GRADUATE NURSING ACADEMY PREPARATION | ADVANCED PRACTICE
NURSING
NUR 634 ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING
2026/2027
NUR 634 FINAL ACTUAL EXAM
200 Comprehensive Practice Questions & Clinical Diagnostic Rationales
Advanced Physical Assessment, Clinical Decision Making, & Differential
Diagnosis
Comprehensive Head-to-Toe Physical Exam, History Taking, Systemic Diagnostics, & Advanced
Practice Nursing Reasoning
NUR 634 EXAM DOMAIN & ASSESSMENT BREAKDOWN
• Advanced History Taking, OLDCARTS, & Clinical Decision Making (Q1 – Q25)
• Head, Eyes, Ears, Nose, Throat (HEENT) & Cranial Nerve Assessment (Q26 – Q50)
• Advanced Cardiovascular & Peripheral Vascular Diagnostics (Q51 – Q75)
• Respiratory & Thoracic Physical Assessment & Diagnostic Imaging (Q76 – Q100)
• Gastrointestinal & Abdominal Examination & Special Maneuvers (Q101 – Q125)
• Neurological System, Reflexes, Motor/Sensory, & Cognitive Exams (Q126 – Q150)
• Musculoskeletal Assessment, Special Orthopedic Tests, & Joint Pathology (Q151 – Q175)
• Dermatological, Endocrine, Genitourinary, & Lifespan Diagnostic Reasoning (Q176 – Q200)
QUESTION COUNT FORMAT EXAM VERSION
200 Questions Multiple Choice + Rationales 2026/2027 Actual Prep
,NUR 634 FINAL EXAM QUESTION BANK (Q1 - Q200)
Question 1 [Q1] An advanced practice registered nurse (APRN) auscultates a low-pitched,
mid-diastolic rumbling murmur at the cardiac apex with the bell of the stethoscope in the left
lateral decubitus position. An opening snap is also noted. Which valvular lesion is most
consistent with these physical findings?
(A) Mitral stenosis
(B) Aortic regurgitation
(C) Mitral valve prolapse
(D) Tricuspid regurgitation
CORRECT ANSWER: (A) Mitral stenosis
Diagnostic Rationale: Mitral stenosis characteristically produces a low-pitched, mid-diastolic rumbling
murmur best heard at the apex with the bell in the left lateral position, often preceded by an opening snap
following S2.
Question 2 [Q2] During an examination of the internal jugular venous pressure (JVP), the
APRN measures the highest point of oscillation at 4 cm above the sternal angle. If the sternal
angle is assumed to be 5 cm above the right atrium, what is the estimated JVP, and how
should it be interpreted?
(A) 4 cm H2O, which represents normal central venous pressure
(B) 5 cm H2O, which is borderline low
(C) 14 cm H2O, which indicates severe hypovolemia
(D) 9 cm H2O, which indicates elevated jugular venous pressure
CORRECT ANSWER: (D) 9 cm H2O, which indicates elevated jugular venous pressure
Diagnostic Rationale: Total JVP is calculated by adding the height of the venous column above the sternal
angle (4 cm) to the distance from the sternal angle to the right atrium (5 cm), giving 9 cm H2O. A value > 8 cm
H2O is considered elevated.
Question 3 [Q3] While performing lung auscultation on a client with fever and productive
cough, the APRN hears spoken words ('ninety-nine') clearly and distinctly through the
stethoscope over the right lower lobe. What is the name of this physical exam finding, and
what underlying pathology does it suggest?
(A) Whispered pectoriloquy, indicating pneumothorax
(B) Stridor, indicating upper airway obstruction
(C) Bronchophony, indicating lobar pulmonary consolidation
(D) Egophony, indicating pleural effusion
CORRECT ANSWER: (C) Bronchophony, indicating lobar pulmonary consolidation
Diagnostic Rationale: Bronchophony occurs when spoken words sound louder and clearer over
consolidated lung tissue (e.g., pneumonia) because dense sound-transmitting fluid/exudate replaces air-filled
alveoli.
,Question 4 [Q4] The APRN evaluates a client presenting with sudden-onset unilateral pleuritic
chest pain and shortness of breath. Physical exam reveals hyperresonance to percussion,
absent breath sounds, and decreased tactile fremitus over the affected hemithorax. Which
diagnosis is most likely?
(A) Atelectasis
(B) Spontaneous pneumothorax
(C) Lobar pneumonia
(D) Pleural effusion
CORRECT ANSWER: (B) Spontaneous pneumothorax
Diagnostic Rationale: Hyperresonance combined with absent breath sounds and decreased tactile fremitus
on one side is classic for pneumothorax due to trapped air in the pleural space.
Question 5 [Q5] During an ophthalmoscopic examination, the APRN observes a pale,
yellowish optic disc with clear margins and a central optic cup ratio > 0.6, along with loss of
peripheral vision in the client's visual field test. Which underlying ocular condition is most
likely present?
(A) Glaucoma
(B) Macular degeneration
(C) Hypertensive retinopathy
(D) Diabetic retinopathy
CORRECT ANSWER: (A) Glaucoma
Diagnostic Rationale: Glaucoma causes progressive optic nerve cupping (increased cup-to-disc ratio > 0.5–
0.6), disc pallor, and characteristically leads to painless loss of peripheral vision.
Question 6 [Q6] When testing cranial nerves IX and X, the APRN asks the client to say 'ah' and
notes that the soft palate fails to rise on the left side and the uvula deviates to the right. Which
cranial nerve dysfunction is present?
(A) Right cranial nerve IX (Glossopharyngeal nerve) lesion
(B) Left cranial nerve VII (Facial nerve) palsy
(C) Bilateral cranial nerve XII (Hypoglossal nerve) injury
(D) Left cranial nerve X (Vagus nerve) lesion
CORRECT ANSWER: (D) Left cranial nerve X (Vagus nerve) lesion
Diagnostic Rationale: In unilateral vagus nerve (CN X) paralysis, the soft palate fails to elevate on the
involved side, causing the uvula to deviate toward the intact (unaffected) side (right side in this case).
Question 7 [Q7] The APRN performs deep palpation in the right lower quadrant while pressing
deeply in the left lower quadrant. The client reports sharp pain in the right lower quadrant upon
, release of pressure in the left lower quadrant. What is the name of this diagnostic sign?
(A) Psoas sign
(B) Obturator sign
(C) Rovsing sign
(D) Murphy sign
CORRECT ANSWER: (C) Rovsing sign
Diagnostic Rationale: Rovsing sign is positive when deep pressure applied in the left lower quadrant causes
referred pain in the right lower quadrant, suggestive of acute appendicitis.
Question 8 [Q8] When evaluating a client suspected of acute cholecystitis, the APRN hooks
the fingers under the right costal margin at the lateral border of the rectus muscle and asks the
client to inhale deeply. The client abruptly stops breathing due to sharp tenderness. What is
this finding?
(A) Positive Grey Turner sign
(B) Positive Murphy sign
(C) Positive McBurney sign
(D) Positive Cullen sign
CORRECT ANSWER: (B) Positive Murphy sign
Diagnostic Rationale: Murphy sign is demonstrated when sharp pain causes inspiratory arrest during
palpation of the right upper quadrant as the inflamed gallbladder touches the examining hand upon
diaphragmatic descent.
Question 9 [Q9] The APRN stroke the lateral aspect of the sole of the foot from the heel
upward across the ball of the foot in an adult client. The big toe dorsiflexes and the other toes
fan outward. How should the APRN document this finding and what does it indicate?
(A) Positive Babinski response, indicating upper motor neuron (UMN) lesion
(B) Normal plantar reflex response in adults
(C) Negative Babinski sign, indicating lower motor neuron (LMN) damage
(D) Hyperactive deep tendon reflex, indicating cerebellar disease
CORRECT ANSWER: (A) Positive Babinski response, indicating upper motor neuron (UMN)
lesion
Diagnostic Rationale: Dorsiflexion of the big toe with fanning of the lesser toes in an adult represents a
positive Babinski sign, which is an abnormal reflex indicating an upper motor neuron corticospinal tract lesion.
Question 10 [Q10] The APRN evaluates a client with knee pain following a sports injury. With
the client supine and knee flexed to 90 degrees, the APRN stabilizes the foot, grasps the
proximal tibia, and pulls it anteriorly. Increased anterior translation of the tibia relative to the
femur indicates damage to which structure?
(A) Posterior cruciate ligament (PCL)
NURSING
NUR 634 ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING
2026/2027
NUR 634 FINAL ACTUAL EXAM
200 Comprehensive Practice Questions & Clinical Diagnostic Rationales
Advanced Physical Assessment, Clinical Decision Making, & Differential
Diagnosis
Comprehensive Head-to-Toe Physical Exam, History Taking, Systemic Diagnostics, & Advanced
Practice Nursing Reasoning
NUR 634 EXAM DOMAIN & ASSESSMENT BREAKDOWN
• Advanced History Taking, OLDCARTS, & Clinical Decision Making (Q1 – Q25)
• Head, Eyes, Ears, Nose, Throat (HEENT) & Cranial Nerve Assessment (Q26 – Q50)
• Advanced Cardiovascular & Peripheral Vascular Diagnostics (Q51 – Q75)
• Respiratory & Thoracic Physical Assessment & Diagnostic Imaging (Q76 – Q100)
• Gastrointestinal & Abdominal Examination & Special Maneuvers (Q101 – Q125)
• Neurological System, Reflexes, Motor/Sensory, & Cognitive Exams (Q126 – Q150)
• Musculoskeletal Assessment, Special Orthopedic Tests, & Joint Pathology (Q151 – Q175)
• Dermatological, Endocrine, Genitourinary, & Lifespan Diagnostic Reasoning (Q176 – Q200)
QUESTION COUNT FORMAT EXAM VERSION
200 Questions Multiple Choice + Rationales 2026/2027 Actual Prep
,NUR 634 FINAL EXAM QUESTION BANK (Q1 - Q200)
Question 1 [Q1] An advanced practice registered nurse (APRN) auscultates a low-pitched,
mid-diastolic rumbling murmur at the cardiac apex with the bell of the stethoscope in the left
lateral decubitus position. An opening snap is also noted. Which valvular lesion is most
consistent with these physical findings?
(A) Mitral stenosis
(B) Aortic regurgitation
(C) Mitral valve prolapse
(D) Tricuspid regurgitation
CORRECT ANSWER: (A) Mitral stenosis
Diagnostic Rationale: Mitral stenosis characteristically produces a low-pitched, mid-diastolic rumbling
murmur best heard at the apex with the bell in the left lateral position, often preceded by an opening snap
following S2.
Question 2 [Q2] During an examination of the internal jugular venous pressure (JVP), the
APRN measures the highest point of oscillation at 4 cm above the sternal angle. If the sternal
angle is assumed to be 5 cm above the right atrium, what is the estimated JVP, and how
should it be interpreted?
(A) 4 cm H2O, which represents normal central venous pressure
(B) 5 cm H2O, which is borderline low
(C) 14 cm H2O, which indicates severe hypovolemia
(D) 9 cm H2O, which indicates elevated jugular venous pressure
CORRECT ANSWER: (D) 9 cm H2O, which indicates elevated jugular venous pressure
Diagnostic Rationale: Total JVP is calculated by adding the height of the venous column above the sternal
angle (4 cm) to the distance from the sternal angle to the right atrium (5 cm), giving 9 cm H2O. A value > 8 cm
H2O is considered elevated.
Question 3 [Q3] While performing lung auscultation on a client with fever and productive
cough, the APRN hears spoken words ('ninety-nine') clearly and distinctly through the
stethoscope over the right lower lobe. What is the name of this physical exam finding, and
what underlying pathology does it suggest?
(A) Whispered pectoriloquy, indicating pneumothorax
(B) Stridor, indicating upper airway obstruction
(C) Bronchophony, indicating lobar pulmonary consolidation
(D) Egophony, indicating pleural effusion
CORRECT ANSWER: (C) Bronchophony, indicating lobar pulmonary consolidation
Diagnostic Rationale: Bronchophony occurs when spoken words sound louder and clearer over
consolidated lung tissue (e.g., pneumonia) because dense sound-transmitting fluid/exudate replaces air-filled
alveoli.
,Question 4 [Q4] The APRN evaluates a client presenting with sudden-onset unilateral pleuritic
chest pain and shortness of breath. Physical exam reveals hyperresonance to percussion,
absent breath sounds, and decreased tactile fremitus over the affected hemithorax. Which
diagnosis is most likely?
(A) Atelectasis
(B) Spontaneous pneumothorax
(C) Lobar pneumonia
(D) Pleural effusion
CORRECT ANSWER: (B) Spontaneous pneumothorax
Diagnostic Rationale: Hyperresonance combined with absent breath sounds and decreased tactile fremitus
on one side is classic for pneumothorax due to trapped air in the pleural space.
Question 5 [Q5] During an ophthalmoscopic examination, the APRN observes a pale,
yellowish optic disc with clear margins and a central optic cup ratio > 0.6, along with loss of
peripheral vision in the client's visual field test. Which underlying ocular condition is most
likely present?
(A) Glaucoma
(B) Macular degeneration
(C) Hypertensive retinopathy
(D) Diabetic retinopathy
CORRECT ANSWER: (A) Glaucoma
Diagnostic Rationale: Glaucoma causes progressive optic nerve cupping (increased cup-to-disc ratio > 0.5–
0.6), disc pallor, and characteristically leads to painless loss of peripheral vision.
Question 6 [Q6] When testing cranial nerves IX and X, the APRN asks the client to say 'ah' and
notes that the soft palate fails to rise on the left side and the uvula deviates to the right. Which
cranial nerve dysfunction is present?
(A) Right cranial nerve IX (Glossopharyngeal nerve) lesion
(B) Left cranial nerve VII (Facial nerve) palsy
(C) Bilateral cranial nerve XII (Hypoglossal nerve) injury
(D) Left cranial nerve X (Vagus nerve) lesion
CORRECT ANSWER: (D) Left cranial nerve X (Vagus nerve) lesion
Diagnostic Rationale: In unilateral vagus nerve (CN X) paralysis, the soft palate fails to elevate on the
involved side, causing the uvula to deviate toward the intact (unaffected) side (right side in this case).
Question 7 [Q7] The APRN performs deep palpation in the right lower quadrant while pressing
deeply in the left lower quadrant. The client reports sharp pain in the right lower quadrant upon
, release of pressure in the left lower quadrant. What is the name of this diagnostic sign?
(A) Psoas sign
(B) Obturator sign
(C) Rovsing sign
(D) Murphy sign
CORRECT ANSWER: (C) Rovsing sign
Diagnostic Rationale: Rovsing sign is positive when deep pressure applied in the left lower quadrant causes
referred pain in the right lower quadrant, suggestive of acute appendicitis.
Question 8 [Q8] When evaluating a client suspected of acute cholecystitis, the APRN hooks
the fingers under the right costal margin at the lateral border of the rectus muscle and asks the
client to inhale deeply. The client abruptly stops breathing due to sharp tenderness. What is
this finding?
(A) Positive Grey Turner sign
(B) Positive Murphy sign
(C) Positive McBurney sign
(D) Positive Cullen sign
CORRECT ANSWER: (B) Positive Murphy sign
Diagnostic Rationale: Murphy sign is demonstrated when sharp pain causes inspiratory arrest during
palpation of the right upper quadrant as the inflamed gallbladder touches the examining hand upon
diaphragmatic descent.
Question 9 [Q9] The APRN stroke the lateral aspect of the sole of the foot from the heel
upward across the ball of the foot in an adult client. The big toe dorsiflexes and the other toes
fan outward. How should the APRN document this finding and what does it indicate?
(A) Positive Babinski response, indicating upper motor neuron (UMN) lesion
(B) Normal plantar reflex response in adults
(C) Negative Babinski sign, indicating lower motor neuron (LMN) damage
(D) Hyperactive deep tendon reflex, indicating cerebellar disease
CORRECT ANSWER: (A) Positive Babinski response, indicating upper motor neuron (UMN)
lesion
Diagnostic Rationale: Dorsiflexion of the big toe with fanning of the lesser toes in an adult represents a
positive Babinski sign, which is an abnormal reflex indicating an upper motor neuron corticospinal tract lesion.
Question 10 [Q10] The APRN evaluates a client with knee pain following a sports injury. With
the client supine and knee flexed to 90 degrees, the APRN stabilizes the foot, grasps the
proximal tibia, and pulls it anteriorly. Increased anterior translation of the tibia relative to the
femur indicates damage to which structure?
(A) Posterior cruciate ligament (PCL)
