NSG 500 Final Exam V3 | NSG 500
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. During a cardiac assessment, the nurse practitioner notes a low-pitched, mid-diastolic
murmur best heard at the apex with the patient in the left lateral decubitus position. This
finding most likely indicates:
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Tricuspid Stenosis
Answer: C
Rationale: Mitral stenosis typically presents as a low-pitched rumbling murmur occurring
in mid-diastole. It is best localized at the apex using the bell of the stethoscope while the
patient is in the left lateral decubitus position. This position brings the left atrium and
ventricle closer to the chest wall, enhancing the sound of the restricted blood flow through
the mitral valve.
,2. A 45-year-old patient presents with sudden onset of severe right upper quadrant pain that
radiates to the right scapula. On examination, the patient halts inspiration during deep
palpation of the right subcostal area. This is known as a positive:
A. Murphy Sign
B. Psoas Sign
C. Rovsing Sign
D. McBurney Sign
Answer: A
Rationale: A positive Murphy sign is highly suggestive of acute cholecystitis. It occurs
when the inflamed gallbladder comes into contact with the examiner’s hand during deep
inspiration, causing the patient to stop breathing mid-cycle due to pain. Rovsing and Psoas
signs are typically associated with appendicitis rather than biliary issues.
3. When assessing the cranial nerves, the practitioner asks the patient to stick out their
tongue and move it from side to side. Which cranial nerve is being evaluated?
A. CN IX (Glossopharyngeal)
B. CN XII (Hypoglossal)
C. CN X (Vagus)
D. CN VII (Facial)
Answer: B
, Rationale: Cranial Nerve XII, the hypoglossal nerve, is responsible for the motor
movement of the tongue. Deviation to one side or the inability to move the tongue
symmetrically suggests a lesion of this nerve. CN IX and X are primarily involved in the gag
reflex and swallowing, while CN VII controls facial expressions.
4. Which of the following findings on a fundoscopic examination is most characteristic of
chronic hypertension?
A. Cotton wool spots
B. Arteriovenous (AV) nicking
C. Papilledema
D. Neovascularization
Answer: B
Rationale: AV nicking occurs when a thickened retinal artery crosses over a vein, causing
the vein to appear narrowed or ‘nicked.’ This is a classic vascular change associated with
long-standing hypertension. Cotton wool spots represent micro-infarcts and can be seen in
both hypertension and diabetes, while papilledema indicates increased intracranial
pressure.
5. While performing a respiratory assessment, the practitioner notes increased tactile
fremitus over the right lower lobe. This finding is most consistent with:
A. Lobar Pneumonia
B. Pleural Effusion
Advanced Health Assessment | Wilkes
University | 2026 Q&A with Rationale
(Wilkes NSG500 Final Exam 2026)
1. During a cardiac assessment, the nurse practitioner notes a low-pitched, mid-diastolic
murmur best heard at the apex with the patient in the left lateral decubitus position. This
finding most likely indicates:
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Stenosis
D. Tricuspid Stenosis
Answer: C
Rationale: Mitral stenosis typically presents as a low-pitched rumbling murmur occurring
in mid-diastole. It is best localized at the apex using the bell of the stethoscope while the
patient is in the left lateral decubitus position. This position brings the left atrium and
ventricle closer to the chest wall, enhancing the sound of the restricted blood flow through
the mitral valve.
,2. A 45-year-old patient presents with sudden onset of severe right upper quadrant pain that
radiates to the right scapula. On examination, the patient halts inspiration during deep
palpation of the right subcostal area. This is known as a positive:
A. Murphy Sign
B. Psoas Sign
C. Rovsing Sign
D. McBurney Sign
Answer: A
Rationale: A positive Murphy sign is highly suggestive of acute cholecystitis. It occurs
when the inflamed gallbladder comes into contact with the examiner’s hand during deep
inspiration, causing the patient to stop breathing mid-cycle due to pain. Rovsing and Psoas
signs are typically associated with appendicitis rather than biliary issues.
3. When assessing the cranial nerves, the practitioner asks the patient to stick out their
tongue and move it from side to side. Which cranial nerve is being evaluated?
A. CN IX (Glossopharyngeal)
B. CN XII (Hypoglossal)
C. CN X (Vagus)
D. CN VII (Facial)
Answer: B
, Rationale: Cranial Nerve XII, the hypoglossal nerve, is responsible for the motor
movement of the tongue. Deviation to one side or the inability to move the tongue
symmetrically suggests a lesion of this nerve. CN IX and X are primarily involved in the gag
reflex and swallowing, while CN VII controls facial expressions.
4. Which of the following findings on a fundoscopic examination is most characteristic of
chronic hypertension?
A. Cotton wool spots
B. Arteriovenous (AV) nicking
C. Papilledema
D. Neovascularization
Answer: B
Rationale: AV nicking occurs when a thickened retinal artery crosses over a vein, causing
the vein to appear narrowed or ‘nicked.’ This is a classic vascular change associated with
long-standing hypertension. Cotton wool spots represent micro-infarcts and can be seen in
both hypertension and diabetes, while papilledema indicates increased intracranial
pressure.
5. While performing a respiratory assessment, the practitioner notes increased tactile
fremitus over the right lower lobe. This finding is most consistent with:
A. Lobar Pneumonia
B. Pleural Effusion
