NUR 6001/NUR6001 Exam 2 V1 | Advanced
Health Assessment Q&A with Rationale |
William Paterson University
1. During an assessment of a 45-year-old patient, the nurse practitioner hears high-pitched,
musical sounds primarily during expiration. How should this finding be documented?
A. Crackles
B. Rhonchi
C. Wheezes
D. Friction rub
Correct Answer: C
Expert Explanation: Wheezes are continuous, high-pitched musical sounds caused by air
flowing through narrowed bronchioles. They are most commonly heard during expiration
but can also occur during inspiration in severe cases. This assessment finding is often
associated with conditions like asthma or chronic obstructive pulmonary disease.
2. When auscultating heart sounds, where is the S2 sound typically heard the loudest?
A. Apex of the heart
B. Left sternal border
C. Fifth intercostal space
D. Base of the heart
,Correct Answer: D
Expert Explanation: The S2 heart sound represents the closure of the semilunar valves,
which includes the aortic and pulmonic valves. It is characteristically loudest at the base of
the heart in the second intercostal space. Conversely, the S1 sound is loudest at the apex
due to the closure of the AV valves.
3. A patient presents with right upper quadrant pain. The practitioner asks the patient to take
a deep breath while applying pressure under the right costal margin, causing the patient to
stop breathing mid-inspiration. What is this sign?
A. Murphy’s sign
B. Rovsing’s sign
C. McBurney’s sign
D. Psoas sign
Correct Answer: A
Expert Explanation: Murphy’s sign is an indicator used to identify inflammation of the
gallbladder or cholecystitis. A positive result occurs when the patient experiences sharp
pain and abruptly halts inspiration during deep palpation. This sign is highly specific for
gallbladder disease when compared to other abdominal tests.
4. Which cranial nerve is primarily responsible for pupillary constriction and most extraocular
movements?
A. CN II (Optic)
, B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN VI (Abducens)
Correct Answer: B
Expert Explanation: Cranial Nerve III, the oculomotor nerve, controls most of the muscles
that move the eye. It is also responsible for pupillary constriction and maintaining an open
eyelid. Dysfunction of this nerve may lead to ptosis, a dilated pupil, or impaired eye
movement.
5. When performing a breast examination, in which quadrant are the majority of breast
tumors located?
A. Upper outer quadrant
B. Lower inner quadrant
C. Upper inner quadrant
D. Lower outer quadrant
Correct Answer: A
Expert Explanation: The upper outer quadrant of the breast, which includes the Tail of
Spence, is the most common site for breast cancer. This area contains a large amount of
glandular tissue that extends into the axilla. Practitioners must ensure thorough palpation
of this specific region during clinical exams.
Health Assessment Q&A with Rationale |
William Paterson University
1. During an assessment of a 45-year-old patient, the nurse practitioner hears high-pitched,
musical sounds primarily during expiration. How should this finding be documented?
A. Crackles
B. Rhonchi
C. Wheezes
D. Friction rub
Correct Answer: C
Expert Explanation: Wheezes are continuous, high-pitched musical sounds caused by air
flowing through narrowed bronchioles. They are most commonly heard during expiration
but can also occur during inspiration in severe cases. This assessment finding is often
associated with conditions like asthma or chronic obstructive pulmonary disease.
2. When auscultating heart sounds, where is the S2 sound typically heard the loudest?
A. Apex of the heart
B. Left sternal border
C. Fifth intercostal space
D. Base of the heart
,Correct Answer: D
Expert Explanation: The S2 heart sound represents the closure of the semilunar valves,
which includes the aortic and pulmonic valves. It is characteristically loudest at the base of
the heart in the second intercostal space. Conversely, the S1 sound is loudest at the apex
due to the closure of the AV valves.
3. A patient presents with right upper quadrant pain. The practitioner asks the patient to take
a deep breath while applying pressure under the right costal margin, causing the patient to
stop breathing mid-inspiration. What is this sign?
A. Murphy’s sign
B. Rovsing’s sign
C. McBurney’s sign
D. Psoas sign
Correct Answer: A
Expert Explanation: Murphy’s sign is an indicator used to identify inflammation of the
gallbladder or cholecystitis. A positive result occurs when the patient experiences sharp
pain and abruptly halts inspiration during deep palpation. This sign is highly specific for
gallbladder disease when compared to other abdominal tests.
4. Which cranial nerve is primarily responsible for pupillary constriction and most extraocular
movements?
A. CN II (Optic)
, B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN VI (Abducens)
Correct Answer: B
Expert Explanation: Cranial Nerve III, the oculomotor nerve, controls most of the muscles
that move the eye. It is also responsible for pupillary constriction and maintaining an open
eyelid. Dysfunction of this nerve may lead to ptosis, a dilated pupil, or impaired eye
movement.
5. When performing a breast examination, in which quadrant are the majority of breast
tumors located?
A. Upper outer quadrant
B. Lower inner quadrant
C. Upper inner quadrant
D. Lower outer quadrant
Correct Answer: A
Expert Explanation: The upper outer quadrant of the breast, which includes the Tail of
Spence, is the most common site for breast cancer. This area contains a large amount of
glandular tissue that extends into the axilla. Practitioners must ensure thorough palpation
of this specific region during clinical exams.
