NURS 629 EXAM 2 MARYVILLE 2026/2027 Actual
Exam – Complete Questions & Detailed Rationales
– Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Health Assessment | Q1 – Q10
Section 2 | Differential Diagnosis | Q11 – Q20
Section 3 | Diagnostic Reasoning | Q21 – Q30
Section 4 | Clinical Decision Making | Q31 – Q40
Section 5 | Complex Case Integration | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
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SECTION 1: ADVANCED HEALTH ASSESSMENT Q1 – Q10
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Question 1 of 50
A 62-year-old male presents to the cardiology clinic with new-onset atrial fibrillation
detected on a routine ECG. He is asymptomatic except for mild fatigue. During cardiac
auscultation, the rhythm is irregularly irregular.
A. Palpate the carotid pulse to assess for parvus et tardus
B. Listen with the bell at the apex for a low-pitched diastolic murmur suggestive of
mitral stenosis ✓ CORRECT
C. Auscultate the lungs for bibasilar crackles indicating heart failure
D. Perform dynamic auscultation with handgrip to differentiate aortic stenosis severity
Correct Answer: B
,Rationale: In new-onset atrial fibrillation, assessing for mitral stenosis is crucial because
rheumatic valvular disease is a leading precipitant; the bell at the apex captures
low-frequency diastolic murmurs. Palpating for parvus et tardus assesses aortic
stenosis, which is unrelated to atrial fibrillation pathophysiology. New atrial fibrillation in
older adults always warrants a thorough valvular examination before initiating
anticoagulation.
Question 2 of 50
A 45-year-old female with a BMI of 32 and a waist circumference of 38 inches is
undergoing a routine wellness examination. Her blood pressure is 142/88 mmHg, and
laboratory studies reveal a fasting glucose of 118 mg/dL.
A. Caput medusae around the umbilicus indicating portal hypertension
B. Rebound tenderness suggesting underlying peritonitis
C. A pulsatile abdominal mass in the epigastrium
D. Hepatomegaly with a smooth, firm edge consistent with hepatic steatosis ✓
CORRECT
Correct Answer: D
Rationale: Hepatomegaly with a smooth, firm edge suggests nonalcoholic fatty liver
disease, which is strongly associated with metabolic syndrome and insulin resistance.
Caput medusae indicates portal hypertension from cirrhosis, a distinct pathology with
different implications. Abdominal assessment in patients with metabolic risk factors
should include careful liver palpation and percussion to identify early organ
involvement.
Question 3 of 50
A 28-year-old male collegiate soccer player reports anterior knee pain that worsens
when climbing stairs or sitting for long periods. The patellar grind test is positive, and he
experiences pain with resisted knee extension.
,A. No joint line tenderness or effusion supports patellofemoral pain syndrome ✓
CORRECT
B. Positive McMurray test with a painful click indicates a meniscal tear
C. Laxity on Lachman testing suggests anterior cruciate ligament insufficiency
D. Pain with valgus stress at 30 degrees of flexion confirms medial collateral ligament
injury
Correct Answer: A
Rationale: Patellofemoral pain syndrome typically presents without joint line tenderness
or effusion, whereas meniscal tears demonstrate localized joint line pain and possible
effusion. A positive McMurray test actually suggests a meniscal tear rather than
differentiating it from patellofemoral dysfunction. Knee examination should always
localize pain to the joint line, patella, or periarticular structures before ordering imaging.
Question 4 of 50
A 58-year-old female with a 40 pack-year smoking history presents with progressive
dyspnea on exertion. Percussion over the anterior chest yields a hyperresonant note,
and breath sounds are distant bilaterally.
A. High-pitched wheezes throughout expiration suggesting bronchospasm
B. Coarse rhonchi that clear with coughing consistent with mucus accumulation
C. Markedly diminished breath sounds with a prolonged expiratory phase ✓ CORRECT
D. Fine bibasilar crackles indicating interstitial fibrosis
Correct Answer: C
Rationale: Advanced emphysema destroys alveolar architecture and reduces effective
air movement, producing characteristically distant or diminished breath sounds with a
prolonged expiratory phase. Coarse rhonchi that clear with coughing are classic for
chronic bronchitis rather than emphysema. Distinguishing COPD phenotypes during
physical examination guides whether bronchodilators or anti-inflammatory therapies
should be prioritized.
, Question 5 of 50
A 35-year-old female complains of palpitations and occasional lightheadedness. Her
blood pressure is 110/72 mmHg and her heart rate is 96 beats per minute in a regular
rhythm. Auscultation reveals a mid-systolic click at the apex followed by a late systolic
murmur.
A. Handgrip maneuver to increase afterload and diminish the murmur intensity
B. Standing from a squatting position to reduce venous return and accentuate the click
✓ CORRECT
C. Supine leg raise to increase preload and shorten the murmur duration
D. Amyl nitrate inhalation to decrease afterload and delay the systolic click
Correct Answer: B
Rationale: The standing maneuver reduces venous return and left ventricular volume,
causing the mitral valve prolapse click and murmur to occur earlier and intensify.
Handgrip increases afterload and would not accentuate mitral valve prolapse findings.
Dynamic auscultation is essential for evaluating systolic clicks and murmurs in young
adults presenting with palpitations.
Question 6 of 50
A 72-year-old male with a recent lacunar stroke is undergoing a follow-up neurologic
examination. When asked to hold both arms fully supinated with his eyes closed, the
right arm slowly pronates and drifts downward within ten seconds.
A. This indicates cerebellar ataxia requiring further Romberg testing
B. This demonstrates posterior column loss from a sensory deficit
C. This confirms peripheral nerve injury in the brachial plexus
D. This reveals subtle corticospinal tract weakness not apparent on standard motor
testing ✓ CORRECT
Correct Answer: D
Exam – Complete Questions & Detailed Rationales
– Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Health Assessment | Q1 – Q10
Section 2 | Differential Diagnosis | Q11 – Q20
Section 3 | Diagnostic Reasoning | Q21 – Q30
Section 4 | Clinical Decision Making | Q31 – Q40
Section 5 | Complex Case Integration | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED HEALTH ASSESSMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 62-year-old male presents to the cardiology clinic with new-onset atrial fibrillation
detected on a routine ECG. He is asymptomatic except for mild fatigue. During cardiac
auscultation, the rhythm is irregularly irregular.
A. Palpate the carotid pulse to assess for parvus et tardus
B. Listen with the bell at the apex for a low-pitched diastolic murmur suggestive of
mitral stenosis ✓ CORRECT
C. Auscultate the lungs for bibasilar crackles indicating heart failure
D. Perform dynamic auscultation with handgrip to differentiate aortic stenosis severity
Correct Answer: B
,Rationale: In new-onset atrial fibrillation, assessing for mitral stenosis is crucial because
rheumatic valvular disease is a leading precipitant; the bell at the apex captures
low-frequency diastolic murmurs. Palpating for parvus et tardus assesses aortic
stenosis, which is unrelated to atrial fibrillation pathophysiology. New atrial fibrillation in
older adults always warrants a thorough valvular examination before initiating
anticoagulation.
Question 2 of 50
A 45-year-old female with a BMI of 32 and a waist circumference of 38 inches is
undergoing a routine wellness examination. Her blood pressure is 142/88 mmHg, and
laboratory studies reveal a fasting glucose of 118 mg/dL.
A. Caput medusae around the umbilicus indicating portal hypertension
B. Rebound tenderness suggesting underlying peritonitis
C. A pulsatile abdominal mass in the epigastrium
D. Hepatomegaly with a smooth, firm edge consistent with hepatic steatosis ✓
CORRECT
Correct Answer: D
Rationale: Hepatomegaly with a smooth, firm edge suggests nonalcoholic fatty liver
disease, which is strongly associated with metabolic syndrome and insulin resistance.
Caput medusae indicates portal hypertension from cirrhosis, a distinct pathology with
different implications. Abdominal assessment in patients with metabolic risk factors
should include careful liver palpation and percussion to identify early organ
involvement.
Question 3 of 50
A 28-year-old male collegiate soccer player reports anterior knee pain that worsens
when climbing stairs or sitting for long periods. The patellar grind test is positive, and he
experiences pain with resisted knee extension.
,A. No joint line tenderness or effusion supports patellofemoral pain syndrome ✓
CORRECT
B. Positive McMurray test with a painful click indicates a meniscal tear
C. Laxity on Lachman testing suggests anterior cruciate ligament insufficiency
D. Pain with valgus stress at 30 degrees of flexion confirms medial collateral ligament
injury
Correct Answer: A
Rationale: Patellofemoral pain syndrome typically presents without joint line tenderness
or effusion, whereas meniscal tears demonstrate localized joint line pain and possible
effusion. A positive McMurray test actually suggests a meniscal tear rather than
differentiating it from patellofemoral dysfunction. Knee examination should always
localize pain to the joint line, patella, or periarticular structures before ordering imaging.
Question 4 of 50
A 58-year-old female with a 40 pack-year smoking history presents with progressive
dyspnea on exertion. Percussion over the anterior chest yields a hyperresonant note,
and breath sounds are distant bilaterally.
A. High-pitched wheezes throughout expiration suggesting bronchospasm
B. Coarse rhonchi that clear with coughing consistent with mucus accumulation
C. Markedly diminished breath sounds with a prolonged expiratory phase ✓ CORRECT
D. Fine bibasilar crackles indicating interstitial fibrosis
Correct Answer: C
Rationale: Advanced emphysema destroys alveolar architecture and reduces effective
air movement, producing characteristically distant or diminished breath sounds with a
prolonged expiratory phase. Coarse rhonchi that clear with coughing are classic for
chronic bronchitis rather than emphysema. Distinguishing COPD phenotypes during
physical examination guides whether bronchodilators or anti-inflammatory therapies
should be prioritized.
, Question 5 of 50
A 35-year-old female complains of palpitations and occasional lightheadedness. Her
blood pressure is 110/72 mmHg and her heart rate is 96 beats per minute in a regular
rhythm. Auscultation reveals a mid-systolic click at the apex followed by a late systolic
murmur.
A. Handgrip maneuver to increase afterload and diminish the murmur intensity
B. Standing from a squatting position to reduce venous return and accentuate the click
✓ CORRECT
C. Supine leg raise to increase preload and shorten the murmur duration
D. Amyl nitrate inhalation to decrease afterload and delay the systolic click
Correct Answer: B
Rationale: The standing maneuver reduces venous return and left ventricular volume,
causing the mitral valve prolapse click and murmur to occur earlier and intensify.
Handgrip increases afterload and would not accentuate mitral valve prolapse findings.
Dynamic auscultation is essential for evaluating systolic clicks and murmurs in young
adults presenting with palpitations.
Question 6 of 50
A 72-year-old male with a recent lacunar stroke is undergoing a follow-up neurologic
examination. When asked to hold both arms fully supinated with his eyes closed, the
right arm slowly pronates and drifts downward within ten seconds.
A. This indicates cerebellar ataxia requiring further Romberg testing
B. This demonstrates posterior column loss from a sensory deficit
C. This confirms peripheral nerve injury in the brachial plexus
D. This reveals subtle corticospinal tract weakness not apparent on standard motor
testing ✓ CORRECT
Correct Answer: D
