NUR611/NUR 611 Exam 3 V1 | Adv
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A patient presents with acute right upper quadrant pain that radiates to the right scapula.
Which physical examination maneuver is most indicative of acute cholecystitis?
A. The Psoas sign, which involves passive extension of the right hip.
B. The Rovsing’s sign, which is performed by palpating the left lower quadrant.
C. The McBurney’s point tenderness test, located in the right lower quadrant.
D. The Murphy’s sign, which involves palpating the gallbladder area during inspiration.
Correct Answer: D
Expert Explanation: A positive Murphy’s sign occurs when the patient experiences a
sudden cessation of inspiration due to pain when the gallbladder is palpated. This finding is
highly suggestive of inflammatory gallbladder disease such as acute cholecystitis. The other
tests listed are typically used to evaluate for appendicitis rather than gallbladder issues.
2. Which physical examination finding is most characteristic of a patient with Parkinson’s
disease?
A. The patient exhibits a rapid, high-pitched vocalization and hyperactive reflexes.
B. The patient shows an intention tremor that worsens as the hand nears a target.
C. The patient demonstrates a resting ‘pill-rolling’ tremor and bradykinesia.
,D. The patient has a wide-based, ataxic gait with frequent loss of balance.
Correct Answer: C
Expert Explanation: Parkinson’s disease is characterized by a triad of resting tremor,
bradykinesia, and postural instability. The classic ‘pill-rolling’ tremor is often the first sign
noticed by patients or family members. Diagnosis is primarily clinical, and these motor
symptoms reflect the underlying depletion of dopamine in the substantia nigra.
3. A patient reports a sudden, severe ‘thunderclap’ headache. What is the most likely
underlying condition that requires immediate emergency intervention?
A. The patient is likely experiencing a severe tension-type headache from stress.
B. The patient is experiencing a classic migraine with aura symptoms.
C. The patient is suffering from a subarachnoid hemorrhage due to a ruptured aneurysm.
D. The patient has acute sinusitis causing referred pain to the forehead.
Correct Answer: C
Expert Explanation: A thunderclap headache is defined by its sudden onset and peak
intensity within seconds to minutes, often described as the worst headache of life. This
presentation is a hallmark of subarachnoid hemorrhage, which is a neurosurgical
emergency. Immediate imaging with a CT scan and potentially a lumbar puncture is
necessary for diagnosis.
, 4. When assessing for carpal tunnel syndrome, the nurse practitioner asks the patient to hold
their wrists in acute flexion for 60 seconds. What is the name of this test?
A. The Phalen’s maneuver.
B. The Tinel’s sign test.
C. The Lachman’s test.
D. The Finkelstein’s test.
Correct Answer: A
Expert Explanation: The Phalen’s maneuver involves flexing the wrists to compress the
median nerve within the carpal tunnel. If the patient experiences numbness or tingling in
the thumb, index, and middle fingers, the test is positive. This helps differentiate carpal
tunnel syndrome from other wrist pathologies like de Quervain’s tenosynovitis.
5. Which diagnostic test is considered the gold standard for confirming the diagnosis of
gastroesophageal reflux disease (GERD) in complex cases?
A. A barium swallow study to visualize esophageal strictures.
B. The fecal occult blood test to check for gastrointestinal bleeding.
C. An upper gastrointestinal series using contrast medium.
D. The 24-hour ambulatory esophageal pH monitoring.
Correct Answer: D
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A patient presents with acute right upper quadrant pain that radiates to the right scapula.
Which physical examination maneuver is most indicative of acute cholecystitis?
A. The Psoas sign, which involves passive extension of the right hip.
B. The Rovsing’s sign, which is performed by palpating the left lower quadrant.
C. The McBurney’s point tenderness test, located in the right lower quadrant.
D. The Murphy’s sign, which involves palpating the gallbladder area during inspiration.
Correct Answer: D
Expert Explanation: A positive Murphy’s sign occurs when the patient experiences a
sudden cessation of inspiration due to pain when the gallbladder is palpated. This finding is
highly suggestive of inflammatory gallbladder disease such as acute cholecystitis. The other
tests listed are typically used to evaluate for appendicitis rather than gallbladder issues.
2. Which physical examination finding is most characteristic of a patient with Parkinson’s
disease?
A. The patient exhibits a rapid, high-pitched vocalization and hyperactive reflexes.
B. The patient shows an intention tremor that worsens as the hand nears a target.
C. The patient demonstrates a resting ‘pill-rolling’ tremor and bradykinesia.
,D. The patient has a wide-based, ataxic gait with frequent loss of balance.
Correct Answer: C
Expert Explanation: Parkinson’s disease is characterized by a triad of resting tremor,
bradykinesia, and postural instability. The classic ‘pill-rolling’ tremor is often the first sign
noticed by patients or family members. Diagnosis is primarily clinical, and these motor
symptoms reflect the underlying depletion of dopamine in the substantia nigra.
3. A patient reports a sudden, severe ‘thunderclap’ headache. What is the most likely
underlying condition that requires immediate emergency intervention?
A. The patient is likely experiencing a severe tension-type headache from stress.
B. The patient is experiencing a classic migraine with aura symptoms.
C. The patient is suffering from a subarachnoid hemorrhage due to a ruptured aneurysm.
D. The patient has acute sinusitis causing referred pain to the forehead.
Correct Answer: C
Expert Explanation: A thunderclap headache is defined by its sudden onset and peak
intensity within seconds to minutes, often described as the worst headache of life. This
presentation is a hallmark of subarachnoid hemorrhage, which is a neurosurgical
emergency. Immediate imaging with a CT scan and potentially a lumbar puncture is
necessary for diagnosis.
, 4. When assessing for carpal tunnel syndrome, the nurse practitioner asks the patient to hold
their wrists in acute flexion for 60 seconds. What is the name of this test?
A. The Phalen’s maneuver.
B. The Tinel’s sign test.
C. The Lachman’s test.
D. The Finkelstein’s test.
Correct Answer: A
Expert Explanation: The Phalen’s maneuver involves flexing the wrists to compress the
median nerve within the carpal tunnel. If the patient experiences numbness or tingling in
the thumb, index, and middle fingers, the test is positive. This helps differentiate carpal
tunnel syndrome from other wrist pathologies like de Quervain’s tenosynovitis.
5. Which diagnostic test is considered the gold standard for confirming the diagnosis of
gastroesophageal reflux disease (GERD) in complex cases?
A. A barium swallow study to visualize esophageal strictures.
B. The fecal occult blood test to check for gastrointestinal bleeding.
C. An upper gastrointestinal series using contrast medium.
D. The 24-hour ambulatory esophageal pH monitoring.
Correct Answer: D
