NUR 6001/NUR6001 Exam 4 V3 | Advanced
Health Assessment Q&A with Rationale |
William Paterson University
1. When assessing a patient for a suspected tension pneumothorax, which of the following
physical findings is most diagnostic?
A. Vesicular breath sounds throughout all lobes
B. Increased tactile fremitus on the affected side
C. Dullness to percussion over the lung fields
D. Tracheal deviation to the contralateral side
Correct Answer: D
Expert Explanation: Tension pneumothorax causes a shift in mediastinal structures due to
increasing pressure in the pleural space. This pressure buildup pushes the trachea away
from the affected side, which is a late and critical sign. The healthcare provider must
recognize this emergency immediately to perform decompression.
2. During a cardiac examination, the nurse practitioner auscultates a mid-systolic click. This
sound is most commonly associated with which condition?
A. Aortic stenosis
B. Pericardial friction rub
C. Ventricular septal defect
,D. Mitral valve prolapse
Correct Answer: D
Expert Explanation: A mid-systolic click is the hallmark clinical finding of mitral valve
prolapse (MVP). It is caused by the sudden tensing of the chordae tendineae as the valve
leaflets billow into the left atrium. This sound may be followed by a late systolic murmur if
mitral regurgitation is present.
3. A 55-year-old patient presents with complaints of ‘the worst headache of my life.’ Which of
the following should the provider prioritize in the differential diagnosis?
A. Tension-type headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Classical migraine
Correct Answer: C
Expert Explanation: The description of a ‘thunderclap’ headache or the ‘worst headache of
one’s life’ is a classic presentation of a subarachnoid hemorrhage. This condition often
results from a ruptured intracranial aneurysm and requires emergent imaging. Failing to
identify this can lead to catastrophic neurological outcomes or death.
4. While performing an abdominal assessment, the provider notes a positive Murphy’s sign.
This finding is indicative of which inflammatory process?
A. Diverticulitis
, B. Acute appendicitis
C. Acute cholecystitis
D. Pancreatitis
Correct Answer: C
Expert Explanation: Murphy’s sign is elicited by palpating the right upper quadrant while
the patient takes a deep breath. If the patient abruptly stops inhaling due to pain when the
gallbladder contacts the examiner’s hand, the test is positive. This sign has high specificity
for acute cholecystitis.
5. To evaluate a patient’s cerebellar function, which of the following maneuvers would be
most appropriate?
A. Checking the deep tendon reflexes
B. Assessing the pupillary light reflex
C. Testing for stereognosis
D. Performing the Romberg test
Correct Answer: D
Expert Explanation: The Romberg test assesses cerebellar function and proprioception by
evaluating the patient’s ability to maintain balance. Rapid alternating movements and the
finger-to-nose test are also standard methods for checking cerebellar integrity. Abnormal
results may indicate ataxia or vestibular dysfunction.
Health Assessment Q&A with Rationale |
William Paterson University
1. When assessing a patient for a suspected tension pneumothorax, which of the following
physical findings is most diagnostic?
A. Vesicular breath sounds throughout all lobes
B. Increased tactile fremitus on the affected side
C. Dullness to percussion over the lung fields
D. Tracheal deviation to the contralateral side
Correct Answer: D
Expert Explanation: Tension pneumothorax causes a shift in mediastinal structures due to
increasing pressure in the pleural space. This pressure buildup pushes the trachea away
from the affected side, which is a late and critical sign. The healthcare provider must
recognize this emergency immediately to perform decompression.
2. During a cardiac examination, the nurse practitioner auscultates a mid-systolic click. This
sound is most commonly associated with which condition?
A. Aortic stenosis
B. Pericardial friction rub
C. Ventricular septal defect
,D. Mitral valve prolapse
Correct Answer: D
Expert Explanation: A mid-systolic click is the hallmark clinical finding of mitral valve
prolapse (MVP). It is caused by the sudden tensing of the chordae tendineae as the valve
leaflets billow into the left atrium. This sound may be followed by a late systolic murmur if
mitral regurgitation is present.
3. A 55-year-old patient presents with complaints of ‘the worst headache of my life.’ Which of
the following should the provider prioritize in the differential diagnosis?
A. Tension-type headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Classical migraine
Correct Answer: C
Expert Explanation: The description of a ‘thunderclap’ headache or the ‘worst headache of
one’s life’ is a classic presentation of a subarachnoid hemorrhage. This condition often
results from a ruptured intracranial aneurysm and requires emergent imaging. Failing to
identify this can lead to catastrophic neurological outcomes or death.
4. While performing an abdominal assessment, the provider notes a positive Murphy’s sign.
This finding is indicative of which inflammatory process?
A. Diverticulitis
, B. Acute appendicitis
C. Acute cholecystitis
D. Pancreatitis
Correct Answer: C
Expert Explanation: Murphy’s sign is elicited by palpating the right upper quadrant while
the patient takes a deep breath. If the patient abruptly stops inhaling due to pain when the
gallbladder contacts the examiner’s hand, the test is positive. This sign has high specificity
for acute cholecystitis.
5. To evaluate a patient’s cerebellar function, which of the following maneuvers would be
most appropriate?
A. Checking the deep tendon reflexes
B. Assessing the pupillary light reflex
C. Testing for stereognosis
D. Performing the Romberg test
Correct Answer: D
Expert Explanation: The Romberg test assesses cerebellar function and proprioception by
evaluating the patient’s ability to maintain balance. Rapid alternating movements and the
finger-to-nose test are also standard methods for checking cerebellar integrity. Abnormal
results may indicate ataxia or vestibular dysfunction.
