NUR 6111 Exam 4 V1 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 45-year-old male presents with epigastric pain that is relieved by food but returns 2-3
hours after a meal. Which diagnosis is most consistent with this clinical presentation?
A. Gastric ulcer
B. Duodenal ulcer
C. Gastroesophageal reflux disease (GERD)
D. Acute pancreatitis
Answer: B
Rationale: Duodenal ulcers are classically characterized by ‘hunger pain’ that is
temporarily relieved by food or antacids. This occurs because the food buffers the acid in
the stomach before it enters the duodenum. In contrast, gastric ulcer pain is often
exacerbated by eating due to increased acid secretion.
2. During a physical exam, the nurse practitioner elicits sharp pain upon deep inspiration
while palpating the right upper quadrant. This finding is documented as a positive:
A. Rovsing sign
B. Psoas sign
,C. Murphy’s sign
D. McBurney’s sign
Answer: C
Rationale: Murphy’s sign is a clinical indicator of acute cholecystitis. It is performed by
having the patient inspire deeply while the examiner’s hand is placed under the right costal
margin. A positive test occurs when the patient catches their breath due to the gallbladder
coming in contact with the examiner’s hand.
3. A 68-year-old male presents with a sudden onset of painless gross hematuria. What is the
most critical condition the nurse practitioner must rule out?
A. Urolithiasis
B. Acute prostatitis
C. Bladder cancer
D. Benign prostatic hyperplasia (BPH)
Answer: C
Rationale: Painless hematuria in an older adult, particularly those with a smoking history,
is highly suspicious for bladder malignancy. While BPH and stones can cause bleeding, they
are rarely painless or the primary concern in this age group. Immediate referral for
cystoscopy and imaging is required to evaluate the urinary tract.
,4. A patient with suspected acute appendicitis exhibits pain in the right lower quadrant when
the left lower quadrant is deeply palpated. What is this sign called?
A. Rovsing’s sign
B. Psoas sign
C. Obturator sign
D. Markle sign
Answer: A
Rationale: Rovsing’s sign is an indicator of peritoneal irritation and is frequently
associated with appendicitis. When the examiner presses on the left side of the abdomen,
the displaced gas causes pressure in the cecum, irritating the inflamed appendix. This
referred pain is a hallmark of the clinical diagnostic process for appendicitis.
5. Which of the following is the first-line treatment for a healthy 30-year-old female
diagnosed with an uncomplicated urinary tract infection (UTI)?
A. Nitrofurantoin (Macrobid) 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 7 days
C. Amoxicillin 500 mg TID for 10 days
D. Doxycycline 100 mg BID for 7 days
Answer: A
, Rationale: Nitrofurantoin is considered first-line therapy for uncomplicated cystitis
according to current IDSA guidelines. It has a low rate of resistance and provides excellent
coverage for E. coli. Fluoroquinolones like ciprofloxacin should be reserved for more
complicated infections or when other options are not viable.
6. A 60-year-old patient presents with new-onset constipation and thin, pencil-like stools.
Which diagnostic test is most essential to order?
A. Fecal occult blood test (FOBT)
B. Colonoscopy
C. Abdominal ultrasound
D. Barium enema
Answer: B
Rationale: Pencil-thin stools in an older adult are a ‘red flag’ sign for colorectal cancer,
specifically left-sided lesions that narrow the intestinal lumen. A colonoscopy is the
definitive diagnostic tool as it allows for direct visualization and biopsy of any masses.
Delaying this study could lead to a late-stage diagnosis of malignancy.
7. Which physical exam maneuver is specifically used to assess for a tear in the meniscus of
the knee?
A. Lachman test
B. Valgus stress test
C. Anterior drawer test
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 45-year-old male presents with epigastric pain that is relieved by food but returns 2-3
hours after a meal. Which diagnosis is most consistent with this clinical presentation?
A. Gastric ulcer
B. Duodenal ulcer
C. Gastroesophageal reflux disease (GERD)
D. Acute pancreatitis
Answer: B
Rationale: Duodenal ulcers are classically characterized by ‘hunger pain’ that is
temporarily relieved by food or antacids. This occurs because the food buffers the acid in
the stomach before it enters the duodenum. In contrast, gastric ulcer pain is often
exacerbated by eating due to increased acid secretion.
2. During a physical exam, the nurse practitioner elicits sharp pain upon deep inspiration
while palpating the right upper quadrant. This finding is documented as a positive:
A. Rovsing sign
B. Psoas sign
,C. Murphy’s sign
D. McBurney’s sign
Answer: C
Rationale: Murphy’s sign is a clinical indicator of acute cholecystitis. It is performed by
having the patient inspire deeply while the examiner’s hand is placed under the right costal
margin. A positive test occurs when the patient catches their breath due to the gallbladder
coming in contact with the examiner’s hand.
3. A 68-year-old male presents with a sudden onset of painless gross hematuria. What is the
most critical condition the nurse practitioner must rule out?
A. Urolithiasis
B. Acute prostatitis
C. Bladder cancer
D. Benign prostatic hyperplasia (BPH)
Answer: C
Rationale: Painless hematuria in an older adult, particularly those with a smoking history,
is highly suspicious for bladder malignancy. While BPH and stones can cause bleeding, they
are rarely painless or the primary concern in this age group. Immediate referral for
cystoscopy and imaging is required to evaluate the urinary tract.
,4. A patient with suspected acute appendicitis exhibits pain in the right lower quadrant when
the left lower quadrant is deeply palpated. What is this sign called?
A. Rovsing’s sign
B. Psoas sign
C. Obturator sign
D. Markle sign
Answer: A
Rationale: Rovsing’s sign is an indicator of peritoneal irritation and is frequently
associated with appendicitis. When the examiner presses on the left side of the abdomen,
the displaced gas causes pressure in the cecum, irritating the inflamed appendix. This
referred pain is a hallmark of the clinical diagnostic process for appendicitis.
5. Which of the following is the first-line treatment for a healthy 30-year-old female
diagnosed with an uncomplicated urinary tract infection (UTI)?
A. Nitrofurantoin (Macrobid) 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 7 days
C. Amoxicillin 500 mg TID for 10 days
D. Doxycycline 100 mg BID for 7 days
Answer: A
, Rationale: Nitrofurantoin is considered first-line therapy for uncomplicated cystitis
according to current IDSA guidelines. It has a low rate of resistance and provides excellent
coverage for E. coli. Fluoroquinolones like ciprofloxacin should be reserved for more
complicated infections or when other options are not viable.
6. A 60-year-old patient presents with new-onset constipation and thin, pencil-like stools.
Which diagnostic test is most essential to order?
A. Fecal occult blood test (FOBT)
B. Colonoscopy
C. Abdominal ultrasound
D. Barium enema
Answer: B
Rationale: Pencil-thin stools in an older adult are a ‘red flag’ sign for colorectal cancer,
specifically left-sided lesions that narrow the intestinal lumen. A colonoscopy is the
definitive diagnostic tool as it allows for direct visualization and biopsy of any masses.
Delaying this study could lead to a late-stage diagnosis of malignancy.
7. Which physical exam maneuver is specifically used to assess for a tear in the meniscus of
the knee?
A. Lachman test
B. Valgus stress test
C. Anterior drawer test
