color is not a normal variant
based on skin tone.