Exam for NUR 6001 — Advanced Health Assessment (2026)
, NUR 6001 — Advanced Health Assessment (2026)
TABLE OF CONTENTS
NUR 6001 — Advanced Health Assessment (2026)
Set 1
Foundations of Assessment
History & Interviewing
Vital Signs
Core System Examination
Clinical Reasoning
Set 2
Advanced Physical Examination
Functional & Older-Adult Assessment
Medication Review
System-Based Findings
Red-Flag Recognition
Set 3
Skin & Oral Assessment
Nutrition & Hydration
Cranial Nerves
Reproductive Assessment
Diagnostic Interpretation
Set 4
Acute Symptom Assessment
Neurologic Localization
Endocrine Patterns
Perfusion Assessment
Emergency Priorities
Set 5
Vascular Disorders
Peripheral Nerve Syndromes
Musculoskeletal Conditions
Hematologic & Nutritional Findings
Acute Emergencies
Set 6
Visual & Intracranial Disorders
Renal & Hepatic Assessment
Hormonal & Electrolyte Disorders
Pulmonary Function
Metabolic Crises
Set 7
Complex Differential Diagnosis
Gastrointestinal & Genitourinary Disorders
Gait & Movement Assessment
Infectious & Inflammatory Conditions
Clinical Deterioration
Set 8
Advanced Clinical Integration
Cardiopulmonary Emergencies
Neurologic Red Flags
Multisystem Assessment
Shock & Organ Perfusion
2
, NUR 6001 — Advanced Health Assessment (2026)
Set 1
Question 1
Review of an intake form identifies “dizziness” as the chief concern. Which opening question best helps the
clinician develop an appropriate differential diagnosis?
A. “Does the dizziness happen because your blood pressure drops?”
B. “Have you tried drinking more water?”
C. “Do your relatives experience vertigo?”
D. “Describe exactly what you feel when the dizziness occurs.”
Correct answer: D. “Describe exactly what you feel when the dizziness occurs.”
Rationale: Patients use “dizziness” to describe spinning, near-fainting, imbalance, and other sensations. Clarifying the
experience helps direct subsequent questions about timing, triggers, and associated symptoms. Suggesting low blood
pressure introduces an unconfirmed explanation. Hydration advice and family history may become relevant after the
symptom has been characterized.
Clinical Pearl: Clarify the patient’s meaning before translating a symptom into medical terminology.
Exam Strategy: Begin with a neutral question that gathers information without suggesting the answer.
Question 2
Office blood pressure is 152/94 mm Hg immediately after the patient walks rapidly from the parking area. The
patient is talking, has crossed legs, and holds the measured arm unsupported. No acute symptoms are present.
What should the clinician do next?
A. Repeat the measurement after quiet rest with correct positioning and an appropriate cuff.
B. Diagnose hypertension from the current reading.
C. Repeat the measurement immediately without changing the position.
D. Discard the result and postpone all measurements until the next annual visit.
Correct answer: A. Repeat the measurement after quiet rest with correct positioning and an appropriate cuff.
Rationale: Recent activity, talking, crossed legs, and an unsupported arm can affect blood pressure measurement.
Allow at least five minutes of quiet seated rest, with the back supported, feet flat, and arm supported at heart level. An
improperly obtained reading should not establish a diagnosis. Repeating the same technique preserves the problem,
while postponing reassessment misses an opportunity to obtain useful information. CDC: Measuring Your Blood
Pressure
Clinical Pearl: Confirm measurement quality before interpreting an unexpected result.
Exam Strategy: Correct an identifiable technique error before drawing a diagnostic conclusion.
Question 3
Medication reconciliation reveals that prescribed tablets are sometimes skipped because the patient cannot afford
refills. Which response best advances the assessment?
A. “You realize that this is irresponsible, correct?”
B. “Why did you fail to mention this earlier?”
C. “Which medicines are difficult to afford, and how often do you miss them?”
D. “I will document that you refuse treatment.”
Correct answer: C. “Which medicines are difficult to afford, and how often do you miss them?”
Rationale: This response identifies the affected medications and the extent of interrupted treatment without assigning
blame. Financial barriers can often be addressed through collaborative planning. Accusatory wording may reduce
further disclosure. Documenting refusal would inaccurately characterize the patient’s stated difficulty obtaining
treatment.
Clinical Pearl: Include cost, access, side effects, and understanding when assessing medication use.
Exam Strategy: Choose specific, nonjudgmental exploration of the barrier.
3
, NUR 6001 — Advanced Health Assessment (2026)
Question 4
Examination of the right posterior lung base produces the following findings:
Assessment component Finding
Percussion Dullness
Tactile fremitus Increased
Breath sounds Bronchial sounds over a peripheral field
Voice transmission Increased
Which process best explains this pattern?
A. Pleural effusion
B. Pulmonary consolidation with a patent bronchus
C. Pneumothorax
D. Diffuse emphysema
Correct answer: B. Pulmonary consolidation with a patent bronchus
Rationale: Consolidated lung transmits sound and vibration more effectively when the supplying bronchus remains
open. This accounts for increased fremitus, greater voice transmission, and peripheral bronchial breath sounds. Pleural
fluid generally reduces fremitus over the affected area. Pneumothorax and emphysema more commonly produce
increased percussion resonance.
Clinical Pearl: Fremitus helps distinguish consolidation from pleural fluid when both cause dullness.
Exam Strategy: Interpret the combination of findings rather than choosing from percussion alone.
Question 5
Neurologic symptoms begin suddenly while a patient is waiting for an appointment. Examination identifies new
facial asymmetry, right arm weakness, and difficulty speaking. Which action takes priority?
A. Activate emergency stroke evaluation and establish the last-known-well time.
B. Complete the routine health history before deciding on referral.
C. Reassess in one hour to determine whether the findings resolve.
D. Arrange an outpatient neurology appointment for the following week.
Correct answer: A. Activate emergency stroke evaluation and establish the last-known-well time.
Rationale: Sudden focal weakness and speech difficulty require immediate evaluation for stroke. Establishing when the
patient was last known to be at baseline helps guide time-sensitive assessment and treatment. Waiting for spontaneous
improvement or completing a lengthy routine history could delay care. Even symptoms that resolve may indicate a
transient ischemic attack requiring urgent evaluation. CDC: Signs and Symptoms of Stroke
Clinical Pearl: “Last known well” may differ from the time someone first noticed the symptoms.
Exam Strategy: Prioritize sudden focal neurologic changes over routine assessment tasks.
Question 6
Cardiac auscultation identifies a harsh crescendo–decrescendo systolic murmur at the right upper sternal border,
radiating toward the carotid arteries. Which additional finding most strongly supports aortic stenosis?
A. An opening snap after S2
B. A pericardial friction rub
C. A fixed, widely split S2
D. A delayed, diminished carotid upstroke
Correct answer: D. A delayed, diminished carotid upstroke
Rationale: Significant obstruction of aortic outflow can produce a slow-rising, low-amplitude carotid pulse. An opening
snap is classically associated with mitral stenosis. A friction rub suggests pericardial inflammation. Fixed splitting of S2
is associated with an atrial septal defect rather than the described aortic valve pattern.
Clinical Pearl: Evaluate murmur timing, location, radiation, and associated pulse findings together.
Exam Strategy: Select the finding that reflects the same underlying hemodynamic abnormality.
4
, NUR 6001 — Advanced Health Assessment (2026)
Question 7
Abdominal discomfort prompts a focused examination. Which sequence is conventionally used to assess bowel
sounds before abdominal manipulation?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
C. Auscultation, palpation, inspection, percussion
D. Percussion, inspection, palpation, auscultation
Correct answer: B. Inspection, auscultation, percussion, palpation
Rationale: The conventional abdominal examination begins with inspection, followed by auscultation before percussion
and palpation. This allows assessment of bowel sounds before manipulation potentially alters them. Palpation generally
begins away from the most painful area. The other sequences either delay visual assessment or place manipulation
before auscultation.
Clinical Pearl: Observe facial expression, guarding, and respiratory movement throughout the examination.
Exam Strategy: Remember the abdomen’s conventional exception to the usual examination sequence.
Question 8
Results from a hypothetical diagnostic study are shown below:
Test result Disease present Disease absent
Positive 90 30
Negative 10 870
What is the sensitivity of the test?
A. 75%
B. 96.7%
C. 90%
D. 98.9%
Correct answer: C. 90%
Rationale: Sensitivity is the proportion of individuals with disease who test positive. Calculate 90 ÷ (90 + 10), which
equals 90%. The value 75% is the positive predictive value, and 96.7% is the specificity. The negative predictive value
is approximately 98.9%.
Clinical Pearl: Sensitivity uses the disease-present group as its denominator.
Exam Strategy: Identify the requested measure before selecting numbers from the table.
Question 9
New hearing difficulty is evaluated with tuning-fork testing. Weber testing lateralizes to the left. Rinne testing
shows bone conduction greater than air conduction on the left and air conduction greater than bone conduction
on the right. Which interpretation best fits?
A. Right conductive hearing loss
B. Left sensorineural hearing loss
C. Normal hearing bilaterally
D. Left conductive hearing loss
Correct answer: D. Left conductive hearing loss
Rationale: Conductive hearing loss typically causes Weber lateralization toward the affected ear and an abnormal
Rinne result on that side. The left-sided finding of bone conduction exceeding air conduction supports this
interpretation. Sensorineural loss usually preserves air conduction greater than bone conduction, with Weber
lateralizing toward the better-hearing ear. Otoscopy and audiologic assessment help establish the cause and degree of
impairment.
Clinical Pearl: Interpret Weber and Rinne findings together.
Exam Strategy: Identify the abnormal Rinne result, then determine whether Weber supports it.
Question 10
Skin examination reveals a flat, nonpalpable brown lesion measuring 6 mm in diameter. There is no fluid, surface
elevation, or palpable depth. Which primary lesion term is most appropriate?
A. Papule
B. Macule
5
, NUR 6001 — Advanced Health Assessment (2026)
C. Vesicle
D. Nodule
Correct answer: B. Macule
Rationale: A macule is a small, flat area of altered skin color. A papule is raised and solid, while a vesicle contains fluid.
A nodule is a solid lesion that generally extends more deeply into the skin. The description establishes morphology but
does not identify the lesion’s cause.
Clinical Pearl: Describe morphology before naming a presumed skin disorder.
Exam Strategy: First distinguish flat from raised, then solid from fluid-filled.
Question 11
Assessment of positional lightheadedness produces these measurements:
Position and timing Blood pressure Heart rate
Supine after five minutes 138/80 mm Hg 70/min
Standing at one minute 112/68 mm Hg 88/min
Standing at three minutes 114/68 mm Hg 86/min
Symptoms recur on standing. Which interpretation is most appropriate?
A. The result is normal because systolic pressure remains above 100 mm Hg.
B. The measurements establish postural orthostatic tachycardia syndrome.
C. The measurements meet the blood pressure criterion for orthostatic hypotension.
D. The measurements prove an autonomic neurologic disorder.
Correct answer: C. The measurements meet the blood pressure criterion for orthostatic hypotension.
Rationale: A sustained systolic decrease of at least 20 mm Hg or diastolic decrease of at least 10 mm Hg within three
minutes of standing supports orthostatic hypotension. Both changes are present here. The measurements identify a
physiologic response but do not establish its cause. Medication effects, volume depletion, and autonomic dysfunction
remain possible explanations.
Clinical Pearl: Interpret the change from baseline rather than the final blood pressure alone.
Exam Strategy: Calculate both systolic and diastolic differences before choosing an answer.
Question 12
Before a sensitive examination, the patient becomes tense and says, “I do not think I can do this today.” What is
the best response?
A. Pause, explore the concern, and confirm consent before proceeding.
B. Continue because attendance at the appointment implies consent.
C. Explain that stopping makes the entire visit invalid.
D. Ask an accompanying relative to authorize the examination.
Correct answer: A. Pause, explore the concern, and confirm consent before proceeding.
Rationale: Consent is ongoing, and the patient’s hesitation requires a pause and discussion. Explaining the
examination, offering choices, and agreeing on a stop signal may support comfort and control. Attendance does not
imply consent to every procedure. A relative cannot override the decision of a patient who has decision-making
capacity.
Clinical Pearl: Explain each step before touching the patient.
Exam Strategy: Reassess consent when willingness to proceed changes.
Question 13
Neurologic examination demonstrates weakness, increased muscle tone, brisk deep tendon reflexes, and an
extensor plantar response in the right leg. Which localization best fits?
A. Neuromuscular junction dysfunction
B. Upper motor neuron pathway dysfunction
C. Isolated peripheral sensory neuropathy
D. Primary muscle disease
Correct answer: B. Upper motor neuron pathway dysfunction
Rationale: Weakness with increased tone, hyperreflexia, and an extensor plantar response supports upper motor
neuron dysfunction. Lower motor neuron disorders more commonly reduce tone and reflexes. Neuromuscular junction
6
, NUR 6001 — Advanced Health Assessment (2026)
disorders generally do not produce this reflex pattern. Primary muscle disease also does not typically explain an
extensor plantar response.
Clinical Pearl: Strength, tone, reflexes, and plantar responses help localize neurologic dysfunction.
Exam Strategy: Identify the affected pathway before selecting a specific disease.
Question 14
Joint assessment reveals acute atraumatic knee swelling, warmth, severe pain with passive movement, and
fever. The patient uses immunosuppressive medication for rheumatoid arthritis. Which action is most appropriate?
A. Attribute the symptoms to a routine inflammatory flare.
B. Diagnose gout using serum uric acid alone.
C. Begin strengthening exercises and reassess in two weeks.
D. Arrange urgent evaluation for septic arthritis, including arthrocentesis.
Correct answer: D. Arrange urgent evaluation for septic arthritis, including arthrocentesis.
Rationale: An acutely painful, swollen joint with fever requires prompt consideration of infection, particularly with
immunosuppression. Synovial fluid testing helps evaluate infection and crystal disease. A preexisting inflammatory
disorder does not exclude septic arthritis, and serum uric acid cannot establish the cause. Delayed reassessment could
postpone treatment of a joint-threatening infection. AAFP: Septic Arthritis—Diagnosis and Treatment
Clinical Pearl: Crystals in synovial fluid do not exclude concurrent infection.
Exam Strategy: Prioritize a time-sensitive diagnosis when the presentation and risk factors support it.
Question 15
Family members report that an older adult became confused yesterday after previously managing independently.
Attention fluctuates during the interview, and the patient cannot consistently follow a short conversation. Which
syndrome best fits?
A. Delirium
B. Stable mild cognitive impairment
C. Typical gradual progression of Alzheimer disease
D. Normal cognitive aging
Correct answer: A. Delirium
Rationale: Acute onset, fluctuation, and impaired attention strongly support delirium. Dementia generally develops more
gradually, although delirium can occur in someone with existing dementia. Mild cognitive impairment and normal aging
do not explain this abrupt change. Assessment should seek precipitating illness, medication effects, metabolic
abnormalities, and other contributing factors.
Clinical Pearl: Obtain collateral information about baseline cognition and function.
Exam Strategy: Use onset and attention to distinguish acute from chronic cognitive change.
Question 16
Documentation after cardiac auscultation states only, “Abnormal heart sounds present.” Which revision provides
the most useful objective information?
A. “Heart sounds are concerning.”
B. “Probable severe valvular disease.”
C. “Grade 2/6 systolic murmur at the apex, radiating toward the left axilla.”
D. “Cardiovascular examination positive.”
Correct answer: C. “Grade 2/6 systolic murmur at the apex, radiating toward the left axilla.”
Rationale: This entry specifies intensity, timing, location, and radiation, allowing another clinician to understand the
finding. “Concerning” and “positive” are vague descriptions. Labeling valve disease as severe exceeds what the
supplied examination establishes. Objective observations and diagnostic interpretations should be documented
distinctly.
Clinical Pearl: Useful documentation allows another clinician to reconstruct the examination findings.
Exam Strategy: Prefer measurable, anatomically specific descriptions over general judgments.
Question 17
Persistent fatigue is accompanied by constipation, cold intolerance, dry skin, a slow pulse, and delayed relaxation
of ankle reflexes. Which hypothesis best integrates these findings?
A. Hyperthyroidism
B. Acute stimulant intoxication
7
, NUR 6001 — Advanced Health Assessment (2026)
C. Seasonal allergic rhinitis
D. Hypothyroidism
Correct answer: D. Hypothyroidism
Rationale: Cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation form a pattern compatible
with hypothyroidism. Hyperthyroidism more often causes heat intolerance, tachycardia, and brisk reflexes. Stimulant
intoxication generally increases sympathetic activity. Allergic rhinitis does not explain the multisystem pattern, and
thyroid testing is needed to evaluate the hypothesis.
Clinical Pearl: A coherent group of findings is more informative than fatigue alone.
Exam Strategy: Choose the diagnosis that explains the largest number of linked findings.
Question 18
Symptom review reveals chest pressure when climbing stairs that resolves after several minutes of rest. The
patient has diabetes and a history of smoking. Which reasoning approach is most appropriate?
A. Exclude myocardial ischemia because the discomfort resolves.
B. Prioritize possible myocardial ischemia while clarifying current symptoms and urgency.
C. Diagnose reflux because the discomfort is described as pressure.
D. Exclude cardiac disease unless pain radiates to the left arm.
Correct answer: B. Prioritize possible myocardial ischemia while clarifying current symptoms and urgency.
Rationale: Exertional pressure relieved by rest raises concern for myocardial ischemia, particularly with cardiovascular
risk factors. Relief with rest does not establish a benign cause. Arm radiation is not required, and pressure alone does
not diagnose reflux. Current, prolonged, or worsening symptoms and associated instability determine the need for
emergency escalation.
Clinical Pearl: Ask whether symptoms are present now and whether the pattern has changed.
Exam Strategy: Combine symptom characteristics with risk factors rather than requiring every classic feature.
Question 19
Assessment for possible appendicitis identifies progressive right lower quadrant pain, anorexia, and focal
tenderness, but no rebound tenderness. What is the best interpretation?
A. Absence of rebound tenderness excludes appendicitis.
B. Anorexia alone confirms appendicitis.
C. Appendicitis remains possible and requires further assessment.
D. Focal tenderness is irrelevant without abdominal rigidity.
Correct answer: C. Appendicitis remains possible and requires further assessment.
Rationale: No single absent examination sign reliably excludes appendicitis in this presentation. The evolving history
and focal tenderness must be considered alongside other findings and appropriate testing. Anorexia is nonspecific and
cannot establish the diagnosis. Rigidity may indicate peritoneal irritation but is not required for appendicitis to be
present.
Clinical Pearl: Interpret negative findings according to their diagnostic limitations.
Exam Strategy: Be cautious when an option claims that one absent sign completely excludes disease.
Question 20
Reassessment of presumed mechanical back pain reveals new urinary retention, numbness around the
perineum, and bilateral leg weakness. What is the priority?
A. Arrange emergency evaluation for possible cauda equina syndrome.
B. Continue conservative care and reassess in six weeks.
C. Perform repeated stretching exercises before deciding on referral.
D. Attribute urinary retention to pain without further investigation.
Correct answer: A. Arrange emergency evaluation for possible cauda equina syndrome.
Rationale: New bladder dysfunction, saddle-region sensory change, and bilateral weakness suggest possible
compression affecting the cauda equina. Emergency evaluation and urgent spinal imaging are needed. Routine
conservative care could delay recognition of a time-sensitive neurologic condition. Attributing these findings to pain
alone would disregard evidence requiring revision of the original diagnosis.
Clinical Pearl: Ask about bladder function and saddle sensation when back pain has neurologic features.
Exam Strategy: New red flags can change an initially routine presentation into an emergency.
8
, NUR 6001 — Advanced Health Assessment (2026)
Question 21
Visual assessment follows a sudden increase in floaters, flashing lights, and a dark curtain extending across the
vision of one eye. The eye is painless. Which action is most appropriate?
A. Schedule routine refraction.
B. Reassure the patient because the eye is painless.
C. Arrange immediate ophthalmologic or emergency evaluation.
D. Recommend lubricating drops and reassess in one week.
Correct answer: C. Arrange immediate ophthalmologic or emergency evaluation.
Rationale: Sudden flashes, new floaters, and a curtain-like visual defect are warning signs of retinal detachment.
Immediate evaluation is needed because delayed treatment can result in permanent visual loss. Absence of pain does
not reduce the urgency of this pattern. Refraction and lubricating drops do not address a suspected retinal abnormality.
National Eye Institute: Retinal Detachment
Clinical Pearl: Sudden painless visual loss can represent an ophthalmic emergency.
Exam Strategy: Prioritize onset and visual field changes over the presence or absence of pain.
Question 22
Neck examination identifies a firm, nontender left supraclavicular lymph node that has enlarged over six weeks.
Unintentional weight loss is reported without a recent respiratory infection. Which interpretation is most
appropriate?
A. Prompt evaluation for malignancy and other serious causes is warranted.
B. Lack of tenderness establishes a benign process.
C. Enlarged supraclavicular nodes are expected in healthy adults.
D. Observation alone is appropriate until the node becomes painful.
Correct answer: A. Prompt evaluation for malignancy and other serious causes is warranted.
Rationale: Progressive enlargement, supraclavicular location, firmness, and unexplained weight loss raise concern for
serious disease. These findings do not prove malignancy, but they justify prompt investigation. Nontender nodes occur
in both malignant and nonmalignant conditions. Waiting for pain could delay diagnosis.
Clinical Pearl: Document node location, size, consistency, mobility, tenderness, and duration.
Exam Strategy: Assess the overall risk pattern rather than using tenderness as a benign-versus-malignant test.
Question 23
Peripheral vascular testing produces the following Doppler systolic pressures:
Measurement site Systolic pressure
Right brachial artery 144 mm Hg
Left brachial artery 150 mm Hg
Right dorsalis pedis artery 108 mm Hg
Right posterior tibial artery 114 mm Hg
Using the higher ankle pressure divided by the higher brachial pressure, what is the right ankle–brachial index?
A. 1.32
B. 0.72
C. 0.79
D. 0.76
Correct answer: D. 0.76
Rationale: Use 114 mm Hg as the higher right ankle pressure and 150 mm Hg as the higher brachial pressure. Dividing
114 by 150 gives 0.76, an abnormal result consistent with peripheral arterial disease. Values of 0.72 and 0.79 use an
incorrect pressure selection. The value 1.32 reverses the required ratio.
Clinical Pearl: Calculate each leg’s index separately using the higher pressure from that ankle.
Exam Strategy: Select the correct numerator and denominator before calculating.
9
, NUR 6001 — Advanced Health Assessment (2026)
Question 24
Respiratory examination reveals reduced left basal expansion, dullness to percussion, diminished breath sounds,
and decreased tactile fremitus. Which condition best explains the combination?
A. Lobar consolidation with a patent bronchus
B. Pleural effusion
C. Uncomplicated asthma
D. Pneumothorax
Correct answer: B. Pleural effusion
Rationale: Pleural fluid reduces transmission of breath sounds and palpable vibration while producing dullness to
percussion. Consolidation with a patent bronchus more often increases fremitus. Asthma usually produces airflow-
related findings rather than this focal pattern. Pneumothorax also decreases sound transmission but generally
produces hyperresonance instead of dullness.
Clinical Pearl: Pleural fluid and consolidated lung transmit vibrations differently.
Exam Strategy: Combine percussion and fremitus to distinguish fluid, air, and consolidation.
Question 25
Functional assessment shows independence with bathing, dressing, toileting, and feeding. However, the patient
repeatedly misses bill payments and cannot organize medications correctly. Which conclusion is most accurate?
A. Basic activities of daily living are completely dependent.
B. Instrumental activities are impaired despite preserved basic activities.
C. Preserved bathing ability excludes meaningful functional impairment.
D. The findings alone establish a specific neurocognitive disorder.
Correct answer: B. Instrumental activities are impaired despite preserved basic activities.
Rationale: Managing finances and medications are instrumental activities of daily living requiring complex
organizational skills. Bathing, dressing, toileting, and feeding are basic activities. Preserved basic self-care does not
establish the ability to live independently without support. Further assessment is needed to identify the cause of the
functional change.
Clinical Pearl: Ask what tasks the person actually performs and what assistance is required.
Exam Strategy: Separate basic self-care from complex independent-living activities.
Question 26
Shoulder examination identifies pain and marked restriction when the patient raises the arm independently.
Passive movement through the same arc is nearly full. Which interpretation is most appropriate?
A. The findings establish global joint capsule restriction.
B. The findings confirm adhesive capsulitis.
C. Preserved passive motion excludes significant shoulder disease.
D. Pain inhibition, weakness, or a muscle–tendon problem may limit active movement.
Correct answer: D. Pain inhibition, weakness, or a muscle–tendon problem may limit active movement.
Rationale: Active movement requires effective muscle and tendon function, whereas passive movement does not
require the same contraction. Greater active than passive restriction suggests pain inhibition, weakness, or a contractile
structure problem. Adhesive capsulitis usually limits both active and passive motion. Preserved passive movement
does not exclude rotator cuff disease or another important abnormality.
Clinical Pearl: Compare active and passive motion before interpreting restricted movement.
Exam Strategy: Determine whether the limitation depends on the patient generating the movement.
Question 27
Language assessment reveals relatively preserved understanding of simple commands but slow, effortful speech
consisting of short phrases. The main difficulty is forming language rather than articulating sounds. Which term
best describes the finding?
A. Nonfluent aphasia
B. Dysarthria
10
, NUR 6001 — Advanced Health Assessment (2026)
TABLE OF CONTENTS
NUR 6001 — Advanced Health Assessment (2026)
Set 1
Foundations of Assessment
History & Interviewing
Vital Signs
Core System Examination
Clinical Reasoning
Set 2
Advanced Physical Examination
Functional & Older-Adult Assessment
Medication Review
System-Based Findings
Red-Flag Recognition
Set 3
Skin & Oral Assessment
Nutrition & Hydration
Cranial Nerves
Reproductive Assessment
Diagnostic Interpretation
Set 4
Acute Symptom Assessment
Neurologic Localization
Endocrine Patterns
Perfusion Assessment
Emergency Priorities
Set 5
Vascular Disorders
Peripheral Nerve Syndromes
Musculoskeletal Conditions
Hematologic & Nutritional Findings
Acute Emergencies
Set 6
Visual & Intracranial Disorders
Renal & Hepatic Assessment
Hormonal & Electrolyte Disorders
Pulmonary Function
Metabolic Crises
Set 7
Complex Differential Diagnosis
Gastrointestinal & Genitourinary Disorders
Gait & Movement Assessment
Infectious & Inflammatory Conditions
Clinical Deterioration
Set 8
Advanced Clinical Integration
Cardiopulmonary Emergencies
Neurologic Red Flags
Multisystem Assessment
Shock & Organ Perfusion
2
, NUR 6001 — Advanced Health Assessment (2026)
Set 1
Question 1
Review of an intake form identifies “dizziness” as the chief concern. Which opening question best helps the
clinician develop an appropriate differential diagnosis?
A. “Does the dizziness happen because your blood pressure drops?”
B. “Have you tried drinking more water?”
C. “Do your relatives experience vertigo?”
D. “Describe exactly what you feel when the dizziness occurs.”
Correct answer: D. “Describe exactly what you feel when the dizziness occurs.”
Rationale: Patients use “dizziness” to describe spinning, near-fainting, imbalance, and other sensations. Clarifying the
experience helps direct subsequent questions about timing, triggers, and associated symptoms. Suggesting low blood
pressure introduces an unconfirmed explanation. Hydration advice and family history may become relevant after the
symptom has been characterized.
Clinical Pearl: Clarify the patient’s meaning before translating a symptom into medical terminology.
Exam Strategy: Begin with a neutral question that gathers information without suggesting the answer.
Question 2
Office blood pressure is 152/94 mm Hg immediately after the patient walks rapidly from the parking area. The
patient is talking, has crossed legs, and holds the measured arm unsupported. No acute symptoms are present.
What should the clinician do next?
A. Repeat the measurement after quiet rest with correct positioning and an appropriate cuff.
B. Diagnose hypertension from the current reading.
C. Repeat the measurement immediately without changing the position.
D. Discard the result and postpone all measurements until the next annual visit.
Correct answer: A. Repeat the measurement after quiet rest with correct positioning and an appropriate cuff.
Rationale: Recent activity, talking, crossed legs, and an unsupported arm can affect blood pressure measurement.
Allow at least five minutes of quiet seated rest, with the back supported, feet flat, and arm supported at heart level. An
improperly obtained reading should not establish a diagnosis. Repeating the same technique preserves the problem,
while postponing reassessment misses an opportunity to obtain useful information. CDC: Measuring Your Blood
Pressure
Clinical Pearl: Confirm measurement quality before interpreting an unexpected result.
Exam Strategy: Correct an identifiable technique error before drawing a diagnostic conclusion.
Question 3
Medication reconciliation reveals that prescribed tablets are sometimes skipped because the patient cannot afford
refills. Which response best advances the assessment?
A. “You realize that this is irresponsible, correct?”
B. “Why did you fail to mention this earlier?”
C. “Which medicines are difficult to afford, and how often do you miss them?”
D. “I will document that you refuse treatment.”
Correct answer: C. “Which medicines are difficult to afford, and how often do you miss them?”
Rationale: This response identifies the affected medications and the extent of interrupted treatment without assigning
blame. Financial barriers can often be addressed through collaborative planning. Accusatory wording may reduce
further disclosure. Documenting refusal would inaccurately characterize the patient’s stated difficulty obtaining
treatment.
Clinical Pearl: Include cost, access, side effects, and understanding when assessing medication use.
Exam Strategy: Choose specific, nonjudgmental exploration of the barrier.
3
, NUR 6001 — Advanced Health Assessment (2026)
Question 4
Examination of the right posterior lung base produces the following findings:
Assessment component Finding
Percussion Dullness
Tactile fremitus Increased
Breath sounds Bronchial sounds over a peripheral field
Voice transmission Increased
Which process best explains this pattern?
A. Pleural effusion
B. Pulmonary consolidation with a patent bronchus
C. Pneumothorax
D. Diffuse emphysema
Correct answer: B. Pulmonary consolidation with a patent bronchus
Rationale: Consolidated lung transmits sound and vibration more effectively when the supplying bronchus remains
open. This accounts for increased fremitus, greater voice transmission, and peripheral bronchial breath sounds. Pleural
fluid generally reduces fremitus over the affected area. Pneumothorax and emphysema more commonly produce
increased percussion resonance.
Clinical Pearl: Fremitus helps distinguish consolidation from pleural fluid when both cause dullness.
Exam Strategy: Interpret the combination of findings rather than choosing from percussion alone.
Question 5
Neurologic symptoms begin suddenly while a patient is waiting for an appointment. Examination identifies new
facial asymmetry, right arm weakness, and difficulty speaking. Which action takes priority?
A. Activate emergency stroke evaluation and establish the last-known-well time.
B. Complete the routine health history before deciding on referral.
C. Reassess in one hour to determine whether the findings resolve.
D. Arrange an outpatient neurology appointment for the following week.
Correct answer: A. Activate emergency stroke evaluation and establish the last-known-well time.
Rationale: Sudden focal weakness and speech difficulty require immediate evaluation for stroke. Establishing when the
patient was last known to be at baseline helps guide time-sensitive assessment and treatment. Waiting for spontaneous
improvement or completing a lengthy routine history could delay care. Even symptoms that resolve may indicate a
transient ischemic attack requiring urgent evaluation. CDC: Signs and Symptoms of Stroke
Clinical Pearl: “Last known well” may differ from the time someone first noticed the symptoms.
Exam Strategy: Prioritize sudden focal neurologic changes over routine assessment tasks.
Question 6
Cardiac auscultation identifies a harsh crescendo–decrescendo systolic murmur at the right upper sternal border,
radiating toward the carotid arteries. Which additional finding most strongly supports aortic stenosis?
A. An opening snap after S2
B. A pericardial friction rub
C. A fixed, widely split S2
D. A delayed, diminished carotid upstroke
Correct answer: D. A delayed, diminished carotid upstroke
Rationale: Significant obstruction of aortic outflow can produce a slow-rising, low-amplitude carotid pulse. An opening
snap is classically associated with mitral stenosis. A friction rub suggests pericardial inflammation. Fixed splitting of S2
is associated with an atrial septal defect rather than the described aortic valve pattern.
Clinical Pearl: Evaluate murmur timing, location, radiation, and associated pulse findings together.
Exam Strategy: Select the finding that reflects the same underlying hemodynamic abnormality.
4
, NUR 6001 — Advanced Health Assessment (2026)
Question 7
Abdominal discomfort prompts a focused examination. Which sequence is conventionally used to assess bowel
sounds before abdominal manipulation?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation
C. Auscultation, palpation, inspection, percussion
D. Percussion, inspection, palpation, auscultation
Correct answer: B. Inspection, auscultation, percussion, palpation
Rationale: The conventional abdominal examination begins with inspection, followed by auscultation before percussion
and palpation. This allows assessment of bowel sounds before manipulation potentially alters them. Palpation generally
begins away from the most painful area. The other sequences either delay visual assessment or place manipulation
before auscultation.
Clinical Pearl: Observe facial expression, guarding, and respiratory movement throughout the examination.
Exam Strategy: Remember the abdomen’s conventional exception to the usual examination sequence.
Question 8
Results from a hypothetical diagnostic study are shown below:
Test result Disease present Disease absent
Positive 90 30
Negative 10 870
What is the sensitivity of the test?
A. 75%
B. 96.7%
C. 90%
D. 98.9%
Correct answer: C. 90%
Rationale: Sensitivity is the proportion of individuals with disease who test positive. Calculate 90 ÷ (90 + 10), which
equals 90%. The value 75% is the positive predictive value, and 96.7% is the specificity. The negative predictive value
is approximately 98.9%.
Clinical Pearl: Sensitivity uses the disease-present group as its denominator.
Exam Strategy: Identify the requested measure before selecting numbers from the table.
Question 9
New hearing difficulty is evaluated with tuning-fork testing. Weber testing lateralizes to the left. Rinne testing
shows bone conduction greater than air conduction on the left and air conduction greater than bone conduction
on the right. Which interpretation best fits?
A. Right conductive hearing loss
B. Left sensorineural hearing loss
C. Normal hearing bilaterally
D. Left conductive hearing loss
Correct answer: D. Left conductive hearing loss
Rationale: Conductive hearing loss typically causes Weber lateralization toward the affected ear and an abnormal
Rinne result on that side. The left-sided finding of bone conduction exceeding air conduction supports this
interpretation. Sensorineural loss usually preserves air conduction greater than bone conduction, with Weber
lateralizing toward the better-hearing ear. Otoscopy and audiologic assessment help establish the cause and degree of
impairment.
Clinical Pearl: Interpret Weber and Rinne findings together.
Exam Strategy: Identify the abnormal Rinne result, then determine whether Weber supports it.
Question 10
Skin examination reveals a flat, nonpalpable brown lesion measuring 6 mm in diameter. There is no fluid, surface
elevation, or palpable depth. Which primary lesion term is most appropriate?
A. Papule
B. Macule
5
, NUR 6001 — Advanced Health Assessment (2026)
C. Vesicle
D. Nodule
Correct answer: B. Macule
Rationale: A macule is a small, flat area of altered skin color. A papule is raised and solid, while a vesicle contains fluid.
A nodule is a solid lesion that generally extends more deeply into the skin. The description establishes morphology but
does not identify the lesion’s cause.
Clinical Pearl: Describe morphology before naming a presumed skin disorder.
Exam Strategy: First distinguish flat from raised, then solid from fluid-filled.
Question 11
Assessment of positional lightheadedness produces these measurements:
Position and timing Blood pressure Heart rate
Supine after five minutes 138/80 mm Hg 70/min
Standing at one minute 112/68 mm Hg 88/min
Standing at three minutes 114/68 mm Hg 86/min
Symptoms recur on standing. Which interpretation is most appropriate?
A. The result is normal because systolic pressure remains above 100 mm Hg.
B. The measurements establish postural orthostatic tachycardia syndrome.
C. The measurements meet the blood pressure criterion for orthostatic hypotension.
D. The measurements prove an autonomic neurologic disorder.
Correct answer: C. The measurements meet the blood pressure criterion for orthostatic hypotension.
Rationale: A sustained systolic decrease of at least 20 mm Hg or diastolic decrease of at least 10 mm Hg within three
minutes of standing supports orthostatic hypotension. Both changes are present here. The measurements identify a
physiologic response but do not establish its cause. Medication effects, volume depletion, and autonomic dysfunction
remain possible explanations.
Clinical Pearl: Interpret the change from baseline rather than the final blood pressure alone.
Exam Strategy: Calculate both systolic and diastolic differences before choosing an answer.
Question 12
Before a sensitive examination, the patient becomes tense and says, “I do not think I can do this today.” What is
the best response?
A. Pause, explore the concern, and confirm consent before proceeding.
B. Continue because attendance at the appointment implies consent.
C. Explain that stopping makes the entire visit invalid.
D. Ask an accompanying relative to authorize the examination.
Correct answer: A. Pause, explore the concern, and confirm consent before proceeding.
Rationale: Consent is ongoing, and the patient’s hesitation requires a pause and discussion. Explaining the
examination, offering choices, and agreeing on a stop signal may support comfort and control. Attendance does not
imply consent to every procedure. A relative cannot override the decision of a patient who has decision-making
capacity.
Clinical Pearl: Explain each step before touching the patient.
Exam Strategy: Reassess consent when willingness to proceed changes.
Question 13
Neurologic examination demonstrates weakness, increased muscle tone, brisk deep tendon reflexes, and an
extensor plantar response in the right leg. Which localization best fits?
A. Neuromuscular junction dysfunction
B. Upper motor neuron pathway dysfunction
C. Isolated peripheral sensory neuropathy
D. Primary muscle disease
Correct answer: B. Upper motor neuron pathway dysfunction
Rationale: Weakness with increased tone, hyperreflexia, and an extensor plantar response supports upper motor
neuron dysfunction. Lower motor neuron disorders more commonly reduce tone and reflexes. Neuromuscular junction
6
, NUR 6001 — Advanced Health Assessment (2026)
disorders generally do not produce this reflex pattern. Primary muscle disease also does not typically explain an
extensor plantar response.
Clinical Pearl: Strength, tone, reflexes, and plantar responses help localize neurologic dysfunction.
Exam Strategy: Identify the affected pathway before selecting a specific disease.
Question 14
Joint assessment reveals acute atraumatic knee swelling, warmth, severe pain with passive movement, and
fever. The patient uses immunosuppressive medication for rheumatoid arthritis. Which action is most appropriate?
A. Attribute the symptoms to a routine inflammatory flare.
B. Diagnose gout using serum uric acid alone.
C. Begin strengthening exercises and reassess in two weeks.
D. Arrange urgent evaluation for septic arthritis, including arthrocentesis.
Correct answer: D. Arrange urgent evaluation for septic arthritis, including arthrocentesis.
Rationale: An acutely painful, swollen joint with fever requires prompt consideration of infection, particularly with
immunosuppression. Synovial fluid testing helps evaluate infection and crystal disease. A preexisting inflammatory
disorder does not exclude septic arthritis, and serum uric acid cannot establish the cause. Delayed reassessment could
postpone treatment of a joint-threatening infection. AAFP: Septic Arthritis—Diagnosis and Treatment
Clinical Pearl: Crystals in synovial fluid do not exclude concurrent infection.
Exam Strategy: Prioritize a time-sensitive diagnosis when the presentation and risk factors support it.
Question 15
Family members report that an older adult became confused yesterday after previously managing independently.
Attention fluctuates during the interview, and the patient cannot consistently follow a short conversation. Which
syndrome best fits?
A. Delirium
B. Stable mild cognitive impairment
C. Typical gradual progression of Alzheimer disease
D. Normal cognitive aging
Correct answer: A. Delirium
Rationale: Acute onset, fluctuation, and impaired attention strongly support delirium. Dementia generally develops more
gradually, although delirium can occur in someone with existing dementia. Mild cognitive impairment and normal aging
do not explain this abrupt change. Assessment should seek precipitating illness, medication effects, metabolic
abnormalities, and other contributing factors.
Clinical Pearl: Obtain collateral information about baseline cognition and function.
Exam Strategy: Use onset and attention to distinguish acute from chronic cognitive change.
Question 16
Documentation after cardiac auscultation states only, “Abnormal heart sounds present.” Which revision provides
the most useful objective information?
A. “Heart sounds are concerning.”
B. “Probable severe valvular disease.”
C. “Grade 2/6 systolic murmur at the apex, radiating toward the left axilla.”
D. “Cardiovascular examination positive.”
Correct answer: C. “Grade 2/6 systolic murmur at the apex, radiating toward the left axilla.”
Rationale: This entry specifies intensity, timing, location, and radiation, allowing another clinician to understand the
finding. “Concerning” and “positive” are vague descriptions. Labeling valve disease as severe exceeds what the
supplied examination establishes. Objective observations and diagnostic interpretations should be documented
distinctly.
Clinical Pearl: Useful documentation allows another clinician to reconstruct the examination findings.
Exam Strategy: Prefer measurable, anatomically specific descriptions over general judgments.
Question 17
Persistent fatigue is accompanied by constipation, cold intolerance, dry skin, a slow pulse, and delayed relaxation
of ankle reflexes. Which hypothesis best integrates these findings?
A. Hyperthyroidism
B. Acute stimulant intoxication
7
, NUR 6001 — Advanced Health Assessment (2026)
C. Seasonal allergic rhinitis
D. Hypothyroidism
Correct answer: D. Hypothyroidism
Rationale: Cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation form a pattern compatible
with hypothyroidism. Hyperthyroidism more often causes heat intolerance, tachycardia, and brisk reflexes. Stimulant
intoxication generally increases sympathetic activity. Allergic rhinitis does not explain the multisystem pattern, and
thyroid testing is needed to evaluate the hypothesis.
Clinical Pearl: A coherent group of findings is more informative than fatigue alone.
Exam Strategy: Choose the diagnosis that explains the largest number of linked findings.
Question 18
Symptom review reveals chest pressure when climbing stairs that resolves after several minutes of rest. The
patient has diabetes and a history of smoking. Which reasoning approach is most appropriate?
A. Exclude myocardial ischemia because the discomfort resolves.
B. Prioritize possible myocardial ischemia while clarifying current symptoms and urgency.
C. Diagnose reflux because the discomfort is described as pressure.
D. Exclude cardiac disease unless pain radiates to the left arm.
Correct answer: B. Prioritize possible myocardial ischemia while clarifying current symptoms and urgency.
Rationale: Exertional pressure relieved by rest raises concern for myocardial ischemia, particularly with cardiovascular
risk factors. Relief with rest does not establish a benign cause. Arm radiation is not required, and pressure alone does
not diagnose reflux. Current, prolonged, or worsening symptoms and associated instability determine the need for
emergency escalation.
Clinical Pearl: Ask whether symptoms are present now and whether the pattern has changed.
Exam Strategy: Combine symptom characteristics with risk factors rather than requiring every classic feature.
Question 19
Assessment for possible appendicitis identifies progressive right lower quadrant pain, anorexia, and focal
tenderness, but no rebound tenderness. What is the best interpretation?
A. Absence of rebound tenderness excludes appendicitis.
B. Anorexia alone confirms appendicitis.
C. Appendicitis remains possible and requires further assessment.
D. Focal tenderness is irrelevant without abdominal rigidity.
Correct answer: C. Appendicitis remains possible and requires further assessment.
Rationale: No single absent examination sign reliably excludes appendicitis in this presentation. The evolving history
and focal tenderness must be considered alongside other findings and appropriate testing. Anorexia is nonspecific and
cannot establish the diagnosis. Rigidity may indicate peritoneal irritation but is not required for appendicitis to be
present.
Clinical Pearl: Interpret negative findings according to their diagnostic limitations.
Exam Strategy: Be cautious when an option claims that one absent sign completely excludes disease.
Question 20
Reassessment of presumed mechanical back pain reveals new urinary retention, numbness around the
perineum, and bilateral leg weakness. What is the priority?
A. Arrange emergency evaluation for possible cauda equina syndrome.
B. Continue conservative care and reassess in six weeks.
C. Perform repeated stretching exercises before deciding on referral.
D. Attribute urinary retention to pain without further investigation.
Correct answer: A. Arrange emergency evaluation for possible cauda equina syndrome.
Rationale: New bladder dysfunction, saddle-region sensory change, and bilateral weakness suggest possible
compression affecting the cauda equina. Emergency evaluation and urgent spinal imaging are needed. Routine
conservative care could delay recognition of a time-sensitive neurologic condition. Attributing these findings to pain
alone would disregard evidence requiring revision of the original diagnosis.
Clinical Pearl: Ask about bladder function and saddle sensation when back pain has neurologic features.
Exam Strategy: New red flags can change an initially routine presentation into an emergency.
8
, NUR 6001 — Advanced Health Assessment (2026)
Question 21
Visual assessment follows a sudden increase in floaters, flashing lights, and a dark curtain extending across the
vision of one eye. The eye is painless. Which action is most appropriate?
A. Schedule routine refraction.
B. Reassure the patient because the eye is painless.
C. Arrange immediate ophthalmologic or emergency evaluation.
D. Recommend lubricating drops and reassess in one week.
Correct answer: C. Arrange immediate ophthalmologic or emergency evaluation.
Rationale: Sudden flashes, new floaters, and a curtain-like visual defect are warning signs of retinal detachment.
Immediate evaluation is needed because delayed treatment can result in permanent visual loss. Absence of pain does
not reduce the urgency of this pattern. Refraction and lubricating drops do not address a suspected retinal abnormality.
National Eye Institute: Retinal Detachment
Clinical Pearl: Sudden painless visual loss can represent an ophthalmic emergency.
Exam Strategy: Prioritize onset and visual field changes over the presence or absence of pain.
Question 22
Neck examination identifies a firm, nontender left supraclavicular lymph node that has enlarged over six weeks.
Unintentional weight loss is reported without a recent respiratory infection. Which interpretation is most
appropriate?
A. Prompt evaluation for malignancy and other serious causes is warranted.
B. Lack of tenderness establishes a benign process.
C. Enlarged supraclavicular nodes are expected in healthy adults.
D. Observation alone is appropriate until the node becomes painful.
Correct answer: A. Prompt evaluation for malignancy and other serious causes is warranted.
Rationale: Progressive enlargement, supraclavicular location, firmness, and unexplained weight loss raise concern for
serious disease. These findings do not prove malignancy, but they justify prompt investigation. Nontender nodes occur
in both malignant and nonmalignant conditions. Waiting for pain could delay diagnosis.
Clinical Pearl: Document node location, size, consistency, mobility, tenderness, and duration.
Exam Strategy: Assess the overall risk pattern rather than using tenderness as a benign-versus-malignant test.
Question 23
Peripheral vascular testing produces the following Doppler systolic pressures:
Measurement site Systolic pressure
Right brachial artery 144 mm Hg
Left brachial artery 150 mm Hg
Right dorsalis pedis artery 108 mm Hg
Right posterior tibial artery 114 mm Hg
Using the higher ankle pressure divided by the higher brachial pressure, what is the right ankle–brachial index?
A. 1.32
B. 0.72
C. 0.79
D. 0.76
Correct answer: D. 0.76
Rationale: Use 114 mm Hg as the higher right ankle pressure and 150 mm Hg as the higher brachial pressure. Dividing
114 by 150 gives 0.76, an abnormal result consistent with peripheral arterial disease. Values of 0.72 and 0.79 use an
incorrect pressure selection. The value 1.32 reverses the required ratio.
Clinical Pearl: Calculate each leg’s index separately using the higher pressure from that ankle.
Exam Strategy: Select the correct numerator and denominator before calculating.
9
, NUR 6001 — Advanced Health Assessment (2026)
Question 24
Respiratory examination reveals reduced left basal expansion, dullness to percussion, diminished breath sounds,
and decreased tactile fremitus. Which condition best explains the combination?
A. Lobar consolidation with a patent bronchus
B. Pleural effusion
C. Uncomplicated asthma
D. Pneumothorax
Correct answer: B. Pleural effusion
Rationale: Pleural fluid reduces transmission of breath sounds and palpable vibration while producing dullness to
percussion. Consolidation with a patent bronchus more often increases fremitus. Asthma usually produces airflow-
related findings rather than this focal pattern. Pneumothorax also decreases sound transmission but generally
produces hyperresonance instead of dullness.
Clinical Pearl: Pleural fluid and consolidated lung transmit vibrations differently.
Exam Strategy: Combine percussion and fremitus to distinguish fluid, air, and consolidation.
Question 25
Functional assessment shows independence with bathing, dressing, toileting, and feeding. However, the patient
repeatedly misses bill payments and cannot organize medications correctly. Which conclusion is most accurate?
A. Basic activities of daily living are completely dependent.
B. Instrumental activities are impaired despite preserved basic activities.
C. Preserved bathing ability excludes meaningful functional impairment.
D. The findings alone establish a specific neurocognitive disorder.
Correct answer: B. Instrumental activities are impaired despite preserved basic activities.
Rationale: Managing finances and medications are instrumental activities of daily living requiring complex
organizational skills. Bathing, dressing, toileting, and feeding are basic activities. Preserved basic self-care does not
establish the ability to live independently without support. Further assessment is needed to identify the cause of the
functional change.
Clinical Pearl: Ask what tasks the person actually performs and what assistance is required.
Exam Strategy: Separate basic self-care from complex independent-living activities.
Question 26
Shoulder examination identifies pain and marked restriction when the patient raises the arm independently.
Passive movement through the same arc is nearly full. Which interpretation is most appropriate?
A. The findings establish global joint capsule restriction.
B. The findings confirm adhesive capsulitis.
C. Preserved passive motion excludes significant shoulder disease.
D. Pain inhibition, weakness, or a muscle–tendon problem may limit active movement.
Correct answer: D. Pain inhibition, weakness, or a muscle–tendon problem may limit active movement.
Rationale: Active movement requires effective muscle and tendon function, whereas passive movement does not
require the same contraction. Greater active than passive restriction suggests pain inhibition, weakness, or a contractile
structure problem. Adhesive capsulitis usually limits both active and passive motion. Preserved passive movement
does not exclude rotator cuff disease or another important abnormality.
Clinical Pearl: Compare active and passive motion before interpreting restricted movement.
Exam Strategy: Determine whether the limitation depends on the patient generating the movement.
Question 27
Language assessment reveals relatively preserved understanding of simple commands but slow, effortful speech
consisting of short phrases. The main difficulty is forming language rather than articulating sounds. Which term
best describes the finding?
A. Nonfluent aphasia
B. Dysarthria
10
