NUR 3066C
Clinical Reasoning: Health
Assessment
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 68-year-old patient presents with acute onset dyspnea and a
productive cough. On auscultation you note fine inspiratory crackles at
the lung bases. Which assessment finding most strongly suggests
pulmonary edema rather than pneumonia?
- A. Fever of 38.5°C
- B. Pink, frothy sputum
- C. Pleural friction rub
- D. Localized chest pain
Correct ANS: B
Rationale: Pink, frothy sputum is characteristic of fluid accumulation in
alveoli, indicating pulmonary edema. Crackles in pneumonia are usually
accompanied by purulent sputum.
---
2. During a neurological assessment, you test cranial nerve VII by asking
the patient to smile. The patient’s right side of the face remains
immobile. Which type of facial nerve lesion does this finding indicate?
- A. Upper motor neuron lesion on the left
- B. Lower motor neuron lesion on the right
- C. Upper motor neuron lesion on the right
- D. Lower motor neuron lesion on the left
Correct ANS: B
Rationale: A lower motor neuron lesion causes ipsilateral complete
facial paralysis. Upper motor lesions spare the forehead.
---
3. You palpate a patient’s abdomen and find a firm, nodular mass in the
right upper quadrant beneath the costal margin. This most likely
2
,represents:
- A. Enlarged spleen
- B. Inflamed gallbladder
- C. Enlarged kidney
- D. Hepatomegaly
Correct ANS: D
Rationale: Hepatomegaly presents as a firm mass below the right costal
margin. An inflamed gallbladder is tender but not nodular and spleen is in
left upper quadrant.
---
4. When assessing a patient’s pulses, you note a bisferiens pulse (double
systolic peak). This finding is most associated with:
- A. Aortic stenosis
- B. Hypertrophic cardiomyopathy
- C. Mitral regurgitation
- D. Pericardial tamponade
Correct ANS: B
Rationale: Hypertrophic cardiomyopathy produces a bisferiens pulse
due to ventricular outflow obstruction and rapid ejection.
---
5. A diabetic patient complains of numbness in the feet. You perform
monofilament testing. Which result indicates protective sensation is
intact?
- A. Sensation perceived at fewer than 3 sites
- B. Sensation perceived at all 10 sites
- C. Sensation perceived at 5 out of 10 sites
- D. Sensation perceived only when pressure is doubled
Correct ANS: B
3
, Rationale: Perception at all test sites indicates intact protective
sensation; fewer indicates neuropathy.
---
6. In an older adult, you detect jugular venous distention when the
patient is seated at 60 degrees. The most likely diagnosis is:
- A. Right-sided heart failure
- B. Chronic obstructive pulmonary disease
- C. Tricuspid regurgitation
- D. Superior vena cava syndrome
Correct ANS: A
Rationale: Elevated jugular venous pressure in semi-recumbent position
is hallmark of right-sided heart failure.
---
7. A patient with suspected meningitis has a positive Brudzinski’s sign. To
elicit this, you perform:
- A. Passive extension of the knee
- B. Flexion of the patient’s neck
- C. Tapping over the site of the median nerve
- D. Passive dorsiflexion of the foot
Correct ANS: B
Rationale: Neck flexion that causes involuntary hip and knee flexion
indicates meningeal irritation.
---
8. Which auscultatory finding over the renal arteries suggests
renovascular hypertension?
- A. Systolic murmur
- B. Continuous bruit
4
Clinical Reasoning: Health
Assessment
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 68-year-old patient presents with acute onset dyspnea and a
productive cough. On auscultation you note fine inspiratory crackles at
the lung bases. Which assessment finding most strongly suggests
pulmonary edema rather than pneumonia?
- A. Fever of 38.5°C
- B. Pink, frothy sputum
- C. Pleural friction rub
- D. Localized chest pain
Correct ANS: B
Rationale: Pink, frothy sputum is characteristic of fluid accumulation in
alveoli, indicating pulmonary edema. Crackles in pneumonia are usually
accompanied by purulent sputum.
---
2. During a neurological assessment, you test cranial nerve VII by asking
the patient to smile. The patient’s right side of the face remains
immobile. Which type of facial nerve lesion does this finding indicate?
- A. Upper motor neuron lesion on the left
- B. Lower motor neuron lesion on the right
- C. Upper motor neuron lesion on the right
- D. Lower motor neuron lesion on the left
Correct ANS: B
Rationale: A lower motor neuron lesion causes ipsilateral complete
facial paralysis. Upper motor lesions spare the forehead.
---
3. You palpate a patient’s abdomen and find a firm, nodular mass in the
right upper quadrant beneath the costal margin. This most likely
2
,represents:
- A. Enlarged spleen
- B. Inflamed gallbladder
- C. Enlarged kidney
- D. Hepatomegaly
Correct ANS: D
Rationale: Hepatomegaly presents as a firm mass below the right costal
margin. An inflamed gallbladder is tender but not nodular and spleen is in
left upper quadrant.
---
4. When assessing a patient’s pulses, you note a bisferiens pulse (double
systolic peak). This finding is most associated with:
- A. Aortic stenosis
- B. Hypertrophic cardiomyopathy
- C. Mitral regurgitation
- D. Pericardial tamponade
Correct ANS: B
Rationale: Hypertrophic cardiomyopathy produces a bisferiens pulse
due to ventricular outflow obstruction and rapid ejection.
---
5. A diabetic patient complains of numbness in the feet. You perform
monofilament testing. Which result indicates protective sensation is
intact?
- A. Sensation perceived at fewer than 3 sites
- B. Sensation perceived at all 10 sites
- C. Sensation perceived at 5 out of 10 sites
- D. Sensation perceived only when pressure is doubled
Correct ANS: B
3
, Rationale: Perception at all test sites indicates intact protective
sensation; fewer indicates neuropathy.
---
6. In an older adult, you detect jugular venous distention when the
patient is seated at 60 degrees. The most likely diagnosis is:
- A. Right-sided heart failure
- B. Chronic obstructive pulmonary disease
- C. Tricuspid regurgitation
- D. Superior vena cava syndrome
Correct ANS: A
Rationale: Elevated jugular venous pressure in semi-recumbent position
is hallmark of right-sided heart failure.
---
7. A patient with suspected meningitis has a positive Brudzinski’s sign. To
elicit this, you perform:
- A. Passive extension of the knee
- B. Flexion of the patient’s neck
- C. Tapping over the site of the median nerve
- D. Passive dorsiflexion of the foot
Correct ANS: B
Rationale: Neck flexion that causes involuntary hip and knee flexion
indicates meningeal irritation.
---
8. Which auscultatory finding over the renal arteries suggests
renovascular hypertension?
- A. Systolic murmur
- B. Continuous bruit
4
