NUR 6001 Exam 2 Actual Exam V2 | NUR 6001 Advanced Health
Assessment (NUR6001 Exam 2) | William Paterson University
1. During a cardiovascular assessment of an 82-year-old patient, the nurse practitioner
detects a low-pitched extra heart sound early in diastole at the apex. What is the most likely
interpretation of this finding?
A. A normal physiological S3 common in the elderly
B. An S4 heart sound indicating decreased ventricular compliance
C. A pathological S3 indicating ventricular volume overload or heart failure
D. A systolic click associated with mitral valve prolapse
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, occurs early in diastole during the
rapid ventricular filling phase. While it can be normal in children and young adults, its
presence in an older adult is highly suggestive of heart failure or volume overload. The
clinician should correlate this finding with other signs such as jugular venous distention
and pulmonary rales.
2. When assessing for appendicitis, the nurse practitioner performs the Rovsing sign. Which
of the following describes a positive Rovsing sign?
A. Pain elicited by internal rotation of the right hip
B. Pain in the right lower quadrant elicited by palpation of the left lower quadrant
C. Increased pain when the patient is asked to cough
D. Pain elicited by extension of the right hip
Answer: B
Rationale: Rovsing’s sign is a clinical indicator used to identify peritoneal irritation in the
appendix. By applying pressure to the left lower quadrant, gas is displaced toward the
cecum, causing pain in the right lower quadrant. This finding is considered positive for
appendicitis and warrants further surgical consultation or imaging.
3. A 55-year-old patient presents with a cough and fever. Upon auscultation, the nurse
practitioner hears ‘A’ when the patient says ‘E’. This finding is known as:
A. Egophony
B. Whispered pectoriloquy
C. Bronchophony
D. Tactile fremitus
,Answer: A
Rationale: Egophony is a voice sound assessment where the ‘E’ sound is transmitted as a
nasal ‘A’ sound over areas of lung consolidation. This occurs because sound waves travel
more efficiently through solid or liquid media than through air-filled alveoli. It is a critical
finding when differentiating pneumonia from other respiratory conditions.
4. To estimate the pressure in the right atrium, the nurse practitioner assesses the jugular
venous pressure (JVP). What is the correct position for the patient during this assessment?
A. Head of the bed elevated to 30 to 45 degrees
B. Supine with the head of the bed flat
C. Sitting upright at a 90-degree angle
D. Left lateral decubitus position
Answer: A
Rationale: Measuring JVP requires the patient to be reclined so the pulsations of the
internal jugular vein can be visualized. The standard elevation is 30 to 45 degrees to allow
for the best visualization of the meniscus of the blood column. A vertical measurement is
then taken from the sternal angle to the highest point of pulsation to estimate central
venous pressure.
5. A 45-year-old female presents with sudden onset of severe right upper quadrant pain that
radiates to the right scapula. Upon deep palpation under the right costal margin, the patient
suddenly stops inspiration due to pain. This is known as:
A. Murphy’s sign
B. McBurney’s sign
C. Psoas sign
D. Obturator sign
Answer: A
Rationale: Murphy’s sign is highly specific for acute cholecystitis. When the inflamed
gallbladder comes into contact with the examiner’s fingers during deep inspiration, the
patient experiences sharp pain and ceases breathing. This clinical maneuver helps
differentiate biliary pathology from other causes of abdominal pain.
6. The nurse practitioner is assessing a patient for peripheral artery disease (PAD). Which of
the following physical findings is most consistent with chronic arterial insufficiency?
A. Pitting edema and brownish skin discoloration
B. Warm, erythematous skin with palpable cords
C. Thickened, brittle toenails and pale, cool skin
, D. Presence of stasis ulcers on the medial malleolus
Answer: C
Rationale: Chronic arterial insufficiency leads to decreased blood flow to the distal
extremities, resulting in trophic changes. These changes include thin, shiny, cool skin, hair
loss on the legs, and thickened or brittle nails. In contrast, edema and brownish
discoloration are typical of chronic venous insufficiency.
7. During a respiratory exam, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most likely associated with:
A. Lobal pneumonia
B. Pleural effusion
C. Pneumothorax
D. Chronic obstructive pulmonary disease
Answer: A
Rationale: Tactile fremitus refers to the palpable vibrations transmitted through the
bronchopulmonary system to the chest wall. Consolidation, such as in pneumonia,
increases the density of the lung tissue, which enhances the transmission of these
vibrations. Conversely, air or fluid in the pleural space would decrease or muffle these
vibrations.
8. Which heart sound is associated with the ‘atrial kick’ and is frequently heard in patients
with long-standing hypertension and left ventricular hypertrophy?
A. S4
B. S2
C. S3
D. S1
Answer: A
Rationale: The S4 heart sound, or atrial gallop, occurs late in diastole just before S1. It is
produced when the atria contract to push blood into a stiff or non-compliant ventricle. This
is a common finding in conditions like hypertensive heart disease and aortic stenosis
where the ventricle is hypertrophied.
9. While performing an abdominal assessment, the nurse practitioner notes a large, pulsatile
mass in the midline above the umbilicus. What is the priority action?
A. Deeply palpate the mass to determine its borders
B. Auscultate for a bruit and avoid deep palpation
Assessment (NUR6001 Exam 2) | William Paterson University
1. During a cardiovascular assessment of an 82-year-old patient, the nurse practitioner
detects a low-pitched extra heart sound early in diastole at the apex. What is the most likely
interpretation of this finding?
A. A normal physiological S3 common in the elderly
B. An S4 heart sound indicating decreased ventricular compliance
C. A pathological S3 indicating ventricular volume overload or heart failure
D. A systolic click associated with mitral valve prolapse
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, occurs early in diastole during the
rapid ventricular filling phase. While it can be normal in children and young adults, its
presence in an older adult is highly suggestive of heart failure or volume overload. The
clinician should correlate this finding with other signs such as jugular venous distention
and pulmonary rales.
2. When assessing for appendicitis, the nurse practitioner performs the Rovsing sign. Which
of the following describes a positive Rovsing sign?
A. Pain elicited by internal rotation of the right hip
B. Pain in the right lower quadrant elicited by palpation of the left lower quadrant
C. Increased pain when the patient is asked to cough
D. Pain elicited by extension of the right hip
Answer: B
Rationale: Rovsing’s sign is a clinical indicator used to identify peritoneal irritation in the
appendix. By applying pressure to the left lower quadrant, gas is displaced toward the
cecum, causing pain in the right lower quadrant. This finding is considered positive for
appendicitis and warrants further surgical consultation or imaging.
3. A 55-year-old patient presents with a cough and fever. Upon auscultation, the nurse
practitioner hears ‘A’ when the patient says ‘E’. This finding is known as:
A. Egophony
B. Whispered pectoriloquy
C. Bronchophony
D. Tactile fremitus
,Answer: A
Rationale: Egophony is a voice sound assessment where the ‘E’ sound is transmitted as a
nasal ‘A’ sound over areas of lung consolidation. This occurs because sound waves travel
more efficiently through solid or liquid media than through air-filled alveoli. It is a critical
finding when differentiating pneumonia from other respiratory conditions.
4. To estimate the pressure in the right atrium, the nurse practitioner assesses the jugular
venous pressure (JVP). What is the correct position for the patient during this assessment?
A. Head of the bed elevated to 30 to 45 degrees
B. Supine with the head of the bed flat
C. Sitting upright at a 90-degree angle
D. Left lateral decubitus position
Answer: A
Rationale: Measuring JVP requires the patient to be reclined so the pulsations of the
internal jugular vein can be visualized. The standard elevation is 30 to 45 degrees to allow
for the best visualization of the meniscus of the blood column. A vertical measurement is
then taken from the sternal angle to the highest point of pulsation to estimate central
venous pressure.
5. A 45-year-old female presents with sudden onset of severe right upper quadrant pain that
radiates to the right scapula. Upon deep palpation under the right costal margin, the patient
suddenly stops inspiration due to pain. This is known as:
A. Murphy’s sign
B. McBurney’s sign
C. Psoas sign
D. Obturator sign
Answer: A
Rationale: Murphy’s sign is highly specific for acute cholecystitis. When the inflamed
gallbladder comes into contact with the examiner’s fingers during deep inspiration, the
patient experiences sharp pain and ceases breathing. This clinical maneuver helps
differentiate biliary pathology from other causes of abdominal pain.
6. The nurse practitioner is assessing a patient for peripheral artery disease (PAD). Which of
the following physical findings is most consistent with chronic arterial insufficiency?
A. Pitting edema and brownish skin discoloration
B. Warm, erythematous skin with palpable cords
C. Thickened, brittle toenails and pale, cool skin
, D. Presence of stasis ulcers on the medial malleolus
Answer: C
Rationale: Chronic arterial insufficiency leads to decreased blood flow to the distal
extremities, resulting in trophic changes. These changes include thin, shiny, cool skin, hair
loss on the legs, and thickened or brittle nails. In contrast, edema and brownish
discoloration are typical of chronic venous insufficiency.
7. During a respiratory exam, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most likely associated with:
A. Lobal pneumonia
B. Pleural effusion
C. Pneumothorax
D. Chronic obstructive pulmonary disease
Answer: A
Rationale: Tactile fremitus refers to the palpable vibrations transmitted through the
bronchopulmonary system to the chest wall. Consolidation, such as in pneumonia,
increases the density of the lung tissue, which enhances the transmission of these
vibrations. Conversely, air or fluid in the pleural space would decrease or muffle these
vibrations.
8. Which heart sound is associated with the ‘atrial kick’ and is frequently heard in patients
with long-standing hypertension and left ventricular hypertrophy?
A. S4
B. S2
C. S3
D. S1
Answer: A
Rationale: The S4 heart sound, or atrial gallop, occurs late in diastole just before S1. It is
produced when the atria contract to push blood into a stiff or non-compliant ventricle. This
is a common finding in conditions like hypertensive heart disease and aortic stenosis
where the ventricle is hypertrophied.
9. While performing an abdominal assessment, the nurse practitioner notes a large, pulsatile
mass in the midline above the umbilicus. What is the priority action?
A. Deeply palpate the mass to determine its borders
B. Auscultate for a bruit and avoid deep palpation
