NUR 6001 Exam 2 Actual Exam V3 | NUR 6001 Advanced Health
Assessment (NUR6001 Exam 2) | William Paterson University
1. A 65-year-old patient presents with a mid-systolic crescendo-decrescendo murmur heard
best at the second right intercostal space, radiating to the carotids. Which of the following is
the most likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Rationale: The location and radiation of the murmur are classic for aortic stenosis. The
crescendo-decrescendo pattern occurs during systole as blood is forced through a
narrowed valve. Clinical reasoning suggests that radiation to the carotids differentiates this
from other systolic murmurs like mitral regurgitation.
2. During a physical exam, you note a patient has increased tactile fremitus over the right
lower lobe. Which condition does this finding most strongly suggest?
A. Pneumothorax
B. Pleural Effusion
C. Chronic Obstructive Pulmonary Disease
D. Lobar Pneumonia
Answer: D
Rationale: Tactile fremitus increases when there is consolidation in the lung tissue, such as
in lobar pneumonia. Liquid or solid medium transmits vibrations better than air. In
contrast, conditions like pneumothorax or pleural effusion decrease or eliminate fremitus
because they separate the lung from the chest wall.
3. A 45-year-old female reports severe right upper quadrant pain that radiates to her right
shoulder after eating a fatty meal. Murphy’s sign is positive. What is the most likely
diagnosis?
A. Acute Appendicitis
B. Acute Cholecystitis
C. Peptic Ulcer Disease
D. Acute Pancreatitis
,Answer: B
Rationale: Murphy’s sign is a clinical test for gallbladder inflammation where the patient
stops breathing during deep palpation of the RUQ. Pain triggered by fatty meals is highly
characteristic of biliary pathology. Differential considerations include pancreatitis, but the
localized RUQ pain and positive Murphy’s sign point specifically to cholecystitis.
4. When assessing the cranial nerves, you ask the patient to follow your finger in an ‘H’
pattern. You notice the patient’s right eye cannot move laterally. Which cranial nerve is likely
affected?
A. Cranial Nerve VI (Abducens)
B. Cranial Nerve IV (Trochlear)
C. Cranial Nerve III (Oculomotor)
D. Cranial Nerve VII (Facial)
Answer: A
Rationale: The Abducens nerve (CN VI) controls the lateral rectus muscle, which is
responsible for lateral eye movement (abduction). Dysfunction leads to an inability to look
outward towards the ear on the affected side. This assessment is a standard part of the
extraocular movement exam to differentiate between various nerve palsies.
5. An elderly patient presents with a ‘stiff-legged’ gait and difficulty initiating movement,
along with a resting ‘pill-rolling’ tremor. These findings are indicative of:
A. Multiple Sclerosis
B. Cerebellar Ataxia
C. Parkinson’s Disease
D. Amyotrophic Lateral Sclerosis
Answer: C
Rationale: Parkinson’s disease is characterized by a triad of symptoms: resting tremor,
bradykinesia, and rigidity. The ‘pill-rolling’ tremor is a hallmark finding during the resting
state. Assessment of the gait usually reveals small, shuffling steps and a lack of arm swing,
known as a festinating gait.
6. Which heart sound is typically associated with heart failure and fluid overload in an older
adult, often referred to as a ventricular gallop?
A. S1
B. S2
C. S4
, D. S3
Answer: D
Rationale: The S3 heart sound occurs early in diastole during the rapid ventricular filling
phase. In adults over age 40, it is often a sign of ventricular non-compliance or volume
overload, such as in congestive heart failure. It is best heard with the bell of the stethoscope
at the apex while the patient is in the left lateral decubitus position.
7. While performing a breast exam, you note a single, hard, fixed, non-tender mass with
irregular borders in the upper outer quadrant. What is the most appropriate next step?
A. Advise the patient to return in 6 months for a follow-up exam.
B. Prescribe antibiotics for suspected mastitis.
C. Refer for diagnostic mammography and ultrasound.
D. Reassure the patient that it is likely a fibroadenoma.
Answer: C
Rationale: Fixed, hard, and irregular masses are high-risk indicators for malignancy in
breast tissue. The upper outer quadrant is the most common site for breast cancer. Prompt
diagnostic imaging is the standard of care to differentiate benign findings from life-
threatening pathology.
8. A patient complains of ‘the worst headache of my life’ that started suddenly. Which of the
following should the clinician prioritize?
A. Tension Headache
B. Subarachnoid Hemorrhage
C. Migraine with Aura
D. Cluster Headache
Answer: B
Rationale: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is a classic
presentation of a subarachnoid hemorrhage. This is a medical emergency requiring
immediate neuroimaging (CT scan) to rule out intracranial bleeding. While migraines and
cluster headaches are painful, they typically have different onset patterns and histories.
9. When performing a funduscopic exam, you note blurring of the optic disc margins and a
loss of the physiological cup. This finding is known as:
A. Hypertensive Retinopathy
B. Glaucoma
C. Macular Degeneration
Assessment (NUR6001 Exam 2) | William Paterson University
1. A 65-year-old patient presents with a mid-systolic crescendo-decrescendo murmur heard
best at the second right intercostal space, radiating to the carotids. Which of the following is
the most likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Rationale: The location and radiation of the murmur are classic for aortic stenosis. The
crescendo-decrescendo pattern occurs during systole as blood is forced through a
narrowed valve. Clinical reasoning suggests that radiation to the carotids differentiates this
from other systolic murmurs like mitral regurgitation.
2. During a physical exam, you note a patient has increased tactile fremitus over the right
lower lobe. Which condition does this finding most strongly suggest?
A. Pneumothorax
B. Pleural Effusion
C. Chronic Obstructive Pulmonary Disease
D. Lobar Pneumonia
Answer: D
Rationale: Tactile fremitus increases when there is consolidation in the lung tissue, such as
in lobar pneumonia. Liquid or solid medium transmits vibrations better than air. In
contrast, conditions like pneumothorax or pleural effusion decrease or eliminate fremitus
because they separate the lung from the chest wall.
3. A 45-year-old female reports severe right upper quadrant pain that radiates to her right
shoulder after eating a fatty meal. Murphy’s sign is positive. What is the most likely
diagnosis?
A. Acute Appendicitis
B. Acute Cholecystitis
C. Peptic Ulcer Disease
D. Acute Pancreatitis
,Answer: B
Rationale: Murphy’s sign is a clinical test for gallbladder inflammation where the patient
stops breathing during deep palpation of the RUQ. Pain triggered by fatty meals is highly
characteristic of biliary pathology. Differential considerations include pancreatitis, but the
localized RUQ pain and positive Murphy’s sign point specifically to cholecystitis.
4. When assessing the cranial nerves, you ask the patient to follow your finger in an ‘H’
pattern. You notice the patient’s right eye cannot move laterally. Which cranial nerve is likely
affected?
A. Cranial Nerve VI (Abducens)
B. Cranial Nerve IV (Trochlear)
C. Cranial Nerve III (Oculomotor)
D. Cranial Nerve VII (Facial)
Answer: A
Rationale: The Abducens nerve (CN VI) controls the lateral rectus muscle, which is
responsible for lateral eye movement (abduction). Dysfunction leads to an inability to look
outward towards the ear on the affected side. This assessment is a standard part of the
extraocular movement exam to differentiate between various nerve palsies.
5. An elderly patient presents with a ‘stiff-legged’ gait and difficulty initiating movement,
along with a resting ‘pill-rolling’ tremor. These findings are indicative of:
A. Multiple Sclerosis
B. Cerebellar Ataxia
C. Parkinson’s Disease
D. Amyotrophic Lateral Sclerosis
Answer: C
Rationale: Parkinson’s disease is characterized by a triad of symptoms: resting tremor,
bradykinesia, and rigidity. The ‘pill-rolling’ tremor is a hallmark finding during the resting
state. Assessment of the gait usually reveals small, shuffling steps and a lack of arm swing,
known as a festinating gait.
6. Which heart sound is typically associated with heart failure and fluid overload in an older
adult, often referred to as a ventricular gallop?
A. S1
B. S2
C. S4
, D. S3
Answer: D
Rationale: The S3 heart sound occurs early in diastole during the rapid ventricular filling
phase. In adults over age 40, it is often a sign of ventricular non-compliance or volume
overload, such as in congestive heart failure. It is best heard with the bell of the stethoscope
at the apex while the patient is in the left lateral decubitus position.
7. While performing a breast exam, you note a single, hard, fixed, non-tender mass with
irregular borders in the upper outer quadrant. What is the most appropriate next step?
A. Advise the patient to return in 6 months for a follow-up exam.
B. Prescribe antibiotics for suspected mastitis.
C. Refer for diagnostic mammography and ultrasound.
D. Reassure the patient that it is likely a fibroadenoma.
Answer: C
Rationale: Fixed, hard, and irregular masses are high-risk indicators for malignancy in
breast tissue. The upper outer quadrant is the most common site for breast cancer. Prompt
diagnostic imaging is the standard of care to differentiate benign findings from life-
threatening pathology.
8. A patient complains of ‘the worst headache of my life’ that started suddenly. Which of the
following should the clinician prioritize?
A. Tension Headache
B. Subarachnoid Hemorrhage
C. Migraine with Aura
D. Cluster Headache
Answer: B
Rationale: A ‘thunderclap’ headache or the ‘worst headache of one’s life’ is a classic
presentation of a subarachnoid hemorrhage. This is a medical emergency requiring
immediate neuroimaging (CT scan) to rule out intracranial bleeding. While migraines and
cluster headaches are painful, they typically have different onset patterns and histories.
9. When performing a funduscopic exam, you note blurring of the optic disc margins and a
loss of the physiological cup. This finding is known as:
A. Hypertensive Retinopathy
B. Glaucoma
C. Macular Degeneration
