NUR 504 Final Exam - Advanced Health Assessment - (Latest
) Actual Questions & Answers With Rationales |
University Of St. Thomas.
Page 1
,Q1. During assessment of a patient with dyspnea and orthopnea, you measure jugular venous
pressure. Which finding confirms elevated JVP?
A. Visible pulsation at 4 cm above sternal angle with patient at 30 degrees
B. Hepatojugular reflux sustained >3 seconds
C. Carotid upstroke correlates with heartbeat
D. Abolition of pulsation with pressure at base of neck
Correct Answer: B. Hepatojugular reflux sustained >3 seconds
Rationale: Hepatojugular reflux sustained >3 seconds indicates elevated JVP. A is incorrect because 4
cm above sternal angle is normal (<3 cm). C describes carotid artery, not venous. D suggests venous
obstruction or normal variant.
Why Wrong:
A - Normal JVP is <3 cm above sternal angle; 4 cm is within normal range, not elevated.
C - Carotid upstroke is arterial, not venous; JVP is assessed by observing venous pulsations.
D - Abolition of pulsation with pressure at base of neck may occur with normal JVP due to
compression of jugular vein; it does not confirm elevation.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
9.
Q2. A patient suspected of having lung consolidation. Which finding best distinguishes consolidation
from pleural effusion?
A. Egophony with change from 'E' to 'A'
B. Whispered pectoriloquy with clear words
C. Tactile fremitus decreased
D. Dullness to percussion
Correct Answer: A. Egophony with change from 'E' to 'A'
Rationale: Egophony (E to A change) is specific for consolidation due to enhanced transmission of
high-frequency sounds through consolidated tissue. Whispered pectoriloquy can also occur with effusion
but less pronounced. Tactile fremitus is increased in consolidation, decreased in effusion. Dullness to
percussion occurs in both.
Why Wrong:
B - Whispered pectoriloquy is more pronounced in consolidation but can also be present with
effusion; less specific.
C - Tactile fremitus is increased in consolidation, not decreased; decreased fremitus suggests
effusion.
D - Dullness is a common finding in both consolidation and effusion; does not differentiate.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
10.
Page 2
,Q3. A patient presents with ptosis and miosis in the right eye. Which cranial nerve or sympathetic
lesion is most likely?
A. Right CN III (oculomotor) complete palsy
B. Right Horner syndrome (sympathetic denervation)
C. Right CN IV (trochlear) palsy
D. Right CN VI (abducens) palsy
Correct Answer: B. Right Horner syndrome (sympathetic denervation)
Rationale: Ptosis (partial) and miosis (constricted pupil) are classic signs of Horner syndrome due to
sympathetic disruption. CN III palsy causes ptosis but mydriasis (dilated pupil). Trochlear palsy affects
downward gaze; abducens palsy affects lateral gaze; neither causes ptosis or miosis.
Why Wrong:
A - CN III palsy causes ptosis and mydriasis (dilated pupil), not miosis.
C - Trochlear palsy does not cause ptosis or pupil changes; it limits downward gaze.
D - Abducens palsy limits lateral gaze; no ptosis or miosis.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
17.
Q4. A patient with cirrhosis and possible ascites. Which examination technique is most sensitive for
detecting small-volume ascites?
A. Shifting dullness
B. Fluid wave
C. Bulging flanks
D. Caput medusae
Correct Answer: A. Shifting dullness
Rationale: Shifting dullness can detect as little as 500-1000 mL of ascitic fluid. Fluid wave requires
>1500 mL. Bulging flanks is a late sign of large ascites. Caput medusae indicates portal hypertension but
not ascites itself.
Why Wrong:
B - Fluid wave requires a larger volume of ascites (>1500 mL), thus less sensitive for small volumes.
C - Bulging flanks indicate significant ascites, not an early sign.
D - Caput medusae is a sign of portal hypertension, not directly of ascites.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
12.
Page 3
, Q5. A patient reports shoulder pain with overhead activities. Physical exam reveals a positive Neer
test and full passive range of motion. Which condition is most likely?
A. Subacromial impingement syndrome
B. Rotator cuff tear
C. Adhesive capsulitis
D. Glenohumeral instability
Correct Answer: A. Subacromial impingement syndrome
Rationale: Positive Neer test suggests subacromial impingement. Full passive range of motion rules out
adhesive capsulitis. Rotator cuff tear often presents with weakness and positive drop arm test. Instability
usually has apprehension test positive.
Why Wrong:
B - Rotator cuff tear typically shows weakness on active motion and positive drop arm test, not full
strength.
C - Adhesive capsulitis causes limited passive range of motion, which is absent here.
D - Glenohumeral instability often presents with apprehension or instability tests positive.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
15.
Q6. Which maneuver is most specific for confirming that a midline neck mass originates from the
thyroid gland?
A. Ask the patient to swallow while palpating the mass
B. Transilluminate the mass
C. Auscultate for a bruit over the mass
D. Percuss over the mass for dullness
Correct Answer: A. Ask the patient to swallow while palpating the mass
Rationale: The thyroid gland elevates with swallowing due to its attachment to the larynx.
Transillumination helps identify cystic lesions. Auscultation for bruit may indicate hyperthyroidism but
not origin. Percussion is not useful.
Why Wrong:
B - Transillumination identifies cystic nature but not thyroid origin specifically.
C - Bruit suggests hyperthyroidism but not that the mass is thyroid; can occur in other vascular
masses.
D - Percussion does not differentiate thyroid from other tissue.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
8.
Page 4
) Actual Questions & Answers With Rationales |
University Of St. Thomas.
Page 1
,Q1. During assessment of a patient with dyspnea and orthopnea, you measure jugular venous
pressure. Which finding confirms elevated JVP?
A. Visible pulsation at 4 cm above sternal angle with patient at 30 degrees
B. Hepatojugular reflux sustained >3 seconds
C. Carotid upstroke correlates with heartbeat
D. Abolition of pulsation with pressure at base of neck
Correct Answer: B. Hepatojugular reflux sustained >3 seconds
Rationale: Hepatojugular reflux sustained >3 seconds indicates elevated JVP. A is incorrect because 4
cm above sternal angle is normal (<3 cm). C describes carotid artery, not venous. D suggests venous
obstruction or normal variant.
Why Wrong:
A - Normal JVP is <3 cm above sternal angle; 4 cm is within normal range, not elevated.
C - Carotid upstroke is arterial, not venous; JVP is assessed by observing venous pulsations.
D - Abolition of pulsation with pressure at base of neck may occur with normal JVP due to
compression of jugular vein; it does not confirm elevation.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
9.
Q2. A patient suspected of having lung consolidation. Which finding best distinguishes consolidation
from pleural effusion?
A. Egophony with change from 'E' to 'A'
B. Whispered pectoriloquy with clear words
C. Tactile fremitus decreased
D. Dullness to percussion
Correct Answer: A. Egophony with change from 'E' to 'A'
Rationale: Egophony (E to A change) is specific for consolidation due to enhanced transmission of
high-frequency sounds through consolidated tissue. Whispered pectoriloquy can also occur with effusion
but less pronounced. Tactile fremitus is increased in consolidation, decreased in effusion. Dullness to
percussion occurs in both.
Why Wrong:
B - Whispered pectoriloquy is more pronounced in consolidation but can also be present with
effusion; less specific.
C - Tactile fremitus is increased in consolidation, not decreased; decreased fremitus suggests
effusion.
D - Dullness is a common finding in both consolidation and effusion; does not differentiate.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
10.
Page 2
,Q3. A patient presents with ptosis and miosis in the right eye. Which cranial nerve or sympathetic
lesion is most likely?
A. Right CN III (oculomotor) complete palsy
B. Right Horner syndrome (sympathetic denervation)
C. Right CN IV (trochlear) palsy
D. Right CN VI (abducens) palsy
Correct Answer: B. Right Horner syndrome (sympathetic denervation)
Rationale: Ptosis (partial) and miosis (constricted pupil) are classic signs of Horner syndrome due to
sympathetic disruption. CN III palsy causes ptosis but mydriasis (dilated pupil). Trochlear palsy affects
downward gaze; abducens palsy affects lateral gaze; neither causes ptosis or miosis.
Why Wrong:
A - CN III palsy causes ptosis and mydriasis (dilated pupil), not miosis.
C - Trochlear palsy does not cause ptosis or pupil changes; it limits downward gaze.
D - Abducens palsy limits lateral gaze; no ptosis or miosis.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
17.
Q4. A patient with cirrhosis and possible ascites. Which examination technique is most sensitive for
detecting small-volume ascites?
A. Shifting dullness
B. Fluid wave
C. Bulging flanks
D. Caput medusae
Correct Answer: A. Shifting dullness
Rationale: Shifting dullness can detect as little as 500-1000 mL of ascitic fluid. Fluid wave requires
>1500 mL. Bulging flanks is a late sign of large ascites. Caput medusae indicates portal hypertension but
not ascites itself.
Why Wrong:
B - Fluid wave requires a larger volume of ascites (>1500 mL), thus less sensitive for small volumes.
C - Bulging flanks indicate significant ascites, not an early sign.
D - Caput medusae is a sign of portal hypertension, not directly of ascites.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
12.
Page 3
, Q5. A patient reports shoulder pain with overhead activities. Physical exam reveals a positive Neer
test and full passive range of motion. Which condition is most likely?
A. Subacromial impingement syndrome
B. Rotator cuff tear
C. Adhesive capsulitis
D. Glenohumeral instability
Correct Answer: A. Subacromial impingement syndrome
Rationale: Positive Neer test suggests subacromial impingement. Full passive range of motion rules out
adhesive capsulitis. Rotator cuff tear often presents with weakness and positive drop arm test. Instability
usually has apprehension test positive.
Why Wrong:
B - Rotator cuff tear typically shows weakness on active motion and positive drop arm test, not full
strength.
C - Adhesive capsulitis causes limited passive range of motion, which is absent here.
D - Glenohumeral instability often presents with apprehension or instability tests positive.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
15.
Q6. Which maneuver is most specific for confirming that a midline neck mass originates from the
thyroid gland?
A. Ask the patient to swallow while palpating the mass
B. Transilluminate the mass
C. Auscultate for a bruit over the mass
D. Percuss over the mass for dullness
Correct Answer: A. Ask the patient to swallow while palpating the mass
Rationale: The thyroid gland elevates with swallowing due to its attachment to the larynx.
Transillumination helps identify cystic lesions. Auscultation for bruit may indicate hyperthyroidism but
not origin. Percussion is not useful.
Why Wrong:
B - Transillumination identifies cystic nature but not thyroid origin specifically.
C - Bruit suggests hyperthyroidism but not that the mass is thyroid; can occur in other vascular
masses.
D - Percussion does not differentiate thyroid from other tissue.
Reference: Bickley, L.S. (2026). Bates' Guide to Physical Examination and History Taking, 13th Ed., Ch.
8.
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