NSG 500 Final Exam Actual Exam V2 | NSG 500 Advanced Health
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 65-year-old male presents for a routine check-up. While performing the cardiac exam,
the clinician notes a low-pitched, mid-diastolic murmur heard best at the apex with the bell
of the stethoscope. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: D
Rationale: A mid-diastolic murmur heard at the apex is classic for mitral stenosis. This
condition often results from rheumatic heart disease or calcification in older adults. The
use of the bell is necessary because the murmur is low-pitched.
2. During a mental health screening, a 24-year-old patient reports feeling ‘on edge’ for the
last six months and has difficulty concentrating. Which screening tool is most appropriate for
initial evaluation?
A. PHQ-9
B. Mini-Mental State Exam
C. CAGE Questionnaire
D. GAD-7
Answer: D
Rationale: The GAD-7 is a validated tool specifically designed to screen for and measure
the severity of Generalized Anxiety Disorder. The symptoms of feeling ‘on edge’ and
concentration issues are key criteria for anxiety. Other tools like the PHQ-9 focus primarily
on depression symptoms.
3. A 45-year-old female complains of right upper quadrant pain that radiates to her right
shoulder after eating a fatty meal. Upon palpation, she stops breathing in during inspiration
as the clinician presses under the costal margin. This finding is known as:
A. Rovsing’s Sign
B. Psoas Sign
C. McBurney’s Sign
,D. Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is a clinical indicator for acute cholecystitis. It is elicited when
the patient halts inspiration due to pain as the gallbladder descends against the examiner’s
hand. This finding has high specificity for gallbladder inflammation.
4. An 82-year-old patient is being assessed for functional status. The clinician asks the patient
about their ability to manage finances, go shopping, and prepare meals. These activities are
categorized as:
A. Basic Activities of Daily Living (ADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Mobility Indices
D. Cognitive Reserve Factors
Answer: B
Rationale: IADLs refer to more complex skills needed to live independently, such as
managing money or cooking. Basic ADLs include fundamental tasks like bathing, dressing,
and toileting. Distinguishing between these helps the clinician determine the level of
support an elderly patient may require.
5. A mother brings her 18-month-old toddler for a well-child visit. The clinician notes the
toddler cannot walk independently or speak any words. What is the most appropriate next
step?
A. Reassure the mother that children develop at different rates
B. Perform a comprehensive developmental screening and refer for evaluation
C. Wait until the 2-year visit to see if the child catches up
D. Order an immediate CT scan of the brain
Answer: B
Rationale: Walking should typically occur by 15 months, and the absence of words by 18
months is a developmental red flag. Formal screening is necessary to identify potential
neurodevelopmental delays. Early intervention is crucial for improving long-term
outcomes in pediatric patients.
6. When examining a patient’s thyroid gland using the posterior approach, which instruction
should the clinician give to the patient?
A. Take a deep breath and hold it
B. Tilt the head back and look at the ceiling
, C. Sip some water and swallow
D. Cough vigorously
Answer: C
Rationale: Swallowing causes the thyroid gland and cricoid cartilage to move upward. This
movement allows the clinician to palpate the gland’s consistency and identify any nodules.
It is a standard maneuver for both anterior and posterior thyroid examinations.
7. A 30-year-old male presents with a cough and fever. On auscultation, the clinician hears
high-pitched, musical sounds primarily during expiration. These are identified as:
A. Crackles
B. Wheezes
C. Rhonchi
D. Stridor
Answer: B
Rationale: Wheezes are continuous, musical lung sounds caused by narrowed airways.
They are commonly associated with asthma or COPD exacerbations. Rhonchi are lower-
pitched and suggest secretions in larger airways.
8. During a neurological exam, the clinician asks the patient to stand with feet together and
eyes closed. The patient begins to sway significantly and loses balance. This is a positive:
A. Babinski Sign
B. Romberg Test
C. Pronator Drift
D. Kernig Sign
Answer: B
Rationale: A positive Romberg test indicates a loss of proprioception or vestibular
dysfunction. When eyes are closed, the patient cannot use visual cues to maintain balance.
This test specifically evaluates the integrity of the dorsal column-medial lemniscal
pathway.
9. A 50-year-old male smoker presents with painless hematuria. What is the clinician’s
primary concern?
A. Urinary Tract Infection
B. Bladder Cancer
C. Kidney Stones
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 65-year-old male presents for a routine check-up. While performing the cardiac exam,
the clinician notes a low-pitched, mid-diastolic murmur heard best at the apex with the bell
of the stethoscope. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: D
Rationale: A mid-diastolic murmur heard at the apex is classic for mitral stenosis. This
condition often results from rheumatic heart disease or calcification in older adults. The
use of the bell is necessary because the murmur is low-pitched.
2. During a mental health screening, a 24-year-old patient reports feeling ‘on edge’ for the
last six months and has difficulty concentrating. Which screening tool is most appropriate for
initial evaluation?
A. PHQ-9
B. Mini-Mental State Exam
C. CAGE Questionnaire
D. GAD-7
Answer: D
Rationale: The GAD-7 is a validated tool specifically designed to screen for and measure
the severity of Generalized Anxiety Disorder. The symptoms of feeling ‘on edge’ and
concentration issues are key criteria for anxiety. Other tools like the PHQ-9 focus primarily
on depression symptoms.
3. A 45-year-old female complains of right upper quadrant pain that radiates to her right
shoulder after eating a fatty meal. Upon palpation, she stops breathing in during inspiration
as the clinician presses under the costal margin. This finding is known as:
A. Rovsing’s Sign
B. Psoas Sign
C. McBurney’s Sign
,D. Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is a clinical indicator for acute cholecystitis. It is elicited when
the patient halts inspiration due to pain as the gallbladder descends against the examiner’s
hand. This finding has high specificity for gallbladder inflammation.
4. An 82-year-old patient is being assessed for functional status. The clinician asks the patient
about their ability to manage finances, go shopping, and prepare meals. These activities are
categorized as:
A. Basic Activities of Daily Living (ADLs)
B. Instrumental Activities of Daily Living (IADLs)
C. Mobility Indices
D. Cognitive Reserve Factors
Answer: B
Rationale: IADLs refer to more complex skills needed to live independently, such as
managing money or cooking. Basic ADLs include fundamental tasks like bathing, dressing,
and toileting. Distinguishing between these helps the clinician determine the level of
support an elderly patient may require.
5. A mother brings her 18-month-old toddler for a well-child visit. The clinician notes the
toddler cannot walk independently or speak any words. What is the most appropriate next
step?
A. Reassure the mother that children develop at different rates
B. Perform a comprehensive developmental screening and refer for evaluation
C. Wait until the 2-year visit to see if the child catches up
D. Order an immediate CT scan of the brain
Answer: B
Rationale: Walking should typically occur by 15 months, and the absence of words by 18
months is a developmental red flag. Formal screening is necessary to identify potential
neurodevelopmental delays. Early intervention is crucial for improving long-term
outcomes in pediatric patients.
6. When examining a patient’s thyroid gland using the posterior approach, which instruction
should the clinician give to the patient?
A. Take a deep breath and hold it
B. Tilt the head back and look at the ceiling
, C. Sip some water and swallow
D. Cough vigorously
Answer: C
Rationale: Swallowing causes the thyroid gland and cricoid cartilage to move upward. This
movement allows the clinician to palpate the gland’s consistency and identify any nodules.
It is a standard maneuver for both anterior and posterior thyroid examinations.
7. A 30-year-old male presents with a cough and fever. On auscultation, the clinician hears
high-pitched, musical sounds primarily during expiration. These are identified as:
A. Crackles
B. Wheezes
C. Rhonchi
D. Stridor
Answer: B
Rationale: Wheezes are continuous, musical lung sounds caused by narrowed airways.
They are commonly associated with asthma or COPD exacerbations. Rhonchi are lower-
pitched and suggest secretions in larger airways.
8. During a neurological exam, the clinician asks the patient to stand with feet together and
eyes closed. The patient begins to sway significantly and loses balance. This is a positive:
A. Babinski Sign
B. Romberg Test
C. Pronator Drift
D. Kernig Sign
Answer: B
Rationale: A positive Romberg test indicates a loss of proprioception or vestibular
dysfunction. When eyes are closed, the patient cannot use visual cues to maintain balance.
This test specifically evaluates the integrity of the dorsal column-medial lemniscal
pathway.
9. A 50-year-old male smoker presents with painless hematuria. What is the clinician’s
primary concern?
A. Urinary Tract Infection
B. Bladder Cancer
C. Kidney Stones
