NUR 6111 ADVANCED PHYSICAL
ASSESSMENT COMPREHENSIVE EXAM
QUESTIONS WITH CORRECT ANSWERS
2026/2027
1. During a cardiac assessment, you auscultate a low-pitched extra heart sound occurring in
early diastole at the apex. This finding in a 70-year-old patient is most likely:
A. A physiological S3
B. Mitral valve prolapse click
C. A normal S4 heart sound
D. A pathological S3 indicating heart failure
Answer: D
Conceptual Explanation: In older adults, an S3 (ventricular gallop) is usually pathological
and represents decreased ventricular compliance or volume overload, often seen in heart
failure.
,2. When performing a neurological exam, you ask the patient to stick out their tongue. It
deviates to the right side. Which cranial nerve is likely affected?
A. CN IX (Glossopharyngeal)
B. CN XII (Hypoglossal)
C. CN X (Vagus)
D. CN VII (Facial)
Answer: B
Conceptual Explanation: Cranial Nerve XII (Hypoglossal) controls tongue movement.
Damage causes the tongue to deviate toward the side of the lesion.
3. A patient presents with a ‘tearing’ chest pain radiating to the back. On assessment, there is
a significant blood pressure difference between the right and left arms. What is the priority
differential diagnosis?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Conceptual Explanation: Tearing chest pain radiating to the back combined with
asymmetrical blood pressure readings is a classic presentation of an aortic dissection.
, 4. Upon palpating the abdomen, you feel a distinct, pulsating mass approximately 5 cm wide
just left of the midline in the upper abdomen. Your next action should be:
A. Auscultate for a bruit and avoid further deep palpation
B. Perform deep palpation to determine depth
C. Apply firm pressure to check for rebound tenderness
D. Perform a percussive wave test for ascites
Answer: A
Conceptual Explanation: A pulsating midline mass suggests an Abdominal Aortic
Aneurysm (AAA). Deep palpation should be avoided to prevent rupture, and auscultation
for a bruit is indicated.
5. During a pulmonary exam, you note increased tactile fremitus over the right lower lobe.
This finding is most consistent with:
A. Pneumothorax
B. Pleural effusion
C. Lobar pneumonia
D. COPD
Answer: C
Conceptual Explanation: Tactile fremitus increases with lung consolidation (e.g.,
pneumonia) because sound travels better through solid/liquid media than air.
ASSESSMENT COMPREHENSIVE EXAM
QUESTIONS WITH CORRECT ANSWERS
2026/2027
1. During a cardiac assessment, you auscultate a low-pitched extra heart sound occurring in
early diastole at the apex. This finding in a 70-year-old patient is most likely:
A. A physiological S3
B. Mitral valve prolapse click
C. A normal S4 heart sound
D. A pathological S3 indicating heart failure
Answer: D
Conceptual Explanation: In older adults, an S3 (ventricular gallop) is usually pathological
and represents decreased ventricular compliance or volume overload, often seen in heart
failure.
,2. When performing a neurological exam, you ask the patient to stick out their tongue. It
deviates to the right side. Which cranial nerve is likely affected?
A. CN IX (Glossopharyngeal)
B. CN XII (Hypoglossal)
C. CN X (Vagus)
D. CN VII (Facial)
Answer: B
Conceptual Explanation: Cranial Nerve XII (Hypoglossal) controls tongue movement.
Damage causes the tongue to deviate toward the side of the lesion.
3. A patient presents with a ‘tearing’ chest pain radiating to the back. On assessment, there is
a significant blood pressure difference between the right and left arms. What is the priority
differential diagnosis?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Conceptual Explanation: Tearing chest pain radiating to the back combined with
asymmetrical blood pressure readings is a classic presentation of an aortic dissection.
, 4. Upon palpating the abdomen, you feel a distinct, pulsating mass approximately 5 cm wide
just left of the midline in the upper abdomen. Your next action should be:
A. Auscultate for a bruit and avoid further deep palpation
B. Perform deep palpation to determine depth
C. Apply firm pressure to check for rebound tenderness
D. Perform a percussive wave test for ascites
Answer: A
Conceptual Explanation: A pulsating midline mass suggests an Abdominal Aortic
Aneurysm (AAA). Deep palpation should be avoided to prevent rupture, and auscultation
for a bruit is indicated.
5. During a pulmonary exam, you note increased tactile fremitus over the right lower lobe.
This finding is most consistent with:
A. Pneumothorax
B. Pleural effusion
C. Lobar pneumonia
D. COPD
Answer: C
Conceptual Explanation: Tactile fremitus increases with lung consolidation (e.g.,
pneumonia) because sound travels better through solid/liquid media than air.
