• NURS 190 PA 09/16/2026
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
1. A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which
anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine - Correct Answer :A; Ans: A
P 1
, • NURS 190 PA 09/16/2026
Midterm
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: Chest pain may be due to a musculoskeletal condition, such as costochondritis or intercostal
muscle cramp. This would be worsened by motion of the chest wall. Pleuritic chest pain is also a sharp
chest pain which increases with a deep breath. This type of pain can occur with inflammation of the
pleura from pneumonia or other conditions and pulmonary embolus.
2. A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic
region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: Cardiac disorders such as congestive heart failure are the most likely on this list to result in
shortness of breath. There are cases within the other categories which may also result in shortness of
breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis
with UTI in the urinary category. This demonstrates the "tension" in clinical reasoning between making
sure all possibilities are covered, while still being able to pick the most likely cause.
3. A patient presents for evaluation of a cough. Which of the following anatomic regions can be
responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine - Correct Answer :C; Ans: C
P 2
, • NURS 190 PA 09/16/2026
Midterm
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The cardiac system can cause a cough if the patient has congestive heart failure. This results in
fluid buildup in the lungs, which in turn can cause a cough that produces pink, frothy sputum. A foreign
body in the ear may also cause a cough by stimulating Arnold's branch of the vagus nerve, but this is less
likely to be seen clinically than heart failure.
4. A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in
the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies
recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on
this information, which of the following pathologic processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic - Correct Answer :B; Ans: B
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The description is most consistent with an inflammatory process, although all the other
etiologies should be considered. Lyme disease is an infection which commonly causes arthritis,
hemophilia is a hematologic condition which can cause bleeding in the joints, and trauma can obviously
cause joint pain. Your clinical reasoning skills are important for sorting through all of the data to arrive at
the most likely conclusion.
5. A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several
years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked
as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which
caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory
P 3
, • NURS 190 PA 09/16/2026
Midterm
symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic
process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The description is most consistent with degenerative arthritis in the neck. The patient has had
intermittent symptoms and the questions asked to elicit pertinent negative and positive findings are
negative for infectious, traumatic, or neoplastic disease.
6. A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of
sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most
likely pathologic process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: This description is most consistent with allergic rhinitis.
7. A 19-year old-college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm
mates have been vaccinated, but she hasn't been. Which of the following physical examination
descriptions is most consistent with meningitis?
P 4
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
1. A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which
anatomic area would you localize the symptom to?
A) Musculoskeletal
B) Reproductive
C) Urinary
D) Endocrine - Correct Answer :A; Ans: A
P 1
, • NURS 190 PA 09/16/2026
Midterm
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: Chest pain may be due to a musculoskeletal condition, such as costochondritis or intercostal
muscle cramp. This would be worsened by motion of the chest wall. Pleuritic chest pain is also a sharp
chest pain which increases with a deep breath. This type of pain can occur with inflammation of the
pleura from pneumonia or other conditions and pulmonary embolus.
2. A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic
region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: Cardiac disorders such as congestive heart failure are the most likely on this list to result in
shortness of breath. There are cases within the other categories which may also result in shortness of
breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis
with UTI in the urinary category. This demonstrates the "tension" in clinical reasoning between making
sure all possibilities are covered, while still being able to pick the most likely cause.
3. A patient presents for evaluation of a cough. Which of the following anatomic regions can be
responsible for a cough?
A) Ophthalmologic
B) Auditory
C) Cardiac
D) Endocrine - Correct Answer :C; Ans: C
P 2
, • NURS 190 PA 09/16/2026
Midterm
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The cardiac system can cause a cough if the patient has congestive heart failure. This results in
fluid buildup in the lungs, which in turn can cause a cough that produces pink, frothy sputum. A foreign
body in the ear may also cause a cough by stimulating Arnold's branch of the vagus nerve, but this is less
likely to be seen clinically than heart failure.
4. A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in
the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies
recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on
this information, which of the following pathologic processes would be the most correct?
A) Infectious
B) Inflammatory
C) Hematologic
D) Traumatic - Correct Answer :B; Ans: B
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The description is most consistent with an inflammatory process, although all the other
etiologies should be considered. Lyme disease is an infection which commonly causes arthritis,
hemophilia is a hematologic condition which can cause bleeding in the joints, and trauma can obviously
cause joint pain. Your clinical reasoning skills are important for sorting through all of the data to arrive at
the most likely conclusion.
5. A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several
years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked
as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which
caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory
P 3
, • NURS 190 PA 09/16/2026
Midterm
symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic
process?
A) Infectious
B) Neoplastic
C) Degenerative
D) Traumatic - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: The description is most consistent with degenerative arthritis in the neck. The patient has had
intermittent symptoms and the questions asked to elicit pertinent negative and positive findings are
negative for infectious, traumatic, or neoplastic disease.
6. A 15-year-old high school sophomore comes to the clinic for evaluation of a 3-week history of
sneezing; itchy, watery eyes; clear nasal discharge; ear pain; and nonproductive cough. Which is the most
likely pathologic process?
A) Infection
B) Inflammation
C) Allergic
D) Vascular - Correct Answer :C; Ans: C
Chapter: 02
Page and Header: 27, Assessment and Plan: The Process of Clinical Reasoning
Feedback: This description is most consistent with allergic rhinitis.
7. A 19-year old-college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm
mates have been vaccinated, but she hasn't been. Which of the following physical examination
descriptions is most consistent with meningitis?
P 4
