APUS NURS601 Final Exam (pdf) | 2026/2027 | Advanced Health
Assessment Q&A | Nursing
1. A 65-year-old patient presents with a 3-month history of progressive
dyspnea on exertion, non-productive cough, and fatigue. On auscultation,
you note fine, late-inspiratory crackles at the lung bases. Chest X-ray shows
bilateral interstitial infiltrates. Which of the following is the most likely
diagnosis?
A) Congestive heart failure
B) Idiopathic pulmonary fibrosis
C) Community-acquired pneumonia
D) Chronic obstructive pulmonary disease
Correct Answer: Idiopathic pulmonary fibrosis
Rationale: Idiopathic pulmonary fibrosis typically presents with progressive
dyspnea, non-productive cough, and fine, late-inspiratory crackles (Velcro
crackles) at the lung bases. The bilateral interstitial infiltrates on chest X-ray
are characteristic of this restrictive lung disease. Congestive heart failure
would also present with crackles, but the history of progressive dyspnea
without significant orthopnea or peripheral edema, along with the specific
quality of the crackles and X-ray findings, points toward pulmonary fibrosis.
2. A 72-year-old patient with a history of smoking presents with a hoarse
voice that has been progressively worsening over 6 months. He denies any
upper respiratory infection symptoms. On examination, you note no cervical
lymphadenopathy. Which of the following is the most appropriate initial
diagnostic step?
A) Trial of proton pump inhibitor therapy
B) Direct laryngoscopy
C) Chest X-ray
D) CT scan of the neck
Correct Answer: Direct laryngoscopy
Rationale: Hoarseness persisting for more than 3 weeks in a patient with a
smoking history warrants direct visualization of the larynx. Direct
,laryngoscopy allows for visualization of the vocal cords and surrounding
structures to rule out laryngeal malignancy. While GERD can cause
hoarseness, the progressive nature and smoking history make malignancy a
primary concern.
3. A 58-year-old patient presents with a 2-week history of a painful, vesicular
rash on the left side of his chest. He reports that the pain preceded the rash
by 2 days. Examination reveals grouped vesicles on an erythematous base in
a dermatomal distribution. What is the most likely diagnosis?
A) Contact dermatitis
B) Herpes zoster (shingles)
C) Herpes simplex
D) Impetigo
Correct Answer: Herpes zoster (shingles)
Rationale: Herpes zoster presents with a painful, vesicular rash in a
dermatomal distribution, often preceded by pain or paresthesia in the
affected area. The rash typically appears unilaterally and follows a single
dermatome. Contact dermatitis is not typically dermatomal and is usually
associated with exposure to an irritant. Herpes simplex typically presents
with grouped vesicles on the lips or genitals.
4. A 48-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Physical examination reveals a slow heart rate, dry skin,
and a non-tender, diffuse goiter. Laboratory studies show a TSH of 15.0
mIU/L (normal 0.4-4.0) and a free T4 of 0.5 ng/dL (normal 0.8-1.8). Which of
the following is the most likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Toxic multinodular goiter
Correct Answer: Hashimoto's thyroiditis
,Rationale: Hashimoto's thyroiditis is an autoimmune disorder that is the most
common cause of hypothyroidism in iodine-sufficient areas. It presents with
fatigue, weight gain, cold intolerance, constipation, and a diffuse, non-tender
goiter. Laboratory findings show elevated TSH and low free T4, consistent
with primary hypothyroidism. Graves' disease and toxic multinodular goiter
cause hyperthyroidism, which would present with opposite symptoms
(weight loss, heat intolerance, tachycardia).
5. A 55-year-old male with a history of hypertension and diabetes presents
with a 1-week history of pain and swelling in his right great toe. He reports
that the pain started suddenly last night and is so severe that he cannot bear
weight on the foot. On examination, the joint is erythematous, warm, and
exquisitely tender to palpation. Which of the following is the most
appropriate initial diagnostic test?
A) Serum uric acid level
B) Joint aspiration for crystal analysis
C) X-ray of the foot
D) Complete blood count
Correct Answer: Joint aspiration for crystal analysis
Rationale: The sudden onset of pain, erythema, and swelling in the first
metatarsophalangeal joint is classic for acute gout. While serum uric acid
may be elevated, it can be normal during an acute attack. Joint aspiration for
crystal analysis is the gold standard for diagnosis, demonstrating negatively
birefringent monosodium urate crystals. An X-ray is typically normal in acute
gout.
6. A 62-year-old patient presents with a 3-day history of acute, severe, right-
sided headache. She reports that the headache is located around her right
eye and is associated with redness and tearing of the eye and nasal
congestion on the same side. On examination, you note ptosis and miosis of
the right eye. What is the most likely diagnosis?
A) Migraine
B) Cluster headache
, C) Temporal arteritis
D) Tension headache
Correct Answer: Cluster headache
Rationale: Cluster headaches are characterized by severe, unilateral pain
around the eye, accompanied by autonomic symptoms such as lacrimation,
conjunctival injection, nasal congestion, ptosis, and miosis. They are often
described as the worst headache of a person's life and occur in clusters, with
multiple headaches occurring daily for weeks to months. Migraines are
typically pulsating and associated with nausea and photophobia. Temporal
arteritis typically presents in older adults with a dull, aching headache and
jaw claudication.
7. A 45-year-old patient presents with a 6-month history of progressive
shortness of breath, fatigue, and a non-productive cough. On auscultation,
you note a high-pitched, musical sound during inspiration. Spirometry
reveals a restrictive pattern. Which of the following is the most likely cause
of this patient's symptoms?
A) Asthma
B) COPD
C) Sarcoidosis
D) Pulmonary embolism
Correct Answer: Sarcoidosis
Rationale: Sarcoidosis is a multisystem granulomatous disease that
commonly affects the lungs. It can present with progressive dyspnea,
fatigue, and cough. Auscultation may reveal inspiratory crackles or, in some
cases, wheezing due to airway compression. Spirometry shows a restrictive
pattern. Asthma and COPD typically show obstructive patterns on spirometry.
8. A 70-year-old patient with a history of atrial fibrillation presents with
sudden onset of severe, tearing chest pain that radiates to the back. On
examination, blood pressure is 180/110 mmHg in the right arm and 120/70
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
Assessment Q&A | Nursing
1. A 65-year-old patient presents with a 3-month history of progressive
dyspnea on exertion, non-productive cough, and fatigue. On auscultation,
you note fine, late-inspiratory crackles at the lung bases. Chest X-ray shows
bilateral interstitial infiltrates. Which of the following is the most likely
diagnosis?
A) Congestive heart failure
B) Idiopathic pulmonary fibrosis
C) Community-acquired pneumonia
D) Chronic obstructive pulmonary disease
Correct Answer: Idiopathic pulmonary fibrosis
Rationale: Idiopathic pulmonary fibrosis typically presents with progressive
dyspnea, non-productive cough, and fine, late-inspiratory crackles (Velcro
crackles) at the lung bases. The bilateral interstitial infiltrates on chest X-ray
are characteristic of this restrictive lung disease. Congestive heart failure
would also present with crackles, but the history of progressive dyspnea
without significant orthopnea or peripheral edema, along with the specific
quality of the crackles and X-ray findings, points toward pulmonary fibrosis.
2. A 72-year-old patient with a history of smoking presents with a hoarse
voice that has been progressively worsening over 6 months. He denies any
upper respiratory infection symptoms. On examination, you note no cervical
lymphadenopathy. Which of the following is the most appropriate initial
diagnostic step?
A) Trial of proton pump inhibitor therapy
B) Direct laryngoscopy
C) Chest X-ray
D) CT scan of the neck
Correct Answer: Direct laryngoscopy
Rationale: Hoarseness persisting for more than 3 weeks in a patient with a
smoking history warrants direct visualization of the larynx. Direct
,laryngoscopy allows for visualization of the vocal cords and surrounding
structures to rule out laryngeal malignancy. While GERD can cause
hoarseness, the progressive nature and smoking history make malignancy a
primary concern.
3. A 58-year-old patient presents with a 2-week history of a painful, vesicular
rash on the left side of his chest. He reports that the pain preceded the rash
by 2 days. Examination reveals grouped vesicles on an erythematous base in
a dermatomal distribution. What is the most likely diagnosis?
A) Contact dermatitis
B) Herpes zoster (shingles)
C) Herpes simplex
D) Impetigo
Correct Answer: Herpes zoster (shingles)
Rationale: Herpes zoster presents with a painful, vesicular rash in a
dermatomal distribution, often preceded by pain or paresthesia in the
affected area. The rash typically appears unilaterally and follows a single
dermatome. Contact dermatitis is not typically dermatomal and is usually
associated with exposure to an irritant. Herpes simplex typically presents
with grouped vesicles on the lips or genitals.
4. A 48-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Physical examination reveals a slow heart rate, dry skin,
and a non-tender, diffuse goiter. Laboratory studies show a TSH of 15.0
mIU/L (normal 0.4-4.0) and a free T4 of 0.5 ng/dL (normal 0.8-1.8). Which of
the following is the most likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subacute thyroiditis
D) Toxic multinodular goiter
Correct Answer: Hashimoto's thyroiditis
,Rationale: Hashimoto's thyroiditis is an autoimmune disorder that is the most
common cause of hypothyroidism in iodine-sufficient areas. It presents with
fatigue, weight gain, cold intolerance, constipation, and a diffuse, non-tender
goiter. Laboratory findings show elevated TSH and low free T4, consistent
with primary hypothyroidism. Graves' disease and toxic multinodular goiter
cause hyperthyroidism, which would present with opposite symptoms
(weight loss, heat intolerance, tachycardia).
5. A 55-year-old male with a history of hypertension and diabetes presents
with a 1-week history of pain and swelling in his right great toe. He reports
that the pain started suddenly last night and is so severe that he cannot bear
weight on the foot. On examination, the joint is erythematous, warm, and
exquisitely tender to palpation. Which of the following is the most
appropriate initial diagnostic test?
A) Serum uric acid level
B) Joint aspiration for crystal analysis
C) X-ray of the foot
D) Complete blood count
Correct Answer: Joint aspiration for crystal analysis
Rationale: The sudden onset of pain, erythema, and swelling in the first
metatarsophalangeal joint is classic for acute gout. While serum uric acid
may be elevated, it can be normal during an acute attack. Joint aspiration for
crystal analysis is the gold standard for diagnosis, demonstrating negatively
birefringent monosodium urate crystals. An X-ray is typically normal in acute
gout.
6. A 62-year-old patient presents with a 3-day history of acute, severe, right-
sided headache. She reports that the headache is located around her right
eye and is associated with redness and tearing of the eye and nasal
congestion on the same side. On examination, you note ptosis and miosis of
the right eye. What is the most likely diagnosis?
A) Migraine
B) Cluster headache
, C) Temporal arteritis
D) Tension headache
Correct Answer: Cluster headache
Rationale: Cluster headaches are characterized by severe, unilateral pain
around the eye, accompanied by autonomic symptoms such as lacrimation,
conjunctival injection, nasal congestion, ptosis, and miosis. They are often
described as the worst headache of a person's life and occur in clusters, with
multiple headaches occurring daily for weeks to months. Migraines are
typically pulsating and associated with nausea and photophobia. Temporal
arteritis typically presents in older adults with a dull, aching headache and
jaw claudication.
7. A 45-year-old patient presents with a 6-month history of progressive
shortness of breath, fatigue, and a non-productive cough. On auscultation,
you note a high-pitched, musical sound during inspiration. Spirometry
reveals a restrictive pattern. Which of the following is the most likely cause
of this patient's symptoms?
A) Asthma
B) COPD
C) Sarcoidosis
D) Pulmonary embolism
Correct Answer: Sarcoidosis
Rationale: Sarcoidosis is a multisystem granulomatous disease that
commonly affects the lungs. It can present with progressive dyspnea,
fatigue, and cough. Auscultation may reveal inspiratory crackles or, in some
cases, wheezing due to airway compression. Spirometry shows a restrictive
pattern. Asthma and COPD typically show obstructive patterns on spirometry.
8. A 70-year-old patient with a history of atrial fibrillation presents with
sudden onset of severe, tearing chest pain that radiates to the back. On
examination, blood pressure is 180/110 mmHg in the right arm and 120/70
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
