,NUR 6001 Exam 3 | Advanced Health Assessment |
William Paterson University
1. During an assessment of the musculoskeletal system, the nurse notes a grating
sound and sensation when the patient moves their knee. This is documented as
which of the following?
A) Crepitus
B) Effusion
C) Subluxation
D) Ankylosis
Correct Answer: Crepitus
Rationale: Crepitus is a grating sound or sensation caused by friction between
bone and cartilage surfaces, commonly seen in osteoarthritis. Effusion refers to
fluid accumulation in a joint space. Subluxation is a partial dislocation, and
ankylosis is joint stiffness or fixation.
2. Which cranial nerve is assessed by asking the patient to shrug their shoulders
against resistance?
A) Cranial nerve IX
B) Cranial nerve X
C) Cranial nerve XI
D) Cranial nerve XII
Correct Answer: Cranial nerve XI
,Rationale: The spinal accessory nerve (CN XI) innervates the
sternocleidomastoid and trapezius muscles, which are responsible for shoulder
shrug and head rotation. CN IX and X control the gag reflex and swallowing. CN
XII controls tongue movement.
3. What is the correct sequence for performing an abdominal physical
examination?
A) Inspection, palpation, percussion, auscultation
B) Auscultation, inspection, palpation, percussion
C) Inspection, auscultation, percussion, palpation
D) Palpation, percussion, auscultation, inspection
Correct Answer: Inspection, auscultation, percussion, palpation
Rationale: Auscultation must precede percussion and palpation because these
maneuvers can alter bowel sounds and produce false findings. Inspection is always
first. This sequence differs from other systems where palpation typically follows
inspection.
4. A patient presents with a fixed, hard, irregular mass in the left upper outer
quadrant of the breast with skin tethering. What is the most appropriate next
step?
A) Reassure the patient and schedule a follow-up in 6 months
B) Order a diagnostic mammogram with targeted ultrasound and refer for core
needle biopsy
C) Initiate a 10-day course of antibiotics for mastitis
D) Obtain a serum CA 15-3 tumor marker level
, Correct Answer: Order a diagnostic mammogram with targeted ultrasound and
refer for core needle biopsy
Rationale: A hard, fixed, irregular mass with skin tethering is highly suspicious
for breast malignancy. Diagnostic imaging with biopsy confirmation is required.
Pain is not a reliable indicator of benignity, and delaying care for observation or
unnecessary antibiotics is contraindicated.
5. Which finding during a neurologic assessment indicates cerebellar dysfunction?
A) Positive Romberg sign
B) Ataxia with rapid alternating movements
C) Hyperreflexia
D) Positive Babinski sign
Correct Answer: Ataxia with rapid alternating movements
Rationale: The cerebellum coordinates voluntary movements, balance, and
posture. Ataxia and difficulty with rapid alternating movements indicate
cerebellar dysfunction. Romberg sign assesses proprioception, hyperreflexia
indicates upper motor neuron lesions, and Babinski sign is a corticospinal tract
finding.
6. During a cardiovascular assessment, auscultation at the apex reveals a low-
pitched, late diastolic sound occurring right before S1. How is this finding
documented?
A) S3 gallop
B) S4 gallop
C) Midsystolic click
William Paterson University
1. During an assessment of the musculoskeletal system, the nurse notes a grating
sound and sensation when the patient moves their knee. This is documented as
which of the following?
A) Crepitus
B) Effusion
C) Subluxation
D) Ankylosis
Correct Answer: Crepitus
Rationale: Crepitus is a grating sound or sensation caused by friction between
bone and cartilage surfaces, commonly seen in osteoarthritis. Effusion refers to
fluid accumulation in a joint space. Subluxation is a partial dislocation, and
ankylosis is joint stiffness or fixation.
2. Which cranial nerve is assessed by asking the patient to shrug their shoulders
against resistance?
A) Cranial nerve IX
B) Cranial nerve X
C) Cranial nerve XI
D) Cranial nerve XII
Correct Answer: Cranial nerve XI
,Rationale: The spinal accessory nerve (CN XI) innervates the
sternocleidomastoid and trapezius muscles, which are responsible for shoulder
shrug and head rotation. CN IX and X control the gag reflex and swallowing. CN
XII controls tongue movement.
3. What is the correct sequence for performing an abdominal physical
examination?
A) Inspection, palpation, percussion, auscultation
B) Auscultation, inspection, palpation, percussion
C) Inspection, auscultation, percussion, palpation
D) Palpation, percussion, auscultation, inspection
Correct Answer: Inspection, auscultation, percussion, palpation
Rationale: Auscultation must precede percussion and palpation because these
maneuvers can alter bowel sounds and produce false findings. Inspection is always
first. This sequence differs from other systems where palpation typically follows
inspection.
4. A patient presents with a fixed, hard, irregular mass in the left upper outer
quadrant of the breast with skin tethering. What is the most appropriate next
step?
A) Reassure the patient and schedule a follow-up in 6 months
B) Order a diagnostic mammogram with targeted ultrasound and refer for core
needle biopsy
C) Initiate a 10-day course of antibiotics for mastitis
D) Obtain a serum CA 15-3 tumor marker level
, Correct Answer: Order a diagnostic mammogram with targeted ultrasound and
refer for core needle biopsy
Rationale: A hard, fixed, irregular mass with skin tethering is highly suspicious
for breast malignancy. Diagnostic imaging with biopsy confirmation is required.
Pain is not a reliable indicator of benignity, and delaying care for observation or
unnecessary antibiotics is contraindicated.
5. Which finding during a neurologic assessment indicates cerebellar dysfunction?
A) Positive Romberg sign
B) Ataxia with rapid alternating movements
C) Hyperreflexia
D) Positive Babinski sign
Correct Answer: Ataxia with rapid alternating movements
Rationale: The cerebellum coordinates voluntary movements, balance, and
posture. Ataxia and difficulty with rapid alternating movements indicate
cerebellar dysfunction. Romberg sign assesses proprioception, hyperreflexia
indicates upper motor neuron lesions, and Babinski sign is a corticospinal tract
finding.
6. During a cardiovascular assessment, auscultation at the apex reveals a low-
pitched, late diastolic sound occurring right before S1. How is this finding
documented?
A) S3 gallop
B) S4 gallop
C) Midsystolic click
