NUR 631 ADVANCED HEALTH ASSESSMENT EXAM 4 –
COMPREHENSIVE CLINICAL CASE-BASED
PRACTICE EXAM 300 QUESTIONS WITH EXPANDED
RATIONALES LATEST UPDATE
SECTION 1: GENERAL SURVEY, HISTORY, & VITAL SIGNS (Items 1-40)
1. A 58-year-old male with a history of hypertension on lisinopril reports
dizziness when transitioning from supine to standing over the past week.
Supine BP is 134/86 with HR 74. After standing for 2 minutes, BP is 106/68
with HR 98. He has no chest pain or palpitations. Which of the following
best characterizes this presentation?
A. Normal age-related cardiovascular response
B. Classic orthostatic hypotension from medication effect
C. Hypertensive urgency requiring immediate treatment
D. Carotid sinus hypersensitivity
• Correct Answer: B
Rationale: Orthostatic hypotension is defined as a sustained drop in SBP of at
least 20 mmHg or DBP of at least 10 mmHg within 3 minutes of standing,
accompanied by an HR rise of ≥20 bpm. Here, SBP fell 28 mmHg and HR rose
24 bpm. ACE inhibitors like lisinopril are common culprits due to
vasodilation and reduced sympathetic response. Hypertensive urgency (C)
requires SBP >180 or DBP >120 without end-organ damage, which is absent.
Carotid sinus hypersensitivity (D) presents with syncope triggered by neck
pressure or turning, not postural change. Age-related changes (A) do not
produce this degree of hemodynamic shift.
2. An asymptomatic 72-year-old woman presents for her annual wellness visit.
Her BP is 118/76, HR 68, RR 16, SpO2 98% on room air, BMI 31.4 kg/m².
According to current guidelines, which of the following is the correct
classification of her BMI?
A. Overweight
B. Obesity Class I
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,C. Obesity Class II
D. Obesity Class III
• Correct Answer: B
Rationale: BMI categories established by the WHO and NIH are: underweight
<18.5, normal 18.5–24.9, overweight 25.0–29.9, Obesity Class I 30.0–34.9,
Obesity Class II 35.0–39.9, and Obesity Class III (extreme) ≥40.0. A BMI of
31.4 falls squarely into Class I. This classification carries implications
for cardiovascular risk, screening for diabetes, and counseling on lifestyle
interventions including dietary modification and increased physical activity.
3. A 45-year-old executive presents for a new patient evaluation. He reports
no active complaints but mentions his father had a myocardial infarction at
age 52. He smokes 1.5 packs daily for 25 years, drinks 3–4 beers on weekends,
and works 60 hours per week. Which component of the health history would
capture his father's cardiac history?
A. Past Medical History
B. Social History
C. Family History
D. Review of Systems
• Correct Answer: C
Rationale: Family history systematically documents the health status, age,
and cause of death of first-degree blood relatives (parents, siblings,
children). Early-onset CAD in a first-degree male relative (<55 years) or
female (<65 years) is a major independent risk factor, often prompting
earlier lipid screening and primary prevention strategies. The Past Medical
History (A) is for the patient's own conditions. Social History (B) covers
lifestyle, occupation, and habits. The ROS (D) is a symptom inventory.
4. A 28-year-old female reports that she has missed her last three menstrual
periods. She is not pregnant and has no other symptoms. During the
comprehensive history, this finding should be documented in which section?
A. History of Present Illness (HPI)
B. Past Medical History
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,C. Review of Systems (Genitourinary)
D. Social History
• Correct Answer: C
Rationale: Menstrual abnormalities—amenorrhea, oligomenorrhea,
dysmenorrhea,
or abnormal bleeding—are systematically screened under the Genitourinary
component of the Review of Systems. If amenorrhea were the primary reason for
the visit, it would also appear in the HPI with full OLD CARTS characterization.
However, in a comprehensive history obtained from an asymptomatic patient,
the ROS is the appropriate location for this screening question. PMH (B)
would include prior gynecological diagnoses such as PCOS or endometriosis.
5. A 66-year-old male with a 30-pack-year smoking history and known COPD
presents for a routine physical. He has a chronic cough but notes no change
from baseline. His vital signs are BP 142/88, HR 82, RR 20, SpO2 92% on
room air, temperature 98.2°F. Which vital sign is most clinically significant
and warrants further evaluation?
A. Blood pressure of 142/88
B. Heart rate of 82
C. Respiratory rate of 20
D. Oxygen saturation of 92%
• Correct Answer: D
Rationale: In a patient with known COPD, a baseline SpO2 of 92% may be
acceptable if it is chronic and stable (target 88–92% to avoid CO2 narcosis).
However, a value of 92% in a patient without documented baseline requires
further evaluation—particularly because COPD patients often have normal
saturations at rest and desaturate with exertion. Further assessment should
include comparison to prior values, 6-minute walk test, or ABG if indicated.
BP 142/88 (A) is Stage 1 HTN but does not require urgent action at this
visit. RR of 20 (C) is at the upper limit of normal but not acutely
concerning without increased work of breathing.
6. During a general survey, a 34-year-old patient appears well-nourished,
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, makes good eye contact, speaks in full sentences, and ambulates with a
steady gait. Which of the following elements of the general survey has been
adequately assessed?
A. Skin turgor and hydration status
B. Mental status and affect
C. Neurological deep tendon reflexes
D. Peripheral vascular perfusion
• Correct Answer: B
Rationale: The general survey is the provider's initial impression of the
patient's overall state. It includes appearance (age-appropriate, grooming,
nourishment), behavior (eye contact, cooperation, speech pattern), mobility
(gait, posture), and any signs of distress. Appropriate eye contact and
coherent speech indicate normal affect and cognitive engagement but do not
constitute a full mental status exam (which would include orientation,
memory, and judgment). Skin turgor (A), reflexes (C), and perfusion (D) are
part of the focused physical examination, not the general survey.
7. A 55-year-old female is found to have a BP of 156/94 on two separate
readings taken 2 minutes apart during a single visit. She is asymptomatic.
According to the ACC/AHA 2017 guidelines, what is the correct diagnosis and
initial management?
A. Normal BP – no intervention
B. Elevated BP – lifestyle modification only
C. Stage 1 Hypertension – lifestyle modification and reassess in 1 month
D. Stage 2 Hypertension – lifestyle modification plus pharmacotherapy
• Correct Answer: D
Rationale: ACC/AHA defines Stage 2 HTN as SBP ≥140 or DBP ≥90 confirmed on
two readings in a single visit. Asymptomatic Stage 2 HTN requires initiation
of both non-pharmacological interventions (dietary sodium reduction, DASH
diet, weight loss, exercise) AND pharmacological therapy with a first-line
agent (thiazide, ACEi, ARB, or CCB). Stage 1 HTN (C) is SBP 130–139 or
DBP 80–89 and is managed with lifestyle changes alone if ASCVD risk is low,
or with medication if risk is elevated.
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COMPREHENSIVE CLINICAL CASE-BASED
PRACTICE EXAM 300 QUESTIONS WITH EXPANDED
RATIONALES LATEST UPDATE
SECTION 1: GENERAL SURVEY, HISTORY, & VITAL SIGNS (Items 1-40)
1. A 58-year-old male with a history of hypertension on lisinopril reports
dizziness when transitioning from supine to standing over the past week.
Supine BP is 134/86 with HR 74. After standing for 2 minutes, BP is 106/68
with HR 98. He has no chest pain or palpitations. Which of the following
best characterizes this presentation?
A. Normal age-related cardiovascular response
B. Classic orthostatic hypotension from medication effect
C. Hypertensive urgency requiring immediate treatment
D. Carotid sinus hypersensitivity
• Correct Answer: B
Rationale: Orthostatic hypotension is defined as a sustained drop in SBP of at
least 20 mmHg or DBP of at least 10 mmHg within 3 minutes of standing,
accompanied by an HR rise of ≥20 bpm. Here, SBP fell 28 mmHg and HR rose
24 bpm. ACE inhibitors like lisinopril are common culprits due to
vasodilation and reduced sympathetic response. Hypertensive urgency (C)
requires SBP >180 or DBP >120 without end-organ damage, which is absent.
Carotid sinus hypersensitivity (D) presents with syncope triggered by neck
pressure or turning, not postural change. Age-related changes (A) do not
produce this degree of hemodynamic shift.
2. An asymptomatic 72-year-old woman presents for her annual wellness visit.
Her BP is 118/76, HR 68, RR 16, SpO2 98% on room air, BMI 31.4 kg/m².
According to current guidelines, which of the following is the correct
classification of her BMI?
A. Overweight
B. Obesity Class I
1|Page
,C. Obesity Class II
D. Obesity Class III
• Correct Answer: B
Rationale: BMI categories established by the WHO and NIH are: underweight
<18.5, normal 18.5–24.9, overweight 25.0–29.9, Obesity Class I 30.0–34.9,
Obesity Class II 35.0–39.9, and Obesity Class III (extreme) ≥40.0. A BMI of
31.4 falls squarely into Class I. This classification carries implications
for cardiovascular risk, screening for diabetes, and counseling on lifestyle
interventions including dietary modification and increased physical activity.
3. A 45-year-old executive presents for a new patient evaluation. He reports
no active complaints but mentions his father had a myocardial infarction at
age 52. He smokes 1.5 packs daily for 25 years, drinks 3–4 beers on weekends,
and works 60 hours per week. Which component of the health history would
capture his father's cardiac history?
A. Past Medical History
B. Social History
C. Family History
D. Review of Systems
• Correct Answer: C
Rationale: Family history systematically documents the health status, age,
and cause of death of first-degree blood relatives (parents, siblings,
children). Early-onset CAD in a first-degree male relative (<55 years) or
female (<65 years) is a major independent risk factor, often prompting
earlier lipid screening and primary prevention strategies. The Past Medical
History (A) is for the patient's own conditions. Social History (B) covers
lifestyle, occupation, and habits. The ROS (D) is a symptom inventory.
4. A 28-year-old female reports that she has missed her last three menstrual
periods. She is not pregnant and has no other symptoms. During the
comprehensive history, this finding should be documented in which section?
A. History of Present Illness (HPI)
B. Past Medical History
2|Page
,C. Review of Systems (Genitourinary)
D. Social History
• Correct Answer: C
Rationale: Menstrual abnormalities—amenorrhea, oligomenorrhea,
dysmenorrhea,
or abnormal bleeding—are systematically screened under the Genitourinary
component of the Review of Systems. If amenorrhea were the primary reason for
the visit, it would also appear in the HPI with full OLD CARTS characterization.
However, in a comprehensive history obtained from an asymptomatic patient,
the ROS is the appropriate location for this screening question. PMH (B)
would include prior gynecological diagnoses such as PCOS or endometriosis.
5. A 66-year-old male with a 30-pack-year smoking history and known COPD
presents for a routine physical. He has a chronic cough but notes no change
from baseline. His vital signs are BP 142/88, HR 82, RR 20, SpO2 92% on
room air, temperature 98.2°F. Which vital sign is most clinically significant
and warrants further evaluation?
A. Blood pressure of 142/88
B. Heart rate of 82
C. Respiratory rate of 20
D. Oxygen saturation of 92%
• Correct Answer: D
Rationale: In a patient with known COPD, a baseline SpO2 of 92% may be
acceptable if it is chronic and stable (target 88–92% to avoid CO2 narcosis).
However, a value of 92% in a patient without documented baseline requires
further evaluation—particularly because COPD patients often have normal
saturations at rest and desaturate with exertion. Further assessment should
include comparison to prior values, 6-minute walk test, or ABG if indicated.
BP 142/88 (A) is Stage 1 HTN but does not require urgent action at this
visit. RR of 20 (C) is at the upper limit of normal but not acutely
concerning without increased work of breathing.
6. During a general survey, a 34-year-old patient appears well-nourished,
3|Page
, makes good eye contact, speaks in full sentences, and ambulates with a
steady gait. Which of the following elements of the general survey has been
adequately assessed?
A. Skin turgor and hydration status
B. Mental status and affect
C. Neurological deep tendon reflexes
D. Peripheral vascular perfusion
• Correct Answer: B
Rationale: The general survey is the provider's initial impression of the
patient's overall state. It includes appearance (age-appropriate, grooming,
nourishment), behavior (eye contact, cooperation, speech pattern), mobility
(gait, posture), and any signs of distress. Appropriate eye contact and
coherent speech indicate normal affect and cognitive engagement but do not
constitute a full mental status exam (which would include orientation,
memory, and judgment). Skin turgor (A), reflexes (C), and perfusion (D) are
part of the focused physical examination, not the general survey.
7. A 55-year-old female is found to have a BP of 156/94 on two separate
readings taken 2 minutes apart during a single visit. She is asymptomatic.
According to the ACC/AHA 2017 guidelines, what is the correct diagnosis and
initial management?
A. Normal BP – no intervention
B. Elevated BP – lifestyle modification only
C. Stage 1 Hypertension – lifestyle modification and reassess in 1 month
D. Stage 2 Hypertension – lifestyle modification plus pharmacotherapy
• Correct Answer: D
Rationale: ACC/AHA defines Stage 2 HTN as SBP ≥140 or DBP ≥90 confirmed on
two readings in a single visit. Asymptomatic Stage 2 HTN requires initiation
of both non-pharmacological interventions (dietary sodium reduction, DASH
diet, weight loss, exercise) AND pharmacological therapy with a first-line
agent (thiazide, ACEi, ARB, or CCB). Stage 1 HTN (C) is SBP 130–139 or
DBP 80–89 and is managed with lifestyle changes alone if ASCVD risk is low,
or with medication if risk is elevated.
4|Page
