NURS 6512 Advanced Health Assessment Midterm Exam
2026/2027 - Walden University Complete Midterm Examination |
Actual Questions & Verified Answers | Comprehensive Health
Assessment | Pass Guarantee
1. Cardiovascular Assessment
Scenario: A 68-year-old male presents to urgent care with progressive dyspnea on
exertion and chest discomfort for 3 days. He has a history of metastatic lung cancer,
hypertension, and quit smoking 10 years ago. He denies orthopnea or PND. His father
died of MI at age 55. BP: 98/62 mmHg, HR: 104 bpm, RR: 22, Temp: 98.6°F, SpO2: 94%
on RA. Physical exam reveals JVD at 45 degrees, clear lungs, heart sounds distant with
regular rhythm, no murmurs. During inspiration, his systolic BP drops 18 mmHg while
palpating the radial pulse. 2+ pitting edema in bilateral lower extremities. EKG shows
sinus tachycardia with low voltage QRS complexes.
Question: Based on these advanced cardiovascular findings, which diagnosis is most
likely, and what is the clinical significance of the blood pressure finding during
inspiration?
A) Constrictive pericarditis; the BP finding represents pulsus alternans
B) Cardiac tamponade; the BP finding represents pulsus paradoxus >10 mmHg
indicating compromised cardiac output
C) Acute coronary syndrome; the BP finding is a normal respiratory variation
D) Heart failure with reduced EF; the BP finding represents a normal physiologic
response to tachycardia
,2. Respiratory Assessment
Scenario: A 54-year-old female with rheumatoid arthritis on methotrexate presents with
5 days of fever, productive cough, and pleuritic chest pain. She denies recent travel. Her
mother has COPD. She is a former smoker (20 pack-years). Temp: 102.3°F, BP: 118/74,
HR: 98, RR: 24, SpO2: 91% on RA. Physical exam reveals decreased chest expansion,
tactile fremitus increased in right lower lobe, percussion dullness over right posterior
base, auscultation reveals bronchial breath sounds and egophony in the same area.
Crackles are present on inspiration. No wheezes.
Question: Which finding is most pathognomonic for consolidation versus pleural
effusion, and what is the underlying mechanism?
A) Dullness to percussion; caused by increased tissue density at the pleural surface
B) Egophony (E-to-A changes); caused by enhanced high-frequency transmission
through consolidated lung parenchyma
C) Decreased tactile fremitus; caused by fluid buffering sound wave transmission
D) Bronchial breath sounds; caused by airway narrowing from inflammatory exudate
3. Neurological Assessment
Scenario: A 62-year-old right-handed male presents with acute onset right facial droop
and slurred speech that began 2 hours ago while reading. He has diabetes,
hypertension, and atrial fibrillation on warfarin. His brother had a stroke at age 60. He
drinks 2 beers daily. NIHSS: 8. Physical exam reveals right upper and lower facial
weakness (forehead sparing), right tongue deviation, 3/5 strength in right upper
extremity, 4/5 in right lower extremity. DTRs: 3+ in right biceps, brachioradialis, and
,quadriceps; 2+ in left upper and lower extremities. Plantar reflex: Babinski present on
right, absent on left. Sensory intact. MoCA score: 25/30.
Question: What does the asymmetric DTR finding (3+ right, 2+ left) with accompanying
UMN signs most likely indicate, and which motor neuron pathway is affected?
A) Acute LMN lesion of right corticospinal tract causing hyperreflexia due to dorsal root
ganglion compression
B) Acute UMN lesion left cerebral hemisphere causing contralateral hyperreflexia via
loss of cortical inhibition on right side
C) Chronic peripheral neuropathy causing bilateral asymmetrical reflex loss; requires
EMG for confirmation
D) Functional neurologic disorder with inconsistent reflex findings; requires psychiatric
referral
4. Abdominal Assessment
Scenario: A 34-year-old female presents with 3 days of RUQ pain, nausea, and fever
after a fatty meal. She is obese (BMI 38), takes oral contraceptives, and has no prior
surgeries. Her mother had gallbladder removal. She denies alcohol use. Temp: 101.8°F,
HR: 110, BP: 132/78. Abdominal exam reveals marked tenderness in RUQ with
inspiratory arrest during deep palpation (positive Murphy's sign), voluntary guarding but
no rebound. No palpable masses. Bowel sounds diminished. No CVA tenderness. Urine
pregnancy test negative. WBC: 14,200.
Question: What is the most likely diagnosis, and which critical assessment finding
distinguishes this from other abdominal emergencies?
, A) Acute cholecystitis; inspiratory arrest with deep RUQ palpation indicating inflamed
gallbladder contacting parietal peritoneum
B) Acute cholangitis; Charcot's triad must be present for diagnosis
C) Appendicitis; Rovsing's sign would be positive in this location
D) Peptic ulcer perforation; absence of rebound rules out surgical emergency
5. Musculoskeletal Assessment
Scenario: A 23-year-old male collegiate soccer player injured his left knee during a
non-contact pivot. He felt a "pop" and immediate swelling. He has no prior knee injuries.
He denies chronic joint pain. Father has osteoarthritis. Physical exam reveals large
effusion, positive Lachman test with soft endpoint (5mm anterior tibial translation),
negative McMurray test, varus/valgus stress stable. Patellar grind test negative.
Neurovascular intact. Range of motion limited to 30-90 degrees due to pain.
Question: Based on the advanced knee assessment, which structure is most likely
injured, and what does the "soft endpoint" indicate?
A) Medial meniscus tear; soft endpoint indicates cartilage yielding to pressure
B) Complete ACL tear with hemarthrosis; soft endpoint indicates loss of firm
ligamentous restraint
C) MCL sprain; soft endpoint indicates partial ligamentous continuity
D) Patellar tendon rupture; soft endpoint indicates muscle-tendon junction failure
6. Pediatric Health Assessment
2026/2027 - Walden University Complete Midterm Examination |
Actual Questions & Verified Answers | Comprehensive Health
Assessment | Pass Guarantee
1. Cardiovascular Assessment
Scenario: A 68-year-old male presents to urgent care with progressive dyspnea on
exertion and chest discomfort for 3 days. He has a history of metastatic lung cancer,
hypertension, and quit smoking 10 years ago. He denies orthopnea or PND. His father
died of MI at age 55. BP: 98/62 mmHg, HR: 104 bpm, RR: 22, Temp: 98.6°F, SpO2: 94%
on RA. Physical exam reveals JVD at 45 degrees, clear lungs, heart sounds distant with
regular rhythm, no murmurs. During inspiration, his systolic BP drops 18 mmHg while
palpating the radial pulse. 2+ pitting edema in bilateral lower extremities. EKG shows
sinus tachycardia with low voltage QRS complexes.
Question: Based on these advanced cardiovascular findings, which diagnosis is most
likely, and what is the clinical significance of the blood pressure finding during
inspiration?
A) Constrictive pericarditis; the BP finding represents pulsus alternans
B) Cardiac tamponade; the BP finding represents pulsus paradoxus >10 mmHg
indicating compromised cardiac output
C) Acute coronary syndrome; the BP finding is a normal respiratory variation
D) Heart failure with reduced EF; the BP finding represents a normal physiologic
response to tachycardia
,2. Respiratory Assessment
Scenario: A 54-year-old female with rheumatoid arthritis on methotrexate presents with
5 days of fever, productive cough, and pleuritic chest pain. She denies recent travel. Her
mother has COPD. She is a former smoker (20 pack-years). Temp: 102.3°F, BP: 118/74,
HR: 98, RR: 24, SpO2: 91% on RA. Physical exam reveals decreased chest expansion,
tactile fremitus increased in right lower lobe, percussion dullness over right posterior
base, auscultation reveals bronchial breath sounds and egophony in the same area.
Crackles are present on inspiration. No wheezes.
Question: Which finding is most pathognomonic for consolidation versus pleural
effusion, and what is the underlying mechanism?
A) Dullness to percussion; caused by increased tissue density at the pleural surface
B) Egophony (E-to-A changes); caused by enhanced high-frequency transmission
through consolidated lung parenchyma
C) Decreased tactile fremitus; caused by fluid buffering sound wave transmission
D) Bronchial breath sounds; caused by airway narrowing from inflammatory exudate
3. Neurological Assessment
Scenario: A 62-year-old right-handed male presents with acute onset right facial droop
and slurred speech that began 2 hours ago while reading. He has diabetes,
hypertension, and atrial fibrillation on warfarin. His brother had a stroke at age 60. He
drinks 2 beers daily. NIHSS: 8. Physical exam reveals right upper and lower facial
weakness (forehead sparing), right tongue deviation, 3/5 strength in right upper
extremity, 4/5 in right lower extremity. DTRs: 3+ in right biceps, brachioradialis, and
,quadriceps; 2+ in left upper and lower extremities. Plantar reflex: Babinski present on
right, absent on left. Sensory intact. MoCA score: 25/30.
Question: What does the asymmetric DTR finding (3+ right, 2+ left) with accompanying
UMN signs most likely indicate, and which motor neuron pathway is affected?
A) Acute LMN lesion of right corticospinal tract causing hyperreflexia due to dorsal root
ganglion compression
B) Acute UMN lesion left cerebral hemisphere causing contralateral hyperreflexia via
loss of cortical inhibition on right side
C) Chronic peripheral neuropathy causing bilateral asymmetrical reflex loss; requires
EMG for confirmation
D) Functional neurologic disorder with inconsistent reflex findings; requires psychiatric
referral
4. Abdominal Assessment
Scenario: A 34-year-old female presents with 3 days of RUQ pain, nausea, and fever
after a fatty meal. She is obese (BMI 38), takes oral contraceptives, and has no prior
surgeries. Her mother had gallbladder removal. She denies alcohol use. Temp: 101.8°F,
HR: 110, BP: 132/78. Abdominal exam reveals marked tenderness in RUQ with
inspiratory arrest during deep palpation (positive Murphy's sign), voluntary guarding but
no rebound. No palpable masses. Bowel sounds diminished. No CVA tenderness. Urine
pregnancy test negative. WBC: 14,200.
Question: What is the most likely diagnosis, and which critical assessment finding
distinguishes this from other abdominal emergencies?
, A) Acute cholecystitis; inspiratory arrest with deep RUQ palpation indicating inflamed
gallbladder contacting parietal peritoneum
B) Acute cholangitis; Charcot's triad must be present for diagnosis
C) Appendicitis; Rovsing's sign would be positive in this location
D) Peptic ulcer perforation; absence of rebound rules out surgical emergency
5. Musculoskeletal Assessment
Scenario: A 23-year-old male collegiate soccer player injured his left knee during a
non-contact pivot. He felt a "pop" and immediate swelling. He has no prior knee injuries.
He denies chronic joint pain. Father has osteoarthritis. Physical exam reveals large
effusion, positive Lachman test with soft endpoint (5mm anterior tibial translation),
negative McMurray test, varus/valgus stress stable. Patellar grind test negative.
Neurovascular intact. Range of motion limited to 30-90 degrees due to pain.
Question: Based on the advanced knee assessment, which structure is most likely
injured, and what does the "soft endpoint" indicate?
A) Medial meniscus tear; soft endpoint indicates cartilage yielding to pressure
B) Complete ACL tear with hemarthrosis; soft endpoint indicates loss of firm
ligamentous restraint
C) MCL sprain; soft endpoint indicates partial ligamentous continuity
D) Patellar tendon rupture; soft endpoint indicates muscle-tendon junction failure
6. Pediatric Health Assessment
