NUR 6001 Exam 2 Actual Exam V1 | NUR 6001 Advanced Health
Assessment (NUR6001 Exam 2) | William Paterson University
1. During a cardiovascular assessment, a 68-year-old patient presents with a displaced apical
impulse and an extra heart sound heard in early diastole. Which condition is most likely
associated with these findings?
A. Congestive heart failure and S3
B. Mitral valve stenosis and opening snap
C. Left ventricular hypertrophy and S4
D. Aortic stenosis and systolic click
Answer: A
Rationale: A displaced apical impulse suggests cardiomegaly or ventricular enlargement.
An S3 gallop, occurring in early diastole during rapid ventricular filling, is a hallmark sign
of ventricular volume overload and congestive heart failure in older adults. In contrast, an
S4 is associated with decreased ventricular compliance or stiffening.
2. When assessing a patient for suspected acute cholecystitis, the clinician asks the patient to
take a deep breath while palpating the right upper quadrant. The patient abruptly halts
inspiration due to pain. This is documented as a positive:
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. McBurney’s sign
Answer: A
Rationale: Murphy’s sign is specifically used to assess for inflammation of the gallbladder.
A positive sign occurs when the patient’s breath is ‘caught’ as the inflamed gallbladder
descends and hits the examiner’s fingers during deep inspiration. Rovsing’s and Psoas signs
are typically associated with appendicitis.
3. A 55-year-old patient complains of persistent ‘ringing’ in the ears. During the Weber test,
sound lateralizes to the right ear. The Rinne test shows Bone Conduction > Air Conduction (BC
> AC) on the right side. What is the most likely diagnosis?
A. Sensorineural hearing loss in the left ear
B. Conductive hearing loss in the right ear
C. Sensorineural hearing loss in the right ear
,D. Normal hearing in both ears
Answer: B
Rationale: In conductive hearing loss, the Weber test lateralizes to the affected (impaired)
ear because the sound is not muffled by room noise. The Rinne test confirms this when
bone conduction is heard longer than air conduction (BC > AC) in the affected ear. If it were
sensorineural loss, Weber would lateralize to the ‘good’ ear and Rinne would show AC > BC.
4. A patient presents with sharp, pleuritic chest pain that is relieved by sitting up and leaning
forward. On auscultation, a scratchy, high-pitched sound is heard in the third intercostal
space. Which intervention is the most appropriate next step?
A. Order a chest X-ray to rule out a pneumothorax
B. Administer sublingual nitroglycerin for suspected angina
C. Obtain a 12-lead ECG to evaluate for diffuse ST-segment elevation
D. Perform D-dimer testing to rule out pulmonary embolism
Answer: C
Rationale: The clinical presentation is classic for acute pericarditis, characterized by
positional chest pain and a pericardial friction rub. The most diagnostic initial step is an
ECG, which typically shows diffuse ST-segment elevation and PR-segment depression.
Nitroglycerin would not resolve the inflammatory pain of pericarditis.
5. While assessing the cranial nerves of a patient who suffered a stroke, the clinician observes
that when the patient says ‘Ah,’ the uvula deviates to the right. Which cranial nerve is most
likely affected?
A. Left Cranial Nerve IX (Glossopharyngeal)
B. Left Cranial Nerve X (Vagus)
C. Right Cranial Nerve X (Vagus)
D. Right Cranial Nerve XII (Hypoglossal)
Answer: B
Rationale: The uvula deviates away from the side of the lesion in cases of Cranial Nerve X
(Vagus) dysfunction. If the uvula deviates to the right, it indicates a weakness in the left
side of the soft palate, implying a left CN X lesion. CN XII involvement would cause the
tongue to deviate toward the side of the lesion.
6. A 40-year-old female presents with a palpable thyroid nodule. Which of the following
physical exam findings would most increase the clinical suspicion of malignancy?
A. The nodule is soft and moves with swallowing
B. The presence of a diffuse goiter without bruit
, C. Multiple soft nodules are palpated throughout the gland
D. The nodule is fixed, firm, and associated with cervical lymphadenopathy
Answer: D
Rationale: Malignant thyroid nodules are typically firm, fixed to surrounding tissues, and
often accompanied by enlarged regional lymph nodes. Soft, mobile nodules or multinodular
goiters are more frequently benign. Any fixed mass in the neck requires urgent further
investigation, such as ultrasound or fine-needle aspiration.
7. A clinician is performing a pulmonary exam on a patient with suspected lobar pneumonia.
Which of the following findings is expected over the area of consolidation?
A. Decreased tactile fremitus and hyperresonance
B. Increased tactile fremitus and dullness to percussion
C. Decreased tactile fremitus and dullness to percussion
D. Vesicular breath sounds and resonant percussion
Answer: B
Rationale: Consolidation (fluid or solid tissue) in the lungs conducts sound and vibration
more effectively than air. Therefore, tactile fremitus is increased and the percussion note is
dull over a pneumonic lobe. In contrast, pleural effusions or pneumothorax result in
decreased fremitus.
8. A 72-year-old patient with a history of hypertension presents with a sudden onset of ‘the
worst headache of my life.’ On exam, there is neck stiffness (nuchal rigidity). What is the
priority differential diagnosis?
A. Cluster headache
B. Temporal arteritis
C. Migraine with aura
D. Subarachnoid hemorrhage
Answer: D
Rationale: The ‘thunderclap’ headache or ‘worst headache of life’ combined with signs of
meningeal irritation (nuchal rigidity) is the classic presentation of a subarachnoid
hemorrhage. This is a medical emergency often caused by a ruptured aneurysm. Temporal
arteritis usually presents with localized scalp tenderness and vision changes.
9. When assessing a patient for Carpal Tunnel Syndrome, the clinician asks the patient to hold
the backs of their hands together with wrists flexed at 90 degrees for 60 seconds. This
maneuver is known as:
A. Phalen’s test
Assessment (NUR6001 Exam 2) | William Paterson University
1. During a cardiovascular assessment, a 68-year-old patient presents with a displaced apical
impulse and an extra heart sound heard in early diastole. Which condition is most likely
associated with these findings?
A. Congestive heart failure and S3
B. Mitral valve stenosis and opening snap
C. Left ventricular hypertrophy and S4
D. Aortic stenosis and systolic click
Answer: A
Rationale: A displaced apical impulse suggests cardiomegaly or ventricular enlargement.
An S3 gallop, occurring in early diastole during rapid ventricular filling, is a hallmark sign
of ventricular volume overload and congestive heart failure in older adults. In contrast, an
S4 is associated with decreased ventricular compliance or stiffening.
2. When assessing a patient for suspected acute cholecystitis, the clinician asks the patient to
take a deep breath while palpating the right upper quadrant. The patient abruptly halts
inspiration due to pain. This is documented as a positive:
A. Murphy’s sign
B. Rovsing’s sign
C. Psoas sign
D. McBurney’s sign
Answer: A
Rationale: Murphy’s sign is specifically used to assess for inflammation of the gallbladder.
A positive sign occurs when the patient’s breath is ‘caught’ as the inflamed gallbladder
descends and hits the examiner’s fingers during deep inspiration. Rovsing’s and Psoas signs
are typically associated with appendicitis.
3. A 55-year-old patient complains of persistent ‘ringing’ in the ears. During the Weber test,
sound lateralizes to the right ear. The Rinne test shows Bone Conduction > Air Conduction (BC
> AC) on the right side. What is the most likely diagnosis?
A. Sensorineural hearing loss in the left ear
B. Conductive hearing loss in the right ear
C. Sensorineural hearing loss in the right ear
,D. Normal hearing in both ears
Answer: B
Rationale: In conductive hearing loss, the Weber test lateralizes to the affected (impaired)
ear because the sound is not muffled by room noise. The Rinne test confirms this when
bone conduction is heard longer than air conduction (BC > AC) in the affected ear. If it were
sensorineural loss, Weber would lateralize to the ‘good’ ear and Rinne would show AC > BC.
4. A patient presents with sharp, pleuritic chest pain that is relieved by sitting up and leaning
forward. On auscultation, a scratchy, high-pitched sound is heard in the third intercostal
space. Which intervention is the most appropriate next step?
A. Order a chest X-ray to rule out a pneumothorax
B. Administer sublingual nitroglycerin for suspected angina
C. Obtain a 12-lead ECG to evaluate for diffuse ST-segment elevation
D. Perform D-dimer testing to rule out pulmonary embolism
Answer: C
Rationale: The clinical presentation is classic for acute pericarditis, characterized by
positional chest pain and a pericardial friction rub. The most diagnostic initial step is an
ECG, which typically shows diffuse ST-segment elevation and PR-segment depression.
Nitroglycerin would not resolve the inflammatory pain of pericarditis.
5. While assessing the cranial nerves of a patient who suffered a stroke, the clinician observes
that when the patient says ‘Ah,’ the uvula deviates to the right. Which cranial nerve is most
likely affected?
A. Left Cranial Nerve IX (Glossopharyngeal)
B. Left Cranial Nerve X (Vagus)
C. Right Cranial Nerve X (Vagus)
D. Right Cranial Nerve XII (Hypoglossal)
Answer: B
Rationale: The uvula deviates away from the side of the lesion in cases of Cranial Nerve X
(Vagus) dysfunction. If the uvula deviates to the right, it indicates a weakness in the left
side of the soft palate, implying a left CN X lesion. CN XII involvement would cause the
tongue to deviate toward the side of the lesion.
6. A 40-year-old female presents with a palpable thyroid nodule. Which of the following
physical exam findings would most increase the clinical suspicion of malignancy?
A. The nodule is soft and moves with swallowing
B. The presence of a diffuse goiter without bruit
, C. Multiple soft nodules are palpated throughout the gland
D. The nodule is fixed, firm, and associated with cervical lymphadenopathy
Answer: D
Rationale: Malignant thyroid nodules are typically firm, fixed to surrounding tissues, and
often accompanied by enlarged regional lymph nodes. Soft, mobile nodules or multinodular
goiters are more frequently benign. Any fixed mass in the neck requires urgent further
investigation, such as ultrasound or fine-needle aspiration.
7. A clinician is performing a pulmonary exam on a patient with suspected lobar pneumonia.
Which of the following findings is expected over the area of consolidation?
A. Decreased tactile fremitus and hyperresonance
B. Increased tactile fremitus and dullness to percussion
C. Decreased tactile fremitus and dullness to percussion
D. Vesicular breath sounds and resonant percussion
Answer: B
Rationale: Consolidation (fluid or solid tissue) in the lungs conducts sound and vibration
more effectively than air. Therefore, tactile fremitus is increased and the percussion note is
dull over a pneumonic lobe. In contrast, pleural effusions or pneumothorax result in
decreased fremitus.
8. A 72-year-old patient with a history of hypertension presents with a sudden onset of ‘the
worst headache of my life.’ On exam, there is neck stiffness (nuchal rigidity). What is the
priority differential diagnosis?
A. Cluster headache
B. Temporal arteritis
C. Migraine with aura
D. Subarachnoid hemorrhage
Answer: D
Rationale: The ‘thunderclap’ headache or ‘worst headache of life’ combined with signs of
meningeal irritation (nuchal rigidity) is the classic presentation of a subarachnoid
hemorrhage. This is a medical emergency often caused by a ruptured aneurysm. Temporal
arteritis usually presents with localized scalp tenderness and vision changes.
9. When assessing a patient for Carpal Tunnel Syndrome, the clinician asks the patient to hold
the backs of their hands together with wrists flexed at 90 degrees for 60 seconds. This
maneuver is known as:
A. Phalen’s test
