NSG 6020 3P EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
Question 1
A patient visits the clinic because he has recently noticed that the left side of his
mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse
practitioner suspects that he has:
Correct Answer
had a cerebrovascular accident (stroke)
Question 2
Diminished radial pulses may be seen in patients with which of the following?
Correct Answer
Arterial emboli
Question 3
Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You
notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar
aspect of her forearms but nowhere else. She doesn't mention them. They are tender
when you examine them. What should you do?
Correct Answer
Ask how she acquired them.
Page 1 of 86
,Question 4
When examining an infant, the nurse practitioner should examine which area first?
Correct Answer
Abdomen
Question 1: During a comprehensive health assessment of an adult patient
presenting with unexplained weight loss, fatigue, and night sweats, which of
the following historical elements is most critical for the advanced practice
nurse to explore first to guide differential diagnosis?
A. Detailed 24-hour dietary recall only
B. Presence of recent travel, occupational exposures, and family history of
malignancy or autoimmune disease
C. Preferred exercise routine and sleep schedule exclusively
D. Current over-the-counter vitamin use without further inquiry
CORRECT ANSWER: B. Presence of recent travel, occupational exposures, and
family history of malignancy or autoimmune disease
Rationale: Unexplained weight loss, fatigue, and night sweats form a constitutional
symptom cluster that raises concern for systemic illness including malignancy,
infection, or autoimmune disease. A focused history addressing travel, exposures,
and family history is essential to prioritize the differential and direct subsequent
physical examination and diagnostic testing.
Question 2: When performing percussion of the posterior chest in a patient
with suspected pleural effusion, which percussion note is most consistent with
the presence of fluid in the pleural space?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
CORRECT ANSWER: C. Dullness
Rationale: Fluid in the pleural space produces a dull percussion note because sound
transmission is dampened. Hyperresonance is associated with air trapping (e.g.,
emphysema or pneumothorax), tympany with hollow organs, and resonance with
normal aerated lung.
Question 3: In the assessment of a 68-year-old patient with new-onset
confusion, which laboratory finding would most strongly support a diagnosis
of syndrome of inappropriate antidiuretic hormone secretion (SIADH) rather
than dehydration?
Page 2 of 86
,A. Elevated serum sodium and high serum osmolality
B. Low serum sodium, low serum osmolality, and inappropriately high urine
osmolality
C. Elevated blood urea nitrogen and creatinine with high hematocrit
D. Normal serum sodium with elevated glucose
CORRECT ANSWER: B. Low serum sodium, low serum osmolality, and
inappropriately high urine osmolality
Rationale: SIADH is characterized by euvolemic hyponatremia with low serum
osmolality and urine that is inappropriately concentrated. Dehydration typically
produces hypernatremia or elevated BUN/creatinine ratios and high hematocrit.
Question 4: During auscultation of a patient with known aortic stenosis, where
is the murmur most likely to be heard with greatest intensity, and what is its
typical radiation pattern?
A. Apex with radiation to the left axilla
B. Right upper sternal border with radiation to the carotid arteries
C. Left lower sternal border with radiation to the back
D. Mid-clavicular line at the fifth intercostal space with no radiation
CORRECT ANSWER: B. Right upper sternal border with radiation to the carotid
arteries
Rationale: The murmur of aortic stenosis is a systolic ejection murmur best heard at
the right upper sternal border (aortic area) and characteristically radiates to the
carotids because of turbulent flow across the narrowed valve into the ascending
aorta.
Question 5: A 42-year-old woman presents with episodic headaches,
palpitations, and diaphoresis. Which physical examination finding would most
strongly support further evaluation for pheochromocytoma?
A. Isolated systolic hypertension only during office visits
B. Paroxysmal hypertension accompanied by tachycardia and diaphoresis
C. Bradycardia with narrow pulse pressure
D. Orthostatic hypotension without other signs
CORRECT ANSWER: B. Paroxysmal hypertension accompanied by tachycardia
and diaphoresis
Rationale: Pheochromocytoma classically produces paroxysmal catecholamine
surges manifested as episodic hypertension, tachycardia, headache, and
diaphoresis. These findings warrant biochemical testing and imaging.
Page 3 of 86
, Question 6: When assessing cranial nerve function in a patient reporting
diplopia, which examination technique specifically evaluates the integrity of
cranial nerve VI?
A. Testing pupillary light reflex
B. Asking the patient to follow a finger laterally toward the temporal field
C. Assessing jaw strength and corneal reflex
D. Evaluating shoulder shrug against resistance
CORRECT ANSWER: B. Asking the patient to follow a finger laterally toward
the temporal field
Rationale: Cranial nerve VI (abducens) innervates the lateral rectus muscle. Inability
to abduct the eye indicates CN VI dysfunction and is a common cause of horizontal
diplopia.
Question 7: In a patient with suspected acute appendicitis, which physical
examination maneuver is most specific for detecting peritoneal irritation in
the right lower quadrant?
A. Assessment of the apical impulse
B. Rovsing’s sign (pain in the right lower quadrant with left lower quadrant
palpation)
C. Percussion of the costovertebral angle
D. Auscultation for bowel sounds in all four quadrants only
CORRECT ANSWER: B. Rovsing’s sign (pain in the right lower quadrant with
left lower quadrant palpation)
Rationale: Rovsing’s sign indicates peritoneal irritation by eliciting right lower
quadrant pain when pressure is applied in the left lower quadrant. It increases the
likelihood of appendicitis when present with other suggestive findings.
Question 8: A 55-year-old man with a 30-pack-year smoking history presents
with progressive dyspnea and a chronic cough. Which chest examination
finding is most consistent with emphysema rather than chronic bronchitis?
A. Diffuse wheezing and coarse crackles
B. Decreased breath sounds, hyperresonance, and increased anteroposterior
diameter
C. Dullness to percussion at both bases with egophony
D. Inspiratory stridor and tracheal deviation
CORRECT ANSWER: B. Decreased breath sounds, hyperresonance, and
increased anteroposterior diameter
Page 4 of 86
CORRECT ANSWERS WITH RATIONALES
Question 1
A patient visits the clinic because he has recently noticed that the left side of his
mouth is paralyzed. He states that he cannot raise his eyebrow or whistle. The nurse
practitioner suspects that he has:
Correct Answer
had a cerebrovascular accident (stroke)
Question 2
Diminished radial pulses may be seen in patients with which of the following?
Correct Answer
Arterial emboli
Question 3
Ms. Whiting is a 68-year-old female who comes in for her usual follow-up visit. You
notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar
aspect of her forearms but nowhere else. She doesn't mention them. They are tender
when you examine them. What should you do?
Correct Answer
Ask how she acquired them.
Page 1 of 86
,Question 4
When examining an infant, the nurse practitioner should examine which area first?
Correct Answer
Abdomen
Question 1: During a comprehensive health assessment of an adult patient
presenting with unexplained weight loss, fatigue, and night sweats, which of
the following historical elements is most critical for the advanced practice
nurse to explore first to guide differential diagnosis?
A. Detailed 24-hour dietary recall only
B. Presence of recent travel, occupational exposures, and family history of
malignancy or autoimmune disease
C. Preferred exercise routine and sleep schedule exclusively
D. Current over-the-counter vitamin use without further inquiry
CORRECT ANSWER: B. Presence of recent travel, occupational exposures, and
family history of malignancy or autoimmune disease
Rationale: Unexplained weight loss, fatigue, and night sweats form a constitutional
symptom cluster that raises concern for systemic illness including malignancy,
infection, or autoimmune disease. A focused history addressing travel, exposures,
and family history is essential to prioritize the differential and direct subsequent
physical examination and diagnostic testing.
Question 2: When performing percussion of the posterior chest in a patient
with suspected pleural effusion, which percussion note is most consistent with
the presence of fluid in the pleural space?
A. Hyperresonance
B. Tympany
C. Dullness
D. Resonance
CORRECT ANSWER: C. Dullness
Rationale: Fluid in the pleural space produces a dull percussion note because sound
transmission is dampened. Hyperresonance is associated with air trapping (e.g.,
emphysema or pneumothorax), tympany with hollow organs, and resonance with
normal aerated lung.
Question 3: In the assessment of a 68-year-old patient with new-onset
confusion, which laboratory finding would most strongly support a diagnosis
of syndrome of inappropriate antidiuretic hormone secretion (SIADH) rather
than dehydration?
Page 2 of 86
,A. Elevated serum sodium and high serum osmolality
B. Low serum sodium, low serum osmolality, and inappropriately high urine
osmolality
C. Elevated blood urea nitrogen and creatinine with high hematocrit
D. Normal serum sodium with elevated glucose
CORRECT ANSWER: B. Low serum sodium, low serum osmolality, and
inappropriately high urine osmolality
Rationale: SIADH is characterized by euvolemic hyponatremia with low serum
osmolality and urine that is inappropriately concentrated. Dehydration typically
produces hypernatremia or elevated BUN/creatinine ratios and high hematocrit.
Question 4: During auscultation of a patient with known aortic stenosis, where
is the murmur most likely to be heard with greatest intensity, and what is its
typical radiation pattern?
A. Apex with radiation to the left axilla
B. Right upper sternal border with radiation to the carotid arteries
C. Left lower sternal border with radiation to the back
D. Mid-clavicular line at the fifth intercostal space with no radiation
CORRECT ANSWER: B. Right upper sternal border with radiation to the carotid
arteries
Rationale: The murmur of aortic stenosis is a systolic ejection murmur best heard at
the right upper sternal border (aortic area) and characteristically radiates to the
carotids because of turbulent flow across the narrowed valve into the ascending
aorta.
Question 5: A 42-year-old woman presents with episodic headaches,
palpitations, and diaphoresis. Which physical examination finding would most
strongly support further evaluation for pheochromocytoma?
A. Isolated systolic hypertension only during office visits
B. Paroxysmal hypertension accompanied by tachycardia and diaphoresis
C. Bradycardia with narrow pulse pressure
D. Orthostatic hypotension without other signs
CORRECT ANSWER: B. Paroxysmal hypertension accompanied by tachycardia
and diaphoresis
Rationale: Pheochromocytoma classically produces paroxysmal catecholamine
surges manifested as episodic hypertension, tachycardia, headache, and
diaphoresis. These findings warrant biochemical testing and imaging.
Page 3 of 86
, Question 6: When assessing cranial nerve function in a patient reporting
diplopia, which examination technique specifically evaluates the integrity of
cranial nerve VI?
A. Testing pupillary light reflex
B. Asking the patient to follow a finger laterally toward the temporal field
C. Assessing jaw strength and corneal reflex
D. Evaluating shoulder shrug against resistance
CORRECT ANSWER: B. Asking the patient to follow a finger laterally toward
the temporal field
Rationale: Cranial nerve VI (abducens) innervates the lateral rectus muscle. Inability
to abduct the eye indicates CN VI dysfunction and is a common cause of horizontal
diplopia.
Question 7: In a patient with suspected acute appendicitis, which physical
examination maneuver is most specific for detecting peritoneal irritation in
the right lower quadrant?
A. Assessment of the apical impulse
B. Rovsing’s sign (pain in the right lower quadrant with left lower quadrant
palpation)
C. Percussion of the costovertebral angle
D. Auscultation for bowel sounds in all four quadrants only
CORRECT ANSWER: B. Rovsing’s sign (pain in the right lower quadrant with
left lower quadrant palpation)
Rationale: Rovsing’s sign indicates peritoneal irritation by eliciting right lower
quadrant pain when pressure is applied in the left lower quadrant. It increases the
likelihood of appendicitis when present with other suggestive findings.
Question 8: A 55-year-old man with a 30-pack-year smoking history presents
with progressive dyspnea and a chronic cough. Which chest examination
finding is most consistent with emphysema rather than chronic bronchitis?
A. Diffuse wheezing and coarse crackles
B. Decreased breath sounds, hyperresonance, and increased anteroposterior
diameter
C. Dullness to percussion at both bases with egophony
D. Inspiratory stridor and tracheal deviation
CORRECT ANSWER: B. Decreased breath sounds, hyperresonance, and
increased anteroposterior diameter
Page 4 of 86
