NUR 6121 Advanced Health Assessment
Exam 2 2026/2027 – Complete 300 Exam
Questions and Correct Answers with
Rationales Guaranteed Pass (GRADED
A+)
Cardiovascular & Pulmonary Assessment
Question 1
A 68-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) presents with progressive dyspnea,
orthopnea, and 3+ pitting edema to the knees. His current
medications include lisinopril, carvedilol, and furosemide. Which
additional medication has been shown to reduce mortality in this
condition?
A) Digoxin
B) Hydralazine
C) Spironolactone
D) Diltiazem
Correct Answer: C) Spironolactone
Rationale: Spironolactone (mineralocorticoid receptor antagonist)
reduces mortality and hospitalizations in patients with NYHA class
III-IV heart failure with reduced ejection fraction. Digoxin
improves symptoms but not mortality. Hydralazine/nitrates are
,beneficial in African Americans as adjunct therapy. Diltiazem is
contraindicated in HFrEF .
Question 2
A 46-year-old male reports burning retrosternal pain when lying
flat. On auscultation, you hear a soft holosystolic murmur at the
apex radiating to the axilla that increases with handgrip. Which
valvular pathology is most consistent with these findings?
A) Mitral regurgitation
B) Tricuspid stenosis
C) Aortic stenosis
D) Pulmonic regurgitation
Correct Answer: A) Mitral regurgitation
Rationale: Mitral regurgitation presents with a holosystolic
murmur at the apex radiating to the axilla. Handgrip increases
afterload, which worsens mitral regurgitation and increases
murmur intensity. Orthopnea (pain when lying flat) is consistent
with pulmonary congestion secondary to left-sided valvular
disease .
Question 3
A 55-year-old male with a 30-pack-year smoking history presents
with hemoptysis, weight loss, and a persistent cough. Chest X-ray
,shows a right hilar mass. Which additional finding on physical
exam would most suggest lung cancer with superior vena cava
syndrome?
A) Unilateral wheezing
B) Facial swelling and distended neck veins
C) Clubbing of the fingers
D) Horner syndrome
Correct Answer: B) Facial swelling and distended neck veins
Rationale: Superior vena cava syndrome (SVCS) occurs due to
obstruction of the SVC by a mediastinal mass (often lung cancer),
leading to facial edema, plethora, distended neck veins, and upper
extremity swelling. Horner syndrome (ptosis, miosis, anhidrosis)
indicates apical (Pancoast) tumor .
Neurological Assessment
Question 4
A 58-year-old male presents with sudden-onset right facial droop,
slurred speech, and right arm drift lasting 20 minutes. On exam
you note right upper face involvement, left gaze preference, and
no limb ataxia. Carotid auscultation reveals a faint systolic bruit.
Which cranial nerve dysfunction best localizes this transient
episode?
A) Right CN VII nuclear lesion
B) Left CN VI peripheral palsy
, C) Left cortical CN VII upper motor neuron involvement
D) Right CN XII lower motor neuron lesion
Correct Answer: C) Left cortical CN VII upper motor neuron
involvement
Rationale: Upper motor neuron (UMN) lesions of CN VII spare the
forehead (bilateral innervation) and present with contralateral
lower facial weakness. A left cortical lesion would cause right-
sided lower facial weakness (sparing forehead) with arm
involvement, consistent with this presentation .
Question 5
A 71-year-old female with atrial fibrillation on rivaroxaban
presents with acute left calf pain and swelling. Homan sign is
negative but Wells score is 3. Which component of the Wells
criteria carries the highest individual positive weight and should
prompt urgent duplex imaging?
A) Previously documented DVT
B) Active cancer treatment
C) Recent plaster immobilization
D) Alternative diagnosis less likely
Correct Answer: D) Alternative diagnosis less likely
Rationale: In the Wells criteria for DVT, "alternative diagnosis less
likely than DVT" carries a weight of +3 points, the highest
Exam 2 2026/2027 – Complete 300 Exam
Questions and Correct Answers with
Rationales Guaranteed Pass (GRADED
A+)
Cardiovascular & Pulmonary Assessment
Question 1
A 68-year-old male with a history of heart failure with reduced
ejection fraction (HFrEF) presents with progressive dyspnea,
orthopnea, and 3+ pitting edema to the knees. His current
medications include lisinopril, carvedilol, and furosemide. Which
additional medication has been shown to reduce mortality in this
condition?
A) Digoxin
B) Hydralazine
C) Spironolactone
D) Diltiazem
Correct Answer: C) Spironolactone
Rationale: Spironolactone (mineralocorticoid receptor antagonist)
reduces mortality and hospitalizations in patients with NYHA class
III-IV heart failure with reduced ejection fraction. Digoxin
improves symptoms but not mortality. Hydralazine/nitrates are
,beneficial in African Americans as adjunct therapy. Diltiazem is
contraindicated in HFrEF .
Question 2
A 46-year-old male reports burning retrosternal pain when lying
flat. On auscultation, you hear a soft holosystolic murmur at the
apex radiating to the axilla that increases with handgrip. Which
valvular pathology is most consistent with these findings?
A) Mitral regurgitation
B) Tricuspid stenosis
C) Aortic stenosis
D) Pulmonic regurgitation
Correct Answer: A) Mitral regurgitation
Rationale: Mitral regurgitation presents with a holosystolic
murmur at the apex radiating to the axilla. Handgrip increases
afterload, which worsens mitral regurgitation and increases
murmur intensity. Orthopnea (pain when lying flat) is consistent
with pulmonary congestion secondary to left-sided valvular
disease .
Question 3
A 55-year-old male with a 30-pack-year smoking history presents
with hemoptysis, weight loss, and a persistent cough. Chest X-ray
,shows a right hilar mass. Which additional finding on physical
exam would most suggest lung cancer with superior vena cava
syndrome?
A) Unilateral wheezing
B) Facial swelling and distended neck veins
C) Clubbing of the fingers
D) Horner syndrome
Correct Answer: B) Facial swelling and distended neck veins
Rationale: Superior vena cava syndrome (SVCS) occurs due to
obstruction of the SVC by a mediastinal mass (often lung cancer),
leading to facial edema, plethora, distended neck veins, and upper
extremity swelling. Horner syndrome (ptosis, miosis, anhidrosis)
indicates apical (Pancoast) tumor .
Neurological Assessment
Question 4
A 58-year-old male presents with sudden-onset right facial droop,
slurred speech, and right arm drift lasting 20 minutes. On exam
you note right upper face involvement, left gaze preference, and
no limb ataxia. Carotid auscultation reveals a faint systolic bruit.
Which cranial nerve dysfunction best localizes this transient
episode?
A) Right CN VII nuclear lesion
B) Left CN VI peripheral palsy
, C) Left cortical CN VII upper motor neuron involvement
D) Right CN XII lower motor neuron lesion
Correct Answer: C) Left cortical CN VII upper motor neuron
involvement
Rationale: Upper motor neuron (UMN) lesions of CN VII spare the
forehead (bilateral innervation) and present with contralateral
lower facial weakness. A left cortical lesion would cause right-
sided lower facial weakness (sparing forehead) with arm
involvement, consistent with this presentation .
Question 5
A 71-year-old female with atrial fibrillation on rivaroxaban
presents with acute left calf pain and swelling. Homan sign is
negative but Wells score is 3. Which component of the Wells
criteria carries the highest individual positive weight and should
prompt urgent duplex imaging?
A) Previously documented DVT
B) Active cancer treatment
C) Recent plaster immobilization
D) Alternative diagnosis less likely
Correct Answer: D) Alternative diagnosis less likely
Rationale: In the Wells criteria for DVT, "alternative diagnosis less
likely than DVT" carries a weight of +3 points, the highest
