1
NSG 500 Exam 2 – Advanced Health Assessment | Wilkes
University (2026) | Advanced/Hard Difficulty | Professional
Level | 100% Pass Guaranteed | Graded A+
1. A 72-year-old patient presents with a complaint of progressive shortness of breath and dry
cough over the past 6 months. On auscultation, you hear fine, late-inspiratory crackles at the
lung bases that do not clear with coughing. Which of the following is the most likely
diagnosis?
A. Chronic bronchitis
B. Pulmonary edema
C. Idiopathic pulmonary fibrosis
D. Pneumonia
Correct Answer: C
Explanation: Idiopathic pulmonary fibrosis typically presents with progressive dyspnea and
a dry cough in older adults. Fine, late-inspiratory crackles (Velcro crackles) at the bases that do
not clear with coughing are a classic finding. Chronic bronchitis presents with a productive
cough. Pulmonary edema crackles are often associated with cardiac symptoms. Pneumonia
would present with acute symptoms and fever.
,2
2. During an abdominal assessment, you note a pulsatile mass in the epigastric region of a 68-
year-old male with a history of hypertension and smoking. The mass is approximately 5 cm in
diameter. What is the most appropriate next step?
A. Document the finding as a normal abdominal aorta
B. Perform deep palpation to determine the margins
C. Order an abdominal ultrasound
D. Reassure the patient that this is a benign finding
Correct Answer: C
Explanation: A pulsatile epigastric mass in a patient with risk factors for abdominal aortic
aneurysm (AAA) should be evaluated with an abdominal ultrasound. Deep palpation is
contraindicated due to the risk of rupture. Options A and D are incorrect as this finding requires
further evaluation.
,3
3. A 45-year-old patient reports that he has a "mole" on his back that has recently changed
color and begun to bleed. On examination, the lesion is asymmetric, has irregular borders,
and is dark brown with areas of black and red. What is the most appropriate next step?
A. Reassure the patient that the lesion is benign
B. Perform a shave biopsy in the office
C. Refer the patient to a dermatologist for evaluation and possible biopsy
D. Apply cryotherapy to the lesion
Correct Answer: C
Explanation: The ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter
>6mm, Evolution/changes) suggest a possible melanoma. The patient should be referred to a
dermatologist for evaluation and biopsy. Option A would be negligent. Option B should be
performed by a specialist. Option D is not appropriate for a suspicious lesion.
4. When assessing a patient for orthostatic hypotension, which of the following is the correct
sequence for measuring blood pressure and heart rate?
, 4
A. Supine → Sitting → Standing
B. Sitting → Supine → Standing
C. Standing → Sitting → Supine
D. Supine → Standing only
Correct Answer: A
Explanation: The correct sequence for orthostatic vital signs is to first measure BP and HR
while the patient is supine, then after 2-3 minutes of sitting, and finally after 2-3 minutes of
standing. A drop of >20 mmHg systolic or >10 mmHg diastolic, or an increase in HR >20 bpm
with symptoms, indicates orthostatic hypotension.
5. A 58-year-old female with a history of type 2 diabetes and hypertension presents with a
complaint of a "sore on her foot" that has not healed for 4 weeks. On examination, you note
a 2 cm ulcer on the plantar surface of the great toe with a well-defined border and a pale
base. Which of the following assessments is most critical for determining the etiology of this
ulcer?
A. ABI (Ankle-Brachial Index)
B. Serum hemoglobin A1C
NSG 500 Exam 2 – Advanced Health Assessment | Wilkes
University (2026) | Advanced/Hard Difficulty | Professional
Level | 100% Pass Guaranteed | Graded A+
1. A 72-year-old patient presents with a complaint of progressive shortness of breath and dry
cough over the past 6 months. On auscultation, you hear fine, late-inspiratory crackles at the
lung bases that do not clear with coughing. Which of the following is the most likely
diagnosis?
A. Chronic bronchitis
B. Pulmonary edema
C. Idiopathic pulmonary fibrosis
D. Pneumonia
Correct Answer: C
Explanation: Idiopathic pulmonary fibrosis typically presents with progressive dyspnea and
a dry cough in older adults. Fine, late-inspiratory crackles (Velcro crackles) at the bases that do
not clear with coughing are a classic finding. Chronic bronchitis presents with a productive
cough. Pulmonary edema crackles are often associated with cardiac symptoms. Pneumonia
would present with acute symptoms and fever.
,2
2. During an abdominal assessment, you note a pulsatile mass in the epigastric region of a 68-
year-old male with a history of hypertension and smoking. The mass is approximately 5 cm in
diameter. What is the most appropriate next step?
A. Document the finding as a normal abdominal aorta
B. Perform deep palpation to determine the margins
C. Order an abdominal ultrasound
D. Reassure the patient that this is a benign finding
Correct Answer: C
Explanation: A pulsatile epigastric mass in a patient with risk factors for abdominal aortic
aneurysm (AAA) should be evaluated with an abdominal ultrasound. Deep palpation is
contraindicated due to the risk of rupture. Options A and D are incorrect as this finding requires
further evaluation.
,3
3. A 45-year-old patient reports that he has a "mole" on his back that has recently changed
color and begun to bleed. On examination, the lesion is asymmetric, has irregular borders,
and is dark brown with areas of black and red. What is the most appropriate next step?
A. Reassure the patient that the lesion is benign
B. Perform a shave biopsy in the office
C. Refer the patient to a dermatologist for evaluation and possible biopsy
D. Apply cryotherapy to the lesion
Correct Answer: C
Explanation: The ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter
>6mm, Evolution/changes) suggest a possible melanoma. The patient should be referred to a
dermatologist for evaluation and biopsy. Option A would be negligent. Option B should be
performed by a specialist. Option D is not appropriate for a suspicious lesion.
4. When assessing a patient for orthostatic hypotension, which of the following is the correct
sequence for measuring blood pressure and heart rate?
, 4
A. Supine → Sitting → Standing
B. Sitting → Supine → Standing
C. Standing → Sitting → Supine
D. Supine → Standing only
Correct Answer: A
Explanation: The correct sequence for orthostatic vital signs is to first measure BP and HR
while the patient is supine, then after 2-3 minutes of sitting, and finally after 2-3 minutes of
standing. A drop of >20 mmHg systolic or >10 mmHg diastolic, or an increase in HR >20 bpm
with symptoms, indicates orthostatic hypotension.
5. A 58-year-old female with a history of type 2 diabetes and hypertension presents with a
complaint of a "sore on her foot" that has not healed for 4 weeks. On examination, you note
a 2 cm ulcer on the plantar surface of the great toe with a well-defined border and a pale
base. Which of the following assessments is most critical for determining the etiology of this
ulcer?
A. ABI (Ankle-Brachial Index)
B. Serum hemoglobin A1C
