GCU NUR 634 Midterm EXAM LATEST 2026/2027 ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A
OBJECTIVE ASSESSMENT - EXAM
GCU NUR 634 Midterm EXAM LATEST
2026/2027 ACTUAL SUMMER-FALL
SEMESTER EXAM GRADED A
2026/2027 OFFICIAL EXAM
75 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Advanced Health Assessment Health History & Interviewing
Diagnostic Reasoning & Clinical Judgment Cultural & Psychosocial Assessment
Physical Examination Techniques Evidence-Based Practice
COVER PAGE - 1
, SECTION 1 | Advanced Health Assessment | Q1-Q15 | GCU NUR 634 Midterm EXAM LATEST 2026/2027 ACTUAL SUMM
Q1 Question 1 of 75
Q1. A 52-year-old male presents to the primary care clinic for a routine physical examination. The nurse
practitioner plans to perform a comprehensive head-to-toe assessment. Which sequence of examination
techniques follows the standard recommended order for most body systems?
A. Inspection, palpation, percussion, auscultation for all body systems
B. Auscultation, inspection, palpation, percussion for all body systems
C. Inspection, palpation, percussion, auscultation except abdomen which is inspect, auscultate, percuss, palpate
D. Palpation, percussion, inspection, auscultation except abdomen which begins with palpation
Correct Answer: C
Rationale:
The standard examination order is inspection, palpation, percussion, auscultation for most systems. The abdomen is
the exception because palpation and percussion can alter bowel sounds, so the abdomen is examined as inspect,
auscultate, percuss, palpate. The other options either apply auscultation first universally or fail to acknowledge the
abdominal exception.
Q2 Question 2 of 75
Q2. A 67-year-old female with chronic heart failure presents to the clinic with bilateral lower extremity swelling.
On examination, the nurse practitioner notes that pressing a finger against the tibia leaves a 6 mm depression
that takes 45 seconds to rebound. Which grade of pitting edema does this finding represent?
A. Grade 3 pitting edema with a 6 mm depression
B. Grade 1 pitting edema with a 2 mm depression
C. Grade 2 pitting edema with a 4 mm depression
D. Grade 4 pitting edema with an 8 mm depression
Correct Answer: A
Rationale:
Pitting edema is graded on a 1-4 scale: Grade 1 is 2 mm, Grade 2 is 4 mm, Grade 3 is 6 mm, and Grade 4 is 8 mm. A 6
mm depression corresponds to Grade 3 pitting edema, often associated with moderate venous insufficiency or heart
failure. Grade 4 is more severe and typically accompanied by a longer rebound time exceeding several minutes.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 2 of 41
, Q3 Question 3 of 75
Q3. A 45-year-old male presents with acute onset of severe chest pain radiating to the left arm. The nurse
practitioner auscultates the heart and notes a high-pitched, blowing holosystolic murmur best heard at the apex
radiating to the axilla. Which valve abnormality is most consistent with this finding?
A. Aortic regurgitation producing a diastolic decrescendo murmur at the left sternal border
B. Mitral regurgitation producing a holosystolic murmur at the apex radiating to the axilla
C. Aortic stenosis producing a systolic ejection murmur at the right second intercostal space
D. Mitral stenosis producing a diastolic rumble at the apex with an opening snap
Correct Answer: B
Rationale:
Mitral regurgitation produces a high-pitched, blowing holosystolic murmur best heard at the apex radiating to the axilla
due to retrograde flow from the left ventricle to the left atrium during systole. Aortic regurgitation is diastolic at the left
sternal border; aortic stenosis is systolic ejection at the right second ICS; mitral stenosis produces a diastolic rumble.
Location, timing, and radiation differentiate these murmurs.
Q4 Question 4 of 75
Q4. A 70-year-old female presents with fatigue and pallor. On examination of the conjunctiva, the nurse
practitioner notes pale conjunctiva. To estimate hemoglobin level at the bedside, the clinician examines the
inferior palpebral conjunctiva. Which finding suggests a hemoglobin less than 10 g/dL?
A. Pale, washed-out conjunctiva with loss of normal vascular pattern
B. Bright pink conjunctiva with prominent vessels and brisk capillary refill
C. Deep red conjunctiva with engorged vessels and presence of discharge
D. Yellow-tinged conjunctiva with scleral icterus visible in natural light
Correct Answer: A
Rationale:
Pale, washed-out conjunctiva with loss of normal vascular pattern is consistent with significant anemia, correlating with
hemoglobin levels less than 10 g/dL. Bright pink conjunctiva is normal; deep red with discharge suggests conjunctivitis;
yellow-tinged conjunctiva with scleral icterus suggests jaundice from liver disease. Conjunctival examination is a
validated bedside screening tool for anemia.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 3 of 41
, Q5 Question 5 of 75
Q5. A 58-year-old male with a 30-pack-year smoking history presents with chronic cough. The nurse practitioner
performs a respiratory examination and notes decreased tactile fremitus over the right lower lobe. Which
underlying pathophysiology most likely explains this finding?
A. Pleural effusion or bronchial obstruction decreasing transmission of vibrations
B. Consolidation from bacterial pneumonia increasing density of lung tissue
C. Pulmonary fibrosis causing increased density of lung parenchyma
D. Pneumothorax on the contralateral side increasing vibrations on the affected side
Correct Answer: A
Rationale:
Decreased tactile fremitus occurs when sound transmission is impaired by fluid, air, or obstruction between the lung and
chest wall, as seen in pleural effusion or bronchial obstruction. Consolidation and pulmonary fibrosis increase density
and increase fremitus; pneumothorax on the contralateral side would not explain changes on the affected side. Density
changes transmission of vibrations through the chest wall.
Q6 Question 6 of 75
Q6. A 34-year-old female presents with a thyroid nodule found on routine examination. The nurse practitioner
performs thyroid palpation using the posterior approach. Which technique is correctly described for this
examination?
A. Stand facing the patient and palpate the thyroid using both thumbs anteriorly
B. Stand at the patient's side and use one hand to stabilize the head while palpating with the other
C. Position the patient supine with neck extended and palpate from the head of the bed
D. Stand behind the patient, place fingers on the lower neck, and have the patient swallow water to assess the
gland
Correct Answer: D
Rationale:
The posterior approach to thyroid palpation involves standing behind the seated patient, placing fingers on the lower
neck over the thyroid isthmus and lobes, and having the patient swallow sips of water to elevate the thyroid. The
anterior approach uses thumbs from the front; side-lying and supine positions are not standard thyroid examination
techniques. Swallowing accentuates nodules and asymmetry.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 4 of 41
OBJECTIVE ASSESSMENT - EXAM
GCU NUR 634 Midterm EXAM LATEST
2026/2027 ACTUAL SUMMER-FALL
SEMESTER EXAM GRADED A
2026/2027 OFFICIAL EXAM
75 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Advanced Health Assessment Health History & Interviewing
Diagnostic Reasoning & Clinical Judgment Cultural & Psychosocial Assessment
Physical Examination Techniques Evidence-Based Practice
COVER PAGE - 1
, SECTION 1 | Advanced Health Assessment | Q1-Q15 | GCU NUR 634 Midterm EXAM LATEST 2026/2027 ACTUAL SUMM
Q1 Question 1 of 75
Q1. A 52-year-old male presents to the primary care clinic for a routine physical examination. The nurse
practitioner plans to perform a comprehensive head-to-toe assessment. Which sequence of examination
techniques follows the standard recommended order for most body systems?
A. Inspection, palpation, percussion, auscultation for all body systems
B. Auscultation, inspection, palpation, percussion for all body systems
C. Inspection, palpation, percussion, auscultation except abdomen which is inspect, auscultate, percuss, palpate
D. Palpation, percussion, inspection, auscultation except abdomen which begins with palpation
Correct Answer: C
Rationale:
The standard examination order is inspection, palpation, percussion, auscultation for most systems. The abdomen is
the exception because palpation and percussion can alter bowel sounds, so the abdomen is examined as inspect,
auscultate, percuss, palpate. The other options either apply auscultation first universally or fail to acknowledge the
abdominal exception.
Q2 Question 2 of 75
Q2. A 67-year-old female with chronic heart failure presents to the clinic with bilateral lower extremity swelling.
On examination, the nurse practitioner notes that pressing a finger against the tibia leaves a 6 mm depression
that takes 45 seconds to rebound. Which grade of pitting edema does this finding represent?
A. Grade 3 pitting edema with a 6 mm depression
B. Grade 1 pitting edema with a 2 mm depression
C. Grade 2 pitting edema with a 4 mm depression
D. Grade 4 pitting edema with an 8 mm depression
Correct Answer: A
Rationale:
Pitting edema is graded on a 1-4 scale: Grade 1 is 2 mm, Grade 2 is 4 mm, Grade 3 is 6 mm, and Grade 4 is 8 mm. A 6
mm depression corresponds to Grade 3 pitting edema, often associated with moderate venous insufficiency or heart
failure. Grade 4 is more severe and typically accompanied by a longer rebound time exceeding several minutes.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 2 of 41
, Q3 Question 3 of 75
Q3. A 45-year-old male presents with acute onset of severe chest pain radiating to the left arm. The nurse
practitioner auscultates the heart and notes a high-pitched, blowing holosystolic murmur best heard at the apex
radiating to the axilla. Which valve abnormality is most consistent with this finding?
A. Aortic regurgitation producing a diastolic decrescendo murmur at the left sternal border
B. Mitral regurgitation producing a holosystolic murmur at the apex radiating to the axilla
C. Aortic stenosis producing a systolic ejection murmur at the right second intercostal space
D. Mitral stenosis producing a diastolic rumble at the apex with an opening snap
Correct Answer: B
Rationale:
Mitral regurgitation produces a high-pitched, blowing holosystolic murmur best heard at the apex radiating to the axilla
due to retrograde flow from the left ventricle to the left atrium during systole. Aortic regurgitation is diastolic at the left
sternal border; aortic stenosis is systolic ejection at the right second ICS; mitral stenosis produces a diastolic rumble.
Location, timing, and radiation differentiate these murmurs.
Q4 Question 4 of 75
Q4. A 70-year-old female presents with fatigue and pallor. On examination of the conjunctiva, the nurse
practitioner notes pale conjunctiva. To estimate hemoglobin level at the bedside, the clinician examines the
inferior palpebral conjunctiva. Which finding suggests a hemoglobin less than 10 g/dL?
A. Pale, washed-out conjunctiva with loss of normal vascular pattern
B. Bright pink conjunctiva with prominent vessels and brisk capillary refill
C. Deep red conjunctiva with engorged vessels and presence of discharge
D. Yellow-tinged conjunctiva with scleral icterus visible in natural light
Correct Answer: A
Rationale:
Pale, washed-out conjunctiva with loss of normal vascular pattern is consistent with significant anemia, correlating with
hemoglobin levels less than 10 g/dL. Bright pink conjunctiva is normal; deep red with discharge suggests conjunctivitis;
yellow-tinged conjunctiva with scleral icterus suggests jaundice from liver disease. Conjunctival examination is a
validated bedside screening tool for anemia.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 3 of 41
, Q5 Question 5 of 75
Q5. A 58-year-old male with a 30-pack-year smoking history presents with chronic cough. The nurse practitioner
performs a respiratory examination and notes decreased tactile fremitus over the right lower lobe. Which
underlying pathophysiology most likely explains this finding?
A. Pleural effusion or bronchial obstruction decreasing transmission of vibrations
B. Consolidation from bacterial pneumonia increasing density of lung tissue
C. Pulmonary fibrosis causing increased density of lung parenchyma
D. Pneumothorax on the contralateral side increasing vibrations on the affected side
Correct Answer: A
Rationale:
Decreased tactile fremitus occurs when sound transmission is impaired by fluid, air, or obstruction between the lung and
chest wall, as seen in pleural effusion or bronchial obstruction. Consolidation and pulmonary fibrosis increase density
and increase fremitus; pneumothorax on the contralateral side would not explain changes on the affected side. Density
changes transmission of vibrations through the chest wall.
Q6 Question 6 of 75
Q6. A 34-year-old female presents with a thyroid nodule found on routine examination. The nurse practitioner
performs thyroid palpation using the posterior approach. Which technique is correctly described for this
examination?
A. Stand facing the patient and palpate the thyroid using both thumbs anteriorly
B. Stand at the patient's side and use one hand to stabilize the head while palpating with the other
C. Position the patient supine with neck extended and palpate from the head of the bed
D. Stand behind the patient, place fingers on the lower neck, and have the patient swallow water to assess the
gland
Correct Answer: D
Rationale:
The posterior approach to thyroid palpation involves standing behind the seated patient, placing fingers on the lower
neck over the thyroid isthmus and lobes, and having the patient swallow sips of water to elevate the thyroid. The
anterior approach uses thumbs from the front; side-lying and supine positions are not standard thyroid examination
techniques. Swallowing accentuates nodules and asymmetry.
GCU NUR 634 Midterm EXAM -- 2026/2027 | Passing Score: 80% | Page 4 of 41
