NURS 681 Exam 2026: Advanced Health Assessment & Diagnostic
Reasoning EXAM GAURANTEED PASS WITH 100+ TEST BANK
QUESTIONS 2026 CARRICULUM BASSED VERRIFIED TEST INSTANT PDF
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Total Questions: 105
1. A 72-year-old patient presents for a routine physical. During the health history, the patient’s
daughter mentions that her father has been experiencing progressive memory loss and occasionally
gets lost in familiar neighborhoods. What is the most appropriate initial screening tool to assess for
cognitive impairment?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale (GDS)
Answer: B. Montreal Cognitive Assessment (MoCA)
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive impairment (MCI)
and early Alzheimer's disease. The MMSE is better for moderate-to-severe dementia. CAM is for
delirium, and GDS is for depression, which can present with cognitive symptoms.
2. A patient who speaks limited English is brought in by their adult child for an evaluation. The child
insists on translating. What is the best course of action for the advanced practice nurse (APN)?
A. Proceed with the interview using the child as the translator to build rapport.
B. Use a professional medical interpreter service, either in-person or via a phone/video service.
C. Ask the patient to write down their symptoms in English.
D. Use hand gestures and basic English words to communicate directly with the patient.
Answer: B. Use a professional medical interpreter service, either in-person or via a phone/video
service.
Rationale: Using a professional interpreter is legally required (Title VI of the Civil Rights Act) and
clinically best practice. It ensures accurate translation, maintains patient confidentiality, and prevents
the potential for family members to filter information or influence the patient's responses.
,3. During an interview, the patient is speaking at length about their past medical history, providing
excessive detail that is not directly relevant to the chief complaint. Which interviewing technique is
most effective to refocus the conversation?
A. Facilitation
B. Reflection
C. Focusing
D. Confrontation
Answer: C. Focusing
Rationale: Focusing is the technique used to steer the conversation back to the primary topic or to a
specific area of concern when the patient is rambling. Facilitation (e.g., "uh-huh") encourages
elaboration. Reflection repeats the patient's words back to them. Confrontation clarifies
discrepancies.
4. A patient states, "I don't know why I'm here. My wife made me come. I feel fine." This is an
example of which type of patient?
A. A historian
B. A controlling patient
C. A reluctant patient
D. A dependent patient
Answer: C. A reluctant patient
Rationale: A reluctant patient is one who is not voluntarily seeking care and may be uncooperative or
defensive. The APN's goal is to acknowledge their feelings, explore the reasons for the visit, and find
common ground. A controlling patient may interrupt or ask many questions. A dependent patient
looks to the provider for every decision.
5. What is the primary purpose of the "OLDCARTS" mnemonic in health assessment?
A. To assess a patient's mental status.
B. To evaluate the severity of acute pain.
C. To perform a comprehensive functional assessment.
D. To perform a focused assessment of a symptom.
,Answer: D. To perform a focused assessment of a symptom.
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors,
Timing, Severity) is a systematic method for analyzing and describing a patient's presenting symptom,
forming the basis of the history of present illness (HPI).
6. A 45-year-old patient with a history of hypertension and diabetes reports a new onset of chest pain.
After completing the HPI and history, which component of the physical exam is the next priority?
A. Neurological exam
B. Musculoskeletal exam
C. Cardiovascular and pulmonary exam
D. Abdominal exam
Answer: C. Cardiovascular and pulmonary exam.
Rationale: Based on the chief complaint (chest pain) and high-risk comorbidities (HTN, DM), the
cardiovascular and pulmonary systems are the most likely sources of the problem and should be
assessed immediately. This is a focused, problem-oriented exam.
7. An APN is assessing a patient's functional ability. Which of the following questions best assesses
Instrumental Activities of Daily Living (IADLs)?
A. "Are you able to get in and out of the bathtub safely?"
B. "Are you able to dress yourself without assistance?"
C. "Are you able to manage your finances and pay bills?"
D. "Are you able to feed yourself?"
Answer: C. "Are you able to manage your finances and pay bills?"
Rationale: IADLs are more complex tasks needed to live independently in the community (e.g.,
managing finances, shopping, using the telephone, housekeeping). ADLs are basic self-care tasks
(bathing, dressing, eating, toileting, transferring).
8. A 17-year-old patient is brought in by their parent for a sports physical. The parent insists on
staying in the room during the interview and exam. How should the APN handle this situation?
, A. Allow the parent to stay, as the patient is a minor.
B. Ask the patient if they would prefer the parent to leave and honor the patient's wish.
C. Ask the parent to leave without explanation.
D. Proceed with the exam, but ask the parent not to speak.
Answer: B. Ask the patient if they would prefer the parent to leave and honor the patient's wish.
Rationale: The APN should provide an opportunity for the adolescent to speak privately, at least for
part of the interview, to discuss sensitive topics (e.g., sexual activity, substance use, mental health)
and build trust. While legally the parent can consent for care, best practice is to establish
confidentiality ground rules and give the adolescent some autonomy.
9. Which of the following is an example of a "pertinent negative" in a health history?
A. "The patient reports a headache that started three hours ago."
B. "The patient's father had a myocardial infarction at age 55."
C. "The patient denies any shortness of breath."
D. "The patient is a 2-pack-per-day smoker."
Answer: C. "The patient denies any shortness of breath."
Rationale: A pertinent negative is the absence of a sign or symptom that is typically expected given
the patient's chief complaint or condition. For a patient with chest pain, the denial of shortness of
breath is a key piece of information that helps rule out certain differentials.
10. A patient is experiencing acute anxiety and is visibly upset. The APN notices their own heart rate
increasing and feeling tense. This is an example of:
A. Countertransference
B. Transference
C. Projection
D. Empathy
Answer: A. Countertransference
Reasoning EXAM GAURANTEED PASS WITH 100+ TEST BANK
QUESTIONS 2026 CARRICULUM BASSED VERRIFIED TEST INSTANT PDF
DOWNLOAD
Total Questions: 105
1. A 72-year-old patient presents for a routine physical. During the health history, the patient’s
daughter mentions that her father has been experiencing progressive memory loss and occasionally
gets lost in familiar neighborhoods. What is the most appropriate initial screening tool to assess for
cognitive impairment?
A. Mini-Mental State Examination (MMSE)
B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale (GDS)
Answer: B. Montreal Cognitive Assessment (MoCA)
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive impairment (MCI)
and early Alzheimer's disease. The MMSE is better for moderate-to-severe dementia. CAM is for
delirium, and GDS is for depression, which can present with cognitive symptoms.
2. A patient who speaks limited English is brought in by their adult child for an evaluation. The child
insists on translating. What is the best course of action for the advanced practice nurse (APN)?
A. Proceed with the interview using the child as the translator to build rapport.
B. Use a professional medical interpreter service, either in-person or via a phone/video service.
C. Ask the patient to write down their symptoms in English.
D. Use hand gestures and basic English words to communicate directly with the patient.
Answer: B. Use a professional medical interpreter service, either in-person or via a phone/video
service.
Rationale: Using a professional interpreter is legally required (Title VI of the Civil Rights Act) and
clinically best practice. It ensures accurate translation, maintains patient confidentiality, and prevents
the potential for family members to filter information or influence the patient's responses.
,3. During an interview, the patient is speaking at length about their past medical history, providing
excessive detail that is not directly relevant to the chief complaint. Which interviewing technique is
most effective to refocus the conversation?
A. Facilitation
B. Reflection
C. Focusing
D. Confrontation
Answer: C. Focusing
Rationale: Focusing is the technique used to steer the conversation back to the primary topic or to a
specific area of concern when the patient is rambling. Facilitation (e.g., "uh-huh") encourages
elaboration. Reflection repeats the patient's words back to them. Confrontation clarifies
discrepancies.
4. A patient states, "I don't know why I'm here. My wife made me come. I feel fine." This is an
example of which type of patient?
A. A historian
B. A controlling patient
C. A reluctant patient
D. A dependent patient
Answer: C. A reluctant patient
Rationale: A reluctant patient is one who is not voluntarily seeking care and may be uncooperative or
defensive. The APN's goal is to acknowledge their feelings, explore the reasons for the visit, and find
common ground. A controlling patient may interrupt or ask many questions. A dependent patient
looks to the provider for every decision.
5. What is the primary purpose of the "OLDCARTS" mnemonic in health assessment?
A. To assess a patient's mental status.
B. To evaluate the severity of acute pain.
C. To perform a comprehensive functional assessment.
D. To perform a focused assessment of a symptom.
,Answer: D. To perform a focused assessment of a symptom.
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors,
Timing, Severity) is a systematic method for analyzing and describing a patient's presenting symptom,
forming the basis of the history of present illness (HPI).
6. A 45-year-old patient with a history of hypertension and diabetes reports a new onset of chest pain.
After completing the HPI and history, which component of the physical exam is the next priority?
A. Neurological exam
B. Musculoskeletal exam
C. Cardiovascular and pulmonary exam
D. Abdominal exam
Answer: C. Cardiovascular and pulmonary exam.
Rationale: Based on the chief complaint (chest pain) and high-risk comorbidities (HTN, DM), the
cardiovascular and pulmonary systems are the most likely sources of the problem and should be
assessed immediately. This is a focused, problem-oriented exam.
7. An APN is assessing a patient's functional ability. Which of the following questions best assesses
Instrumental Activities of Daily Living (IADLs)?
A. "Are you able to get in and out of the bathtub safely?"
B. "Are you able to dress yourself without assistance?"
C. "Are you able to manage your finances and pay bills?"
D. "Are you able to feed yourself?"
Answer: C. "Are you able to manage your finances and pay bills?"
Rationale: IADLs are more complex tasks needed to live independently in the community (e.g.,
managing finances, shopping, using the telephone, housekeeping). ADLs are basic self-care tasks
(bathing, dressing, eating, toileting, transferring).
8. A 17-year-old patient is brought in by their parent for a sports physical. The parent insists on
staying in the room during the interview and exam. How should the APN handle this situation?
, A. Allow the parent to stay, as the patient is a minor.
B. Ask the patient if they would prefer the parent to leave and honor the patient's wish.
C. Ask the parent to leave without explanation.
D. Proceed with the exam, but ask the parent not to speak.
Answer: B. Ask the patient if they would prefer the parent to leave and honor the patient's wish.
Rationale: The APN should provide an opportunity for the adolescent to speak privately, at least for
part of the interview, to discuss sensitive topics (e.g., sexual activity, substance use, mental health)
and build trust. While legally the parent can consent for care, best practice is to establish
confidentiality ground rules and give the adolescent some autonomy.
9. Which of the following is an example of a "pertinent negative" in a health history?
A. "The patient reports a headache that started three hours ago."
B. "The patient's father had a myocardial infarction at age 55."
C. "The patient denies any shortness of breath."
D. "The patient is a 2-pack-per-day smoker."
Answer: C. "The patient denies any shortness of breath."
Rationale: A pertinent negative is the absence of a sign or symptom that is typically expected given
the patient's chief complaint or condition. For a patient with chest pain, the denial of shortness of
breath is a key piece of information that helps rule out certain differentials.
10. A patient is experiencing acute anxiety and is visibly upset. The APN notices their own heart rate
increasing and feeling tense. This is an example of:
A. Countertransference
B. Transference
C. Projection
D. Empathy
Answer: A. Countertransference
