Advanced Health Assessment for Nurse
Practitioners: Comprehensive 150-Question
Practice Exam
2025/2026
1. A 55-year-old patient presents with a 3-month history of fatigue
and pallor. Laboratory studies reveal microcytic anemia. The most
likely cause is:
A. Vitamin B12 deficiency
B. Iron deficiency
C. Chronic kidney disease
D. Aplastic anemia
B. Iron deficiency
Rationale: Microcytic anemia is most commonly caused by iron
deficiency, often from chronic blood loss or inadequate dietary
intake.
2. On cardiovascular exam, a high-pitched, blowing diastolic murmur
heard at the left sternal border suggests:
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Mitral stenosis
C. Aortic regurgitation
Rationale: Aortic regurgitation typically produces a high-pitched
diastolic murmur along the left sternal border.
3. A patient presents with a sudden, severe headache described as
"the worst headache of my life." The most appropriate initial
assessment is:
, A. MRI of the brain
B. Lumbar puncture
C. Non-contrast CT scan of the head
D. EEG
C. Non-contrast CT scan of the head
Rationale: A sudden, severe headache raises concern for
subarachnoid hemorrhage; a non-contrast CT is the first-line
diagnostic test.
4. On abdominal examination, a bruit heard over the epigastrium
suggests:
A. Cholelithiasis
B. Abdominal aortic aneurysm
C. Hepatitis
D. Pancreatitis
B. Abdominal aortic aneurysm
Rationale: A bruit over the epigastrium may indicate turbulent
flow from an aneurysm or vascular stenosis.
5. The recommended screening test for type 2 diabetes in
asymptomatic adults is:
A. Fasting plasma glucose
B. Hemoglobin A1c
C. Oral glucose tolerance test
D. Random blood glucose
B. Hemoglobin A1c
Rationale: Hemoglobin A1c is recommended for routine
screening because it reflects average glycemia over 2–3 months
and does not require fasting.
6. In the musculoskeletal exam, a positive Phalen’s test indicates:
A. Carpal tunnel syndrome
, B. Rheumatoid arthritis
C. Lateral epicondylitis
D. De Quervain’s tenosynovitis
A. Carpal tunnel syndrome
Rationale: Flexing the wrists in Phalen’s maneuver reproduces
numbness/tingling in the median nerve distribution, indicative of
carpal tunnel syndrome.
7. A 45-year-old woman presents with a palpable thyroid nodule.
The most concerning feature is:
A. Solitary nodule
B. Nodule <1 cm
C. Multinodular goiter
D. Nodule with calcifications on ultrasound
D. Nodule with calcifications on ultrasound
Rationale: Microcalcifications on thyroid ultrasound increase the
risk of malignancy and warrant further evaluation with FNA.
8. A patient presents with dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. The most likely diagnosis is:
A. COPD
B. Asthma
C. Heart failure
D. Pulmonary embolism
C. Heart failure
Rationale: These symptoms suggest fluid overload due to left-
sided heart failure.
9. The most sensitive indicator of early liver disease is:
A. AST
B. ALT
C. Bilirubin
, D. Alkaline phosphatase
B. ALT
Rationale: ALT is more specific to liver injury, particularly
hepatocellular damage, and often rises early in disease.
10. Which physical exam finding is most consistent with chronic
venous insufficiency?
A. Shiny, hairless lower legs
B. Pitting edema
C. Ulcers over bony prominences
D. Cyanosis with elevation
B. Pitting edema
Rationale: Chronic venous insufficiency often presents with
pitting edema due to venous hypertension.
11. A patient has a painless, hard cervical lymph node. The most
appropriate next step is:
A. Observe for 6 weeks
B. Fine-needle aspiration biopsy
C. Empiric antibiotics
D. CT scan of the chest
B. Fine-needle aspiration biopsy
Rationale: Painless, hard lymphadenopathy raises concern for
malignancy; FNA biopsy is indicated.
12. In auscultation, a split S2 that varies with respiration is
normal in:
A. Children
B. Adults
C. Elderly
D. Patients with heart failure
B. Adults
Practitioners: Comprehensive 150-Question
Practice Exam
2025/2026
1. A 55-year-old patient presents with a 3-month history of fatigue
and pallor. Laboratory studies reveal microcytic anemia. The most
likely cause is:
A. Vitamin B12 deficiency
B. Iron deficiency
C. Chronic kidney disease
D. Aplastic anemia
B. Iron deficiency
Rationale: Microcytic anemia is most commonly caused by iron
deficiency, often from chronic blood loss or inadequate dietary
intake.
2. On cardiovascular exam, a high-pitched, blowing diastolic murmur
heard at the left sternal border suggests:
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Mitral stenosis
C. Aortic regurgitation
Rationale: Aortic regurgitation typically produces a high-pitched
diastolic murmur along the left sternal border.
3. A patient presents with a sudden, severe headache described as
"the worst headache of my life." The most appropriate initial
assessment is:
, A. MRI of the brain
B. Lumbar puncture
C. Non-contrast CT scan of the head
D. EEG
C. Non-contrast CT scan of the head
Rationale: A sudden, severe headache raises concern for
subarachnoid hemorrhage; a non-contrast CT is the first-line
diagnostic test.
4. On abdominal examination, a bruit heard over the epigastrium
suggests:
A. Cholelithiasis
B. Abdominal aortic aneurysm
C. Hepatitis
D. Pancreatitis
B. Abdominal aortic aneurysm
Rationale: A bruit over the epigastrium may indicate turbulent
flow from an aneurysm or vascular stenosis.
5. The recommended screening test for type 2 diabetes in
asymptomatic adults is:
A. Fasting plasma glucose
B. Hemoglobin A1c
C. Oral glucose tolerance test
D. Random blood glucose
B. Hemoglobin A1c
Rationale: Hemoglobin A1c is recommended for routine
screening because it reflects average glycemia over 2–3 months
and does not require fasting.
6. In the musculoskeletal exam, a positive Phalen’s test indicates:
A. Carpal tunnel syndrome
, B. Rheumatoid arthritis
C. Lateral epicondylitis
D. De Quervain’s tenosynovitis
A. Carpal tunnel syndrome
Rationale: Flexing the wrists in Phalen’s maneuver reproduces
numbness/tingling in the median nerve distribution, indicative of
carpal tunnel syndrome.
7. A 45-year-old woman presents with a palpable thyroid nodule.
The most concerning feature is:
A. Solitary nodule
B. Nodule <1 cm
C. Multinodular goiter
D. Nodule with calcifications on ultrasound
D. Nodule with calcifications on ultrasound
Rationale: Microcalcifications on thyroid ultrasound increase the
risk of malignancy and warrant further evaluation with FNA.
8. A patient presents with dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea. The most likely diagnosis is:
A. COPD
B. Asthma
C. Heart failure
D. Pulmonary embolism
C. Heart failure
Rationale: These symptoms suggest fluid overload due to left-
sided heart failure.
9. The most sensitive indicator of early liver disease is:
A. AST
B. ALT
C. Bilirubin
, D. Alkaline phosphatase
B. ALT
Rationale: ALT is more specific to liver injury, particularly
hepatocellular damage, and often rises early in disease.
10. Which physical exam finding is most consistent with chronic
venous insufficiency?
A. Shiny, hairless lower legs
B. Pitting edema
C. Ulcers over bony prominences
D. Cyanosis with elevation
B. Pitting edema
Rationale: Chronic venous insufficiency often presents with
pitting edema due to venous hypertension.
11. A patient has a painless, hard cervical lymph node. The most
appropriate next step is:
A. Observe for 6 weeks
B. Fine-needle aspiration biopsy
C. Empiric antibiotics
D. CT scan of the chest
B. Fine-needle aspiration biopsy
Rationale: Painless, hard lymphadenopathy raises concern for
malignancy; FNA biopsy is indicated.
12. In auscultation, a split S2 that varies with respiration is
normal in:
A. Children
B. Adults
C. Elderly
D. Patients with heart failure
B. Adults
