NURS 6512 Advanced Health Assessment | Walden
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents with 3 days of increasing dyspnea on exertion and
orthopnea. He reports a 15-lb weight gain over 2 weeks. PMH: HTN, type 2 DM.
He smokes 1 ppd × 30 years. BP 168/98, HR 104, RR 22, O₂ sat 92 % RA. JVP is 4
cm above sternal angle. On auscultation you hear bilateral basilar crackles
halfway up, an S₃ gallop, and a 2/6 holosystolic murmur at the apex that radiates
to the axilla. There is +2 pitting edema to the knees bilaterally.
Which finding most supports that his dyspnea is due to left-sided heart failure
rather than primary pulmonary disease?
A. Orthopnea
B. S₃ gallop
C. Basilar crackles
D. Peripheral edema
Correct Answer: B
Rationale: An S₃ gallop reflects rapid ventricular filling and is a specific sign of elevated
left-ventricular filling pressures in heart failure. While orthopnea and crackles can occur
in pulmonary disease, the S₃ directly implicates ventricular dysfunction. Peripheral
edema is a right-sided finding.
2. A 24-year-old graduate student complains of 6 weeks of bilateral hand pain and
stiffness that lasts > 1 h in the morning. She also reports fatigue and a 3-lb
weight loss. Exam reveals boggy swelling and warmth at the 2nd and 3rd MCP
and PIP joints bilaterally, with grip strength reduced. There is mild flexor
tenosynovitis at the wrists. No DIP involvement.
, Which physical finding best differentiates an inflammatory arthritis such as RA
from osteoarthritis in this patient?
A. DIP sparing
B. Morning stiffness > 1 h
C. Symmetrical swelling
D. Boggy synovitis on exam
Correct Answer: D
Rationale: Palpable, boggy synovitis reflects active inflammation of the synovial
membrane and is the hallmark of inflammatory arthritides. OA typically affects DIPs,
lacks prolonged morning stiffness, and does not produce warmth or true synovial
thickening.
3. A 32-year-old woman at 30 weeks’ gestation presents with a 2-day history of right
flank pain, dysuria, and low-grade fever. She has no prior UTIs. Vitals: temp 38.2
°C, HR 96, BP 118/74. On exam, CVA tenderness is present on the right.
Urinalysis shows leukocyte esterase (+), nitrites (+), 20–50 WBC/hpf.
Which additional assessment finding is most critical to evaluate next?
A. Fundal height
B. Cervical length by speculum exam
C. Fetal heart rate
D. Deep-tendon reflexes
Correct Answer: C
Rationale: Maternal pyelonephritis can precipitate pre-term labor or fetal hypoxia; fetal
heart rate assessment (normal 110–160) is the priority. Fundal height is less urgent;
cervical checks are avoided unless delivery imminent; DTRs relate to magnesium, not
yet indicated.
4. A 77-year-old woman is brought by her daughter for “confusion.” Over 3 months
she has become less interactive, sleeps more, and has had two near-falls. No
incontinence or headache. PMH: HTN, hypothyroidism. Medications: lisinopril,
levothyroxine 75 µg. MMSE = 24/30 (loses points on recall and attention). Gait is
, slow, shuffling, but arm swing preserved. Strength 5/5, DTRs 2+, plantar flexor.
Sensory exam intact.
Which single bedside test is most appropriate to determine whether this is
normal-pressure hydrocephalus versus a neurodegenerative disorder?
A. Rhomberg
B. Tandem walk
C. Timed Up and Go
D. Appraisal of gait after 30 mL CSF removal via LP
Correct Answer: D
Rationale: NPH classically presents with Hakim triad (gait apraxia, incontinence,
dementia). A positive “tap test” (improved gait 30 min–24 h after high-volume CSF
removal) supports NPH and predicts shunt responsiveness. Other choices do not
differentiate etiology.
5. A 45-year-old man with cirrhosis due to chronic HCV presents for worsening
abdominal distension. He notes mild dyspnea when bending forward. On exam
there is bulging flanks, shifting dullness, and a fluid wave. Estimated fluid volume
by physical exam is > 1.5 L.
Which assessment maneuver best confirms that the dyspnea is related to tense
ascites compressing the diaphragm?
A. Measure JVP in supine and 45° positions
B. Perform bedside abdominal ultrasound to quantify fluid
C. Auscultate for bibasilar crackles
D. Assess respiratory excursion before and after therapeutic paracentesis
Correct Answer: D
Rationale: Improvement in respiratory excursion or oxygen saturation after large-volume
paracentesis directly links ascites to ventilatory compromise. Ultrasound quantifies but
does not establish functional impact.
6. A 6-year-old boy is brought in with 2 days of refusal to walk. His mother reports a
recent viral URI. He points to both knees and ankles as sore. On exam he has a
, reluctance to dorsiflex the ankles and cries with attempted hip internal rotation.
There is no warmth or effusion palpable. Skin shows 2–3 cm annular,
salmon-colored, slightly scaly patches on trunk.
Which additional finding would most support a diagnosis of acute rheumatic
fever?
A. Subcutaneous nodules over extensor surfaces
B. Temperature 37.8 °C
C. Erythema marginatum on trunk
D. Elevated antistreptolysin-O titre
Correct Answer: C
Rationale: Erythema marginatum is a major Jones criterion and presents as evanescent,
pink rings on trunk. Subcutaneous nodules are also major but typically occur in chronic
or severe disease. ASO is supportive but not a physical finding.
7. A 62-year-old woman with COPD (FEV₁ 45 % predicted) presents with 4 days of
increased cough, purulent sputum, and dyspnea. She has been on home O₂ 2 L.
Today her sputum is blood-tinged. Vitals: temp 37.6 °C, HR 98, RR 26, O₂ sat 86 %
on 2 L. Chest exam reveals hyper-resonant percussion, decreased breath sounds,
and prolonged expiration with scattered wheezes and rhonchi. There is no pedal
edema or JVD.
Which finding most raises concern for pneumonia rather than a COPD
exacerbation alone?
A. Increased sputum purulence
B. Temperature 37.6 °C
C. Blood-tinged sputum
D. Oxygen saturation 86 % on home O₂
Correct Answer: A
Rationale: Anthon criteria for COPD exacerbation include increased dyspnea, sputum
volume, and purulence; purulence best correlates with bacterial infection. Low-grade
fever and desaturation can occur in both.
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents with 3 days of increasing dyspnea on exertion and
orthopnea. He reports a 15-lb weight gain over 2 weeks. PMH: HTN, type 2 DM.
He smokes 1 ppd × 30 years. BP 168/98, HR 104, RR 22, O₂ sat 92 % RA. JVP is 4
cm above sternal angle. On auscultation you hear bilateral basilar crackles
halfway up, an S₃ gallop, and a 2/6 holosystolic murmur at the apex that radiates
to the axilla. There is +2 pitting edema to the knees bilaterally.
Which finding most supports that his dyspnea is due to left-sided heart failure
rather than primary pulmonary disease?
A. Orthopnea
B. S₃ gallop
C. Basilar crackles
D. Peripheral edema
Correct Answer: B
Rationale: An S₃ gallop reflects rapid ventricular filling and is a specific sign of elevated
left-ventricular filling pressures in heart failure. While orthopnea and crackles can occur
in pulmonary disease, the S₃ directly implicates ventricular dysfunction. Peripheral
edema is a right-sided finding.
2. A 24-year-old graduate student complains of 6 weeks of bilateral hand pain and
stiffness that lasts > 1 h in the morning. She also reports fatigue and a 3-lb
weight loss. Exam reveals boggy swelling and warmth at the 2nd and 3rd MCP
and PIP joints bilaterally, with grip strength reduced. There is mild flexor
tenosynovitis at the wrists. No DIP involvement.
, Which physical finding best differentiates an inflammatory arthritis such as RA
from osteoarthritis in this patient?
A. DIP sparing
B. Morning stiffness > 1 h
C. Symmetrical swelling
D. Boggy synovitis on exam
Correct Answer: D
Rationale: Palpable, boggy synovitis reflects active inflammation of the synovial
membrane and is the hallmark of inflammatory arthritides. OA typically affects DIPs,
lacks prolonged morning stiffness, and does not produce warmth or true synovial
thickening.
3. A 32-year-old woman at 30 weeks’ gestation presents with a 2-day history of right
flank pain, dysuria, and low-grade fever. She has no prior UTIs. Vitals: temp 38.2
°C, HR 96, BP 118/74. On exam, CVA tenderness is present on the right.
Urinalysis shows leukocyte esterase (+), nitrites (+), 20–50 WBC/hpf.
Which additional assessment finding is most critical to evaluate next?
A. Fundal height
B. Cervical length by speculum exam
C. Fetal heart rate
D. Deep-tendon reflexes
Correct Answer: C
Rationale: Maternal pyelonephritis can precipitate pre-term labor or fetal hypoxia; fetal
heart rate assessment (normal 110–160) is the priority. Fundal height is less urgent;
cervical checks are avoided unless delivery imminent; DTRs relate to magnesium, not
yet indicated.
4. A 77-year-old woman is brought by her daughter for “confusion.” Over 3 months
she has become less interactive, sleeps more, and has had two near-falls. No
incontinence or headache. PMH: HTN, hypothyroidism. Medications: lisinopril,
levothyroxine 75 µg. MMSE = 24/30 (loses points on recall and attention). Gait is
, slow, shuffling, but arm swing preserved. Strength 5/5, DTRs 2+, plantar flexor.
Sensory exam intact.
Which single bedside test is most appropriate to determine whether this is
normal-pressure hydrocephalus versus a neurodegenerative disorder?
A. Rhomberg
B. Tandem walk
C. Timed Up and Go
D. Appraisal of gait after 30 mL CSF removal via LP
Correct Answer: D
Rationale: NPH classically presents with Hakim triad (gait apraxia, incontinence,
dementia). A positive “tap test” (improved gait 30 min–24 h after high-volume CSF
removal) supports NPH and predicts shunt responsiveness. Other choices do not
differentiate etiology.
5. A 45-year-old man with cirrhosis due to chronic HCV presents for worsening
abdominal distension. He notes mild dyspnea when bending forward. On exam
there is bulging flanks, shifting dullness, and a fluid wave. Estimated fluid volume
by physical exam is > 1.5 L.
Which assessment maneuver best confirms that the dyspnea is related to tense
ascites compressing the diaphragm?
A. Measure JVP in supine and 45° positions
B. Perform bedside abdominal ultrasound to quantify fluid
C. Auscultate for bibasilar crackles
D. Assess respiratory excursion before and after therapeutic paracentesis
Correct Answer: D
Rationale: Improvement in respiratory excursion or oxygen saturation after large-volume
paracentesis directly links ascites to ventilatory compromise. Ultrasound quantifies but
does not establish functional impact.
6. A 6-year-old boy is brought in with 2 days of refusal to walk. His mother reports a
recent viral URI. He points to both knees and ankles as sore. On exam he has a
, reluctance to dorsiflex the ankles and cries with attempted hip internal rotation.
There is no warmth or effusion palpable. Skin shows 2–3 cm annular,
salmon-colored, slightly scaly patches on trunk.
Which additional finding would most support a diagnosis of acute rheumatic
fever?
A. Subcutaneous nodules over extensor surfaces
B. Temperature 37.8 °C
C. Erythema marginatum on trunk
D. Elevated antistreptolysin-O titre
Correct Answer: C
Rationale: Erythema marginatum is a major Jones criterion and presents as evanescent,
pink rings on trunk. Subcutaneous nodules are also major but typically occur in chronic
or severe disease. ASO is supportive but not a physical finding.
7. A 62-year-old woman with COPD (FEV₁ 45 % predicted) presents with 4 days of
increased cough, purulent sputum, and dyspnea. She has been on home O₂ 2 L.
Today her sputum is blood-tinged. Vitals: temp 37.6 °C, HR 98, RR 26, O₂ sat 86 %
on 2 L. Chest exam reveals hyper-resonant percussion, decreased breath sounds,
and prolonged expiration with scattered wheezes and rhonchi. There is no pedal
edema or JVD.
Which finding most raises concern for pneumonia rather than a COPD
exacerbation alone?
A. Increased sputum purulence
B. Temperature 37.6 °C
C. Blood-tinged sputum
D. Oxygen saturation 86 % on home O₂
Correct Answer: A
Rationale: Anthon criteria for COPD exacerbation include increased dyspnea, sputum
volume, and purulence; purulence best correlates with bacterial infection. Low-grade
fever and desaturation can occur in both.
