NSG 500 FINAL EXAM – WILKES
ADVANCED HEALTH ASSESSMENT
(2026/2027) QUESTIONS AND ANSWERS
1. During a cardiac assessment, the nurse practitioner hears a low-pitched extra heart sound
immediately after S2 at the apex using the bell of the stethoscope. This sound is most likely:
A. An opening snap, indicating mitral stenosis.
B. An S4 gallop, indicating a non-compliant or stiff ventricle.
C. A mid-systolic click, suggesting mitral valve prolapse.
D. An S3 gallop, often associated with fluid volume overload.
Answer: D
Conceptual Explanation: The S3 gallop occurs early in diastole during the rapid
ventricular filling phase and is best heard with the bell at the apex; it is frequently
associated with heart failure or fluid overload.
2. When performing a physical exam on a patient with suspected appendicitis, the clinician
performs internal rotation of the right hip with the knee flexed. This maneuver is known as:
A. Obturator sign
,B. Rovsing’s sign
C. Psoas sign
D. Murphy’s sign
Answer: A
Conceptual Explanation: The Obturator sign involves internal rotation of the flexed hip.
Pain during this maneuver suggests irritation of the obturator muscle by an inflamed
appendix.
3. A 65-year-old patient presents with a sudden onset of ‘the worst headache of my life.’
Which physical exam finding is most concerning for an intracranial emergency?
A. Nuchal rigidity
B. Unilateral miosis
C. Bilateral ptosis
D. Horizontal nystagmus
Answer: A
Conceptual Explanation: Nuchal rigidity, or neck stiffness, is a classic sign of meningeal
irritation, which can occur in meningitis or subarachnoid hemorrhage (the ‘thunderclap’
headache).
, 4. A patient exhibits a positive Lachman’s test. This finding is highly sensitive for an injury to
which structure?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Lateral meniscus
D. Medial collateral ligament
Answer: A
Conceptual Explanation: The Lachman’s test is considered the most sensitive clinical test
for detecting an ACL tear, performed by pulling the tibia anteriorly at 20-30 degrees of
flexion.
5. While assessing a patient’s vision using the Snellen chart, the result is recorded as 20/50.
This means:
A. The patient can see at 50 feet what a normal eye sees at 20 feet.
B. The patient needs to stand 50 feet away to see the 20 line.
C. The patient’s vision is 50% of the normal standard.
D. The patient can see at 20 feet what a normal eye sees at 50 feet.
Answer: D
ADVANCED HEALTH ASSESSMENT
(2026/2027) QUESTIONS AND ANSWERS
1. During a cardiac assessment, the nurse practitioner hears a low-pitched extra heart sound
immediately after S2 at the apex using the bell of the stethoscope. This sound is most likely:
A. An opening snap, indicating mitral stenosis.
B. An S4 gallop, indicating a non-compliant or stiff ventricle.
C. A mid-systolic click, suggesting mitral valve prolapse.
D. An S3 gallop, often associated with fluid volume overload.
Answer: D
Conceptual Explanation: The S3 gallop occurs early in diastole during the rapid
ventricular filling phase and is best heard with the bell at the apex; it is frequently
associated with heart failure or fluid overload.
2. When performing a physical exam on a patient with suspected appendicitis, the clinician
performs internal rotation of the right hip with the knee flexed. This maneuver is known as:
A. Obturator sign
,B. Rovsing’s sign
C. Psoas sign
D. Murphy’s sign
Answer: A
Conceptual Explanation: The Obturator sign involves internal rotation of the flexed hip.
Pain during this maneuver suggests irritation of the obturator muscle by an inflamed
appendix.
3. A 65-year-old patient presents with a sudden onset of ‘the worst headache of my life.’
Which physical exam finding is most concerning for an intracranial emergency?
A. Nuchal rigidity
B. Unilateral miosis
C. Bilateral ptosis
D. Horizontal nystagmus
Answer: A
Conceptual Explanation: Nuchal rigidity, or neck stiffness, is a classic sign of meningeal
irritation, which can occur in meningitis or subarachnoid hemorrhage (the ‘thunderclap’
headache).
, 4. A patient exhibits a positive Lachman’s test. This finding is highly sensitive for an injury to
which structure?
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Lateral meniscus
D. Medial collateral ligament
Answer: A
Conceptual Explanation: The Lachman’s test is considered the most sensitive clinical test
for detecting an ACL tear, performed by pulling the tibia anteriorly at 20-30 degrees of
flexion.
5. While assessing a patient’s vision using the Snellen chart, the result is recorded as 20/50.
This means:
A. The patient can see at 50 feet what a normal eye sees at 20 feet.
B. The patient needs to stand 50 feet away to see the 20 line.
C. The patient’s vision is 50% of the normal standard.
D. The patient can see at 20 feet what a normal eye sees at 50 feet.
Answer: D
