NUR 612
EXAM IV
(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✔ No filler, no repetition, no outdated content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 68-year-old male presents with sudden onset of right-sided weakness and slurred speech that began
20 minutes ago. His blood pressure is 178/92 mmHg, heart rate is 92 bpm, and respiratory rate is 18
bpm. He has a history of hypertension and atrial fibrillation. Which diagnostic intervention is the
priority for this patient?
A) Immediate CT scan of the head without contrast
B) Lumbar puncture to assess for subarachnoid hemorrhage
C) Carotid Doppler ultrasound to assess for stenosis
D) MRI of the brain to evaluate for ischemic stroke
Correct Answer: A) Immediate CT scan of the head without contrast
Explanation / Rationale:
Non-contrast CT is the gold standard initial imaging modality to rule out intracranial hemorrhage
before administering thrombolytics. MRI is more sensitive for ischemia but takes longer and is not the
first step in the acute setting. Carotid Doppler and lumbar puncture are diagnostic steps performed
after the acute phase or if CT is inconclusive.
A 45-year-old female presents with progressive difficulty swallowing solids over the past six months
and reports a sensation of food "sticking" in the lower chest. She has lost 10 pounds unintentionally.
Which assessment finding would most strongly suggest a mechanical obstruction rather than a
motility disorder?
A) Regurgitation of undigested food
B) Dysphagia that is intermittent and unpredictable
C) Progressive dysphagia for solids before liquids
D) Chest pain that mimics angina pectoris
Correct Answer: C) Progressive dysphagia for solids before liquids
Explanation / Rationale:
Mechanical obstructions, such as esophageal cancer or strictures, typically cause dysphagia for solids
that progresses to liquids as the lumen narrows. Motility disorders, like achalasia, often present with
dysphagia for both solids and liquids simultaneously. Regurgitation and chest pain occur in both
mechanical and motility disorders.
,During a cardiac assessment of a patient with known aortic stenosis, which murmur characteristic is
the advanced practitioner expected to auscultate?
A) A decrescendo diastolic murmur best heard at the left sternal border
B) A crescendo-decrescendo systolic murmur radiating to the carotids
C) A holosystolic murmur that intensifies with handgrip
D) A continuous machinery-like murmur throughout systole and diastole
Correct Answer: B) A crescendo-decrescendo systolic murmur radiating to the carotids
Explanation / Rationale:
Aortic stenosis produces a midsystolic crescendo-decrescendo murmur that often radiates to the
carotid arteries due to the turbulent flow across the narrowed valve. A decrescendo diastolic murmur
indicates aortic regurgitation. A holosystolic murmur intensifying with handgrip is typical of mitral
regurgitation.
A 22-year-old college athlete presents with knee pain after pivoting during a basketball game. He
reports a "pop" at the time of injury and immediate swelling. Which physical examination test is most
specific for an anterior cruciate ligament (ACL) tear?
A) McMurray test
B) Lachman test
C) Valgus stress test
D) Apley compression test
Correct Answer: B) Lachman test
Explanation / Rationale:
The Lachman test is the most sensitive and specific physical exam maneuver for diagnosing ACL tears.
The McMurray test is used for meniscal injuries. Valgus stress test assesses the medial collateral
ligament (MCL). The Apley test is also used to evaluate meniscal pathology.
, A 55-year-old female presents with episodic severe right upper quadrant (RUQ) pain that radiates to
the right scapula, particularly after eating a fatty meal. She is febrile and jaundiced. What is the most
likely diagnosis?
A) Acute cholecystitis
B) Biliary colic
C) Choledocholithiasis with cholangitis
D) Hepatitis
Correct Answer: C) Choledocholithiasis with cholangitis
Explanation / Rationale:
Charcot’s triad (RUQ pain, fever, jaundice) classically indicates ascending cholangitis, often caused by
a stone obstructing the common bile duct (choledocholithiasis). Acute cholecystitis and biliary colic do
not typically present with jaundice unless there is a complicating obstruction. Hepatitis would not
cause the specific post-prandial pain pattern described.
A patient with type 2 diabetes mellitus presents with a foot ulcer on the plantar aspect of the first
metatarsal head. The probe-to-bone test is positive. What does this indicate?
A) The ulcer is superficial and requires only local wound care
B) Osteomyelitis is highly likely
C) The patient has peripheral arterial disease
D) The wound is infected with anaerobic bacteria
Correct Answer: B) Osteomyelitis is highly likely
Explanation / Rationale:
A positive probe-to-bone test has a high positive predictive value for osteomyelitis in diabetic foot
ulcers. While infection and arterial disease may be present, this specific finding signals bone
involvement. Superficial ulcers would not allow a probe to reach bone.
EXAM IV
(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 68-year-old male presents with sudden onset of right-sided weakness and slurred speech that began
20 minutes ago. His blood pressure is 178/92 mmHg, heart rate is 92 bpm, and respiratory rate is 18
bpm. He has a history of hypertension and atrial fibrillation. Which diagnostic intervention is the
priority for this patient?
A) Immediate CT scan of the head without contrast
B) Lumbar puncture to assess for subarachnoid hemorrhage
C) Carotid Doppler ultrasound to assess for stenosis
D) MRI of the brain to evaluate for ischemic stroke
Correct Answer: A) Immediate CT scan of the head without contrast
Explanation / Rationale:
Non-contrast CT is the gold standard initial imaging modality to rule out intracranial hemorrhage
before administering thrombolytics. MRI is more sensitive for ischemia but takes longer and is not the
first step in the acute setting. Carotid Doppler and lumbar puncture are diagnostic steps performed
after the acute phase or if CT is inconclusive.
A 45-year-old female presents with progressive difficulty swallowing solids over the past six months
and reports a sensation of food "sticking" in the lower chest. She has lost 10 pounds unintentionally.
Which assessment finding would most strongly suggest a mechanical obstruction rather than a
motility disorder?
A) Regurgitation of undigested food
B) Dysphagia that is intermittent and unpredictable
C) Progressive dysphagia for solids before liquids
D) Chest pain that mimics angina pectoris
Correct Answer: C) Progressive dysphagia for solids before liquids
Explanation / Rationale:
Mechanical obstructions, such as esophageal cancer or strictures, typically cause dysphagia for solids
that progresses to liquids as the lumen narrows. Motility disorders, like achalasia, often present with
dysphagia for both solids and liquids simultaneously. Regurgitation and chest pain occur in both
mechanical and motility disorders.
,During a cardiac assessment of a patient with known aortic stenosis, which murmur characteristic is
the advanced practitioner expected to auscultate?
A) A decrescendo diastolic murmur best heard at the left sternal border
B) A crescendo-decrescendo systolic murmur radiating to the carotids
C) A holosystolic murmur that intensifies with handgrip
D) A continuous machinery-like murmur throughout systole and diastole
Correct Answer: B) A crescendo-decrescendo systolic murmur radiating to the carotids
Explanation / Rationale:
Aortic stenosis produces a midsystolic crescendo-decrescendo murmur that often radiates to the
carotid arteries due to the turbulent flow across the narrowed valve. A decrescendo diastolic murmur
indicates aortic regurgitation. A holosystolic murmur intensifying with handgrip is typical of mitral
regurgitation.
A 22-year-old college athlete presents with knee pain after pivoting during a basketball game. He
reports a "pop" at the time of injury and immediate swelling. Which physical examination test is most
specific for an anterior cruciate ligament (ACL) tear?
A) McMurray test
B) Lachman test
C) Valgus stress test
D) Apley compression test
Correct Answer: B) Lachman test
Explanation / Rationale:
The Lachman test is the most sensitive and specific physical exam maneuver for diagnosing ACL tears.
The McMurray test is used for meniscal injuries. Valgus stress test assesses the medial collateral
ligament (MCL). The Apley test is also used to evaluate meniscal pathology.
, A 55-year-old female presents with episodic severe right upper quadrant (RUQ) pain that radiates to
the right scapula, particularly after eating a fatty meal. She is febrile and jaundiced. What is the most
likely diagnosis?
A) Acute cholecystitis
B) Biliary colic
C) Choledocholithiasis with cholangitis
D) Hepatitis
Correct Answer: C) Choledocholithiasis with cholangitis
Explanation / Rationale:
Charcot’s triad (RUQ pain, fever, jaundice) classically indicates ascending cholangitis, often caused by
a stone obstructing the common bile duct (choledocholithiasis). Acute cholecystitis and biliary colic do
not typically present with jaundice unless there is a complicating obstruction. Hepatitis would not
cause the specific post-prandial pain pattern described.
A patient with type 2 diabetes mellitus presents with a foot ulcer on the plantar aspect of the first
metatarsal head. The probe-to-bone test is positive. What does this indicate?
A) The ulcer is superficial and requires only local wound care
B) Osteomyelitis is highly likely
C) The patient has peripheral arterial disease
D) The wound is infected with anaerobic bacteria
Correct Answer: B) Osteomyelitis is highly likely
Explanation / Rationale:
A positive probe-to-bone test has a high positive predictive value for osteomyelitis in diabetic foot
ulcers. While infection and arterial disease may be present, this specific finding signals bone
involvement. Superficial ulcers would not allow a probe to reach bone.
