NSG 500 Final Exam Actual Exam V1 | NSG 500 Advanced Health
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 68-year-old male presents with sudden onset of shortness of breath and pleuritic chest
pain. Upon physical examination, the clinician notes decreased breath sounds and
hyperresonance on percussion on the right side. Which of the following is the most likely
diagnosis?
A. Lobar pneumonia
B. Pleural effusion
C. Pneumothorax
D. Pulmonary embolism
Answer: C
Rationale: Hyperresonance on percussion indicates an excess of air in the pleural space,
which is characteristic of a pneumothorax. In contrast, pleural effusion and pneumonia
typically present with dullness to percussion due to fluid or consolidation. The clinician
must act quickly to assess for tracheal deviation and hemodynamic stability in this
scenario.
2. During a cardiovascular assessment of a 72-year-old patient with a history of hypertension,
the NP hears a low-pitched extra heart sound in early diastole at the apex using the bell of
the stethoscope. How should this finding be documented?
A. S4 gallop
B. Opening snap
C. S3 gallop
D. Systolic click
Answer: C
Rationale: An S3 heart sound occurs in early diastole during the rapid ventricular filling
phase and is often associated with heart failure or volume overload in older adults. It is
best heard with the bell of the stethoscope at the apex while the patient is in the left lateral
decubitus position. This finding requires further evaluation of the patient’s fluid status and
cardiac function.
3. A 45-year-old female presents with a chief complaint of a ‘lump’ in her neck. Palpation
reveals a firm, fixed, non-tender nodule in the left lobe of the thyroid. What is the most
appropriate next step in the assessment?
A. Order a TSH level and schedule a follow-up in 6 months.
,B. Reassure the patient that most nodules are benign cysts.
C. Advise the patient to increase iodine intake and re-evaluate.
D. Auscultate for a bruit and order a thyroid ultrasound.
Answer: D
Rationale: A firm, fixed nodule is a red flag for potential malignancy and requires
immediate diagnostic imaging via ultrasound. Auscultating for a bruit can help identify
increased vascularity common in hypermetabolic states. The clinician must prioritize
definitive diagnostic steps over watchful waiting when malignancy is suspected.
4. A 19-year-old college student presents with a severe headache, fever, and a stiff neck.
During the physical exam, the NP flexes the patient’s neck and observes involuntary flexion of
the hips and knees. What is the name of this sign?
A. Kernig’s sign
B. Babinski’s sign
C. Hoffmann’s sign
D. Brudzinski’s sign
Answer: D
Rationale: Brudzinski’s sign is a clinical indicator of meningeal irritation where passive
neck flexion causes reflex hip and knee flexion. This is an urgent finding that suggests
meningitis and requires immediate referral for a lumbar puncture and stabilization.
Kernig’s sign involves pain when straightening the leg at the knee with the hip flexed at 90
degrees.
5. A 55-year-old patient reports persistent epigastric pain that improves slightly after eating.
On examination, the clinician notes a positive Murphy’s sign. Which condition is most
strongly suggested by this specific finding?
A. Acute cholecystitis
B. Peptic ulcer disease
C. Acute pancreatitis
D. Gastroesophageal reflux disease
Answer: A
Rationale: Murphy’s sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath; an abrupt cessation of inspiration due to pain is positive. This
finding is highly suggestive of acute cholecystitis, or gallbladder inflammation. While the
patient’s history of pain relief with food suggests an ulcer, the physical exam finding directs
the clinician toward the biliary system.
, 6. When performing a funduscopic examination on a patient with chronic uncontrolled
hypertension, the NP observes small, light-colored, slightly yellow spots with ill-defined edges
on the retina. These are best described as:
A. Hard exudates
B. Drusen
C. Cotton-wool spots
D. Hemorrhages
Answer: C
Rationale: Cotton-wool spots represent micro-infarctions of the retinal nerve fiber layer
and appear as white or yellowish clouds with fuzzy borders. They are commonly seen in
patients with systemic diseases like hypertension and diabetes mellitus. Distinguishing
these from hard exudates, which have well-defined borders, is essential for accurate
staging of retinopathy.
7. A 30-year-old male presents with a sudden onset of scrotal pain and swelling. On
examination, the left testicle is exquisitely tender and appears higher in the scrotum than the
right. The cremasteric reflex is absent on the left. What is the priority action?
A. Order a urinalysis to check for infection.
B. Immediate surgical consultation for suspected testicular torsion.
C. Provide analgesics and follow up in 24 hours.
D. Perform a transillumination test to check for a hydrocele.
Answer: B
Rationale: Testicular torsion is a surgical emergency characterized by the twisting of the
spermatic cord, which compromises blood flow to the testis. The absence of the
cremasteric reflex and a high-riding testis are classic signs that differentiate torsion from
epididymitis. Delays in treatment can lead to permanent testicular necrosis and loss of the
organ.
8. During an assessment of a 5-year-old child, the NP observes that the child is unable to hop
on one foot or copy a square. According to developmental milestones, these findings are:
A. Normal for this age group.
B. Suggestive of a fine motor delay only.
C. Indicative of a significant gross motor delay.
D. Signs of a potential neurological disorder requiring referral.
Answer: C
Assessment (NSG500 Final Exam) [PDF] | Wilkes University
1. A 68-year-old male presents with sudden onset of shortness of breath and pleuritic chest
pain. Upon physical examination, the clinician notes decreased breath sounds and
hyperresonance on percussion on the right side. Which of the following is the most likely
diagnosis?
A. Lobar pneumonia
B. Pleural effusion
C. Pneumothorax
D. Pulmonary embolism
Answer: C
Rationale: Hyperresonance on percussion indicates an excess of air in the pleural space,
which is characteristic of a pneumothorax. In contrast, pleural effusion and pneumonia
typically present with dullness to percussion due to fluid or consolidation. The clinician
must act quickly to assess for tracheal deviation and hemodynamic stability in this
scenario.
2. During a cardiovascular assessment of a 72-year-old patient with a history of hypertension,
the NP hears a low-pitched extra heart sound in early diastole at the apex using the bell of
the stethoscope. How should this finding be documented?
A. S4 gallop
B. Opening snap
C. S3 gallop
D. Systolic click
Answer: C
Rationale: An S3 heart sound occurs in early diastole during the rapid ventricular filling
phase and is often associated with heart failure or volume overload in older adults. It is
best heard with the bell of the stethoscope at the apex while the patient is in the left lateral
decubitus position. This finding requires further evaluation of the patient’s fluid status and
cardiac function.
3. A 45-year-old female presents with a chief complaint of a ‘lump’ in her neck. Palpation
reveals a firm, fixed, non-tender nodule in the left lobe of the thyroid. What is the most
appropriate next step in the assessment?
A. Order a TSH level and schedule a follow-up in 6 months.
,B. Reassure the patient that most nodules are benign cysts.
C. Advise the patient to increase iodine intake and re-evaluate.
D. Auscultate for a bruit and order a thyroid ultrasound.
Answer: D
Rationale: A firm, fixed nodule is a red flag for potential malignancy and requires
immediate diagnostic imaging via ultrasound. Auscultating for a bruit can help identify
increased vascularity common in hypermetabolic states. The clinician must prioritize
definitive diagnostic steps over watchful waiting when malignancy is suspected.
4. A 19-year-old college student presents with a severe headache, fever, and a stiff neck.
During the physical exam, the NP flexes the patient’s neck and observes involuntary flexion of
the hips and knees. What is the name of this sign?
A. Kernig’s sign
B. Babinski’s sign
C. Hoffmann’s sign
D. Brudzinski’s sign
Answer: D
Rationale: Brudzinski’s sign is a clinical indicator of meningeal irritation where passive
neck flexion causes reflex hip and knee flexion. This is an urgent finding that suggests
meningitis and requires immediate referral for a lumbar puncture and stabilization.
Kernig’s sign involves pain when straightening the leg at the knee with the hip flexed at 90
degrees.
5. A 55-year-old patient reports persistent epigastric pain that improves slightly after eating.
On examination, the clinician notes a positive Murphy’s sign. Which condition is most
strongly suggested by this specific finding?
A. Acute cholecystitis
B. Peptic ulcer disease
C. Acute pancreatitis
D. Gastroesophageal reflux disease
Answer: A
Rationale: Murphy’s sign is elicited by palpating the right upper quadrant while the
patient takes a deep breath; an abrupt cessation of inspiration due to pain is positive. This
finding is highly suggestive of acute cholecystitis, or gallbladder inflammation. While the
patient’s history of pain relief with food suggests an ulcer, the physical exam finding directs
the clinician toward the biliary system.
, 6. When performing a funduscopic examination on a patient with chronic uncontrolled
hypertension, the NP observes small, light-colored, slightly yellow spots with ill-defined edges
on the retina. These are best described as:
A. Hard exudates
B. Drusen
C. Cotton-wool spots
D. Hemorrhages
Answer: C
Rationale: Cotton-wool spots represent micro-infarctions of the retinal nerve fiber layer
and appear as white or yellowish clouds with fuzzy borders. They are commonly seen in
patients with systemic diseases like hypertension and diabetes mellitus. Distinguishing
these from hard exudates, which have well-defined borders, is essential for accurate
staging of retinopathy.
7. A 30-year-old male presents with a sudden onset of scrotal pain and swelling. On
examination, the left testicle is exquisitely tender and appears higher in the scrotum than the
right. The cremasteric reflex is absent on the left. What is the priority action?
A. Order a urinalysis to check for infection.
B. Immediate surgical consultation for suspected testicular torsion.
C. Provide analgesics and follow up in 24 hours.
D. Perform a transillumination test to check for a hydrocele.
Answer: B
Rationale: Testicular torsion is a surgical emergency characterized by the twisting of the
spermatic cord, which compromises blood flow to the testis. The absence of the
cremasteric reflex and a high-riding testis are classic signs that differentiate torsion from
epididymitis. Delays in treatment can lead to permanent testicular necrosis and loss of the
organ.
8. During an assessment of a 5-year-old child, the NP observes that the child is unable to hop
on one foot or copy a square. According to developmental milestones, these findings are:
A. Normal for this age group.
B. Suggestive of a fine motor delay only.
C. Indicative of a significant gross motor delay.
D. Signs of a potential neurological disorder requiring referral.
Answer: C
