NURS 660 Exam 1 | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A 45-year-old female presents with a pruritic, erythematous rash in a herald patch
distribution followed by a ‘Christmas tree’ pattern. What is the most likely diagnosis?
A. Atopic Dermatitis
B. Tinea Corporis
C. Secondary Syphilis
D. Pityriasis Rosea
Answer: D
Rationale: Pityriasis Rosea characteristically begins with a single large herald patch before
progressing to a generalized eruption. The subsequent lesions typically follow the skin
cleavage lines, creating a classic Christmas tree appearance on the trunk. This condition is
usually self-limiting and requires only symptomatic treatment for itching.
2. Which of the following is considered the gold standard for diagnosing a corneal abrasion
during a physical examination?
A. Visual acuity testing
B. Tonometry for intraocular pressure
C. Fluorescein staining with Wood’s lamp
,D. Ophthalmoscopic retinal exam
Answer: C
Rationale: Fluorescein staining is the definitive diagnostic tool for identifying disruptions
in the corneal epithelium. Under a Cobalt blue light or Wood’s lamp, the dye will collect in
the abrasion and appear bright green. It is essential to perform this after checking visual
acuity to ensure no permanent damage is present.
3. A patient presents with a red, bulging tympanic membrane with absent landmarks and
decreased mobility on pneumatic otoscopy. Which diagnosis is most likely?
A. Otitis Externa
B. Acute Otitis Media
C. Serous Otitis Media
D. Tympanosclerosis
Answer: B
Rationale: Acute Otitis Media (AOM) is defined by the rapid onset of signs and symptoms
of inflammation in the middle ear. Key physical findings include a bulging tympanic
membrane and impaired mobility when pressure is applied. These findings help
differentiate AOM from Otitis Media with Effusion, which lacks acute inflammatory signs.
4. In a patient suspected of having Chronic Obstructive Pulmonary Disease (COPD), which
spirometry result is required to confirm the diagnosis?
A. Peak Expiratory Flow Rate improvement of 20%
, B. FEV1/FVC ratio greater than 0.80
C. FEV1/FVC ratio less than 0.70 post-bronchodilator
D. Total Lung Capacity increase of 15%
Answer: C
Rationale: According to the GOLD guidelines, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This measurement ensures
that the obstruction is not fully reversible, which distinguishes COPD from asthma. Proper
spirometry technique is essential for an accurate diagnosis in primary care settings.
5. A 72-year-old male is found to have a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space. Where does this murmur typically radiate?
A. To the left axilla
B. To the xiphoid process
C. To the carotid arteries
D. To the back
Answer: C
Rationale: A systolic crescendo-decrescendo murmur at the right upper sternal border is
characteristic of aortic stenosis. This murmur often radiates to the carotids because of the
high-velocity blood flow through the narrowed aortic valve. It is frequently associated with
symptoms of exertional dyspnea, syncope, or chest pain.
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A 45-year-old female presents with a pruritic, erythematous rash in a herald patch
distribution followed by a ‘Christmas tree’ pattern. What is the most likely diagnosis?
A. Atopic Dermatitis
B. Tinea Corporis
C. Secondary Syphilis
D. Pityriasis Rosea
Answer: D
Rationale: Pityriasis Rosea characteristically begins with a single large herald patch before
progressing to a generalized eruption. The subsequent lesions typically follow the skin
cleavage lines, creating a classic Christmas tree appearance on the trunk. This condition is
usually self-limiting and requires only symptomatic treatment for itching.
2. Which of the following is considered the gold standard for diagnosing a corneal abrasion
during a physical examination?
A. Visual acuity testing
B. Tonometry for intraocular pressure
C. Fluorescein staining with Wood’s lamp
,D. Ophthalmoscopic retinal exam
Answer: C
Rationale: Fluorescein staining is the definitive diagnostic tool for identifying disruptions
in the corneal epithelium. Under a Cobalt blue light or Wood’s lamp, the dye will collect in
the abrasion and appear bright green. It is essential to perform this after checking visual
acuity to ensure no permanent damage is present.
3. A patient presents with a red, bulging tympanic membrane with absent landmarks and
decreased mobility on pneumatic otoscopy. Which diagnosis is most likely?
A. Otitis Externa
B. Acute Otitis Media
C. Serous Otitis Media
D. Tympanosclerosis
Answer: B
Rationale: Acute Otitis Media (AOM) is defined by the rapid onset of signs and symptoms
of inflammation in the middle ear. Key physical findings include a bulging tympanic
membrane and impaired mobility when pressure is applied. These findings help
differentiate AOM from Otitis Media with Effusion, which lacks acute inflammatory signs.
4. In a patient suspected of having Chronic Obstructive Pulmonary Disease (COPD), which
spirometry result is required to confirm the diagnosis?
A. Peak Expiratory Flow Rate improvement of 20%
, B. FEV1/FVC ratio greater than 0.80
C. FEV1/FVC ratio less than 0.70 post-bronchodilator
D. Total Lung Capacity increase of 15%
Answer: C
Rationale: According to the GOLD guidelines, a post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. This measurement ensures
that the obstruction is not fully reversible, which distinguishes COPD from asthma. Proper
spirometry technique is essential for an accurate diagnosis in primary care settings.
5. A 72-year-old male is found to have a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space. Where does this murmur typically radiate?
A. To the left axilla
B. To the xiphoid process
C. To the carotid arteries
D. To the back
Answer: C
Rationale: A systolic crescendo-decrescendo murmur at the right upper sternal border is
characteristic of aortic stenosis. This murmur often radiates to the carotids because of the
high-velocity blood flow through the narrowed aortic valve. It is frequently associated with
symptoms of exertional dyspnea, syncope, or chest pain.
