INSTANT PDF DOWNLOAD — This comprehensive final exam resource for NUR 631 Advanced Health Assessment at Chamberlain University / Graduate Nursing Program covers the 2026/2027 academic year final examination. It features actual exam questions with verified answers and detailed rationales in Next Generation NCLEX (NGN) style formats including multiple-choice, select-all-that-apply (SATA), ordered response, drag-and-drop, cloze (fill-in-the-blank), and clinical judgment case study scenarios aligned with graduate-level advanced practice nursing standards.
ADVANCED HEALTH ASSESSMENT CONCEPTS (FINAL EXAM FOCUS)
COMPREHENSIVE HISTORY TAKING
Comprehensive Health History Components – Identifying data (age, gender, race/ethnicity, occupation, source of history, reliability). Chief complaint (CC) – reason for seeking care, ideally in patient's own words (direct quote). History of present illness (HPI) – OLDCARTS or OLD CAAARTS mnemonic: Onset (when did symptom start? sudden or gradual?), Location (where is symptom? does it radiate? point with one finger), Duration (how long does symptom last when occurs? constant or intermittent?), Character (describe quality – sharp, dull, burning, stabbing, throbbing, aching, pressure, tightness, tearing, ripping, crushing, heaviness, tingling, numbness, electric shock feeling, burning, cold, itching, cramping, colicky, gnawing). Aggravating factors (what makes symptom worse? movement, position, activity, eating, breathing, palpation, stress, cold, heat, time of day, specific triggers). Alleviating (relieving) factors (what makes symptom better? rest, medication, position, ice, heat, distraction, food, drink, bowel movement, urination, passing gas, lying down, sitting up, leaning forward). Radiation (does pain radiate anywhere?), Timing (when does symptom occur? morning, night, after meals, with specific activities, relationship to menstrual cycle, season), Severity (rate 0-10 scale, functional impact, compare to prior episodes). Treatment (what has been tried? any medications? any response?). Understanding (what does patient think is causing symptom?). Values (what level of pain or functional impairment is acceptable to patient?). Past medical history (PMH): childhood illnesses, adult medical conditions (hypertension, diabetes, heart disease, stroke, cancer, thyroid disease, asthma, COPD, arthritis, kidney disease, liver disease, psychiatric conditions), surgeries (type, year, complications, anesthesia issues), hospitalizations (reason, year, duration), trauma/injuries (including head injury with loss of consciousness), transfusions (including reactions), immunizations (status (up to date, overdue, declined, contraindications), last tetanus, influenza annually, pneumococcal (PPSV23 and PCV13), COVID-19 (primary series and boosters), herpes zoster (Shingrix) age 50+, Tdap (tetanus, diphtheria, pertussis) every 10 years, HPV (up to age 45), hepatitis A and B series if at risk, MenACWY and MenB for adolescents/young adults, MMR if no immunity (titer), varicella if no history of chickenpox or vaccination). Family history (FH): first-degree relatives (parents, siblings, children), second-degree (grandparents, aunts, uncles, nieces, nephews). Conditions: hypertension, diabetes, heart disease (age of onset), stroke (age), cancer (type, age of onset), sudden cardiac death (50 years), hereditary conditions (Hereditary Hemochromatosis, Familial Hypercholesterolemia, Marfan syndrome, Ehlers-Danlos syndrome, Polycystic Kidney Disease, Huntington's disease, Cystic Fibrosis, Sickle Cell Trait/Disease, Factor V Leiden, BRCA1/BRCA2, Lynch syndrome). Autoimmune diseases (rheumatoid arthritis, lupus, multiple sclerosis, type 1 diabetes, celiac disease, inflammatory bowel disease (Crohn's, Ulcerative Colitis), thyroid disease (Hashimoto's, Graves'), psoriasis, Sjögren's syndrome), psychiatric conditions (depression, bipolar disorder, schizophrenia, anxiety, OCD, PTSD, eating disorders, substance use disorder, ADHD, autism, suicide (completed)). Family pedigree (minimum three generations, symbols: male=square, female=circle, affected=shaded, deceased=slash, proband=arrow, consultand=arrow with C, pregnancy=P, miscarriage=S, stillbirth=triangle, twins=vertical lines from same circle, monozygotic vs dizygotic lines, consanguinity=double horizontal line). Social history (SH): occupation (exposures (asbestos, silica, chemicals, radiation, heavy metals, noise, extreme temperatures), physical demands (lifting, standing, sitting, repetitive motion)), tobacco use (pack-years calculation = packs per day x years smoking, current use, former use (quit date), type (cigarettes, cigars, pipe, e-cigarettes/vaping, smokeless tobacco), secondhand smoke exposure). Alcohol use (CAGE questionnaire (Cut down, Annoyed by criticism, Guilty about drinking, Eye-opener), AUDIT-C (Alcohol Use Disorders Identification Test), number of drinks per day/week, binge drinking (5 drinks men, 4 drinks women on one occasion), last use, substance use (illicit drugs (marijuana, cocaine, heroin, methamphetamine, hallucinogens, MDMA, PCP), prescription misuse (opioids, benzodiazepines, stimulants), last use, route (oral, inhaled, intranasal, IV, IM, transdermal, rectal)). Sexual history (partners (men, women, both, number in last 6 months, number lifetime), STI history (gonorrhea, chlamydia, syphilis, HIV, HSV, HPV, hepatitis B, hepatitis C, trichomoniasis, pelvic inflammatory disease (PID)), contraception (method (oral contraceptive pill, patch, ring, injection, implant, IUD (copper, hormonal), diaphragm, cervical cap, sponge, spermicide, condoms (male, female), withdrawal, fertility awareness, sterilization (tubal ligation, vasectomy), emergency contraception (Plan B (levonorgestrel), Ella (ulipristal acetate), copper IUD)), barrier protection for STI prevention (condoms, dental dams). Pregnancy history (gravida (number of pregnancies), para (number of births at ≥20 weeks), abortions (spontaneous, induced), ectopic, living children, last pap smear (date, result, HPV co-testing), last mammogram (date, result, BI-RADS score), prostate cancer screening (PSA (prostate-specific antigen) date and result, digital rectal exam (DRE) date and finding), colon cancer screening (colonoscopy (date, finding (normal, polyps (number, type, pathology), cancer), next due, Cologuard (date, result), FIT (date, result), CT colonography (date, result)). Review of systems (ROS): systematic review of body systems for presence or absence of symptoms not already covered in HPI. General (weight change (loss or gain, amount, time frame, intentional vs unintentional), fever, chills, night sweats, fatigue, malaise, weakness, activity intolerance, exercise tolerance, sleep (hours per night, quality, difficulty falling asleep, staying asleep, early awakening, daytime sleepiness), constitutional symptoms. HEENT: head (headache (location, quality, timing, triggers, aura, prodrome, postdrome), head injury (loss of consciousness, amnesia, vomiting, seizure, mechanism), dizziness (lightheadedness, vertigo (room spinning, nausea, vomiting, nystagmus), disequilibrium, presyncope), syncope (preceding symptoms, position, activity, recovery). Eyes: vision changes (blurred, double, floaters, flashes, blind spots, halos, distortion), eye pain, redness, discharge, dryness, itching, tearing, photophobia, history of glaucoma (type, medications, last eye exam, intraocular pressure), cataracts, macular degeneration, diabetic retinopathy, contact lens use (type, cleaning, wearing schedule, last replaced), corrective lenses (glasses, contacts, LASIK/PRK). Ears: hearing loss (gradual, sudden, unilateral, bilateral), tinnitus (ringing, buzzing, roaring, pulsatile), vertigo, ear pain, ear discharge (blood, pus, clear fluid), ear fullness, history of ear infections, surgery (tympanostomy tubes, tympanoplasty, stapedectomy), noise exposure (occupational, recreational, use of hearing protection). Nose and sinuses: nasal congestion, rhinorrhea (clear, purulent, bloody), sneezing, itching, post-nasal drip, sinus pain/pressure/fullness, facial pain (location), anosmia (loss of smell), hyposmia (decreased smell), parosmia (distorted smell), cacosmia (unpleasant smell), epistaxis (nosebleeds), history of sinusitis, nasal polyps, septal deviation, trauma, surgery. Mouth and throat: mouth pain, sore throat (duration, severity, associated symptoms), hoarseness (duration, voice changes), dysphagia (difficulty swallowing food/liquids, progressive, intermittent), odynophagia (painful swallowing), globus sensation (sensation of lump in throat), dry mouth, oral lesions (sores, ulcers, white patches (leukoplakia), red patches (erythroplakia), vesicles, bullae), bleeding gums, dental pain, loose or missing teeth, dentures (fit, comfort), bad breath (halitosis), taste changes (dysgeusia), history of tonsillitis, strep throat, oral cancer. Neck: neck pain, stiffness, swelling or masses (location, size, tenderness, mobility, consistency, change over time), goiter (thyroid enlargement), lymphadenopathy, tenderness, limited range of motion, history of thyroid disease, neck surgery, trauma. Respiratory: cough (dry, productive (sputum color, amount, consistency (purulent, mucoid, bloody, frothy), hemoptysis (blood-tinged, frank blood)), wheezing, shortness of breath (dyspnea on exertion (DOE), at rest, paroxysmal nocturnal dyspnea (PND), orthopnea (number of pillows)), sputum production, chest pain with breathing (pleuritic), respiratory infections (frequency, last episode, treatment). Cardiovascular: chest pain (pressure, tightness, squeezing, heaviness, crushing, substernal, radiation to left arm, jaw, neck, back, shoulder, epigastrium), palpitations (awareness of heartbeat, irregular, racing, fluttering, pounding, skipping), dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema (swelling of feet, ankles, legs (bilateral, unilateral, pitting, non-pitting)), cyanosis, claudication (leg pain with walking, relieved by rest), history of murmur, hypertension, coronary artery disease, myocardial infarction, heart failure, arrhythmias (atrial fibrillation, atrial flutter, SVT, VT, VF, heart block), valvular heart disease, pericarditis, rheumatic fever, endocarditis, pacemaker or implantable cardioverter-defibrillator (ICD). Gastrointestinal: abdominal pain (location, character, radiation, timing, relation to meals, bowel movements), indigestion (dyspepsia), heartburn (pyrosis), regurgitation, nausea, vomiting (frequency, content (food, bilious, bloody, coffee-ground), color, volume), hematemesis (bloody vomiting), diarrhea (frequency, consistency, color, blood/mucus, urgency, incontinence, nocturnal), constipation (frequency, consistency, straining, sensation of incomplete evacuation, need for manual maneuvers), change in stool caliber, melena (black tarry stools), hematochezia (bright red blood per rectum), mucus in stool, steatorrhea (fatty stools, float, foul-smelling), abdominal bloating, excessive flatus, early satiety, loss of appetite, weight changes. Genitourinary: urinary frequency (day, night), urgency, dysuria (painful urination), hesitancy, straining, decreased stream, intermittent stream, terminal dribbling, sensation of incomplete emptying, hematuria (blood in urine), polyuria, nocturia, incontinence (stress, urge, mixed, overflow, functional), suprapubic pain, flank pain, history of UTI, kidney stones, BPH, prostate cancer, bladder cancer. Female reproductive: menstrual history (age at menarche, cycle length, duration of flow, amount of flow (pads/tampons per day), dysmenorrhea (pain with menses), intermenstrual bleeding, postmenopausal bleeding), obstetric history (gravid/para, abortions (spontaneous, induced), ectopic, living children, date of last delivery, mode of delivery (vaginal, cesarean), complications), sexual history, contraception, menopausal status