GCU NUR 634 MIDTERM EXAM LATEST 2026 UPDATE
ACTUAL EXAM SUMMER-FALL SEMESTER|QUESTIONS
AND CORRECT ASNWERS ALREADY GRADED A+||BRAND
NEW!!
A 77-year-old retired bus driver comes to your clinic for a physical
examination at his wife's request. He has recently been losing weight
and has felt very fatigued. He has had no chest pain, shortness of
breath, nausea, vomiting, or fever. His past medical history includes
colon cancer, for which he had surgery, and arthritis. He has been
married for over 40 years. He denies any tobacco or drug use and has
not drunk alcohol in over 40 years. His parents both died of cancer in
their 60s. On examination his vital signs are normal. His head,
cardiac, and pulmonary examinations are unremarkable. On
abdominal examination you hear normal bowel sounds, but when you
palpate his liver it is abnormal. His rectal examination is positive for
occult blood. What further abnormality of the liver was likely found
on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender
ANS: B
Feedback: With his past history of colon cancer and with recent
weight loss and fatigue, a relapse of his colon cancer would be
expected. Colon cancer usually metastasizes to the liver, creating
hard, irregular nodules, which can sometimes be palpated on
examination. A smooth, large liver which is tender is often seen in
hepatitis.
A 21-year-old college senior presents to your clinic, complaining of
shortness of breath and a nonproductive nocturnal cough. She states
she used to feel this way only with extreme exercise, but lately she
pg. 1
,has felt this way continuously. She denies any other upper respiratory
symptoms, chest pain, gastrointestinal symptoms, or urinary tract
symptoms. Her past medical history is significant only for seasonal
allergies, for which she takes a nasal steroid spray but is otherwise on
no other medications. She has had no surgeries. Her mother has
allergies and eczema and her father has high blood pressure. She is an
only child. She denies smoking and illegal drug use but drinks three to
four alcoholic beverages per weekend. She is a junior in finance at a
local university and she has recently started a job as a bartender in
town. On examination she is in no acute distress and her temperature
is 98.6. Her blood pressure is 120/80, her pulse is 80, and her
respirations are 20. Her head, eyes, ears, nose, and throat
examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest,
there is decreased air movement and a high-pitched whistling on
expiration in all lobes. Percussion reveals resonant lungs. Which
disorder of the thorax or lung does this best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough.
It is often associated with a history of allergies and can be made
worse by exercise or irritants such as smoke in a bar. On auscultation
there can be normal to decreased air movement. Wheezing is heard on
expiration and sometimes inspiration. The duration of wheezing in
expiration usually correlates with severity of illness, so it is important
to document this length (e.g., wheezes heard halfway through
exhalation). Realize that in severe asthma, wheezes may not be heard
because of the lack of air movement. Paradoxically, these patients
may have more wheezes after treatment, which actually indicates an
pg. 2
,improvement in condition. Peak flow measurements help to discern
this.
A 17-year-old high school senior presents to your clinic in acute
respiratory distress. Between shallow breaths he states he was at home
finishing his homework when he suddenly began having right-sided
chest pain and severe shortness of breath. He denies any recent
traumas or illnesses. His past medical history is unremarkable. He
doesn't smoke but drinks several beers on the weekend. He has tried
marijuana several times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His parents are both in
good health. He denies any recent weight gain, weight loss, fever, or
night sweats. On examination you see a tall, thin young man in
obvious distress. He is diaphoretic and is breathing at a rate of 35
breaths per minute. On auscultation you hear no breath sounds on the
right side of his superior chest wall. On percussion he is hyper
resonant over the right upper lobe. With palpation he has absent
fremitus over the right upper lobe. What disorder of the thorax or lung
best describes his symptoms?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
ANS: A
Feedback: In left-sided heart failure, fluid starts “backing up” into the
lungs because the heart is unable to handle the volume. The excess
fluid collects in the dependent areas, causing crackles in the bases of
the lower lobes. Sitting up allows patients to breathe easier. The two
main causes are chronic high blood pressure and coronary artery
disease, which lead to myocardial ischemia and decreased
contractility of the heart.
pg. 3
, A 60-year-old baker presents to your clinic, complaining of increasing
shortness of breath and nonproductive cough over the last month. She
feels like she can't do as much activity as she used to do without
becoming tired. She even has to sleep upright in her recliner at night
to be able to breathe comfortably. She denies any chest pain, nausea,
or sweating. Her past medical history is significant for high blood
pressure and coronary artery disease. She had a hysterectomy in her
40s for heavy vaginal bleeding. She is married and is retiring from the
local bakery soon. She denies any tobacco, alcohol, or drug use. Her
mother died of a stroke and her father died from prostate cancer. She
denies any recent upper respiratory illness, and she has had no other
symptoms. On examination she is in no acute distress. Her blood
pressure is 160/100 and her pulse is 100. She is afebrile and her
respiratory rate is 16. With auscultation she has distant air sounds and
she has late inspiratory crackles in both lower lobes. On cardiac
examination the S1 and S2 are distant and an S3 is heard over the
apex. What disorder of the chest best describes her symptoms?
A. Pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural pain
D. Left-sided heart failure
ANS: D
For which of the following patients would a comprehensive health
history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper
respiratory infection"
C. A new patient with the chief complaint of "I am here to establish
care"
D. A new patient with the chief complaint of "I cut my hand"
pg. 4
ACTUAL EXAM SUMMER-FALL SEMESTER|QUESTIONS
AND CORRECT ASNWERS ALREADY GRADED A+||BRAND
NEW!!
A 77-year-old retired bus driver comes to your clinic for a physical
examination at his wife's request. He has recently been losing weight
and has felt very fatigued. He has had no chest pain, shortness of
breath, nausea, vomiting, or fever. His past medical history includes
colon cancer, for which he had surgery, and arthritis. He has been
married for over 40 years. He denies any tobacco or drug use and has
not drunk alcohol in over 40 years. His parents both died of cancer in
their 60s. On examination his vital signs are normal. His head,
cardiac, and pulmonary examinations are unremarkable. On
abdominal examination you hear normal bowel sounds, but when you
palpate his liver it is abnormal. His rectal examination is positive for
occult blood. What further abnormality of the liver was likely found
on examination?
A. Smooth, large, nontender liver
B. Irregular, large liver
C. Smooth, large, tender liver
D. Irregular, small, nontender
ANS: B
Feedback: With his past history of colon cancer and with recent
weight loss and fatigue, a relapse of his colon cancer would be
expected. Colon cancer usually metastasizes to the liver, creating
hard, irregular nodules, which can sometimes be palpated on
examination. A smooth, large liver which is tender is often seen in
hepatitis.
A 21-year-old college senior presents to your clinic, complaining of
shortness of breath and a nonproductive nocturnal cough. She states
she used to feel this way only with extreme exercise, but lately she
pg. 1
,has felt this way continuously. She denies any other upper respiratory
symptoms, chest pain, gastrointestinal symptoms, or urinary tract
symptoms. Her past medical history is significant only for seasonal
allergies, for which she takes a nasal steroid spray but is otherwise on
no other medications. She has had no surgeries. Her mother has
allergies and eczema and her father has high blood pressure. She is an
only child. She denies smoking and illegal drug use but drinks three to
four alcoholic beverages per weekend. She is a junior in finance at a
local university and she has recently started a job as a bartender in
town. On examination she is in no acute distress and her temperature
is 98.6. Her blood pressure is 120/80, her pulse is 80, and her
respirations are 20. Her head, eyes, ears, nose, and throat
examinations are essentially normal. Inspection of her anterior and
posterior chest shows no abnormalities. On auscultation of her chest,
there is decreased air movement and a high-pitched whistling on
expiration in all lobes. Percussion reveals resonant lungs. Which
disorder of the thorax or lung does this best describe?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
ANS: C
Feedback: Asthma causes shortness of breath and a nocturnal cough.
It is often associated with a history of allergies and can be made
worse by exercise or irritants such as smoke in a bar. On auscultation
there can be normal to decreased air movement. Wheezing is heard on
expiration and sometimes inspiration. The duration of wheezing in
expiration usually correlates with severity of illness, so it is important
to document this length (e.g., wheezes heard halfway through
exhalation). Realize that in severe asthma, wheezes may not be heard
because of the lack of air movement. Paradoxically, these patients
may have more wheezes after treatment, which actually indicates an
pg. 2
,improvement in condition. Peak flow measurements help to discern
this.
A 17-year-old high school senior presents to your clinic in acute
respiratory distress. Between shallow breaths he states he was at home
finishing his homework when he suddenly began having right-sided
chest pain and severe shortness of breath. He denies any recent
traumas or illnesses. His past medical history is unremarkable. He
doesn't smoke but drinks several beers on the weekend. He has tried
marijuana several times but denies any other illegal drugs. He is an
honors student and is on the basketball team. His parents are both in
good health. He denies any recent weight gain, weight loss, fever, or
night sweats. On examination you see a tall, thin young man in
obvious distress. He is diaphoretic and is breathing at a rate of 35
breaths per minute. On auscultation you hear no breath sounds on the
right side of his superior chest wall. On percussion he is hyper
resonant over the right upper lobe. With palpation he has absent
fremitus over the right upper lobe. What disorder of the thorax or lung
best describes his symptoms?
A. Spontaneous pneumothorax
B. Chronic obstructive pulmonary disease (COPD)
C. Asthma
D. Pneumonia
ANS: A
Feedback: In left-sided heart failure, fluid starts “backing up” into the
lungs because the heart is unable to handle the volume. The excess
fluid collects in the dependent areas, causing crackles in the bases of
the lower lobes. Sitting up allows patients to breathe easier. The two
main causes are chronic high blood pressure and coronary artery
disease, which lead to myocardial ischemia and decreased
contractility of the heart.
pg. 3
, A 60-year-old baker presents to your clinic, complaining of increasing
shortness of breath and nonproductive cough over the last month. She
feels like she can't do as much activity as she used to do without
becoming tired. She even has to sleep upright in her recliner at night
to be able to breathe comfortably. She denies any chest pain, nausea,
or sweating. Her past medical history is significant for high blood
pressure and coronary artery disease. She had a hysterectomy in her
40s for heavy vaginal bleeding. She is married and is retiring from the
local bakery soon. She denies any tobacco, alcohol, or drug use. Her
mother died of a stroke and her father died from prostate cancer. She
denies any recent upper respiratory illness, and she has had no other
symptoms. On examination she is in no acute distress. Her blood
pressure is 160/100 and her pulse is 100. She is afebrile and her
respiratory rate is 16. With auscultation she has distant air sounds and
she has late inspiratory crackles in both lower lobes. On cardiac
examination the S1 and S2 are distant and an S3 is heard over the
apex. What disorder of the chest best describes her symptoms?
A. Pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Pleural pain
D. Left-sided heart failure
ANS: D
For which of the following patients would a comprehensive health
history be appropriate?
A. A new patient with the chief complaint of "I sprained my ankle"
B. An established patient with the chief complaint of "I have an upper
respiratory infection"
C. A new patient with the chief complaint of "I am here to establish
care"
D. A new patient with the chief complaint of "I cut my hand"
pg. 4
