NUR 643E Advanced Health Assessment Final Exam:
Comprehensive Evaluation of Clinical Reasoning, Differential
Diagnosis, Advanced Interviewing, and Evidence-Based Physical
Examination Techniques for Family and Adult-Gerontology Nurse
Practitioners
Year: 2026
Week: 16 (Final Exam Week)
Difficulty: Advanced / Hard / Mixed
Target Audience: Graduate-level NP students
Questions 1–150
1. A 62-year-old male reports episodic substernal chest pressure
that occurs with shoveling snow and resolves within 5 minutes of
rest. Which feature most strongly supports stable angina over
esophageal spasm?
A) Relief with antacids
B) Association with exertion
C) Burning retrosternal quality
D) Tenderness on chest palpation
Correct Answer: B
Rationale: Exertion-provoked chest pressure relieved by rest is
classic for stable angina; esophageal spasm is not exertion-related.
,2. During cardiac auscultation, you hear a low-pitched diastolic
rumble at the apex with presystolic accentuation in a patient in
sinus rhythm. The most likely valvular lesion is:
A) Mitral stenosis
B) Mitral regurgitation
C) Aortic stenosis
D) Tricuspid stenosis
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched diastolic rumble
at the apex, often with presystolic accentuation in sinus rhythm.
3. A 78-year-old female reports dizziness upon standing. Supine BP
is 150/90, standing BP is 90/60 with no compensatory tachycardia.
Which diagnosis is most likely?
A) Hypovolemia
B) Neurogenic orthostatic hypotension
C) Medication side effect
D) Cardiac arrhythmia
Correct Answer: B
Rationale: Orthostatic hypotension without heart rate increase
suggests autonomic failure (neurogenic).
4. On fundoscopic exam, you see sharp disc margins but a pale,
atrophic optic disc with reduced vessel number. This finding is most
consistent with:
,A) Glaucoma
B) Optic atrophy
C) Papilledema
D) Central retinal vein occlusion
Correct Answer: B
Rationale: Pale, sharp disc with few vessels = optic atrophy from
prior optic nerve damage.
5. A 38-year-old female reports fatigue, weight gain, and cold
intolerance. On exam, you note a delayed relaxation phase of deep
tendon reflexes. The most likely diagnosis is:
A) Hyperthyroidism
B) Hypothyroidism
C) Myasthenia gravis
D) Vitamin D deficiency
Correct Answer: B
Rationale: Hypothyroidism causes hung-up reflexes, bradycardia,
fatigue, and cold intolerance.
6. A 55-year-old male with a 30-pack-year smoking history has a
firm, non-tender, fixed node in the right supraclavicular fossa. This
node most likely indicates:
A) Metastatic lung cancer
B) Reactive hyperplasia
, C) Tuberculosis
D) Sarcoidosis
Correct Answer: A
Rationale: Right supraclavicular node in a smoker is highly
suspicious for metastatic lung or mediastinal malignancy.
7. On respiratory exam, a patient has hyperresonance to percussion,
decreased breath sounds, and absent tactile fremitus on the left.
These findings suggest:
A) Pneumothorax
B) Pleural effusion
C) Lobar pneumonia
D) Atelectasis
Correct Answer: A
Rationale: Hyperresonance + decreased breath sounds + absent
fremitus = pneumothorax.
8. A 72-year-old diabetic reports bilateral numbness and burning in
a stocking distribution, worse at night. Monofilament testing shows
loss of sensation to the mid-calf. The most likely etiology is:
A) Lumbar spinal stenosis
B) Peripheral artery disease
C) Diabetic neuropathy
D) Vitamin B12 deficiency
Comprehensive Evaluation of Clinical Reasoning, Differential
Diagnosis, Advanced Interviewing, and Evidence-Based Physical
Examination Techniques for Family and Adult-Gerontology Nurse
Practitioners
Year: 2026
Week: 16 (Final Exam Week)
Difficulty: Advanced / Hard / Mixed
Target Audience: Graduate-level NP students
Questions 1–150
1. A 62-year-old male reports episodic substernal chest pressure
that occurs with shoveling snow and resolves within 5 minutes of
rest. Which feature most strongly supports stable angina over
esophageal spasm?
A) Relief with antacids
B) Association with exertion
C) Burning retrosternal quality
D) Tenderness on chest palpation
Correct Answer: B
Rationale: Exertion-provoked chest pressure relieved by rest is
classic for stable angina; esophageal spasm is not exertion-related.
,2. During cardiac auscultation, you hear a low-pitched diastolic
rumble at the apex with presystolic accentuation in a patient in
sinus rhythm. The most likely valvular lesion is:
A) Mitral stenosis
B) Mitral regurgitation
C) Aortic stenosis
D) Tricuspid stenosis
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched diastolic rumble
at the apex, often with presystolic accentuation in sinus rhythm.
3. A 78-year-old female reports dizziness upon standing. Supine BP
is 150/90, standing BP is 90/60 with no compensatory tachycardia.
Which diagnosis is most likely?
A) Hypovolemia
B) Neurogenic orthostatic hypotension
C) Medication side effect
D) Cardiac arrhythmia
Correct Answer: B
Rationale: Orthostatic hypotension without heart rate increase
suggests autonomic failure (neurogenic).
4. On fundoscopic exam, you see sharp disc margins but a pale,
atrophic optic disc with reduced vessel number. This finding is most
consistent with:
,A) Glaucoma
B) Optic atrophy
C) Papilledema
D) Central retinal vein occlusion
Correct Answer: B
Rationale: Pale, sharp disc with few vessels = optic atrophy from
prior optic nerve damage.
5. A 38-year-old female reports fatigue, weight gain, and cold
intolerance. On exam, you note a delayed relaxation phase of deep
tendon reflexes. The most likely diagnosis is:
A) Hyperthyroidism
B) Hypothyroidism
C) Myasthenia gravis
D) Vitamin D deficiency
Correct Answer: B
Rationale: Hypothyroidism causes hung-up reflexes, bradycardia,
fatigue, and cold intolerance.
6. A 55-year-old male with a 30-pack-year smoking history has a
firm, non-tender, fixed node in the right supraclavicular fossa. This
node most likely indicates:
A) Metastatic lung cancer
B) Reactive hyperplasia
, C) Tuberculosis
D) Sarcoidosis
Correct Answer: A
Rationale: Right supraclavicular node in a smoker is highly
suspicious for metastatic lung or mediastinal malignancy.
7. On respiratory exam, a patient has hyperresonance to percussion,
decreased breath sounds, and absent tactile fremitus on the left.
These findings suggest:
A) Pneumothorax
B) Pleural effusion
C) Lobar pneumonia
D) Atelectasis
Correct Answer: A
Rationale: Hyperresonance + decreased breath sounds + absent
fremitus = pneumothorax.
8. A 72-year-old diabetic reports bilateral numbness and burning in
a stocking distribution, worse at night. Monofilament testing shows
loss of sensation to the mid-calf. The most likely etiology is:
A) Lumbar spinal stenosis
B) Peripheral artery disease
C) Diabetic neuropathy
D) Vitamin B12 deficiency
