NUR 611 ADVANCED HEALTH
ASSESSMENT COMPREHENSIVE
EXAMINATION
1. When performing a cardiac assessment, a clinician hears a high-pitched, scratchy sound at
the left lower sternal border that increases when the patient leans forward. What is the most
likely cause?
A. Pericardial friction rub
B. Mitral valve prolapse
C. Aortic stenosis
D. S3 heart sound
Answer: A
Conceptual Explanation: A pericardial friction rub is typically high-pitched and scratchy,
heard best with the diaphragm at the left lower sternal border, and intensified when the
patient leans forward in expiration.
2. A patient presents with a ‘shifting dullness’ during abdominal percussion. This finding is
most indicative of which condition?
A. Intestinal obstruction
B. Splenomegaly
,C. Ovarian cyst
D. Ascites
Answer: D
Conceptual Explanation: Shifting dullness occurs when fluid (ascites) moves to the
dependent side of the abdomen as the patient changes position, causing the percussion
note to change from tympany to dullness.
3. During a neurological exam, the nurse practitioner asks the patient to stick out their
tongue. The tongue deviates to the right side. Which cranial nerve is likely affected?
A. CN X (Vagus)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN VII (Facial)
Answer: C
Conceptual Explanation: Cranial Nerve XII (Hypoglossal) controls tongue movement. A
lesion causes the tongue to deviate toward the side of the weakness (the affected side).
4. Which physical examination technique is most specific for diagnosing a suspected meniscus
tear in the knee?
A. Lachman test
B. Anterior drawer test
, C. Bulge sign
D. McMurray test
Answer: D
Conceptual Explanation: The McMurray test involves rotating the lower leg while
extending the knee; a click or pop indicates a meniscus tear. Lachman and Anterior drawer
are for ACL stability.
5. A 65-year-old male reports sudden onset of ‘curtain-like’ vision loss in his right eye. This
symptom is most characteristic of:
A. Retinal detachment
B. Macular degeneration
C. Acute angle-closure glaucoma
D. Cataracts
Answer: A
Conceptual Explanation: Retinal detachment often presents as a shadow or curtain falling
across the field of vision, which is a medical emergency.
6. Tactile fremitus is found to be increased over the right lower lobe. This finding is most
consistent with:
A. Lobar pneumonia
B. Pleural effusion
ASSESSMENT COMPREHENSIVE
EXAMINATION
1. When performing a cardiac assessment, a clinician hears a high-pitched, scratchy sound at
the left lower sternal border that increases when the patient leans forward. What is the most
likely cause?
A. Pericardial friction rub
B. Mitral valve prolapse
C. Aortic stenosis
D. S3 heart sound
Answer: A
Conceptual Explanation: A pericardial friction rub is typically high-pitched and scratchy,
heard best with the diaphragm at the left lower sternal border, and intensified when the
patient leans forward in expiration.
2. A patient presents with a ‘shifting dullness’ during abdominal percussion. This finding is
most indicative of which condition?
A. Intestinal obstruction
B. Splenomegaly
,C. Ovarian cyst
D. Ascites
Answer: D
Conceptual Explanation: Shifting dullness occurs when fluid (ascites) moves to the
dependent side of the abdomen as the patient changes position, causing the percussion
note to change from tympany to dullness.
3. During a neurological exam, the nurse practitioner asks the patient to stick out their
tongue. The tongue deviates to the right side. Which cranial nerve is likely affected?
A. CN X (Vagus)
B. CN IX (Glossopharyngeal)
C. CN XII (Hypoglossal)
D. CN VII (Facial)
Answer: C
Conceptual Explanation: Cranial Nerve XII (Hypoglossal) controls tongue movement. A
lesion causes the tongue to deviate toward the side of the weakness (the affected side).
4. Which physical examination technique is most specific for diagnosing a suspected meniscus
tear in the knee?
A. Lachman test
B. Anterior drawer test
, C. Bulge sign
D. McMurray test
Answer: D
Conceptual Explanation: The McMurray test involves rotating the lower leg while
extending the knee; a click or pop indicates a meniscus tear. Lachman and Anterior drawer
are for ACL stability.
5. A 65-year-old male reports sudden onset of ‘curtain-like’ vision loss in his right eye. This
symptom is most characteristic of:
A. Retinal detachment
B. Macular degeneration
C. Acute angle-closure glaucoma
D. Cataracts
Answer: A
Conceptual Explanation: Retinal detachment often presents as a shadow or curtain falling
across the field of vision, which is a medical emergency.
6. Tactile fremitus is found to be increased over the right lower lobe. This finding is most
consistent with:
A. Lobar pneumonia
B. Pleural effusion
