NUR 504 Exam 1 Advanced Health Assessment – Graduate
Nursing Program – 2026/2027
SECTION I: HEALTH HISTORY & INTERVIEWING (Questions 1–15)
1. A 72-year-old male presents for a routine annual exam. He speaks softly,
answers slowly, and often looks at his wife before responding to your questions.
Which interviewing technique is MOST appropriate initially?
• A) Direct closed-ended questions to expedite the visit
• B) Ask the wife to leave the room to ensure patient privacy
• C) Sit facing the patient at eye level, speak clearly, and allow extra time for
responses
• D) Use medical jargon to assess his health literacy level
Correct Answer: C
Rationale: Elderly patients may have hearing deficits, cognitive slowing, or
anxiety. Sitting at eye level, facing the patient, speaking clearly, and allowing extra
time establishes trust and maximizes accurate data collection. Asking the wife to
leave (B) may remove a crucial support person and increase anxiety. Closed-
ended questions (A) limit narrative and may miss key concerns. Jargon (D) is never
appropriate.
2. A 45-year-old woman reports, "I feel tired all the time." Which of the
following is the BEST open-ended follow-up question?
• A) "Have you been sleeping well?"
• B) "How many hours do you sleep at night?"
• C) "Tell me more about this fatigue—when did it start and how does it
affect your daily life?"
• D) "Are you feeling depressed?"
Correct Answer: C
Rationale: Open-ended questions (C) elicit the patient's narrative in their own
,words, uncovering the context, chronology, and impact of symptoms. Options A,
B, and D are closed-ended or leading, which restrict information and introduce
bias.
3. A 28-year-old male with no prior medical history presents with acute chest
pain. Which question is a PRIORITY to ask during the history of present illness
(HPI)?
• A) "Do you have a family history of heart disease?"
• B) "What were you doing when the pain started?"
• C) "Have you ever had a stress test?"
• D) "Do you have health insurance?"
Correct Answer: B
Rationale: The HPI must include onset, location, duration, character,
aggravating/alleviating factors, radiation, and associated symptoms (OLDCARTS).
Asking about the activity at onset (B) helps differentiate cardiac (exertional)
versus non-cardiac (positional, pleuritic) causes. Family history (A) and prior tests
(C) belong in the past medical/family history, not the HPI. Insurance (D) is a social
history question and not an immediate priority.
4. A 60-year-old patient with limited English proficiency (LEP) arrives with her
10-year-old granddaughter who interprets. What should the provider do FIRST?
• A) Proceed with the exam using the granddaughter as the interpreter
• B) Use a professional medical interpreter (in-person or via video)
• C) Speak loudly and slowly in English
• D) Ask the granddaughter to translate only the "most important" parts
Correct Answer: B
Rationale: Federal and ethical standards mandate that patients with LEP
receive a qualified medical interpreter to ensure accurate, unbiased
,communication. Using a family member (especially a minor) violates privacy, may
introduce errors, and is not legally appropriate. Speaking loudly (C) does not
improve understanding.
5. Which mnemonic is MOST comprehensive for obtaining a complete History of
Presenting Illness?
• A) PQRSTU
• B) OLD CARTS
• C) SOAP
• D) FIFE
Correct Answer: B
Rationale: OLD CARTS (Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity) is the standard
comprehensive mnemonic for HPI. PQRSTU (Provocation, Quality,
Region/Radiation, Severity, Timing, Understanding) is also used but OLD CARTS is
more complete for graduate assessment. SOAP is for documentation. FIFE
(Feelings, Ideas, Function, Expectations) is for patient perspective.
6. A patient reports a history of "anxiety attacks." To differentiate panic attacks
from cardiac arrhythmias, which component of the health history is MOST
critical?
• A) Family history of anxiety
• B) Description of the associated symptoms (e.g., palpitations, diaphoresis,
chest pain, syncope)
• C) Current medications
• D) Occupation and stressors
Correct Answer: B
Rationale: The associated symptoms (B)—specifically whether palpitations
, are regular/irregular, presence of chest tightness vs. sharp pain, diaphoresis, and
whether episodes are triggered by specific situations—are critical. Cardiac issues
often present with exertional triggers, while anxiety may be situational.
Associated symptoms help guide the differential and further diagnostic testing.
7. The "Review of Systems" (ROS) differs from the HPI in that the ROS:
• A) Is a complete physical examination of each body system
• B) Is a comprehensive inventory of symptoms in each organ system, asked
systematically
• C) Only includes symptoms the patient volunteers spontaneously
• D) Is limited to the system related to the chief complaint
Correct Answer: B
Rationale: The ROS is a systematic, head-to-toe inquiry about symptoms that
the patient may not have mentioned in the HPI. It is not a physical exam (A), it is
intentionally comprehensive (not just volunteered or limited to one system, C/D).
8. A 22-year-old college student admits to binge drinking weekly. Which
interviewing approach is MOST effective for eliciting an accurate alcohol
history?
• A) "Do you drink heavily?"
• B) "On a typical day when you drink, how many drinks do you have?"
• C) "You don't drink too much, do you?"
• D) "Are you an alcoholic?"
Correct Answer: B
Rationale: Specific, non-judgmental, quantitative questions (B) yield more
accurate responses. The CAGE or AUDIT questionnaires are validated, but a simple
quantity/frequency question is a good start. Options A, C, and D are judgmental,
leading, or vague, causing underreporting.
Nursing Program – 2026/2027
SECTION I: HEALTH HISTORY & INTERVIEWING (Questions 1–15)
1. A 72-year-old male presents for a routine annual exam. He speaks softly,
answers slowly, and often looks at his wife before responding to your questions.
Which interviewing technique is MOST appropriate initially?
• A) Direct closed-ended questions to expedite the visit
• B) Ask the wife to leave the room to ensure patient privacy
• C) Sit facing the patient at eye level, speak clearly, and allow extra time for
responses
• D) Use medical jargon to assess his health literacy level
Correct Answer: C
Rationale: Elderly patients may have hearing deficits, cognitive slowing, or
anxiety. Sitting at eye level, facing the patient, speaking clearly, and allowing extra
time establishes trust and maximizes accurate data collection. Asking the wife to
leave (B) may remove a crucial support person and increase anxiety. Closed-
ended questions (A) limit narrative and may miss key concerns. Jargon (D) is never
appropriate.
2. A 45-year-old woman reports, "I feel tired all the time." Which of the
following is the BEST open-ended follow-up question?
• A) "Have you been sleeping well?"
• B) "How many hours do you sleep at night?"
• C) "Tell me more about this fatigue—when did it start and how does it
affect your daily life?"
• D) "Are you feeling depressed?"
Correct Answer: C
Rationale: Open-ended questions (C) elicit the patient's narrative in their own
,words, uncovering the context, chronology, and impact of symptoms. Options A,
B, and D are closed-ended or leading, which restrict information and introduce
bias.
3. A 28-year-old male with no prior medical history presents with acute chest
pain. Which question is a PRIORITY to ask during the history of present illness
(HPI)?
• A) "Do you have a family history of heart disease?"
• B) "What were you doing when the pain started?"
• C) "Have you ever had a stress test?"
• D) "Do you have health insurance?"
Correct Answer: B
Rationale: The HPI must include onset, location, duration, character,
aggravating/alleviating factors, radiation, and associated symptoms (OLDCARTS).
Asking about the activity at onset (B) helps differentiate cardiac (exertional)
versus non-cardiac (positional, pleuritic) causes. Family history (A) and prior tests
(C) belong in the past medical/family history, not the HPI. Insurance (D) is a social
history question and not an immediate priority.
4. A 60-year-old patient with limited English proficiency (LEP) arrives with her
10-year-old granddaughter who interprets. What should the provider do FIRST?
• A) Proceed with the exam using the granddaughter as the interpreter
• B) Use a professional medical interpreter (in-person or via video)
• C) Speak loudly and slowly in English
• D) Ask the granddaughter to translate only the "most important" parts
Correct Answer: B
Rationale: Federal and ethical standards mandate that patients with LEP
receive a qualified medical interpreter to ensure accurate, unbiased
,communication. Using a family member (especially a minor) violates privacy, may
introduce errors, and is not legally appropriate. Speaking loudly (C) does not
improve understanding.
5. Which mnemonic is MOST comprehensive for obtaining a complete History of
Presenting Illness?
• A) PQRSTU
• B) OLD CARTS
• C) SOAP
• D) FIFE
Correct Answer: B
Rationale: OLD CARTS (Onset, Location, Duration, Character,
Aggravating/Alleviating, Radiation, Timing, Severity) is the standard
comprehensive mnemonic for HPI. PQRSTU (Provocation, Quality,
Region/Radiation, Severity, Timing, Understanding) is also used but OLD CARTS is
more complete for graduate assessment. SOAP is for documentation. FIFE
(Feelings, Ideas, Function, Expectations) is for patient perspective.
6. A patient reports a history of "anxiety attacks." To differentiate panic attacks
from cardiac arrhythmias, which component of the health history is MOST
critical?
• A) Family history of anxiety
• B) Description of the associated symptoms (e.g., palpitations, diaphoresis,
chest pain, syncope)
• C) Current medications
• D) Occupation and stressors
Correct Answer: B
Rationale: The associated symptoms (B)—specifically whether palpitations
, are regular/irregular, presence of chest tightness vs. sharp pain, diaphoresis, and
whether episodes are triggered by specific situations—are critical. Cardiac issues
often present with exertional triggers, while anxiety may be situational.
Associated symptoms help guide the differential and further diagnostic testing.
7. The "Review of Systems" (ROS) differs from the HPI in that the ROS:
• A) Is a complete physical examination of each body system
• B) Is a comprehensive inventory of symptoms in each organ system, asked
systematically
• C) Only includes symptoms the patient volunteers spontaneously
• D) Is limited to the system related to the chief complaint
Correct Answer: B
Rationale: The ROS is a systematic, head-to-toe inquiry about symptoms that
the patient may not have mentioned in the HPI. It is not a physical exam (A), it is
intentionally comprehensive (not just volunteered or limited to one system, C/D).
8. A 22-year-old college student admits to binge drinking weekly. Which
interviewing approach is MOST effective for eliciting an accurate alcohol
history?
• A) "Do you drink heavily?"
• B) "On a typical day when you drink, how many drinks do you have?"
• C) "You don't drink too much, do you?"
• D) "Are you an alcoholic?"
Correct Answer: B
Rationale: Specific, non-judgmental, quantitative questions (B) yield more
accurate responses. The CAGE or AUDIT questionnaires are validated, but a simple
quantity/frequency question is a good start. Options A, C, and D are judgmental,
leading, or vague, causing underreporting.
