NSG 500 Final Exam V2 | NSG 500
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. A 55-year-old patient presents with a ‘blowing’ holosystolic murmur heard best at the apex
and radiating to the axilla. Which of the following conditions is most likely?
A. Mitral Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Tricuspid Stenosis
Answer: B
Rationale: Mitral regurgitation is characterized by a high-pitched, holosystolic murmur
heard best at the apex with radiation to the left axilla. This sound occurs because blood
flows back into the left atrium during ventricular systole. The clinician must differentiate
this from aortic stenosis, which is typically a crescendodecrescendo murmur heard best at
the base.
2. When performing a physical assessment on an older adult, which finding is considered a
normal age-related change in the respiratory system?
A. Increased elastic recoil of the lungs
,B. Decreased residual volume
C. Increased vital capacity
D. Increased anteroposterior diameter
Answer: D
Rationale: As people age, the chest wall becomes stiffer and the anteroposterior diameter
often increases, sometimes leading to a barrel-chest appearance. There is also a decrease in
elastic recoil and an increase in residual volume. Vital capacity typically decreases rather
than increases in the geriatric population.
3. A patient exhibits a positive Murphy sign during an abdominal examination. This finding is
highly suggestive of which condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenic Infarction
D. Renal Calculi
Answer: A
Rationale: Murphy sign is elicited by palpating the right upper quadrant while the patient
takes a deep breath. If the patient experiences sharp pain and abruptly stops inspiration as
the gallbladder descends against the examiner’s hand, it is considered positive. This
maneuver is a classic clinical indicator for acute cholecystitis.
, 4. During a neurological exam, the clinician asks the patient to identify a common object,
such as a key, placed in their hand while their eyes are closed. What is this test called?
A. Graphesthesia
B. Stereognosis
C. Proprioception
D. Two-point discrimination
Answer: B
Rationale: Stereognosis is the ability to recognize the form and nature of an object by
touch alone. It requires intact sensory cortex function and peripheral nerve pathways.
Graphesthesia refers to the ability to recognize numbers or letters written on the skin,
while proprioception refers to the sense of body position.
5. Which cranial nerve is being assessed when the clinician asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
Answer: B
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. A 55-year-old patient presents with a ‘blowing’ holosystolic murmur heard best at the apex
and radiating to the axilla. Which of the following conditions is most likely?
A. Mitral Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Tricuspid Stenosis
Answer: B
Rationale: Mitral regurgitation is characterized by a high-pitched, holosystolic murmur
heard best at the apex with radiation to the left axilla. This sound occurs because blood
flows back into the left atrium during ventricular systole. The clinician must differentiate
this from aortic stenosis, which is typically a crescendodecrescendo murmur heard best at
the base.
2. When performing a physical assessment on an older adult, which finding is considered a
normal age-related change in the respiratory system?
A. Increased elastic recoil of the lungs
,B. Decreased residual volume
C. Increased vital capacity
D. Increased anteroposterior diameter
Answer: D
Rationale: As people age, the chest wall becomes stiffer and the anteroposterior diameter
often increases, sometimes leading to a barrel-chest appearance. There is also a decrease in
elastic recoil and an increase in residual volume. Vital capacity typically decreases rather
than increases in the geriatric population.
3. A patient exhibits a positive Murphy sign during an abdominal examination. This finding is
highly suggestive of which condition?
A. Acute Cholecystitis
B. Acute Appendicitis
C. Splenic Infarction
D. Renal Calculi
Answer: A
Rationale: Murphy sign is elicited by palpating the right upper quadrant while the patient
takes a deep breath. If the patient experiences sharp pain and abruptly stops inspiration as
the gallbladder descends against the examiner’s hand, it is considered positive. This
maneuver is a classic clinical indicator for acute cholecystitis.
, 4. During a neurological exam, the clinician asks the patient to identify a common object,
such as a key, placed in their hand while their eyes are closed. What is this test called?
A. Graphesthesia
B. Stereognosis
C. Proprioception
D. Two-point discrimination
Answer: B
Rationale: Stereognosis is the ability to recognize the form and nature of an object by
touch alone. It requires intact sensory cortex function and peripheral nerve pathways.
Graphesthesia refers to the ability to recognize numbers or letters written on the skin,
while proprioception refers to the sense of body position.
5. Which cranial nerve is being assessed when the clinician asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
Answer: B
