UR 101/ NUR101 Exam 4 – Health
N
Assessment Review ACTUAL EXAM
2026/2027 | Health Assessment Review |
Verified Q&A | Pass Guaranteed - A+
Graded
ART A – MULTIPLE CHOICE (Q1‑60)
P
Q1 (Clinical reasoning – diagnostic test selection): A 58-year-old male presents with sudden
onset dyspnea, pleuritic chest pain, and tachycardia. He recently had knee replacement surgery
5 days ago. The nurse practitioner uses the Wells score to assess pre-test probability. Which
Wells criterion carries the HIGHEST point value?
A. Clinical signs of DVT (3 points)
B. Alternative diagnosis less likely than PE (3 points)
C. Heart rate >100 bpm (1.5 points)
D. Immobilization or surgery within 4 weeks (1.5 points)
[CORRECT] B
Rationale: The Wells score for PE assigns 3 points to "alternative diagnosis less likely than PE,"
which is the highest-weighted criterion, reflecting its strong discriminatory value in clinical
reasoning. Option A (clinical signs of DVT) also carries 3 points, but "alternative diagnosis less
likely" is the most critical clinical judgment point and is often emphasized in teaching. Option C
(tachycardia) and D (immobilization) carry only 1.5 points each.
Clinical pearl: When Wells score is >4 (high probability), imaging (CT pulmonary angiography) is
indicated without waiting for D-dimer results.
Q2 (Special populations – bariatric assessment): A nurse is preparing to obtain vital signs on a
patient with BMI 48. Which action is MOST appropriate for accurate blood pressure
measurement?
A. Use a standard adult cuff on the forearm if the upper arm is too large
B. Use a thigh cuff on the upper arm to ensure complete encirclement
C. Use a large adult cuff (15 cm width) regardless of arm circumference
D. Use a wrist blood pressure monitor for consistency
[CORRECT] B
Rationale: For patients with large upper arms (>33 cm circumference), a thigh cuff (18 cm width)
should be used on the upper arm to ensure the bladder encircles at least 80% of the arm
circumference, per AHA guidelines. Option A (forearm measurement) produces falsely elevated
readings due to increased vascular resistance distal to the brachial artery. Option C (standard
,large adult cuff) is insufficient for arms >33 cm. Option D (wrist monitors) are less accurate and
should be avoided in bariatric patients.
Clinical pearl: Always measure arm circumference before selecting a cuff; using an undersized
cuff can overestimate BP by 10-30 mmHg.
Q3 (Mental health assessment – suicide risk): A 24-year-old college student is brought to the
clinic by a roommate who found a note mentioning "ending it all." Using the C-SSRS screening
tool, which question assesses the CRITICAL distinction between passive ideation and active
suicidal intent?
A. "Have you wished you were dead or wished you could go to sleep and not wake up?"
B. "Have you had these thoughts and had some intention of acting on them?"
C. "Have you been thinking about how you might do this?"
D. "Have you done anything to end your life?"
[CORRECT] B
Rationale: The C-SSRS distinguishes passive suicidal ideation (wishing to be dead) from active
suicidal intent by asking whether the patient has intention to act on thoughts, which is the critical
threshold for immediate safety intervention. Option A assesses passive ideation only. Option C
assesses suicidal planning (means/method) but not necessarily intent. Option D assesses past
suicide attempts.
Clinical pearl: Intent to act (not just ideation or planning) is the strongest predictor of imminent
suicide risk and requires immediate psychiatric evaluation and safety planning.
Q4 (Substance use assessment): A nurse is screening a patient for alcohol use disorder using
the AUDIT-C. Which response pattern would yield the HIGHEST possible score, indicating the
greatest concern?
A. Drinking 4+ times weekly, 5+ drinks per occasion, unable to cut down
B. Drinking 2-3 times monthly, 3-4 drinks per occasion, felt guilty
C. Drinking 2-4 times monthly, 2-3 drinks per occasion, needed eye-opener
D. Drinking 2-3 times weekly, 5-6 drinks per occasion, injured someone
[CORRECT] A
Rationale: The AUDIT-C scores frequency (0-4 points), quantity (0-4 points), and binge
drinking/inability to cut down (0-4 points), with a maximum of 12 points; option A describes the
highest frequency (4+ times = 4 points), highest quantity (5+ drinks = 4 points), and inability to
cut down (4 points) = 12 points total. Option D describes high quantity but lower frequency.
Options B and C describe lower overall patterns.
Clinical pearl: An AUDIT-C score ≥4 in men or ≥3 in women indicates unhealthy alcohol use
requiring brief intervention; scores ≥8 suggest alcohol use disorder requiring formal evaluation.
Q5 (Environmental/occupational health): A nurse in an occupational health clinic is assessing a
45-year-old construction worker who reports chronic cough, dyspnea on exertion, and chest
tightness. He has worked in demolition for 20 years. Which exposure is MOST likely
responsible?
A. Silica dust from concrete cutting
B. Lead paint from older buildings
C. Carbon monoxide from gasoline-powered equipment
D. Mold from water-damaged structures
[CORRECT] A
, ationale: Chronic silica exposure in construction/demolition causes silicosis, presenting with
R
progressive dyspnea, cough, and restrictive lung disease; silica is classified as a human
carcinogen by IARC. Option B (lead) primarily causes neurological and hematologic effects, not
chronic respiratory symptoms. Option C (carbon monoxide) causes acute poisoning, not chronic
cough. Option D (mold) can cause allergic reactions but is less likely to produce progressive
restrictive lung disease in this occupational context.
Clinical pearl: OSHA requires silica exposure monitoring and respiratory protection; workers
with >10 years of silica exposure should receive periodic chest X-rays.
Q6 (Genetic and genomic assessment): A nurse is constructing a three-generation pedigree for
a patient whose father has Huntington disease and whose mother is unaffected. What is the
probability that this patient has inherited the Huntington gene?
A. 25%
B. 50%
C. 75%
D. 100%
[CORRECT] B
Rationale: Huntington disease is an autosomal dominant disorder; an affected parent has a 50%
chance of transmitting the mutated gene to each offspring, regardless of the unaffected parent's
status. Option A (25%) would apply to autosomal recessive inheritance with two carrier parents.
Option C (75%) has no basis in Mendelian inheritance. Option D (100%) would only apply if
both parents were affected.
Clinical pearl: Autosomal dominant conditions show vertical transmission (affected individuals in
every generation), and genetic counseling is essential before predictive testing due to
psychological implications of knowing one's status.
Q7 (LGBTQ+ health assessment): A nurse is conducting a sexual history with a transgender
man (female-to-male) who has not undergone bottom surgery. Which question is MOST
inclusive and clinically relevant for STI screening?
A. "Do you have sex with men, women, or both?"
B. "What anatomy do you have that you use for sexual activity?"
C. "When was your last menstrual period?"
D. "Are you taking testosterone for transition?"
[CORRECT] B
Rationale: Asking about anatomy used for sexual activity is the most inclusive approach that
captures actual sexual practices and exposure risks without making assumptions about gender
identity or surgical status, per WPATH standards. Option A focuses on partner gender but may
miss anatomical risk factors. Option C assumes retained uterine function and may be
dysphoria-triggering. Option D, while relevant to overall health, does not directly inform STI
screening needs.
Clinical pearl: Use anatomically inclusive language (e.g., "front hole" or "genitals" as patient
prefers) and screen based on anatomy present, not gender identity alone.
Q8 (Clinical reasoning – cognitive bias): A nurse practitioner evaluates a 62-year-old with chest
pain and immediately attributes it to GERD because the patient had GERD documented three
years ago. The NP fails to order an ECG. Which cognitive bias is demonstrated?
A. Anchoring bias
, . Premature closure
B
C. Confirmation bias
D. Availability heuristic
[CORRECT] B
Rationale: Premature closure occurs when a clinician accepts a diagnosis before it has been
fully verified, stopping the diagnostic process prematurely; attributing chest pain to GERD
without ruling out cardiac causes exemplifies this dangerous error. Option A (anchoring)
involves over-relying on the first piece of information. Option C (confirmation bias) involves
seeking evidence to support a preconceived notion. Option D (availability heuristic) involves
judging probability based on recent memorable cases.
Clinical pearl: Chest pain in patients over 40 requires cardiac workup (ECG, troponins)
regardless of prior GERD diagnosis—always rule out life-threatening causes before accepting
benign explanations.
Q9 (Veterans health assessment): A nurse is screening a 34-year-old Iraq veteran for PTSD
using the PC-PTSD-5. Which symptom cluster is NOT included in this validated screening tool?
A. Re-experiencing (nightmares, flashbacks)
B. Avoidance (avoiding reminders)
C. Negative alterations in cognition/mood
D. Hyperarousal (hypervigilance, startle response)
[CORRECT] C
Rationale: The PC-PTSD-5 screens for re-experiencing, avoidance, hyperarousal, and numbing
(4 clusters), but does NOT include the DSM-5 "negative alterations in cognition and mood"
cluster, which requires more detailed clinical assessment. Options A, B, and D are all included
in the PC-PTSD-5.
Clinical pearl: A positive screen on PC-PTSD-5 (≥3 "yes" answers) requires referral for
comprehensive PTSD evaluation; veterans with burn pit exposure should also be screened for
respiratory conditions per 2022 PACT Act.
Q10 (Nutritional assessment – eating disorders): A nurse is assessing a 19-year-old female with
BMI 16.5 who reports restricting intake to 800 calories daily and exercising 3 hours daily. Which
finding is MOST concerning for imminent refeeding syndrome risk?
A. Serum potassium 3.2 mEq/L
B. Serum phosphorus 2.8 mg/dL
C. Recent weight loss of 15% in 3 months
D. Bradycardia (HR 48 bpm)
[CORRECT] B
Rationale: Hypophosphatemia (phosphorus <2.5 mg/dL) is the hallmark and most dangerous
manifestation of refeeding syndrome, which can cause cardiac failure, respiratory failure, and
death; a level of 2.8 mg/dL indicates depletion and high risk. Option A (hypokalemia) also
occurs but is less specific. Option C (rapid weight loss) is a risk factor but not an active
metabolic derangement. Option D (bradycardia) reflects starvation adaptation.
Clinical pearl: Before refeeding malnourished patients, check and replete phosphorus,
potassium, and magnesium; start nutrition at 10-20 kcal/kg and advance slowly with daily
electrolyte monitoring.
N
Assessment Review ACTUAL EXAM
2026/2027 | Health Assessment Review |
Verified Q&A | Pass Guaranteed - A+
Graded
ART A – MULTIPLE CHOICE (Q1‑60)
P
Q1 (Clinical reasoning – diagnostic test selection): A 58-year-old male presents with sudden
onset dyspnea, pleuritic chest pain, and tachycardia. He recently had knee replacement surgery
5 days ago. The nurse practitioner uses the Wells score to assess pre-test probability. Which
Wells criterion carries the HIGHEST point value?
A. Clinical signs of DVT (3 points)
B. Alternative diagnosis less likely than PE (3 points)
C. Heart rate >100 bpm (1.5 points)
D. Immobilization or surgery within 4 weeks (1.5 points)
[CORRECT] B
Rationale: The Wells score for PE assigns 3 points to "alternative diagnosis less likely than PE,"
which is the highest-weighted criterion, reflecting its strong discriminatory value in clinical
reasoning. Option A (clinical signs of DVT) also carries 3 points, but "alternative diagnosis less
likely" is the most critical clinical judgment point and is often emphasized in teaching. Option C
(tachycardia) and D (immobilization) carry only 1.5 points each.
Clinical pearl: When Wells score is >4 (high probability), imaging (CT pulmonary angiography) is
indicated without waiting for D-dimer results.
Q2 (Special populations – bariatric assessment): A nurse is preparing to obtain vital signs on a
patient with BMI 48. Which action is MOST appropriate for accurate blood pressure
measurement?
A. Use a standard adult cuff on the forearm if the upper arm is too large
B. Use a thigh cuff on the upper arm to ensure complete encirclement
C. Use a large adult cuff (15 cm width) regardless of arm circumference
D. Use a wrist blood pressure monitor for consistency
[CORRECT] B
Rationale: For patients with large upper arms (>33 cm circumference), a thigh cuff (18 cm width)
should be used on the upper arm to ensure the bladder encircles at least 80% of the arm
circumference, per AHA guidelines. Option A (forearm measurement) produces falsely elevated
readings due to increased vascular resistance distal to the brachial artery. Option C (standard
,large adult cuff) is insufficient for arms >33 cm. Option D (wrist monitors) are less accurate and
should be avoided in bariatric patients.
Clinical pearl: Always measure arm circumference before selecting a cuff; using an undersized
cuff can overestimate BP by 10-30 mmHg.
Q3 (Mental health assessment – suicide risk): A 24-year-old college student is brought to the
clinic by a roommate who found a note mentioning "ending it all." Using the C-SSRS screening
tool, which question assesses the CRITICAL distinction between passive ideation and active
suicidal intent?
A. "Have you wished you were dead or wished you could go to sleep and not wake up?"
B. "Have you had these thoughts and had some intention of acting on them?"
C. "Have you been thinking about how you might do this?"
D. "Have you done anything to end your life?"
[CORRECT] B
Rationale: The C-SSRS distinguishes passive suicidal ideation (wishing to be dead) from active
suicidal intent by asking whether the patient has intention to act on thoughts, which is the critical
threshold for immediate safety intervention. Option A assesses passive ideation only. Option C
assesses suicidal planning (means/method) but not necessarily intent. Option D assesses past
suicide attempts.
Clinical pearl: Intent to act (not just ideation or planning) is the strongest predictor of imminent
suicide risk and requires immediate psychiatric evaluation and safety planning.
Q4 (Substance use assessment): A nurse is screening a patient for alcohol use disorder using
the AUDIT-C. Which response pattern would yield the HIGHEST possible score, indicating the
greatest concern?
A. Drinking 4+ times weekly, 5+ drinks per occasion, unable to cut down
B. Drinking 2-3 times monthly, 3-4 drinks per occasion, felt guilty
C. Drinking 2-4 times monthly, 2-3 drinks per occasion, needed eye-opener
D. Drinking 2-3 times weekly, 5-6 drinks per occasion, injured someone
[CORRECT] A
Rationale: The AUDIT-C scores frequency (0-4 points), quantity (0-4 points), and binge
drinking/inability to cut down (0-4 points), with a maximum of 12 points; option A describes the
highest frequency (4+ times = 4 points), highest quantity (5+ drinks = 4 points), and inability to
cut down (4 points) = 12 points total. Option D describes high quantity but lower frequency.
Options B and C describe lower overall patterns.
Clinical pearl: An AUDIT-C score ≥4 in men or ≥3 in women indicates unhealthy alcohol use
requiring brief intervention; scores ≥8 suggest alcohol use disorder requiring formal evaluation.
Q5 (Environmental/occupational health): A nurse in an occupational health clinic is assessing a
45-year-old construction worker who reports chronic cough, dyspnea on exertion, and chest
tightness. He has worked in demolition for 20 years. Which exposure is MOST likely
responsible?
A. Silica dust from concrete cutting
B. Lead paint from older buildings
C. Carbon monoxide from gasoline-powered equipment
D. Mold from water-damaged structures
[CORRECT] A
, ationale: Chronic silica exposure in construction/demolition causes silicosis, presenting with
R
progressive dyspnea, cough, and restrictive lung disease; silica is classified as a human
carcinogen by IARC. Option B (lead) primarily causes neurological and hematologic effects, not
chronic respiratory symptoms. Option C (carbon monoxide) causes acute poisoning, not chronic
cough. Option D (mold) can cause allergic reactions but is less likely to produce progressive
restrictive lung disease in this occupational context.
Clinical pearl: OSHA requires silica exposure monitoring and respiratory protection; workers
with >10 years of silica exposure should receive periodic chest X-rays.
Q6 (Genetic and genomic assessment): A nurse is constructing a three-generation pedigree for
a patient whose father has Huntington disease and whose mother is unaffected. What is the
probability that this patient has inherited the Huntington gene?
A. 25%
B. 50%
C. 75%
D. 100%
[CORRECT] B
Rationale: Huntington disease is an autosomal dominant disorder; an affected parent has a 50%
chance of transmitting the mutated gene to each offspring, regardless of the unaffected parent's
status. Option A (25%) would apply to autosomal recessive inheritance with two carrier parents.
Option C (75%) has no basis in Mendelian inheritance. Option D (100%) would only apply if
both parents were affected.
Clinical pearl: Autosomal dominant conditions show vertical transmission (affected individuals in
every generation), and genetic counseling is essential before predictive testing due to
psychological implications of knowing one's status.
Q7 (LGBTQ+ health assessment): A nurse is conducting a sexual history with a transgender
man (female-to-male) who has not undergone bottom surgery. Which question is MOST
inclusive and clinically relevant for STI screening?
A. "Do you have sex with men, women, or both?"
B. "What anatomy do you have that you use for sexual activity?"
C. "When was your last menstrual period?"
D. "Are you taking testosterone for transition?"
[CORRECT] B
Rationale: Asking about anatomy used for sexual activity is the most inclusive approach that
captures actual sexual practices and exposure risks without making assumptions about gender
identity or surgical status, per WPATH standards. Option A focuses on partner gender but may
miss anatomical risk factors. Option C assumes retained uterine function and may be
dysphoria-triggering. Option D, while relevant to overall health, does not directly inform STI
screening needs.
Clinical pearl: Use anatomically inclusive language (e.g., "front hole" or "genitals" as patient
prefers) and screen based on anatomy present, not gender identity alone.
Q8 (Clinical reasoning – cognitive bias): A nurse practitioner evaluates a 62-year-old with chest
pain and immediately attributes it to GERD because the patient had GERD documented three
years ago. The NP fails to order an ECG. Which cognitive bias is demonstrated?
A. Anchoring bias
, . Premature closure
B
C. Confirmation bias
D. Availability heuristic
[CORRECT] B
Rationale: Premature closure occurs when a clinician accepts a diagnosis before it has been
fully verified, stopping the diagnostic process prematurely; attributing chest pain to GERD
without ruling out cardiac causes exemplifies this dangerous error. Option A (anchoring)
involves over-relying on the first piece of information. Option C (confirmation bias) involves
seeking evidence to support a preconceived notion. Option D (availability heuristic) involves
judging probability based on recent memorable cases.
Clinical pearl: Chest pain in patients over 40 requires cardiac workup (ECG, troponins)
regardless of prior GERD diagnosis—always rule out life-threatening causes before accepting
benign explanations.
Q9 (Veterans health assessment): A nurse is screening a 34-year-old Iraq veteran for PTSD
using the PC-PTSD-5. Which symptom cluster is NOT included in this validated screening tool?
A. Re-experiencing (nightmares, flashbacks)
B. Avoidance (avoiding reminders)
C. Negative alterations in cognition/mood
D. Hyperarousal (hypervigilance, startle response)
[CORRECT] C
Rationale: The PC-PTSD-5 screens for re-experiencing, avoidance, hyperarousal, and numbing
(4 clusters), but does NOT include the DSM-5 "negative alterations in cognition and mood"
cluster, which requires more detailed clinical assessment. Options A, B, and D are all included
in the PC-PTSD-5.
Clinical pearl: A positive screen on PC-PTSD-5 (≥3 "yes" answers) requires referral for
comprehensive PTSD evaluation; veterans with burn pit exposure should also be screened for
respiratory conditions per 2022 PACT Act.
Q10 (Nutritional assessment – eating disorders): A nurse is assessing a 19-year-old female with
BMI 16.5 who reports restricting intake to 800 calories daily and exercising 3 hours daily. Which
finding is MOST concerning for imminent refeeding syndrome risk?
A. Serum potassium 3.2 mEq/L
B. Serum phosphorus 2.8 mg/dL
C. Recent weight loss of 15% in 3 months
D. Bradycardia (HR 48 bpm)
[CORRECT] B
Rationale: Hypophosphatemia (phosphorus <2.5 mg/dL) is the hallmark and most dangerous
manifestation of refeeding syndrome, which can cause cardiac failure, respiratory failure, and
death; a level of 2.8 mg/dL indicates depletion and high risk. Option A (hypokalemia) also
occurs but is less specific. Option C (rapid weight loss) is a risk factor but not an active
metabolic derangement. Option D (bradycardia) reflects starvation adaptation.
Clinical pearl: Before refeeding malnourished patients, check and replete phosphorus,
potassium, and magnesium; start nutrition at 10-20 kcal/kg and advance slowly with daily
electrolyte monitoring.
