NUR 6111 Exam 4 V3 | NUR 6111
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 65-year-old patient presents with a pearly, translucent papule on the nose that has
visible telangiectasias and a central depression. Which of the following is the most likely
diagnosis?
A. Actinic Keratosis
B. Squamous Cell Carcinoma
C. Basal Cell Carcinoma
D. Malignant Melanoma
Answer: C
Rationale: Basal cell carcinoma is the most common form of skin cancer and typically
presents as a pearly or waxy nodule. The presence of telangiectasias and a rolled border
are classic clinical features seen in primary care settings. Early recognition is vital as these
lesions, while slow-growing, can cause significant local tissue destruction if left untreated.
,2. During a physical examination, the advanced practice nurse notes a grade III/VI
holosystolic murmur heard best at the apex, radiating to the left axilla. This finding is most
consistent with:
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Valve Prolapse
D. Tricuspid Stenosis
Answer: B
Rationale: Mitral regurgitation is characterized by a high-pitched holosystolic murmur
that is best heard at the apex of the heart. The radiation to the axilla is a key diagnostic
differentiator from other systolic murmurs like aortic stenosis. This condition occurs when
the mitral valve fails to close completely during ventricular systole, leading to retrograde
flow into the left atrium.
3. A patient complains of acute onset of severe eye pain, blurred vision, and seeing halos
around lights. Physical exam reveals a hazy cornea and a mid-dilated pupil. What is the most
likely diagnosis?
A. Open-angle Glaucoma
B. Cataracts
C. Acute Angle-closure Glaucoma
D. Bacterial Conjunctivitis
, Answer: C
Rationale: Acute angle-closure glaucoma is a medical emergency caused by a rapid
increase in intraocular pressure. Symptoms typically include sudden ocular pain, headache,
and decreased visual acuity with characteristic halos. Immediate referral to an
ophthalmologist is required to prevent permanent vision loss due to optic nerve damage.
4. Which physical exam maneuver is specifically used to assess for an anterior cruciate
ligament (ACL) tear?
A. McMurray Test
B. Phalen’s Sign
C. Lachman Test
D. Empty Can Test
Answer: C
Rationale: The Lachman test is considered the most sensitive clinical physical exam
maneuver for detecting an ACL injury. The clinician stabilizes the femur and pulls the tibia
anteriorly to assess for excessive forward displacement and the quality of the endpoint. A
soft or absent endpoint indicates a positive result and potential ligamentous rupture.
5. A patient presents with sudden onset of right lower quadrant pain, fever, and nausea. The
APN notes pain in the RLQ when pressure is applied to the LLQ. What is the name of this sign?
A. Murphy’s Sign
B. Rovsing’s Sign
Advanced Practice Nursing I | Q&A with
Rationale (NUR6111 Exam 4) | William
Paterson University
1. A 65-year-old patient presents with a pearly, translucent papule on the nose that has
visible telangiectasias and a central depression. Which of the following is the most likely
diagnosis?
A. Actinic Keratosis
B. Squamous Cell Carcinoma
C. Basal Cell Carcinoma
D. Malignant Melanoma
Answer: C
Rationale: Basal cell carcinoma is the most common form of skin cancer and typically
presents as a pearly or waxy nodule. The presence of telangiectasias and a rolled border
are classic clinical features seen in primary care settings. Early recognition is vital as these
lesions, while slow-growing, can cause significant local tissue destruction if left untreated.
,2. During a physical examination, the advanced practice nurse notes a grade III/VI
holosystolic murmur heard best at the apex, radiating to the left axilla. This finding is most
consistent with:
A. Aortic Stenosis
B. Mitral Regurgitation
C. Mitral Valve Prolapse
D. Tricuspid Stenosis
Answer: B
Rationale: Mitral regurgitation is characterized by a high-pitched holosystolic murmur
that is best heard at the apex of the heart. The radiation to the axilla is a key diagnostic
differentiator from other systolic murmurs like aortic stenosis. This condition occurs when
the mitral valve fails to close completely during ventricular systole, leading to retrograde
flow into the left atrium.
3. A patient complains of acute onset of severe eye pain, blurred vision, and seeing halos
around lights. Physical exam reveals a hazy cornea and a mid-dilated pupil. What is the most
likely diagnosis?
A. Open-angle Glaucoma
B. Cataracts
C. Acute Angle-closure Glaucoma
D. Bacterial Conjunctivitis
, Answer: C
Rationale: Acute angle-closure glaucoma is a medical emergency caused by a rapid
increase in intraocular pressure. Symptoms typically include sudden ocular pain, headache,
and decreased visual acuity with characteristic halos. Immediate referral to an
ophthalmologist is required to prevent permanent vision loss due to optic nerve damage.
4. Which physical exam maneuver is specifically used to assess for an anterior cruciate
ligament (ACL) tear?
A. McMurray Test
B. Phalen’s Sign
C. Lachman Test
D. Empty Can Test
Answer: C
Rationale: The Lachman test is considered the most sensitive clinical physical exam
maneuver for detecting an ACL injury. The clinician stabilizes the femur and pulls the tibia
anteriorly to assess for excessive forward displacement and the quality of the endpoint. A
soft or absent endpoint indicates a positive result and potential ligamentous rupture.
5. A patient presents with sudden onset of right lower quadrant pain, fever, and nausea. The
APN notes pain in the RLQ when pressure is applied to the LLQ. What is the name of this sign?
A. Murphy’s Sign
B. Rovsing’s Sign
