NR601 Midterm Exam: 100 Practice Questions with
Answers & Rationales | Advanced Health Assessment |
Latest Update 2026
SECTION A: CARDIOVASCULAR ASSESSMENT (Questions 1-15)
1. A 72-year-old male presents with exertional dyspnea and orthopnea. He
reports awakening at night gasping for air. On examination, you note jugular
venous distention and bilateral lower extremity edema. Which of the following
is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Pulmonary embolism
C) Heart failure with reduced ejection fraction
D) Pneumonia
Rationale: The classic triad of exertional dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea (PND) with physical findings of JVD and peripheral edema
strongly suggests heart failure. COPD typically presents with chronic productive
cough and wheezing, not PND. Pulmonary embolism presents acutely with
sudden-onset dyspnea and pleuritic chest pain. Pneumonia would present with
fever, productive cough, and crackles.
2. A 65-year-old female with a history of hypertension presents with chest
pressure that radiates to her jaw and left arm. The pain began 30 minutes ago
while she was resting. Which of the following is the most appropriate initial
diagnostic test?
A) Chest X-ray
B) Electrocardiogram (ECG)
C) Complete blood count
D) Echocardiogram
Rationale: The ECG is the most rapid and essential initial diagnostic test for
suspected acute coronary syndrome, as it can detect ST-segment elevation
(STEMI) or other ischemic changes. Chest X-ray and CBC may be useful but are
,not the priority. Echocardiogram, while valuable, is not typically the first test in
acute chest pain.
3. A 78-year-old male presents with a systolic ejection murmur heard best at
the right upper sternal border with radiation to the carotid arteries. The
murmur is crescendo-decrescendo. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid stenosis
D) Pulmonary stenosis
Rationale: Aortic stenosis presents with a systolic ejection murmur heard best at
the right upper sternal border (aortic area) with radiation to the carotids. The
murmur is crescendo-decrescendo (diamond-shaped). Mitral regurgitation is a
holosystolic murmur at the apex. Tricuspid stenosis is diastolic and rare.
Pulmonary stenosis is heard at the left upper sternal border.
4. A patient reports episodes of palpitations, lightheadedness, and near-
syncope. On cardiac monitoring, you note a regular, narrow-complex
tachycardia at 180 beats per minute. What is the most likely rhythm?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
Rationale: SVT is characterized by a regular, narrow-complex tachycardia
typically between 150-250 bpm. Atrial fibrillation is irregularly irregular.
Ventricular tachycardia is wide-complex. Sinus tachycardia is typically less than
150 bpm and has a gradual onset/offset.
5. A 58-year-old female with type 2 diabetes presents with complaints of
dyspnea and fatigue. She denies chest pain. Which of the following is true
regarding silent myocardial ischemia in diabetic patients?
,A) Diabetic patients are at lower risk for silent ischemia
B) Diabetic patients may experience atypical symptoms such as fatigue,
dyspnea, or nausea
C) Silent ischemia does not occur in diabetic patients
D) Chest pain is always present with MI in diabetic patients
Rationale: Diabetic patients with autonomic neuropathy often have silent
myocardial ischemia, presenting with atypical symptoms such as fatigue, dyspnea,
nausea, or diaphoresis without chest pain. This population is at higher, not lower,
risk for silent ischemia.
6. A 71-year-old male with known coronary artery disease presents with
increasing dyspnea on exertion and a new S3 gallop on cardiac auscultation.
What does the presence of an S3 heart sound most likely indicate?
A) Normal aging finding
B) Volume overload or heart failure
C) Aortic stenosis
D) Pericarditis
Rationale: An S3 gallop (ventricular gallop) is associated with volume overload
states such as heart failure, mitral regurgitation, and ventricular dysfunction. In
older adults, S3 is always pathologic and indicates decreased ventricular
compliance or volume overload.
7. A patient presents with a blood pressure of 168/98 mmHg on two separate
occasions. He has no target organ damage or associated conditions. What is
the most appropriate initial medication class for this patient?
A) Beta-blocker
B) Thiazide diuretic or ACE inhibitor
C) Alpha-blocker
D) Direct vasodilator
Rationale: According to JNC-8 guidelines, initial treatment for hypertension in the
general population (including older adults) should include a thiazide diuretic,
calcium channel blocker, ACE inhibitor, or ARB. ACE inhibitors are preferred in
patients with diabetes or CKD.
, 8. A 66-year-old female presents with sudden-onset severe headache, nausea,
vomiting, and photophobia. She has a history of hypertension. On
examination, you note a stiff neck. What is the most concerning diagnosis to
rule out?
A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Sinusitis
Rationale: The acute onset of "worst headache of my life" with meningeal signs
(neck stiffness, photophobia, nausea/vomiting) suggests subarachnoid hemorrhage
until proven otherwise. This is a life-threatening emergency requiring immediate
CT and possible lumbar puncture.
9. A 74-year-old male presents with unilateral leg swelling and pain that
began suddenly. The leg is warm, erythematous, and tender to palpation.
What is the most appropriate initial diagnostic study?
A) D-dimer
B) Doppler ultrasound
C) Venography
D) CT angiography
Rationale: Doppler ultrasound (venous duplex) is the gold-standard initial imaging
test for deep vein thrombosis (DVT) due to its noninvasive nature, high sensitivity,
and specificity. D-dimer is sensitive but not specific and is often elevated in older
adults for other reasons.
10. A 62-year-old patient reports intermittent claudication in both calves after
walking one block. Which of the following is the most significant risk factor
for peripheral arterial disease (PAD)?
A) Family history
B) Smoking
Answers & Rationales | Advanced Health Assessment |
Latest Update 2026
SECTION A: CARDIOVASCULAR ASSESSMENT (Questions 1-15)
1. A 72-year-old male presents with exertional dyspnea and orthopnea. He
reports awakening at night gasping for air. On examination, you note jugular
venous distention and bilateral lower extremity edema. Which of the following
is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Pulmonary embolism
C) Heart failure with reduced ejection fraction
D) Pneumonia
Rationale: The classic triad of exertional dyspnea, orthopnea, and paroxysmal
nocturnal dyspnea (PND) with physical findings of JVD and peripheral edema
strongly suggests heart failure. COPD typically presents with chronic productive
cough and wheezing, not PND. Pulmonary embolism presents acutely with
sudden-onset dyspnea and pleuritic chest pain. Pneumonia would present with
fever, productive cough, and crackles.
2. A 65-year-old female with a history of hypertension presents with chest
pressure that radiates to her jaw and left arm. The pain began 30 minutes ago
while she was resting. Which of the following is the most appropriate initial
diagnostic test?
A) Chest X-ray
B) Electrocardiogram (ECG)
C) Complete blood count
D) Echocardiogram
Rationale: The ECG is the most rapid and essential initial diagnostic test for
suspected acute coronary syndrome, as it can detect ST-segment elevation
(STEMI) or other ischemic changes. Chest X-ray and CBC may be useful but are
,not the priority. Echocardiogram, while valuable, is not typically the first test in
acute chest pain.
3. A 78-year-old male presents with a systolic ejection murmur heard best at
the right upper sternal border with radiation to the carotid arteries. The
murmur is crescendo-decrescendo. What is the most likely diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Tricuspid stenosis
D) Pulmonary stenosis
Rationale: Aortic stenosis presents with a systolic ejection murmur heard best at
the right upper sternal border (aortic area) with radiation to the carotids. The
murmur is crescendo-decrescendo (diamond-shaped). Mitral regurgitation is a
holosystolic murmur at the apex. Tricuspid stenosis is diastolic and rare.
Pulmonary stenosis is heard at the left upper sternal border.
4. A patient reports episodes of palpitations, lightheadedness, and near-
syncope. On cardiac monitoring, you note a regular, narrow-complex
tachycardia at 180 beats per minute. What is the most likely rhythm?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Supraventricular tachycardia (SVT)
D) Sinus tachycardia
Rationale: SVT is characterized by a regular, narrow-complex tachycardia
typically between 150-250 bpm. Atrial fibrillation is irregularly irregular.
Ventricular tachycardia is wide-complex. Sinus tachycardia is typically less than
150 bpm and has a gradual onset/offset.
5. A 58-year-old female with type 2 diabetes presents with complaints of
dyspnea and fatigue. She denies chest pain. Which of the following is true
regarding silent myocardial ischemia in diabetic patients?
,A) Diabetic patients are at lower risk for silent ischemia
B) Diabetic patients may experience atypical symptoms such as fatigue,
dyspnea, or nausea
C) Silent ischemia does not occur in diabetic patients
D) Chest pain is always present with MI in diabetic patients
Rationale: Diabetic patients with autonomic neuropathy often have silent
myocardial ischemia, presenting with atypical symptoms such as fatigue, dyspnea,
nausea, or diaphoresis without chest pain. This population is at higher, not lower,
risk for silent ischemia.
6. A 71-year-old male with known coronary artery disease presents with
increasing dyspnea on exertion and a new S3 gallop on cardiac auscultation.
What does the presence of an S3 heart sound most likely indicate?
A) Normal aging finding
B) Volume overload or heart failure
C) Aortic stenosis
D) Pericarditis
Rationale: An S3 gallop (ventricular gallop) is associated with volume overload
states such as heart failure, mitral regurgitation, and ventricular dysfunction. In
older adults, S3 is always pathologic and indicates decreased ventricular
compliance or volume overload.
7. A patient presents with a blood pressure of 168/98 mmHg on two separate
occasions. He has no target organ damage or associated conditions. What is
the most appropriate initial medication class for this patient?
A) Beta-blocker
B) Thiazide diuretic or ACE inhibitor
C) Alpha-blocker
D) Direct vasodilator
Rationale: According to JNC-8 guidelines, initial treatment for hypertension in the
general population (including older adults) should include a thiazide diuretic,
calcium channel blocker, ACE inhibitor, or ARB. ACE inhibitors are preferred in
patients with diabetes or CKD.
, 8. A 66-year-old female presents with sudden-onset severe headache, nausea,
vomiting, and photophobia. She has a history of hypertension. On
examination, you note a stiff neck. What is the most concerning diagnosis to
rule out?
A) Migraine
B) Subarachnoid hemorrhage
C) Tension headache
D) Sinusitis
Rationale: The acute onset of "worst headache of my life" with meningeal signs
(neck stiffness, photophobia, nausea/vomiting) suggests subarachnoid hemorrhage
until proven otherwise. This is a life-threatening emergency requiring immediate
CT and possible lumbar puncture.
9. A 74-year-old male presents with unilateral leg swelling and pain that
began suddenly. The leg is warm, erythematous, and tender to palpation.
What is the most appropriate initial diagnostic study?
A) D-dimer
B) Doppler ultrasound
C) Venography
D) CT angiography
Rationale: Doppler ultrasound (venous duplex) is the gold-standard initial imaging
test for deep vein thrombosis (DVT) due to its noninvasive nature, high sensitivity,
and specificity. D-dimer is sensitive but not specific and is often elevated in older
adults for other reasons.
10. A 62-year-old patient reports intermittent claudication in both calves after
walking one block. Which of the following is the most significant risk factor
for peripheral arterial disease (PAD)?
A) Family history
B) Smoking
