NUR-634 Midterm Exam | Complete Practice Exam
Question Bank with Verified Answers and Detailed
Rationales | Grand Canyon University (GCU) | Latest
Edition- Updated 2026/2027
Question 1
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand"
Answer: C
Rationale: This patient is here to establish care, and because she is new to you, a comprehensive
health history is appropriate.
Question 2
The following information is recorded in the health history: "The patient completed 8th grade.
He currently lives with his wife and two children. He works on old cars on the weekend. He
works in a glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems
Answer: C
Rationale: Personal and social history information includes educational level, family of origin,
current household status, personal interests, employment, religious beliefs, military history, and
lifestyle.
Question 3
Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus
erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash,
it doesn't blanch. What is this finding?
A. Palpable purpura
B. Allergic reaction
pg. 1
,C. Chemical exposure
D. Contact dermatitis
Answer: A
Rationale: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory
condition of the blood vessels often associated with systemic rheumatic disease such as SLE.
Question 4
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with
elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against
resistance when her palms face the floor. What condition does she have?
A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture
Answer: C
Rationale: Mary's injury probably occurred by lifting heavy buckets with her palms down
(toward the bucket). This caused a chronic overuse injury at the lateral epicondyle. Lateral
epicondylitis has reproducible pain with dorsiflexion against resistance when palms face the
floor.
Question 5
Mrs. T. comes for her regular visit to the clinic. You have heard about her many times from your
colleague and are aware that she is a very talkative person. Which of the following is a helpful
technique to improve the quality of the interview for both the provider and the patient?
A. Allow the patient to speak uninterrupted for the duration of the appointment
B. Briefly summarize what you heard from the patient in the first 5 minutes and then try to have
her focus on one aspect of what she told you
C. Set the time limit at the beginning of the interview and stick with it, no matter what occurs
D. Allow your impatience to show so that the patient picks up on your nonverbal cues
Answer: B
Rationale: You can say, "I want to make sure I take good care of this problem because it is very
important. We may need to talk about the others at the next appointment. Is that okay with you?"
This validates the patient's concerns and provides structure to the interview.
Question 6
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and
side-to-side directions. Which of the following is most likely?
pg. 2
,A. Cancer
B. Lymph node
C. Thyroid nodule
D. Lipoma
Answer: B
Rationale: A useful maneuver for discerning lymph nodes from other masses in the neck is to
check for their mobility in all directions. Many other masses are mobile in only two directions.
Cancerous masses may also be "fixed," or immobile.
Question 7
A 77-year-old retired bus driver comes to your clinic for a physical examination at his wife's
request. He has recently been losing weight and has felt very fatigued. His past medical history
includes colon cancer, for which he had surgery. On abdominal examination, you palpate his
liver and find it abnormal. His rectal examination is positive for occult blood. What further
abnormality of the liver was likely found on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender liver
Answer: B
Rationale: With his past history of colon cancer and with recent weight loss and fatigue, a
relapse of his colon cancer would be expected. Colon cancer usually metastasizes to the liver,
creating hard, irregular nodules.
Question 8
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise,
but lately she has felt this way continuously. What is the most likely diagnosis?
A. Pneumonia
B. COPD
C. Asthma
D. Heart failure
Answer: C
Rationale: Asthma causes shortness of breath and a nocturnal cough. It is often associated with
exercise-induced symptoms, and symptoms may progress over time.
pg. 3
, Question 9
A 19-year-old college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about meningococcal meningitis. Which physical examination
description is most consistent with meningitis?
A. Head normocephalic, fundi with sharp discs, neck supple
B. Head normocephalic, fundi with sharp discs, neck with paraspinous muscle spasm
C. Head normocephalic, fundi with blurred disc margins, neck tender, unable to perform ROM
D. Head normocephalic, fundi with blurred disc margins, neck supple
Answer: C
Rationale: Blurred disc margins are consistent with papilledema, and neck tenderness with lack
of range of motion is consistent with neck stiffness from meningeal inflammation.
Question 10
A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath and
nonproductive cough over the last month. She even has to sleep upright in her recliner at night to
be able to breathe comfortably. Her past medical history is significant for high blood pressure
and coronary artery disease. On examination, she has late inspiratory crackles in both lower
lobes. An S3 is heard over the apex. What disorder best describes her symptoms?
A. Pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural pain
D. Left-sided heart failure
Answer: D
Rationale: Fluid backs up into the lungs because the heart is unable to handle the volume. The
excess fluid collects in dependent areas, causing crackles in the bases of the lower lobes. Sitting
up allows patients to breathe easier. The two main causes are chronic high blood pressure and
coronary artery disease.
Question 11
When a patient is suspected of having medial epicondylitis (pitcher's, golfer's, or Little League
elbow), where would they experience pain?
A. Lateral elbow
B. Medial elbow
C. Olecranon process
D. Supracondylar area
Answer: B
Rationale: Medial epicondylitis involves pain and tenderness at the medial epicondyle of the
elbow. It is often caused by repetitive flexion and pronation of the forearm.
pg. 4
Question Bank with Verified Answers and Detailed
Rationales | Grand Canyon University (GCU) | Latest
Edition- Updated 2026/2027
Question 1
For which of the following patients would a comprehensive health history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper respiratory infection"
C. A new patient with the chief complaint of "I am here to establish care"
D. A new patient with the chief complaint of "I cut my hand"
Answer: C
Rationale: This patient is here to establish care, and because she is new to you, a comprehensive
health history is appropriate.
Question 2
The following information is recorded in the health history: "The patient completed 8th grade.
He currently lives with his wife and two children. He works on old cars on the weekend. He
works in a glass factory during the week." Which category does it belong to?
A. Chief complaint
B. Present illness
C. Personal and social history
D. Review of systems
Answer: C
Rationale: Personal and social history information includes educational level, family of origin,
current household status, personal interests, employment, religious beliefs, military history, and
lifestyle.
Question 3
Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus
erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash,
it doesn't blanch. What is this finding?
A. Palpable purpura
B. Allergic reaction
pg. 1
,C. Chemical exposure
D. Contact dermatitis
Answer: A
Rationale: A "palpable purpura" is usually associated with a vasculitis. This is an inflammatory
condition of the blood vessels often associated with systemic rheumatic disease such as SLE.
Question 4
Two weeks ago, Mary started a job which requires carrying 40-pound buckets. She presents with
elbow pain worse on the right. On examination, it hurts her elbows to dorsiflex her hands against
resistance when her palms face the floor. What condition does she have?
A. Medial epicondylitis (golfer's elbow)
B. Olecranon bursitis
C. Lateral epicondylitis (tennis elbow)
D. Supracondylar fracture
Answer: C
Rationale: Mary's injury probably occurred by lifting heavy buckets with her palms down
(toward the bucket). This caused a chronic overuse injury at the lateral epicondyle. Lateral
epicondylitis has reproducible pain with dorsiflexion against resistance when palms face the
floor.
Question 5
Mrs. T. comes for her regular visit to the clinic. You have heard about her many times from your
colleague and are aware that she is a very talkative person. Which of the following is a helpful
technique to improve the quality of the interview for both the provider and the patient?
A. Allow the patient to speak uninterrupted for the duration of the appointment
B. Briefly summarize what you heard from the patient in the first 5 minutes and then try to have
her focus on one aspect of what she told you
C. Set the time limit at the beginning of the interview and stick with it, no matter what occurs
D. Allow your impatience to show so that the patient picks up on your nonverbal cues
Answer: B
Rationale: You can say, "I want to make sure I take good care of this problem because it is very
important. We may need to talk about the others at the next appointment. Is that okay with you?"
This validates the patient's concerns and provides structure to the interview.
Question 6
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and
side-to-side directions. Which of the following is most likely?
pg. 2
,A. Cancer
B. Lymph node
C. Thyroid nodule
D. Lipoma
Answer: B
Rationale: A useful maneuver for discerning lymph nodes from other masses in the neck is to
check for their mobility in all directions. Many other masses are mobile in only two directions.
Cancerous masses may also be "fixed," or immobile.
Question 7
A 77-year-old retired bus driver comes to your clinic for a physical examination at his wife's
request. He has recently been losing weight and has felt very fatigued. His past medical history
includes colon cancer, for which he had surgery. On abdominal examination, you palpate his
liver and find it abnormal. His rectal examination is positive for occult blood. What further
abnormality of the liver was likely found on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender liver
Answer: B
Rationale: With his past history of colon cancer and with recent weight loss and fatigue, a
relapse of his colon cancer would be expected. Colon cancer usually metastasizes to the liver,
creating hard, irregular nodules.
Question 8
A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a
nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise,
but lately she has felt this way continuously. What is the most likely diagnosis?
A. Pneumonia
B. COPD
C. Asthma
D. Heart failure
Answer: C
Rationale: Asthma causes shortness of breath and a nocturnal cough. It is often associated with
exercise-induced symptoms, and symptoms may progress over time.
pg. 3
, Question 9
A 19-year-old college student presents to the emergency room with fever, headache, and neck
pain/stiffness. She is concerned about meningococcal meningitis. Which physical examination
description is most consistent with meningitis?
A. Head normocephalic, fundi with sharp discs, neck supple
B. Head normocephalic, fundi with sharp discs, neck with paraspinous muscle spasm
C. Head normocephalic, fundi with blurred disc margins, neck tender, unable to perform ROM
D. Head normocephalic, fundi with blurred disc margins, neck supple
Answer: C
Rationale: Blurred disc margins are consistent with papilledema, and neck tenderness with lack
of range of motion is consistent with neck stiffness from meningeal inflammation.
Question 10
A 60-year-old baker presents to your clinic, complaining of increasing shortness of breath and
nonproductive cough over the last month. She even has to sleep upright in her recliner at night to
be able to breathe comfortably. Her past medical history is significant for high blood pressure
and coronary artery disease. On examination, she has late inspiratory crackles in both lower
lobes. An S3 is heard over the apex. What disorder best describes her symptoms?
A. Pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural pain
D. Left-sided heart failure
Answer: D
Rationale: Fluid backs up into the lungs because the heart is unable to handle the volume. The
excess fluid collects in dependent areas, causing crackles in the bases of the lower lobes. Sitting
up allows patients to breathe easier. The two main causes are chronic high blood pressure and
coronary artery disease.
Question 11
When a patient is suspected of having medial epicondylitis (pitcher's, golfer's, or Little League
elbow), where would they experience pain?
A. Lateral elbow
B. Medial elbow
C. Olecranon process
D. Supracondylar area
Answer: B
Rationale: Medial epicondylitis involves pain and tenderness at the medial epicondyle of the
elbow. It is often caused by repetitive flexion and pronation of the forearm.
pg. 4
