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 3 hours of crushing substernal chest pain
radiating to the left arm. He is diaphoretic and nauseated. BP 90/60, HR 105,
SpO₂ 94 %. On auscultation you note a harsh, loud systolic murmur at the apex
radiating to the axilla and S₃ gallop. Lung bases are clear. ECG shows 3 mm ST
elevation in leads V₃–V₆. Which physical finding is most concerning for a
potentially life-threatening complication?
A. S₃ gallop
B. Apical pansystolic murmur
C. Clear lung fields
D. HR 105
Correct Answer: B
Rationale: A new harsh apical pansystolic murmur with S₃ and inferior-lateral
STEMI suggests acute papillary-muscle rupture causing severe MR—mechanical
complication requiring emergent intervention. S₃ alone can reflect LV
dysfunction; clear lungs argue against pulmonary edema; HR 105 is
compensatory.
2. A 28-year-old woman at 30 weeks gestation complains of sudden-onset dyspnea
and right-sided chest pain. She has no fever or cough. HR 104, RR 22, BP 110/70,
SpO₂ 92 % on room air. Inspection reveals mild pedal edema; lungs are clear;
heart rhythm is regular. You perform bedside spirometry: FEV₁ 95 % predicted,
FVC 98 %, FEV₁/FVC 0.82. Which specialized maneuver is most critical next?
A. Peak flow measurement
B. D-dimer blood test
C. Chest X-ray
D. Compression lower-extremity ultrasound
Correct Answer: D
Rationale: Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, and
pregnancy (hypercoagulable) raise high suspicion for pulmonary embolism;
, lower-extremity compression US has high specificity and avoids radiation while
potentially identifying the source.
3. A 6-year-old boy is brought in with 2 days of bilateral knee pain and a limp. He
had a viral illness last week. On exam he is afebrile; hips and knees have full ROM
but are tender with effusion. He has a subtle erythematous, scaly rash behind the
ears and in the scalp creases. Which additional assessment finding would best
distinguish post-infectious arthritis from juvenile idiopathic arthritis?
A. Presence of enthesitis on heel squeeze
B. Nail pitting
C. Psoriatic rash in typical locations
D. Symmetric small-joint swelling
Correct Answer: C
Rationale: Scaly rash in scalp/retro-auricular areas plus large-joint oligoarthritis
fulfills criteria for juvenile psoriatic arthritis; nail changes and enthesitis support
JIA categories but are less specific than documented psoriasis.
4. A 74-year-old woman presents after a fall. She denies loss of consciousness. BP
160/90, HR 88 and regular. She is on metformin and warfarin for atrial fibrillation.
On exam she has left parietal scalp tenderness and ecchymosis; no focal
neurologic deficits. INR is 3.2. Which element of the physical exam is most
urgent to document serially?
A. Pupil size and reactivity
B. Rhomberg test
C. Monofilament testing of feet
D. PERRLA
Correct Answer: A
Rationale: Anticoagulated elderly patients are at high risk for delayed intracranial
hemorrhage; serial neuro checks including pupils detect early herniation signs.
Rhomberg and monofilament are important but not urgent in this acute setting.
5. A 42-year-old man with alcohol use disorder complains of worsening fatigue and
abdominal distension. On exam you note bulging flanks, shifting dullness, and a
fluid wave. HR 92 regular, BP 100/60, no asterixis. Which bedside ultrasound view
is most appropriate to confirm ascites and guide paracentesis?
A. Right-upper-quadrant longitudinal (Morrison pouch)
B. Suprapubic transverse
C. Right-mid-axillary longitudinal at the costal margin
D. Peri-umbilical transverse
Correct Answer: B
Rationale: Suprapubic transverse visualizes the bladder and the deepest
, dependent fluid pocket; it is the preferred site for safe needle insertion while
avoiding vessels.
6. A 55-year-old woman with DM type 2 and HTN presents with 1 week of fatigue
and bilateral leg swelling. JVP is 12 cm with prominent x and y descents; you
hear a high-pitched early diastolic sound (pericardial knock) at the apex. Liver
edge is palpable 4 cm below costal margin and pulsatile. Which assessment
finding best supports your leading diagnosis?
A. Pulsatile liver
B. JVP 12 cm
C. Pericardial knock
D. Bilateral edema
Correct Answer: C
Rationale: Pericardial knock is pathognomonic for constrictive pericarditis;
pulsatile liver reflects tricuspid regurg or severe RV failure, less specific; JVP and
edema are common in many volume-overloaded states.
7. A 19-year-old college student is seen for a 3-day history of sore throat, fatigue,
and low-grade fever. On exam she has tender posterior cervical and axillary
nodes, pharyngeal erythema without exudate, and palatal petechiae.
Splenomegaly is suspected. Which bedside maneuver has highest sensitivity to
detect mild splenic enlargement?
A. Castell sign (percussion in left mid-axillary line)
B. Traube space percussion
C. Nixon method (percussion in left posterior axillary line)
D. Light bimanual palpation with patient in right lateral decubitus
Correct Answer: A
Rationale: Castell sign (resonant to dull note change on inspiration) has ~80 %
sensitivity for spleens >1 cm enlarged; Traube space has lower sensitivity in
obese patients.
8. A 33-year-old man with HIV (CD4 220, VL 85,000) presents with 2 weeks of dry
cough, low-grade fever, and dyspnea on exertion. O₂ sat 91 % on room air. Lung
fields are clear; you note no clubbing or calf tenderness. Which point-of-care
diagnostic is most appropriate next?
A. Peak-flow meter
B. Chest X-ray
C. D-dimer
D. Sputum culture
Correct Answer: B
Rationale: CD4 <200 places him at risk for Pneumocystis jirovecii pneumonia
(PJP) despite clear lungs; CXR may show perihilar infiltrates or be normal but
2026/2027 - Walden University Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents with 3 hours of crushing substernal chest pain
radiating to the left arm. He is diaphoretic and nauseated. BP 90/60, HR 105,
SpO₂ 94 %. On auscultation you note a harsh, loud systolic murmur at the apex
radiating to the axilla and S₃ gallop. Lung bases are clear. ECG shows 3 mm ST
elevation in leads V₃–V₆. Which physical finding is most concerning for a
potentially life-threatening complication?
A. S₃ gallop
B. Apical pansystolic murmur
C. Clear lung fields
D. HR 105
Correct Answer: B
Rationale: A new harsh apical pansystolic murmur with S₃ and inferior-lateral
STEMI suggests acute papillary-muscle rupture causing severe MR—mechanical
complication requiring emergent intervention. S₃ alone can reflect LV
dysfunction; clear lungs argue against pulmonary edema; HR 105 is
compensatory.
2. A 28-year-old woman at 30 weeks gestation complains of sudden-onset dyspnea
and right-sided chest pain. She has no fever or cough. HR 104, RR 22, BP 110/70,
SpO₂ 92 % on room air. Inspection reveals mild pedal edema; lungs are clear;
heart rhythm is regular. You perform bedside spirometry: FEV₁ 95 % predicted,
FVC 98 %, FEV₁/FVC 0.82. Which specialized maneuver is most critical next?
A. Peak flow measurement
B. D-dimer blood test
C. Chest X-ray
D. Compression lower-extremity ultrasound
Correct Answer: D
Rationale: Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, and
pregnancy (hypercoagulable) raise high suspicion for pulmonary embolism;
, lower-extremity compression US has high specificity and avoids radiation while
potentially identifying the source.
3. A 6-year-old boy is brought in with 2 days of bilateral knee pain and a limp. He
had a viral illness last week. On exam he is afebrile; hips and knees have full ROM
but are tender with effusion. He has a subtle erythematous, scaly rash behind the
ears and in the scalp creases. Which additional assessment finding would best
distinguish post-infectious arthritis from juvenile idiopathic arthritis?
A. Presence of enthesitis on heel squeeze
B. Nail pitting
C. Psoriatic rash in typical locations
D. Symmetric small-joint swelling
Correct Answer: C
Rationale: Scaly rash in scalp/retro-auricular areas plus large-joint oligoarthritis
fulfills criteria for juvenile psoriatic arthritis; nail changes and enthesitis support
JIA categories but are less specific than documented psoriasis.
4. A 74-year-old woman presents after a fall. She denies loss of consciousness. BP
160/90, HR 88 and regular. She is on metformin and warfarin for atrial fibrillation.
On exam she has left parietal scalp tenderness and ecchymosis; no focal
neurologic deficits. INR is 3.2. Which element of the physical exam is most
urgent to document serially?
A. Pupil size and reactivity
B. Rhomberg test
C. Monofilament testing of feet
D. PERRLA
Correct Answer: A
Rationale: Anticoagulated elderly patients are at high risk for delayed intracranial
hemorrhage; serial neuro checks including pupils detect early herniation signs.
Rhomberg and monofilament are important but not urgent in this acute setting.
5. A 42-year-old man with alcohol use disorder complains of worsening fatigue and
abdominal distension. On exam you note bulging flanks, shifting dullness, and a
fluid wave. HR 92 regular, BP 100/60, no asterixis. Which bedside ultrasound view
is most appropriate to confirm ascites and guide paracentesis?
A. Right-upper-quadrant longitudinal (Morrison pouch)
B. Suprapubic transverse
C. Right-mid-axillary longitudinal at the costal margin
D. Peri-umbilical transverse
Correct Answer: B
Rationale: Suprapubic transverse visualizes the bladder and the deepest
, dependent fluid pocket; it is the preferred site for safe needle insertion while
avoiding vessels.
6. A 55-year-old woman with DM type 2 and HTN presents with 1 week of fatigue
and bilateral leg swelling. JVP is 12 cm with prominent x and y descents; you
hear a high-pitched early diastolic sound (pericardial knock) at the apex. Liver
edge is palpable 4 cm below costal margin and pulsatile. Which assessment
finding best supports your leading diagnosis?
A. Pulsatile liver
B. JVP 12 cm
C. Pericardial knock
D. Bilateral edema
Correct Answer: C
Rationale: Pericardial knock is pathognomonic for constrictive pericarditis;
pulsatile liver reflects tricuspid regurg or severe RV failure, less specific; JVP and
edema are common in many volume-overloaded states.
7. A 19-year-old college student is seen for a 3-day history of sore throat, fatigue,
and low-grade fever. On exam she has tender posterior cervical and axillary
nodes, pharyngeal erythema without exudate, and palatal petechiae.
Splenomegaly is suspected. Which bedside maneuver has highest sensitivity to
detect mild splenic enlargement?
A. Castell sign (percussion in left mid-axillary line)
B. Traube space percussion
C. Nixon method (percussion in left posterior axillary line)
D. Light bimanual palpation with patient in right lateral decubitus
Correct Answer: A
Rationale: Castell sign (resonant to dull note change on inspiration) has ~80 %
sensitivity for spleens >1 cm enlarged; Traube space has lower sensitivity in
obese patients.
8. A 33-year-old man with HIV (CD4 220, VL 85,000) presents with 2 weeks of dry
cough, low-grade fever, and dyspnea on exertion. O₂ sat 91 % on room air. Lung
fields are clear; you note no clubbing or calf tenderness. Which point-of-care
diagnostic is most appropriate next?
A. Peak-flow meter
B. Chest X-ray
C. D-dimer
D. Sputum culture
Correct Answer: B
Rationale: CD4 <200 places him at risk for Pneumocystis jirovecii pneumonia
(PJP) despite clear lungs; CXR may show perihilar infiltrates or be normal but
