NUR 504 Exam 6 (PDF) | (Updated) Advanced Health
Assessment Exam QuestionsNUR 504 Exam 6 (PDF) |
(Updated) Advanced Health Assessment Exam
Questions
1. A patient presents with gradual onset of fatigue, weight loss, and a palpable, non-tender
supraclavicular lymph node on the left side. Which of the following is the most appropriate next
step in the diagnostic workup?
A. Order a complete blood count and peripheral smear
B. Initiate empiric antibiotics for presumed infection
C. Perform an excisional biopsy of the lymph node
D. Schedule a CT scan of the chest, abdomen, and pelvis
Answer: C
Rationale: A palpable, non-tender supraclavicular lymph node (Virchow's node) is often associated with
malignancy, particularly gastric or lung cancer. Excisional biopsy is indicated for histological
diagnosis. Empiric antibiotics are not indicated without evidence of infection. CT scan may be useful for
staging but is not the next step prior to tissue diagnosis. CBC is nonspecific.
2. Which of the following physical examination findings is most consistent with a diagnosis of
aortic regurgitation?
A. Widened pulse pressure and a decrescendo diastolic murmur at the left sternal border
B. Narrowed pulse pressure and a crescendo-decrescendo systolic murmur at the right upper sternal border
C. Pulsus paradoxus and a pericardial friction rub
D. Split S2 and a mid-systolic click at the apex
Answer: A
Rationale: Aortic regurgitation typically presents with a widened pulse pressure due to increased stroke
volume and rapid diastolic runoff, and a high-pitched decrescendo diastolic murmur heard best at the
left sternal border. Option B describes aortic stenosis. Option C is associated with pericarditis or
cardiac tamponade. Option D describes mitral valve prolapse.
3. A patient with a history of type 2 diabetes mellitus and hypertension is found to have an elevated
creatinine level and proteinuria on urinalysis. Which of the following is the most appropriate next
step to assess for diabetic nephropathy?
A. Measure the urine albumin-to-creatinine ratio
B. Perform a renal ultrasound
C. Order a 24-hour urine collection for protein
D. Schedule a renal biopsy
Page 1
,Answer: A
Rationale: The urine albumin-to-creatinine ratio (UACR) is the recommended screening test for diabetic
nephropathy, as it is more sensitive and convenient than 24-hour urine collection. Renal ultrasound is
used to assess structure, not function. Renal biopsy is reserved for atypical presentations. UACR can
detect microalbuminuria early.
4. A patient presents with acute onset of severe, tearing chest pain radiating to the back, with a
blood pressure difference of 20 mmHg between arms. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Severe tearing chest pain radiating to the back with a blood pressure differential between
arms is classic for aortic dissection. Myocardial infarction pain is typically crushing and may radiate to
the jaw or left arm. Pulmonary embolism presents with pleuritic pain and dyspnea. Pericarditis pain is
sharp and positional, often with a friction rub.
5. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with
increased dyspnea and purulent sputum. Which of the following findings would most suggest a
need for hospitalization?
A. Oxygen saturation of 92% on room air
B. Use of accessory muscles and inability to speak in full sentences
C. Presence of wheezing on auscultation
D. Mild increase in sputum purulence
Answer: B
Rationale: Use of accessory muscles and inability to speak in full sentences indicate severe respiratory
distress and need for hospitalization. Oxygen saturation of 92% is borderline but not an absolute
criterion. Wheezing is common in exacerbations and may respond to bronchodilators. Sputum changes
alone do not indicate severity.
6. Which of the following best describes the correct technique for palpation of the thyroid gland
from an anterior approach?
A. Place both hands on the patient's neck, with thumbs meeting at the midline, and ask the patient to swallow
while palpating
B. Stand behind the patient, place fingers on both sides of the trachea, and ask the patient to flex the neck
C. Use one hand to retract the sternocleidomastoid muscle while palpating with the other hand, and ask the
patient to swallow
D. Place the index and middle fingers of both hands in the suprasternal notch and palpate upward during
swallowing
Answer: A
Rationale: The anterior approach involves standing in front of the patient, placing thumbs on the midline
and fingers around the neck, and asking the patient to swallow to allow the thyroid to rise. The posterior
Page 2
,approach (behind the patient) is also correct but uses fingers. Option C is incorrect because retracting
the sternocleidomastoid is not standard. Option D is incorrect as it describes a different technique.
7. A patient with a history of intravenous drug use presents with fever, murmur, and Janeway
lesions. Which of the following is the most likely causative organism?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Enterococcus faecalis
D. Haemophilus influenzae
Answer: B
Rationale: Janeway lesions are non-tender hemorrhagic macules on the palms and soles, associated with
acute infective endocarditis, most commonly caused by Staphylococcus aureus in IV drug users.
Streptococcus viridans is associated with subacute endocarditis on damaged valves. Enterococcus is less
common. H. influenzae is not a typical cause.
8. A patient presents with right lower quadrant abdominal pain, rebound tenderness, and a
positive psoas sign. Which of the following is the most likely diagnosis?
A. Acute cholecystitis
B. Diverticulitis
C. Acute appendicitis
D. Pancreatitis
Answer: C
Rationale: Rebound tenderness and a positive psoas sign (pain with extension of the right hip) are classic
for acute appendicitis, especially when the appendix is retrocecal. Cholecystitis presents with right
upper quadrant pain. Diverticulitis typically causes left lower quadrant pain. Pancreatitis presents with
epigastric pain radiating to the back.
9. Which of the following laboratory findings is most consistent with a diagnosis of primary
hyperaldosteronism?
A. Low plasma renin activity, high serum aldosterone, hypokalemia
B. High plasma renin activity, high serum aldosterone, hyperkalemia
C. Low plasma renin activity, low serum aldosterone, hyponatremia
D. High plasma renin activity, low serum aldosterone, hypokalemia
Answer: A
Rationale: Primary hyperaldosteronism (Conn's syndrome) is characterized by autonomous aldosterone
secretion, suppressing renin (low renin activity), leading to hypertension and hypokalemia. High renin
with high aldosterone suggests secondary hyperaldosteronism. Low renin with low aldosterone may be
seen in hypoaldosteronism. High renin with low aldosterone suggests reninoma.
10. A patient with a history of chronic kidney disease presents with asterixis, pericardial friction
rub, and a serum potassium of 6.8 mEq/L. Which of the following is the most appropriate
immediate intervention?
Page 3
, A. Intravenous calcium gluconate and insulin with glucose
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide
D. Hemodialysis
Answer: A
Rationale: Severe hyperkalemia (K+ > 6.5 mEq/L) with ECG changes or symptoms requires immediate
stabilization with intravenous calcium gluconate to protect the heart, followed by shifting potassium into
cells with insulin and glucose. Sodium polystyrene sulfonate is slow-acting. Furosemide may be used but
is not first-line in emergencies. Hemodialysis is definitive but not immediate.
11. A patient presents with a sudden onset of severe, tearing chest pain radiating to the back,
associated with hypertension and a widened mediastinum on chest X-ray. Which assessment
finding is most critical to differentiate acute aortic dissection from acute myocardial infarction?
A. Presence of ST-segment elevation on ECG
B. Elevated cardiac troponin levels
C. Pulse deficit or blood pressure differential between arms
D. Pericardial friction rub on auscultation
Answer: C
Rationale: Pulse deficit or blood pressure differential between arms is a key finding in aortic dissection
due to involvement of branch vessels, whereas in MI, pulses are usually symmetric. ST elevation and
troponin elevation can occur in both, but are more characteristic of MI. Pericardial rub suggests
pericarditis, not dissection.
12. In a patient with chronic obstructive pulmonary disease (COPD) and suspected cor pulmonale,
which physical examination finding is most indicative of right ventricular failure?
A. Bibasilar crackles
B. Hepatojugular reflux
C. Pulsus paradoxus
D. S4 gallop at the apex
Answer: B
Rationale: Hepatojugular reflux is a sign of elevated right atrial pressure and right ventricular failure.
Bibasilar crackles suggest left heart failure, not cor pulmonale. Pulsus paradoxus is seen in cardiac
tamponade. S4 gallop is associated with left ventricular stiffness.
13. A patient with a history of intravenous drug use presents with fever, a new regurgitant
murmur, and Osler nodes on the fingertips. Which diagnostic test should be performed first to
confirm the suspected diagnosis?
A. Transesophageal echocardiography
B. Blood cultures drawn from two separate sites
C. Transthoracic echocardiography
D. Chest X-ray
Answer: B
Page 4
Assessment Exam QuestionsNUR 504 Exam 6 (PDF) |
(Updated) Advanced Health Assessment Exam
Questions
1. A patient presents with gradual onset of fatigue, weight loss, and a palpable, non-tender
supraclavicular lymph node on the left side. Which of the following is the most appropriate next
step in the diagnostic workup?
A. Order a complete blood count and peripheral smear
B. Initiate empiric antibiotics for presumed infection
C. Perform an excisional biopsy of the lymph node
D. Schedule a CT scan of the chest, abdomen, and pelvis
Answer: C
Rationale: A palpable, non-tender supraclavicular lymph node (Virchow's node) is often associated with
malignancy, particularly gastric or lung cancer. Excisional biopsy is indicated for histological
diagnosis. Empiric antibiotics are not indicated without evidence of infection. CT scan may be useful for
staging but is not the next step prior to tissue diagnosis. CBC is nonspecific.
2. Which of the following physical examination findings is most consistent with a diagnosis of
aortic regurgitation?
A. Widened pulse pressure and a decrescendo diastolic murmur at the left sternal border
B. Narrowed pulse pressure and a crescendo-decrescendo systolic murmur at the right upper sternal border
C. Pulsus paradoxus and a pericardial friction rub
D. Split S2 and a mid-systolic click at the apex
Answer: A
Rationale: Aortic regurgitation typically presents with a widened pulse pressure due to increased stroke
volume and rapid diastolic runoff, and a high-pitched decrescendo diastolic murmur heard best at the
left sternal border. Option B describes aortic stenosis. Option C is associated with pericarditis or
cardiac tamponade. Option D describes mitral valve prolapse.
3. A patient with a history of type 2 diabetes mellitus and hypertension is found to have an elevated
creatinine level and proteinuria on urinalysis. Which of the following is the most appropriate next
step to assess for diabetic nephropathy?
A. Measure the urine albumin-to-creatinine ratio
B. Perform a renal ultrasound
C. Order a 24-hour urine collection for protein
D. Schedule a renal biopsy
Page 1
,Answer: A
Rationale: The urine albumin-to-creatinine ratio (UACR) is the recommended screening test for diabetic
nephropathy, as it is more sensitive and convenient than 24-hour urine collection. Renal ultrasound is
used to assess structure, not function. Renal biopsy is reserved for atypical presentations. UACR can
detect microalbuminuria early.
4. A patient presents with acute onset of severe, tearing chest pain radiating to the back, with a
blood pressure difference of 20 mmHg between arms. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C
Rationale: Severe tearing chest pain radiating to the back with a blood pressure differential between
arms is classic for aortic dissection. Myocardial infarction pain is typically crushing and may radiate to
the jaw or left arm. Pulmonary embolism presents with pleuritic pain and dyspnea. Pericarditis pain is
sharp and positional, often with a friction rub.
5. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with
increased dyspnea and purulent sputum. Which of the following findings would most suggest a
need for hospitalization?
A. Oxygen saturation of 92% on room air
B. Use of accessory muscles and inability to speak in full sentences
C. Presence of wheezing on auscultation
D. Mild increase in sputum purulence
Answer: B
Rationale: Use of accessory muscles and inability to speak in full sentences indicate severe respiratory
distress and need for hospitalization. Oxygen saturation of 92% is borderline but not an absolute
criterion. Wheezing is common in exacerbations and may respond to bronchodilators. Sputum changes
alone do not indicate severity.
6. Which of the following best describes the correct technique for palpation of the thyroid gland
from an anterior approach?
A. Place both hands on the patient's neck, with thumbs meeting at the midline, and ask the patient to swallow
while palpating
B. Stand behind the patient, place fingers on both sides of the trachea, and ask the patient to flex the neck
C. Use one hand to retract the sternocleidomastoid muscle while palpating with the other hand, and ask the
patient to swallow
D. Place the index and middle fingers of both hands in the suprasternal notch and palpate upward during
swallowing
Answer: A
Rationale: The anterior approach involves standing in front of the patient, placing thumbs on the midline
and fingers around the neck, and asking the patient to swallow to allow the thyroid to rise. The posterior
Page 2
,approach (behind the patient) is also correct but uses fingers. Option C is incorrect because retracting
the sternocleidomastoid is not standard. Option D is incorrect as it describes a different technique.
7. A patient with a history of intravenous drug use presents with fever, murmur, and Janeway
lesions. Which of the following is the most likely causative organism?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Enterococcus faecalis
D. Haemophilus influenzae
Answer: B
Rationale: Janeway lesions are non-tender hemorrhagic macules on the palms and soles, associated with
acute infective endocarditis, most commonly caused by Staphylococcus aureus in IV drug users.
Streptococcus viridans is associated with subacute endocarditis on damaged valves. Enterococcus is less
common. H. influenzae is not a typical cause.
8. A patient presents with right lower quadrant abdominal pain, rebound tenderness, and a
positive psoas sign. Which of the following is the most likely diagnosis?
A. Acute cholecystitis
B. Diverticulitis
C. Acute appendicitis
D. Pancreatitis
Answer: C
Rationale: Rebound tenderness and a positive psoas sign (pain with extension of the right hip) are classic
for acute appendicitis, especially when the appendix is retrocecal. Cholecystitis presents with right
upper quadrant pain. Diverticulitis typically causes left lower quadrant pain. Pancreatitis presents with
epigastric pain radiating to the back.
9. Which of the following laboratory findings is most consistent with a diagnosis of primary
hyperaldosteronism?
A. Low plasma renin activity, high serum aldosterone, hypokalemia
B. High plasma renin activity, high serum aldosterone, hyperkalemia
C. Low plasma renin activity, low serum aldosterone, hyponatremia
D. High plasma renin activity, low serum aldosterone, hypokalemia
Answer: A
Rationale: Primary hyperaldosteronism (Conn's syndrome) is characterized by autonomous aldosterone
secretion, suppressing renin (low renin activity), leading to hypertension and hypokalemia. High renin
with high aldosterone suggests secondary hyperaldosteronism. Low renin with low aldosterone may be
seen in hypoaldosteronism. High renin with low aldosterone suggests reninoma.
10. A patient with a history of chronic kidney disease presents with asterixis, pericardial friction
rub, and a serum potassium of 6.8 mEq/L. Which of the following is the most appropriate
immediate intervention?
Page 3
, A. Intravenous calcium gluconate and insulin with glucose
B. Oral sodium polystyrene sulfonate
C. Intravenous furosemide
D. Hemodialysis
Answer: A
Rationale: Severe hyperkalemia (K+ > 6.5 mEq/L) with ECG changes or symptoms requires immediate
stabilization with intravenous calcium gluconate to protect the heart, followed by shifting potassium into
cells with insulin and glucose. Sodium polystyrene sulfonate is slow-acting. Furosemide may be used but
is not first-line in emergencies. Hemodialysis is definitive but not immediate.
11. A patient presents with a sudden onset of severe, tearing chest pain radiating to the back,
associated with hypertension and a widened mediastinum on chest X-ray. Which assessment
finding is most critical to differentiate acute aortic dissection from acute myocardial infarction?
A. Presence of ST-segment elevation on ECG
B. Elevated cardiac troponin levels
C. Pulse deficit or blood pressure differential between arms
D. Pericardial friction rub on auscultation
Answer: C
Rationale: Pulse deficit or blood pressure differential between arms is a key finding in aortic dissection
due to involvement of branch vessels, whereas in MI, pulses are usually symmetric. ST elevation and
troponin elevation can occur in both, but are more characteristic of MI. Pericardial rub suggests
pericarditis, not dissection.
12. In a patient with chronic obstructive pulmonary disease (COPD) and suspected cor pulmonale,
which physical examination finding is most indicative of right ventricular failure?
A. Bibasilar crackles
B. Hepatojugular reflux
C. Pulsus paradoxus
D. S4 gallop at the apex
Answer: B
Rationale: Hepatojugular reflux is a sign of elevated right atrial pressure and right ventricular failure.
Bibasilar crackles suggest left heart failure, not cor pulmonale. Pulsus paradoxus is seen in cardiac
tamponade. S4 gallop is associated with left ventricular stiffness.
13. A patient with a history of intravenous drug use presents with fever, a new regurgitant
murmur, and Osler nodes on the fingertips. Which diagnostic test should be performed first to
confirm the suspected diagnosis?
A. Transesophageal echocardiography
B. Blood cultures drawn from two separate sites
C. Transthoracic echocardiography
D. Chest X-ray
Answer: B
Page 4
