Chamberlain University NR-603 CEA
MIDTERM EXAM: Advanced Clinical
Diagnosis: Advanced Practice Clinical
Assessment | Differential Diagnosis |
Detailed Rationales
Comprehensive 100-Question Test Bank
Latest update. | Advanced Practice | Detailed Rationales
,DOMAIN 1: ADVANCED PHYSICAL ASSESSMENT TECHNIQUES
(Questions 1-15)
Question 1
During a cardiovascular examination, the nurse practitioner auscultates a harsh,
holosystolic murmur at the apex that radiates to the axilla. The murmur does not
change significantly with respiration or position changes. What is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: B
Rationale: A holosystolic murmur at the apex radiating to the axilla is classic
for mitral regurgitation. Aortic stenosis (A) produces a systolic ejection murmur
at the right upper sternal border radiating to the carotids. Mitral stenosis (C)
produces a diastolic murmur. Tricuspid regurgitation (D) murmur increases with
inspiration (Carvallo's sign) .
Question 2
A 55-year-old male presents for a routine physical. On cardiac auscultation, you
,hear a mid-systolic click followed by a late systolic murmur at the apex. What is
the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
D. Mitral regurgitation
Correct Answer: B
Rationale: A mid-systolic click followed by a late systolic murmur is classic
for mitral valve prolapse (MVP) . The click occurs when the valve leaflets prolapse
into the left atrium. The murmur is due to mitral regurgitation that occurs in late
systole. Aortic stenosis (A) presents with a systolic ejection murmur. Hypertrophic
cardiomyopathy (C) murmur increases with Valsalva. Mitral regurgitation (D) is
holosystolic .
Question 3
During a respiratory examination, you note that a patient has a prolonged
expiratory phase and wheezing on auscultation. These findings are most
consistent with:
A. Restrictive lung disease
B. Obstructive lung disease
C. Interstitial lung disease
D. Pleural effusion
Correct Answer: B
, Rationale: A prolonged expiratory phase with wheezing is characteristic
of obstructive lung disease (asthma, COPD). Restrictive lung disease (A) causes
decreased lung volumes with normal expiratory flow rates. Interstitial lung
disease (C) causes crackles. Pleural effusion (D) causes decreased breath sounds
and dullness to percussion .
Question 4
A 65-year-old female presents with a complaint of a "lump" in her right breast. On
examination, you palpate a firm, irregular, non-moveable mass in the upper outer
quadrant. There is no tenderness. What is the most appropriate next step?
A. Reassure the patient that it is likely benign
B. Order a diagnostic mammogram and ultrasound
C. Prescribe antibiotics for possible mastitis
D. Refer for fine-needle aspiration
Correct Answer: B
Rationale: A firm, irregular, non-moveable mass in a postmenopausal woman is
concerning for malignancy. The appropriate next step is diagnostic mammogram
and ultrasound. Reassurance (A) is inappropriate without imaging. Antibiotics (C)
are for mastitis, which presents with tenderness and erythema. Fine-needle
aspiration (D) may follow imaging but is not the first step .
Question 5
During an abdominal examination, you palpate a pulsatile mass in the midline just
above the umbilicus. What is the most appropriate next step?
A. Deep palpation to delineate the borders
B. Auscultation for a bruit
MIDTERM EXAM: Advanced Clinical
Diagnosis: Advanced Practice Clinical
Assessment | Differential Diagnosis |
Detailed Rationales
Comprehensive 100-Question Test Bank
Latest update. | Advanced Practice | Detailed Rationales
,DOMAIN 1: ADVANCED PHYSICAL ASSESSMENT TECHNIQUES
(Questions 1-15)
Question 1
During a cardiovascular examination, the nurse practitioner auscultates a harsh,
holosystolic murmur at the apex that radiates to the axilla. The murmur does not
change significantly with respiration or position changes. What is the most likely
diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: B
Rationale: A holosystolic murmur at the apex radiating to the axilla is classic
for mitral regurgitation. Aortic stenosis (A) produces a systolic ejection murmur
at the right upper sternal border radiating to the carotids. Mitral stenosis (C)
produces a diastolic murmur. Tricuspid regurgitation (D) murmur increases with
inspiration (Carvallo's sign) .
Question 2
A 55-year-old male presents for a routine physical. On cardiac auscultation, you
,hear a mid-systolic click followed by a late systolic murmur at the apex. What is
the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
D. Mitral regurgitation
Correct Answer: B
Rationale: A mid-systolic click followed by a late systolic murmur is classic
for mitral valve prolapse (MVP) . The click occurs when the valve leaflets prolapse
into the left atrium. The murmur is due to mitral regurgitation that occurs in late
systole. Aortic stenosis (A) presents with a systolic ejection murmur. Hypertrophic
cardiomyopathy (C) murmur increases with Valsalva. Mitral regurgitation (D) is
holosystolic .
Question 3
During a respiratory examination, you note that a patient has a prolonged
expiratory phase and wheezing on auscultation. These findings are most
consistent with:
A. Restrictive lung disease
B. Obstructive lung disease
C. Interstitial lung disease
D. Pleural effusion
Correct Answer: B
, Rationale: A prolonged expiratory phase with wheezing is characteristic
of obstructive lung disease (asthma, COPD). Restrictive lung disease (A) causes
decreased lung volumes with normal expiratory flow rates. Interstitial lung
disease (C) causes crackles. Pleural effusion (D) causes decreased breath sounds
and dullness to percussion .
Question 4
A 65-year-old female presents with a complaint of a "lump" in her right breast. On
examination, you palpate a firm, irregular, non-moveable mass in the upper outer
quadrant. There is no tenderness. What is the most appropriate next step?
A. Reassure the patient that it is likely benign
B. Order a diagnostic mammogram and ultrasound
C. Prescribe antibiotics for possible mastitis
D. Refer for fine-needle aspiration
Correct Answer: B
Rationale: A firm, irregular, non-moveable mass in a postmenopausal woman is
concerning for malignancy. The appropriate next step is diagnostic mammogram
and ultrasound. Reassurance (A) is inappropriate without imaging. Antibiotics (C)
are for mastitis, which presents with tenderness and erythema. Fine-needle
aspiration (D) may follow imaging but is not the first step .
Question 5
During an abdominal examination, you palpate a pulsatile mass in the midline just
above the umbilicus. What is the most appropriate next step?
A. Deep palpation to delineate the borders
B. Auscultation for a bruit
