NU 518 Advanced Nursing Assessment: Exam 2
50 questions
1. Why is it important to ask open-ended questions early in the interview?
A. They shorten the interview
B. They lead the patient to the correct answer
C. They replace the physical exam
D. They allow the patient to describe concerns in their own words and reveal unexpected information
Correct Answer: D. They allow the patient to describe concerns in their own words and reveal
unexpected information
Rationale: Closed questions are useful later to clarify details.
2. Premature closure in diagnostic reasoning means:
A. Ordering too many tests
B. Asking too many questions
C. Referring too quickly
D. Accepting a diagnosis before it is fully verified and stopping the search for alternatives
Correct Answer: D. Accepting a diagnosis before it is fully verified and stopping the search
for alternatives
Rationale: It is a common cause of diagnostic error.
3. A patient with chest pain has a normal ECG. Why should the clinician not immediately exclude
acute coronary syndrome?
A. An initial ECG can be normal; serial ECGs and troponins are needed
B. A normal ECG always rules out ACS
C. Chest pain is never cardiac
D. ECGs are not used for chest pain
Correct Answer: A. An initial ECG can be normal; serial ECGs and troponins are needed
Rationale: Sensitivity of a single ECG is limited.
4. Why is a validated pain scale useful?
A. It diagnoses the cause of pain
B. It provides a consistent measure to track changes and responses to treatment
C. It replaces the history
D. It measures vital signs
Correct Answer: B. It provides a consistent measure to track changes and responses to
treatment
Rationale: Standardized measurement aids reassessment.
5. Which BP measurement technique gives the most accurate result?
A. Patient talking with legs crossed
B. Measuring over clothing
C. Arm hanging below the heart
D. Patient seated 5 minutes, back supported, feet flat, arm at heart level, correct cuff
Correct Answer: D. Patient seated 5 minutes, back supported, feet flat, arm at heart level,
correct cuff
Rationale: Poor technique can falsely raise readings by several mm Hg.
, 6. Why is BMI an imperfect measure of body fat?
A. It does not distinguish muscle from fat or show fat distribution
B. It includes height
C. It is never used clinically
D. It measures only waist size
Correct Answer: A. It does not distinguish muscle from fat or show fat distribution
Rationale: Muscular people may have high BMI with low fat.
7. A lesion has a central ulcer with rolled pearly borders. The most likely diagnosis and next step
is:
A. Benign nevus; no action
B. Basal cell carcinoma; refer for biopsy
C. Psoriasis; topical steroids
D. Wart; cryotherapy without evaluation
Correct Answer: B. Basal cell carcinoma; refer for biopsy
Rationale: Suspicious lesions need tissue diagnosis.
8. In a patient with darkly pigmented skin, pallor is best detected by examining the:
A. Back
B. Forehead only
C. Conjunctivae, oral mucosa and nail beds
D. Upper arms
Correct Answer: C. Conjunctivae, oral mucosa and nail beds
Rationale: These areas show color changes more clearly.
9. Why should the full skin exam include the scalp, between toes and soles?
A. These areas never have lesions
B. It is required only for children
C. Melanoma and other lesions can occur in areas not exposed to the sun
D. It saves time
Correct Answer: C. Melanoma and other lesions can occur in areas not exposed to the sun
Rationale: Acral melanoma occurs on palms and soles.
10. A patient has unilateral eye pain, decreased vision, halos around lights and a mid-dilated
pupil. This suggests:
A. Acute angle-closure glaucoma (emergency)
B. Presbyopia
C. Conjunctivitis
D. Normal aging
Correct Answer: A. Acute angle-closure glaucoma (emergency)
Rationale: Elevated intraocular pressure threatens vision.
11. A patient's pupils do not constrict to light but do constrict with accommodation. This pattern
is called:
A. Normal PERRLA
B. Anisocoria only
C. Nystagmus
D. Light-near dissociation
Correct Answer: D. Light-near dissociation
Rationale: It may be seen in neurosyphilis (Argyll Robertson pupil) or diabetic neuropathy.
50 questions
1. Why is it important to ask open-ended questions early in the interview?
A. They shorten the interview
B. They lead the patient to the correct answer
C. They replace the physical exam
D. They allow the patient to describe concerns in their own words and reveal unexpected information
Correct Answer: D. They allow the patient to describe concerns in their own words and reveal
unexpected information
Rationale: Closed questions are useful later to clarify details.
2. Premature closure in diagnostic reasoning means:
A. Ordering too many tests
B. Asking too many questions
C. Referring too quickly
D. Accepting a diagnosis before it is fully verified and stopping the search for alternatives
Correct Answer: D. Accepting a diagnosis before it is fully verified and stopping the search
for alternatives
Rationale: It is a common cause of diagnostic error.
3. A patient with chest pain has a normal ECG. Why should the clinician not immediately exclude
acute coronary syndrome?
A. An initial ECG can be normal; serial ECGs and troponins are needed
B. A normal ECG always rules out ACS
C. Chest pain is never cardiac
D. ECGs are not used for chest pain
Correct Answer: A. An initial ECG can be normal; serial ECGs and troponins are needed
Rationale: Sensitivity of a single ECG is limited.
4. Why is a validated pain scale useful?
A. It diagnoses the cause of pain
B. It provides a consistent measure to track changes and responses to treatment
C. It replaces the history
D. It measures vital signs
Correct Answer: B. It provides a consistent measure to track changes and responses to
treatment
Rationale: Standardized measurement aids reassessment.
5. Which BP measurement technique gives the most accurate result?
A. Patient talking with legs crossed
B. Measuring over clothing
C. Arm hanging below the heart
D. Patient seated 5 minutes, back supported, feet flat, arm at heart level, correct cuff
Correct Answer: D. Patient seated 5 minutes, back supported, feet flat, arm at heart level,
correct cuff
Rationale: Poor technique can falsely raise readings by several mm Hg.
, 6. Why is BMI an imperfect measure of body fat?
A. It does not distinguish muscle from fat or show fat distribution
B. It includes height
C. It is never used clinically
D. It measures only waist size
Correct Answer: A. It does not distinguish muscle from fat or show fat distribution
Rationale: Muscular people may have high BMI with low fat.
7. A lesion has a central ulcer with rolled pearly borders. The most likely diagnosis and next step
is:
A. Benign nevus; no action
B. Basal cell carcinoma; refer for biopsy
C. Psoriasis; topical steroids
D. Wart; cryotherapy without evaluation
Correct Answer: B. Basal cell carcinoma; refer for biopsy
Rationale: Suspicious lesions need tissue diagnosis.
8. In a patient with darkly pigmented skin, pallor is best detected by examining the:
A. Back
B. Forehead only
C. Conjunctivae, oral mucosa and nail beds
D. Upper arms
Correct Answer: C. Conjunctivae, oral mucosa and nail beds
Rationale: These areas show color changes more clearly.
9. Why should the full skin exam include the scalp, between toes and soles?
A. These areas never have lesions
B. It is required only for children
C. Melanoma and other lesions can occur in areas not exposed to the sun
D. It saves time
Correct Answer: C. Melanoma and other lesions can occur in areas not exposed to the sun
Rationale: Acral melanoma occurs on palms and soles.
10. A patient has unilateral eye pain, decreased vision, halos around lights and a mid-dilated
pupil. This suggests:
A. Acute angle-closure glaucoma (emergency)
B. Presbyopia
C. Conjunctivitis
D. Normal aging
Correct Answer: A. Acute angle-closure glaucoma (emergency)
Rationale: Elevated intraocular pressure threatens vision.
11. A patient's pupils do not constrict to light but do constrict with accommodation. This pattern
is called:
A. Normal PERRLA
B. Anisocoria only
C. Nystagmus
D. Light-near dissociation
Correct Answer: D. Light-near dissociation
Rationale: It may be seen in neurosyphilis (Argyll Robertson pupil) or diabetic neuropathy.
