GCU NUR 634 Midterm EXAM LATEST
2025/2026 ACTUAL SUMMER-FALL
SEMESTER EXAM GRADED A+
INSTRUCTIONS
● This comprehensive practice exam contains 100 questions for
the GCU NUR 634 Midterm
● Questions are formatted as multiple choice and
select-all-that-apply
● Each question includes the correct answer and a detailed
rationale
● Topics include: advanced health assessment, pathophysiology,
pharmacology, differential diagnosis, and clinical
decision-making
SECTION 1: ADVANCED HEALTH ASSESSMENT
(Questions 1-25)
Question 1
A 58-year-old male presents with a complaint of chest pain that
occurs with exertion and is relieved by rest. He describes the pain as a
heavy pressure in the center of his chest that radiates to his left jaw.
Which of the following is the most important initial question to ask?
,A) "How long does the pain last?"
B) "Does the pain occur at rest?"
C) "What were you doing when the pain started?"
D) "Have you ever had this pain before?"
Answer: C) "What were you doing when the pain started?"
Rationale: This question addresses the onset and precipitating factors
of the chest pain. Exertional chest pain relieved by rest is classic for
stable angina. The onset of symptoms in relation to activity helps
differentiate stable angina from unstable angina or myocardial
infarction. Asking about the activity at onset provides critical
information for determining the likelihood of coronary artery disease
and guides immediate management decisions.
Question 2
During a cardiovascular examination, you auscultate a systolic
ejection murmur at the right upper sternal border that radiates to the
carotids. The murmur is best heard with the patient leaning forward.
This is most consistent with which diagnosis?
A) Mitral stenosis
B) Aortic stenosis
C) Pulmonic stenosis
D) Hypertrophic cardiomyopathy
Answer: B) Aortic stenosis
Rationale: Aortic stenosis produces a systolic ejection murmur heard
best at the right upper sternal border (second intercostal space) with
radiation to the carotids. The murmur is often described as harsh and
,crescendo-decrescendo. Leaning forward during expiration enhances
the murmur. Aortic stenosis can lead to syncope, angina, and heart
failure if severe.
Question 3
A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. On examination, you note dry skin,
thinning hair, and a bradycardia of 52 beats per minute. Which
laboratory finding would you expect?
A) Elevated TSH, low free T4
B) Low TSH, high free T4
C) Normal TSH, normal free T4
D) Elevated TSH, elevated free T4
Answer: A) Elevated TSH, low free T4
Rationale: This patient presents with classic symptoms of
hypothyroidism. Primary hypothyroidism is characterized by an
elevated TSH due to the pituitary attempting to stimulate an
underactive thyroid gland, with a low free T4 level. Common
symptoms include fatigue, weight gain, cold intolerance, dry skin, and
bradycardia. Levothyroxine replacement therapy is the standard
treatment.
Question 4
A patient reports a sudden onset of severe, "tearing" chest pain that
radiates to the back. The pain is described as the worst pain of the
, patient's life. Blood pressure is 100/60 in the right arm and 140/80 in
the left arm. This presentation is most consistent with:
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Acute aortic dissection presents with sudden, severe,
tearing chest pain that often radiates to the back. Blood pressure
differential between arms (10-20 mmHg difference) is a classic
finding. The patient may have a history of hypertension or connective
tissue disorders. Immediate CT angiography is needed for diagnosis,
and this is a surgical emergency.
Question 5
A 32-year-old G2P1 at 28 weeks gestation presents with a blood
pressure of 145/95 mmHg. She reports a headache that has not
resolved with acetaminophen and visual changes including "spots" in
her vision. Which of the following is the most likely diagnosis?
A) Gestational hypertension
B) Chronic hypertension
C) Preeclampsia with severe features
D) Migraine headache
Answer: C) Preeclampsia with severe features
2025/2026 ACTUAL SUMMER-FALL
SEMESTER EXAM GRADED A+
INSTRUCTIONS
● This comprehensive practice exam contains 100 questions for
the GCU NUR 634 Midterm
● Questions are formatted as multiple choice and
select-all-that-apply
● Each question includes the correct answer and a detailed
rationale
● Topics include: advanced health assessment, pathophysiology,
pharmacology, differential diagnosis, and clinical
decision-making
SECTION 1: ADVANCED HEALTH ASSESSMENT
(Questions 1-25)
Question 1
A 58-year-old male presents with a complaint of chest pain that
occurs with exertion and is relieved by rest. He describes the pain as a
heavy pressure in the center of his chest that radiates to his left jaw.
Which of the following is the most important initial question to ask?
,A) "How long does the pain last?"
B) "Does the pain occur at rest?"
C) "What were you doing when the pain started?"
D) "Have you ever had this pain before?"
Answer: C) "What were you doing when the pain started?"
Rationale: This question addresses the onset and precipitating factors
of the chest pain. Exertional chest pain relieved by rest is classic for
stable angina. The onset of symptoms in relation to activity helps
differentiate stable angina from unstable angina or myocardial
infarction. Asking about the activity at onset provides critical
information for determining the likelihood of coronary artery disease
and guides immediate management decisions.
Question 2
During a cardiovascular examination, you auscultate a systolic
ejection murmur at the right upper sternal border that radiates to the
carotids. The murmur is best heard with the patient leaning forward.
This is most consistent with which diagnosis?
A) Mitral stenosis
B) Aortic stenosis
C) Pulmonic stenosis
D) Hypertrophic cardiomyopathy
Answer: B) Aortic stenosis
Rationale: Aortic stenosis produces a systolic ejection murmur heard
best at the right upper sternal border (second intercostal space) with
radiation to the carotids. The murmur is often described as harsh and
,crescendo-decrescendo. Leaning forward during expiration enhances
the murmur. Aortic stenosis can lead to syncope, angina, and heart
failure if severe.
Question 3
A 45-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. On examination, you note dry skin,
thinning hair, and a bradycardia of 52 beats per minute. Which
laboratory finding would you expect?
A) Elevated TSH, low free T4
B) Low TSH, high free T4
C) Normal TSH, normal free T4
D) Elevated TSH, elevated free T4
Answer: A) Elevated TSH, low free T4
Rationale: This patient presents with classic symptoms of
hypothyroidism. Primary hypothyroidism is characterized by an
elevated TSH due to the pituitary attempting to stimulate an
underactive thyroid gland, with a low free T4 level. Common
symptoms include fatigue, weight gain, cold intolerance, dry skin, and
bradycardia. Levothyroxine replacement therapy is the standard
treatment.
Question 4
A patient reports a sudden onset of severe, "tearing" chest pain that
radiates to the back. The pain is described as the worst pain of the
, patient's life. Blood pressure is 100/60 in the right arm and 140/80 in
the left arm. This presentation is most consistent with:
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Acute aortic dissection presents with sudden, severe,
tearing chest pain that often radiates to the back. Blood pressure
differential between arms (10-20 mmHg difference) is a classic
finding. The patient may have a history of hypertension or connective
tissue disorders. Immediate CT angiography is needed for diagnosis,
and this is a surgical emergency.
Question 5
A 32-year-old G2P1 at 28 weeks gestation presents with a blood
pressure of 145/95 mmHg. She reports a headache that has not
resolved with acetaminophen and visual changes including "spots" in
her vision. Which of the following is the most likely diagnosis?
A) Gestational hypertension
B) Chronic hypertension
C) Preeclampsia with severe features
D) Migraine headache
Answer: C) Preeclampsia with severe features
