NURS 6512 Advanced Health Assessment Midterm Exam
2026/2027 - Walden University Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents with 2 hours of acute chest pressure radiating to the
left arm. HPI: onset while mowing, 8/10 “crushing,” mild dyspnea, no prior
episodes. PMH: HTN, hyperlipidemia, 40 pack-year tobacco. Medications:
amlodipine 5 mg daily. VS: BP 148/88, HR 96 reg, RR 20, SpO₂ 95 % RA, T 36.6 °C.
Inspection: no JVD, no pedal edema. Palpation: PMI 5th ICS MCL, no heave or
thrill. Auscultation: regular S1/S2, soft S₄ heard at apex in expiration; no
murmurs, rubs, or gallops. Lungs clear bilaterally; no CVA tenderness. EKG: sinus
rhythm, mild ST depression in V₄-V₆. Which finding MOST increases the likelihood
that his pain is cardiac in origin?
A. S₄ gallop
B. ST depression on EKG
C. Absence of murmur
D. Clear lung fields
Correct Answer: B
Rationale: ST depression in lateral precordial leads during symptomatic chest pain is
objective EKG evidence of possible ischemia. S₄ can occur with HTN alone; absence of
murmur or crackles neither confirms nor excludes acute coronary syndrome.
2. A 24-year-old woman complains of 3 days of sore throat, fatigue, and 1 day of
dyspnea. PMH: asthma (childhood). VS: BP 118/70, HR 110, RR 24, SpO₂ 93 %
RA, T 38.9 °C. She is sitting upright, speaking in 2-word sentences. Inspection:
mild tracheal tug, intercostal retractions. Auscultation: inspiratory and expiratory
wheezes throughout, prolonged expiratory phase, no crackles; no clubbing or
cyanosis. Peak flow 180 L/min (personal best 420). Which is the SINGLE most
, urgent focused assessment maneuver to perform NEXT?
A. Chest X-ray
B. Arterial blood gas
C. Pulmonary function tests
D. Assessment of pulsus paradoxus with blood-pressure cuff
Correct Answer: D
Rationale: Severe asthma exacerbation with tachycardia, tachypnea, accessory-muscle
use, and low peak flow raises concern for imminent respiratory failure; pulsus
paradoxus ≥20 mmHg signals severe airway obstruction and need for immediate
escalated therapy (magnesium, BiPAP, or intubation). ABG is useful but not bedside;
PFTs are contraindicated in acute distress.
3. A 67-year-old woman is seen for annual exam. No chest symptoms. PMH:
osteoporosis, 40-year 1 pack/day tobacco (quit 5 years ago). VS stable. On
cardiac auscultation you hear a soft, high-pitched, early-peaking systolic murmur
at the right 2nd ICS radiating to the carotids; no S₃ or S₄; carotid upstrokes are
brisk. Which is the MOST appropriate documentation of the murmur in your
SOAP note?
A. “2/6 holosystolic murmur, apex, no radiation”
B. “1-2/6 early-systolic ejection murmur, R 2nd ICS, carotid radiation,
early-peaking”
C. “3/6 late-peaking systolic murmur, L 2nd ICS, S₃ present”
D. “Continuous machinery murmur, L 2nd ICS, throughout systole and diastole”
**Correct Answer: B
Rationale: Description fits benign aortic sclerosis (early-peaking, <3/6) versus aortic
stenosis; location and radiation are classic for aortic area. No S₃ is noted. Choice A
describes mitral regurgitation; C suggests severe AS (late-peaking) and adds an
unnoted S₃; D is patent ductus arteriosus.
, 4. A 6-year-old boy is brought in with 1 day of limping and left knee swelling. His
mother notes a viral illness 2 weeks ago. VS: afebrile, HR 90. Inspection: swollen
left knee, erythema, flexed 20°. Palpation: warm, tender; ROM limited by pain. No
rash. Which additional focused history question is MOST critical?
A. History of insect tick bites
B. Recent strep throat infection or positive strep test
C. Immunization status for pertussis
D. Family history of muscular dystrophy
**Correct Answer: B
Rationale: Acute monoarthritis following viral illness raises post-streptococcal reactive
arthritis or acute rheumatic fever (Jones criteria require preceding GAS). Tick bite
(Lyme) is possible but less likely with single joint and no rash in a 6-year-old in winter
scenario.
5. A 55-year-old man with DM type 2 and ESRD on hemodialysis presents for pre-op
assessment ( elective inguinal herniorrhaphy). He reports progressive dyspnea
on exertion and orthopnea. VS: BP 150/90, HR 88, SpO₂ 94 % RA. JVD is visible at
45°; bilateral pitting edema to knees. Auscultation: S₃ gallop, bibasilar crackles.
Which is the MOST likely cause of his symptoms?
A. Acute COPD exacerbation
B. Fluid overload related to ESRD and diastolic dysfunction
C. Pulmonary embolism
D. Primary pulmonary hypertension
**Correct Answer: B
Rationale: Volume overload in ESRD plus S₃ and JVD point to heart failure with fluid
overload (likely high-output or diastolic HF common in ESRD). Crackles and edema
support this; no fever or wheeze for COPD, no pleuritic chest pain for PE.
6. A 19-year-old college student complains of 4 weeks of fatigue, intermittent
low-grade fever, and 3 days of facial swelling. She returned from a spring-break
mission trip to rural Central America 6 weeks ago. VS: BP 110/70, HR 84, T 37.8
, °C. Facial puffiness bilateral, no erythema; mild pitting edema lower extremities.
Urine dipstick: 3+ protein, trace blood. Which is the SINGLE most urgent
diagnostic test to order NEXT?
A. CBC with differential
B. 24-h urine protein
C. Rapid strep and ASO titer
D. Renal ultrasound with Doppler
**Correct Answer: B
Rationale: Nephrotic-range proteinuria (>3.5 g/day) must be quantified; facial and
peripheral edema with heavy proteinuria suggests nephrotic syndrome (possible
minimal-change disease post-infection or parasitic etiology). CBC is useful but not next
urgent; strep unlikely without pharyngitis; ultrasound not immediately needed.
7. A 42-year-old woman presents with 2 months of dry cough and 10-lb weight loss.
No fever. PMH: asthma, GERD. She is never-smoker. VS stable. Chest
auscultation: scattered expiratory wheezes R lung mid-zone; no crackles. CXR:
right perihilar infiltrate, no effusion. Peak flow 350 L/min (predicted 450). Which
specialized NP assessment should you perform NEXT to refine differential?
A. Sputum culture and cytology
B. Methacholine challenge
C. Spirometry pre/post bronchodilator
D. Assess for paradoxical vocal-fold motion (inspiratory stridor during attack)
**Correct Answer: A
Rationale: Chronic cough, weight loss, localized wheeze and CXR infiltrate raise red
flags for malignancy or atypical infection; sputum cytology/culture is initial step.
Spirometry is routine asthma monitoring but does not explain focal infiltrate;
methacholine not indicated with structural finding.
8. A 70-year-old man is seen 6 weeks post-MI. He denies chest pain. VS: BP 130/80,
HR 72 irregularly irregular. Lungs clear. On cardiac auscultation you hear a
high-pitched, blowing, pansystolic murmur at the apex radiating to the axilla; no
2026/2027 - Walden University Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents with 2 hours of acute chest pressure radiating to the
left arm. HPI: onset while mowing, 8/10 “crushing,” mild dyspnea, no prior
episodes. PMH: HTN, hyperlipidemia, 40 pack-year tobacco. Medications:
amlodipine 5 mg daily. VS: BP 148/88, HR 96 reg, RR 20, SpO₂ 95 % RA, T 36.6 °C.
Inspection: no JVD, no pedal edema. Palpation: PMI 5th ICS MCL, no heave or
thrill. Auscultation: regular S1/S2, soft S₄ heard at apex in expiration; no
murmurs, rubs, or gallops. Lungs clear bilaterally; no CVA tenderness. EKG: sinus
rhythm, mild ST depression in V₄-V₆. Which finding MOST increases the likelihood
that his pain is cardiac in origin?
A. S₄ gallop
B. ST depression on EKG
C. Absence of murmur
D. Clear lung fields
Correct Answer: B
Rationale: ST depression in lateral precordial leads during symptomatic chest pain is
objective EKG evidence of possible ischemia. S₄ can occur with HTN alone; absence of
murmur or crackles neither confirms nor excludes acute coronary syndrome.
2. A 24-year-old woman complains of 3 days of sore throat, fatigue, and 1 day of
dyspnea. PMH: asthma (childhood). VS: BP 118/70, HR 110, RR 24, SpO₂ 93 %
RA, T 38.9 °C. She is sitting upright, speaking in 2-word sentences. Inspection:
mild tracheal tug, intercostal retractions. Auscultation: inspiratory and expiratory
wheezes throughout, prolonged expiratory phase, no crackles; no clubbing or
cyanosis. Peak flow 180 L/min (personal best 420). Which is the SINGLE most
, urgent focused assessment maneuver to perform NEXT?
A. Chest X-ray
B. Arterial blood gas
C. Pulmonary function tests
D. Assessment of pulsus paradoxus with blood-pressure cuff
Correct Answer: D
Rationale: Severe asthma exacerbation with tachycardia, tachypnea, accessory-muscle
use, and low peak flow raises concern for imminent respiratory failure; pulsus
paradoxus ≥20 mmHg signals severe airway obstruction and need for immediate
escalated therapy (magnesium, BiPAP, or intubation). ABG is useful but not bedside;
PFTs are contraindicated in acute distress.
3. A 67-year-old woman is seen for annual exam. No chest symptoms. PMH:
osteoporosis, 40-year 1 pack/day tobacco (quit 5 years ago). VS stable. On
cardiac auscultation you hear a soft, high-pitched, early-peaking systolic murmur
at the right 2nd ICS radiating to the carotids; no S₃ or S₄; carotid upstrokes are
brisk. Which is the MOST appropriate documentation of the murmur in your
SOAP note?
A. “2/6 holosystolic murmur, apex, no radiation”
B. “1-2/6 early-systolic ejection murmur, R 2nd ICS, carotid radiation,
early-peaking”
C. “3/6 late-peaking systolic murmur, L 2nd ICS, S₃ present”
D. “Continuous machinery murmur, L 2nd ICS, throughout systole and diastole”
**Correct Answer: B
Rationale: Description fits benign aortic sclerosis (early-peaking, <3/6) versus aortic
stenosis; location and radiation are classic for aortic area. No S₃ is noted. Choice A
describes mitral regurgitation; C suggests severe AS (late-peaking) and adds an
unnoted S₃; D is patent ductus arteriosus.
, 4. A 6-year-old boy is brought in with 1 day of limping and left knee swelling. His
mother notes a viral illness 2 weeks ago. VS: afebrile, HR 90. Inspection: swollen
left knee, erythema, flexed 20°. Palpation: warm, tender; ROM limited by pain. No
rash. Which additional focused history question is MOST critical?
A. History of insect tick bites
B. Recent strep throat infection or positive strep test
C. Immunization status for pertussis
D. Family history of muscular dystrophy
**Correct Answer: B
Rationale: Acute monoarthritis following viral illness raises post-streptococcal reactive
arthritis or acute rheumatic fever (Jones criteria require preceding GAS). Tick bite
(Lyme) is possible but less likely with single joint and no rash in a 6-year-old in winter
scenario.
5. A 55-year-old man with DM type 2 and ESRD on hemodialysis presents for pre-op
assessment ( elective inguinal herniorrhaphy). He reports progressive dyspnea
on exertion and orthopnea. VS: BP 150/90, HR 88, SpO₂ 94 % RA. JVD is visible at
45°; bilateral pitting edema to knees. Auscultation: S₃ gallop, bibasilar crackles.
Which is the MOST likely cause of his symptoms?
A. Acute COPD exacerbation
B. Fluid overload related to ESRD and diastolic dysfunction
C. Pulmonary embolism
D. Primary pulmonary hypertension
**Correct Answer: B
Rationale: Volume overload in ESRD plus S₃ and JVD point to heart failure with fluid
overload (likely high-output or diastolic HF common in ESRD). Crackles and edema
support this; no fever or wheeze for COPD, no pleuritic chest pain for PE.
6. A 19-year-old college student complains of 4 weeks of fatigue, intermittent
low-grade fever, and 3 days of facial swelling. She returned from a spring-break
mission trip to rural Central America 6 weeks ago. VS: BP 110/70, HR 84, T 37.8
, °C. Facial puffiness bilateral, no erythema; mild pitting edema lower extremities.
Urine dipstick: 3+ protein, trace blood. Which is the SINGLE most urgent
diagnostic test to order NEXT?
A. CBC with differential
B. 24-h urine protein
C. Rapid strep and ASO titer
D. Renal ultrasound with Doppler
**Correct Answer: B
Rationale: Nephrotic-range proteinuria (>3.5 g/day) must be quantified; facial and
peripheral edema with heavy proteinuria suggests nephrotic syndrome (possible
minimal-change disease post-infection or parasitic etiology). CBC is useful but not next
urgent; strep unlikely without pharyngitis; ultrasound not immediately needed.
7. A 42-year-old woman presents with 2 months of dry cough and 10-lb weight loss.
No fever. PMH: asthma, GERD. She is never-smoker. VS stable. Chest
auscultation: scattered expiratory wheezes R lung mid-zone; no crackles. CXR:
right perihilar infiltrate, no effusion. Peak flow 350 L/min (predicted 450). Which
specialized NP assessment should you perform NEXT to refine differential?
A. Sputum culture and cytology
B. Methacholine challenge
C. Spirometry pre/post bronchodilator
D. Assess for paradoxical vocal-fold motion (inspiratory stridor during attack)
**Correct Answer: A
Rationale: Chronic cough, weight loss, localized wheeze and CXR infiltrate raise red
flags for malignancy or atypical infection; sputum cytology/culture is initial step.
Spirometry is routine asthma monitoring but does not explain focal infiltrate;
methacholine not indicated with structural finding.
8. A 70-year-old man is seen 6 weeks post-MI. He denies chest pain. VS: BP 130/80,
HR 72 irregularly irregular. Lungs clear. On cardiac auscultation you hear a
high-pitched, blowing, pansystolic murmur at the apex radiating to the axilla; no
