Wilkes University
3 MAXE · 005 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
Advanced Health Assessment NSG 500 Exam 3
R E CTA L , M US CU LO S K E L E TA L , N E U R O LO G I C A L & S P E C I A L P O P U L AT I O N S A SS E SS M E N T
INSTITUTION Wilkes University COURSE CODE NSG 500
PROGRAM Master of Science in Nursing — FNP EXAM Exam 3 — Comprehensive Systems
Assessment
EXAM TITLE Advanced Health Assessment NSG 500 TOTAL QUESTIONS 80 Questions
Exam 3
COURSE TITLE Advanced Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Rectal/prostate examination, musculoskeletal examination (special tests, ROM, strength grading), neurological
examination (cranial nerves, reflexes, sensory testing), headache types, and geriatric/developmental assessment are all
testable content.
▸ Differentiation of OA vs. RA, gout vs. septic arthritis, meningitis signs, and spinal stenosis are emphasized.
▸ Correct answers and clinical rationales appear below each question for comprehensive exam preparation.
▸ All content reflects advanced health assessment standards and NSG 500 course objectives.
, SECTION I — ADVANCED HEALTH ASSESSMENT: RECTAL, MSK, NEURO
Questions 1 – 80
& SPECIAL POPULATIONS
1. The correct position for performing a rectal/prostate examination is:
A. Supine with legs extended
B. Side-lying position — this allows optimal access to the anus and prostate
C. Standing upright
D. Prone position
CORRECT ANSWER B — Side-lying position
RATIONALE The side-lying (left lateral decubitus or Sims') position is the standard position for digital rectal
examination and prostate palpation. The patient lies on their left side with knees flexed toward the
chest. This position allows optimal access to the anorectal area, relaxes the pelvic musculature,
and permits the examiner to palpate the posterior surface of the prostate gland through the
anterior rectal wall. Supine (Choice A), standing (Choice C), and prone (Choice D) positions do not
provide adequate access or relaxation for this examination. The NSG 500 emphasizes proper
patient positioning as essential for accurate assessment and patient comfort during intimate
examinations.
2. The general sequence of the musculoskeletal examination is:
A. Palpate, inspect, assess ROM, perform stability tests
B. Inspect, palpate, assess passive and active range of motion, and assess joint stability
C. Auscultate, percuss, palpate, inspect
D. Assess ROM first, then inspect, then palpate
CORRECT ANSWER B — Inspect, palpate, assess passive/active ROM, assess joint stability
RATIONALE The standard musculoskeletal examination sequence is: (1) Inspection — observe joint symmetry,
deformities, swelling, erythema, muscle atrophy; (2) Palpation — assess for tenderness, warmth,
effusion (boggy/spongy feel indicating fluid), crepitus; (3) Range of Motion — assess both active
(patient moves) and passive (examiner moves) ROM, noting limitations, pain, or asymmetry; (4)
Joint stability/special tests — stress the joint (e.g., Lachman test for ACL, McMurray for meniscus,
Neer's/Hawkins for rotator cuff) to assess ligament and tendon integrity. Choice A reverses the
order. Choice C describes the general physical exam sequence, not specifically MSK. Choice D is
incorrect. The NSG 500 emphasizes that stability testing is performed LAST after inflammation or
acute injury has been assessed.
,3. What does a normal prostate feel like on palpation?
A. Hard, nodular, and irregular
B. Rubbery and smooth — approximately 4 cm, with a palpable median sulcus
C. Soft and fluctuant with pus
D. Enlarged, firm, and tender
CORRECT ANSWER B — Rubbery and smooth — approximately 4 cm with palpable median sulcus
RATIONALE The normal prostate gland palpated through the anterior rectal wall feels rubbery and smooth,
approximately 4 cm in diameter, with a palpable median sulcus (groove) separating the right and
left lobes. It should be non-tender. During the exam, the posterior surface of the prostate is
palpated. A hard, nodular, irregular prostate (Choice A) suggests prostate cancer and requires
further evaluation with PSA and biopsy. Soft and fluctuant (Choice C) suggests prostatic abscess.
Enlarged, firm, and tender (Choice D) suggests acute prostatitis. The NSG 500 emphasizes that
prostate examination is an essential component of the male preventive health examination,
particularly in men over 50 (or over 45 for high-risk groups).
4. The general sequence of the neurological examination is:
A. Reflexes, strength, sensation, cranial nerves, gait, mental status
B. Level of consciousness/mental status, cranial nerves I–XII, sensation, strength, coordination, reflexes, gait,
and inspection of skull/spine
C. Gait, strength, cranial nerves, mental status
D. Coordination, reflexes, cranial nerves, sensation
CORRECT ANSWER B — LOC/mental status → CN I–XII → sensation → strength → coordination → reflexes →
gait → skull/spine inspection
RATIONALE The systematic neurological examination proceeds from higher cortical function to peripheral
function: (1) Level of consciousness/mental status (GCS, orientation, cognition); (2) Cranial nerves
I–XII (olfactory, visual acuity/fields, pupillary response, extraocular movements, facial sensation
and movement, hearing, gag, shoulder shrug, tongue); (3) Sensation (upper and lower extremity —
pain, temperature, light touch, vibration, proprioception); (4) Strength (graded 0–5); (5)
Coordination (finger-to-nose, heel-to-shin, rapid alternating movements); (6) Deep tendon reflexes
(biceps, brachioradialis, triceps, patellar, Achilles); (7) Gait and balance (including Romberg test);
(8) Inspection of skull and spine. Choice A and D are out of sequence. The NSG 500 emphasizes this
organized approach to avoid missing findings.
, 5. How do you know that someone has rectal prolapse?
A. The patient reports chronic constipation
B. There is sliding of the rectum through the anus — visible protrusion of rectal mucosa, especially during
straining or Valsalva maneuver
C. Digital examination reveals a hard, fixed mass
D. The patient has bright red blood per rectum
CORRECT ANSWER B — Visible sliding of the rectum through the anus during straining
RATIONALE Rectal prolapse is the protrusion of rectal mucosa or the full thickness of the rectal wall through the
anal opening. It is best demonstrated by asking the patient to bear down (Valsalva maneuver) or
strain — the prolapse becomes visible externally. Chronic constipation (Choice A) is a risk factor, not
the diagnostic finding. A hard fixed mass (Choice C) suggests malignancy. Bright red blood (Choice
D) may occur with hemorrhoids, fissures, or lower GI bleeding but is not specific for prolapse. The
NSG 500 emphasizes that rectal prolapse is a clinical diagnosis made by direct visualization during
straining — the finding may not be present when the patient is at rest.
6. The Lachman test is used to assess for:
A. Meniscal tear
B. ACL tear — the Lachman test is the most sensitive test for anterior cruciate ligament integrity
C. Rotator cuff tear
D. Carpal tunnel syndrome
CORRECT ANSWER B — ACL tear — the most sensitive test for anterior cruciate ligament integrity
RATIONALE The Lachman test is the most sensitive physical examination test for ACL (anterior cruciate
ligament) tears. Technique: the patient lies supine with the knee flexed approximately 20–30
degrees. The examiner stabilizes the femur with one hand while pulling the tibia anteriorly with the
other. Excessive anterior translation of the tibia with a soft or absent endpoint compared to the
uninjured knee indicates ACL insufficiency. The McMurray test (Choice A) assesses meniscal tears.
Neer's, Hawkins, and drop arm tests (Choice C) assess rotator cuff pathology. Tinel and Phalen tests
(Choice D) assess carpal tunnel syndrome. The NSG 500 emphasizes using the correct special test
for each suspected injury.
3 MAXE · 005 GSN
W
Passan School of Nursing
EST. 1933
UNITY AMIDST DIVERSITY
Advanced Health Assessment NSG 500 Exam 3
R E CTA L , M US CU LO S K E L E TA L , N E U R O LO G I C A L & S P E C I A L P O P U L AT I O N S A SS E SS M E N T
INSTITUTION Wilkes University COURSE CODE NSG 500
PROGRAM Master of Science in Nursing — FNP EXAM Exam 3 — Comprehensive Systems
Assessment
EXAM TITLE Advanced Health Assessment NSG 500 TOTAL QUESTIONS 80 Questions
Exam 3
COURSE TITLE Advanced Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Rectal/prostate examination, musculoskeletal examination (special tests, ROM, strength grading), neurological
examination (cranial nerves, reflexes, sensory testing), headache types, and geriatric/developmental assessment are all
testable content.
▸ Differentiation of OA vs. RA, gout vs. septic arthritis, meningitis signs, and spinal stenosis are emphasized.
▸ Correct answers and clinical rationales appear below each question for comprehensive exam preparation.
▸ All content reflects advanced health assessment standards and NSG 500 course objectives.
, SECTION I — ADVANCED HEALTH ASSESSMENT: RECTAL, MSK, NEURO
Questions 1 – 80
& SPECIAL POPULATIONS
1. The correct position for performing a rectal/prostate examination is:
A. Supine with legs extended
B. Side-lying position — this allows optimal access to the anus and prostate
C. Standing upright
D. Prone position
CORRECT ANSWER B — Side-lying position
RATIONALE The side-lying (left lateral decubitus or Sims') position is the standard position for digital rectal
examination and prostate palpation. The patient lies on their left side with knees flexed toward the
chest. This position allows optimal access to the anorectal area, relaxes the pelvic musculature,
and permits the examiner to palpate the posterior surface of the prostate gland through the
anterior rectal wall. Supine (Choice A), standing (Choice C), and prone (Choice D) positions do not
provide adequate access or relaxation for this examination. The NSG 500 emphasizes proper
patient positioning as essential for accurate assessment and patient comfort during intimate
examinations.
2. The general sequence of the musculoskeletal examination is:
A. Palpate, inspect, assess ROM, perform stability tests
B. Inspect, palpate, assess passive and active range of motion, and assess joint stability
C. Auscultate, percuss, palpate, inspect
D. Assess ROM first, then inspect, then palpate
CORRECT ANSWER B — Inspect, palpate, assess passive/active ROM, assess joint stability
RATIONALE The standard musculoskeletal examination sequence is: (1) Inspection — observe joint symmetry,
deformities, swelling, erythema, muscle atrophy; (2) Palpation — assess for tenderness, warmth,
effusion (boggy/spongy feel indicating fluid), crepitus; (3) Range of Motion — assess both active
(patient moves) and passive (examiner moves) ROM, noting limitations, pain, or asymmetry; (4)
Joint stability/special tests — stress the joint (e.g., Lachman test for ACL, McMurray for meniscus,
Neer's/Hawkins for rotator cuff) to assess ligament and tendon integrity. Choice A reverses the
order. Choice C describes the general physical exam sequence, not specifically MSK. Choice D is
incorrect. The NSG 500 emphasizes that stability testing is performed LAST after inflammation or
acute injury has been assessed.
,3. What does a normal prostate feel like on palpation?
A. Hard, nodular, and irregular
B. Rubbery and smooth — approximately 4 cm, with a palpable median sulcus
C. Soft and fluctuant with pus
D. Enlarged, firm, and tender
CORRECT ANSWER B — Rubbery and smooth — approximately 4 cm with palpable median sulcus
RATIONALE The normal prostate gland palpated through the anterior rectal wall feels rubbery and smooth,
approximately 4 cm in diameter, with a palpable median sulcus (groove) separating the right and
left lobes. It should be non-tender. During the exam, the posterior surface of the prostate is
palpated. A hard, nodular, irregular prostate (Choice A) suggests prostate cancer and requires
further evaluation with PSA and biopsy. Soft and fluctuant (Choice C) suggests prostatic abscess.
Enlarged, firm, and tender (Choice D) suggests acute prostatitis. The NSG 500 emphasizes that
prostate examination is an essential component of the male preventive health examination,
particularly in men over 50 (or over 45 for high-risk groups).
4. The general sequence of the neurological examination is:
A. Reflexes, strength, sensation, cranial nerves, gait, mental status
B. Level of consciousness/mental status, cranial nerves I–XII, sensation, strength, coordination, reflexes, gait,
and inspection of skull/spine
C. Gait, strength, cranial nerves, mental status
D. Coordination, reflexes, cranial nerves, sensation
CORRECT ANSWER B — LOC/mental status → CN I–XII → sensation → strength → coordination → reflexes →
gait → skull/spine inspection
RATIONALE The systematic neurological examination proceeds from higher cortical function to peripheral
function: (1) Level of consciousness/mental status (GCS, orientation, cognition); (2) Cranial nerves
I–XII (olfactory, visual acuity/fields, pupillary response, extraocular movements, facial sensation
and movement, hearing, gag, shoulder shrug, tongue); (3) Sensation (upper and lower extremity —
pain, temperature, light touch, vibration, proprioception); (4) Strength (graded 0–5); (5)
Coordination (finger-to-nose, heel-to-shin, rapid alternating movements); (6) Deep tendon reflexes
(biceps, brachioradialis, triceps, patellar, Achilles); (7) Gait and balance (including Romberg test);
(8) Inspection of skull and spine. Choice A and D are out of sequence. The NSG 500 emphasizes this
organized approach to avoid missing findings.
, 5. How do you know that someone has rectal prolapse?
A. The patient reports chronic constipation
B. There is sliding of the rectum through the anus — visible protrusion of rectal mucosa, especially during
straining or Valsalva maneuver
C. Digital examination reveals a hard, fixed mass
D. The patient has bright red blood per rectum
CORRECT ANSWER B — Visible sliding of the rectum through the anus during straining
RATIONALE Rectal prolapse is the protrusion of rectal mucosa or the full thickness of the rectal wall through the
anal opening. It is best demonstrated by asking the patient to bear down (Valsalva maneuver) or
strain — the prolapse becomes visible externally. Chronic constipation (Choice A) is a risk factor, not
the diagnostic finding. A hard fixed mass (Choice C) suggests malignancy. Bright red blood (Choice
D) may occur with hemorrhoids, fissures, or lower GI bleeding but is not specific for prolapse. The
NSG 500 emphasizes that rectal prolapse is a clinical diagnosis made by direct visualization during
straining — the finding may not be present when the patient is at rest.
6. The Lachman test is used to assess for:
A. Meniscal tear
B. ACL tear — the Lachman test is the most sensitive test for anterior cruciate ligament integrity
C. Rotator cuff tear
D. Carpal tunnel syndrome
CORRECT ANSWER B — ACL tear — the most sensitive test for anterior cruciate ligament integrity
RATIONALE The Lachman test is the most sensitive physical examination test for ACL (anterior cruciate
ligament) tears. Technique: the patient lies supine with the knee flexed approximately 20–30
degrees. The examiner stabilizes the femur with one hand while pulling the tibia anteriorly with the
other. Excessive anterior translation of the tibia with a soft or absent endpoint compared to the
uninjured knee indicates ACL insufficiency. The McMurray test (Choice A) assesses meniscal tears.
Neer's, Hawkins, and drop arm tests (Choice C) assess rotator cuff pathology. Tinel and Phalen tests
(Choice D) assess carpal tunnel syndrome. The NSG 500 emphasizes using the correct special test
for each suspected injury.
