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NU 518 EXAM 2: ADVANCED HEALTH ASSESSMENT EXAM LATEST
VERSION QUESTIONS AND ANSWERS 2026 EDITION
NU 518 EXAM 2: Advanced Health Assessment Practice Questions with Rationales
SECTION 1: HEAD, EYES, EARS, NOSE, AND THROAT ASSESSMENT (Questions
1-50)
1. The nurse is preparing to assess the visual acuity of a 6-year-old child. Which visual
acuity chart is most appropriate for this age group?
A. Snellen chart
B. Allen picture chart
C. Tumbling E chart
D. Rosenbaum pocket screener
Answer: B. Allen picture chart
Rationale: The Allen picture chart is designed for children aged 3-6 years who cannot read
letters. It uses recognizable pictures (apple, house, umbrella) to assess visual acuity. The
Snellen chart is appropriate for older children and adults who can read letters. The Tumbling
E chart is used for children who cannot read but can point in the direction of the E. The
Rosenbaum pocket screener is used for near vision testing.
2. A 45-year-old patient presents with a complaint of difficulty seeing objects up close,
which has been progressively worsening over the past year. The nurse recognizes this
condition as:
A. Myopia
B. Presbyopia
C. Hyperopia
D. Astigmatism
Answer: B. Presbyopia
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Rationale: Presbyopia is an age-related loss of near vision due to decreased elasticity of the
lens, typically beginning around age 40. Myopia is nearsightedness, where distant objects
are blurry. Hyperopia is farsightedness, where near objects are blurry. Astigmatism is an
irregular curvature of the cornea causing blurred vision at all distances.
3. The nurse is assessing a patient's pupil response to light. A direct light is shone into
the right eye, and both pupils constrict. This response indicates:
A. Anisocoria
B. Consensual light reflex
C. Accommodation reflex
D. Miosis
Answer: B. Consensual light reflex
Rationale: The consensual light reflex occurs when light is shone into one eye and both
pupils constrict due to the crossing of nerve fibers in the optic chiasm. Anisocoria refers to
unequal pupil size. Accommodation is the pupillary constriction that occurs with focusing on
a near object. Miosis is pupillary constriction from any cause.
4. A patient presents with a red, painful eye, photophobia, and a "cobblestone"
appearance of the upper eyelid upon eversion. The nurse suspects:
A. Viral conjunctivitis
B. Allergic conjunctivitis
C. Bacterial conjunctivitis
D. Keratitis
Answer: B. Allergic conjunctivitis
Rationale: Allergic conjunctivitis presents with redness, itching, tearing, and a "cobblestone"
appearance of the palpebral conjunctiva (upper eyelid). Viral conjunctivitis presents with
watery discharge and is highly contagious. Bacterial conjunctivitis presents with purulent
discharge. Keratitis presents with corneal involvement and severe pain.
5. The nurse is assessing a patient with suspected glaucoma. Which finding is most
concerning for acute angle-closure glaucoma?
A. Painless, gradual vision loss
B. Halos around lights and eye pain
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C. Decreased peripheral vision
D. Cupping of the optic disc
Answer: B. Halos around lights and eye pain
Rationale: Acute angle-closure glaucoma is a medical emergency characterized by sudden
eye pain, headache, halos around lights, nausea, vomiting, and blurred vision. Painless,
gradual vision loss and decreased peripheral vision are characteristic of chronic open-angle
glaucoma. Cupping of the optic disc is a sign of chronic glaucoma, not acute.
6. The nurse is performing an otoscopic examination on an adult patient. To visualize
the tympanic membrane, the nurse should pull the pinna:
A. Up and back
B. Down and forward
C. Straight back
D. Down and back
Answer: A. Up and back
Rationale: In adults, the ear canal curves upward and forward, so the pinna should be pulled
up and back to straighten the canal for optimal visualization of the tympanic membrane. In
children, the pinna is pulled down and back because the ear canal is shorter and straighter in
children.
7. A 3-year-old child is brought to the clinic with a complaint of ear pain and fever. The
nurse notes that the tympanic membrane is bulging, erythematous, and has decreased
mobility. This finding is most consistent with:
A. Acute otitis media
B. Otitis media with effusion
C. Serous otitis media
D. Perforated tympanic membrane
Answer: A. Acute otitis media
Rationale: Acute otitis media presents with a bulging, erythematous tympanic membrane with
decreased mobility and signs of infection (fever, ear pain). Otitis media with effusion (OME)
presents with a retracted or normal-appearing TM with fluid behind it but no signs of acute
infection. Serous otitis media is often asymptomatic. A perforated TM would show a hole or
tear.
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8. The nurse is assessing a patient's hearing using the Rinne test. The patient reports
that air conduction is heard longer than bone conduction. This result is considered:
A. Normal
B. Conductive hearing loss
C. Sensorineural hearing loss
D. Mixed hearing loss
Answer: A. Normal
Rationale: In a normal Rinne test, air conduction is heard twice as long as bone conduction
(AC > BC). A positive Rinne test (AC > BC) is normal. A negative Rinne test (BC > AC)
indicates conductive hearing loss. Sensorineural hearing loss may show AC > BC but both
are decreased in duration.
9. A patient presents with a sudden loss of vision in one eye described as a "curtain
coming down." The nurse should suspect:
A. Retinal detachment
B. Glaucoma
C. Cataract
D. Macular degeneration
Answer: A. Retinal detachment
Rationale: Retinal detachment typically presents as sudden, painless loss of vision described
as a curtain or shadow coming down over the field of vision. Floaters and flashes of light
may also be present. Glaucoma causes gradual peripheral vision loss. Cataracts cause
gradual, painless blurring. Macular degeneration causes central vision loss.
10. The nurse is assessing a patient with suspected sinusitis. Which sinus is most
commonly affected?
A. Frontal sinus
B. Maxillary sinus
C. Ethmoid sinus
D. Sphenoid sinus
Answer: B. Maxillary sinus
Rationale: The maxillary sinuses are the most commonly affected sinuses in sinusitis due to
their location and drainage pattern. Maxillary sinusitis presents with facial pain over the
NU 518 EXAM 2: ADVANCED HEALTH ASSESSMENT EXAM LATEST
VERSION QUESTIONS AND ANSWERS 2026 EDITION
NU 518 EXAM 2: Advanced Health Assessment Practice Questions with Rationales
SECTION 1: HEAD, EYES, EARS, NOSE, AND THROAT ASSESSMENT (Questions
1-50)
1. The nurse is preparing to assess the visual acuity of a 6-year-old child. Which visual
acuity chart is most appropriate for this age group?
A. Snellen chart
B. Allen picture chart
C. Tumbling E chart
D. Rosenbaum pocket screener
Answer: B. Allen picture chart
Rationale: The Allen picture chart is designed for children aged 3-6 years who cannot read
letters. It uses recognizable pictures (apple, house, umbrella) to assess visual acuity. The
Snellen chart is appropriate for older children and adults who can read letters. The Tumbling
E chart is used for children who cannot read but can point in the direction of the E. The
Rosenbaum pocket screener is used for near vision testing.
2. A 45-year-old patient presents with a complaint of difficulty seeing objects up close,
which has been progressively worsening over the past year. The nurse recognizes this
condition as:
A. Myopia
B. Presbyopia
C. Hyperopia
D. Astigmatism
Answer: B. Presbyopia
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Rationale: Presbyopia is an age-related loss of near vision due to decreased elasticity of the
lens, typically beginning around age 40. Myopia is nearsightedness, where distant objects
are blurry. Hyperopia is farsightedness, where near objects are blurry. Astigmatism is an
irregular curvature of the cornea causing blurred vision at all distances.
3. The nurse is assessing a patient's pupil response to light. A direct light is shone into
the right eye, and both pupils constrict. This response indicates:
A. Anisocoria
B. Consensual light reflex
C. Accommodation reflex
D. Miosis
Answer: B. Consensual light reflex
Rationale: The consensual light reflex occurs when light is shone into one eye and both
pupils constrict due to the crossing of nerve fibers in the optic chiasm. Anisocoria refers to
unequal pupil size. Accommodation is the pupillary constriction that occurs with focusing on
a near object. Miosis is pupillary constriction from any cause.
4. A patient presents with a red, painful eye, photophobia, and a "cobblestone"
appearance of the upper eyelid upon eversion. The nurse suspects:
A. Viral conjunctivitis
B. Allergic conjunctivitis
C. Bacterial conjunctivitis
D. Keratitis
Answer: B. Allergic conjunctivitis
Rationale: Allergic conjunctivitis presents with redness, itching, tearing, and a "cobblestone"
appearance of the palpebral conjunctiva (upper eyelid). Viral conjunctivitis presents with
watery discharge and is highly contagious. Bacterial conjunctivitis presents with purulent
discharge. Keratitis presents with corneal involvement and severe pain.
5. The nurse is assessing a patient with suspected glaucoma. Which finding is most
concerning for acute angle-closure glaucoma?
A. Painless, gradual vision loss
B. Halos around lights and eye pain
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C. Decreased peripheral vision
D. Cupping of the optic disc
Answer: B. Halos around lights and eye pain
Rationale: Acute angle-closure glaucoma is a medical emergency characterized by sudden
eye pain, headache, halos around lights, nausea, vomiting, and blurred vision. Painless,
gradual vision loss and decreased peripheral vision are characteristic of chronic open-angle
glaucoma. Cupping of the optic disc is a sign of chronic glaucoma, not acute.
6. The nurse is performing an otoscopic examination on an adult patient. To visualize
the tympanic membrane, the nurse should pull the pinna:
A. Up and back
B. Down and forward
C. Straight back
D. Down and back
Answer: A. Up and back
Rationale: In adults, the ear canal curves upward and forward, so the pinna should be pulled
up and back to straighten the canal for optimal visualization of the tympanic membrane. In
children, the pinna is pulled down and back because the ear canal is shorter and straighter in
children.
7. A 3-year-old child is brought to the clinic with a complaint of ear pain and fever. The
nurse notes that the tympanic membrane is bulging, erythematous, and has decreased
mobility. This finding is most consistent with:
A. Acute otitis media
B. Otitis media with effusion
C. Serous otitis media
D. Perforated tympanic membrane
Answer: A. Acute otitis media
Rationale: Acute otitis media presents with a bulging, erythematous tympanic membrane with
decreased mobility and signs of infection (fever, ear pain). Otitis media with effusion (OME)
presents with a retracted or normal-appearing TM with fluid behind it but no signs of acute
infection. Serous otitis media is often asymptomatic. A perforated TM would show a hole or
tear.
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8. The nurse is assessing a patient's hearing using the Rinne test. The patient reports
that air conduction is heard longer than bone conduction. This result is considered:
A. Normal
B. Conductive hearing loss
C. Sensorineural hearing loss
D. Mixed hearing loss
Answer: A. Normal
Rationale: In a normal Rinne test, air conduction is heard twice as long as bone conduction
(AC > BC). A positive Rinne test (AC > BC) is normal. A negative Rinne test (BC > AC)
indicates conductive hearing loss. Sensorineural hearing loss may show AC > BC but both
are decreased in duration.
9. A patient presents with a sudden loss of vision in one eye described as a "curtain
coming down." The nurse should suspect:
A. Retinal detachment
B. Glaucoma
C. Cataract
D. Macular degeneration
Answer: A. Retinal detachment
Rationale: Retinal detachment typically presents as sudden, painless loss of vision described
as a curtain or shadow coming down over the field of vision. Floaters and flashes of light
may also be present. Glaucoma causes gradual peripheral vision loss. Cataracts cause
gradual, painless blurring. Macular degeneration causes central vision loss.
10. The nurse is assessing a patient with suspected sinusitis. Which sinus is most
commonly affected?
A. Frontal sinus
B. Maxillary sinus
C. Ethmoid sinus
D. Sphenoid sinus
Answer: B. Maxillary sinus
Rationale: The maxillary sinuses are the most commonly affected sinuses in sinusitis due to
their location and drainage pattern. Maxillary sinusitis presents with facial pain over the
