NUR612/NUR 612 Exam 2 V2 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old male presents with sudden, sharp chest pain and a mid-systolic click followed
by a late systolic murmur on auscultation. Which condition is most likely?
A. Aortic Stenosis
B. Tricuspid Regurgitation
C. Mitral Valve Prolapse
D. Ventricular Septal Defect
Correct Answer: C
Expert Explanation: Mitral valve prolapse is classically characterized by a mid-systolic
click and a late systolic murmur heard best at the apex. This condition occurs when the
mitral valve leaflets bulge into the left atrium during contraction. Diagnosis is often
confirmed via echocardiography to visualize the leaflet displacement.
2. During a physical examination, the nurse practitioner asks the patient to puff out their
cheeks and show their teeth. Which cranial nerve is being assessed?
A. CN V (Trigeminal)
B. CN XII (Hypoglossal)
C. CN VII (Facial)
,D. CN X (Vagus)
Correct Answer: C
Expert Explanation: Cranial Nerve VII, the facial nerve, controls the muscles of facial
expression. Testing involves observing for symmetry during movements like smiling,
frowning, and puffing the cheeks. Asymmetry in these movements may indicate a
peripheral nerve lesion or central nervous system pathology.
3. Which of the following findings on an abdominal exam is most indicative of acute
cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. Psoas Sign
D. Grey Turner’s Sign
Correct Answer: B
Expert Explanation: Murphy’s sign is assessed by palpating the right upper quadrant
while the patient takes a deep breath. A positive sign occurs when the patient experiences
sharp pain and abruptly stops inspiration as the gallbladder descends against the
examiner’s hand. This is a highly specific indicator for gallbladder inflammation.
4. When performing the Weber test, the patient reports that the sound is heard louder in the
right ear. If the patient has a known conductive hearing loss, in which ear is the loss located?
A. Neither ear; this indicates sensorineural loss
, B. The left ear
C. The right ear
D. Both ears
Correct Answer: C
Expert Explanation: In the Weber test, sound lateralizes to the ‘bad’ ear in conductive
hearing loss because the background noise is blocked. Conversely, in sensorineural loss, the
sound lateralizes to the ‘good’ ear. This test helps differentiate between the types of
hearing impairment based on where the sound is perceived.
5. A patient exhibits increased tactile fremitus over the right lower lobe. What is the most
likely underlying pathology?
A. Lobar Pneumonia
B. Pleural Effusion
C. Pneumothorax
D. Emphysema
Correct Answer: A
Expert Explanation: Tactile fremitus increases with the consolidation of lung tissue, such
as in lobar pneumonia, because sound travels better through solid or fluid-filled medium
than air. Conditions like pneumothorax or emphysema involve more air in the pleural
Nursing II Q&A with Rationale | William
Paterson University
1. A 55-year-old male presents with sudden, sharp chest pain and a mid-systolic click followed
by a late systolic murmur on auscultation. Which condition is most likely?
A. Aortic Stenosis
B. Tricuspid Regurgitation
C. Mitral Valve Prolapse
D. Ventricular Septal Defect
Correct Answer: C
Expert Explanation: Mitral valve prolapse is classically characterized by a mid-systolic
click and a late systolic murmur heard best at the apex. This condition occurs when the
mitral valve leaflets bulge into the left atrium during contraction. Diagnosis is often
confirmed via echocardiography to visualize the leaflet displacement.
2. During a physical examination, the nurse practitioner asks the patient to puff out their
cheeks and show their teeth. Which cranial nerve is being assessed?
A. CN V (Trigeminal)
B. CN XII (Hypoglossal)
C. CN VII (Facial)
,D. CN X (Vagus)
Correct Answer: C
Expert Explanation: Cranial Nerve VII, the facial nerve, controls the muscles of facial
expression. Testing involves observing for symmetry during movements like smiling,
frowning, and puffing the cheeks. Asymmetry in these movements may indicate a
peripheral nerve lesion or central nervous system pathology.
3. Which of the following findings on an abdominal exam is most indicative of acute
cholecystitis?
A. Rovsing’s Sign
B. Murphy’s Sign
C. Psoas Sign
D. Grey Turner’s Sign
Correct Answer: B
Expert Explanation: Murphy’s sign is assessed by palpating the right upper quadrant
while the patient takes a deep breath. A positive sign occurs when the patient experiences
sharp pain and abruptly stops inspiration as the gallbladder descends against the
examiner’s hand. This is a highly specific indicator for gallbladder inflammation.
4. When performing the Weber test, the patient reports that the sound is heard louder in the
right ear. If the patient has a known conductive hearing loss, in which ear is the loss located?
A. Neither ear; this indicates sensorineural loss
, B. The left ear
C. The right ear
D. Both ears
Correct Answer: C
Expert Explanation: In the Weber test, sound lateralizes to the ‘bad’ ear in conductive
hearing loss because the background noise is blocked. Conversely, in sensorineural loss, the
sound lateralizes to the ‘good’ ear. This test helps differentiate between the types of
hearing impairment based on where the sound is perceived.
5. A patient exhibits increased tactile fremitus over the right lower lobe. What is the most
likely underlying pathology?
A. Lobar Pneumonia
B. Pleural Effusion
C. Pneumothorax
D. Emphysema
Correct Answer: A
Expert Explanation: Tactile fremitus increases with the consolidation of lung tissue, such
as in lobar pneumonia, because sound travels better through solid or fluid-filled medium
than air. Conditions like pneumothorax or emphysema involve more air in the pleural
