NSG 500 Final Exam Actual Exam V3 | NSG 500 Advanced Health
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 65-year-old male presents with a complaint of sudden, severe ‘tearing’ chest pain that
radiates to his back. His blood pressure is 180/100 mmHg in the right arm and 150/90 mmHg
in the left arm. What is the most likely life-threatening condition the clinician must assess
for?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Rationale: The presentation of tearing chest pain radiating to the back combined with a
significant blood pressure differential between arms is highly characteristic of an aortic
dissection. This condition requires immediate diagnostic imaging, typically a CT angiogram,
to confirm the diagnosis and prevent rupture. The AI analysis suggests that prompt
recognition is critical because the mortality rate increases significantly every hour the
diagnosis is delayed.
2. A 45-year-old female patient presents with RUQ abdominal pain that worsens after eating
a high-fat meal. During the physical exam, the clinician asks the patient to take a deep breath
while palpating the RUQ, causing the patient to abruptly stop inhaling due to pain. This
finding is known as:
A. McBurney’s Sign
B. Rovsing’s Sign
C. Psoas Sign
D. Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is a clinical indicator for acute cholecystitis, performed by
palpating the gallbladder area during inspiration. The cessation of inspiration due to pain
occurs as the inflamed gallbladder contacts the clinician’s hand. AI analysis emphasizes
that while this sign is sensitive, clinicians must also consider the patient’s dietary history
and presence of fever or leukocytosis.
,3. During a mental status examination, a 78-year-old patient is unable to recall three words
after a five-minute delay and is unable to draw a clock face correctly. These findings primarily
indicate a need for further evaluation of:
A. Delirium
B. Major Depressive Disorder
C. Normal Age-Related Memory Loss
D. Cognitive Impairment or Dementia
Answer: D
Rationale: The Mini-Cog, which includes word recall and a clock-drawing test, is an
efficient screen for cognitive impairment in older adults. Failure in these areas is not a
definitive diagnosis but serves as a red flag for dementia that warrants a comprehensive
neurological workup. AI analysis indicates that functional status and ADLs should also be
assessed to determine the severity of the impairment.
4. A 30-year-old female presents with fatigue, cold intolerance, and a slow heart rate. Upon
palpation, the thyroid gland is enlarged but non-tender. Which lab finding would most likely
confirm the suspected primary diagnosis?
A. Low TSH and Low Free T4
B. Low TSH and Elevated Free T4
C. Elevated TSH and Elevated Free T4
D. Elevated TSH and Low Free T4
Answer: D
Rationale: The symptoms of fatigue, bradycardia, and cold intolerance are classic for
hypothyroidism. In primary hypothyroidism, the pituitary gland increases TSH production
to stimulate the underactive thyroid, resulting in high TSH and low T4 levels. AI analysis
notes that Hashimoto’s thyroiditis is a common cause in this demographic, requiring
assessment for thyroid antibodies.
5. When assessing a patient’s risk for cardiovascular disease, which of the following findings
during a physical examination would be the most concerning for a high risk of stroke?
A. A carotid bruit heard during auscultation
B. Bilateral pedal edema
C. A grade II/VI systolic murmur at the apex
D. An S4 heart sound
Answer: A
, Rationale: A carotid bruit is an abnormal sound heard over the carotid arteries, often
indicating turbulent blood flow due to atherosclerotic narrowing. This finding is a
significant risk factor for transient ischemic attacks and ischemic strokes. AI analysis
suggests that the clinician should follow up with a carotid ultrasound to quantify the
degree of stenosis.
6. A 22-year-old college student presents with a high fever, stiff neck, and a severe headache.
While the patient is lying supine, the clinician flexes the patient’s neck, which results in the
involuntary flexion of the patient’s hips and knees. This is:
A. Brudzinski’s Sign
B. Kernig’s Sign
C. Lhermitte’s Sign
D. Babinski’s Sign
Answer: A
Rationale: Brudzinski’s sign is a classic clinical marker for meningeal irritation, often seen
in bacterial meningitis. Its presence, along with fever and nuchal rigidity, constitutes a
medical emergency requiring immediate lumbar puncture and antibiotics. AI analysis
highlights that the absence of these signs does not entirely rule out meningitis, especially in
immunocompromised patients.
7. A clinician is performing a transcultural health assessment on a patient from a culture that
values ‘balance’ and views illness as an imbalance between ‘hot’ and ‘cold’ forces. Which
approach by the clinician is most appropriate?
A. Explain that scientific evidence does not support hot/cold theories.
B. Ignore the cultural belief and treat only based on Western medicine.
C. Ask the patient how they believe the illness should be treated based on their traditions.
D. Provide a list of foods the patient must avoid regardless of their beliefs.
Answer: C
Rationale: Integrating cultural beliefs into the treatment plan improves patient adherence
and the therapeutic relationship. By asking the patient for their perspective, the clinician
can find a middle ground that respects the patient’s worldview while ensuring safe medical
care. AI analysis suggests that cultural humility is essential for providing effective care in a
diverse population.
8. During a respiratory assessment of a patient with suspected lobar pneumonia, the clinician
asks the patient to say ‘99’ while auscultating the lungs. The clinician hears the sound clearly
and loudly through the stethoscope. This finding is:
A. Bronchophony
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 65-year-old male presents with a complaint of sudden, severe ‘tearing’ chest pain that
radiates to his back. His blood pressure is 180/100 mmHg in the right arm and 150/90 mmHg
in the left arm. What is the most likely life-threatening condition the clinician must assess
for?
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Rationale: The presentation of tearing chest pain radiating to the back combined with a
significant blood pressure differential between arms is highly characteristic of an aortic
dissection. This condition requires immediate diagnostic imaging, typically a CT angiogram,
to confirm the diagnosis and prevent rupture. The AI analysis suggests that prompt
recognition is critical because the mortality rate increases significantly every hour the
diagnosis is delayed.
2. A 45-year-old female patient presents with RUQ abdominal pain that worsens after eating
a high-fat meal. During the physical exam, the clinician asks the patient to take a deep breath
while palpating the RUQ, causing the patient to abruptly stop inhaling due to pain. This
finding is known as:
A. McBurney’s Sign
B. Rovsing’s Sign
C. Psoas Sign
D. Murphy’s Sign
Answer: D
Rationale: Murphy’s sign is a clinical indicator for acute cholecystitis, performed by
palpating the gallbladder area during inspiration. The cessation of inspiration due to pain
occurs as the inflamed gallbladder contacts the clinician’s hand. AI analysis emphasizes
that while this sign is sensitive, clinicians must also consider the patient’s dietary history
and presence of fever or leukocytosis.
,3. During a mental status examination, a 78-year-old patient is unable to recall three words
after a five-minute delay and is unable to draw a clock face correctly. These findings primarily
indicate a need for further evaluation of:
A. Delirium
B. Major Depressive Disorder
C. Normal Age-Related Memory Loss
D. Cognitive Impairment or Dementia
Answer: D
Rationale: The Mini-Cog, which includes word recall and a clock-drawing test, is an
efficient screen for cognitive impairment in older adults. Failure in these areas is not a
definitive diagnosis but serves as a red flag for dementia that warrants a comprehensive
neurological workup. AI analysis indicates that functional status and ADLs should also be
assessed to determine the severity of the impairment.
4. A 30-year-old female presents with fatigue, cold intolerance, and a slow heart rate. Upon
palpation, the thyroid gland is enlarged but non-tender. Which lab finding would most likely
confirm the suspected primary diagnosis?
A. Low TSH and Low Free T4
B. Low TSH and Elevated Free T4
C. Elevated TSH and Elevated Free T4
D. Elevated TSH and Low Free T4
Answer: D
Rationale: The symptoms of fatigue, bradycardia, and cold intolerance are classic for
hypothyroidism. In primary hypothyroidism, the pituitary gland increases TSH production
to stimulate the underactive thyroid, resulting in high TSH and low T4 levels. AI analysis
notes that Hashimoto’s thyroiditis is a common cause in this demographic, requiring
assessment for thyroid antibodies.
5. When assessing a patient’s risk for cardiovascular disease, which of the following findings
during a physical examination would be the most concerning for a high risk of stroke?
A. A carotid bruit heard during auscultation
B. Bilateral pedal edema
C. A grade II/VI systolic murmur at the apex
D. An S4 heart sound
Answer: A
, Rationale: A carotid bruit is an abnormal sound heard over the carotid arteries, often
indicating turbulent blood flow due to atherosclerotic narrowing. This finding is a
significant risk factor for transient ischemic attacks and ischemic strokes. AI analysis
suggests that the clinician should follow up with a carotid ultrasound to quantify the
degree of stenosis.
6. A 22-year-old college student presents with a high fever, stiff neck, and a severe headache.
While the patient is lying supine, the clinician flexes the patient’s neck, which results in the
involuntary flexion of the patient’s hips and knees. This is:
A. Brudzinski’s Sign
B. Kernig’s Sign
C. Lhermitte’s Sign
D. Babinski’s Sign
Answer: A
Rationale: Brudzinski’s sign is a classic clinical marker for meningeal irritation, often seen
in bacterial meningitis. Its presence, along with fever and nuchal rigidity, constitutes a
medical emergency requiring immediate lumbar puncture and antibiotics. AI analysis
highlights that the absence of these signs does not entirely rule out meningitis, especially in
immunocompromised patients.
7. A clinician is performing a transcultural health assessment on a patient from a culture that
values ‘balance’ and views illness as an imbalance between ‘hot’ and ‘cold’ forces. Which
approach by the clinician is most appropriate?
A. Explain that scientific evidence does not support hot/cold theories.
B. Ignore the cultural belief and treat only based on Western medicine.
C. Ask the patient how they believe the illness should be treated based on their traditions.
D. Provide a list of foods the patient must avoid regardless of their beliefs.
Answer: C
Rationale: Integrating cultural beliefs into the treatment plan improves patient adherence
and the therapeutic relationship. By asking the patient for their perspective, the clinician
can find a middle ground that respects the patient’s worldview while ensuring safe medical
care. AI analysis suggests that cultural humility is essential for providing effective care in a
diverse population.
8. During a respiratory assessment of a patient with suspected lobar pneumonia, the clinician
asks the patient to say ‘99’ while auscultating the lungs. The clinician hears the sound clearly
and loudly through the stethoscope. This finding is:
A. Bronchophony
