NURS6512 Advanced Health Assessment Midterm
Exam 2026/2027 - Already Graded A Verified
Questions & Answers
Section 1: Comprehensive Assessment & Clinical Reasoning
A 58-year-old cisgender female presents for follow-up 10 days after a moderate
COVID-19 illness. She reports persistent “heaviness” in her chest when climbing the 12
stairs to her apartment. Vital signs: BP 142/88 mmHg, HR 104 bpm regular, SpO₂ 94 %
on room air, RR 18. Lungs are clear to auscultation; cardiac exam reveals a soft S₃ at the
apex and a 1/6 systolic flow murmur at the left sternal border. B-type natriuretic peptide
(BNP) is 188 pg/mL (reference <100 pg/mL); high-sensitivity troponin I is 6 ng/L
(reference <15 ng/L). ECG shows sinus tachycardia with new T-wave inversions in
V₅–V₆. Which assessment maneuver best clarifies the etiology of her exertional
symptoms before ordering advanced imaging?
1. A) Perform passive straight-leg raise to evaluate for orthostatic hypotension
B) Auscultate the chest while the patient squats from standing to detect mitral
valve prolapse click
C) Have the patient briskly walk the hallway for 3 minutes, then auscultate for
new crackles or S₃ accentuation
D) Apply 20 mmHg pressure to the right upper abdomen for 30 seconds to
assess for hepatojugular reflux
Correct Answer: D
Correct Answer Text: Apply 20 mmHg pressure to the right upper abdomen for 30
seconds to assess for hepatojugular reflux
Rationale: The 2026 AHA/ACC post-COVID cardiovascular guidelines emphasize
early recognition of right-sided heart strain. A positive hepatojugular reflux (≥3
cm sustained JVP rise) indicates elevated left-sided filling pressures despite
clear lungs—a hallmark of post-viral diastolic dysfunction. Walking the hallway
(C) risks arrhythmia in a deconditioned patient; squatting (B) targets MVP, not
suspected here; orthostatics (A) are low yield when SpO₂ is stable.
, During a refugee health screening, a 19-year-old Afghan woman through a Dari
interpreter reports “pressure under my ribs” and 4 kg weight loss since arrival 6 weeks
ago. She avoids eye contact, answers only after husband speaks, and has multiple
0.5–1.5 cm healing ecchymoses on the upper inner arms. Which 2026
CDC–recommended screening question most sensitively identifies potential
intimate-partner violence (IPV) in this cultural context?
2. A) “Do you feel safe in your current relationship?”
B) “Has anyone close to you ever hurt you physically?”
C) “Within the past year, has your partner prevented you from seeing your
family?”
D) “When you disagree with your husband, are you afraid?”
Correct Answer: C
Correct Answer Text: “Within the past year, has your partner prevented you from
seeing your family?”
Rationale: The 2026 CDC IPV Toolkit notes that isolation from natal kin is a
culturally universal coercive control indicator and is less threatening than direct
queries about physical harm in collectivist societies. Afghan women often view
physical violence as “private”; asking about family access (C) yields higher
disclosure rates (sensitivity 84 %) than the HITS or HARK general questions (A, B,
D).
A 4-day-old exclusively breastfed newborn has lost 9 % of birth weight. Mother reports
feeding q2h x 25 min per breast. Exam: anterior fontanelle flat, skin turgor ↓, capillary
refill 2.5 s, mild jaundice (TcB 11 mg/dL). Which advanced assessment best
differentiates insufficient milk transfer from hypernatremic dehydration?
3. A) Test-strip urine specific gravity via clean-catch bag
B) Pre- and post-feed breast weight using calibrated 2027 WHO lactation scale
C) Digital intra-oral suck-swallow-breathe coordination ultrasound
D) Serum sodium, BUN, and creatinine drawn from heel stick
Correct Answer: B
Correct Answer Text: Pre- and post-feed breast weight using calibrated 2027
WHO lactation scale
Rationale: The 2027 WHO Breastfeeding Protocol endorses pre/post breast
weight (±2 g accuracy) as the non-invasive gold standard to quantify actual milk
intake (<80 mL per feed warrants supplementation). Serum labs (D) are delayed
and invasive; urine SG (A) is invalid before 72 h of life; ultrasound (C) is
research-only and unavailable clinically.
Exam 2026/2027 - Already Graded A Verified
Questions & Answers
Section 1: Comprehensive Assessment & Clinical Reasoning
A 58-year-old cisgender female presents for follow-up 10 days after a moderate
COVID-19 illness. She reports persistent “heaviness” in her chest when climbing the 12
stairs to her apartment. Vital signs: BP 142/88 mmHg, HR 104 bpm regular, SpO₂ 94 %
on room air, RR 18. Lungs are clear to auscultation; cardiac exam reveals a soft S₃ at the
apex and a 1/6 systolic flow murmur at the left sternal border. B-type natriuretic peptide
(BNP) is 188 pg/mL (reference <100 pg/mL); high-sensitivity troponin I is 6 ng/L
(reference <15 ng/L). ECG shows sinus tachycardia with new T-wave inversions in
V₅–V₆. Which assessment maneuver best clarifies the etiology of her exertional
symptoms before ordering advanced imaging?
1. A) Perform passive straight-leg raise to evaluate for orthostatic hypotension
B) Auscultate the chest while the patient squats from standing to detect mitral
valve prolapse click
C) Have the patient briskly walk the hallway for 3 minutes, then auscultate for
new crackles or S₃ accentuation
D) Apply 20 mmHg pressure to the right upper abdomen for 30 seconds to
assess for hepatojugular reflux
Correct Answer: D
Correct Answer Text: Apply 20 mmHg pressure to the right upper abdomen for 30
seconds to assess for hepatojugular reflux
Rationale: The 2026 AHA/ACC post-COVID cardiovascular guidelines emphasize
early recognition of right-sided heart strain. A positive hepatojugular reflux (≥3
cm sustained JVP rise) indicates elevated left-sided filling pressures despite
clear lungs—a hallmark of post-viral diastolic dysfunction. Walking the hallway
(C) risks arrhythmia in a deconditioned patient; squatting (B) targets MVP, not
suspected here; orthostatics (A) are low yield when SpO₂ is stable.
, During a refugee health screening, a 19-year-old Afghan woman through a Dari
interpreter reports “pressure under my ribs” and 4 kg weight loss since arrival 6 weeks
ago. She avoids eye contact, answers only after husband speaks, and has multiple
0.5–1.5 cm healing ecchymoses on the upper inner arms. Which 2026
CDC–recommended screening question most sensitively identifies potential
intimate-partner violence (IPV) in this cultural context?
2. A) “Do you feel safe in your current relationship?”
B) “Has anyone close to you ever hurt you physically?”
C) “Within the past year, has your partner prevented you from seeing your
family?”
D) “When you disagree with your husband, are you afraid?”
Correct Answer: C
Correct Answer Text: “Within the past year, has your partner prevented you from
seeing your family?”
Rationale: The 2026 CDC IPV Toolkit notes that isolation from natal kin is a
culturally universal coercive control indicator and is less threatening than direct
queries about physical harm in collectivist societies. Afghan women often view
physical violence as “private”; asking about family access (C) yields higher
disclosure rates (sensitivity 84 %) than the HITS or HARK general questions (A, B,
D).
A 4-day-old exclusively breastfed newborn has lost 9 % of birth weight. Mother reports
feeding q2h x 25 min per breast. Exam: anterior fontanelle flat, skin turgor ↓, capillary
refill 2.5 s, mild jaundice (TcB 11 mg/dL). Which advanced assessment best
differentiates insufficient milk transfer from hypernatremic dehydration?
3. A) Test-strip urine specific gravity via clean-catch bag
B) Pre- and post-feed breast weight using calibrated 2027 WHO lactation scale
C) Digital intra-oral suck-swallow-breathe coordination ultrasound
D) Serum sodium, BUN, and creatinine drawn from heel stick
Correct Answer: B
Correct Answer Text: Pre- and post-feed breast weight using calibrated 2027
WHO lactation scale
Rationale: The 2027 WHO Breastfeeding Protocol endorses pre/post breast
weight (±2 g accuracy) as the non-invasive gold standard to quantify actual milk
intake (<80 mL per feed warrants supplementation). Serum labs (D) are delayed
and invasive; urine SG (A) is invalid before 72 h of life; ultrasound (C) is
research-only and unavailable clinically.
