NU 673 Midterm Exam Question and
Answer (2026) A+ Verified Real Exam
Prep
• A pt presents to the clinic with severe right sided abdominal pain for 12 hours. He
began having a "stomach ache" yesterday, with decreased appetite, but today the pain
seems to be just on the lower right side. He has had some nausea & vomiting, but no
constipation or diarrhea. His last BM was last night and was normal. He has had no
fever or chills. He denies any recent illness or injuries. His PMH is unremarkable. He
denies any tobacco or drug use and drinks 4-6 beers/week. on exam, he appears ill and
is lying on his right side. His temp is 100.4 F and HR is 110. His bowel sounds are
decreased and he has rebound pain and guarding one third of the way between anterior
superior iliac spine and the umbilicus in the right lower quadrant. What is the most likely
cause of his pain?
A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis -✓✓A. Acute appendicitis
• An APRN notes a 12 mm Hg difference in systolic BP during inspiration. How should
the APRN document this finding?
A. Acute stenosis
B. Carotid arterial disease
C. Paradoxical pulse
D. Pulsus alternans -✓✓C. Paradoxical pulse
• Which of the following percussion notes is obtained over a gastric bubble?
A. Flatness
B. Hyperresonance
C. Tympany
D. Resonance -✓✓C. Tympany
• The APRN is performing a cardiac exam on a pt with SOB and palpitations. She
listens to the heart with the pt sitting upright, then has the pt change to a supine
position, and finally she has the pt turn onto the left side in the left lateral decubitus
position. Which of the following valvular defects is best heard in this position?
A. Mitral
B. Aortic
C. Tricuspid
, D. Pulmonic -✓✓A. Mitral
• A 20 year old male has a history of leukemia and an enlarged spleen. Today he
presents with a fairly significant left upper quadrant pain. On exam of the area a rough
grating noise is heard. What is this sound known as?
A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular noise
D. It represents borborygmi -✓✓B. It is a splenic rub
• An elderly pt with a history of smoking 2 packs/day for 50 years reports to the APRN
prolonged shortness of breath. On cardiac exam, the APRN feels the most prominent
palpable impulse to be in the xiphoid area. This is most likely a result of what condition?
A. COPD
B. Aortic stenosis
C. Mitral regurgitation
D. Pulmonary hypertension -✓✓D. Pulmonary hypertension
• A pt reports "chest pain" during a visit to the APRN. The pt describes it as "severe"
and "sharp" and worse when taking a deep breath. PMH is unremarkable and there is
no history of tobacco use. VS are normal. Pt appears comfortable. Cardiac and
respiratory exam are unremarkable. What is the most likely diagnosis?
A. GERD
B. Aortic dissection
C. Myocardial infarction
D. Pleuritic pain -✓✓D. Pleuritic pain
• The APRN would anticipate a bounding radial pulse in:
A. Aortic regurgitation
B. Arterial embolism
C. Mitral stenosis
D. Hyperthyroidism -✓✓A. Aortic regurgitation
• A pt with longstanding COPD reports that he was told his liver was enlarged. The
APRN needs to assess the pt. Which of the following should the APRN do first?
A. Order a hepatitis panel
B. Measure the span of the liver
C. Obtain an ultrasound of the liver
D. Percuss the lower border of the liver -✓✓D. Percuss the lower border of the liver
Answer (2026) A+ Verified Real Exam
Prep
• A pt presents to the clinic with severe right sided abdominal pain for 12 hours. He
began having a "stomach ache" yesterday, with decreased appetite, but today the pain
seems to be just on the lower right side. He has had some nausea & vomiting, but no
constipation or diarrhea. His last BM was last night and was normal. He has had no
fever or chills. He denies any recent illness or injuries. His PMH is unremarkable. He
denies any tobacco or drug use and drinks 4-6 beers/week. on exam, he appears ill and
is lying on his right side. His temp is 100.4 F and HR is 110. His bowel sounds are
decreased and he has rebound pain and guarding one third of the way between anterior
superior iliac spine and the umbilicus in the right lower quadrant. What is the most likely
cause of his pain?
A. Acute appendicitis
B. Mesenteric ischemia
C. Acute mechanical intestinal obstruction
D. Acute cholecystitis -✓✓A. Acute appendicitis
• An APRN notes a 12 mm Hg difference in systolic BP during inspiration. How should
the APRN document this finding?
A. Acute stenosis
B. Carotid arterial disease
C. Paradoxical pulse
D. Pulsus alternans -✓✓C. Paradoxical pulse
• Which of the following percussion notes is obtained over a gastric bubble?
A. Flatness
B. Hyperresonance
C. Tympany
D. Resonance -✓✓C. Tympany
• The APRN is performing a cardiac exam on a pt with SOB and palpitations. She
listens to the heart with the pt sitting upright, then has the pt change to a supine
position, and finally she has the pt turn onto the left side in the left lateral decubitus
position. Which of the following valvular defects is best heard in this position?
A. Mitral
B. Aortic
C. Tricuspid
, D. Pulmonic -✓✓A. Mitral
• A 20 year old male has a history of leukemia and an enlarged spleen. Today he
presents with a fairly significant left upper quadrant pain. On exam of the area a rough
grating noise is heard. What is this sound known as?
A. It is a variant of bowel noise
B. It is a splenic rub
C. Vascular noise
D. It represents borborygmi -✓✓B. It is a splenic rub
• An elderly pt with a history of smoking 2 packs/day for 50 years reports to the APRN
prolonged shortness of breath. On cardiac exam, the APRN feels the most prominent
palpable impulse to be in the xiphoid area. This is most likely a result of what condition?
A. COPD
B. Aortic stenosis
C. Mitral regurgitation
D. Pulmonary hypertension -✓✓D. Pulmonary hypertension
• A pt reports "chest pain" during a visit to the APRN. The pt describes it as "severe"
and "sharp" and worse when taking a deep breath. PMH is unremarkable and there is
no history of tobacco use. VS are normal. Pt appears comfortable. Cardiac and
respiratory exam are unremarkable. What is the most likely diagnosis?
A. GERD
B. Aortic dissection
C. Myocardial infarction
D. Pleuritic pain -✓✓D. Pleuritic pain
• The APRN would anticipate a bounding radial pulse in:
A. Aortic regurgitation
B. Arterial embolism
C. Mitral stenosis
D. Hyperthyroidism -✓✓A. Aortic regurgitation
• A pt with longstanding COPD reports that he was told his liver was enlarged. The
APRN needs to assess the pt. Which of the following should the APRN do first?
A. Order a hepatitis panel
B. Measure the span of the liver
C. Obtain an ultrasound of the liver
D. Percuss the lower border of the liver -✓✓D. Percuss the lower border of the liver
