NUR 6111 – Exam 3 (Advanced Practice Nursing I) 2026 – William
Peterson University
1. A 45-year-old female presents with acute right upper quadrant pain radiating
to the right shoulder. Which physical exam finding is most suggestive of acute
cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. Murphy’s sign
D. McBurney’s point tenderness
Answer: C
Rationale: Murphy’s sign is highly specific for gallbladder inflammation; it occurs when
the patient halts inspiration during deep palpation of the right upper quadrant.
2. Which organism is the most common cause of Peptic Ulcer Disease (PUD)?
A. Helicobacter pylori
B. Staphylococcus aureus
C. Escherichia coli
D. Clostridium difficile
Answer: A
Rationale: Helicobacter pylori is the most frequent cause of peptic ulcers worldwide,
requiring antibiotic eradication.
,3. What is the first-line medication class for a patient diagnosed with mild
Gastroesophageal Reflux Disease (GERD) who has not responded to lifestyle
modifications?
A. H2-receptor antagonists
B. Proton Pump Inhibitors (PPIs)
C. Antacids
D. Prokinetic agents
Answer: A
Rationale: For mild, intermittent GERD symptoms, H2-receptor antagonists are usually the
first pharmacologic step after lifestyle changes.
4. A positive Psoas sign is indicative of irritation to the psoas muscle, which is
commonly associated with which condition?
A. Cholecystitis
B. Diverticulitis
C. Pancreatitis
D. Appendicitis
Answer: D
Rationale: The psoas sign is a physical exam maneuver used to detect appendicitis,
indicating inflammation in the retrocecal area.
5. Which laboratory value is the most sensitive indicator for diagnosing Chronic
Kidney Disease (CKD) progression?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Answer: C
, Rationale: GFR is the gold standard for staging CKD and assessing the overall functional
capacity of the kidneys.
6. An elderly patient presents with fatigue and a Mean Corpuscular Volume
(MCV) of 110 fL. Which deficiency should the nurse practitioner suspect first?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Thalassemia
D. Anemia of chronic disease
Answer: B
Rationale: An MCV greater than 100 fL indicates macrocytic anemia, which is most
commonly caused by Vitamin B12 or folate deficiency.
7. Heberden’s nodes are characteristic physical exam findings in which of the
following conditions?
A. Rheumatoid Arthritis
B. Osteoarthritis
C. Gouty Arthritis
D. Septic Arthritis
Answer: B
Rationale: Heberden’s nodes are bony enlargements of the distal interphalangeal (DIP)
joints, classic for Osteoarthritis.
8. What is the primary screening test for Syphilis?
A. FTA-ABS
B. RPR (Rapid Plasma Reagin)
C. TPPA
D. PCR
Answer: B
Peterson University
1. A 45-year-old female presents with acute right upper quadrant pain radiating
to the right shoulder. Which physical exam finding is most suggestive of acute
cholecystitis?
A. Rovsing’s sign
B. Psoas sign
C. Murphy’s sign
D. McBurney’s point tenderness
Answer: C
Rationale: Murphy’s sign is highly specific for gallbladder inflammation; it occurs when
the patient halts inspiration during deep palpation of the right upper quadrant.
2. Which organism is the most common cause of Peptic Ulcer Disease (PUD)?
A. Helicobacter pylori
B. Staphylococcus aureus
C. Escherichia coli
D. Clostridium difficile
Answer: A
Rationale: Helicobacter pylori is the most frequent cause of peptic ulcers worldwide,
requiring antibiotic eradication.
,3. What is the first-line medication class for a patient diagnosed with mild
Gastroesophageal Reflux Disease (GERD) who has not responded to lifestyle
modifications?
A. H2-receptor antagonists
B. Proton Pump Inhibitors (PPIs)
C. Antacids
D. Prokinetic agents
Answer: A
Rationale: For mild, intermittent GERD symptoms, H2-receptor antagonists are usually the
first pharmacologic step after lifestyle changes.
4. A positive Psoas sign is indicative of irritation to the psoas muscle, which is
commonly associated with which condition?
A. Cholecystitis
B. Diverticulitis
C. Pancreatitis
D. Appendicitis
Answer: D
Rationale: The psoas sign is a physical exam maneuver used to detect appendicitis,
indicating inflammation in the retrocecal area.
5. Which laboratory value is the most sensitive indicator for diagnosing Chronic
Kidney Disease (CKD) progression?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Answer: C
, Rationale: GFR is the gold standard for staging CKD and assessing the overall functional
capacity of the kidneys.
6. An elderly patient presents with fatigue and a Mean Corpuscular Volume
(MCV) of 110 fL. Which deficiency should the nurse practitioner suspect first?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Thalassemia
D. Anemia of chronic disease
Answer: B
Rationale: An MCV greater than 100 fL indicates macrocytic anemia, which is most
commonly caused by Vitamin B12 or folate deficiency.
7. Heberden’s nodes are characteristic physical exam findings in which of the
following conditions?
A. Rheumatoid Arthritis
B. Osteoarthritis
C. Gouty Arthritis
D. Septic Arthritis
Answer: B
Rationale: Heberden’s nodes are bony enlargements of the distal interphalangeal (DIP)
joints, classic for Osteoarthritis.
8. What is the primary screening test for Syphilis?
A. FTA-ABS
B. RPR (Rapid Plasma Reagin)
C. TPPA
D. PCR
Answer: B
