NR-581 NR581: Nurse Practitioner Assessment and
Clinical Placement – Advanced Health Evaluation,
Diagnostic Reasoning, and Evidence-Based Patient
Management 2025-2026
1. Which is the most appropriate initial step in the NP
assessment of a new adult patient?
A. Perform a focused physical exam
B. Review previous medical records
C. Conduct a comprehensive history and physical
D. Order laboratory tests
Answer: C. Conduct a comprehensive history and physical
Rationale: A complete history and physical exam is the
foundation for identifying patient problems and guiding further
assessment and testing.
2. During a cardiovascular assessment, you note a murmur
best heard at the apex with the patient in the left lateral
decubitus position. Which type of murmur is this most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
,Answer: C. Mitral stenosis
Rationale: Mitral stenosis murmurs are best heard at the apex
with the patient in the left lateral position, often with a diastolic
rumble.
3. A 45-year-old patient presents with a 2-week history of
persistent cough and dyspnea. What is the first priority in
assessment?
A. Order a chest X-ray
B. Perform a focused pulmonary exam
C. Assess vital signs and oxygen saturation
D. Prescribe an antibiotic
Answer: C. Assess vital signs and oxygen saturation
Rationale: Initial assessment should prioritize identifying life-
threatening conditions; vital signs and oxygen saturation
provide critical information about stability.
4. Which technique is used to assess for hepatomegaly?
A. Percussion and palpation
B. Auscultation of the abdomen
C. Inspection of skin color
D. Measuring blood pressure
Answer: A. Percussion and palpation
Rationale: Liver enlargement is assessed through percussion to
,estimate size and palpation to determine consistency and
tenderness.
5. In a neurological exam, which test evaluates cerebellar
function?
A. Deep tendon reflexes
B. Finger-to-nose test
C. Babinski reflex
D. Sensory discrimination
Answer: B. Finger-to-nose test
Rationale: The finger-to-nose test assesses coordination and
cerebellar function.
6. Which of the following is a hallmark sign of Cushing’s
syndrome?
A. Thin, fragile skin with purple striae
B. Bradycardia
C. Hypotension
D. Hyperpigmented skin
Answer: A. Thin, fragile skin with purple striae
Rationale: Cortisol excess leads to characteristic skin changes,
central obesity, and moon face.
7. What is the first step in conducting a mental status exam?
, A. Assess mood and affect
B. Evaluate memory
C. Observe appearance and behavior
D. Test language function
Answer: C. Observe appearance and behavior
Rationale: Mental status assessment begins with observation of
general appearance, behavior, and level of consciousness.
8. When auscultating lungs, you hear coarse crackles that
persist after a cough. This finding is most consistent with:
A. Asthma
B. Pneumonia
C. Pulmonary edema
D. Pneumothorax
Answer: B. Pneumonia
Rationale: Coarse crackles that do not clear with coughing often
indicate alveolar consolidation seen in pneumonia.
9. A patient reports severe, sudden-onset headache described
as “the worst ever.” The most appropriate initial action is:
A. Prescribe analgesics and observe
B. Obtain a CT scan of the head
C. Reassure the patient
D. Schedule routine follow-up
Clinical Placement – Advanced Health Evaluation,
Diagnostic Reasoning, and Evidence-Based Patient
Management 2025-2026
1. Which is the most appropriate initial step in the NP
assessment of a new adult patient?
A. Perform a focused physical exam
B. Review previous medical records
C. Conduct a comprehensive history and physical
D. Order laboratory tests
Answer: C. Conduct a comprehensive history and physical
Rationale: A complete history and physical exam is the
foundation for identifying patient problems and guiding further
assessment and testing.
2. During a cardiovascular assessment, you note a murmur
best heard at the apex with the patient in the left lateral
decubitus position. Which type of murmur is this most likely?
A. Aortic stenosis
B. Mitral regurgitation
C. Mitral stenosis
D. Tricuspid regurgitation
,Answer: C. Mitral stenosis
Rationale: Mitral stenosis murmurs are best heard at the apex
with the patient in the left lateral position, often with a diastolic
rumble.
3. A 45-year-old patient presents with a 2-week history of
persistent cough and dyspnea. What is the first priority in
assessment?
A. Order a chest X-ray
B. Perform a focused pulmonary exam
C. Assess vital signs and oxygen saturation
D. Prescribe an antibiotic
Answer: C. Assess vital signs and oxygen saturation
Rationale: Initial assessment should prioritize identifying life-
threatening conditions; vital signs and oxygen saturation
provide critical information about stability.
4. Which technique is used to assess for hepatomegaly?
A. Percussion and palpation
B. Auscultation of the abdomen
C. Inspection of skin color
D. Measuring blood pressure
Answer: A. Percussion and palpation
Rationale: Liver enlargement is assessed through percussion to
,estimate size and palpation to determine consistency and
tenderness.
5. In a neurological exam, which test evaluates cerebellar
function?
A. Deep tendon reflexes
B. Finger-to-nose test
C. Babinski reflex
D. Sensory discrimination
Answer: B. Finger-to-nose test
Rationale: The finger-to-nose test assesses coordination and
cerebellar function.
6. Which of the following is a hallmark sign of Cushing’s
syndrome?
A. Thin, fragile skin with purple striae
B. Bradycardia
C. Hypotension
D. Hyperpigmented skin
Answer: A. Thin, fragile skin with purple striae
Rationale: Cortisol excess leads to characteristic skin changes,
central obesity, and moon face.
7. What is the first step in conducting a mental status exam?
, A. Assess mood and affect
B. Evaluate memory
C. Observe appearance and behavior
D. Test language function
Answer: C. Observe appearance and behavior
Rationale: Mental status assessment begins with observation of
general appearance, behavior, and level of consciousness.
8. When auscultating lungs, you hear coarse crackles that
persist after a cough. This finding is most consistent with:
A. Asthma
B. Pneumonia
C. Pulmonary edema
D. Pneumothorax
Answer: B. Pneumonia
Rationale: Coarse crackles that do not clear with coughing often
indicate alveolar consolidation seen in pneumonia.
9. A patient reports severe, sudden-onset headache described
as “the worst ever.” The most appropriate initial action is:
A. Prescribe analgesics and observe
B. Obtain a CT scan of the head
C. Reassure the patient
D. Schedule routine follow-up
