NURS 5220 EXAM /NURS 5220 ADVANCED HEALTH ASSESSMENT AND
DIAGNOSTIC REASONING EXAM 2 ACTUAL 2026/2027 PRACTICE
QUESTIONS AND STUDY GUIDE ACCURATE EXAM
1. A 68-year-old patient with hypertension presents for an advanced health
assessment and reports progressive exertional dyspnea. During cardiac
auscultation, the clinician hears a low-frequency sound immediately after
S2 that is best appreciated with the bell at the cardiac apex while the
patient is in the left lateral decubitus position. Which finding is most
consistent with this assessment?
A. Physiologic splitting of S2
B. Pericardial friction rub
C. S3 gallop associated with ventricular volume overload
D. S4 caused by atrial contraction against a compliant ventricle
Answer: B
2. A 72-year-old patient with a long history of poorly controlled hypertension
reports exertional dyspnea and decreased exercise tolerance. The clinician
hears a low-frequency sound immediately before S1 that is most prominent
at the apex. Which interpretation is most appropriate?
A. S4 associated with decreased ventricular compliance
B. S3 associated with rapid ventricular filling
C. Opening snap associated with mitral stenosis
D. Pericardial knock associated with constrictive disease
Answer: A
3. A patient presents for neurologic assessment after family members report
new difficulty understanding spoken language despite fluent speech. The
patient can speak at length but the statements lack meaningful content.
Which cortical region is most strongly associated with this pattern?
A. Dominant frontal Broca area
B. Occipital visual cortex
C. Primary motor cortex
pg. 1
, D. Dominant temporal Wernicke area
Answer: D
4. During a neurologic examination, a patient understands questions but
responds with great effort using short, fragmented phrases. The patient
recognizes the difficulty and becomes frustrated. Which finding does this
presentation most strongly suggest?
A. Wernicke aphasia
B. Broca expressive aphasia
C. Global agnosia
D. Dysarthria caused solely by weakness of the tongue
Answer: B
5. A patient with a recent cerebrovascular event can see an object placed in
the hand but cannot identify the object by touch with the eyes closed
despite intact primary sensation. Which cortical function is impaired?
A. Tactile recognition involving the parietal cortex
B. Auditory recognition involving the temporal cortex
C. Visual recognition involving the occipital cortex
D. Language production involving the frontal cortex
Answer: C
6. During a mental-status examination, the clinician asks a patient to explain
how an apple and an orange are alike. The patient responds appropriately
but has difficulty interpreting a proverb and cannot explain an abstract
similarity. Which cognitive function is being evaluated?
A. Immediate registration
B. Abstract reasoning
C. Remote memory
D. Level of consciousness
Answer: B
7. A patient presents with altered mental status after several days of
confusion. The clinician first evaluates alertness, orientation, attention,
memory, language, thought process, and perception. Which component
pg. 2
, should be assessed before interpreting more complex cognitive responses?
A. Level of consciousness
B. Abstract reasoning
C. Judgment
D. Remote memory
Answer: A
8. A patient with suspected neurologic disease is asked to follow a three-step
command, repeat a phrase, name common objects, and read a written
sentence. Which cranial nerve function is being evaluated most directly by
these tasks?
A. CN II
B. CN V
C. CN VIII
D. Cortical language function rather than a single cranial nerve
Answer: D
9. A patient reports sudden loss of vision in the right eye. During examination,
the clinician evaluates visual acuity, visual fields, and the optic disc. Which
cranial nerve is primarily responsible for transmitting visual information
from the retina to the brain?
A. CN III
B. CN II
C. CN IV
D. CN VI
Answer: B
10. During examination of the extraocular muscles, the clinician asks the
patient to follow a finger through the six cardinal fields of gaze. Which
finding would be most concerning for an ocular motor nerve abnormality?
A. Symmetric movement of both eyes
B. Pupils constricting appropriately to light
C. Inability of one eye to abduct
pg. 3
, D. Ability to maintain fixation
Answer: C
11. A patient has diplopia that becomes worse when looking downward and
medially, particularly while walking downstairs. Which cranial nerve should
the clinician evaluate most carefully?
A. CN II
B. CN III
C. CN IV
D. CN VI
Answer: C
12. During cranial nerve testing, a patient cannot abduct the right eye, causing
horizontal diplopia that is worse when looking toward the affected side.
Which nerve is most likely impaired?
A. Abducens nerve
B. Trochlear nerve
C. Optic nerve
D. Trigeminal nerve
Answer: A
13. A patient has ptosis, a dilated pupil, and the affected eye rests in a down-
and-out position. Which cranial nerve lesion best explains these findings?
A. CN II
B. CN IV
C. CN VI
D. CN III
Answer: D
14. During facial sensory testing, the clinician evaluates light touch over the
forehead, cheeks, and jaw. Which cranial nerve provides the major sensory
innervation to these regions?
A. Facial nerve
B. Trigeminal nerve
C. Glossopharyngeal nerve
pg. 4
DIAGNOSTIC REASONING EXAM 2 ACTUAL 2026/2027 PRACTICE
QUESTIONS AND STUDY GUIDE ACCURATE EXAM
1. A 68-year-old patient with hypertension presents for an advanced health
assessment and reports progressive exertional dyspnea. During cardiac
auscultation, the clinician hears a low-frequency sound immediately after
S2 that is best appreciated with the bell at the cardiac apex while the
patient is in the left lateral decubitus position. Which finding is most
consistent with this assessment?
A. Physiologic splitting of S2
B. Pericardial friction rub
C. S3 gallop associated with ventricular volume overload
D. S4 caused by atrial contraction against a compliant ventricle
Answer: B
2. A 72-year-old patient with a long history of poorly controlled hypertension
reports exertional dyspnea and decreased exercise tolerance. The clinician
hears a low-frequency sound immediately before S1 that is most prominent
at the apex. Which interpretation is most appropriate?
A. S4 associated with decreased ventricular compliance
B. S3 associated with rapid ventricular filling
C. Opening snap associated with mitral stenosis
D. Pericardial knock associated with constrictive disease
Answer: A
3. A patient presents for neurologic assessment after family members report
new difficulty understanding spoken language despite fluent speech. The
patient can speak at length but the statements lack meaningful content.
Which cortical region is most strongly associated with this pattern?
A. Dominant frontal Broca area
B. Occipital visual cortex
C. Primary motor cortex
pg. 1
, D. Dominant temporal Wernicke area
Answer: D
4. During a neurologic examination, a patient understands questions but
responds with great effort using short, fragmented phrases. The patient
recognizes the difficulty and becomes frustrated. Which finding does this
presentation most strongly suggest?
A. Wernicke aphasia
B. Broca expressive aphasia
C. Global agnosia
D. Dysarthria caused solely by weakness of the tongue
Answer: B
5. A patient with a recent cerebrovascular event can see an object placed in
the hand but cannot identify the object by touch with the eyes closed
despite intact primary sensation. Which cortical function is impaired?
A. Tactile recognition involving the parietal cortex
B. Auditory recognition involving the temporal cortex
C. Visual recognition involving the occipital cortex
D. Language production involving the frontal cortex
Answer: C
6. During a mental-status examination, the clinician asks a patient to explain
how an apple and an orange are alike. The patient responds appropriately
but has difficulty interpreting a proverb and cannot explain an abstract
similarity. Which cognitive function is being evaluated?
A. Immediate registration
B. Abstract reasoning
C. Remote memory
D. Level of consciousness
Answer: B
7. A patient presents with altered mental status after several days of
confusion. The clinician first evaluates alertness, orientation, attention,
memory, language, thought process, and perception. Which component
pg. 2
, should be assessed before interpreting more complex cognitive responses?
A. Level of consciousness
B. Abstract reasoning
C. Judgment
D. Remote memory
Answer: A
8. A patient with suspected neurologic disease is asked to follow a three-step
command, repeat a phrase, name common objects, and read a written
sentence. Which cranial nerve function is being evaluated most directly by
these tasks?
A. CN II
B. CN V
C. CN VIII
D. Cortical language function rather than a single cranial nerve
Answer: D
9. A patient reports sudden loss of vision in the right eye. During examination,
the clinician evaluates visual acuity, visual fields, and the optic disc. Which
cranial nerve is primarily responsible for transmitting visual information
from the retina to the brain?
A. CN III
B. CN II
C. CN IV
D. CN VI
Answer: B
10. During examination of the extraocular muscles, the clinician asks the
patient to follow a finger through the six cardinal fields of gaze. Which
finding would be most concerning for an ocular motor nerve abnormality?
A. Symmetric movement of both eyes
B. Pupils constricting appropriately to light
C. Inability of one eye to abduct
pg. 3
, D. Ability to maintain fixation
Answer: C
11. A patient has diplopia that becomes worse when looking downward and
medially, particularly while walking downstairs. Which cranial nerve should
the clinician evaluate most carefully?
A. CN II
B. CN III
C. CN IV
D. CN VI
Answer: C
12. During cranial nerve testing, a patient cannot abduct the right eye, causing
horizontal diplopia that is worse when looking toward the affected side.
Which nerve is most likely impaired?
A. Abducens nerve
B. Trochlear nerve
C. Optic nerve
D. Trigeminal nerve
Answer: A
13. A patient has ptosis, a dilated pupil, and the affected eye rests in a down-
and-out position. Which cranial nerve lesion best explains these findings?
A. CN II
B. CN IV
C. CN VI
D. CN III
Answer: D
14. During facial sensory testing, the clinician evaluates light touch over the
forehead, cheeks, and jaw. Which cranial nerve provides the major sensory
innervation to these regions?
A. Facial nerve
B. Trigeminal nerve
C. Glossopharyngeal nerve
pg. 4
