WGU MSN Nursing Assessment ACTUAL EXAM |
QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY GRADED A+
WGU MSN Nursing Assessment: 100-Question Practice Exam
,Section 1: Advanced Health Assessment (Questions 1-25)
1. When performing a mental status exam on an older adult, the nurse notes the patient is alert but disoriented to time and
place. The nurse should document this as:
A. Lethargy
B. Delirium
C. Dementia
D. Stupor
Answer: B
Rationale: Delirium is an acute, fluctuating disturbance in attention and awareness. Lethargy is drowsiness. Dementia is a
chronic, progressive decline. Stupor is a state of near-unconsciousness.
2. A patient presents with a blood pressure of 160/100 mmHg in the right arm and 130/80 mmHg in the left arm. The nurse
recognizes this as:
A. Normal variation
B. Coarctation of the aorta
C. Aortic stenosis
D. Subclavian steal syndrome
Answer: D
Rationale: A difference of >15-20 mmHg between arms is a hallmark of subclavian steal syndrome or peripheral vascular
disease. Coarctation of the aorta typically presents with hypertension in the arms and hypotension in the legs.
,3. During an abdominal assessment, the nurse hears a bruit over the epigastric region. This finding is most consistent
with:
A. Normal bowel sounds
B. An abdominal aortic aneurysm
C. A renal artery stenosis
D. A hernia
Answer: B
Rationale: A bruit is a swooshing sound caused by turbulent blood flow. In the epigastric area, it is a classic sign of an
abdominal aortic aneurysm (AAA).
4. The nurse is assessing for meningeal irritation. Which test involves flexing the patient's neck and observing for
involuntary flexion of the hips and knees?
A. Kernig's sign
B. Brudzinski's sign
C. Babinski's sign
D. Romberg's sign
Answer: B
Rationale: Brudzinski's sign is positive when neck flexion causes hip/knee flexion. Kernig's sign is positive when extending
the knee while the hip is flexed causes pain.
, 5. A patient has a positive Babinski sign. The nurse interprets this as:
A. A normal finding in adults
B. A sign of upper motor neuron lesion
C. A sign of lower motor neuron lesion
D. A sign of cerebellar dysfunction
Answer: B
Rationale: A positive Babinski (dorsiflexion of the great toe and fanning of other toes) is normal in infants but indicates an
upper motor neuron lesion (e.g., stroke, spinal cord injury) in adults.
6. Which breath sound is described as low-pitched, coarse, and rumbling, often heard in patients with bronchitis?
A. Vesicular
B. Bronchial
C. Rhonchi
D. Crackles
Answer: C
Rationale: Rhonchi are continuous, low-pitched sounds caused by secretions in the large airways. Crackles are
discontinuous and high-pitched.
7. The nurse is assessing a patient's jugular venous pressure (JVP). The patient is at a 45-degree angle. The nurse notes
the JVP is 5 cm above the sternal angle. This indicates:
QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY GRADED A+
WGU MSN Nursing Assessment: 100-Question Practice Exam
,Section 1: Advanced Health Assessment (Questions 1-25)
1. When performing a mental status exam on an older adult, the nurse notes the patient is alert but disoriented to time and
place. The nurse should document this as:
A. Lethargy
B. Delirium
C. Dementia
D. Stupor
Answer: B
Rationale: Delirium is an acute, fluctuating disturbance in attention and awareness. Lethargy is drowsiness. Dementia is a
chronic, progressive decline. Stupor is a state of near-unconsciousness.
2. A patient presents with a blood pressure of 160/100 mmHg in the right arm and 130/80 mmHg in the left arm. The nurse
recognizes this as:
A. Normal variation
B. Coarctation of the aorta
C. Aortic stenosis
D. Subclavian steal syndrome
Answer: D
Rationale: A difference of >15-20 mmHg between arms is a hallmark of subclavian steal syndrome or peripheral vascular
disease. Coarctation of the aorta typically presents with hypertension in the arms and hypotension in the legs.
,3. During an abdominal assessment, the nurse hears a bruit over the epigastric region. This finding is most consistent
with:
A. Normal bowel sounds
B. An abdominal aortic aneurysm
C. A renal artery stenosis
D. A hernia
Answer: B
Rationale: A bruit is a swooshing sound caused by turbulent blood flow. In the epigastric area, it is a classic sign of an
abdominal aortic aneurysm (AAA).
4. The nurse is assessing for meningeal irritation. Which test involves flexing the patient's neck and observing for
involuntary flexion of the hips and knees?
A. Kernig's sign
B. Brudzinski's sign
C. Babinski's sign
D. Romberg's sign
Answer: B
Rationale: Brudzinski's sign is positive when neck flexion causes hip/knee flexion. Kernig's sign is positive when extending
the knee while the hip is flexed causes pain.
, 5. A patient has a positive Babinski sign. The nurse interprets this as:
A. A normal finding in adults
B. A sign of upper motor neuron lesion
C. A sign of lower motor neuron lesion
D. A sign of cerebellar dysfunction
Answer: B
Rationale: A positive Babinski (dorsiflexion of the great toe and fanning of other toes) is normal in infants but indicates an
upper motor neuron lesion (e.g., stroke, spinal cord injury) in adults.
6. Which breath sound is described as low-pitched, coarse, and rumbling, often heard in patients with bronchitis?
A. Vesicular
B. Bronchial
C. Rhonchi
D. Crackles
Answer: C
Rationale: Rhonchi are continuous, low-pitched sounds caused by secretions in the large airways. Crackles are
discontinuous and high-pitched.
7. The nurse is assessing a patient's jugular venous pressure (JVP). The patient is at a 45-degree angle. The nurse notes
the JVP is 5 cm above the sternal angle. This indicates:
