NR 601
Final Exam
Test Bank
2026 – 2027 Edition
300 Questions with Rationales & Answer Key
Prepared for NP Students | Six Sections | Multiple Choice
, SECTION 1: Advanced Health Assessment
Q1. During cardiac auscultation of a 68-year-old patient, the nurse practitioner hears an S4 gallop.
This finding is most consistent with:
A. Acute mitral regurgitation
B. Left ventricular hypertrophy
C. Acute pericarditis
D. Papillary muscle rupture
Rationale: An S4 gallop (atrial gallop) occurs when noncompliant ventricles resist rapid filling during atrial contraction.
It is commonly associated with left ventricular hypertrophy, hypertension, aortic stenosis, and other conditions causing
a stiff ventricle.
Q2. A 45-year-old patient presents with a unilateral, throbbing headache accompanied by nausea
and photophobia. Which finding on physical examination is most consistent with migraine headache?
A. Ipsilateral ptosis and miosis
B. Unilateral carotid bruit
C. Nuchal rigidity
D. Temporomandibular joint crepitus
Rationale: Migraine headaches may present with autonomic features including ipsilateral ptosis and miosis
(Horner-like syndrome) during the attack. Nuchal rigidity suggests meningitis, TMJ crepitus suggests
temporomandibular disorder, and carotid bruit suggests vascular disease.
Q3. When performing a heel-to-shin test, the patient misses the shin and performs the movement
inaccurately. This finding indicates a problem with:
A. Proprioception
B. Corticospinal tract integrity
C. Cerebellar function
D. Dorsal column integrity
Rationale: The heel-to-shin test assesses cerebellar function and coordination. Inability to perform this smoothly
(dysmetria) indicates cerebellar ataxia. Proprioception and dorsal column integrity are tested by joint position sense,
while corticospinal tract integrity is tested by motor strength and reflexes.
Q4. On fundoscopic examination, the nurse practitioner notes cotton-wool spots, flame-shaped
hemorrhages, and hard exudates. These findings are most characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Papilledema
D. Retinal detachment
, Rationale: Hypertensive retinopathy is characterized by arteriolar narrowing, AV nicking, cotton-wool spots,
flame-shaped hemorrhages, and hard exudates. Diabetic retinopathy features microaneurysms, dot-blot hemorrhages,
and neovascularization.
Q5. A patient presents with painless vision loss described as a 'curtain coming down' over one eye.
Which diagnosis should be suspected first?
A. Optic neuritis
B. Retinal detachment
C. Age-related macular degeneration
D. Open-angle glaucoma
Rationale: The classic description of a 'curtain or veil' coming down over the visual field is pathognomonic for retinal
detachment. This is an ophthalmologic emergency requiring urgent referral.
Q6. During abdominal examination, the nurse practitioner palpates a pulsatile midline mass. The
most appropriate next step is:
A. Immediate surgical consultation
B. Abdominal ultrasound
C. CT angiography
D. Observation and re-examination in 6 months
Rationale: A pulsatile midline abdominal mass in an adult raises concern for abdominal aortic aneurysm (AAA). CT
angiography is the gold standard for confirming the diagnosis, assessing size, and planning intervention.
Q7. Which physical exam maneuver is most specific for diagnosing carpal tunnel syndrome?
A. Tinel sign
B. Phalen maneuver
C. Finkelstein test
D. Allen test
Rationale: The Phalen maneuver (forced wrist flexion for 60 seconds) is highly specific for carpal tunnel syndrome
when it reproduces symptoms. Tinel sign is sensitive but less specific. Finkelstein test diagnoses de Quervain's
tenosynovitis, and Allen test assesses arterial supply to the hand.
Q8. A patient has a positive straight leg raise test at 30 degrees. This finding is most indicative of:
A. Lumbar spinal stenosis
B. L4-L5 disc herniation
C. Piriformis syndrome
D. Sacroiliac joint dysfunction
Rationale: The straight leg raise (Lasegue) test is positive when radicular pain is reproduced below the knee between
30-70 degrees of leg elevation. It is most sensitive for L4-L5 and L5-S1 disc herniations causing nerve root
compression.
, Q9. During thyroid examination, the nurse practitioner notes a bruit over the gland. This finding
suggests:
A. Hashimoto thyroiditis
B. Thyroid malignancy
C. Graves disease
D. Colloid goiter
Rationale: A thyroid bruit indicates increased vascularity and is characteristic of Graves disease (diffuse toxic goiter).
It is not typically seen in Hashimoto's, malignancy, or colloid goiter.
Q10. On cardiac auscultation, a harsh crescendo-decrescendo systolic murmur is heard best at the
right upper sternal border with radiation to the carotids. This is most consistent with:
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral valve prolapse
D. Hypertrophic cardiomyopathy
Rationale: A harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids
is the classic presentation of aortic stenosis. Mitral regurgitation radiates to the axilla, and HCM has a harsh systolic
murmur that increases with Valsalva.
Q11. The whispered voice test is used to assess:
A. Air conduction hearing
B. Bone conduction hearing
C. Speech discrimination
D. High-frequency hearing loss
Rationale: The whispered voice test is a simple screening tool for air conduction hearing. The examiner whispers
combinations of letters and numbers at a standardized distance to assess the patient's ability to hear and repeat them.
Q12. A patient exhibits a positive Romberg test. This indicates a deficit in:
A. Cerebellar function
B. Proprioception
C. Vestibular function
D. Motor strength
Rationale: The Romberg test assesses proprioception (dorsal column function). A positive test (increased sway with
eyes closed) indicates sensory ataxia due to loss of position sense, with cerebellar function being normal.
Q13. During pulmonary examination, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Pleural effusion
Final Exam
Test Bank
2026 – 2027 Edition
300 Questions with Rationales & Answer Key
Prepared for NP Students | Six Sections | Multiple Choice
, SECTION 1: Advanced Health Assessment
Q1. During cardiac auscultation of a 68-year-old patient, the nurse practitioner hears an S4 gallop.
This finding is most consistent with:
A. Acute mitral regurgitation
B. Left ventricular hypertrophy
C. Acute pericarditis
D. Papillary muscle rupture
Rationale: An S4 gallop (atrial gallop) occurs when noncompliant ventricles resist rapid filling during atrial contraction.
It is commonly associated with left ventricular hypertrophy, hypertension, aortic stenosis, and other conditions causing
a stiff ventricle.
Q2. A 45-year-old patient presents with a unilateral, throbbing headache accompanied by nausea
and photophobia. Which finding on physical examination is most consistent with migraine headache?
A. Ipsilateral ptosis and miosis
B. Unilateral carotid bruit
C. Nuchal rigidity
D. Temporomandibular joint crepitus
Rationale: Migraine headaches may present with autonomic features including ipsilateral ptosis and miosis
(Horner-like syndrome) during the attack. Nuchal rigidity suggests meningitis, TMJ crepitus suggests
temporomandibular disorder, and carotid bruit suggests vascular disease.
Q3. When performing a heel-to-shin test, the patient misses the shin and performs the movement
inaccurately. This finding indicates a problem with:
A. Proprioception
B. Corticospinal tract integrity
C. Cerebellar function
D. Dorsal column integrity
Rationale: The heel-to-shin test assesses cerebellar function and coordination. Inability to perform this smoothly
(dysmetria) indicates cerebellar ataxia. Proprioception and dorsal column integrity are tested by joint position sense,
while corticospinal tract integrity is tested by motor strength and reflexes.
Q4. On fundoscopic examination, the nurse practitioner notes cotton-wool spots, flame-shaped
hemorrhages, and hard exudates. These findings are most characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Papilledema
D. Retinal detachment
, Rationale: Hypertensive retinopathy is characterized by arteriolar narrowing, AV nicking, cotton-wool spots,
flame-shaped hemorrhages, and hard exudates. Diabetic retinopathy features microaneurysms, dot-blot hemorrhages,
and neovascularization.
Q5. A patient presents with painless vision loss described as a 'curtain coming down' over one eye.
Which diagnosis should be suspected first?
A. Optic neuritis
B. Retinal detachment
C. Age-related macular degeneration
D. Open-angle glaucoma
Rationale: The classic description of a 'curtain or veil' coming down over the visual field is pathognomonic for retinal
detachment. This is an ophthalmologic emergency requiring urgent referral.
Q6. During abdominal examination, the nurse practitioner palpates a pulsatile midline mass. The
most appropriate next step is:
A. Immediate surgical consultation
B. Abdominal ultrasound
C. CT angiography
D. Observation and re-examination in 6 months
Rationale: A pulsatile midline abdominal mass in an adult raises concern for abdominal aortic aneurysm (AAA). CT
angiography is the gold standard for confirming the diagnosis, assessing size, and planning intervention.
Q7. Which physical exam maneuver is most specific for diagnosing carpal tunnel syndrome?
A. Tinel sign
B. Phalen maneuver
C. Finkelstein test
D. Allen test
Rationale: The Phalen maneuver (forced wrist flexion for 60 seconds) is highly specific for carpal tunnel syndrome
when it reproduces symptoms. Tinel sign is sensitive but less specific. Finkelstein test diagnoses de Quervain's
tenosynovitis, and Allen test assesses arterial supply to the hand.
Q8. A patient has a positive straight leg raise test at 30 degrees. This finding is most indicative of:
A. Lumbar spinal stenosis
B. L4-L5 disc herniation
C. Piriformis syndrome
D. Sacroiliac joint dysfunction
Rationale: The straight leg raise (Lasegue) test is positive when radicular pain is reproduced below the knee between
30-70 degrees of leg elevation. It is most sensitive for L4-L5 and L5-S1 disc herniations causing nerve root
compression.
, Q9. During thyroid examination, the nurse practitioner notes a bruit over the gland. This finding
suggests:
A. Hashimoto thyroiditis
B. Thyroid malignancy
C. Graves disease
D. Colloid goiter
Rationale: A thyroid bruit indicates increased vascularity and is characteristic of Graves disease (diffuse toxic goiter).
It is not typically seen in Hashimoto's, malignancy, or colloid goiter.
Q10. On cardiac auscultation, a harsh crescendo-decrescendo systolic murmur is heard best at the
right upper sternal border with radiation to the carotids. This is most consistent with:
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral valve prolapse
D. Hypertrophic cardiomyopathy
Rationale: A harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids
is the classic presentation of aortic stenosis. Mitral regurgitation radiates to the axilla, and HCM has a harsh systolic
murmur that increases with Valsalva.
Q11. The whispered voice test is used to assess:
A. Air conduction hearing
B. Bone conduction hearing
C. Speech discrimination
D. High-frequency hearing loss
Rationale: The whispered voice test is a simple screening tool for air conduction hearing. The examiner whispers
combinations of letters and numbers at a standardized distance to assess the patient's ability to hear and repeat them.
Q12. A patient exhibits a positive Romberg test. This indicates a deficit in:
A. Cerebellar function
B. Proprioception
C. Vestibular function
D. Motor strength
Rationale: The Romberg test assesses proprioception (dorsal column function). A positive test (increased sway with
eyes closed) indicates sensory ataxia due to loss of position sense, with cerebellar function being normal.
Q13. During pulmonary examination, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Pleural effusion
