NURS 6560 Midterm Exam Actual Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | 100% Verified | Pass Guaranteed – A+
Graded
EXAM INFORMATION
Total Questions: 50
Recommended Time: 75 minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Professional Decision-Making Questions
==============================
SECTION 1: Advanced Health Assessment and Diagnostic Reasoning
Question 1: A 58-year-old male presents to the clinic with complaints of progressive
dyspnea on exertion, orthopnea, and bilateral lower extremity edema over the past three
weeks. On physical examination, jugular venous distention is noted at 8 cm, S3 gallop is
present, and there are bilateral crackles at the lung bases. Which additional finding on
physical examination would most strongly support a diagnosis of right-sided heart
failure?
A. Pulsus paradoxus greater than 10 mmHg
B. Hepatojugular reflux with sustained elevation
C. Systolic ejection murmur at the right upper sternal border
D. Unilateral calf swelling with erythema
,Correct Answer: B
Rationale: Right-sided heart failure is characterized by systemic venous congestion. The
hepatojugular reflux test assesses the ability of the right ventricle to handle increased
venous return. A sustained elevation of the jugular venous pressure during sustained
abdominal compression indicates right ventricular dysfunction and elevated right atrial
pressure. Pulsus paradoxus is associated with cardiac tamponade or severe obstructive
lung disease. A systolic ejection murmur at the right upper sternal border suggests
aortic stenosis. Unilateral calf swelling with erythema is suggestive of deep vein
thrombosis.
Question 2: A 42-year-old female presents with sudden onset of unilateral facial droop,
inability to close the right eye, and decreased taste sensation on the anterior two-thirds
of the tongue. There is no weakness in the extremities. Which cranial nerve is most
likely affected, and what is the most appropriate initial diagnostic step?
A. Trigeminal nerve (CN V); MRI of the brain with contrast
B. Facial nerve (CN VII); clinical diagnosis with supportive care
C. Glossopharyngeal nerve (CN IX); CT angiography of the head and neck
D. Hypoglossal nerve (CN XII); lumbar puncture for CSF analysis
Correct Answer: B
Rationale: The presentation of unilateral facial droop, inability to close the eye, and
altered taste on the anterior two-thirds of the tongue is classic for Bell palsy, which
involves the facial nerve (CN VII). Bell palsy is typically a clinical diagnosis based on
history and physical examination. Initial management includes supportive eye care to
,prevent corneal damage and corticosteroids if initiated within 72 hours. Imaging is
reserved for atypical presentations or when other causes such as stroke or tumor are
suspected.
Question 3: During a routine wellness visit, a 55-year-old male with a 30-pack-year
smoking history is noted to have decreased breath sounds and dullness to percussion
in the right lower lung field. Which finding on chest auscultation would most specifically
indicate a pleural effusion rather than atelectasis or consolidation?
A. Bronchial breath sounds over the affected area
B. Egophony and whispered pectoriloquy
C. Absence of breath sounds with decreased tactile fremitus
D. Fine inspiratory crackles that do not clear with coughing
Correct Answer: C
Rationale: A pleural effusion typically presents with absent or significantly decreased
breath sounds, dullness to percussion, and decreased tactile fremitus due to the
presence of fluid in the pleural space separating the lung from the chest wall. Bronchial
breath sounds, egophony, and whispered pectoriloquy are associated with
consolidation, as in pneumonia. Fine inspiratory crackles are more suggestive of
interstitial lung disease or early pulmonary edema.
Question 4: A 67-year-old female with a history of type 2 diabetes mellitus presents with
a two-week history of progressive numbness and tingling in a stocking-glove
, distribution, with decreased vibration sense and absent ankle reflexes. Which additional
finding on the neurological examination would be most consistent with diabetic
peripheral neuropathy?
A. Positive Romberg sign with intact proprioception in the upper extremities
B. Loss of pain and temperature sensation in a dermatomal pattern
C. Hyperreflexia at the patellar and Achilles tendons
D. Asymmetric motor weakness in the proximal lower extremities
Correct Answer: A
Rationale: Diabetic peripheral neuropathy is a length-dependent sensorimotor
polyneuropathy that typically presents with a stocking-glove distribution of sensory loss,
decreased vibration sense, and diminished or absent ankle reflexes. A positive Romberg
sign indicates loss of proprioception, which is affected in advanced diabetic
neuropathy. The Romberg sign specifically tests dorsal column function. Loss of pain
and temperature in a dermatomal pattern suggests a radiculopathy. Hyperreflexia is
inconsistent with peripheral neuropathy, which causes hyporeflexia. Asymmetric
proximal weakness suggests a different etiology such as inflammatory myopathy.
Question 5: A 35-year-old female presents with complaints of palpitations, heat
intolerance, and a 10-pound weight loss over two months. On examination, the thyroid is
diffusely enlarged and non-tender, with a bruit audible over the gland. Which laboratory
finding would be most consistent with the likely diagnosis?
A. Elevated thyroid-stimulating hormone with low free thyroxine
B. Low thyroid-stimulating hormone with elevated free thyroxine and triiodothyronine
C. Normal thyroid-stimulating hormone with elevated thyroid peroxidase antibodies
Complete Exam-Style Questions | 100% Verified | Pass Guaranteed – A+
Graded
EXAM INFORMATION
Total Questions: 50
Recommended Time: 75 minutes
Passing Threshold: 85%
Exam Format: Multiple Choice Questions (MCQs)
Question Style: Scenario-Based, Applied, and Professional Decision-Making Questions
==============================
SECTION 1: Advanced Health Assessment and Diagnostic Reasoning
Question 1: A 58-year-old male presents to the clinic with complaints of progressive
dyspnea on exertion, orthopnea, and bilateral lower extremity edema over the past three
weeks. On physical examination, jugular venous distention is noted at 8 cm, S3 gallop is
present, and there are bilateral crackles at the lung bases. Which additional finding on
physical examination would most strongly support a diagnosis of right-sided heart
failure?
A. Pulsus paradoxus greater than 10 mmHg
B. Hepatojugular reflux with sustained elevation
C. Systolic ejection murmur at the right upper sternal border
D. Unilateral calf swelling with erythema
,Correct Answer: B
Rationale: Right-sided heart failure is characterized by systemic venous congestion. The
hepatojugular reflux test assesses the ability of the right ventricle to handle increased
venous return. A sustained elevation of the jugular venous pressure during sustained
abdominal compression indicates right ventricular dysfunction and elevated right atrial
pressure. Pulsus paradoxus is associated with cardiac tamponade or severe obstructive
lung disease. A systolic ejection murmur at the right upper sternal border suggests
aortic stenosis. Unilateral calf swelling with erythema is suggestive of deep vein
thrombosis.
Question 2: A 42-year-old female presents with sudden onset of unilateral facial droop,
inability to close the right eye, and decreased taste sensation on the anterior two-thirds
of the tongue. There is no weakness in the extremities. Which cranial nerve is most
likely affected, and what is the most appropriate initial diagnostic step?
A. Trigeminal nerve (CN V); MRI of the brain with contrast
B. Facial nerve (CN VII); clinical diagnosis with supportive care
C. Glossopharyngeal nerve (CN IX); CT angiography of the head and neck
D. Hypoglossal nerve (CN XII); lumbar puncture for CSF analysis
Correct Answer: B
Rationale: The presentation of unilateral facial droop, inability to close the eye, and
altered taste on the anterior two-thirds of the tongue is classic for Bell palsy, which
involves the facial nerve (CN VII). Bell palsy is typically a clinical diagnosis based on
history and physical examination. Initial management includes supportive eye care to
,prevent corneal damage and corticosteroids if initiated within 72 hours. Imaging is
reserved for atypical presentations or when other causes such as stroke or tumor are
suspected.
Question 3: During a routine wellness visit, a 55-year-old male with a 30-pack-year
smoking history is noted to have decreased breath sounds and dullness to percussion
in the right lower lung field. Which finding on chest auscultation would most specifically
indicate a pleural effusion rather than atelectasis or consolidation?
A. Bronchial breath sounds over the affected area
B. Egophony and whispered pectoriloquy
C. Absence of breath sounds with decreased tactile fremitus
D. Fine inspiratory crackles that do not clear with coughing
Correct Answer: C
Rationale: A pleural effusion typically presents with absent or significantly decreased
breath sounds, dullness to percussion, and decreased tactile fremitus due to the
presence of fluid in the pleural space separating the lung from the chest wall. Bronchial
breath sounds, egophony, and whispered pectoriloquy are associated with
consolidation, as in pneumonia. Fine inspiratory crackles are more suggestive of
interstitial lung disease or early pulmonary edema.
Question 4: A 67-year-old female with a history of type 2 diabetes mellitus presents with
a two-week history of progressive numbness and tingling in a stocking-glove
, distribution, with decreased vibration sense and absent ankle reflexes. Which additional
finding on the neurological examination would be most consistent with diabetic
peripheral neuropathy?
A. Positive Romberg sign with intact proprioception in the upper extremities
B. Loss of pain and temperature sensation in a dermatomal pattern
C. Hyperreflexia at the patellar and Achilles tendons
D. Asymmetric motor weakness in the proximal lower extremities
Correct Answer: A
Rationale: Diabetic peripheral neuropathy is a length-dependent sensorimotor
polyneuropathy that typically presents with a stocking-glove distribution of sensory loss,
decreased vibration sense, and diminished or absent ankle reflexes. A positive Romberg
sign indicates loss of proprioception, which is affected in advanced diabetic
neuropathy. The Romberg sign specifically tests dorsal column function. Loss of pain
and temperature in a dermatomal pattern suggests a radiculopathy. Hyperreflexia is
inconsistent with peripheral neuropathy, which causes hyporeflexia. Asymmetric
proximal weakness suggests a different etiology such as inflammatory myopathy.
Question 5: A 35-year-old female presents with complaints of palpitations, heat
intolerance, and a 10-pound weight loss over two months. On examination, the thyroid is
diffusely enlarged and non-tender, with a bruit audible over the gland. Which laboratory
finding would be most consistent with the likely diagnosis?
A. Elevated thyroid-stimulating hormone with low free thyroxine
B. Low thyroid-stimulating hormone with elevated free thyroxine and triiodothyronine
C. Normal thyroid-stimulating hormone with elevated thyroid peroxidase antibodies
