NSG 5442 FINAL EXAM | 2026 UPDATE | QUESTIONS AND
ANSWERS | WITH COMPLETE SOLUTIONS - SOUTH
COLLEGE Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass Guaranteed
– A+ Graded
Advanced Health Assessment and Diagnostic Reasoning
Q1: A 65-year-old male presents with a new onset of a harsh, crescendo-decrescendo
systolic murmur heard best at the right upper sternal border, radiating to the carotids.
Which valvular disorder is most likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Tricuspid stenosis
D. Pulmonic regurgitation
Correct Answer: B
Rationale: The best answer is B because a harsh, crescendo-decrescendo systolic murmur at
the right upper sternal border radiating to the carotids is the classic presentation of aortic
stenosis.
Q2: During a cranial nerve assessment, a patient is unable to shrug their shoulders against
resistance. Which cranial nerve is likely impaired?
A. Cranial Nerve IX
B. Cranial Nerve X
C. Cranial Nerve XI [CORRECT]
D. Cranial Nerve XII
Correct Answer: C
Rationale: This choice is correct because Cranial Nerve XI (spinal accessory) innervates the
sternocleidomastoid and trapezius muscles, which are responsible for shoulder shrugging.
Q3: A 45-year-old female reports a 3-month history of morning stiffness in her hands lasting
over an hour, with symmetric swelling of the MCP joints. What is the most appropriate
initial diagnostic test?
A. Serum uric acid
B. Rheumatoid factor and anti-CCP antibodies [CORRECT]
C. X-ray of the cervical spine
D. Complete blood count only
Correct Answer: B
Rationale: This aligns with current guidelines, as rheumatoid factor and anti-CCP are the
most specific initial serologic tests for suspected rheumatoid arthritis.
Q4: Which finding during a breast examination is most suspicious for malignancy?
A. Bilateral, cyclical tenderness
,B. A freely mobile, rubbery mass
C. A fixed, irregular, non-tender mass with overlying skin dimpling [CORRECT]
D. Multiple small, symmetric lumps that change with the menstrual cycle
Correct Answer: C
Rationale: The best answer is C because a fixed, irregular, non-tender mass with skin
dimpling strongly suggests a malignant process rather than a benign fibroadenoma or
fibrocystic change.
Q5: A patient presents with acute right lower quadrant pain. Rebound tenderness is noted.
What does this physical exam finding primarily indicate?
A. Bowel obstruction
B. Peritoneal inflammation [CORRECT]
C. Renal colic
D. Gastric ulcer perforation
Correct Answer: B
Rationale: This matches the principle that rebound tenderness (Blumberg sign) is a classic
indicator of peritoneal irritation or inflammation, such as in appendicitis.
Q6: When assessing a patient with suspected deep vein thrombosis (DVT), which clinical
prediction rule is most appropriate to determine the need for ultrasound?
A. CHA2DS2-VASc score
B. Wells criteria [CORRECT]
C. CURB-65 score
D. HEART score
Correct Answer: B
Rationale: The best answer is B because the Wells criteria is the validated clinical prediction
rule used to estimate the pretest probability of DVT and guide diagnostic imaging.
Q7: A 70-year-old male with a history of smoking presents with a chronic cough and
unexplained weight loss. A chest X-ray reveals a solitary pulmonary nodule. What is the
most critical next step in diagnostic reasoning?
A. Prescribe a trial of antibiotics
B. Order a CT scan of the chest for further characterization [CORRECT]
C. Reassure the patient and follow up in 6 months
D. Immediately schedule a lobectomy
Correct Answer: B
Rationale: This choice is correct because a CT scan is necessary to evaluate the nodule's size,
margins, and characteristics to determine malignancy risk before any invasive procedures.
Q8: Which heart sound is typically associated with heart failure and represents rapid
ventricular filling?
A. S1
B. S2
C. S3 [CORRECT]
D. S4
Correct Answer: C
, Rationale: The best answer is C because an S3 gallop is an early diastolic sound that often
indicates volume overload and systolic heart failure in adults.
Q9: A patient complains of vertigo triggered by rolling over in bed, lasting less than one
minute. The Dix-Hallpike maneuver elicits rotary nystagmus. What is the most likely
diagnosis?
A. Meniere’s disease
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo (BPPV) [CORRECT]
D. Acoustic neuroma
Correct Answer: C
Rationale: This aligns with the classic presentation of BPPV, which is characterized by brief
episodes of vertigo triggered by head position changes and a positive Dix-Hallpike test.
Q10: During an abdominal assessment, you hear high-pitched, tinkling bowel sounds. This
finding is most suggestive of:
A. Paralytic ileus
B. Early bowel obstruction [CORRECT]
C. Gastroenteritis
D. Normal bowel function
Correct Answer: B
Rationale: The best answer is B because high-pitched, tinkling bowel sounds occur as the
bowel attempts to push contents past a mechanical obstruction.
Q11: A 30-year-old female presents with a butterfly rash across her cheeks and nose,
sparing the nasolabial folds, along with joint pain. Which condition should be highest on
your differential?
A. Rosacea
B. Systemic lupus erythematosus (SLE) [CORRECT]
C. Psoriasis
D. Contact dermatitis
Correct Answer: B
Rationale: This choice is correct because a malar rash sparing the nasolabial folds, combined
with arthralgia, is a hallmark clinical feature of SLE.
Q12: What is the primary purpose of performing a monofilament test on a patient with
diabetes?
A. To assess arterial blood flow
B. To evaluate protective sensation and neuropathy risk [CORRECT]
C. To measure joint proprioception
D. To detect early signs of cellulitis
Correct Answer: B
Rationale: The best answer is B because the 10-gram monofilament test is the standard
screening tool for loss of protective sensation, which predisposes patients to foot ulcers.
Q13: A patient presents with sudden onset of the "worst headache of my life." What is the
most critical diagnosis to rule out immediately?
ANSWERS | WITH COMPLETE SOLUTIONS - SOUTH
COLLEGE Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass Guaranteed
– A+ Graded
Advanced Health Assessment and Diagnostic Reasoning
Q1: A 65-year-old male presents with a new onset of a harsh, crescendo-decrescendo
systolic murmur heard best at the right upper sternal border, radiating to the carotids.
Which valvular disorder is most likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Tricuspid stenosis
D. Pulmonic regurgitation
Correct Answer: B
Rationale: The best answer is B because a harsh, crescendo-decrescendo systolic murmur at
the right upper sternal border radiating to the carotids is the classic presentation of aortic
stenosis.
Q2: During a cranial nerve assessment, a patient is unable to shrug their shoulders against
resistance. Which cranial nerve is likely impaired?
A. Cranial Nerve IX
B. Cranial Nerve X
C. Cranial Nerve XI [CORRECT]
D. Cranial Nerve XII
Correct Answer: C
Rationale: This choice is correct because Cranial Nerve XI (spinal accessory) innervates the
sternocleidomastoid and trapezius muscles, which are responsible for shoulder shrugging.
Q3: A 45-year-old female reports a 3-month history of morning stiffness in her hands lasting
over an hour, with symmetric swelling of the MCP joints. What is the most appropriate
initial diagnostic test?
A. Serum uric acid
B. Rheumatoid factor and anti-CCP antibodies [CORRECT]
C. X-ray of the cervical spine
D. Complete blood count only
Correct Answer: B
Rationale: This aligns with current guidelines, as rheumatoid factor and anti-CCP are the
most specific initial serologic tests for suspected rheumatoid arthritis.
Q4: Which finding during a breast examination is most suspicious for malignancy?
A. Bilateral, cyclical tenderness
,B. A freely mobile, rubbery mass
C. A fixed, irregular, non-tender mass with overlying skin dimpling [CORRECT]
D. Multiple small, symmetric lumps that change with the menstrual cycle
Correct Answer: C
Rationale: The best answer is C because a fixed, irregular, non-tender mass with skin
dimpling strongly suggests a malignant process rather than a benign fibroadenoma or
fibrocystic change.
Q5: A patient presents with acute right lower quadrant pain. Rebound tenderness is noted.
What does this physical exam finding primarily indicate?
A. Bowel obstruction
B. Peritoneal inflammation [CORRECT]
C. Renal colic
D. Gastric ulcer perforation
Correct Answer: B
Rationale: This matches the principle that rebound tenderness (Blumberg sign) is a classic
indicator of peritoneal irritation or inflammation, such as in appendicitis.
Q6: When assessing a patient with suspected deep vein thrombosis (DVT), which clinical
prediction rule is most appropriate to determine the need for ultrasound?
A. CHA2DS2-VASc score
B. Wells criteria [CORRECT]
C. CURB-65 score
D. HEART score
Correct Answer: B
Rationale: The best answer is B because the Wells criteria is the validated clinical prediction
rule used to estimate the pretest probability of DVT and guide diagnostic imaging.
Q7: A 70-year-old male with a history of smoking presents with a chronic cough and
unexplained weight loss. A chest X-ray reveals a solitary pulmonary nodule. What is the
most critical next step in diagnostic reasoning?
A. Prescribe a trial of antibiotics
B. Order a CT scan of the chest for further characterization [CORRECT]
C. Reassure the patient and follow up in 6 months
D. Immediately schedule a lobectomy
Correct Answer: B
Rationale: This choice is correct because a CT scan is necessary to evaluate the nodule's size,
margins, and characteristics to determine malignancy risk before any invasive procedures.
Q8: Which heart sound is typically associated with heart failure and represents rapid
ventricular filling?
A. S1
B. S2
C. S3 [CORRECT]
D. S4
Correct Answer: C
, Rationale: The best answer is C because an S3 gallop is an early diastolic sound that often
indicates volume overload and systolic heart failure in adults.
Q9: A patient complains of vertigo triggered by rolling over in bed, lasting less than one
minute. The Dix-Hallpike maneuver elicits rotary nystagmus. What is the most likely
diagnosis?
A. Meniere’s disease
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo (BPPV) [CORRECT]
D. Acoustic neuroma
Correct Answer: C
Rationale: This aligns with the classic presentation of BPPV, which is characterized by brief
episodes of vertigo triggered by head position changes and a positive Dix-Hallpike test.
Q10: During an abdominal assessment, you hear high-pitched, tinkling bowel sounds. This
finding is most suggestive of:
A. Paralytic ileus
B. Early bowel obstruction [CORRECT]
C. Gastroenteritis
D. Normal bowel function
Correct Answer: B
Rationale: The best answer is B because high-pitched, tinkling bowel sounds occur as the
bowel attempts to push contents past a mechanical obstruction.
Q11: A 30-year-old female presents with a butterfly rash across her cheeks and nose,
sparing the nasolabial folds, along with joint pain. Which condition should be highest on
your differential?
A. Rosacea
B. Systemic lupus erythematosus (SLE) [CORRECT]
C. Psoriasis
D. Contact dermatitis
Correct Answer: B
Rationale: This choice is correct because a malar rash sparing the nasolabial folds, combined
with arthralgia, is a hallmark clinical feature of SLE.
Q12: What is the primary purpose of performing a monofilament test on a patient with
diabetes?
A. To assess arterial blood flow
B. To evaluate protective sensation and neuropathy risk [CORRECT]
C. To measure joint proprioception
D. To detect early signs of cellulitis
Correct Answer: B
Rationale: The best answer is B because the 10-gram monofilament test is the standard
screening tool for loss of protective sensation, which predisposes patients to foot ulcers.
Q13: A patient presents with sudden onset of the "worst headache of my life." What is the
most critical diagnosis to rule out immediately?
