NUR612/NUR 612 Exam 1 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. Which of the following findings is most indicative of lung consolidation, such as in
pneumonia, during a physical examination?
A. Decreased vocal resonance
B. Hyperresonance on percussion
C. Increased tactile fremitus
D. Tracheal deviation to the opposite side
Answer: C
Rationale: Increased tactile fremitus occurs when there is consolidated lung tissue, which
conducts vibrations better than air-filled tissue. In conditions like pneumonia, the presence
of fluid or solid mass enhances the transmission of sound. This is a key diagnostic physical
finding used to differentiate consolidation from pleural effusion or pneumothorax.
2. During a cardiac assessment, the nurse practitioner hears a high-pitched, scratchy sound at
the left lower sternal border with the patient leaning forward. This likely represents:
A. A pericardial friction rub
B. A systolic murmur
C. An S3 gallop
,D. A physiological split S2
Answer: A
Rationale: A pericardial friction rub is a hallmark sign of pericarditis and is best heard
with the diaphragm at the left sternal border. The sound is often described as scratchy or
leathery and may have three components corresponding to atrial systole, ventricular
systole, and ventricular diastole. Positioning the patient leaning forward or exhaling can
make the sound more prominent.
3. A 65-year-old patient presents with sudden onset of ‘the worst headache of my life.’ Which
condition should the nurse practitioner suspect first?
A. Cluster headache
B. Tension-type headache
C. Subarachnoid hemorrhage
D. Migraine with aura
Answer: C
Rationale: A ‘thunderclap’ headache or ‘the worst headache of my life’ is the classic
presentation for a subarachnoid hemorrhage. This is a medical emergency often caused by
a ruptured intracranial aneurysm. Immediate neuroimaging, typically a non-contrast CT
scan, is required to confirm the diagnosis and prevent further neurological damage.
, 4. When assessing a patient for appendicitis, the nurse practitioner applies deep pressure to
the left lower quadrant and the patient feels pain in the right lower quadrant. This is known
as:
A. Murphy’s sign
B. McBurney’s sign
C. Rovsing’s sign
D. Psoas sign
Answer: C
Rationale: Rovsing’s sign is positive when pressure on the left side of the abdomen causes
pain on the right side. This suggests peritoneal irritation and is frequently associated with
acute appendicitis. Understanding these specific maneuvers helps clinicians narrow down
the cause of acute abdominal pain during the physical exam.
5. Which cranial nerve is being tested when the nurse practitioner asks the patient to shrug
their shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XI (Spinal Accessory)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Answer: B
Nursing II Q&A with Rationale | William
Paterson University
1. Which of the following findings is most indicative of lung consolidation, such as in
pneumonia, during a physical examination?
A. Decreased vocal resonance
B. Hyperresonance on percussion
C. Increased tactile fremitus
D. Tracheal deviation to the opposite side
Answer: C
Rationale: Increased tactile fremitus occurs when there is consolidated lung tissue, which
conducts vibrations better than air-filled tissue. In conditions like pneumonia, the presence
of fluid or solid mass enhances the transmission of sound. This is a key diagnostic physical
finding used to differentiate consolidation from pleural effusion or pneumothorax.
2. During a cardiac assessment, the nurse practitioner hears a high-pitched, scratchy sound at
the left lower sternal border with the patient leaning forward. This likely represents:
A. A pericardial friction rub
B. A systolic murmur
C. An S3 gallop
,D. A physiological split S2
Answer: A
Rationale: A pericardial friction rub is a hallmark sign of pericarditis and is best heard
with the diaphragm at the left sternal border. The sound is often described as scratchy or
leathery and may have three components corresponding to atrial systole, ventricular
systole, and ventricular diastole. Positioning the patient leaning forward or exhaling can
make the sound more prominent.
3. A 65-year-old patient presents with sudden onset of ‘the worst headache of my life.’ Which
condition should the nurse practitioner suspect first?
A. Cluster headache
B. Tension-type headache
C. Subarachnoid hemorrhage
D. Migraine with aura
Answer: C
Rationale: A ‘thunderclap’ headache or ‘the worst headache of my life’ is the classic
presentation for a subarachnoid hemorrhage. This is a medical emergency often caused by
a ruptured intracranial aneurysm. Immediate neuroimaging, typically a non-contrast CT
scan, is required to confirm the diagnosis and prevent further neurological damage.
, 4. When assessing a patient for appendicitis, the nurse practitioner applies deep pressure to
the left lower quadrant and the patient feels pain in the right lower quadrant. This is known
as:
A. Murphy’s sign
B. McBurney’s sign
C. Rovsing’s sign
D. Psoas sign
Answer: C
Rationale: Rovsing’s sign is positive when pressure on the left side of the abdomen causes
pain on the right side. This suggests peritoneal irritation and is frequently associated with
acute appendicitis. Understanding these specific maneuvers helps clinicians narrow down
the cause of acute abdominal pain during the physical exam.
5. Which cranial nerve is being tested when the nurse practitioner asks the patient to shrug
their shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XI (Spinal Accessory)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Answer: B
