NSG 500 Final Exam V1 | NSG 500
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. During a physical examination, the Nurse Practitioner notes a low-pitched, mid-diastolic
rumbling murmur heard best at the apex with the patient in the left lateral decubitus
position. Which condition is most likely indicated?
A. Aortic Regurgitation
B. Mitral Valve Prolapse
C. Mitral Stenosis
D. Tricuspid Regurgitation
Answer: C
Rationale: Mitral stenosis is typically characterized by a low-pitched diastolic rumble
heard best at the apex. Using the bell of the stethoscope and placing the patient in the left
lateral decubitus position enhances the detection of this specific murmur. This clinical
finding often results from rheumatic heart disease or calcification of the mitral valve in
older adults.
2. When performing the Rinne test, a patient reports that bone conduction is longer than air
conduction in the right ear. How should the clinician document this finding?
A. Sensorineural hearing loss in the right ear
,B. Presbycusis
C. Normal hearing in the right ear
D. Conductive hearing loss in the right ear
Answer: D
Rationale: In conductive hearing loss, bone conduction (BC) is heard longer than or equal
to air conduction (AC), which is a negative Rinne test. Normal hearing and sensorineural
hearing loss both show AC greater than BC. This finding suggests an obstruction or
pathology in the external or middle ear that prevents sound from reaching the cochlea
effectively.
3. A 45-year-old female presents with acute right upper quadrant pain that radiates to the
right scapula. On examination, she experiences a sharp halt in inspiration when the clinician
palpates deeply under the right costal margin. This sign is known as:
A. McBurney’s sign
B. Psoas sign
C. Murphy’s sign
D. Rovsing’s sign
Answer: C
Rationale: Murphy’s sign is a classic clinical indicator of acute cholecystitis. When the
inflamed gallbladder comes into contact with the examiner’s hand during deep inspiration,
, the patient experiences sharp pain and abruptly stops breathing. This assessment
technique is essential for differentiating gallbladder disease from other causes of
abdominal pain.
4. Which of the following cranial nerves is primarily responsible for the motor function of the
tongue?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. CN XI (Spinal Accessory)
Answer: C
Rationale: Cranial Nerve XII, the Hypoglossal nerve, provides motor innervation to all
intrinsic and extrinsic muscles of the tongue except the palatoglossus. Assessment is
performed by asking the patient to stick out their tongue and checking for deviation or
atrophy. Weakness or deviation to one side suggests a lesion of the hypoglossal nerve on
that specific side.
5. While assessing a patient’s respiratory system, the clinician hears a loud, high-pitched,
musical sound during inspiration. What is this sound most likely associated with?
A. Wheezing
B. Stridor
C. Coarse crackles
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. During a physical examination, the Nurse Practitioner notes a low-pitched, mid-diastolic
rumbling murmur heard best at the apex with the patient in the left lateral decubitus
position. Which condition is most likely indicated?
A. Aortic Regurgitation
B. Mitral Valve Prolapse
C. Mitral Stenosis
D. Tricuspid Regurgitation
Answer: C
Rationale: Mitral stenosis is typically characterized by a low-pitched diastolic rumble
heard best at the apex. Using the bell of the stethoscope and placing the patient in the left
lateral decubitus position enhances the detection of this specific murmur. This clinical
finding often results from rheumatic heart disease or calcification of the mitral valve in
older adults.
2. When performing the Rinne test, a patient reports that bone conduction is longer than air
conduction in the right ear. How should the clinician document this finding?
A. Sensorineural hearing loss in the right ear
,B. Presbycusis
C. Normal hearing in the right ear
D. Conductive hearing loss in the right ear
Answer: D
Rationale: In conductive hearing loss, bone conduction (BC) is heard longer than or equal
to air conduction (AC), which is a negative Rinne test. Normal hearing and sensorineural
hearing loss both show AC greater than BC. This finding suggests an obstruction or
pathology in the external or middle ear that prevents sound from reaching the cochlea
effectively.
3. A 45-year-old female presents with acute right upper quadrant pain that radiates to the
right scapula. On examination, she experiences a sharp halt in inspiration when the clinician
palpates deeply under the right costal margin. This sign is known as:
A. McBurney’s sign
B. Psoas sign
C. Murphy’s sign
D. Rovsing’s sign
Answer: C
Rationale: Murphy’s sign is a classic clinical indicator of acute cholecystitis. When the
inflamed gallbladder comes into contact with the examiner’s hand during deep inspiration,
, the patient experiences sharp pain and abruptly stops breathing. This assessment
technique is essential for differentiating gallbladder disease from other causes of
abdominal pain.
4. Which of the following cranial nerves is primarily responsible for the motor function of the
tongue?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XII (Hypoglossal)
D. CN XI (Spinal Accessory)
Answer: C
Rationale: Cranial Nerve XII, the Hypoglossal nerve, provides motor innervation to all
intrinsic and extrinsic muscles of the tongue except the palatoglossus. Assessment is
performed by asking the patient to stick out their tongue and checking for deviation or
atrophy. Weakness or deviation to one side suggests a lesion of the hypoglossal nerve on
that specific side.
5. While assessing a patient’s respiratory system, the clinician hears a loud, high-pitched,
musical sound during inspiration. What is this sound most likely associated with?
A. Wheezing
B. Stridor
C. Coarse crackles
