NSG 5140: ADVANCED HEALTH
ASSESSMENT COMPREHENSIVE
EXAMINATION QUESTIONS AND
ANSWERS
1. When assessing for Murphy’s sign, which of the following best describes a positive result?
A. Sharp pain and abrupt cessation of inspiration during deep palpation of the right upper
quadrant.
B. Rebound tenderness experienced in the right lower quadrant upon pressure to the left
lower quadrant.
C. Pain elicited by internal rotation of the right hip with the knee flexed.
D. Pain triggered by the patient attempting to raise their right leg against resistance.
Answer: A
Conceptual Explanation: Murphy’s sign is specifically used to assess for acute
cholecystitis. A positive result occurs when the patient experiences sharp pain and stops
breathing in (inspiratory arrest) as the examiner palpates the gallbladder area during deep
inspiration.
,2. A 22-year-old athlete presents with an acute knee injury. The clinician performs the
Lachman test. Which finding indicates a positive result?
A. Excessive posterior displacement of the tibia relative to the femur.
B. Lateral deviation of the patella during extension.
C. Significant anterior translation of the tibia with a soft or mushy endpoint.
D. Audible clicking or popping during internal rotation and extension of the knee.
Answer: C
Conceptual Explanation: The Lachman test is the most sensitive physical exam maneuver
for detecting an Anterior Cruciate Ligament (ACL) tear. It is characterized by significant
anterior displacement of the tibia compared to the femur.
3. During cardiac auscultation of a 75-year-old male with a history of hypertension, you hear
a low-pitched sound just before S1. What is the most likely identification of this sound?
A. S4 atrial gallop
B. Ejection click
C. S3 ventricular gallop
D. Opening snap
Answer: A
, Conceptual Explanation: An S4 heart sound (atrial gallop) occurs in late diastole, just
before S1. In older adults, it often indicates a stiff, non-compliant left ventricle, frequently
seen in long-standing hypertension.
4. In a patient with conductive hearing loss in the right ear, how would you expect the results
of the Weber and Rinne tests to appear?
A. Weber lateralizes to the left; Rinne AC > BC in the right ear.
B. Weber lateralizes to the right; Rinne AC > BC in the right ear.
C. Weber lateralizes to the left; Rinne BC > AC in the right ear.
D. Weber lateralizes to the right; Rinne BC > AC in the right ear.
Answer: D
Conceptual Explanation: In conductive hearing loss, the Weber test lateralizes to the
affected ear (right), and the Rinne test shows bone conduction (BC) lasting longer than air
conduction (AC) in that same ear.
5. A patient presents with ‘the worst headache of my life.’ The clinician notes neck stiffness
and a positive Brudzinski sign. What does a positive Brudzinski sign involve?
A. Contralateral pupillary constriction when light is shone into one eye.
B. Resistance to leg extension when the hip is flexed at 90 degrees.
C. Flexion of the neck when the patient is asked to touch their chin to their chest.
D. Involuntary flexion of the hips and knees when the neck is passively flexed.
ASSESSMENT COMPREHENSIVE
EXAMINATION QUESTIONS AND
ANSWERS
1. When assessing for Murphy’s sign, which of the following best describes a positive result?
A. Sharp pain and abrupt cessation of inspiration during deep palpation of the right upper
quadrant.
B. Rebound tenderness experienced in the right lower quadrant upon pressure to the left
lower quadrant.
C. Pain elicited by internal rotation of the right hip with the knee flexed.
D. Pain triggered by the patient attempting to raise their right leg against resistance.
Answer: A
Conceptual Explanation: Murphy’s sign is specifically used to assess for acute
cholecystitis. A positive result occurs when the patient experiences sharp pain and stops
breathing in (inspiratory arrest) as the examiner palpates the gallbladder area during deep
inspiration.
,2. A 22-year-old athlete presents with an acute knee injury. The clinician performs the
Lachman test. Which finding indicates a positive result?
A. Excessive posterior displacement of the tibia relative to the femur.
B. Lateral deviation of the patella during extension.
C. Significant anterior translation of the tibia with a soft or mushy endpoint.
D. Audible clicking or popping during internal rotation and extension of the knee.
Answer: C
Conceptual Explanation: The Lachman test is the most sensitive physical exam maneuver
for detecting an Anterior Cruciate Ligament (ACL) tear. It is characterized by significant
anterior displacement of the tibia compared to the femur.
3. During cardiac auscultation of a 75-year-old male with a history of hypertension, you hear
a low-pitched sound just before S1. What is the most likely identification of this sound?
A. S4 atrial gallop
B. Ejection click
C. S3 ventricular gallop
D. Opening snap
Answer: A
, Conceptual Explanation: An S4 heart sound (atrial gallop) occurs in late diastole, just
before S1. In older adults, it often indicates a stiff, non-compliant left ventricle, frequently
seen in long-standing hypertension.
4. In a patient with conductive hearing loss in the right ear, how would you expect the results
of the Weber and Rinne tests to appear?
A. Weber lateralizes to the left; Rinne AC > BC in the right ear.
B. Weber lateralizes to the right; Rinne AC > BC in the right ear.
C. Weber lateralizes to the left; Rinne BC > AC in the right ear.
D. Weber lateralizes to the right; Rinne BC > AC in the right ear.
Answer: D
Conceptual Explanation: In conductive hearing loss, the Weber test lateralizes to the
affected ear (right), and the Rinne test shows bone conduction (BC) lasting longer than air
conduction (AC) in that same ear.
5. A patient presents with ‘the worst headache of my life.’ The clinician notes neck stiffness
and a positive Brudzinski sign. What does a positive Brudzinski sign involve?
A. Contralateral pupillary constriction when light is shone into one eye.
B. Resistance to leg extension when the hip is flexed at 90 degrees.
C. Flexion of the neck when the patient is asked to touch their chin to their chest.
D. Involuntary flexion of the hips and knees when the neck is passively flexed.
