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EXAMS
(2026) Diagnostic Reasoning Questions | Health Assessment (PDF) |
Questions & Answers (Verified Answers) With Rationales (
Update)
This Document Contains:
NUR 612 Final Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NUR 612 Final Exam (2026) Diagnostic Reasoning Questions | Health
Assessment (PDF) - 2026/2027 Update
Page 1
,Question 1
A 45-year-old individual presents with acute-onset severe epigastric pain radiating to the back,
accompanied by nausea and vomiting. Serum lipase is elevated three times the upper limit. On
examination, there is guarding and rebound tenderness in the upper abdomen. Which of the
following findings would most strongly suggest a complication requiring immediate surgical
intervention?
A) Cullen sign and Grey Turner sign
B) Positive Murphy sign with fever
C) Hypoactive bowel sounds and distension
D) Erythema ab igne on the anterior abdomen
Answer: A) Cullen sign and Grey Turner sign
Explanation: Cullen sign (periumbilical ecchymosis) and Grey Turner sign (flank ecchymosis)
indicate retroperitoneal hemorrhage, often from necrotizing pancreatitis or ruptured
pseudoaneurysm, necessitating surgical consultation. Murphy sign is specific for
cholecystitis, not a complication of pancreatitis. Hypoactive bowel sounds suggest ileus,
common in pancreatitis but not surgical. Erythema ab igne is from chronic heat
exposure, unrelated.
Question 2
A 60-year-old with a history of hypertension and type 2 diabetes presents with sudden-onset,
severe, tearing chest pain that radiates to the back. Blood pressure is 200/110 mm Hg in the right
arm and 150/90 mm Hg in the left arm. Which diagnostic test is most appropriate to confirm the
suspected diagnosis?
A) CT angiography of the chest
B) Transthoracic echocardiogram
C) D-dimer assay
D) Ventilation-perfusion scan
Answer: A) CT angiography of the chest
Explanation: The presentation is classic for acute aortic dissection. CT angiography is the gold
standard for diagnosis, with high sensitivity and specificity. Transthoracic echo may
miss distal dissections. D-dimer is sensitive but not specific; it is used to rule out
pulmonary embolism, not dissection. V/Q scan is for pulmonary embolism.
Page 2
,Question 3
During a comprehensive health assessment, a clinician notes a positive Hoffmann sign in an
asymptomatic individual. Which of the following is the most appropriate next step?
A) Reassure the patient and document the finding
B) Order cervical spine MRI
C) Perform a Babinski test
D) Refer for neurosurgical evaluation
Answer: C) Perform a Babinski test
Explanation: Hoffmann sign indicates upper motor neuron lesion, but can be present in up to 3% of
normal individuals. The Babinski test (plantar reflex) is a more specific sign; if positive,
it suggests corticospinal tract dysfunction and warrants further investigation.
Reassurance alone is premature without further evaluation. MRI and neurosurgical
referral are indicated only if other signs of myelopathy are present.
Question 4
A 55-year-old with a 30-pack-year smoking history presents with hemoptysis and weight loss.
Chest X-ray shows a hilar mass. Which of the following findings on physical examination is most
consistent with superior vena cava syndrome?
A) Unilateral ptosis, miosis, and anhidrosis
B) Dilated neck veins and facial edema
C) Clubbing and cyanosis of the fingers
D) Tracheal deviation and distant breath sounds
Answer: B) Dilated neck veins and facial edema
Explanation: Superior vena cava syndrome results from obstruction of venous return from the head,
neck, and upper extremities, causing dilated neck veins and facial edema. Option A
describes Horner syndrome (from Pancoast tumor). Clubbing and cyanosis (option C)
are associated with chronic hypoxia, not SVC syndrome. Tracheal deviation and distant
breath sounds (option D) suggest pleural effusion or mass effect.
Page 3
, Question 5
A 70-year-old with atrial fibrillation on warfarin presents with acute onset of severe headache,
nausea, and photophobia. Vital signs are normal. Neurologic exam is non-focal. Which of the
following is the most appropriate initial diagnostic test?
A) Non-contrast head CT
B) Lumbar puncture
C) CT angiography of the head
D) MRI brain with contrast
Answer: A) Non-contrast head CT
Explanation: Given the presentation (severe headache, nausea, photophobia) and anticoagulation,
subarachnoid hemorrhage is a concern. Non-contrast head CT is the initial test of choice
to detect acute blood, with high sensitivity within first 6 hours. Lumbar puncture is done
if CT is negative but suspicion remains. CT angiography is for vascular lesions, not
first-line. MRI is less sensitive for acute subarachnoid hemorrhage.
Question 6
A 35-year-old presents with acute onset of severe right lower quadrant abdominal pain, nausea,
and low-grade fever. On examination, there is tenderness at McBurney's point. Which of the
following additional findings would most strongly support a diagnosis of acute appendicitis?
A) Positive psoas sign on the right
B) Positive Murphy sign
C) Positive obturator sign on the left
D) Hyperactive bowel sounds in all quadrants
Answer: A) Positive psoas sign on the right
Explanation: The psoas sign (pain on extension of the right hip) indicates irritation of the psoas
muscle by an inflamed appendix, often seen in retrocecal appendicitis. Murphy sign is
for cholecystitis. Obturator sign on the left would suggest pelvic pathology on the left,
not typical for appendicitis. Hyperactive bowel sounds are more common in
gastroenteritis.
Page 4
Download Download
EXAMS
(2026) Diagnostic Reasoning Questions | Health Assessment (PDF) |
Questions & Answers (Verified Answers) With Rationales (
Update)
This Document Contains:
NUR 612 Final Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NUR 612 Final Exam (2026) Diagnostic Reasoning Questions | Health
Assessment (PDF) - 2026/2027 Update
Page 1
,Question 1
A 45-year-old individual presents with acute-onset severe epigastric pain radiating to the back,
accompanied by nausea and vomiting. Serum lipase is elevated three times the upper limit. On
examination, there is guarding and rebound tenderness in the upper abdomen. Which of the
following findings would most strongly suggest a complication requiring immediate surgical
intervention?
A) Cullen sign and Grey Turner sign
B) Positive Murphy sign with fever
C) Hypoactive bowel sounds and distension
D) Erythema ab igne on the anterior abdomen
Answer: A) Cullen sign and Grey Turner sign
Explanation: Cullen sign (periumbilical ecchymosis) and Grey Turner sign (flank ecchymosis)
indicate retroperitoneal hemorrhage, often from necrotizing pancreatitis or ruptured
pseudoaneurysm, necessitating surgical consultation. Murphy sign is specific for
cholecystitis, not a complication of pancreatitis. Hypoactive bowel sounds suggest ileus,
common in pancreatitis but not surgical. Erythema ab igne is from chronic heat
exposure, unrelated.
Question 2
A 60-year-old with a history of hypertension and type 2 diabetes presents with sudden-onset,
severe, tearing chest pain that radiates to the back. Blood pressure is 200/110 mm Hg in the right
arm and 150/90 mm Hg in the left arm. Which diagnostic test is most appropriate to confirm the
suspected diagnosis?
A) CT angiography of the chest
B) Transthoracic echocardiogram
C) D-dimer assay
D) Ventilation-perfusion scan
Answer: A) CT angiography of the chest
Explanation: The presentation is classic for acute aortic dissection. CT angiography is the gold
standard for diagnosis, with high sensitivity and specificity. Transthoracic echo may
miss distal dissections. D-dimer is sensitive but not specific; it is used to rule out
pulmonary embolism, not dissection. V/Q scan is for pulmonary embolism.
Page 2
,Question 3
During a comprehensive health assessment, a clinician notes a positive Hoffmann sign in an
asymptomatic individual. Which of the following is the most appropriate next step?
A) Reassure the patient and document the finding
B) Order cervical spine MRI
C) Perform a Babinski test
D) Refer for neurosurgical evaluation
Answer: C) Perform a Babinski test
Explanation: Hoffmann sign indicates upper motor neuron lesion, but can be present in up to 3% of
normal individuals. The Babinski test (plantar reflex) is a more specific sign; if positive,
it suggests corticospinal tract dysfunction and warrants further investigation.
Reassurance alone is premature without further evaluation. MRI and neurosurgical
referral are indicated only if other signs of myelopathy are present.
Question 4
A 55-year-old with a 30-pack-year smoking history presents with hemoptysis and weight loss.
Chest X-ray shows a hilar mass. Which of the following findings on physical examination is most
consistent with superior vena cava syndrome?
A) Unilateral ptosis, miosis, and anhidrosis
B) Dilated neck veins and facial edema
C) Clubbing and cyanosis of the fingers
D) Tracheal deviation and distant breath sounds
Answer: B) Dilated neck veins and facial edema
Explanation: Superior vena cava syndrome results from obstruction of venous return from the head,
neck, and upper extremities, causing dilated neck veins and facial edema. Option A
describes Horner syndrome (from Pancoast tumor). Clubbing and cyanosis (option C)
are associated with chronic hypoxia, not SVC syndrome. Tracheal deviation and distant
breath sounds (option D) suggest pleural effusion or mass effect.
Page 3
, Question 5
A 70-year-old with atrial fibrillation on warfarin presents with acute onset of severe headache,
nausea, and photophobia. Vital signs are normal. Neurologic exam is non-focal. Which of the
following is the most appropriate initial diagnostic test?
A) Non-contrast head CT
B) Lumbar puncture
C) CT angiography of the head
D) MRI brain with contrast
Answer: A) Non-contrast head CT
Explanation: Given the presentation (severe headache, nausea, photophobia) and anticoagulation,
subarachnoid hemorrhage is a concern. Non-contrast head CT is the initial test of choice
to detect acute blood, with high sensitivity within first 6 hours. Lumbar puncture is done
if CT is negative but suspicion remains. CT angiography is for vascular lesions, not
first-line. MRI is less sensitive for acute subarachnoid hemorrhage.
Question 6
A 35-year-old presents with acute onset of severe right lower quadrant abdominal pain, nausea,
and low-grade fever. On examination, there is tenderness at McBurney's point. Which of the
following additional findings would most strongly support a diagnosis of acute appendicitis?
A) Positive psoas sign on the right
B) Positive Murphy sign
C) Positive obturator sign on the left
D) Hyperactive bowel sounds in all quadrants
Answer: A) Positive psoas sign on the right
Explanation: The psoas sign (pain on extension of the right hip) indicates irritation of the psoas
muscle by an inflamed appendix, often seen in retrocecal appendicitis. Murphy sign is
for cholecystitis. Obturator sign on the left would suggest pelvic pathology on the left,
not typical for appendicitis. Hyperactive bowel sounds are more common in
gastroenteritis.
Page 4
