NSG 6020 ADVANCED HEALTH AND PHYSICAL ASSESSMENT
FINAL EXAM –COMPLETE STUDY GUIDE | PRACTICE
QUESTIONS AND ANSWERS-RATIONALES | EXAM PREP |
DOWNLOAD INSTANT PDF | GUARANTEED PASS || LATEST
EXAM 2026-2027
1. A 45-year-old male presents for a routine physical examination. During the
cardiovascular assessment, the advanced practice registered nurse (APRN) auscultates a
high-pitched, blowing decrescendo diastolic murmur heard best at the third left intercostal
space at the sternal border with the patient leaning forward. Which condition is most
strongly associated with this auscultatory finding?
A. Mitral valve stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Aortic regurgitation produces an early high-pitched, blowing decrescendo diastolic murmur
heard best along the left sternal border when the patient is sitting up and leaning forward at
end-expiration. This occurs due to the retrograde flow of blood from the aorta back into the
left ventricle during diastole.
2. A 68-year-old female with a history of long-standing hypertension and type 2 diabetes
mellitus reports intermittent claudication in her right calf when walking two blocks. The
APRN performs an ankle-brachial index (ABI). Which of the following ABI results would
be considered diagnostic for moderate peripheral artery disease (PAD)?
A. 1.25
B. 0.95
C. 0.65
D. 0.35
An ankle-brachial index between 0.50 and 0.70 typically indicates moderate peripheral artery
disease. An ABI of 1.00 to 1.40 is considered normal, 0.91 to 0.99 is borderline, and less than
0.50 indicates severe disease, while values above 1.40 suggest non-compressible, calcified
vessels.
,3. During a comprehensive neurological examination, an APRN strokes the lateral aspect of
the sole of an adult patient's foot from the heel toward the ball and observes dorsiflexion of
the big toe along with fanning of the other toes. How should the clinician document this
abnormal finding?
A. Positive Babinski reflex, indicating upper motor neuron lesion
B. Negative Chaddock reflex, indicating lower motor neuron disease
C. Normal plantar response, indicating intact corticospinal tracts
D. Positive Oppenheim reflex, indicating cerebellar dysfunction
A positive Babinski reflex in an adult is characterized by great toe dorsiflexion and toe
fanning in response to plantar stimulation, indicating damage or pathology along the
pyramidal or corticospinal tract (upper motor neuron lesion).
4. A 55-year-old male presents with acute, severe right flank pain radiating to the groin,
accompanied by nausea and microscopic hematuria. To assess for renal inflammation or
perinephric irritation during the physical examination, which specialized maneuver should
the APRN perform?
A. Palpation of McBurney's point
B. Indirect percussion over the costovertebral angle
C. Deep bimanual palpation of the left upper quadrant
D. Assessment of the psoas sign
Costovertebral angle (CVA) tenderness is elicited by indirect percussion over the CVA (formed
by the 12th rib and spine) and is a hallmark sign of pyelonephritis, nephrolithiasis, or
perinephric abscess.
5. An APRN is evaluating a 30-year-old female complaining of palpitations and fatigue. On
auscultation, the clinician hears a midsystolic click followed by a late systolic murmur
heard best at the apex. This finding is characteristic of which structural heart disorder?
A. Aortic stenosis
B. Mitral valve prolapse
C. Ventricular septal defect
D. Mitral annular calcification
, Mitral valve prolapse classically presents with a midsystolic click followed by a late systolic
murmur due to delayed or redundant closure of the mitral valve leaflets into the left atrium
during ventricular systole.
6. A 62-year-old male with a 40 pack-year smoking history presents with a chronic cough
and dyspnea. Physical examination reveals an increased anteroposterior chest diameter,
decreased tactile fremitus, hyperresonance to percussion, and distant breath sounds. These
findings are most consistent with which pulmonary condition?
A. Lobar pneumonia
B. Pleural effusion
C. Emphysema
D. Pulmonary fibrosis
Emphysema, a form of chronic obstructive pulmonary disease, results in hyperinflation and
loss of lung elasticity, manifesting as an increased AP diameter (barrel chest), decreased
tactile fremitus, hyperresonance, and diminished breath sounds.
7. A 24-year-old female presents with acute right lower quadrant abdominal pain, low-
grade fever, and nausea. The APRN tests for appendicitis by passively extending the
patient's right thigh while she lies on her left side, eliciting right lower quadrant pain.
What is the name of this diagnostic sign?
A. Rovsing's sign
B. Psoas sign
C. Obturator sign
D. Blumberg's sign
The psoas sign is elicited by passive hyperextension of the right hip, which stretches the psoas
muscle against an inflamed appendix positioned retrocaecally, causing localized abdominal
pain.
8. During an eye examination using an ophthalmoscope, the APRN visualizes sharp disc
margins, a normal cup-to-disc ratio of 0.3, and prominent, branching retinal vessels
without hemorrhages or exudates. How should the clinician document this finding?
A. Normal optic fundus
B. Early papilledema
FINAL EXAM –COMPLETE STUDY GUIDE | PRACTICE
QUESTIONS AND ANSWERS-RATIONALES | EXAM PREP |
DOWNLOAD INSTANT PDF | GUARANTEED PASS || LATEST
EXAM 2026-2027
1. A 45-year-old male presents for a routine physical examination. During the
cardiovascular assessment, the advanced practice registered nurse (APRN) auscultates a
high-pitched, blowing decrescendo diastolic murmur heard best at the third left intercostal
space at the sternal border with the patient leaning forward. Which condition is most
strongly associated with this auscultatory finding?
A. Mitral valve stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Aortic regurgitation produces an early high-pitched, blowing decrescendo diastolic murmur
heard best along the left sternal border when the patient is sitting up and leaning forward at
end-expiration. This occurs due to the retrograde flow of blood from the aorta back into the
left ventricle during diastole.
2. A 68-year-old female with a history of long-standing hypertension and type 2 diabetes
mellitus reports intermittent claudication in her right calf when walking two blocks. The
APRN performs an ankle-brachial index (ABI). Which of the following ABI results would
be considered diagnostic for moderate peripheral artery disease (PAD)?
A. 1.25
B. 0.95
C. 0.65
D. 0.35
An ankle-brachial index between 0.50 and 0.70 typically indicates moderate peripheral artery
disease. An ABI of 1.00 to 1.40 is considered normal, 0.91 to 0.99 is borderline, and less than
0.50 indicates severe disease, while values above 1.40 suggest non-compressible, calcified
vessels.
,3. During a comprehensive neurological examination, an APRN strokes the lateral aspect of
the sole of an adult patient's foot from the heel toward the ball and observes dorsiflexion of
the big toe along with fanning of the other toes. How should the clinician document this
abnormal finding?
A. Positive Babinski reflex, indicating upper motor neuron lesion
B. Negative Chaddock reflex, indicating lower motor neuron disease
C. Normal plantar response, indicating intact corticospinal tracts
D. Positive Oppenheim reflex, indicating cerebellar dysfunction
A positive Babinski reflex in an adult is characterized by great toe dorsiflexion and toe
fanning in response to plantar stimulation, indicating damage or pathology along the
pyramidal or corticospinal tract (upper motor neuron lesion).
4. A 55-year-old male presents with acute, severe right flank pain radiating to the groin,
accompanied by nausea and microscopic hematuria. To assess for renal inflammation or
perinephric irritation during the physical examination, which specialized maneuver should
the APRN perform?
A. Palpation of McBurney's point
B. Indirect percussion over the costovertebral angle
C. Deep bimanual palpation of the left upper quadrant
D. Assessment of the psoas sign
Costovertebral angle (CVA) tenderness is elicited by indirect percussion over the CVA (formed
by the 12th rib and spine) and is a hallmark sign of pyelonephritis, nephrolithiasis, or
perinephric abscess.
5. An APRN is evaluating a 30-year-old female complaining of palpitations and fatigue. On
auscultation, the clinician hears a midsystolic click followed by a late systolic murmur
heard best at the apex. This finding is characteristic of which structural heart disorder?
A. Aortic stenosis
B. Mitral valve prolapse
C. Ventricular septal defect
D. Mitral annular calcification
, Mitral valve prolapse classically presents with a midsystolic click followed by a late systolic
murmur due to delayed or redundant closure of the mitral valve leaflets into the left atrium
during ventricular systole.
6. A 62-year-old male with a 40 pack-year smoking history presents with a chronic cough
and dyspnea. Physical examination reveals an increased anteroposterior chest diameter,
decreased tactile fremitus, hyperresonance to percussion, and distant breath sounds. These
findings are most consistent with which pulmonary condition?
A. Lobar pneumonia
B. Pleural effusion
C. Emphysema
D. Pulmonary fibrosis
Emphysema, a form of chronic obstructive pulmonary disease, results in hyperinflation and
loss of lung elasticity, manifesting as an increased AP diameter (barrel chest), decreased
tactile fremitus, hyperresonance, and diminished breath sounds.
7. A 24-year-old female presents with acute right lower quadrant abdominal pain, low-
grade fever, and nausea. The APRN tests for appendicitis by passively extending the
patient's right thigh while she lies on her left side, eliciting right lower quadrant pain.
What is the name of this diagnostic sign?
A. Rovsing's sign
B. Psoas sign
C. Obturator sign
D. Blumberg's sign
The psoas sign is elicited by passive hyperextension of the right hip, which stretches the psoas
muscle against an inflamed appendix positioned retrocaecally, causing localized abdominal
pain.
8. During an eye examination using an ophthalmoscope, the APRN visualizes sharp disc
margins, a normal cup-to-disc ratio of 0.3, and prominent, branching retinal vessels
without hemorrhages or exudates. How should the clinician document this finding?
A. Normal optic fundus
B. Early papilledema
