South University NSG 6020 Final Exam – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified – Pass
Guaranteed – A+ Graded
Question 1
During a cardiovascular examination of a 58-year-old male, the nurse practitioner
auscultates the aortic valve area and hears a high-pitched, blowing diastolic murmur
that radiates toward the apex. The patient reports progressive dyspnea on exertion.
Which valvular disorder is most consistent with these findings?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation
Correct Answer: B
Rationale: Aortic regurgitation (AR) produces a high-pitched, blowing diastolic
decrescendo murmur best heard at the second right intercostal space (aortic area) with
radiation toward the apex. The progressive dyspnea on exertion reflects left ventricular
volume overload and eventual heart failure. Option A (aortic stenosis) produces a harsh
crescendo-decrescendo systolic murmur. Option C (mitral stenosis) produces a
low-pitched diastolic rumble at the apex with an opening snap. Option D (mitral
regurgitation) produces a holosystolic blowing murmur at the apex radiating to the
axilla.
Question 2
A 4-year-old child is brought to the clinic with fever, sore throat, and a sandpaper-like
rash that began on the neck and chest and spread to the extremities. The tongue is
,bright red with prominent papillae. Which assessment finding would the nurse
practitioner expect on palpation of the cervical lymph nodes?
A. Small, mobile, non-tender anterior cervical nodes
B. Bilateral, tender, enlarged anterior cervical nodes
C. Firm, fixed, matted posterior cervical nodes
D. Shotty, non-tender supraclavicular nodes
Correct Answer: B
Rationale: This child has scarlet fever (group A streptococcal pharyngitis with
erythrogenic toxin). Tender, enlarged anterior cervical lymph nodes are characteristic of
acute bacterial pharyngitis. Option A describes normal or viral lymphadenopathy. Option
C (firm, fixed, matted nodes) suggests malignancy or tuberculosis. Option D (shotty
nodes) is typical of viral infections; supraclavicular nodes are concerning for
malignancy.
Question 3
During abdominal percussion of a 45-year-old patient with suspected ascites, the nurse
practitioner notes a tympanitic sound in the umbilical region and dullness in the flanks
that shifts when the patient turns to the side. This finding is called:
A. Rebound tenderness
B. Shifting dullness
C. Puddle sign
D. Fluid wave
Correct Answer: B
Rationale: Shifting dullness is the classic percussion finding for ascites: tympany
centrally (bowel gas floats) with dullness in the flanks (fluid settles dependently), and
the dullness shifts when the patient changes position. Option A (rebound tenderness)
indicates peritoneal inflammation. Option C (puddle sign) detects small amounts of
ascitic fluid (≥120 mL) with the patient in a knee-chest position. Option D (fluid wave)
,requires an assistant to press on the midline while the examiner taps one flank and
feels the opposite flank for a transmitted wave.
Question 4
A 72-year-old woman is evaluated after a fall. Her blood pressure is 142/88 mmHg
supine and 118/72 mmHg standing after 3 minutes. She reports lightheadedness upon
standing. These findings are most consistent with:
A. Orthostatic hypotension
B. Postprandial hypotension
C. Supine hypertension
D. Autonomic dysreflexia
Correct Answer: A
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mmHg or
diastolic BP ≥10 mmHg within 3 minutes of standing, often accompanied by symptoms.
This patient shows a 24 mmHg systolic and 16 mmHg diastolic drop with symptoms.
Option B occurs after eating. Option C describes elevated BP while supine without
positional change. Option D occurs in patients with spinal cord injury above T6 with
uncontrolled sympathetic response.
Question 5
Select all that apply. When performing a Weber test on a patient with unilateral hearing
loss, which findings would indicate a conductive hearing loss in the affected ear?
(Select all that apply.)
A. Sound lateralizes to the affected ear
B. Sound lateralizes to the unaffected ear
C. Sound is heard equally in both ears
D. Rinne test shows air conduction > bone conduction in the affected ear
E. Rinne test shows bone conduction > air conduction in the affected ear
, Correct Answer: A, E
Rationale: In conductive hearing loss, the Weber test lateralizes to the affected ear
because ambient noise masking is reduced on that side, allowing better bone
conduction perception. The Rinne test shows bone conduction > air conduction (BC >
AC) in the affected ear because the conductive deficit prevents efficient air conduction
transmission. Option B indicates sensorineural loss in the affected ear. Option C is
normal. Option D (AC > BC) is normal or indicates sensorineural loss.
Question 6
A 34-year-old pregnant patient at 28 weeks gestation reports progressive shortness of
breath when climbing stairs. Physical examination reveals a widely split S1, an
accentuated S3, and mild peripheral edema. Cardiac output is increased. Which
statement best explains these findings?
A. The patient has developed peripartum cardiomyopathy
B. These are expected physiologic changes of pregnancy
C. The findings indicate mitral valve prolapse exacerbated by pregnancy
D. The patient has a pulmonary embolism
Correct Answer: B
Rationale: Normal pregnancy physiology includes increased cardiac output (30-50%
increase), a widely split S1 due to delayed closure of the tricuspid valve, a physiologic
S3 from increased blood volume, and mild peripheral edema from venous compression
and increased hydrostatic pressure. Option A (peripartum cardiomyopathy) would
present with signs of heart failure (gallops, severe edema, pulmonary crackles) and
typically occurs in the last month of pregnancy or first 5 months postpartum. Option C
would present with a midsystolic click and late systolic murmur. Option D would present
with sudden dyspnea, tachypnea, pleuritic chest pain, and possibly hemoptysis.
Question 7
Questions with Detailed Rationales | 100% Verified – Pass
Guaranteed – A+ Graded
Question 1
During a cardiovascular examination of a 58-year-old male, the nurse practitioner
auscultates the aortic valve area and hears a high-pitched, blowing diastolic murmur
that radiates toward the apex. The patient reports progressive dyspnea on exertion.
Which valvular disorder is most consistent with these findings?
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Mitral regurgitation
Correct Answer: B
Rationale: Aortic regurgitation (AR) produces a high-pitched, blowing diastolic
decrescendo murmur best heard at the second right intercostal space (aortic area) with
radiation toward the apex. The progressive dyspnea on exertion reflects left ventricular
volume overload and eventual heart failure. Option A (aortic stenosis) produces a harsh
crescendo-decrescendo systolic murmur. Option C (mitral stenosis) produces a
low-pitched diastolic rumble at the apex with an opening snap. Option D (mitral
regurgitation) produces a holosystolic blowing murmur at the apex radiating to the
axilla.
Question 2
A 4-year-old child is brought to the clinic with fever, sore throat, and a sandpaper-like
rash that began on the neck and chest and spread to the extremities. The tongue is
,bright red with prominent papillae. Which assessment finding would the nurse
practitioner expect on palpation of the cervical lymph nodes?
A. Small, mobile, non-tender anterior cervical nodes
B. Bilateral, tender, enlarged anterior cervical nodes
C. Firm, fixed, matted posterior cervical nodes
D. Shotty, non-tender supraclavicular nodes
Correct Answer: B
Rationale: This child has scarlet fever (group A streptococcal pharyngitis with
erythrogenic toxin). Tender, enlarged anterior cervical lymph nodes are characteristic of
acute bacterial pharyngitis. Option A describes normal or viral lymphadenopathy. Option
C (firm, fixed, matted nodes) suggests malignancy or tuberculosis. Option D (shotty
nodes) is typical of viral infections; supraclavicular nodes are concerning for
malignancy.
Question 3
During abdominal percussion of a 45-year-old patient with suspected ascites, the nurse
practitioner notes a tympanitic sound in the umbilical region and dullness in the flanks
that shifts when the patient turns to the side. This finding is called:
A. Rebound tenderness
B. Shifting dullness
C. Puddle sign
D. Fluid wave
Correct Answer: B
Rationale: Shifting dullness is the classic percussion finding for ascites: tympany
centrally (bowel gas floats) with dullness in the flanks (fluid settles dependently), and
the dullness shifts when the patient changes position. Option A (rebound tenderness)
indicates peritoneal inflammation. Option C (puddle sign) detects small amounts of
ascitic fluid (≥120 mL) with the patient in a knee-chest position. Option D (fluid wave)
,requires an assistant to press on the midline while the examiner taps one flank and
feels the opposite flank for a transmitted wave.
Question 4
A 72-year-old woman is evaluated after a fall. Her blood pressure is 142/88 mmHg
supine and 118/72 mmHg standing after 3 minutes. She reports lightheadedness upon
standing. These findings are most consistent with:
A. Orthostatic hypotension
B. Postprandial hypotension
C. Supine hypertension
D. Autonomic dysreflexia
Correct Answer: A
Rationale: Orthostatic hypotension is defined as a drop in systolic BP ≥20 mmHg or
diastolic BP ≥10 mmHg within 3 minutes of standing, often accompanied by symptoms.
This patient shows a 24 mmHg systolic and 16 mmHg diastolic drop with symptoms.
Option B occurs after eating. Option C describes elevated BP while supine without
positional change. Option D occurs in patients with spinal cord injury above T6 with
uncontrolled sympathetic response.
Question 5
Select all that apply. When performing a Weber test on a patient with unilateral hearing
loss, which findings would indicate a conductive hearing loss in the affected ear?
(Select all that apply.)
A. Sound lateralizes to the affected ear
B. Sound lateralizes to the unaffected ear
C. Sound is heard equally in both ears
D. Rinne test shows air conduction > bone conduction in the affected ear
E. Rinne test shows bone conduction > air conduction in the affected ear
, Correct Answer: A, E
Rationale: In conductive hearing loss, the Weber test lateralizes to the affected ear
because ambient noise masking is reduced on that side, allowing better bone
conduction perception. The Rinne test shows bone conduction > air conduction (BC >
AC) in the affected ear because the conductive deficit prevents efficient air conduction
transmission. Option B indicates sensorineural loss in the affected ear. Option C is
normal. Option D (AC > BC) is normal or indicates sensorineural loss.
Question 6
A 34-year-old pregnant patient at 28 weeks gestation reports progressive shortness of
breath when climbing stairs. Physical examination reveals a widely split S1, an
accentuated S3, and mild peripheral edema. Cardiac output is increased. Which
statement best explains these findings?
A. The patient has developed peripartum cardiomyopathy
B. These are expected physiologic changes of pregnancy
C. The findings indicate mitral valve prolapse exacerbated by pregnancy
D. The patient has a pulmonary embolism
Correct Answer: B
Rationale: Normal pregnancy physiology includes increased cardiac output (30-50%
increase), a widely split S1 due to delayed closure of the tricuspid valve, a physiologic
S3 from increased blood volume, and mild peripheral edema from venous compression
and increased hydrostatic pressure. Option A (peripartum cardiomyopathy) would
present with signs of heart failure (gallops, severe edema, pulmonary crackles) and
typically occurs in the last month of pregnancy or first 5 months postpartum. Option C
would present with a midsystolic click and late systolic murmur. Option D would present
with sudden dyspnea, tachypnea, pleuritic chest pain, and possibly hemoptysis.
Question 7
