NURS6512 Advanced Health Assessment Midterm
Exam 2026/2027 - Already Graded A Verified
Questions & Answers
Section 1: Comprehensive Assessment & Clinical Reasoning
1. A 68-year-old man with COPD GOLD D reports 3 days of increased dyspnea,
pleuritic chest pain, and hemoptysis. BP 94/60 mm Hg, HR 118 bpm, RR 26, SpO₂
88 % on 4 L NC. Auscultation reveals asymmetric diminished breath sounds right
lower zone with a sharp, localized pain on palpation of the intercostal spaces.
D-dimer is 2,800 ng/mL (ref < 500). Which advanced assessment maneuver best
clarifies the immediate etiology prior to imaging?
A) Egophony at the right base
B) Pulmonary expansion comparison with caliper metric
C) Tactile fremition (vocal fremitus) at the right lower posterior chest
D) Whispered pectoriloquy at the apex
Correct Answer: C
Correct Answer Text: Tactile fremition (vocal fremitus) at the right lower posterior chest
Rationale: Unilateral decreased fremitus supports pleural effusion or pneumothorax;
increased fremitus suggests consolidation. In the setting of pleuritic pain, hypoxemia,
and high D-dimer, distinguishing consolidation from pleural pathology guides urgency of
CT-PE protocol vs thoracentesis. Egophony and whispered pectoriloquy evaluate lung
parenchyma, not pleura. Caliper metric is insensitive for acute diagnoses.
, 2. A 24-year-old primigravida at 30 weeks presents with frontal headache, right
upper-quadrant pain, and 3+ pitting edema. BP 162/104 mm Hg, HR 92, platelets
88 k/µL, AST 210 U/L, ALT 190 U/L. Deep-tendon reflexes are 3+ with 2 beats of
clonus. Which targeted physical assessment finding best differentiates HELLP
syndrome from acute fatty liver of pregnancy (AFLP)?
A) Presence of hyper-reflexia and clonus
B) Scleral icterus
C) Fetor hepaticus
D) Hepatomegaly with palpable liver edge 4 cm below costal margin
Correct Answer: A
Correct Answer Text: Presence of hyper-reflexia and clonus
Rationale: HELLP is a hypertensive disorder; CNS irritability (hyper-reflexia, clonus) is
characteristic. AFLP typically shows normotension, hypoglycemia, and coagulopathy
without neuromuscular excitation. Scleral icterus and fetor hepaticus are nonspecific;
liver edge may be tender in both but not discriminative.
3. A 56-year-old woman with metastatic breast cancer on palbociclib reports
increasing fatigue and syncope. HR 38 bpm, regular, BP 88/50 mm Hg. ECG
shows sinus bradycardia with QT 640 ms. Which cranial-nerve assessment best
identifies the reversible contributing factor prior to laboratory results?
A) Oculocephalic (doll’s eyes) for CN VIII
B) Carotid sinus massage while auscultating for bruit
C) Oculocardiac reflex (CN V & X) with gentle ocular compression
D) Corneal reflex (CN V & VII)
Correct Answer: C
, Correct Answer Text: Oculocardiac reflex (CN V & X) with gentle ocular compression
Rationale: Exaggerated oculocardiac reflex (HR drop > 10 % with 20 s globe pressure)
suggests heightened vagal tone, common with intracranial metastases or medication
effects. Identifying vagotonia guides temporary atropine use while awaiting labs.
Carotid massage is contraindicated without bruit assessment; doll’s eyes evaluate
brainstem integrity, not autonomic tone.
4. A 72-year-old woman with diabetes and heart failure with preserved EF reports
burning pain and “wooden” feeling in both feet. Monofilament testing reveals
absent protective sensation at six plantar sites, vibration sense lost at the medial
malleolus, and ankle reflexes absent. Dorsalis pedis pulses are 2+. Which
additional test best establishes the predominant pathophysiologic mechanism?
A) Ipsilateral Achilles Tinel sign
B) 128-Hz tuning-fork placement at the great toe IP joint
C) Ipsilateral straight-leg-raise against resistance
D) Ipsilateral calf-squeeze (Thompson) test
Correct Answer: B
Correct Answer Text: 128-Hz tuning-fork placement at the great toe IP joint
Rationale: Loss of 128-Hz vibration at the IP joint is the earliest quantifiable indicator of
large-fiber diabetic polyneuropathy. Absent ankle reflexes and stocking-glove sensory
loss confirm large-fiber dysfunction versus small-fiber (burning preserved vibration).
Tinel evaluates tarsal tunnel; straight-leg-raise tests lumbosacral radiculopathy;
Thompson assesses Achilles rupture.
Exam 2026/2027 - Already Graded A Verified
Questions & Answers
Section 1: Comprehensive Assessment & Clinical Reasoning
1. A 68-year-old man with COPD GOLD D reports 3 days of increased dyspnea,
pleuritic chest pain, and hemoptysis. BP 94/60 mm Hg, HR 118 bpm, RR 26, SpO₂
88 % on 4 L NC. Auscultation reveals asymmetric diminished breath sounds right
lower zone with a sharp, localized pain on palpation of the intercostal spaces.
D-dimer is 2,800 ng/mL (ref < 500). Which advanced assessment maneuver best
clarifies the immediate etiology prior to imaging?
A) Egophony at the right base
B) Pulmonary expansion comparison with caliper metric
C) Tactile fremition (vocal fremitus) at the right lower posterior chest
D) Whispered pectoriloquy at the apex
Correct Answer: C
Correct Answer Text: Tactile fremition (vocal fremitus) at the right lower posterior chest
Rationale: Unilateral decreased fremitus supports pleural effusion or pneumothorax;
increased fremitus suggests consolidation. In the setting of pleuritic pain, hypoxemia,
and high D-dimer, distinguishing consolidation from pleural pathology guides urgency of
CT-PE protocol vs thoracentesis. Egophony and whispered pectoriloquy evaluate lung
parenchyma, not pleura. Caliper metric is insensitive for acute diagnoses.
, 2. A 24-year-old primigravida at 30 weeks presents with frontal headache, right
upper-quadrant pain, and 3+ pitting edema. BP 162/104 mm Hg, HR 92, platelets
88 k/µL, AST 210 U/L, ALT 190 U/L. Deep-tendon reflexes are 3+ with 2 beats of
clonus. Which targeted physical assessment finding best differentiates HELLP
syndrome from acute fatty liver of pregnancy (AFLP)?
A) Presence of hyper-reflexia and clonus
B) Scleral icterus
C) Fetor hepaticus
D) Hepatomegaly with palpable liver edge 4 cm below costal margin
Correct Answer: A
Correct Answer Text: Presence of hyper-reflexia and clonus
Rationale: HELLP is a hypertensive disorder; CNS irritability (hyper-reflexia, clonus) is
characteristic. AFLP typically shows normotension, hypoglycemia, and coagulopathy
without neuromuscular excitation. Scleral icterus and fetor hepaticus are nonspecific;
liver edge may be tender in both but not discriminative.
3. A 56-year-old woman with metastatic breast cancer on palbociclib reports
increasing fatigue and syncope. HR 38 bpm, regular, BP 88/50 mm Hg. ECG
shows sinus bradycardia with QT 640 ms. Which cranial-nerve assessment best
identifies the reversible contributing factor prior to laboratory results?
A) Oculocephalic (doll’s eyes) for CN VIII
B) Carotid sinus massage while auscultating for bruit
C) Oculocardiac reflex (CN V & X) with gentle ocular compression
D) Corneal reflex (CN V & VII)
Correct Answer: C
, Correct Answer Text: Oculocardiac reflex (CN V & X) with gentle ocular compression
Rationale: Exaggerated oculocardiac reflex (HR drop > 10 % with 20 s globe pressure)
suggests heightened vagal tone, common with intracranial metastases or medication
effects. Identifying vagotonia guides temporary atropine use while awaiting labs.
Carotid massage is contraindicated without bruit assessment; doll’s eyes evaluate
brainstem integrity, not autonomic tone.
4. A 72-year-old woman with diabetes and heart failure with preserved EF reports
burning pain and “wooden” feeling in both feet. Monofilament testing reveals
absent protective sensation at six plantar sites, vibration sense lost at the medial
malleolus, and ankle reflexes absent. Dorsalis pedis pulses are 2+. Which
additional test best establishes the predominant pathophysiologic mechanism?
A) Ipsilateral Achilles Tinel sign
B) 128-Hz tuning-fork placement at the great toe IP joint
C) Ipsilateral straight-leg-raise against resistance
D) Ipsilateral calf-squeeze (Thompson) test
Correct Answer: B
Correct Answer Text: 128-Hz tuning-fork placement at the great toe IP joint
Rationale: Loss of 128-Hz vibration at the IP joint is the earliest quantifiable indicator of
large-fiber diabetic polyneuropathy. Absent ankle reflexes and stocking-glove sensory
loss confirm large-fiber dysfunction versus small-fiber (burning preserved vibration).
Tinel evaluates tarsal tunnel; straight-leg-raise tests lumbosacral radiculopathy;
Thompson assesses Achilles rupture.
