NURS 6512 Advanced Health Assessment | Walden
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 68-year-old man presents to urgent care with 3 hours of acute chest pressure
that radiates to the left arm. He appears diaphoretic. Vital signs: BP 90/60, HR
105, RR 22, SpO₂ 94 % on room air. Auscultation reveals an S₄ gallop and a new
3/6 holosystolic murmur at the apex that radiates to the axilla. Lung fields are
clear. Which physical-exam finding is most concerning for acute papillary-muscle
rupture?
A. S₄ gallop
B. Murmur radiating to axilla
C. Clear lungs
D. BP 90/60
Correct Answer: B
Rationale: A new holosystolic murmur at the apex radiating to the axilla is
pathognomonic for acute mitral regurgitation due to papillary-muscle rupture
complicating infero-posterior MI. The S₄ may reflect decreased compliance but is
non-specific; clear lungs can occur because pulmonary edema may lag; hypotension is
a consequence, not the primary finding.
2. A 54-year-old woman with COPD (GOLD stage 3) reports increased dyspnea and
ankle edema for 1 week. Temperature 37 °C, HR 96, RR 26, JVP 7 cm above
sternal angle, bilateral pitting edema to knees. Lung auscultation reveals faint
wheezes and hyper-resonance; no crackles. Heart sounds are distant. Which
assessment maneuver best differentiates cor pulmonale from left-sided heart
, failure in this patient?
A. Hepatojugular reflux
B. Paradoxical pulse (pulsus paradoxus)
C. E-point septal separation on cardiac echo
D. Sit-up test
Correct Answer: A
Rationale: Positive hepatojugular reflux indicates right ventricular dysfunction or
elevated filling pressures typical of cor pulmonale. Crackles would suggest left-sided
failure but are absent; pulsus paradoxus evaluates tamponade/asthma severity; echo is
imaging, not a bedside maneuver.
3. A 6-year-old boy is brought in with a barking cough and hoarseness since
midnight. Temp 38 °C, RR 30, stridor audible at rest. He is alert but prefers sitting
up. Which next assessment action is most urgent?
A. Obtain peak expiratory flow
B. Inspect tonsils with tongue depressor
C. Assess response to nebulized epinephrine while preparing to intubate
D. Palpate cervical nodes
Correct Answer: C
Rationale: Stridor at rest indicates moderate-to-severe croup with potential airway
compromise; immediate airway assessment and readiness for intervention (racemic
epinephrine) supersede full exam maneuvers that could agitate the child.
4. A 32-year-old pregnant woman (G2P1, 30 weeks) reports sudden right calf pain.
Homans sign is negative, but calf circumference is 2 cm larger than left, and
there is mild erythema. Which additional physical exam test is most helpful?
A. Pratt sign (squeezing posterior tibial vein)
B. Buerger test (elevation-dependency)
C. Wells score elements (tenderness along venous system)
D. Knee arthrometer
, Correct Answer: C
Rationale: Clinical prediction rules (Wells) incorporate tenderness, swelling, and pitting
edema to stratify DVT probability; Homans and Pratt signs lack sensitivity/specificity in
pregnancy. Buerger test assesses arterial perfusion.
5. A 77-year-old woman with hypertension presents after a fall. She recalls hitting
her head but did not lose consciousness. She now complains of a mild
headache. Which geriatric assessment tool should be used first to determine her
baseline cognitive function?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale
Correct Answer: B
Rationale: MoCA is more sensitive than Mini-Cog for mild cognitive impairment
common in older adults; CAM diagnoses delirium (not baseline); GDS screens for
depression.
6. A 45-year-old man with alcohol-use disorder has ascites and dilated abdominal
wall veins that flow upward in the epigastrium. Which underlying pathophysiology
best explains this finding?
A. Inferior vena cava thrombosis
B. Portal hypertension with caput medusae
C. Right heart failure
D. Nephrotic syndrome
Correct Answer: B
Rationale: Direction of flow (upward) and dilated periumbilical veins indicate recanalized
umbilical vein due to portal hypertension (caput medusae). IVC obstruction would
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 68-year-old man presents to urgent care with 3 hours of acute chest pressure
that radiates to the left arm. He appears diaphoretic. Vital signs: BP 90/60, HR
105, RR 22, SpO₂ 94 % on room air. Auscultation reveals an S₄ gallop and a new
3/6 holosystolic murmur at the apex that radiates to the axilla. Lung fields are
clear. Which physical-exam finding is most concerning for acute papillary-muscle
rupture?
A. S₄ gallop
B. Murmur radiating to axilla
C. Clear lungs
D. BP 90/60
Correct Answer: B
Rationale: A new holosystolic murmur at the apex radiating to the axilla is
pathognomonic for acute mitral regurgitation due to papillary-muscle rupture
complicating infero-posterior MI. The S₄ may reflect decreased compliance but is
non-specific; clear lungs can occur because pulmonary edema may lag; hypotension is
a consequence, not the primary finding.
2. A 54-year-old woman with COPD (GOLD stage 3) reports increased dyspnea and
ankle edema for 1 week. Temperature 37 °C, HR 96, RR 26, JVP 7 cm above
sternal angle, bilateral pitting edema to knees. Lung auscultation reveals faint
wheezes and hyper-resonance; no crackles. Heart sounds are distant. Which
assessment maneuver best differentiates cor pulmonale from left-sided heart
, failure in this patient?
A. Hepatojugular reflux
B. Paradoxical pulse (pulsus paradoxus)
C. E-point septal separation on cardiac echo
D. Sit-up test
Correct Answer: A
Rationale: Positive hepatojugular reflux indicates right ventricular dysfunction or
elevated filling pressures typical of cor pulmonale. Crackles would suggest left-sided
failure but are absent; pulsus paradoxus evaluates tamponade/asthma severity; echo is
imaging, not a bedside maneuver.
3. A 6-year-old boy is brought in with a barking cough and hoarseness since
midnight. Temp 38 °C, RR 30, stridor audible at rest. He is alert but prefers sitting
up. Which next assessment action is most urgent?
A. Obtain peak expiratory flow
B. Inspect tonsils with tongue depressor
C. Assess response to nebulized epinephrine while preparing to intubate
D. Palpate cervical nodes
Correct Answer: C
Rationale: Stridor at rest indicates moderate-to-severe croup with potential airway
compromise; immediate airway assessment and readiness for intervention (racemic
epinephrine) supersede full exam maneuvers that could agitate the child.
4. A 32-year-old pregnant woman (G2P1, 30 weeks) reports sudden right calf pain.
Homans sign is negative, but calf circumference is 2 cm larger than left, and
there is mild erythema. Which additional physical exam test is most helpful?
A. Pratt sign (squeezing posterior tibial vein)
B. Buerger test (elevation-dependency)
C. Wells score elements (tenderness along venous system)
D. Knee arthrometer
, Correct Answer: C
Rationale: Clinical prediction rules (Wells) incorporate tenderness, swelling, and pitting
edema to stratify DVT probability; Homans and Pratt signs lack sensitivity/specificity in
pregnancy. Buerger test assesses arterial perfusion.
5. A 77-year-old woman with hypertension presents after a fall. She recalls hitting
her head but did not lose consciousness. She now complains of a mild
headache. Which geriatric assessment tool should be used first to determine her
baseline cognitive function?
A. Mini-Cog
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale
Correct Answer: B
Rationale: MoCA is more sensitive than Mini-Cog for mild cognitive impairment
common in older adults; CAM diagnoses delirium (not baseline); GDS screens for
depression.
6. A 45-year-old man with alcohol-use disorder has ascites and dilated abdominal
wall veins that flow upward in the epigastrium. Which underlying pathophysiology
best explains this finding?
A. Inferior vena cava thrombosis
B. Portal hypertension with caput medusae
C. Right heart failure
D. Nephrotic syndrome
Correct Answer: B
Rationale: Direction of flow (upward) and dilated periumbilical veins indicate recanalized
umbilical vein due to portal hypertension (caput medusae). IVC obstruction would
