NURS 681 Valerie Miller Virtual SIM Lab:
100-Question Practice Exam2026/2027
Study Guide • Migraine Without Aura • SOAP
Documentation • Clinical Assessment and
Management
This original practice exam is designed to help you prepare for the Valerie Miller virtual
simulation and related NURS 681 assessments. It includes multiple-choice questions, select-all-
that-apply (SATA), clinical scenarios, SOAP documentation, differential diagnosis,
pharmacology, patient education, and clinical judgment.
Exam format
• 100 questions with A–D options where appropriate.
• Correct answer and detailed rationale immediately after each question.
• Questions progress from foundational knowledge to advanced clinical application.
• These are original practice questions, not verified questions from a secured university
exam or the proprietary simulation.
Section 1: Migraine Fundamentals and Clinical Presentation
Question 1
Which statement best describes migraine without aura?
A. A headache always preceded by visual disturbances B. A primary headache disorder that
occurs without aura symptoms C. A headache caused exclusively by sinus inflammation D. A
headache that always produces loss of consciousness
Correct answer: B. A primary headache disorder that occurs without aura symptoms.
Rationale: Migraine without aura is a primary headache disorder characterized by recurrent
attacks with typical migraine features. Aura involves reversible neurological symptoms, such as
visual or sensory disturbances, that occur before or during some migraine attacks.
Question 2
,Which headache characteristic is commonly associated with migraine?
A. Mild pain that never interferes with activity B. Pain that occurs only when coughing C.
Pulsating pain that may worsen with routine physical activity D. Pain that always occurs on both
sides of the head
Correct answer: C. Pulsating pain that may worsen with routine physical activity.
Rationale: Migraine pain is often pulsating and may be unilateral, moderate to severe, and
aggravated by routine activity. Bilateral pain can also occur, so location alone does not establish
or exclude the diagnosis.
Question 3
Which symptom commonly accompanies migraine?
A. Photophobia B. Persistent jaundice C. Joint deformity D. Urinary retention
Correct answer: A. Photophobia.
Rationale: Photophobia, or sensitivity to light, is a common migraine symptom. Phonophobia,
nausea, and vomiting may also occur. The overall symptom pattern helps distinguish migraine
from other headache disorders.
Question 4
An adult reports a recurrent headache lasting 12 hours with nausea and sensitivity to light. Which
diagnosis is most consistent with this presentation?
A. Migraine B. Acute appendicitis C. Otitis externa D. Peripheral neuropathy
Correct answer: A. Migraine.
Rationale: Headache accompanied by nausea and photophobia is compatible with migraine. The
clinician must still assess the headache's onset, characteristics, neurological findings, medical
history, and red flags before making a diagnosis.
Question 5
Which feature distinguishes migraine without aura from migraine with aura?
A. Migraine without aura cannot cause nausea. B. Migraine without aura never causes severe
pain. C. Migraine without aura is not associated with neurological symptoms of any kind. D.
Migraine without aura occurs without the characteristic reversible aura phenomenon.
,Correct answer: D. Migraine without aura occurs without the characteristic reversible aura
phenomenon.
Rationale: Aura consists of specific, usually reversible neurological symptoms, such as visual,
sensory, or speech/language disturbances. Migraine without aura does not include that
characteristic aura pattern, although other symptoms may occur during an attack.
Question 6
Which question best assesses the severity of Valerie Miller's headache?
A. "What did you eat yesterday?" B. "On a scale of 0 to 10, how severe is your headache?" C.
"How many people live in your home?" D. "What is your favorite exercise?"
Correct answer: B. "On a scale of 0 to 10, how severe is your headache?"
Rationale: A numeric pain scale provides a standardized subjective measure that can be used to
monitor response to treatment. It should be interpreted alongside the patient's functional
limitations and other symptoms.
Question 7
Which duration is typical of an untreated or unsuccessfully treated migraine attack in adults?
A. 5–15 minutes B. 30–60 minutes in every case C. 4–72 hours D. More than one month in every
case
Correct answer: C. 4–72 hours.
Rationale: A typical migraine attack lasts 4–72 hours. Headache duration varies, and prolonged
or changing symptoms may require reassessment for complications or alternative diagnoses.
Question 8
Which associated symptom is most consistent with phonophobia?
A. Sensitivity to sound B. Sensitivity to touch only C. Difficulty urinating D. Loss of smell
caused by nasal obstruction
Correct answer: A. Sensitivity to sound.
Rationale: Phonophobia means sound sensitivity. It frequently accompanies migraine and may
cause patients to seek a quiet environment during an attack.
Question 9
, Which statement about migraine location is correct?
A. Migraine must always affect the right side. B. Migraine must always affect both temples. C.
Migraine only occurs behind the eyes. D. Migraine may be unilateral or bilateral.
Correct answer: D. Migraine may be unilateral or bilateral.
Rationale: Although migraine is frequently unilateral, bilateral pain can occur. Diagnosis
depends on the full clinical pattern rather than one location characteristic.
Question 10
A patient reports that walking upstairs worsens a pulsating headache. Which interpretation is
most appropriate?
A. This finding excludes migraine. B. Worsening with routine physical activity supports a
possible migraine diagnosis. C. This finding proves that the patient has an intracranial
hemorrhage. D. This finding confirms bacterial sinusitis.
Correct answer: B. Worsening with routine physical activity supports a possible migraine
diagnosis.
Rationale: Aggravation by or avoidance of routine physical activity is a recognized migraine
characteristic. However, exertional onset of a sudden or severe headache is a warning sign that
requires urgent evaluation.
Section 2: History Taking and Clinical Assessment
Question 11
What is the primary purpose of using OLDCARTS when assessing Valerie's headache?
A. To calculate medication dosage B. To establish the patient's insurance eligibility C. To
organize the symptom history systematically D. To replace the neurological examination
Correct answer: C. To organize the symptom history systematically.
Rationale: OLDCARTS organizes the history around onset, location, duration, character,
aggravating factors, relieving factors, timing, and severity. It improves completeness but does
not replace examination or clinical judgment.
Question 12
Which question best assesses the onset of a headache?
100-Question Practice Exam2026/2027
Study Guide • Migraine Without Aura • SOAP
Documentation • Clinical Assessment and
Management
This original practice exam is designed to help you prepare for the Valerie Miller virtual
simulation and related NURS 681 assessments. It includes multiple-choice questions, select-all-
that-apply (SATA), clinical scenarios, SOAP documentation, differential diagnosis,
pharmacology, patient education, and clinical judgment.
Exam format
• 100 questions with A–D options where appropriate.
• Correct answer and detailed rationale immediately after each question.
• Questions progress from foundational knowledge to advanced clinical application.
• These are original practice questions, not verified questions from a secured university
exam or the proprietary simulation.
Section 1: Migraine Fundamentals and Clinical Presentation
Question 1
Which statement best describes migraine without aura?
A. A headache always preceded by visual disturbances B. A primary headache disorder that
occurs without aura symptoms C. A headache caused exclusively by sinus inflammation D. A
headache that always produces loss of consciousness
Correct answer: B. A primary headache disorder that occurs without aura symptoms.
Rationale: Migraine without aura is a primary headache disorder characterized by recurrent
attacks with typical migraine features. Aura involves reversible neurological symptoms, such as
visual or sensory disturbances, that occur before or during some migraine attacks.
Question 2
,Which headache characteristic is commonly associated with migraine?
A. Mild pain that never interferes with activity B. Pain that occurs only when coughing C.
Pulsating pain that may worsen with routine physical activity D. Pain that always occurs on both
sides of the head
Correct answer: C. Pulsating pain that may worsen with routine physical activity.
Rationale: Migraine pain is often pulsating and may be unilateral, moderate to severe, and
aggravated by routine activity. Bilateral pain can also occur, so location alone does not establish
or exclude the diagnosis.
Question 3
Which symptom commonly accompanies migraine?
A. Photophobia B. Persistent jaundice C. Joint deformity D. Urinary retention
Correct answer: A. Photophobia.
Rationale: Photophobia, or sensitivity to light, is a common migraine symptom. Phonophobia,
nausea, and vomiting may also occur. The overall symptom pattern helps distinguish migraine
from other headache disorders.
Question 4
An adult reports a recurrent headache lasting 12 hours with nausea and sensitivity to light. Which
diagnosis is most consistent with this presentation?
A. Migraine B. Acute appendicitis C. Otitis externa D. Peripheral neuropathy
Correct answer: A. Migraine.
Rationale: Headache accompanied by nausea and photophobia is compatible with migraine. The
clinician must still assess the headache's onset, characteristics, neurological findings, medical
history, and red flags before making a diagnosis.
Question 5
Which feature distinguishes migraine without aura from migraine with aura?
A. Migraine without aura cannot cause nausea. B. Migraine without aura never causes severe
pain. C. Migraine without aura is not associated with neurological symptoms of any kind. D.
Migraine without aura occurs without the characteristic reversible aura phenomenon.
,Correct answer: D. Migraine without aura occurs without the characteristic reversible aura
phenomenon.
Rationale: Aura consists of specific, usually reversible neurological symptoms, such as visual,
sensory, or speech/language disturbances. Migraine without aura does not include that
characteristic aura pattern, although other symptoms may occur during an attack.
Question 6
Which question best assesses the severity of Valerie Miller's headache?
A. "What did you eat yesterday?" B. "On a scale of 0 to 10, how severe is your headache?" C.
"How many people live in your home?" D. "What is your favorite exercise?"
Correct answer: B. "On a scale of 0 to 10, how severe is your headache?"
Rationale: A numeric pain scale provides a standardized subjective measure that can be used to
monitor response to treatment. It should be interpreted alongside the patient's functional
limitations and other symptoms.
Question 7
Which duration is typical of an untreated or unsuccessfully treated migraine attack in adults?
A. 5–15 minutes B. 30–60 minutes in every case C. 4–72 hours D. More than one month in every
case
Correct answer: C. 4–72 hours.
Rationale: A typical migraine attack lasts 4–72 hours. Headache duration varies, and prolonged
or changing symptoms may require reassessment for complications or alternative diagnoses.
Question 8
Which associated symptom is most consistent with phonophobia?
A. Sensitivity to sound B. Sensitivity to touch only C. Difficulty urinating D. Loss of smell
caused by nasal obstruction
Correct answer: A. Sensitivity to sound.
Rationale: Phonophobia means sound sensitivity. It frequently accompanies migraine and may
cause patients to seek a quiet environment during an attack.
Question 9
, Which statement about migraine location is correct?
A. Migraine must always affect the right side. B. Migraine must always affect both temples. C.
Migraine only occurs behind the eyes. D. Migraine may be unilateral or bilateral.
Correct answer: D. Migraine may be unilateral or bilateral.
Rationale: Although migraine is frequently unilateral, bilateral pain can occur. Diagnosis
depends on the full clinical pattern rather than one location characteristic.
Question 10
A patient reports that walking upstairs worsens a pulsating headache. Which interpretation is
most appropriate?
A. This finding excludes migraine. B. Worsening with routine physical activity supports a
possible migraine diagnosis. C. This finding proves that the patient has an intracranial
hemorrhage. D. This finding confirms bacterial sinusitis.
Correct answer: B. Worsening with routine physical activity supports a possible migraine
diagnosis.
Rationale: Aggravation by or avoidance of routine physical activity is a recognized migraine
characteristic. However, exertional onset of a sudden or severe headache is a warning sign that
requires urgent evaluation.
Section 2: History Taking and Clinical Assessment
Question 11
What is the primary purpose of using OLDCARTS when assessing Valerie's headache?
A. To calculate medication dosage B. To establish the patient's insurance eligibility C. To
organize the symptom history systematically D. To replace the neurological examination
Correct answer: C. To organize the symptom history systematically.
Rationale: OLDCARTS organizes the history around onset, location, duration, character,
aggravating factors, relieving factors, timing, and severity. It improves completeness but does
not replace examination or clinical judgment.
Question 12
Which question best assesses the onset of a headache?
