NUR 504 EXAM 3 – ADVANCED HEALTH ASSESSMENT –ACTUAL QUESTIONS COMPLETE ANSWERS WITH DETAILED RATIONALES | UNIVERSITY OF ST. THOMAS

NUR 504 EXAM 3 – ADVANCED HEALTH ASSESSMENT –ACTUAL QUESTIONS COMPLETE ANSWERS WITH DETAILED RATIONALES | UNIVERSITY OF ST. THOMAS 1. A 72-year-old patient presents with new-onset confusion. What is the nurse practitioner's priority assessment? A. Mini-Mental State Examination B. Review of medication list for anticholinergics C. Complete cranial nerve examination D. Serum glucose measurement Answer: B. Review of medication list for anticholinergics Rationale: In older adults, new-onset confusion is often iatrogenic, with medications (anticholinergics, benzodiazepines, opioids) being a common cause. Assessing medication effects should precede cognitive testing or lab work unless hypoglycemia is suspected. ________________________________________ 2. Which technique best assesses for hepatojugular reflux? A. Auscultating over the liver while the patient inhales deeply B. Applying sustained pressure to the right upper quadrant for 30–60 seconds C. Percussing the lower border of the liver in the midclavicular line D. Palpating the liver edge during Valsalva maneuver Answer: B. Applying sustained pressure to the right upper quadrant for 30–60 seconds Rationale: Hepatojugular reflux is assessed by firm, sustained pressure over the liver; a rise in jugular venous pressure greater than 3 cm suggests right heart failure or volume overload. ________________________________________ 3. A patient reports chest pain that worsens when lying flat and improves when leaning forward. This is most characteristic of: A. Myocardial ischemia B. Pericarditis C. Aortic dissection D. Pulmonary embolism Answer: B. Pericarditis Rationale: Pericarditis pain is typically positional—worsening when supine and improving when leaning forward. This classic presentation helps differentiate it from other causes of chest pain. ________________________________________ 4. In assessing a patient's gait, you note a wide-based, unsteady gait that worsens with eyes closed (Romberg positive). This suggests: A. Vestibular disorder B. Cerebellar ataxia C. Peripheral neuropathy D. Parkinson's disease Answer: B. Cerebellar ataxia Rationale: A wide-based, unsteady gait with a positive Romberg sign (loss of proprioception when eyes are closed) suggests cerebellar dysfunction or sensory ataxia. ________________________________________ 5. A 45-year-old male has blood pressure 158/92 mm Hg in the right arm and 120/80 mm Hg in the left arm. This difference is most concerning for: A. Subclavian steal syndrome B. Coarctation of the aorta C. Aortic dissection D. Atherosclerotic disease Answer: C. Aortic dissection Rationale: A significant inter-arm blood pressure difference (10–15 mmHg) is concerning for aortic dissection and requires immediate evaluation. ________________________________________ 6. A 68-year-old male reports unintentional weight loss of 15 lbs in 2 months. What is the priority question? A. "Do you have food allergies?" B. "Have you had any change in appetite or difficulty swallowing?" C. "What is your favorite food?" D. "Are you on a low-carb diet?" Answer: B. "Have you had any change in appetite or difficulty swallowing?" Rationale: Dysphagia or anorexia may indicate underlying malignancy or GI disorder; weight loss requires ruling out serious causes first. ________________________________________ 7. Which technique is most accurate for assessing jugular venous pressure (JVP)? A. Palpating the carotid artery bilaterally B. Observing the patient at 45°, measuring vertical height above sternal angle