NUR 634 Final Exam Study Guide | Advanced
Health Assessment and Diagnostic Reasoning-
Grand Canyon University (GCU) | Latest Update
2026/2027 – Graded A+
Question 1
You are examining an elderly man and notice the following: Decreased vibration sense
in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and
diminished abdominal reflexes. Which of these is abnormal?
A. Decreased vibration sense
B. Diminished gag reflex
C. Diminished right patellar reflex compared to the left
D. Diminished abdominal reflexes
Answer: C
Rationale: Diminished right patellar reflex compared to the left is abnormal and
indicates asymmetry. Decreased vibration sense in the feet and ankles is an expected
age-related change. Diminished gag reflex and diminished abdominal reflexes are also
expected with aging.
Question 2
A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On
the right temporal area of the forehead, you see a flattened papule the same color as his
skin, covered by a dry scale that is round and feels hard. He has several more of these
scattered on the forehead, arms, and legs. Based on this description, what is your most
likely diagnosis?
A. Actinic keratosis
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
Answer: A
Rationale: Actinic keratosis presents as a rough, scaly, erythematous or skin-colored
papule or plaque on sun-exposed areas. It is a precursor to squamous cell carcinoma.
pg. 1
,Question 3
A 14-year-old junior high school student is brought in by his mother and father because
he seems to be developing breasts. The mother is upset because she read on the Internet
that smoking marijuana leads to breast enlargement in males. The young man
adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes
in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is
unremarkable. His parents are both in good health. He has two older brothers who
never had this problem. On examination, you see a mildly overweight teenager with
enlarged breast tissue that is slightly tender on both sides. Otherwise his examination is
normal. He is agreeable to taking a drug test. What is the most likely cause of his
gynecomastia?
A. Breast cancer
B. Imbalance of hormones of puberty
C. Drug use
D. Alcohol use
Answer: B
Rationale: Gynecomastia in adolescent males is common and usually due to the
hormonal imbalance of puberty, with increased estrogen relative to testosterone. It
typically resolves spontaneously within 6-24 months.
Question 4
A 17-year-old female presents to your office, complaining of a clear discharge from her
right breast for 2 months. She states that she noticed it when she and her boyfriend were
"messing around" and he squeezed her nipple. She continues to have this discharge
anytime she squeezes that nipple. She denies any trauma to her breasts. Her past
medical history is unremarkable. She denies any pregnancies. Both of her parents are
healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week.
On examination, her breasts are symmetric with no skin changes. You are able to
express clear discharge from her right nipple. You feel no discrete masses and her axillae
are normal. The remainder of her heart, lung, abdominal, and pelvic examinations are
unremarkable. A urine pregnancy test is negative. What cause of nipple discharge is the
most likely in her circumstance?
A. Benign breast abnormality
B. Breast cancer
C. Nonpuerperal galactorrhea
D. Paget's disease
Answer: A
pg. 2
,Rationale: Clear, non-bloody nipple discharge without a mass in a young woman is
most likely due to a benign breast abnormality such as fibrocystic changes or a benign
intraductal papilloma.
Question 5
A 26-year-old flight attendant presents for a third trimester prenatal visit. She has had
prenatal care since her sixth week of pregnancy. She has no complaints today and her
prenatal course has been unremarkable. Today her blood pressure and weight gain are
appropriate, and her urine is unremarkable. You have a first-year medical student
shadowing you, so you ask the student to get Doptones and measure the patient's uterus
in centimeters. The nurse practitioner student promptly reports fetal heart tones of 140,
but he is having difficulty obtaining the correct measurement. He knows one end of the
tape goes over the uterine fundus. From what inferior anatomic position should the tape
be placed?
A. Vagina
B. Clitoris
C. Pubic symphysis
D. Umbilicus
Answer: C
Rationale: Fundal height is measured from the pubic symphysis to the top of the
uterine fundus. This measurement in centimeters correlates with gestational age after
20 weeks.
Question 6
A 58-year-old gardener presents to your office for evaluation of a new lesion on her
upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated
with a flat surface. It has a rough, wart-like texture on palpation. Based on this
description, what is your most likely diagnosis?
A. Actinic keratosis
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
Answer: B
Rationale: Seborrheic keratosis presents as a "stuck-on," waxy, brownish lesion with a
rough surface. It is benign and common in older adults.
pg. 3
, Question 7
Which of the following represents age-related changes in the lungs?
A. Decrease in chest wall compliance
B. Speed of expiration increases
C. Increase in respiratory muscle strength
D. Increased elastic recoil of lung tissue
Answer: A
Rationale: Aging causes decreased chest wall compliance, decreased elastic recoil, and
decreased respiratory muscle strength. Expiratory flow rates decrease with age.
Question 8
A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The
ear examination is as follows: external ear, normal appearance and no tenderness with
manipulation; canal, normal diameter without evidence of inflammation; tympanic
membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain.
What is the most likely condition here?
A. Otitis externa
B. Cholesteatoma
C. Ruptured tympanic membrane
D. Otitis media
Answer: D
Rationale: Bulging, erythematous, opaque tympanic membrane with fever and
fussiness is classic for acute otitis media. Otitis externa would involve the external canal
and be tender with manipulation.
Question 9
A 28-year-old musician presents to your clinic, complaining of a "spot" on his penis. He
states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt.
He has had no burning with urination and no pain during intercourse. He has had
several partners in the last year and uses condoms occasionally. His past medical history
consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any
surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and
smokes marijuana and occasionally crack. He has injected IV drugs before but not in the
last few years. He is single and currently unemployed. His mother has rheumatoid
arthritis, and he doesn't know anything about his father. On examination, you see a
young man appearing deconditioned but pleasant. His vital signs are unremarkable. On
visualization of his penis, there is a 6-mm red, oval ulcer with an indurated base just
pg. 4
Health Assessment and Diagnostic Reasoning-
Grand Canyon University (GCU) | Latest Update
2026/2027 – Graded A+
Question 1
You are examining an elderly man and notice the following: Decreased vibration sense
in the feet and ankles, diminished gag reflex, right patellar reflex less than the left, and
diminished abdominal reflexes. Which of these is abnormal?
A. Decreased vibration sense
B. Diminished gag reflex
C. Diminished right patellar reflex compared to the left
D. Diminished abdominal reflexes
Answer: C
Rationale: Diminished right patellar reflex compared to the left is abnormal and
indicates asymmetry. Decreased vibration sense in the feet and ankles is an expected
age-related change. Diminished gag reflex and diminished abdominal reflexes are also
expected with aging.
Question 2
A 68-year-old retired farmer presents to your office for evaluation of a skin lesion. On
the right temporal area of the forehead, you see a flattened papule the same color as his
skin, covered by a dry scale that is round and feels hard. He has several more of these
scattered on the forehead, arms, and legs. Based on this description, what is your most
likely diagnosis?
A. Actinic keratosis
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
Answer: A
Rationale: Actinic keratosis presents as a rough, scaly, erythematous or skin-colored
papule or plaque on sun-exposed areas. It is a precursor to squamous cell carcinoma.
pg. 1
,Question 3
A 14-year-old junior high school student is brought in by his mother and father because
he seems to be developing breasts. The mother is upset because she read on the Internet
that smoking marijuana leads to breast enlargement in males. The young man
adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes
in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is
unremarkable. His parents are both in good health. He has two older brothers who
never had this problem. On examination, you see a mildly overweight teenager with
enlarged breast tissue that is slightly tender on both sides. Otherwise his examination is
normal. He is agreeable to taking a drug test. What is the most likely cause of his
gynecomastia?
A. Breast cancer
B. Imbalance of hormones of puberty
C. Drug use
D. Alcohol use
Answer: B
Rationale: Gynecomastia in adolescent males is common and usually due to the
hormonal imbalance of puberty, with increased estrogen relative to testosterone. It
typically resolves spontaneously within 6-24 months.
Question 4
A 17-year-old female presents to your office, complaining of a clear discharge from her
right breast for 2 months. She states that she noticed it when she and her boyfriend were
"messing around" and he squeezed her nipple. She continues to have this discharge
anytime she squeezes that nipple. She denies any trauma to her breasts. Her past
medical history is unremarkable. She denies any pregnancies. Both of her parents are
healthy. She denies using tobacco or illegal drugs and drinks three to four beers a week.
On examination, her breasts are symmetric with no skin changes. You are able to
express clear discharge from her right nipple. You feel no discrete masses and her axillae
are normal. The remainder of her heart, lung, abdominal, and pelvic examinations are
unremarkable. A urine pregnancy test is negative. What cause of nipple discharge is the
most likely in her circumstance?
A. Benign breast abnormality
B. Breast cancer
C. Nonpuerperal galactorrhea
D. Paget's disease
Answer: A
pg. 2
,Rationale: Clear, non-bloody nipple discharge without a mass in a young woman is
most likely due to a benign breast abnormality such as fibrocystic changes or a benign
intraductal papilloma.
Question 5
A 26-year-old flight attendant presents for a third trimester prenatal visit. She has had
prenatal care since her sixth week of pregnancy. She has no complaints today and her
prenatal course has been unremarkable. Today her blood pressure and weight gain are
appropriate, and her urine is unremarkable. You have a first-year medical student
shadowing you, so you ask the student to get Doptones and measure the patient's uterus
in centimeters. The nurse practitioner student promptly reports fetal heart tones of 140,
but he is having difficulty obtaining the correct measurement. He knows one end of the
tape goes over the uterine fundus. From what inferior anatomic position should the tape
be placed?
A. Vagina
B. Clitoris
C. Pubic symphysis
D. Umbilicus
Answer: C
Rationale: Fundal height is measured from the pubic symphysis to the top of the
uterine fundus. This measurement in centimeters correlates with gestational age after
20 weeks.
Question 6
A 58-year-old gardener presents to your office for evaluation of a new lesion on her
upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated
with a flat surface. It has a rough, wart-like texture on palpation. Based on this
description, what is your most likely diagnosis?
A. Actinic keratosis
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
Answer: B
Rationale: Seborrheic keratosis presents as a "stuck-on," waxy, brownish lesion with a
rough surface. It is benign and common in older adults.
pg. 3
, Question 7
Which of the following represents age-related changes in the lungs?
A. Decrease in chest wall compliance
B. Speed of expiration increases
C. Increase in respiratory muscle strength
D. Increased elastic recoil of lung tissue
Answer: A
Rationale: Aging causes decreased chest wall compliance, decreased elastic recoil, and
decreased respiratory muscle strength. Expiratory flow rates decrease with age.
Question 8
A 15-month-old is brought to you for a fever of 38.6 degrees Celsius and fussiness. The
ear examination is as follows: external ear, normal appearance and no tenderness with
manipulation; canal, normal diameter without evidence of inflammation; tympanic
membrane, bulging, erythematous, and opaque. Insufflation is deferred due to pain.
What is the most likely condition here?
A. Otitis externa
B. Cholesteatoma
C. Ruptured tympanic membrane
D. Otitis media
Answer: D
Rationale: Bulging, erythematous, opaque tympanic membrane with fever and
fussiness is classic for acute otitis media. Otitis externa would involve the external canal
and be tender with manipulation.
Question 9
A 28-year-old musician presents to your clinic, complaining of a "spot" on his penis. He
states his partner noticed it 2 days ago and it hasn't gone away. He says it doesn't hurt.
He has had no burning with urination and no pain during intercourse. He has had
several partners in the last year and uses condoms occasionally. His past medical history
consists of nongonococcal urethritis from Chlamydia and prostatitis. He denies any
surgeries. He smokes two packs of cigarettes a day, drinks a case of beer a week, and
smokes marijuana and occasionally crack. He has injected IV drugs before but not in the
last few years. He is single and currently unemployed. His mother has rheumatoid
arthritis, and he doesn't know anything about his father. On examination, you see a
young man appearing deconditioned but pleasant. His vital signs are unremarkable. On
visualization of his penis, there is a 6-mm red, oval ulcer with an indurated base just
pg. 4
