NURS6540 ADVANCED HEALTH
ASSESSMENT AND DIAGNOSTIC
REASONING COMPREHENSIVE EXAM
1. During a cardiac examination, a provider notes a mid-systolic click followed by a late
systolic murmur at the apex. This finding is most consistent with:
A. Aortic Stenosis
B. Pulmonary Stenosis
C. Mitral Regurgitation
D. Mitral Valve Prolapse
Answer: D
Conceptual Explanation: Mitral Valve Prolapse (MVP) is characteristically associated with
a mid-systolic click and a late systolic murmur. Aortic stenosis is typically a crescendo-
decrescendo systolic murmur at the right upper sternal border.
2. When performing a physical exam on a patient suspected of having appendicitis, the
clinician performs the Psoas sign. Which of the following describes a positive Psoas sign?
A. Pain in the right lower quadrant with internal rotation of the right hip
B. Pain in the right lower quadrant when pressure is released from the left lower quadrant
,C. Pain in the right lower quadrant when the clinician percusses the heel
D. Pain in the right lower quadrant when the patient extends the right hip against
resistance
Answer: D
Conceptual Explanation: The Psoas sign is positive when there is RLQ pain with right hip
extension, suggesting an inflamed appendix irritating the psoas muscle. Option A describes
the Obturator sign, and B describes Rovsing’s sign.
3. A 65-year-old patient presents with sudden, painless loss of vision in one eye and describes
‘curtain closing’ over their field of vision. This is most likely:
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Macular Degeneration
D. Cataracts
Answer: A
Conceptual Explanation: Retinal detachment is often described as a shadow or curtain
falling over the field of vision and is usually painless. Glaucoma is typically painful and
associated with halos.
4. In the Rinne test, a patient with conductive hearing loss in the right ear will demonstrate:
A. Air conduction longer than bone conduction in the right ear
, B. Symmetric hearing in both ears
C. Lateralization of sound to the left ear
D. Bone conduction longer than or equal to air conduction in the right ear
Answer: D
Conceptual Explanation: In conductive hearing loss, bone conduction (BC) is greater than
or equal to air conduction (AC) in the affected ear because the sound bypasses the
external/middle ear obstruction.
5. A clinician is assessing a patient’s cranial nerves. When the patient is asked to stick out
their tongue, it deviates to the right. This indicates a lesion in which cranial nerve?
A. CN XII (Hypoglossal)
B. CN X (Vagus)
C. CN XI (Spinal Accessory)
D. CN IX (Glossopharyngeal)
Answer: A
Conceptual Explanation: The Hypoglossal nerve (CN XII) controls tongue movement. A
lesion causes the tongue to deviate toward the side of the lesion (the weak side).
6. Which physical exam finding is most diagnostic of a pleural effusion during thoracic
percussion and auscultation?
A. Hyperresonance and increased tactile fremitus
ASSESSMENT AND DIAGNOSTIC
REASONING COMPREHENSIVE EXAM
1. During a cardiac examination, a provider notes a mid-systolic click followed by a late
systolic murmur at the apex. This finding is most consistent with:
A. Aortic Stenosis
B. Pulmonary Stenosis
C. Mitral Regurgitation
D. Mitral Valve Prolapse
Answer: D
Conceptual Explanation: Mitral Valve Prolapse (MVP) is characteristically associated with
a mid-systolic click and a late systolic murmur. Aortic stenosis is typically a crescendo-
decrescendo systolic murmur at the right upper sternal border.
2. When performing a physical exam on a patient suspected of having appendicitis, the
clinician performs the Psoas sign. Which of the following describes a positive Psoas sign?
A. Pain in the right lower quadrant with internal rotation of the right hip
B. Pain in the right lower quadrant when pressure is released from the left lower quadrant
,C. Pain in the right lower quadrant when the clinician percusses the heel
D. Pain in the right lower quadrant when the patient extends the right hip against
resistance
Answer: D
Conceptual Explanation: The Psoas sign is positive when there is RLQ pain with right hip
extension, suggesting an inflamed appendix irritating the psoas muscle. Option A describes
the Obturator sign, and B describes Rovsing’s sign.
3. A 65-year-old patient presents with sudden, painless loss of vision in one eye and describes
‘curtain closing’ over their field of vision. This is most likely:
A. Retinal Detachment
B. Acute Angle-Closure Glaucoma
C. Macular Degeneration
D. Cataracts
Answer: A
Conceptual Explanation: Retinal detachment is often described as a shadow or curtain
falling over the field of vision and is usually painless. Glaucoma is typically painful and
associated with halos.
4. In the Rinne test, a patient with conductive hearing loss in the right ear will demonstrate:
A. Air conduction longer than bone conduction in the right ear
, B. Symmetric hearing in both ears
C. Lateralization of sound to the left ear
D. Bone conduction longer than or equal to air conduction in the right ear
Answer: D
Conceptual Explanation: In conductive hearing loss, bone conduction (BC) is greater than
or equal to air conduction (AC) in the affected ear because the sound bypasses the
external/middle ear obstruction.
5. A clinician is assessing a patient’s cranial nerves. When the patient is asked to stick out
their tongue, it deviates to the right. This indicates a lesion in which cranial nerve?
A. CN XII (Hypoglossal)
B. CN X (Vagus)
C. CN XI (Spinal Accessory)
D. CN IX (Glossopharyngeal)
Answer: A
Conceptual Explanation: The Hypoglossal nerve (CN XII) controls tongue movement. A
lesion causes the tongue to deviate toward the side of the lesion (the weak side).
6. Which physical exam finding is most diagnostic of a pleural effusion during thoracic
percussion and auscultation?
A. Hyperresonance and increased tactile fremitus
