NU 518 – ADVANCED HEALTH
ASSESSMENT | UNIVERSITY OF SOUTH
ALABAMA FINAL EXAM
COMPREHENSIVE CUMULATIVE
ASSESSMENT
Keywords
comprehensive health assessment, clinical reasoning, differential diagnosis, physical
examination, neurological assessment, cardiovascular assessment, respiratory
assessment, abdominal assessment, musculoskeletal assessment, dermatological
,assessment, head and neck assessment, geriatric assessment, pediatric assessment,
mental status examination, documentation, evidence-based practice
Question 1
A 65-year-old patient presents with a 3-month history of progressive difficulty walking,
urinary incontinence, and memory loss. On examination, the patient has a wide-based,
unsteady gait and bilateral leg weakness. This presentation is most consistent with:
A) Alzheimer's disease
B) Normal pressure hydrocephalus (NPH)
C) Parkinson's disease
D) Lumbar spinal stenosis
Correct Answer: B
Rationale:
✅Correct (B): Normal pressure hydrocephalus (NPH) presents with the classic triad: gait
disturbance (wide-based, unsteady, magnetic gait), urinary incontinence (often early),
and cognitive impairment (memory loss, executive dysfunction). Symptoms may
improve with lumbar puncture (removal of CSF). Alzheimer's (A) does not cause gait
disturbance early; Parkinson's (C) causes resting tremor, rigidity; spinal stenosis (D)
causes neurogenic claudication without cognitive changes .
✅ Incorrect (A): Alzheimer's primarily affects memory, not gait (early).
✅ Incorrect (C): Parkinson's has resting tremor, rigidity, bradykinesia.
✅ Incorrect (D): Spinal stenosis causes back/leg pain with walking, no cognitive
symptoms.
Study Tip: "NPH triad = gait disturbance + urinary incontinence + cognitive
impairment."
Question 2
The nurse practitioner is assessing a patient with suspected hyperthyroidism. Which
physical examination finding is most consistent with hyperthyroidism?
,A) Bradycardia and weight gain
B) Lid lag and exophthalmos
C) Dry skin and constipation
D) Cold intolerance and thinning hair
Correct Answer: B
Rationale:
✅Correct (B): Hyperthyroidism (Graves' disease) causes lid lag (delayed descent of the
upper eyelid when looking down), exophthalmos (proptosis, bulging eyes), tachycardia,
weight loss, heat intolerance, tremors, and hyperreflexia. Bradycardia, weight gain, dry
skin, constipation, cold intolerance, and thinning hair (A, C, D) are findings of
hypothyroidism .
✅ Incorrect (A): Bradycardia and weight gain = hypothyroidism.
✅ Incorrect (C): Dry skin and constipation = hypothyroidism.
✅ Incorrect (D): Cold intolerance and thinning hair = hypothyroidism.
StudyTip: "Hyperthyroidism = lid lag, exophthalmos, tachycardia, weight loss, heat
intolerance."
Question 3
The nurse practitioner is performing a cardiovascular examination. The NP auscultates a
diastolic decrescendo murmur at the left sternal border. This murmur is most consistent
with:
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Mitral regurgitation
Correct Answer: B
Rationale:
✅Correct (B): Aortic regurgitation (AR) produces a high-pitched, blowing, diastolic
decrescendo murmur best heard at the left sternal border (3rd-4th intercostal spaces).
Patients may also have bounding pulses (Corrigan's pulse), wide pulse pressure, and a
, diastolic thrill. Aortic stenosis (A) is systolic; mitral stenosis (C) is diastolic but with
opening snap; mitral regurgitation (D) is systolic .
✅ Incorrect (A): Aortic stenosis = systolic murmur at right 2nd ICS.
✅ Incorrect (C): Mitral stenosis = diastolic rumble with opening snap.
✅ Incorrect (D): Mitral regurgitation = holosystolic murmur at apex radiating to axilla.
StudyTip: "Aortic regurgitation = diastolic decrescendo murmur at left sternal border."
Question 4
The nurse practitioner is assessing a patient with suspected rheumatoid arthritis. Which
extra-articular manifestation is most commonly associated with rheumatoid arthritis?
A) Heberden's nodes
B) Rheumatoid nodules
C) Bouchard's nodes
D) Psoriatic plaques
Correct Answer: B
Rationale:
✅Correct (B): Rheumatoid nodules are firm, non-tender, subcutaneous nodules that
occur over extensor surfaces (elbows, fingers). They are the most common extra-
articular manifestation of rheumatoid arthritis (present in about 25% of patients).
Heberden's nodes (A) and Bouchard's nodes (C) are associated with osteoarthritis (DIP
and PIP joints, respectively). Psoriatic plaques (D) are associated with psoriatic arthritis .
✅ Incorrect (A): Heberden's nodes = osteoarthritis (DIP joints).
✅ Incorrect (C): Bouchard's nodes = osteoarthritis (PIP joints).
✅ Incorrect (D): Psoriatic plaques = psoriatic arthritis.
StudyTip: "Rheumatoid arthritis = rheumatoid nodules (extensor surfaces)."
ASSESSMENT | UNIVERSITY OF SOUTH
ALABAMA FINAL EXAM
COMPREHENSIVE CUMULATIVE
ASSESSMENT
Keywords
comprehensive health assessment, clinical reasoning, differential diagnosis, physical
examination, neurological assessment, cardiovascular assessment, respiratory
assessment, abdominal assessment, musculoskeletal assessment, dermatological
,assessment, head and neck assessment, geriatric assessment, pediatric assessment,
mental status examination, documentation, evidence-based practice
Question 1
A 65-year-old patient presents with a 3-month history of progressive difficulty walking,
urinary incontinence, and memory loss. On examination, the patient has a wide-based,
unsteady gait and bilateral leg weakness. This presentation is most consistent with:
A) Alzheimer's disease
B) Normal pressure hydrocephalus (NPH)
C) Parkinson's disease
D) Lumbar spinal stenosis
Correct Answer: B
Rationale:
✅Correct (B): Normal pressure hydrocephalus (NPH) presents with the classic triad: gait
disturbance (wide-based, unsteady, magnetic gait), urinary incontinence (often early),
and cognitive impairment (memory loss, executive dysfunction). Symptoms may
improve with lumbar puncture (removal of CSF). Alzheimer's (A) does not cause gait
disturbance early; Parkinson's (C) causes resting tremor, rigidity; spinal stenosis (D)
causes neurogenic claudication without cognitive changes .
✅ Incorrect (A): Alzheimer's primarily affects memory, not gait (early).
✅ Incorrect (C): Parkinson's has resting tremor, rigidity, bradykinesia.
✅ Incorrect (D): Spinal stenosis causes back/leg pain with walking, no cognitive
symptoms.
Study Tip: "NPH triad = gait disturbance + urinary incontinence + cognitive
impairment."
Question 2
The nurse practitioner is assessing a patient with suspected hyperthyroidism. Which
physical examination finding is most consistent with hyperthyroidism?
,A) Bradycardia and weight gain
B) Lid lag and exophthalmos
C) Dry skin and constipation
D) Cold intolerance and thinning hair
Correct Answer: B
Rationale:
✅Correct (B): Hyperthyroidism (Graves' disease) causes lid lag (delayed descent of the
upper eyelid when looking down), exophthalmos (proptosis, bulging eyes), tachycardia,
weight loss, heat intolerance, tremors, and hyperreflexia. Bradycardia, weight gain, dry
skin, constipation, cold intolerance, and thinning hair (A, C, D) are findings of
hypothyroidism .
✅ Incorrect (A): Bradycardia and weight gain = hypothyroidism.
✅ Incorrect (C): Dry skin and constipation = hypothyroidism.
✅ Incorrect (D): Cold intolerance and thinning hair = hypothyroidism.
StudyTip: "Hyperthyroidism = lid lag, exophthalmos, tachycardia, weight loss, heat
intolerance."
Question 3
The nurse practitioner is performing a cardiovascular examination. The NP auscultates a
diastolic decrescendo murmur at the left sternal border. This murmur is most consistent
with:
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Mitral regurgitation
Correct Answer: B
Rationale:
✅Correct (B): Aortic regurgitation (AR) produces a high-pitched, blowing, diastolic
decrescendo murmur best heard at the left sternal border (3rd-4th intercostal spaces).
Patients may also have bounding pulses (Corrigan's pulse), wide pulse pressure, and a
, diastolic thrill. Aortic stenosis (A) is systolic; mitral stenosis (C) is diastolic but with
opening snap; mitral regurgitation (D) is systolic .
✅ Incorrect (A): Aortic stenosis = systolic murmur at right 2nd ICS.
✅ Incorrect (C): Mitral stenosis = diastolic rumble with opening snap.
✅ Incorrect (D): Mitral regurgitation = holosystolic murmur at apex radiating to axilla.
StudyTip: "Aortic regurgitation = diastolic decrescendo murmur at left sternal border."
Question 4
The nurse practitioner is assessing a patient with suspected rheumatoid arthritis. Which
extra-articular manifestation is most commonly associated with rheumatoid arthritis?
A) Heberden's nodes
B) Rheumatoid nodules
C) Bouchard's nodes
D) Psoriatic plaques
Correct Answer: B
Rationale:
✅Correct (B): Rheumatoid nodules are firm, non-tender, subcutaneous nodules that
occur over extensor surfaces (elbows, fingers). They are the most common extra-
articular manifestation of rheumatoid arthritis (present in about 25% of patients).
Heberden's nodes (A) and Bouchard's nodes (C) are associated with osteoarthritis (DIP
and PIP joints, respectively). Psoriatic plaques (D) are associated with psoriatic arthritis .
✅ Incorrect (A): Heberden's nodes = osteoarthritis (DIP joints).
✅ Incorrect (C): Bouchard's nodes = osteoarthritis (PIP joints).
✅ Incorrect (D): Psoriatic plaques = psoriatic arthritis.
StudyTip: "Rheumatoid arthritis = rheumatoid nodules (extensor surfaces)."
