NSG-500: Final Exam Advanced Health Assessment
QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED.pdf
Question 1: When assessing a patient's voice quality while you are auscultating the lung
field you note the voice sound is intensified, there is a nasal quality to the voice and e’s
sound like a’s. This sound described is called:
Correct Answer: D) Egophony
Rationale: Egophony occurs when spoken "ee" sounds like "ay" with a
nasal/bleating quality through the stethoscope due to increased sound transmission
through consolidated lung tissue (e.g., pneumonia).
Question 2: You observe that a patient’s tonsils are enlarged and they nearly touch the
uvula. You would document this as:
Correct Answer: C) 3+
Rationale: Tonsillar grading scale: 1+ (visible), 2+ (halfway between tonsillar pillars
and uvula), 3+ (touching/nearly touching the uvula), 4+ (touching each other at the
midline / "kissing tonsils").
Question 3: Which of the following is used to test near vision?
Correct Answer: A) Rosenbaum chart
Rationale: The Rosenbaum card (or Jaeger card) tests near visual acuity at a
distance of 14 inches. Snellen tests distance vision, confrontation tests peripheral
visual fields, and cover-uncover tests for strabismus/ocular alignment.
Question 4: Peritonitis often produces bowel sounds that are:
Correct Answer: D) Absent
Rationale: Peritoneal inflammation causes reflex paralytic ileus, resulting in
hypoactive or completely absent bowel sounds (must listen for 5 full minutes to
confirm absent bowel sounds).
Question 5: Which of the following reflect current screening recommendations for breast
cancer?
, Correct Answer: B) The American Cancer Society recommends starting annual
mammography screening by age 45.
Rationale: ACS guidelines recommend average-risk women begin annual screening
mammograms at age 45 (with the option to start at 40), transitioning to biennial
screening at age 55 (or continuing annually).
Question 6: In the older adult, which finding can occur in the absence of disease as a result
of age-related changes of the chest or lungs?
Correct Answer: A) Decreased diaphragmatic excursion
Rationale: Age-related calcification of costal cartilages, loss of elastic recoil, and
diaphragm flattening lead to decreased diaphragmatic excursion in healthy older
adults. Productive cough, asymmetric expansion, and infiltrates are always
abnormal.
Question 7: Which of the following is a risk factor for testicular cancer?
Correct Answer: C) Cryptorchidism
Rationale: An undescended testicle (cryptorchidism) is the single most significant
risk factor for testicular germ cell tumors.
Question 8: To distinguish crackles from rhonchi, you should auscultate the lungs:
Correct Answer: A) Before and after the patient coughs
Rationale: Rhonchi are low-pitched adventitious sounds caused by secretions in
large airways that frequently clear or change with coughing, whereas crackles
(alveolar/small airway process) do not clear with coughing.
Question 9: To evaluate for the presence of ascites, the APRN should:
Correct Answer: B) Percuss for shifting dullness.
Rationale: Physical exam techniques to confirm free fluid/ascites in the peritoneal
cavity include percussing for shifting dullness and testing for a fluid wave. Murphy
test assesses cholecystitis; iliopsoas test assesses appendicitis.
10. A positive Murphy’s sign upon deep palpation of the right upper quadrant during
deep inspiration indicates:
A) Acute appendicitis
B) Acute cholecystitis
,C) Acute pancreatitis
D) Acute pyelonephritis
Answer: B
Rationale: Abrupt cessation of inspiration due to pain when the inflamed gallbladder
descends against the examiner's palmar fingers is a positive Murphy sign.
11. Pain experienced in the right lower quadrant when palpating the left lower
quadrant is known as:
A) McBurney's sign
B) Rovsing's sign
C) Psoas sign
D) Obturator sign
Answer: B
Rationale: Rovsing’s sign is referred rebound tenderness in the RLQ elicited by
deep palpation in the LLQ, indicating peritoneal irritation in acute appendicitis.
12. Extension of the right hip causing pain in the right lower quadrant is a positive:
A) Psoas sign
B) Obturator sign
C) Chvostek sign
D) Kernig sign
Answer: A
Rationale: The psoas sign stretches the retrocecal iliopsoas muscle; pain indicates
an inflamed appendix overlying the muscle.
13. Internal rotation of the flexed right hip producing RLQ abdominal pain is known
as the:
A) Psoas sign
, B) Obturator sign
C) Cullen sign
D) Grey Turner sign
Answer: B
Rationale: Internal rotation of the flexed hip stretches the obturator internus muscle,
irritating a pelvically located inflamed appendix.
14. Bluish discoloration around the umbilicus (Cullen’s sign) is a clinical indicator of:
A) Acute cholecystitis
B) Retroperitoneal hemorrhage or acute hemorrhagic pancreatitis
C) Splenic rupture
D) Intestinal obstruction
Answer: B
Rationale: Cullen’s sign (periumbilical ecchymosis) indicates intraperitoneal or
retroperitoneal bleeding, classic for severe hemorrhagic pancreatitis or ruptured
ectopic pregnancy.
15. Ecchymosis localized to the patient's flanks is termed:
A) Cullen's sign
B) Grey Turner's sign
C) Kehr's sign
D) Trousseau's sign
Answer: B
Rationale: Grey Turner’s sign is flank ecchymosis resulting from retroperitoneal
blood extravasation.
16. Pain in the left shoulder radiating from the abdomen due to splenic rupture or
irritation of the diaphragm is called:
QUESTIONS AND DETAILED SOLUTIONS JUST
RELEASED.pdf
Question 1: When assessing a patient's voice quality while you are auscultating the lung
field you note the voice sound is intensified, there is a nasal quality to the voice and e’s
sound like a’s. This sound described is called:
Correct Answer: D) Egophony
Rationale: Egophony occurs when spoken "ee" sounds like "ay" with a
nasal/bleating quality through the stethoscope due to increased sound transmission
through consolidated lung tissue (e.g., pneumonia).
Question 2: You observe that a patient’s tonsils are enlarged and they nearly touch the
uvula. You would document this as:
Correct Answer: C) 3+
Rationale: Tonsillar grading scale: 1+ (visible), 2+ (halfway between tonsillar pillars
and uvula), 3+ (touching/nearly touching the uvula), 4+ (touching each other at the
midline / "kissing tonsils").
Question 3: Which of the following is used to test near vision?
Correct Answer: A) Rosenbaum chart
Rationale: The Rosenbaum card (or Jaeger card) tests near visual acuity at a
distance of 14 inches. Snellen tests distance vision, confrontation tests peripheral
visual fields, and cover-uncover tests for strabismus/ocular alignment.
Question 4: Peritonitis often produces bowel sounds that are:
Correct Answer: D) Absent
Rationale: Peritoneal inflammation causes reflex paralytic ileus, resulting in
hypoactive or completely absent bowel sounds (must listen for 5 full minutes to
confirm absent bowel sounds).
Question 5: Which of the following reflect current screening recommendations for breast
cancer?
, Correct Answer: B) The American Cancer Society recommends starting annual
mammography screening by age 45.
Rationale: ACS guidelines recommend average-risk women begin annual screening
mammograms at age 45 (with the option to start at 40), transitioning to biennial
screening at age 55 (or continuing annually).
Question 6: In the older adult, which finding can occur in the absence of disease as a result
of age-related changes of the chest or lungs?
Correct Answer: A) Decreased diaphragmatic excursion
Rationale: Age-related calcification of costal cartilages, loss of elastic recoil, and
diaphragm flattening lead to decreased diaphragmatic excursion in healthy older
adults. Productive cough, asymmetric expansion, and infiltrates are always
abnormal.
Question 7: Which of the following is a risk factor for testicular cancer?
Correct Answer: C) Cryptorchidism
Rationale: An undescended testicle (cryptorchidism) is the single most significant
risk factor for testicular germ cell tumors.
Question 8: To distinguish crackles from rhonchi, you should auscultate the lungs:
Correct Answer: A) Before and after the patient coughs
Rationale: Rhonchi are low-pitched adventitious sounds caused by secretions in
large airways that frequently clear or change with coughing, whereas crackles
(alveolar/small airway process) do not clear with coughing.
Question 9: To evaluate for the presence of ascites, the APRN should:
Correct Answer: B) Percuss for shifting dullness.
Rationale: Physical exam techniques to confirm free fluid/ascites in the peritoneal
cavity include percussing for shifting dullness and testing for a fluid wave. Murphy
test assesses cholecystitis; iliopsoas test assesses appendicitis.
10. A positive Murphy’s sign upon deep palpation of the right upper quadrant during
deep inspiration indicates:
A) Acute appendicitis
B) Acute cholecystitis
,C) Acute pancreatitis
D) Acute pyelonephritis
Answer: B
Rationale: Abrupt cessation of inspiration due to pain when the inflamed gallbladder
descends against the examiner's palmar fingers is a positive Murphy sign.
11. Pain experienced in the right lower quadrant when palpating the left lower
quadrant is known as:
A) McBurney's sign
B) Rovsing's sign
C) Psoas sign
D) Obturator sign
Answer: B
Rationale: Rovsing’s sign is referred rebound tenderness in the RLQ elicited by
deep palpation in the LLQ, indicating peritoneal irritation in acute appendicitis.
12. Extension of the right hip causing pain in the right lower quadrant is a positive:
A) Psoas sign
B) Obturator sign
C) Chvostek sign
D) Kernig sign
Answer: A
Rationale: The psoas sign stretches the retrocecal iliopsoas muscle; pain indicates
an inflamed appendix overlying the muscle.
13. Internal rotation of the flexed right hip producing RLQ abdominal pain is known
as the:
A) Psoas sign
, B) Obturator sign
C) Cullen sign
D) Grey Turner sign
Answer: B
Rationale: Internal rotation of the flexed hip stretches the obturator internus muscle,
irritating a pelvically located inflamed appendix.
14. Bluish discoloration around the umbilicus (Cullen’s sign) is a clinical indicator of:
A) Acute cholecystitis
B) Retroperitoneal hemorrhage or acute hemorrhagic pancreatitis
C) Splenic rupture
D) Intestinal obstruction
Answer: B
Rationale: Cullen’s sign (periumbilical ecchymosis) indicates intraperitoneal or
retroperitoneal bleeding, classic for severe hemorrhagic pancreatitis or ruptured
ectopic pregnancy.
15. Ecchymosis localized to the patient's flanks is termed:
A) Cullen's sign
B) Grey Turner's sign
C) Kehr's sign
D) Trousseau's sign
Answer: B
Rationale: Grey Turner’s sign is flank ecchymosis resulting from retroperitoneal
blood extravasation.
16. Pain in the left shoulder radiating from the abdomen due to splenic rupture or
irritation of the diaphragm is called:
