NURS 5220 ADVANCED HEALTH
ASSESSMENT AND DIAGNOSTIC
REASONING — EXAM 3
COMPREHENSIVE REVIEW QUESTIONS
AND CORRECT ANSWERS WITH
EXPLANATIONS JUST RELEASED
1. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the second right intercostal space, radiating to the carotid arteries. Which diagnosis is
most likely?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Aortic Stenosis
D. Mitral Stenosis
Answer: C
Conceptual Explanation: Aortic stenosis typically produces a harsh systolic crescendo-
decrescendo murmur at the right second ICS that radiates to the neck/carotids.
2. During an abdominal assessment, the provider deeply palpates the left lower quadrant and
the patient reports 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
Conceptual Explanation: Rovsing’s sign is referred pain to the RLQ when pressure is
applied to the LLQ, suggesting peritoneal irritation or appendicitis.
3. Which physical exam finding is most consistent with a diagnosis of consolidation (such as
pneumonia) in the lung?
A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Hyperresonance on percussion
D. Diaphragmatic excursion of 5 cm
Answer: A
Conceptual Explanation: Consolidation (solid/fluid-filled tissue) transmits sound
vibrations better than air, leading to increased tactile fremitus and dullness to percussion.
4. When assessing the cardiovascular system, a third heart sound (S3) is most likely indicative
of which condition in an older adult?
A. Left ventricular hypertrophy
B. Heart failure or volume overload
, C. Aortic valve calcification
D. Normal physiological aging
Answer: B
Conceptual Explanation: While S3 can be normal in children and athletes, in older adults
it often signifies decreased ventricular compliance and fluid overload (CHF).
5. A patient presents with ‘the worst headache of my life,’ accompanied by neck stiffness and
photophobia. What is the priority diagnostic suspicion?
A. Subarachnoid hemorrhage
B. Migraine with aura
C. Temporal arteritis
D. Cluster headache
Answer: A
Conceptual Explanation: A ‘thunderclap’ headache or the ‘worst headache of life’ is a
classic presentation for subarachnoid hemorrhage, often due to a ruptured aneurysm.
6. The Phalen’s test and Tinel’s sign are physical examination maneuvers used to screen for:
A. Radial nerve palsy
B. De Quervain’s tenosynovitis
C. Carpal tunnel syndrome
ASSESSMENT AND DIAGNOSTIC
REASONING — EXAM 3
COMPREHENSIVE REVIEW QUESTIONS
AND CORRECT ANSWERS WITH
EXPLANATIONS JUST RELEASED
1. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the second right intercostal space, radiating to the carotid arteries. Which diagnosis is
most likely?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Aortic Stenosis
D. Mitral Stenosis
Answer: C
Conceptual Explanation: Aortic stenosis typically produces a harsh systolic crescendo-
decrescendo murmur at the right second ICS that radiates to the neck/carotids.
2. During an abdominal assessment, the provider deeply palpates the left lower quadrant and
the patient reports 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
Conceptual Explanation: Rovsing’s sign is referred pain to the RLQ when pressure is
applied to the LLQ, suggesting peritoneal irritation or appendicitis.
3. Which physical exam finding is most consistent with a diagnosis of consolidation (such as
pneumonia) in the lung?
A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Hyperresonance on percussion
D. Diaphragmatic excursion of 5 cm
Answer: A
Conceptual Explanation: Consolidation (solid/fluid-filled tissue) transmits sound
vibrations better than air, leading to increased tactile fremitus and dullness to percussion.
4. When assessing the cardiovascular system, a third heart sound (S3) is most likely indicative
of which condition in an older adult?
A. Left ventricular hypertrophy
B. Heart failure or volume overload
, C. Aortic valve calcification
D. Normal physiological aging
Answer: B
Conceptual Explanation: While S3 can be normal in children and athletes, in older adults
it often signifies decreased ventricular compliance and fluid overload (CHF).
5. A patient presents with ‘the worst headache of my life,’ accompanied by neck stiffness and
photophobia. What is the priority diagnostic suspicion?
A. Subarachnoid hemorrhage
B. Migraine with aura
C. Temporal arteritis
D. Cluster headache
Answer: A
Conceptual Explanation: A ‘thunderclap’ headache or the ‘worst headache of life’ is a
classic presentation for subarachnoid hemorrhage, often due to a ruptured aneurysm.
6. The Phalen’s test and Tinel’s sign are physical examination maneuvers used to screen for:
A. Radial nerve palsy
B. De Quervain’s tenosynovitis
C. Carpal tunnel syndrome
