NSG 500 Exam 3 Actual Exam V3 | NSG 500 Advanced Health
Assessment (NSG500 Exam 3) [PDF] | Wilkes University
1. A 45-year-old female presents with severe right upper quadrant pain that radiates to her
right shoulder after eating a fatty meal. On physical examination, the clinician notes a sharp
halt in inspiration during deep palpation of the right subcostal area. Which physical sign is
being demonstrated, and what is the most likely diagnosis?
A. Rovsing sign; Appendicitis
B. Psoas sign; Peritonitis
C. Murphy sign; Acute cholecystitis
D. Grey Turner sign; Pancreatitis
Answer: C
Rationale: The Murphy sign is characterized by an abrupt cessation of inspiration when
the examiner’s fingers touch the inflamed gallbladder during deep palpation. This finding is
highly specific for acute cholecystitis, often triggered by biliary calculi. The radiation of
pain to the right scapula, known as Boas’ sign, further supports this clinical assessment.
2. A 68-year-old male patient reports a weak urinary stream, hesitancy, and the sensation of
incomplete bladder emptying. Digital rectal examination (DRE) reveals a smooth, firm, and
non-tender symmetrically enlarged prostate. What is the most appropriate next step in the
clinical assessment?
A. Immediate referral for prostate biopsy
B. Begin aggressive antibiotic therapy for prostatitis
C. Assessment for urinary tract infection and checking PSA levels
D. Perform a pelvic ultrasound to rule out bladder cancer
Answer: C
Rationale: These findings are consistent with Benign Prostatic Hyperplasia (BPH), which is
a common condition in aging men. The smooth and non-tender enlargement differentiates
it from the nodular, hard surface typically associated with prostate cancer. Clinical
management involves evaluating for associated complications like UTI and monitoring
Prostate-Specific Antigen (PSA) levels to establish a baseline.
,3. During an abdominal assessment, the clinician performs the ‘shifting dullness’ test on a
patient with significant abdominal distention. Percussion reveals dullness in the flanks while
the patient is supine, which shifts to the dependent side when the patient moves to a lateral
position. What does this finding indicate?
A. The presence of a large abdominal mass
B. Gaseous distention of the bowel
C. Intestinal obstruction
D. The presence of ascites
Answer: D
Rationale: Shifting dullness occurs when free fluid in the peritoneal cavity, known as
ascites, moves according to gravity. When the patient is supine, the fluid settles in the
flanks, and when they turn, the fluid moves to the lower side while the air-filled bowel
floats to the top. This technique is useful for detecting moderate amounts of fluid, although
ultrasound remains more sensitive for small volumes.
4. A 22-year-old male presents to the emergency department with sudden, severe unilateral
scrotal pain that began two hours ago. Physical exam reveals a high-riding, horizontally
oriented testis and an absent cremasteric reflex on the affected side. What is the priority
intervention?
A. Prescribe broad-spectrum antibiotics for epididymitis
B. Obtain an immediate surgical consultation for suspected testicular torsion
C. Apply ice packs and recommend scrotal support
D. Order a urinalysis to check for sexually transmitted infections
Answer: B
Rationale: Testicular torsion is a urologic emergency that requires prompt surgical
intervention to prevent testicular ischemia and loss. The absence of the cremasteric reflex
and a horizontal lie are classic indicators that distinguish torsion from other causes of
scrotal pain. Delaying treatment beyond a 6-hour window significantly reduces the
likelihood of salvaging the testis.
5. A clinician is assessing a 60-year-old patient who complains of chronic epigastric pain that
is relieved by eating but returns 2-3 hours later. The patient also mentions waking up at night
with pain. Which condition is most likely based on this history?
A. Gastric ulcer
B. Duodenal ulcer
C. Acute pancreatitis
D. Gastroesophageal reflux disease (GERD)
, Answer: B
Rationale: Duodenal ulcers typically cause pain that is improved by food intake because
the bicarbonate secretion into the duodenum buffers the acid. The pain usually reappears
when the stomach is empty, often occurring in the middle of the night when acid
production is high. In contrast, gastric ulcer pain is often exacerbated by eating, leading to
weight loss.
6. An elderly patient presents with tenting of the skin when pinched, dry mucous
membranes, and a longitudinal furrow in the tongue. The patient’s blood pressure is 100/60
mmHg, and heart rate is 105 bpm. What is the primary assessment priority?
A. Nutritional deficiency screening
B. Neurological assessment for stroke
C. Cardiac enzyme panel
D. Evaluation of hydration status
Answer: D
Rationale: The clinical findings of skin tenting, dry mucous membranes, and tachycardia
are hallmark signs of significant dehydration. Tenting, or poor skin turgor, indicates a loss
of interstitial fluid and elasticity. In the elderly, these signs are critical indicators that
require immediate fluid resuscitation to prevent renal failure or hypovolemic shock.
7. During a nutritional assessment, the clinician notes that a patient has a Body Mass Index
(BMI) of 17.5 kg/m2, brittle hair, and spoon-shaped nails (koilonychia). Which nutritional
deficiency should be investigated first?
A. Vitamin C deficiency
B. Iron deficiency
C. Protein-energy malnutrition
D. Vitamin B12 deficiency
Answer: B
Rationale: Koilonychia, or spoon-shaped nails, is a classic physical sign associated with
chronic iron deficiency anemia. The low BMI suggests an overall nutritional deficit, but the
specific nail finding is a diagnostic clue for iron status. Further laboratory tests, including
serum ferritin and a complete blood count, are necessary to confirm the diagnosis.
8. A patient with a history of chronic alcohol use presents with bruising around the umbilicus
(Cullen sign) and severe epigastric pain radiating to the back. Which condition is most likely?
A. Acute pancreatitis
B. Ruptured aortic aneurysm
Assessment (NSG500 Exam 3) [PDF] | Wilkes University
1. A 45-year-old female presents with severe right upper quadrant pain that radiates to her
right shoulder after eating a fatty meal. On physical examination, the clinician notes a sharp
halt in inspiration during deep palpation of the right subcostal area. Which physical sign is
being demonstrated, and what is the most likely diagnosis?
A. Rovsing sign; Appendicitis
B. Psoas sign; Peritonitis
C. Murphy sign; Acute cholecystitis
D. Grey Turner sign; Pancreatitis
Answer: C
Rationale: The Murphy sign is characterized by an abrupt cessation of inspiration when
the examiner’s fingers touch the inflamed gallbladder during deep palpation. This finding is
highly specific for acute cholecystitis, often triggered by biliary calculi. The radiation of
pain to the right scapula, known as Boas’ sign, further supports this clinical assessment.
2. A 68-year-old male patient reports a weak urinary stream, hesitancy, and the sensation of
incomplete bladder emptying. Digital rectal examination (DRE) reveals a smooth, firm, and
non-tender symmetrically enlarged prostate. What is the most appropriate next step in the
clinical assessment?
A. Immediate referral for prostate biopsy
B. Begin aggressive antibiotic therapy for prostatitis
C. Assessment for urinary tract infection and checking PSA levels
D. Perform a pelvic ultrasound to rule out bladder cancer
Answer: C
Rationale: These findings are consistent with Benign Prostatic Hyperplasia (BPH), which is
a common condition in aging men. The smooth and non-tender enlargement differentiates
it from the nodular, hard surface typically associated with prostate cancer. Clinical
management involves evaluating for associated complications like UTI and monitoring
Prostate-Specific Antigen (PSA) levels to establish a baseline.
,3. During an abdominal assessment, the clinician performs the ‘shifting dullness’ test on a
patient with significant abdominal distention. Percussion reveals dullness in the flanks while
the patient is supine, which shifts to the dependent side when the patient moves to a lateral
position. What does this finding indicate?
A. The presence of a large abdominal mass
B. Gaseous distention of the bowel
C. Intestinal obstruction
D. The presence of ascites
Answer: D
Rationale: Shifting dullness occurs when free fluid in the peritoneal cavity, known as
ascites, moves according to gravity. When the patient is supine, the fluid settles in the
flanks, and when they turn, the fluid moves to the lower side while the air-filled bowel
floats to the top. This technique is useful for detecting moderate amounts of fluid, although
ultrasound remains more sensitive for small volumes.
4. A 22-year-old male presents to the emergency department with sudden, severe unilateral
scrotal pain that began two hours ago. Physical exam reveals a high-riding, horizontally
oriented testis and an absent cremasteric reflex on the affected side. What is the priority
intervention?
A. Prescribe broad-spectrum antibiotics for epididymitis
B. Obtain an immediate surgical consultation for suspected testicular torsion
C. Apply ice packs and recommend scrotal support
D. Order a urinalysis to check for sexually transmitted infections
Answer: B
Rationale: Testicular torsion is a urologic emergency that requires prompt surgical
intervention to prevent testicular ischemia and loss. The absence of the cremasteric reflex
and a horizontal lie are classic indicators that distinguish torsion from other causes of
scrotal pain. Delaying treatment beyond a 6-hour window significantly reduces the
likelihood of salvaging the testis.
5. A clinician is assessing a 60-year-old patient who complains of chronic epigastric pain that
is relieved by eating but returns 2-3 hours later. The patient also mentions waking up at night
with pain. Which condition is most likely based on this history?
A. Gastric ulcer
B. Duodenal ulcer
C. Acute pancreatitis
D. Gastroesophageal reflux disease (GERD)
, Answer: B
Rationale: Duodenal ulcers typically cause pain that is improved by food intake because
the bicarbonate secretion into the duodenum buffers the acid. The pain usually reappears
when the stomach is empty, often occurring in the middle of the night when acid
production is high. In contrast, gastric ulcer pain is often exacerbated by eating, leading to
weight loss.
6. An elderly patient presents with tenting of the skin when pinched, dry mucous
membranes, and a longitudinal furrow in the tongue. The patient’s blood pressure is 100/60
mmHg, and heart rate is 105 bpm. What is the primary assessment priority?
A. Nutritional deficiency screening
B. Neurological assessment for stroke
C. Cardiac enzyme panel
D. Evaluation of hydration status
Answer: D
Rationale: The clinical findings of skin tenting, dry mucous membranes, and tachycardia
are hallmark signs of significant dehydration. Tenting, or poor skin turgor, indicates a loss
of interstitial fluid and elasticity. In the elderly, these signs are critical indicators that
require immediate fluid resuscitation to prevent renal failure or hypovolemic shock.
7. During a nutritional assessment, the clinician notes that a patient has a Body Mass Index
(BMI) of 17.5 kg/m2, brittle hair, and spoon-shaped nails (koilonychia). Which nutritional
deficiency should be investigated first?
A. Vitamin C deficiency
B. Iron deficiency
C. Protein-energy malnutrition
D. Vitamin B12 deficiency
Answer: B
Rationale: Koilonychia, or spoon-shaped nails, is a classic physical sign associated with
chronic iron deficiency anemia. The low BMI suggests an overall nutritional deficit, but the
specific nail finding is a diagnostic clue for iron status. Further laboratory tests, including
serum ferritin and a complete blood count, are necessary to confirm the diagnosis.
8. A patient with a history of chronic alcohol use presents with bruising around the umbilicus
(Cullen sign) and severe epigastric pain radiating to the back. Which condition is most likely?
A. Acute pancreatitis
B. Ruptured aortic aneurysm
