NU 673 Exam 4 Actual Exam 2026/2027 –
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
1. The APRN notes a 12 mm Hg difference in systolic blood pressure during inspiration.
How should the APRN document this finding?
A. Aortic stenosis
B. Carotid arterial disease
C. Paradoxical pulse
D. Pulsus alternans
Answer: C. Paradoxical pulse
Explanation: Paradoxical pulse (pulsus paradoxus) is defined as a >10 mmHg drop in systolic BP
during inspiration. It can occur in cardiac tamponade, severe asthma, or COPD .
2. A patient is suspected to have COPD. The APRN instructs the patient to take a deep
breath in, and then with his mouth open, breathe out as fast and completely as he can. For
what is the APRN checking?
A. Whispered pectoriloquy
B. Forced expiratory time
C. Egophony
D. Tactile fremitus
Answer: B. Forced expiratory time
Explanation: Forced expiratory time assesses airflow limitation. Prolonged expiration (>6
seconds) suggests obstruction, as seen in COPD or asthma .
3. A patient presents to the clinic with severe right-sided abdominal pain for 12 hours. The
pain began as a "stomach ache" with decreased appetite and has now localized to the
right lower quadrant. Rebound pain and guarding are present. What is the most likely
diagnosis?
,A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis
Answer: A. Acute appendicitis
Explanation: This presentation is classic for appendicitis: initial periumbilical pain migrating to
right lower quadrant, with guarding, rebound tenderness, and McBurney's point tenderness .
4. Which percussion note is obtained over a gastric bubble?
A. Flatness
B. Hyperresonance
C. Tympany
D. Resonance
Answer: C. Tympany
Explanation: Tympany is the percussion note over air-filled structures such as the gastric
bubble. Resonance is heard over normal lung, hyperresonance over hyperinflated lung, and
flatness over solid organs or fluid .
5. The APRN is performing a cardiac exam on a patient with SOB and palpitations. She
listens to the heart with the patient sitting upright, then supine, and finally left lateral
decubitus position. Which valvular defect is best heard in this position?
A. Mitral
B. Aortic
C. Tricuspid
D. Pulmonic
Answer: A. Mitral
Explanation: Mitral valve murmurs (particularly mitral stenosis) are best heard in the left lateral
decubitus position with the bell of the stethoscope at the apex .
6. A 20-year-old male has a history of leukemia and an enlarged spleen. Today he presents
with a fairly significant left upper quadrant pain. On exam of the area a rough grating
noise is heard. What is this sound known as?
,A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular bruit
D. Pericardial rub
Answer: B. It is a splenic rub
Explanation: A splenic rub is a rough, grating sound heard over the left upper quadrant, often
associated with splenomegaly or splenic infarction .
7. A 21-year-old construction worker presents for evaluation of a rash. The patient notes
that it started on their back with a multitude of spots and is also on their upper chest and
arms. It itches a little. On physical examination, you note hyperpigmented, oval macules
scattered more prominently around the upper back, chest, neck, and upper arms as well as
under the arms. What is the most likely diagnosis?
A. Tinea versicolor
B. Pityriasis rosea
C. Atopic eczema
D. Tinea capitis
Answer: A. Tinea versicolor
Explanation: Tinea versicolor presents with hyperpigmented or hypopigmented oval macules
on the trunk, neck, and upper arms. It is caused by Malassezia furfur and is more prominent in
warm, humid conditions .
8. Why is percussing the lower border of the liver considered the first step in assessing an
enlarged liver in a COPD patient?
A. It is a non-invasive method to check for liver function.
B. Percussing helps determine liver size and assess for hepatomegaly.
C. It provides immediate results for liver enzyme levels.
D. It is the only method to diagnose liver diseases.
Answer: B. Percussing helps determine liver size and assess for hepatomegaly.
Explanation: In COPD patients, the liver may be displaced downward by hyperinflated lungs.
Percussion helps determine actual liver size and assess for hepatomegaly .
, 9. The APRN is assessing a patient for peripheral vascular disease in the arms. The patient
reports increasing weakness and a history of CAD and diabetes. The APRN assesses the
brachial and radial pulses and they are bounding. This would be recorded as:
A. 0
B. 1+
C. 2+
D. 3+
Answer: D. 3+
Explanation: Pulse grading: 0 = absent, 1+ = diminished, 2+ = normal, 3+ =
increased/bounding .
10. What is the primary purpose of assessing deep tendon reflexes in a clinical setting?
A. To measure muscle strength
B. To evaluate the integrity of the nervous system
C. To diagnose specific mental health conditions
D. To assess cognitive function
Answer: B. To evaluate the integrity of the nervous system
Explanation: Deep tendon reflex assessment evaluates the integrity of the nervous system,
particularly spinal cord and peripheral nerve function .
11. A patient with COPD presents with pursed-lip breathing and tripod positioning. This
suggests:
A. Mild exacerbation
B. Moderate exacerbation
C. Severe respiratory distress
D. Stable disease
Answer: C. Severe respiratory distress
Explanation: Pursed-lip breathing and tripod positioning are signs of severe respiratory distress
and represent compensatory mechanisms to improve ventilation .
12. The APRN is evaluating a patient for DVT. Which finding suggests the patient is at
high risk?
Complete Exam-Style Questions with
Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
1. The APRN notes a 12 mm Hg difference in systolic blood pressure during inspiration.
How should the APRN document this finding?
A. Aortic stenosis
B. Carotid arterial disease
C. Paradoxical pulse
D. Pulsus alternans
Answer: C. Paradoxical pulse
Explanation: Paradoxical pulse (pulsus paradoxus) is defined as a >10 mmHg drop in systolic BP
during inspiration. It can occur in cardiac tamponade, severe asthma, or COPD .
2. A patient is suspected to have COPD. The APRN instructs the patient to take a deep
breath in, and then with his mouth open, breathe out as fast and completely as he can. For
what is the APRN checking?
A. Whispered pectoriloquy
B. Forced expiratory time
C. Egophony
D. Tactile fremitus
Answer: B. Forced expiratory time
Explanation: Forced expiratory time assesses airflow limitation. Prolonged expiration (>6
seconds) suggests obstruction, as seen in COPD or asthma .
3. A patient presents to the clinic with severe right-sided abdominal pain for 12 hours. The
pain began as a "stomach ache" with decreased appetite and has now localized to the
right lower quadrant. Rebound pain and guarding are present. What is the most likely
diagnosis?
,A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis
Answer: A. Acute appendicitis
Explanation: This presentation is classic for appendicitis: initial periumbilical pain migrating to
right lower quadrant, with guarding, rebound tenderness, and McBurney's point tenderness .
4. Which percussion note is obtained over a gastric bubble?
A. Flatness
B. Hyperresonance
C. Tympany
D. Resonance
Answer: C. Tympany
Explanation: Tympany is the percussion note over air-filled structures such as the gastric
bubble. Resonance is heard over normal lung, hyperresonance over hyperinflated lung, and
flatness over solid organs or fluid .
5. The APRN is performing a cardiac exam on a patient with SOB and palpitations. She
listens to the heart with the patient sitting upright, then supine, and finally left lateral
decubitus position. Which valvular defect is best heard in this position?
A. Mitral
B. Aortic
C. Tricuspid
D. Pulmonic
Answer: A. Mitral
Explanation: Mitral valve murmurs (particularly mitral stenosis) are best heard in the left lateral
decubitus position with the bell of the stethoscope at the apex .
6. A 20-year-old male has a history of leukemia and an enlarged spleen. Today he presents
with a fairly significant left upper quadrant pain. On exam of the area a rough grating
noise is heard. What is this sound known as?
,A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular bruit
D. Pericardial rub
Answer: B. It is a splenic rub
Explanation: A splenic rub is a rough, grating sound heard over the left upper quadrant, often
associated with splenomegaly or splenic infarction .
7. A 21-year-old construction worker presents for evaluation of a rash. The patient notes
that it started on their back with a multitude of spots and is also on their upper chest and
arms. It itches a little. On physical examination, you note hyperpigmented, oval macules
scattered more prominently around the upper back, chest, neck, and upper arms as well as
under the arms. What is the most likely diagnosis?
A. Tinea versicolor
B. Pityriasis rosea
C. Atopic eczema
D. Tinea capitis
Answer: A. Tinea versicolor
Explanation: Tinea versicolor presents with hyperpigmented or hypopigmented oval macules
on the trunk, neck, and upper arms. It is caused by Malassezia furfur and is more prominent in
warm, humid conditions .
8. Why is percussing the lower border of the liver considered the first step in assessing an
enlarged liver in a COPD patient?
A. It is a non-invasive method to check for liver function.
B. Percussing helps determine liver size and assess for hepatomegaly.
C. It provides immediate results for liver enzyme levels.
D. It is the only method to diagnose liver diseases.
Answer: B. Percussing helps determine liver size and assess for hepatomegaly.
Explanation: In COPD patients, the liver may be displaced downward by hyperinflated lungs.
Percussion helps determine actual liver size and assess for hepatomegaly .
, 9. The APRN is assessing a patient for peripheral vascular disease in the arms. The patient
reports increasing weakness and a history of CAD and diabetes. The APRN assesses the
brachial and radial pulses and they are bounding. This would be recorded as:
A. 0
B. 1+
C. 2+
D. 3+
Answer: D. 3+
Explanation: Pulse grading: 0 = absent, 1+ = diminished, 2+ = normal, 3+ =
increased/bounding .
10. What is the primary purpose of assessing deep tendon reflexes in a clinical setting?
A. To measure muscle strength
B. To evaluate the integrity of the nervous system
C. To diagnose specific mental health conditions
D. To assess cognitive function
Answer: B. To evaluate the integrity of the nervous system
Explanation: Deep tendon reflex assessment evaluates the integrity of the nervous system,
particularly spinal cord and peripheral nerve function .
11. A patient with COPD presents with pursed-lip breathing and tripod positioning. This
suggests:
A. Mild exacerbation
B. Moderate exacerbation
C. Severe respiratory distress
D. Stable disease
Answer: C. Severe respiratory distress
Explanation: Pursed-lip breathing and tripod positioning are signs of severe respiratory distress
and represent compensatory mechanisms to improve ventilation .
12. The APRN is evaluating a patient for DVT. Which finding suggests the patient is at
high risk?
