NUR612/NUR 612 Exam 3 V1 | Advanced
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old patient presents with a ‘gallop’ rhythm heard early in diastole. What does
the S3 heart sound most likely indicate in this patient?
A. Normal physiological finding in the elderly
B. Aortic stenosis
C. Ventricular volume overload or heart failure
D. Closure of the semilunar valves
Correct Answer: C
Expert Explanation: The S3 heart sound, or ventricular gallop, occurs during the rapid
filling phase of diastole. In older adults, it is often a sign of pathology such as congestive
heart failure or volume overload. It is best heard with the bell of the stethoscope at the
apex while the patient is in the left lateral decubitus position.
2. When assessing for appendicitis, the nurse performs the Psoas sign. How is this test
correctly conducted?
A. Have the patient extend the right leg against resistance while lying supine
B. Apply pressure to the left lower quadrant to see if pain is felt on the right
C. Have the patient flex the hip and rotate the leg internally
,D. Palpate the gallbladder area during deep inspiration
Correct Answer: A
Expert Explanation: The Psoas sign is performed by having the patient lie supine and
extend the right leg against the resistance of the examiner’s hand. If the patient feels pain in
the right lower quadrant, it suggests irritation of the psoas muscle due to an inflamed
appendix. This maneuver is a critical part of the abdominal physical examination for acute
surgical conditions.
3. A patient exhibits ‘E-to-A’ change during auscultation of the lungs. What is this clinical
finding called?
A. Bronchophony
B. Egophony
C. Whispered pectoriloquy
D. Tactile fremitus
Correct Answer: B
Expert Explanation: Egophony is a physical exam finding where the spoken ‘E’ sounds like
an ‘A’ through a stethoscope. This change in resonance occurs when lung tissue is
consolidated, such as in pneumonia. The sound travels better through solid or fluid-filled
media than through air-filled lung tissue.
, 4. Which cranial nerve is being tested when the nurse asks the patient to shrug their
shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XII (Hypoglossal)
C. Cranial Nerve XI (Spinal Accessory)
D. Cranial Nerve IX (Glossopharyngeal)
Correct Answer: C
Expert Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius
and sternocleidomastoid muscles. To assess this nerve, the nurse asks the patient to shrug
their shoulders and turn their head against resistance. Weakness or asymmetry may
indicate nerve damage or muscle pathology.
5. When assessing the thyroid gland, which of the following is considered an abnormal finding
that requires further investigation?
A. A non-palpable thyroid gland
B. The presence of a soft, symmetric gland
C. A palpable bruit upon auscultation
D. The thyroid moves upward during swallowing
Correct Answer: C
Nursing II Q&A with Rationale | William
Paterson University
1. A 65-year-old patient presents with a ‘gallop’ rhythm heard early in diastole. What does
the S3 heart sound most likely indicate in this patient?
A. Normal physiological finding in the elderly
B. Aortic stenosis
C. Ventricular volume overload or heart failure
D. Closure of the semilunar valves
Correct Answer: C
Expert Explanation: The S3 heart sound, or ventricular gallop, occurs during the rapid
filling phase of diastole. In older adults, it is often a sign of pathology such as congestive
heart failure or volume overload. It is best heard with the bell of the stethoscope at the
apex while the patient is in the left lateral decubitus position.
2. When assessing for appendicitis, the nurse performs the Psoas sign. How is this test
correctly conducted?
A. Have the patient extend the right leg against resistance while lying supine
B. Apply pressure to the left lower quadrant to see if pain is felt on the right
C. Have the patient flex the hip and rotate the leg internally
,D. Palpate the gallbladder area during deep inspiration
Correct Answer: A
Expert Explanation: The Psoas sign is performed by having the patient lie supine and
extend the right leg against the resistance of the examiner’s hand. If the patient feels pain in
the right lower quadrant, it suggests irritation of the psoas muscle due to an inflamed
appendix. This maneuver is a critical part of the abdominal physical examination for acute
surgical conditions.
3. A patient exhibits ‘E-to-A’ change during auscultation of the lungs. What is this clinical
finding called?
A. Bronchophony
B. Egophony
C. Whispered pectoriloquy
D. Tactile fremitus
Correct Answer: B
Expert Explanation: Egophony is a physical exam finding where the spoken ‘E’ sounds like
an ‘A’ through a stethoscope. This change in resonance occurs when lung tissue is
consolidated, such as in pneumonia. The sound travels better through solid or fluid-filled
media than through air-filled lung tissue.
, 4. Which cranial nerve is being tested when the nurse asks the patient to shrug their
shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XII (Hypoglossal)
C. Cranial Nerve XI (Spinal Accessory)
D. Cranial Nerve IX (Glossopharyngeal)
Correct Answer: C
Expert Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius
and sternocleidomastoid muscles. To assess this nerve, the nurse asks the patient to shrug
their shoulders and turn their head against resistance. Weakness or asymmetry may
indicate nerve damage or muscle pathology.
5. When assessing the thyroid gland, which of the following is considered an abnormal finding
that requires further investigation?
A. A non-palpable thyroid gland
B. The presence of a soft, symmetric gland
C. A palpable bruit upon auscultation
D. The thyroid moves upward during swallowing
Correct Answer: C
