NUR 612
EXAM II
(Advanced Health Assessment)
100% Exam-Focused | High-Yield | Scenario-Based
✔ Advanced, exam-style multiple-choice questions
✔ Select-All-That-Apply (SATA) questions
✔ Clinical scenario-based decision-making
✔ Pathophysiology-driven physical assessment integration
✔ Diagnostic reasoning and prioritization
✔ Board-style wording aligned with graduate nursing exams
✔ Clear, concise, exam-ready rationales
✔ No filler, no repetition, no outdated content
,A 55-year-old male presents with a progressive history of dyspnea on exertion and orthopnea. During
the cardiovascular examination, you note a sustained, high-amplitude apical impulse that is displaced
laterally to the left midclavicular line. Which of the following pathologies is most consistent with this
finding?
A) Aortic regurgitation
B) Mitral stenosis
C) Left ventricular hypertrophy
D) Pericardial effusion
Correct Answer: C) Left ventricular hypertrophy
Explanation / Rationale:
A laterally displaced and sustained apical impulse indicates volume overload or pressure overload
leading to left ventricular hypertrophy. Aortic regurgitation typically causes a hyperdynamic,
displaced impulse, but mitral stenosis usually does not displace the PMI. Pericardial effusion would
muffle the cardiac impulse rather than making it sustained or high-amplitude.
A patient presents with acute onset of right upper quadrant pain, fever, and jaundice. During the
abdominal examination, you attempt to elicit Murphy’s sign. Which technique is correctly performed
to assess this sign?
A) Deep palpation of the left lower quadrant while observing for referred pain in the right upper
quadrant
B) Palpation of the right upper quadrant during deep inspiration while the patient is supine
C) Percussion of the liver borders while the patient is in the left lateral decubitus position
D) Firm percussion over the costovertebral angle on the right side
Correct Answer: B) Palpation of the right upper quadrant during deep inspiration while the
patient is supine
Explanation / Rationale:
,Murphy’s sign is elicited by palpating the subcostal region during a deep inspiration, which causes the
inflamed gallbladder to contact the examiner's hand, producing pain and inspiratory arrest. Pain in
the left lower quadrant does not correlate with gallbladder pathology. Costovertebral angle
tenderness is associated with renal pathology, not hepatobiliary disease.
You are assessing a 70-year-old female with complaints of dizziness and syncope. Upon auscultation
of the heart, you note a crescendo-decrescendo systolic murmur best heard at the second right
intercostal space that radiates to the carotid arteries. Which valvular defect is the primary diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Aortic regurgitation
Correct Answer: B) Aortic stenosis
Explanation / Rationale:
A crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids is
the classic presentation of aortic stenosis. Mitral regurgitation typically presents as a holosystolic
murmur at the apex radiating to the axilla. Aortic regurgitation produces a diastolic decrescendo
murmur.
A 22-year-old college student presents with a severe sore throat, fever, and fatigue. On examination,
you observe pharyngeal erythema with exudates and palatal petechiae. Posterior cervical
lymphadenopathy is present. Which assessment finding would most strongly differentiate viral
mononucleosis from streptococcal pharyngitis in this patient?
A) Presence of splenomegaly
B) Unilateral tonsillar swelling
C) Absence of cough
D) Tonsillar exudates
Correct Answer: A) Presence of splenomegaly
Explanation / Rationale:
,Splenomegaly is a hallmark sign of infectious mononucleosis and is rarely seen in streptococcal
pharyngitis. While exudates and anterior cervical adenopathy are common in both, posterior cervical
adenopathy and splenomegaly point specifically to mononucleosis. The absence of cough is a Centor
criterion for Strep, but does not rule out mono.
A 45-year-old male presents with chest pain. You suspect acute pericarditis. Which auscultatory
finding would best support this diagnosis?
A) A high-pitched, blowing diastolic murmur
B) A scratchy, grating sound heard best at the lower left sternal border
C) A holosystolic murmur that increases with handgrip
D) An S3 heart sound
Correct Answer: B) A scratchy, grating sound heard best at the lower left sternal border
Explanation / Rationale:
A pericardial friction rub is a scratchy, grating sound that sounds like leather rubbing against leather,
characteristic of pericarditis. A high-pitched blowing diastolic murmur suggests aortic regurgitation. A
holosystolic murmur increasing with handgrip indicates mitral regurgitation, and an S3 suggests heart
failure.
During a neurological exam, you ask the patient to stand with feet together and eyes open, then close
their eyes. The patient begins to sway significantly and loses balance when the eyes are closed. This
positive finding is known as:
A) Romberg sign
B) Homan’s sign
C) Kernig’s sign
D) Brudzinski’s sign
Correct Answer: A) Romberg sign
Explanation / Rationale:
,A positive Romberg sign indicates a loss of proprioception and is suggestive of dorsal column disease
or sensory ataxia. Homan’s sign is an outdated sign for deep vein thrombosis. Kernig’s and
Brudzinski’s signs are meningeal signs used to assess for meningitis.
A patient with known chronic obstructive pulmonary disease (COPD) presents for a routine physical.
Which thoracic configuration would you expect to find upon inspection?
A) Funnel chest
B) Barrel chest
C) Pigeon chest
D) Kyphoscoliosis
Correct Answer: B) Barrel chest
Explanation / Rationale:
Barrel chest is a common finding in advanced COPD due to hyperinflation of the lungs and loss of lung
elasticity. Pigeon chest is associated with rickets or Marfan syndrome. Funnel chest is a congenital
deformity. Kyphoscoliosis causes restrictive lung disease but is not a direct result of COPD.
A 30-year-old female presents with episodic hypertension, headache, and palpitations. You suspect a
pheochromocytoma. While performing the abdominal examination, which specific maneuver should
you avoid to prevent a hypertensive crisis?
A) Deep palpation of the abdomen
B) Percussion of the liver span
C) Rebound tenderness testing
D) Checking for shifting dullness
Correct Answer: A) Deep palpation of the abdomen
Explanation / Rationale:
Deep palpation of a pheochromocytoma can trigger a massive release of catecholamines, leading to a
dangerous hypertensive crisis. Percussion and rebound testing are less likely to induce this release.
Light palpation is generally safe, but deep pressure is contraindicated until the tumor is removed.
,An elderly patient presents with sudden onset of confusion and left-sided weakness. You perform the
Cincinnati Prehospital Stroke Scale. Which of the following three assessments are included in this
scale? (Select All That Apply)
A) Blood pressure measurement
B) Facial droop
C) Arm drift
D) Slurred speech
E) Pupillary reaction
Correct Answer: B) Facial droop, C) Arm drift, D) Slurred speech
Explanation / Rationale:
The Cincinnati Prehospital Stroke Scale consists of three rapid tests: facial droop, arm drift, and
abnormal speech. Blood pressure and pupillary reaction are important parts of the neurological exam
but are not components of this specific screening tool. These three components have high sensitivity
for detecting anterior circulation strokes.
A 60-year-old male presents with swelling in the scrotum. You transilluminate the scrotal mass, and it
glows brightly red. What is the most likely diagnosis?
A) Hydrocele
B) Varicocele
C) Testicular torsion
D) Inguinal hernia
Correct Answer: A) Hydrocele
Explanation / Rationale:
A hydrocele is a collection of fluid in the scrotum that transilluminates brightly due to its clear fluid
content. Varicoceles and hernias usually do not transillumulate because they contain solid tissue or
,bowel. Testicular torsion is a surgical emergency characterized by a tender, high-riding testis and does
not typically transillumulate.
You are assessing a patient for suspected heart failure. While auscultating the lungs, you hear low-
pitched, rumbling sounds present at the base of the lungs that clear with coughing. How are these
sounds documented?
A) Wheezes
B) Rhonchi
C) Fine crackles
D) Stridor
Correct Answer: B) Rhonchi
Explanation / Rationale:
Rhonchi are low-pitched, sonorous sounds caused by secretions in larger airways that often clear with
coughing. Fine crackles are high-pitched, popping sounds caused by fluid in alveoli and do not clear
with coughing. Wheezes are high-pitched musical sounds caused by narrowed airways.
A patient presents with acute abdominal pain. Upon auscultation, you note high-pitched, tinkling
sounds with rushes coinciding with cramping pain. This bowel sound pattern is most consistent with:
A) Paralytic ileus
B) Mechanical intestinal obstruction
C) Peritonitis
D) Early gastroenteritis
Correct Answer: B) Mechanical intestinal obstruction
Explanation / Rationale:
Hyperactive bowel sounds with rushes and tinkling noises (borborygmi) are classic signs of mechanical
intestinal obstruction as the gut attempts to overcome the blockage. Paralytic ileus presents with
hypoactive or absent bowel sounds. Peritonitis often causes absent bowel sounds due to bowel
paralysis.
,A 14-year-old female is brought in for a sports physical. You note a lateral curvature of the spine with
asymmetry of the rib cage. Which screening test is most appropriate to quantify the severity of this
deformity?
A) Scoliometer measurement
B) Range of motion testing
C) Straight leg raise test
D) Heel-to-shin test
Correct Answer: A) Scoliometer measurement
Explanation / Rationale:
A scoliometer is used to measure the angle of trunk rotation, which helps assess the severity of
scoliosis. Range of motion and neurologic checks assess function but do not quantify curvature. The
straight leg raise tests for radiculopathy.
A patient presents with persistent shoulder pain that worsens with reaching overhead. You perform
Neer’s sign by passively flexing the patient's arm. The test is positive if this maneuver reproduces the
pain. What structure is most likely implicated?
A) Acromioclavicular joint
B) Subacromial bursa / Rotator cuff
C) Glenoid labrum
D) Biceps tendon
Correct Answer: B) Subacromial bursa / Rotator cuff
Explanation / Rationale:
Neer’s sign is used to identify impingement of the rotator cuff tendons or subacromial bursa under the
acromion process. AC joint pain is usually isolated to the specific joint. Labral tears are often assessed
with the O’Brien’s test. Biceps tendonitis is tested via Speed’s or Yergason’s test.
,During a cardiovascular assessment, you palpate the precordium and feel a thrill over the apex. What
does a thrill signify?
A) Normal physiological variation
B) Pericardial friction rub
C) Turbulent blood flow (palpable murmur)
D) Hyperdynamic circulation
Correct Answer: C) Turbulent blood flow (palpable murmur)
Explanation / Rationale:
A thrill is a palpable vibration caused by turbulent blood flow and indicates a significant murmur,
usually grade 4 or higher. It is not a normal finding. Pericardial rubs are heard, not typically felt as
thrills, though a rub may have a gritty feel. Hyperdynamic circulation causes a strong impulse, not
necessarily a thrill.
A 40-year-old patient presents with a swollen, painful knee. You aspirate fluid from the joint. Analysis
of the fluid reveals a white blood cell count of 2,000/µL and clear, viscous fluid. What is the most
likely etiology?
A) Septic arthritis
B) Gout
C) Osteoarthritis
D) Rheumatoid arthritis
Correct Answer: C) Osteoarthritis
Explanation / Rationale:
Osteoarthritis fluid is typically non-inflammatory, with a WBC count < 2,000/µL and clear, viscous
appearance. Septic arthritis usually has a WBC count > 50,000/µL. Gout and RA cause inflammatory
effusions with higher WBC counts (often 5,000–50,000/µL) and non-viscous fluid.
, You are examining a patient with suspected meningitis. Which of the following findings would NOT be
consistent with meningeal irritation?
A) Nuchal rigidity
B) Positive Brudzinski’s sign
C) Positive Kernig’s sign
D) Hyperreflexia in the lower extremities
Correct Answer: D) Hyperreflexia in the lower extremities
Explanation / Rationale:
While upper motor neuron signs can occur, meningitis primarily irritates the meninges, causing nuchal
rigidity and positive Kernig and Brudzinski signs. Hyperreflexia is not a primary diagnostic indicator of
meningeal irritation and may be absent or variable. The classic triad focuses on fever, headache, and
neck stiffness.
A patient with liver disease presents with dilated, superficial veins radiating from the umbilicus. This
specific finding is known as:
A) Spider angiomas
B) Caput medusae
C) Palmar erythema
D) Terry’s nails
Correct Answer: B) Caput medusae
Explanation / Rationale:
Caput medusae describes the pattern of dilated periumbilical veins resulting from portal hypertension.
Spider angiomas are small, spider-like telangiectasias on the skin, not specifically around the
umbilicus. Palmar erythema is redness of the palms.
EXAM II
(Advanced Health Assessment)
100% Exam-Focused | High-Yield | Scenario-Based
✔ Advanced, exam-style multiple-choice questions
✔ Select-All-That-Apply (SATA) questions
✔ Clinical scenario-based decision-making
✔ Pathophysiology-driven physical assessment integration
✔ Diagnostic reasoning and prioritization
✔ Board-style wording aligned with graduate nursing exams
✔ Clear, concise, exam-ready rationales
✔ No filler, no repetition, no outdated content
,A 55-year-old male presents with a progressive history of dyspnea on exertion and orthopnea. During
the cardiovascular examination, you note a sustained, high-amplitude apical impulse that is displaced
laterally to the left midclavicular line. Which of the following pathologies is most consistent with this
finding?
A) Aortic regurgitation
B) Mitral stenosis
C) Left ventricular hypertrophy
D) Pericardial effusion
Correct Answer: C) Left ventricular hypertrophy
Explanation / Rationale:
A laterally displaced and sustained apical impulse indicates volume overload or pressure overload
leading to left ventricular hypertrophy. Aortic regurgitation typically causes a hyperdynamic,
displaced impulse, but mitral stenosis usually does not displace the PMI. Pericardial effusion would
muffle the cardiac impulse rather than making it sustained or high-amplitude.
A patient presents with acute onset of right upper quadrant pain, fever, and jaundice. During the
abdominal examination, you attempt to elicit Murphy’s sign. Which technique is correctly performed
to assess this sign?
A) Deep palpation of the left lower quadrant while observing for referred pain in the right upper
quadrant
B) Palpation of the right upper quadrant during deep inspiration while the patient is supine
C) Percussion of the liver borders while the patient is in the left lateral decubitus position
D) Firm percussion over the costovertebral angle on the right side
Correct Answer: B) Palpation of the right upper quadrant during deep inspiration while the
patient is supine
Explanation / Rationale:
,Murphy’s sign is elicited by palpating the subcostal region during a deep inspiration, which causes the
inflamed gallbladder to contact the examiner's hand, producing pain and inspiratory arrest. Pain in
the left lower quadrant does not correlate with gallbladder pathology. Costovertebral angle
tenderness is associated with renal pathology, not hepatobiliary disease.
You are assessing a 70-year-old female with complaints of dizziness and syncope. Upon auscultation
of the heart, you note a crescendo-decrescendo systolic murmur best heard at the second right
intercostal space that radiates to the carotid arteries. Which valvular defect is the primary diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid regurgitation
D) Aortic regurgitation
Correct Answer: B) Aortic stenosis
Explanation / Rationale:
A crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids is
the classic presentation of aortic stenosis. Mitral regurgitation typically presents as a holosystolic
murmur at the apex radiating to the axilla. Aortic regurgitation produces a diastolic decrescendo
murmur.
A 22-year-old college student presents with a severe sore throat, fever, and fatigue. On examination,
you observe pharyngeal erythema with exudates and palatal petechiae. Posterior cervical
lymphadenopathy is present. Which assessment finding would most strongly differentiate viral
mononucleosis from streptococcal pharyngitis in this patient?
A) Presence of splenomegaly
B) Unilateral tonsillar swelling
C) Absence of cough
D) Tonsillar exudates
Correct Answer: A) Presence of splenomegaly
Explanation / Rationale:
,Splenomegaly is a hallmark sign of infectious mononucleosis and is rarely seen in streptococcal
pharyngitis. While exudates and anterior cervical adenopathy are common in both, posterior cervical
adenopathy and splenomegaly point specifically to mononucleosis. The absence of cough is a Centor
criterion for Strep, but does not rule out mono.
A 45-year-old male presents with chest pain. You suspect acute pericarditis. Which auscultatory
finding would best support this diagnosis?
A) A high-pitched, blowing diastolic murmur
B) A scratchy, grating sound heard best at the lower left sternal border
C) A holosystolic murmur that increases with handgrip
D) An S3 heart sound
Correct Answer: B) A scratchy, grating sound heard best at the lower left sternal border
Explanation / Rationale:
A pericardial friction rub is a scratchy, grating sound that sounds like leather rubbing against leather,
characteristic of pericarditis. A high-pitched blowing diastolic murmur suggests aortic regurgitation. A
holosystolic murmur increasing with handgrip indicates mitral regurgitation, and an S3 suggests heart
failure.
During a neurological exam, you ask the patient to stand with feet together and eyes open, then close
their eyes. The patient begins to sway significantly and loses balance when the eyes are closed. This
positive finding is known as:
A) Romberg sign
B) Homan’s sign
C) Kernig’s sign
D) Brudzinski’s sign
Correct Answer: A) Romberg sign
Explanation / Rationale:
,A positive Romberg sign indicates a loss of proprioception and is suggestive of dorsal column disease
or sensory ataxia. Homan’s sign is an outdated sign for deep vein thrombosis. Kernig’s and
Brudzinski’s signs are meningeal signs used to assess for meningitis.
A patient with known chronic obstructive pulmonary disease (COPD) presents for a routine physical.
Which thoracic configuration would you expect to find upon inspection?
A) Funnel chest
B) Barrel chest
C) Pigeon chest
D) Kyphoscoliosis
Correct Answer: B) Barrel chest
Explanation / Rationale:
Barrel chest is a common finding in advanced COPD due to hyperinflation of the lungs and loss of lung
elasticity. Pigeon chest is associated with rickets or Marfan syndrome. Funnel chest is a congenital
deformity. Kyphoscoliosis causes restrictive lung disease but is not a direct result of COPD.
A 30-year-old female presents with episodic hypertension, headache, and palpitations. You suspect a
pheochromocytoma. While performing the abdominal examination, which specific maneuver should
you avoid to prevent a hypertensive crisis?
A) Deep palpation of the abdomen
B) Percussion of the liver span
C) Rebound tenderness testing
D) Checking for shifting dullness
Correct Answer: A) Deep palpation of the abdomen
Explanation / Rationale:
Deep palpation of a pheochromocytoma can trigger a massive release of catecholamines, leading to a
dangerous hypertensive crisis. Percussion and rebound testing are less likely to induce this release.
Light palpation is generally safe, but deep pressure is contraindicated until the tumor is removed.
,An elderly patient presents with sudden onset of confusion and left-sided weakness. You perform the
Cincinnati Prehospital Stroke Scale. Which of the following three assessments are included in this
scale? (Select All That Apply)
A) Blood pressure measurement
B) Facial droop
C) Arm drift
D) Slurred speech
E) Pupillary reaction
Correct Answer: B) Facial droop, C) Arm drift, D) Slurred speech
Explanation / Rationale:
The Cincinnati Prehospital Stroke Scale consists of three rapid tests: facial droop, arm drift, and
abnormal speech. Blood pressure and pupillary reaction are important parts of the neurological exam
but are not components of this specific screening tool. These three components have high sensitivity
for detecting anterior circulation strokes.
A 60-year-old male presents with swelling in the scrotum. You transilluminate the scrotal mass, and it
glows brightly red. What is the most likely diagnosis?
A) Hydrocele
B) Varicocele
C) Testicular torsion
D) Inguinal hernia
Correct Answer: A) Hydrocele
Explanation / Rationale:
A hydrocele is a collection of fluid in the scrotum that transilluminates brightly due to its clear fluid
content. Varicoceles and hernias usually do not transillumulate because they contain solid tissue or
,bowel. Testicular torsion is a surgical emergency characterized by a tender, high-riding testis and does
not typically transillumulate.
You are assessing a patient for suspected heart failure. While auscultating the lungs, you hear low-
pitched, rumbling sounds present at the base of the lungs that clear with coughing. How are these
sounds documented?
A) Wheezes
B) Rhonchi
C) Fine crackles
D) Stridor
Correct Answer: B) Rhonchi
Explanation / Rationale:
Rhonchi are low-pitched, sonorous sounds caused by secretions in larger airways that often clear with
coughing. Fine crackles are high-pitched, popping sounds caused by fluid in alveoli and do not clear
with coughing. Wheezes are high-pitched musical sounds caused by narrowed airways.
A patient presents with acute abdominal pain. Upon auscultation, you note high-pitched, tinkling
sounds with rushes coinciding with cramping pain. This bowel sound pattern is most consistent with:
A) Paralytic ileus
B) Mechanical intestinal obstruction
C) Peritonitis
D) Early gastroenteritis
Correct Answer: B) Mechanical intestinal obstruction
Explanation / Rationale:
Hyperactive bowel sounds with rushes and tinkling noises (borborygmi) are classic signs of mechanical
intestinal obstruction as the gut attempts to overcome the blockage. Paralytic ileus presents with
hypoactive or absent bowel sounds. Peritonitis often causes absent bowel sounds due to bowel
paralysis.
,A 14-year-old female is brought in for a sports physical. You note a lateral curvature of the spine with
asymmetry of the rib cage. Which screening test is most appropriate to quantify the severity of this
deformity?
A) Scoliometer measurement
B) Range of motion testing
C) Straight leg raise test
D) Heel-to-shin test
Correct Answer: A) Scoliometer measurement
Explanation / Rationale:
A scoliometer is used to measure the angle of trunk rotation, which helps assess the severity of
scoliosis. Range of motion and neurologic checks assess function but do not quantify curvature. The
straight leg raise tests for radiculopathy.
A patient presents with persistent shoulder pain that worsens with reaching overhead. You perform
Neer’s sign by passively flexing the patient's arm. The test is positive if this maneuver reproduces the
pain. What structure is most likely implicated?
A) Acromioclavicular joint
B) Subacromial bursa / Rotator cuff
C) Glenoid labrum
D) Biceps tendon
Correct Answer: B) Subacromial bursa / Rotator cuff
Explanation / Rationale:
Neer’s sign is used to identify impingement of the rotator cuff tendons or subacromial bursa under the
acromion process. AC joint pain is usually isolated to the specific joint. Labral tears are often assessed
with the O’Brien’s test. Biceps tendonitis is tested via Speed’s or Yergason’s test.
,During a cardiovascular assessment, you palpate the precordium and feel a thrill over the apex. What
does a thrill signify?
A) Normal physiological variation
B) Pericardial friction rub
C) Turbulent blood flow (palpable murmur)
D) Hyperdynamic circulation
Correct Answer: C) Turbulent blood flow (palpable murmur)
Explanation / Rationale:
A thrill is a palpable vibration caused by turbulent blood flow and indicates a significant murmur,
usually grade 4 or higher. It is not a normal finding. Pericardial rubs are heard, not typically felt as
thrills, though a rub may have a gritty feel. Hyperdynamic circulation causes a strong impulse, not
necessarily a thrill.
A 40-year-old patient presents with a swollen, painful knee. You aspirate fluid from the joint. Analysis
of the fluid reveals a white blood cell count of 2,000/µL and clear, viscous fluid. What is the most
likely etiology?
A) Septic arthritis
B) Gout
C) Osteoarthritis
D) Rheumatoid arthritis
Correct Answer: C) Osteoarthritis
Explanation / Rationale:
Osteoarthritis fluid is typically non-inflammatory, with a WBC count < 2,000/µL and clear, viscous
appearance. Septic arthritis usually has a WBC count > 50,000/µL. Gout and RA cause inflammatory
effusions with higher WBC counts (often 5,000–50,000/µL) and non-viscous fluid.
, You are examining a patient with suspected meningitis. Which of the following findings would NOT be
consistent with meningeal irritation?
A) Nuchal rigidity
B) Positive Brudzinski’s sign
C) Positive Kernig’s sign
D) Hyperreflexia in the lower extremities
Correct Answer: D) Hyperreflexia in the lower extremities
Explanation / Rationale:
While upper motor neuron signs can occur, meningitis primarily irritates the meninges, causing nuchal
rigidity and positive Kernig and Brudzinski signs. Hyperreflexia is not a primary diagnostic indicator of
meningeal irritation and may be absent or variable. The classic triad focuses on fever, headache, and
neck stiffness.
A patient with liver disease presents with dilated, superficial veins radiating from the umbilicus. This
specific finding is known as:
A) Spider angiomas
B) Caput medusae
C) Palmar erythema
D) Terry’s nails
Correct Answer: B) Caput medusae
Explanation / Rationale:
Caput medusae describes the pattern of dilated periumbilical veins resulting from portal hypertension.
Spider angiomas are small, spider-like telangiectasias on the skin, not specifically around the
umbilicus. Palmar erythema is redness of the palms.
