NUR 6001 Exam 3 Actual Exam V1 | NUR 6001 Advanced Health
Assessment (NUR6001 Exam 3) | William Paterson University
1. A 55-year-old female presents with a new palpable lump in her left breast. Upon physical
examination, you note the mass is fixed, non-tender, and has irregular borders. Which of the
following findings would most strongly suggest malignancy in this complex patient scenario?
A. Peau d’orange appearance of the skin
B. Mobile, rubbery consistency
C. Presence of tenderness upon palpation
D. Fluctuant quality to the mass
Answer: A
Rationale: The presence of peau d’orange, or an orange-peel appearance, indicates
lymphatic obstruction often associated with inflammatory breast cancer. Fixed, non-tender,
and irregular masses are classic indicators of potential malignancy rather than benign cysts
or fibroadenomas. Advanced practice nurses must utilize clinical reasoning to differentiate
these findings from mobile or fluctuant masses which typically suggest benign conditions.
2. During an abdominal assessment, the nurse practitioner performs the Rovsing sign by
palpating deeply in the left lower quadrant. The patient reports pain in the right lower
quadrant. How should this finding be interpreted?
A. Indicative of diverticulitis in the descending colon
B. Negative sign for appendicitis as the pain should be localized to the left
C. Positive Rovsing sign indicating peritoneal irritation or appendicitis
D. Normal finding during deep palpation of the abdomen
Answer: C
Rationale: A positive Rovsing sign occurs when pressure applied to the left lower quadrant
causes pain in the right lower quadrant, suggesting appendicitis. This phenomenon is due
to the displacement of gas and peritoneal irritation affecting the inflamed appendix. This
clinical reasoning is a vital part of the evidence-based assessment for acute abdominal pain
in emergency settings.
3. A 68-year-old male reports sudden onset of severe lower back pain and a ‘tearing’
sensation in his abdomen. On palpation, you detect a pulsatile mass in the periumbilical area.
What is the most critical differential consideration?
A. Acute bowel obstruction
B. Renal calculi with hydronephrosis
,C. Abdominal Aortic Aneurysm (AAA)
D. Severe lumbar disc herniation
Answer: C
Rationale: The presence of a pulsatile mass combined with tearing abdominal or back pain
is a classic presentation of an Abdominal Aortic Aneurysm (AAA). This is a medical
emergency that requires immediate surgical consultation and imaging to prevent rupture.
Advanced health assessment focuses on recognizing these high-risk vascular signs through
careful palpation and history taking.
4. When assessing the cranial nerves of a patient who suffered a stroke, you note the patient
is unable to shrug their shoulders against resistance. Which cranial nerve is likely affected?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve IX (Glossopharyngeal)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve XI (Spinal Accessory)
Answer: D
Rationale: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius and
sternocleidomastoid muscles. Testing the ability to shrug shoulders and turn the head
against resistance evaluates this nerve’s motor function. Deficits here often indicate central
nervous system damage or peripheral nerve injury following trauma or stroke.
5. A 30-year-old athlete presents with knee pain after a pivoting injury. The nurse practitioner
performs the Lachman test, noting significant forward excursion of the tibia. This finding is
most sensitive for which injury?
A. Medial collateral ligament (MCL) tear
B. Meniscal tear
C. Anterior cruciate ligament (ACL) tear
D. Posterior cruciate ligament (PCL) tear
Answer: C
Rationale: The Lachman test is considered the most sensitive clinical maneuver for
diagnosing an acute ACL tear. It involves stabilizing the femur and pulling the tibia forward
with the knee flexed at 20-30 degrees. Understanding the biomechanics of knee stability is
essential for accurate clinical reasoning in sports medicine assessments.
6. During a musculoskeletal exam of an elderly patient with joint pain, you observe
Heberden’s nodes. Where are these nodes specifically located?
A. Metacarpophalangeal (MCP) joints
, B. Proximal interphalangeal (PIP) joints
C. Distal interphalangeal (DIP) joints
D. Wrist (radiocarpal) joints
Answer: C
Rationale: Heberden’s nodes are bony overgrowths located at the distal interphalangeal
(DIP) joints, characteristic of Osteoarthritis. In contrast, Bouchard’s nodes occur at the
proximal interphalangeal (PIP) joints. Differentiating between these helps the clinician
distinguish Osteoarthritis from Rheumatoid Arthritis, which typically spares the DIP joints.
7. A 24-year-old male presents with acute scrotal pain and a ‘bag of worms’ sensation on
palpation of the left scrotum while standing. The mass disappears when he lies supine. What
is the most likely diagnosis?
A. Hydrocele
B. Testicular torsion
C. Varicocele
D. Spermatocele
Answer: C
Rationale: A varicocele is a dilation of the pampiniform plexus of veins and is often
described as a ‘bag of worms.’ It typically occurs on the left side due to venous anatomy and
characteristically decompresses when the patient is in a recumbent position. Identifying
this finding is important because large varicoceles can impact fertility and sperm quality.
8. During a neurological exam, the nurse practitioner uses a tuning fork to test vibratory
sense on the patient’s great toe. The patient is unable to feel the vibration. Loss of vibratory
sense is often one of the first signs of:
A. Cerebellar ataxia
B. Peripheral neuropathy (e.g., Diabetes)
C. Multiple Sclerosis
D. Parkinson’s Disease
Answer: B
Rationale: Vibratory sense is often the first modality lost in peripheral neuropathy,
common in patients with poorly controlled diabetes or B12 deficiency. This assessment
targets the large-fiber sensory pathways and the dorsal columns of the spinal cord. Regular
screening in at-risk populations is an evidence-based practice to prevent complications like
foot ulcers.
Assessment (NUR6001 Exam 3) | William Paterson University
1. A 55-year-old female presents with a new palpable lump in her left breast. Upon physical
examination, you note the mass is fixed, non-tender, and has irregular borders. Which of the
following findings would most strongly suggest malignancy in this complex patient scenario?
A. Peau d’orange appearance of the skin
B. Mobile, rubbery consistency
C. Presence of tenderness upon palpation
D. Fluctuant quality to the mass
Answer: A
Rationale: The presence of peau d’orange, or an orange-peel appearance, indicates
lymphatic obstruction often associated with inflammatory breast cancer. Fixed, non-tender,
and irregular masses are classic indicators of potential malignancy rather than benign cysts
or fibroadenomas. Advanced practice nurses must utilize clinical reasoning to differentiate
these findings from mobile or fluctuant masses which typically suggest benign conditions.
2. During an abdominal assessment, the nurse practitioner performs the Rovsing sign by
palpating deeply in the left lower quadrant. The patient reports pain in the right lower
quadrant. How should this finding be interpreted?
A. Indicative of diverticulitis in the descending colon
B. Negative sign for appendicitis as the pain should be localized to the left
C. Positive Rovsing sign indicating peritoneal irritation or appendicitis
D. Normal finding during deep palpation of the abdomen
Answer: C
Rationale: A positive Rovsing sign occurs when pressure applied to the left lower quadrant
causes pain in the right lower quadrant, suggesting appendicitis. This phenomenon is due
to the displacement of gas and peritoneal irritation affecting the inflamed appendix. This
clinical reasoning is a vital part of the evidence-based assessment for acute abdominal pain
in emergency settings.
3. A 68-year-old male reports sudden onset of severe lower back pain and a ‘tearing’
sensation in his abdomen. On palpation, you detect a pulsatile mass in the periumbilical area.
What is the most critical differential consideration?
A. Acute bowel obstruction
B. Renal calculi with hydronephrosis
,C. Abdominal Aortic Aneurysm (AAA)
D. Severe lumbar disc herniation
Answer: C
Rationale: The presence of a pulsatile mass combined with tearing abdominal or back pain
is a classic presentation of an Abdominal Aortic Aneurysm (AAA). This is a medical
emergency that requires immediate surgical consultation and imaging to prevent rupture.
Advanced health assessment focuses on recognizing these high-risk vascular signs through
careful palpation and history taking.
4. When assessing the cranial nerves of a patient who suffered a stroke, you note the patient
is unable to shrug their shoulders against resistance. Which cranial nerve is likely affected?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve IX (Glossopharyngeal)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve XI (Spinal Accessory)
Answer: D
Rationale: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius and
sternocleidomastoid muscles. Testing the ability to shrug shoulders and turn the head
against resistance evaluates this nerve’s motor function. Deficits here often indicate central
nervous system damage or peripheral nerve injury following trauma or stroke.
5. A 30-year-old athlete presents with knee pain after a pivoting injury. The nurse practitioner
performs the Lachman test, noting significant forward excursion of the tibia. This finding is
most sensitive for which injury?
A. Medial collateral ligament (MCL) tear
B. Meniscal tear
C. Anterior cruciate ligament (ACL) tear
D. Posterior cruciate ligament (PCL) tear
Answer: C
Rationale: The Lachman test is considered the most sensitive clinical maneuver for
diagnosing an acute ACL tear. It involves stabilizing the femur and pulling the tibia forward
with the knee flexed at 20-30 degrees. Understanding the biomechanics of knee stability is
essential for accurate clinical reasoning in sports medicine assessments.
6. During a musculoskeletal exam of an elderly patient with joint pain, you observe
Heberden’s nodes. Where are these nodes specifically located?
A. Metacarpophalangeal (MCP) joints
, B. Proximal interphalangeal (PIP) joints
C. Distal interphalangeal (DIP) joints
D. Wrist (radiocarpal) joints
Answer: C
Rationale: Heberden’s nodes are bony overgrowths located at the distal interphalangeal
(DIP) joints, characteristic of Osteoarthritis. In contrast, Bouchard’s nodes occur at the
proximal interphalangeal (PIP) joints. Differentiating between these helps the clinician
distinguish Osteoarthritis from Rheumatoid Arthritis, which typically spares the DIP joints.
7. A 24-year-old male presents with acute scrotal pain and a ‘bag of worms’ sensation on
palpation of the left scrotum while standing. The mass disappears when he lies supine. What
is the most likely diagnosis?
A. Hydrocele
B. Testicular torsion
C. Varicocele
D. Spermatocele
Answer: C
Rationale: A varicocele is a dilation of the pampiniform plexus of veins and is often
described as a ‘bag of worms.’ It typically occurs on the left side due to venous anatomy and
characteristically decompresses when the patient is in a recumbent position. Identifying
this finding is important because large varicoceles can impact fertility and sperm quality.
8. During a neurological exam, the nurse practitioner uses a tuning fork to test vibratory
sense on the patient’s great toe. The patient is unable to feel the vibration. Loss of vibratory
sense is often one of the first signs of:
A. Cerebellar ataxia
B. Peripheral neuropathy (e.g., Diabetes)
C. Multiple Sclerosis
D. Parkinson’s Disease
Answer: B
Rationale: Vibratory sense is often the first modality lost in peripheral neuropathy,
common in patients with poorly controlled diabetes or B12 deficiency. This assessment
targets the large-fiber sensory pathways and the dorsal columns of the spinal cord. Regular
screening in at-risk populations is an evidence-based practice to prevent complications like
foot ulcers.
