NUR 643E Advanced Health Assessment
Actual Final Exam 2026 – Version B |
Comprehensive Review & Verified Guide
Domain 1: Advanced Physical Examination & Techniques (Questions 1-10)
Q1: A 71-year-old female presents with exertional dyspnea and orthopnea. During
cardiac auscultation, you hear a blowing, decrescendo diastolic murmur best heard at
the left sternal border with the patient leaning forward and exhaling. Which peripheral
finding would you most expect?
A. Pulsus alternans with regular rhythm
B. Quincke's pulses (capillary pulsations) and wide pulse pressure
C. Pulsus tardus et parvus with delayed carotid upstroke
D. Kussmaul's sign (paradoxical JVP elevation with inspiration)
Correct Answer: B
Rationale: The presentation is classic for aortic regurgitation—the early diastolic
decrescendo murmur at the left sternal border (Erb's point) accentuated by leaning
forward and exhalation. Chronic severe AR produces wide pulse pressure (systolic
hypertension, diastolic hypotension) with peripheral signs of hyperdynamic circulation:
Quincke's pulses (visible nail bed pulsations), de Musset's sign (head bobbing), and
Corrigan's pulse (water-hammer carotid). Pulsus alternans (A) indicates severe left
,ventricular dysfunction. Pulsus tardus et parvus (C) is aortic stenosis. Kussmaul's sign
(D) is constrictive pericarditis or right ventricular infarction.
Q2: During examination of a 61-year-old male with suspected splenomegaly, you
perform percussion using Castell's method. You hear dullness in the lowest intercostal
space in the left anterior axillary line during full expiration that disappears on full
inspiration. What is the correct interpretation?
A. Positive Castell's sign; spleen enlarged and palpable below costal margin
B. Negative Castell's sign; spleen not enlarged
C. False positive due to left pleural effusion
D. Technique error; should percuss in midaxillary line
Correct Answer: B
Rationale: Castell's method for splenic percussion: Dullness in the left anterior axillary
line at full expiration that persists or increases on inspiration is positive (suggests
splenomegaly). Disappearance of dullness on inspiration is negative—the diaphragm
descends, moving the spleen downward away from the percussion site if normal-sized.
This patient has negative Castell's sign, making significant splenomegaly unlikely.
Pleural effusion (C) would cause persistent dullness. Midaxillary line (D) is incorrect
location.
Q3: A 45-year-old female with systemic lupus erythematosus presents with acute
pericarditis. You suspect a pericardial friction rub. Which technique best facilitates
detection of this finding?
A. Auscultation with the bell of the stethoscope at the apex during expiration
,B. Auscultation with the diaphragm at the left lower sternal border during held
inspiration
C. Auscultation with the diaphragm at the left lower sternal border during held expiration
D. Auscultation with the bell at the right upper sternal border during inspiration
Correct Answer: C
Rationale: The pericardial friction rub is a high-pitched, scratchy, triphasic sound (atrial
systole, ventricular systole, ventricular diastole) best heard with the diaphragm
(high-frequency sounds) at the left lower sternal border (Erb's area) during held
expiration (brings heart closer to chest wall, reduces lung interference). The rub is often
transient and positional, requiring patient sitting forward. Bell at apex (A) is for
low-frequency sounds (S3, S4, mitral stenosis). Held inspiration (B) accentuates
right-sided murmurs (Rivero-Carvallo sign). Right upper sternal border (D) is aortic valve
area.
Q4: You are assessing a 68-year-old male for fall risk using the 30-Second Chair Stand
Test. He completes 8 stands in 30 seconds. Which interpretation and recommendation
are most appropriate?
A. Normal lower body strength; no fall risk interventions needed
B. Below expected for age; strengthening exercises and fall risk assessment indicated
C. Severe impairment; immediate assistive device and home health referral
D. Test is invalid; should use TUG test instead for this age group
Correct Answer: B
, Rationale: The 30-Second Chair Stand Test norms: Ages 60-64, average 14-19 stands
for men; ages 65-69, 12-17; ages 70-74, 11-16; ages 75-79, 10-15; ages 80-84, 8-14. 8
stands indicates below-expected performance for any age group ≥60, suggesting lower
extremity weakness and increased fall risk. Recommendation: strengthening exercises
(physical therapy referral) and comprehensive fall risk assessment. Not normal (A) or
severe impairment requiring immediate devices (C). Test is valid for this age (D
incorrect); TUG is complementary, not replacement.
Q5: During musculoskeletal examination of a 28-year-old baseball pitcher with shoulder
pain, you perform the Hawkins-Kennedy test. The patient reports pain with forward
flexion of the shoulder to 90 degrees and forced internal rotation. Which structure is
most likely impinged?
A. Long head of the biceps tendon
B. Superior labrum (SLAP lesion)
C. Supraspinatus tendon in the subacromial space
D. Infraspinatus tendon posteriorly
Correct Answer: C
Rationale: The Hawkins-Kennedy test (90° forward flexion with forced internal rotation)
narrows the subacromial space, compressing the supraspinatus tendon and
subacromial bursa against the coracoacromial ligament and anterior acromion. Pain
indicates subacromial impingement syndrome or rotator cuff tendinopathy. Biceps
tendon (A) is tested with Speed's test or Yergason's test. SLAP lesions (B) with O'Brien's
test or crank test. Infraspinatus (D) with external rotation lag sign or resisted external
rotation.
Actual Final Exam 2026 – Version B |
Comprehensive Review & Verified Guide
Domain 1: Advanced Physical Examination & Techniques (Questions 1-10)
Q1: A 71-year-old female presents with exertional dyspnea and orthopnea. During
cardiac auscultation, you hear a blowing, decrescendo diastolic murmur best heard at
the left sternal border with the patient leaning forward and exhaling. Which peripheral
finding would you most expect?
A. Pulsus alternans with regular rhythm
B. Quincke's pulses (capillary pulsations) and wide pulse pressure
C. Pulsus tardus et parvus with delayed carotid upstroke
D. Kussmaul's sign (paradoxical JVP elevation with inspiration)
Correct Answer: B
Rationale: The presentation is classic for aortic regurgitation—the early diastolic
decrescendo murmur at the left sternal border (Erb's point) accentuated by leaning
forward and exhalation. Chronic severe AR produces wide pulse pressure (systolic
hypertension, diastolic hypotension) with peripheral signs of hyperdynamic circulation:
Quincke's pulses (visible nail bed pulsations), de Musset's sign (head bobbing), and
Corrigan's pulse (water-hammer carotid). Pulsus alternans (A) indicates severe left
,ventricular dysfunction. Pulsus tardus et parvus (C) is aortic stenosis. Kussmaul's sign
(D) is constrictive pericarditis or right ventricular infarction.
Q2: During examination of a 61-year-old male with suspected splenomegaly, you
perform percussion using Castell's method. You hear dullness in the lowest intercostal
space in the left anterior axillary line during full expiration that disappears on full
inspiration. What is the correct interpretation?
A. Positive Castell's sign; spleen enlarged and palpable below costal margin
B. Negative Castell's sign; spleen not enlarged
C. False positive due to left pleural effusion
D. Technique error; should percuss in midaxillary line
Correct Answer: B
Rationale: Castell's method for splenic percussion: Dullness in the left anterior axillary
line at full expiration that persists or increases on inspiration is positive (suggests
splenomegaly). Disappearance of dullness on inspiration is negative—the diaphragm
descends, moving the spleen downward away from the percussion site if normal-sized.
This patient has negative Castell's sign, making significant splenomegaly unlikely.
Pleural effusion (C) would cause persistent dullness. Midaxillary line (D) is incorrect
location.
Q3: A 45-year-old female with systemic lupus erythematosus presents with acute
pericarditis. You suspect a pericardial friction rub. Which technique best facilitates
detection of this finding?
A. Auscultation with the bell of the stethoscope at the apex during expiration
,B. Auscultation with the diaphragm at the left lower sternal border during held
inspiration
C. Auscultation with the diaphragm at the left lower sternal border during held expiration
D. Auscultation with the bell at the right upper sternal border during inspiration
Correct Answer: C
Rationale: The pericardial friction rub is a high-pitched, scratchy, triphasic sound (atrial
systole, ventricular systole, ventricular diastole) best heard with the diaphragm
(high-frequency sounds) at the left lower sternal border (Erb's area) during held
expiration (brings heart closer to chest wall, reduces lung interference). The rub is often
transient and positional, requiring patient sitting forward. Bell at apex (A) is for
low-frequency sounds (S3, S4, mitral stenosis). Held inspiration (B) accentuates
right-sided murmurs (Rivero-Carvallo sign). Right upper sternal border (D) is aortic valve
area.
Q4: You are assessing a 68-year-old male for fall risk using the 30-Second Chair Stand
Test. He completes 8 stands in 30 seconds. Which interpretation and recommendation
are most appropriate?
A. Normal lower body strength; no fall risk interventions needed
B. Below expected for age; strengthening exercises and fall risk assessment indicated
C. Severe impairment; immediate assistive device and home health referral
D. Test is invalid; should use TUG test instead for this age group
Correct Answer: B
, Rationale: The 30-Second Chair Stand Test norms: Ages 60-64, average 14-19 stands
for men; ages 65-69, 12-17; ages 70-74, 11-16; ages 75-79, 10-15; ages 80-84, 8-14. 8
stands indicates below-expected performance for any age group ≥60, suggesting lower
extremity weakness and increased fall risk. Recommendation: strengthening exercises
(physical therapy referral) and comprehensive fall risk assessment. Not normal (A) or
severe impairment requiring immediate devices (C). Test is valid for this age (D
incorrect); TUG is complementary, not replacement.
Q5: During musculoskeletal examination of a 28-year-old baseball pitcher with shoulder
pain, you perform the Hawkins-Kennedy test. The patient reports pain with forward
flexion of the shoulder to 90 degrees and forced internal rotation. Which structure is
most likely impinged?
A. Long head of the biceps tendon
B. Superior labrum (SLAP lesion)
C. Supraspinatus tendon in the subacromial space
D. Infraspinatus tendon posteriorly
Correct Answer: C
Rationale: The Hawkins-Kennedy test (90° forward flexion with forced internal rotation)
narrows the subacromial space, compressing the supraspinatus tendon and
subacromial bursa against the coracoacromial ligament and anterior acromion. Pain
indicates subacromial impingement syndrome or rotator cuff tendinopathy. Biceps
tendon (A) is tested with Speed's test or Yergason's test. SLAP lesions (B) with O'Brien's
test or crank test. Infraspinatus (D) with external rotation lag sign or resisted external
rotation.
