D’Youville College Nur 631 Advanced
Health Assessment Exam 2 All Questions
And Solutions (Rationales) | Exam Prep
Q&A 2026/2027
1. A 58-year-old patient presents with progressive fatigue, shortness of breath during
exertion, and occasional palpitations. During the cardiovascular examination, the advanced
practice nurse notes a displaced point of maximal impulse (PMI). Which condition is most
strongly suggested by this finding?
a) Acute pericarditis
b) Left ventricular enlargement
c) Right atrial enlargement
d) Normal age-related cardiac changes
A laterally displaced PMI may indicate left ventricular enlargement, often associated with
chronic hypertension or other conditions that increase cardiac workload. The finding should
be interpreted alongside the patient's symptoms, medical history, and other examination
results.
2. During a neurological assessment, a patient closes their eyes and is asked to identify the
position of the great toe as it is moved upward or downward. Which sensory pathway is
primarily being evaluated?
a) Spinothalamic tract
b) Corticospinal tract
c) Vestibulocochlear pathway
d) Posterior column-medial lemniscus pathway
Joint-position sense is transmitted primarily through the posterior column-medial lemniscus
pathway. Testing proprioception helps assess large sensory fibers and the integrity of the
dorsal columns.
3. A 46-year-old patient reports persistent epigastric discomfort that radiates to the back
and worsens after meals. The patient also reports nausea and unintended weight loss.
Which assessment approach is most appropriate?
a) Obtain a detailed history, assess for red flags, and arrange appropriate diagnostic
evaluation
b) Reassure the patient that the symptoms are consistent with uncomplicated indigestion
,c) Recommend an antacid trial without further assessment
d) Focus exclusively on the patient's dietary habits
Persistent epigastric pain radiating to the back, particularly with weight loss, requires further
evaluation for potentially serious gastrointestinal or pancreatic disease. A focused history,
physical examination, and timely diagnostic assessment are necessary before attributing
symptoms to uncomplicated indigestion.
4. An advanced practice nurse is examining a patient with suspected hyperthyroidism.
Which finding would most strongly support this diagnosis?
a) Bradycardia and dry skin
b) Cold intolerance and delayed relaxation of reflexes
c) Tachycardia, heat intolerance, and a fine hand tremor
d) Weight gain accompanied by constipation
Hyperthyroidism increases metabolic activity and sympathetic responsiveness, commonly
producing tachycardia, heat intolerance, fine tremors, and weight loss. Bradycardia, cold
intolerance, and delayed reflex relaxation are more consistent with hypothyroidism.
5. A patient reports sudden unilateral leg swelling and calf discomfort following several
days of immobility. Which action should the nurse prioritize?
a) Perform vigorous calf palpation to determine the extent of tenderness
b) Assess for signs of venous thromboembolism and arrange urgent diagnostic evaluation
c) Recommend walking frequently until the swelling resolves
d) Apply deep massage to improve venous circulation
Unilateral leg swelling and pain after immobility raise concern for deep vein thrombosis. The
patient requires prompt evaluation using an appropriate diagnostic pathway. Vigorous
massage and relying on physical examination alone are inappropriate because they do not
reliably exclude thrombosis.
6. During an abdominal examination, which sequence should the advanced practice nurse
use for the four standard examination techniques?
a) Inspection, palpation, percussion, auscultation
b) Palpation, inspection, auscultation, percussion
c) Auscultation, percussion, inspection, palpation
d) Inspection, auscultation, percussion, palpation
The abdomen is examined in the sequence of inspection, auscultation, percussion, and
palpation. Auscultation precedes percussion and palpation because these maneuvers may
alter bowel sounds.
,7. A 67-year-old patient presents with new-onset confusion, fever, and urinary frequency.
The family reports that the patient's mental status changed over several hours. What is the
most appropriate initial clinical approach?
a) Attribute the confusion to normal aging
b) Diagnose dementia based on the reported cognitive changes
c) Assess vital signs, oxygenation, glucose, neurological status, and potential acute causes
d) Schedule routine cognitive screening at the next annual visit
Acute confusion suggests delirium or another urgent condition rather than normal aging or
established dementia. Initial assessment should identify immediately reversible threats,
including hypoxia, hypoglycemia, infection, medication effects, and neurological emergencies.
8. During an eye examination, a patient has unequal pupils. The difference is longstanding,
the pupils are reactive, and the patient has no visual symptoms or neurological deficits.
What is the best interpretation?
a) Physiological anisocoria is possible, and the finding should be compared with prior
documentation
b) The finding establishes an acute intracranial hemorrhage
c) The patient necessarily has an oculomotor nerve palsy
d) The finding confirms increased intraocular pressure
Small, longstanding differences in pupil size may represent physiological anisocoria,
particularly when reactivity and neurological findings are normal. New or symptomatic
anisocoria requires urgent assessment for neurological and ophthalmic causes.
9. A 35-year-old patient reports episodic headaches accompanied by visual disturbances
and nausea. Which additional history is most important when characterizing the
headache?
a) The patient's preferred sleeping position
b) The patient's usual breakfast choices
c) Whether the patient has ever experienced seasonal allergies
d) The onset, duration, progression, associated symptoms, triggers, and neurological warning
signs
A structured headache history helps distinguish primary headache disorders from secondary
causes. Sudden maximal-onset pain, new neurological deficits, fever with meningismus, and
other red flags require prompt evaluation rather than routine headache management.
10. An advanced practice nurse is assessing a patient with chronic hypertension. Which
finding may indicate target-organ involvement requiring further evaluation?
, a) A normal body temperature
b) New visual changes accompanied by severe headache
c) A symmetrical radial pulse
d) A normal capillary refill time
Severe headache and new visual changes in a patient with hypertension may indicate acute
target-organ injury, particularly when blood pressure is markedly elevated. Immediate
assessment of blood pressure, neurological status, and other evidence of end-organ
dysfunction is warranted.
11. A patient reports numbness and tingling in the thumb, index finger, middle finger, and
the thumb-side portion of the ring finger. Symptoms worsen at night and improve when the
patient shakes the hand. Which condition is most likely?
a) Ulnar neuropathy
b) Radial nerve palsy
c) Median nerve compression at the carpal tunnel
d) Cervical spinal cord compression
Carpal tunnel syndrome results from compression of the median nerve at the wrist and
commonly produces paresthesia in the thumb, index, middle, and radial half of the ring
finger. Nocturnal symptoms and relief from shaking the hand are characteristic historical
clues.
12. During a respiratory assessment, the nurse hears fine crackles at both lung bases in a
patient who reports worsening exertional dyspnea and needs additional pillows to sleep.
Which condition should be considered prominently?
a) Acute laryngitis
b) Isolated allergic rhinitis
c) Uncomplicated otitis media
d) Heart failure with pulmonary congestion
Bilateral basal crackles, exertional dyspnea, and orthopnea suggest pulmonary congestion
associated with heart failure. The nurse should assess oxygenation, vital signs, volume status,
and signs of respiratory distress while arranging appropriate diagnostic evaluation.
13. A 24-year-old patient presents with a sore throat, fever, and tender anterior cervical
lymph nodes. The tonsils are enlarged and have exudates, and the patient has no cough.
What is the most appropriate next step when group A streptococcal pharyngitis is
suspected?
a) Use an appropriate clinical decision rule to guide testing and perform a rapid antigen test
or other recommended diagnostic test
b) Prescribe antibiotics solely because tonsillar exudates are present
Health Assessment Exam 2 All Questions
And Solutions (Rationales) | Exam Prep
Q&A 2026/2027
1. A 58-year-old patient presents with progressive fatigue, shortness of breath during
exertion, and occasional palpitations. During the cardiovascular examination, the advanced
practice nurse notes a displaced point of maximal impulse (PMI). Which condition is most
strongly suggested by this finding?
a) Acute pericarditis
b) Left ventricular enlargement
c) Right atrial enlargement
d) Normal age-related cardiac changes
A laterally displaced PMI may indicate left ventricular enlargement, often associated with
chronic hypertension or other conditions that increase cardiac workload. The finding should
be interpreted alongside the patient's symptoms, medical history, and other examination
results.
2. During a neurological assessment, a patient closes their eyes and is asked to identify the
position of the great toe as it is moved upward or downward. Which sensory pathway is
primarily being evaluated?
a) Spinothalamic tract
b) Corticospinal tract
c) Vestibulocochlear pathway
d) Posterior column-medial lemniscus pathway
Joint-position sense is transmitted primarily through the posterior column-medial lemniscus
pathway. Testing proprioception helps assess large sensory fibers and the integrity of the
dorsal columns.
3. A 46-year-old patient reports persistent epigastric discomfort that radiates to the back
and worsens after meals. The patient also reports nausea and unintended weight loss.
Which assessment approach is most appropriate?
a) Obtain a detailed history, assess for red flags, and arrange appropriate diagnostic
evaluation
b) Reassure the patient that the symptoms are consistent with uncomplicated indigestion
,c) Recommend an antacid trial without further assessment
d) Focus exclusively on the patient's dietary habits
Persistent epigastric pain radiating to the back, particularly with weight loss, requires further
evaluation for potentially serious gastrointestinal or pancreatic disease. A focused history,
physical examination, and timely diagnostic assessment are necessary before attributing
symptoms to uncomplicated indigestion.
4. An advanced practice nurse is examining a patient with suspected hyperthyroidism.
Which finding would most strongly support this diagnosis?
a) Bradycardia and dry skin
b) Cold intolerance and delayed relaxation of reflexes
c) Tachycardia, heat intolerance, and a fine hand tremor
d) Weight gain accompanied by constipation
Hyperthyroidism increases metabolic activity and sympathetic responsiveness, commonly
producing tachycardia, heat intolerance, fine tremors, and weight loss. Bradycardia, cold
intolerance, and delayed reflex relaxation are more consistent with hypothyroidism.
5. A patient reports sudden unilateral leg swelling and calf discomfort following several
days of immobility. Which action should the nurse prioritize?
a) Perform vigorous calf palpation to determine the extent of tenderness
b) Assess for signs of venous thromboembolism and arrange urgent diagnostic evaluation
c) Recommend walking frequently until the swelling resolves
d) Apply deep massage to improve venous circulation
Unilateral leg swelling and pain after immobility raise concern for deep vein thrombosis. The
patient requires prompt evaluation using an appropriate diagnostic pathway. Vigorous
massage and relying on physical examination alone are inappropriate because they do not
reliably exclude thrombosis.
6. During an abdominal examination, which sequence should the advanced practice nurse
use for the four standard examination techniques?
a) Inspection, palpation, percussion, auscultation
b) Palpation, inspection, auscultation, percussion
c) Auscultation, percussion, inspection, palpation
d) Inspection, auscultation, percussion, palpation
The abdomen is examined in the sequence of inspection, auscultation, percussion, and
palpation. Auscultation precedes percussion and palpation because these maneuvers may
alter bowel sounds.
,7. A 67-year-old patient presents with new-onset confusion, fever, and urinary frequency.
The family reports that the patient's mental status changed over several hours. What is the
most appropriate initial clinical approach?
a) Attribute the confusion to normal aging
b) Diagnose dementia based on the reported cognitive changes
c) Assess vital signs, oxygenation, glucose, neurological status, and potential acute causes
d) Schedule routine cognitive screening at the next annual visit
Acute confusion suggests delirium or another urgent condition rather than normal aging or
established dementia. Initial assessment should identify immediately reversible threats,
including hypoxia, hypoglycemia, infection, medication effects, and neurological emergencies.
8. During an eye examination, a patient has unequal pupils. The difference is longstanding,
the pupils are reactive, and the patient has no visual symptoms or neurological deficits.
What is the best interpretation?
a) Physiological anisocoria is possible, and the finding should be compared with prior
documentation
b) The finding establishes an acute intracranial hemorrhage
c) The patient necessarily has an oculomotor nerve palsy
d) The finding confirms increased intraocular pressure
Small, longstanding differences in pupil size may represent physiological anisocoria,
particularly when reactivity and neurological findings are normal. New or symptomatic
anisocoria requires urgent assessment for neurological and ophthalmic causes.
9. A 35-year-old patient reports episodic headaches accompanied by visual disturbances
and nausea. Which additional history is most important when characterizing the
headache?
a) The patient's preferred sleeping position
b) The patient's usual breakfast choices
c) Whether the patient has ever experienced seasonal allergies
d) The onset, duration, progression, associated symptoms, triggers, and neurological warning
signs
A structured headache history helps distinguish primary headache disorders from secondary
causes. Sudden maximal-onset pain, new neurological deficits, fever with meningismus, and
other red flags require prompt evaluation rather than routine headache management.
10. An advanced practice nurse is assessing a patient with chronic hypertension. Which
finding may indicate target-organ involvement requiring further evaluation?
, a) A normal body temperature
b) New visual changes accompanied by severe headache
c) A symmetrical radial pulse
d) A normal capillary refill time
Severe headache and new visual changes in a patient with hypertension may indicate acute
target-organ injury, particularly when blood pressure is markedly elevated. Immediate
assessment of blood pressure, neurological status, and other evidence of end-organ
dysfunction is warranted.
11. A patient reports numbness and tingling in the thumb, index finger, middle finger, and
the thumb-side portion of the ring finger. Symptoms worsen at night and improve when the
patient shakes the hand. Which condition is most likely?
a) Ulnar neuropathy
b) Radial nerve palsy
c) Median nerve compression at the carpal tunnel
d) Cervical spinal cord compression
Carpal tunnel syndrome results from compression of the median nerve at the wrist and
commonly produces paresthesia in the thumb, index, middle, and radial half of the ring
finger. Nocturnal symptoms and relief from shaking the hand are characteristic historical
clues.
12. During a respiratory assessment, the nurse hears fine crackles at both lung bases in a
patient who reports worsening exertional dyspnea and needs additional pillows to sleep.
Which condition should be considered prominently?
a) Acute laryngitis
b) Isolated allergic rhinitis
c) Uncomplicated otitis media
d) Heart failure with pulmonary congestion
Bilateral basal crackles, exertional dyspnea, and orthopnea suggest pulmonary congestion
associated with heart failure. The nurse should assess oxygenation, vital signs, volume status,
and signs of respiratory distress while arranging appropriate diagnostic evaluation.
13. A 24-year-old patient presents with a sore throat, fever, and tender anterior cervical
lymph nodes. The tonsils are enlarged and have exudates, and the patient has no cough.
What is the most appropriate next step when group A streptococcal pharyngitis is
suspected?
a) Use an appropriate clinical decision rule to guide testing and perform a rapid antigen test
or other recommended diagnostic test
b) Prescribe antibiotics solely because tonsillar exudates are present
