NU 518: Advanced Nursing Assessment
Exam 2 Study Guide – Complete Practice
Exam with 100% Verified Correct
Answers and Detailed Rationales | Latest
Update - 2026/2027 | Already Graded A+
Question 1
38-year-old accountant with throbbing right temporal headache, nausea,
photophobia, history of similar headaches. Most likely diagnosis?
A. Tension
B. Migraine
C. Cluster
D. Analgesic rebound
Answer: B
Rationale: Migraines are characterized by unilateral, throbbing pain lasting 4-72
hours, often accompanied by nausea, photophobia, and phonophobia. The patient's
history of recurrent similar headaches that respond to OTC analgesics supports this
diagnosis. Tension headaches present with bilateral, band-like tightness without
nausea or photophobia. Cluster headaches cause severe unilateral orbital pain with
autonomic symptoms (tearing, rhinorrhea, ptosis). Analgesic rebound headaches
occur with chronic daily analgesic use and present differently.
Question 2
29-year-old computer programmer with tightening sensation all over head,
moderate, lasted 5 days, no photophobia/nausea, worse with computer work.
Diagnosis?
A. Tension
B. Migraine
C. Cluster
[1]
,D. Analgesic rebound
Answer: A
Rationale: Tension-type headaches are bilateral, pressing/tightening in quality,
mild to moderate intensity, and not aggravated by routine physical activity. They
lack nausea, photophobia, and phonophobia. The patient's prolonged duration (5
days) and association with computer work (poor posture, eye strain) are typical
triggers. Migraines are typically unilateral and throbbing with associated
symptoms. Cluster headaches are severe and periorbital. Analgesic rebound
requires a history of chronic analgesic overuse.
Question 3
Which is a symptom involving the eye?
A. Scotomas
B. Tinnitus
C. Dysphagia
D. Rhinorrhea
Answer: A
Rationale: Scotomas are visual disturbances characterized by partial loss of vision
or blind spots in the visual field. They are often associated with migraines (aura),
retinal disorders, or cerebrovascular events. Tinnitus is ringing in the ears
(auditory). Dysphagia is difficulty swallowing (gastrointestinal/neurological).
Rhinorrhea is nasal discharge (respiratory).
Question 4
49-year-old with spinning dizziness, sudden onset, worse with head position, lasts
seconds, nausea, nystagmus, normal hearing/gait. Diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
C. Meniere's disease
D. Acoustic neuroma
Answer: A
Rationale: Benign paroxysmal positional vertigo (BPPV) is characterized by brief
episodes (seconds) of vertigo triggered by head position changes, with nystagmus
[2]
,and no hearing loss. It results from displaced otoconia in the semicircular canals.
Vestibular neuronitis causes prolonged vertigo (days) without hearing loss.
Meniere's disease involves episodic vertigo lasting hours with tinnitus and hearing
loss. Acoustic neuroma causes gradual unilateral hearing loss and tinnitus with
imbalance, not positional vertigo.
Question 5
55-year-old with episodes of dizziness lasting 3–4 hours, nausea/vomiting, tinnitus,
Weber lateralizes right, air = bone right, nystagmus. Diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
C. Meniere's disease
D. Acoustic neuroma
Answer: C
Rationale: Meniere's disease is characterized by the triad of episodic vertigo
lasting hours, fluctuating sensorineural hearing loss, and tinnitus. The Weber test
lateralizing to the affected ear (right) indicates sensorineural hearing loss in that
ear. Air conduction equal to bone conduction (Rinne positive) also indicates
sensorineural loss. BPPV causes brief positional vertigo without hearing loss.
Vestibular neuronitis causes prolonged vertigo without hearing loss. Acoustic
neuroma causes gradual hearing loss without acute vertigo.
Question 6
73-year-old with new tremors, slow movements, shuffling gait, decreased facial
mobility. Cause?
A. Cushing's syndrome
B. Nephrotic syndrome
C. Myxedema
D. Parkinson's disease
Answer: D
Rationale: Parkinson's disease is characterized by the classic triad of resting
tremor, rigidity, and bradykinesia (slow movement). Additional features include
shuffling gait, decreased facial expression (masked facies), and postural instability.
[3]
, Cushing's syndrome causes moon facies, buffalo hump, and central obesity.
Nephrotic syndrome causes edema and proteinuria. Myxedema (severe
hypothyroidism) causes facial puffiness, cold intolerance, and weight gain but not
the classic Parkinsonian tremor.
Question 7
29-year-old with right eyeball protruding forward. Diagnosis?
A. Ptosis
B. Exophthalmos
C. Ectropion
D. Epicanthus
Answer: B
Rationale: Exophthalmos (proptosis) is the forward protrusion of the eyeball,
commonly associated with Graves' disease (thyroid eye disease), orbital tumors, or
inflammation. Ptosis is drooping of the upper eyelid. Ectropion is outward turning
of the lower eyelid. Epicanthus is a vertical fold of skin over the inner canthus,
common in Asian populations.
Question 8
12-year-old with painful red raised tender area at eyelid margin, no tearing.
Diagnosis?
A. Dacryocystitis
B. Chalazion
C. Hordeolum
D. Xanthelasma
Answer: C
Rationale: A hordeolum (stye) is an acute bacterial infection (usually
Staphylococcus) of the sebaceous glands at the eyelid margin. It presents as a
painful, red, tender nodule. Dacryocystitis is infection of the lacrimal sac, causing
pain and swelling near the inner canthus with tearing. A chalazion is a chronic,
painless granulomatous inflammation of the meibomian gland. Xanthelasma are
yellow cholesterol deposits on the eyelids, painless and non-tender.
[4]
Exam 2 Study Guide – Complete Practice
Exam with 100% Verified Correct
Answers and Detailed Rationales | Latest
Update - 2026/2027 | Already Graded A+
Question 1
38-year-old accountant with throbbing right temporal headache, nausea,
photophobia, history of similar headaches. Most likely diagnosis?
A. Tension
B. Migraine
C. Cluster
D. Analgesic rebound
Answer: B
Rationale: Migraines are characterized by unilateral, throbbing pain lasting 4-72
hours, often accompanied by nausea, photophobia, and phonophobia. The patient's
history of recurrent similar headaches that respond to OTC analgesics supports this
diagnosis. Tension headaches present with bilateral, band-like tightness without
nausea or photophobia. Cluster headaches cause severe unilateral orbital pain with
autonomic symptoms (tearing, rhinorrhea, ptosis). Analgesic rebound headaches
occur with chronic daily analgesic use and present differently.
Question 2
29-year-old computer programmer with tightening sensation all over head,
moderate, lasted 5 days, no photophobia/nausea, worse with computer work.
Diagnosis?
A. Tension
B. Migraine
C. Cluster
[1]
,D. Analgesic rebound
Answer: A
Rationale: Tension-type headaches are bilateral, pressing/tightening in quality,
mild to moderate intensity, and not aggravated by routine physical activity. They
lack nausea, photophobia, and phonophobia. The patient's prolonged duration (5
days) and association with computer work (poor posture, eye strain) are typical
triggers. Migraines are typically unilateral and throbbing with associated
symptoms. Cluster headaches are severe and periorbital. Analgesic rebound
requires a history of chronic analgesic overuse.
Question 3
Which is a symptom involving the eye?
A. Scotomas
B. Tinnitus
C. Dysphagia
D. Rhinorrhea
Answer: A
Rationale: Scotomas are visual disturbances characterized by partial loss of vision
or blind spots in the visual field. They are often associated with migraines (aura),
retinal disorders, or cerebrovascular events. Tinnitus is ringing in the ears
(auditory). Dysphagia is difficulty swallowing (gastrointestinal/neurological).
Rhinorrhea is nasal discharge (respiratory).
Question 4
49-year-old with spinning dizziness, sudden onset, worse with head position, lasts
seconds, nausea, nystagmus, normal hearing/gait. Diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
C. Meniere's disease
D. Acoustic neuroma
Answer: A
Rationale: Benign paroxysmal positional vertigo (BPPV) is characterized by brief
episodes (seconds) of vertigo triggered by head position changes, with nystagmus
[2]
,and no hearing loss. It results from displaced otoconia in the semicircular canals.
Vestibular neuronitis causes prolonged vertigo (days) without hearing loss.
Meniere's disease involves episodic vertigo lasting hours with tinnitus and hearing
loss. Acoustic neuroma causes gradual unilateral hearing loss and tinnitus with
imbalance, not positional vertigo.
Question 5
55-year-old with episodes of dizziness lasting 3–4 hours, nausea/vomiting, tinnitus,
Weber lateralizes right, air = bone right, nystagmus. Diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
C. Meniere's disease
D. Acoustic neuroma
Answer: C
Rationale: Meniere's disease is characterized by the triad of episodic vertigo
lasting hours, fluctuating sensorineural hearing loss, and tinnitus. The Weber test
lateralizing to the affected ear (right) indicates sensorineural hearing loss in that
ear. Air conduction equal to bone conduction (Rinne positive) also indicates
sensorineural loss. BPPV causes brief positional vertigo without hearing loss.
Vestibular neuronitis causes prolonged vertigo without hearing loss. Acoustic
neuroma causes gradual hearing loss without acute vertigo.
Question 6
73-year-old with new tremors, slow movements, shuffling gait, decreased facial
mobility. Cause?
A. Cushing's syndrome
B. Nephrotic syndrome
C. Myxedema
D. Parkinson's disease
Answer: D
Rationale: Parkinson's disease is characterized by the classic triad of resting
tremor, rigidity, and bradykinesia (slow movement). Additional features include
shuffling gait, decreased facial expression (masked facies), and postural instability.
[3]
, Cushing's syndrome causes moon facies, buffalo hump, and central obesity.
Nephrotic syndrome causes edema and proteinuria. Myxedema (severe
hypothyroidism) causes facial puffiness, cold intolerance, and weight gain but not
the classic Parkinsonian tremor.
Question 7
29-year-old with right eyeball protruding forward. Diagnosis?
A. Ptosis
B. Exophthalmos
C. Ectropion
D. Epicanthus
Answer: B
Rationale: Exophthalmos (proptosis) is the forward protrusion of the eyeball,
commonly associated with Graves' disease (thyroid eye disease), orbital tumors, or
inflammation. Ptosis is drooping of the upper eyelid. Ectropion is outward turning
of the lower eyelid. Epicanthus is a vertical fold of skin over the inner canthus,
common in Asian populations.
Question 8
12-year-old with painful red raised tender area at eyelid margin, no tearing.
Diagnosis?
A. Dacryocystitis
B. Chalazion
C. Hordeolum
D. Xanthelasma
Answer: C
Rationale: A hordeolum (stye) is an acute bacterial infection (usually
Staphylococcus) of the sebaceous glands at the eyelid margin. It presents as a
painful, red, tender nodule. Dacryocystitis is infection of the lacrimal sac, causing
pain and swelling near the inner canthus with tearing. A chalazion is a chronic,
painless granulomatous inflammation of the meibomian gland. Xanthelasma are
yellow cholesterol deposits on the eyelids, painless and non-tender.
[4]
