NUR 612 Final Exam | (2026) Diagnostic Reasoning
Questions | Health Assessment (PDF)
1. A 58-year-old male reports “chest pressure” when
walking up stairs. Which element of the history is most
important to clarify first?
A. Family history of coronary artery disease
B. Onset, duration, and relieving factors of the pressure
C. Last physical examination
D. Immunization history
Answer: B
Rationale: For a symptom like chest pressure, the
OLDCARTS (Onset, Location, Duration, Character,
Aggravating/Relieving factors, Timing, Severity)
framework is critical for diagnostic reasoning.
2. During a review of systems, a patient endorses “black,
tarry stools.” This finding most strongly suggests:
1
,A. Hemorrhoids
B. Upper gastrointestinal bleeding
C. Diverticulitis
D. Lactose intolerance
Answer: B
Rationale: Melena (black, tarry stool) indicates blood
digested from the upper GI tract (esophagus, stomach,
proximal small intestine).
3. A patient describes bilateral knee pain that is worse in
the morning and improves with activity. This pattern
suggests:
A. Osteoarthritis
B. Rheumatoid arthritis or inflammatory arthritis
C. Septic arthritis
D. Gout
Answer: B
Rationale: Morning stiffness lasting >30 minutes that
2
,improves with activity is typical of inflammatory arthritis
(e.g., rheumatoid arthritis).
4. Which question best screens for alcohol use disorder?
A. “Do you drink alcohol?”
B. “How many drinks do you have in a typical week?”
C. “Have you ever felt you should cut down on your
drinking?” (CAGE question)
D. “Does alcohol affect your work?”
Answer: C
Rationale: The CAGE questionnaire (Cut down, Annoyed,
Guilty, Eye-opener) is a validated screening tool.
5. A 72-year-old woman reports forgetting appointments
and getting lost in familiar places. The next best step is:
A. Order brain MRI immediately
B. Administer the Mini-Cog or MoCA
C. Refer to neurology
D. Reassure her that age-related memory loss is normal
3
, Answer: B j6
Rationale: Cognitive screening should precede advanced
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j6 imaging or specialtyreferralto establish baseline cognitive
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function.
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6. When a patient uses the term “dizzy,” the provider
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j6 shouldfirst: j6
A. Assume it means vertigo j6 j6 j6
B. Ask the patient to describe exactly what is felt
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j6 (lightheaded, spinning, off-balance) j6 j6
C. Order a CT head j6 j6 j6
D. Check orthostatic vital signs j6 j6 j6
j6 Answer: B j6
Rationale: “Dizzy” is nonspecific; clarifying the sensation
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j6 (vertigo, presyncope, disequilibrium, lightheadedness)
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j6 guides differential diagnosis.
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7. A patientreportsurinaryfrequencyand nocturia. Which
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j6 associated symptom most suggests benign prostatic
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j6 hyperplasia versus infection? j6 j6
4
Questions | Health Assessment (PDF)
1. A 58-year-old male reports “chest pressure” when
walking up stairs. Which element of the history is most
important to clarify first?
A. Family history of coronary artery disease
B. Onset, duration, and relieving factors of the pressure
C. Last physical examination
D. Immunization history
Answer: B
Rationale: For a symptom like chest pressure, the
OLDCARTS (Onset, Location, Duration, Character,
Aggravating/Relieving factors, Timing, Severity)
framework is critical for diagnostic reasoning.
2. During a review of systems, a patient endorses “black,
tarry stools.” This finding most strongly suggests:
1
,A. Hemorrhoids
B. Upper gastrointestinal bleeding
C. Diverticulitis
D. Lactose intolerance
Answer: B
Rationale: Melena (black, tarry stool) indicates blood
digested from the upper GI tract (esophagus, stomach,
proximal small intestine).
3. A patient describes bilateral knee pain that is worse in
the morning and improves with activity. This pattern
suggests:
A. Osteoarthritis
B. Rheumatoid arthritis or inflammatory arthritis
C. Septic arthritis
D. Gout
Answer: B
Rationale: Morning stiffness lasting >30 minutes that
2
,improves with activity is typical of inflammatory arthritis
(e.g., rheumatoid arthritis).
4. Which question best screens for alcohol use disorder?
A. “Do you drink alcohol?”
B. “How many drinks do you have in a typical week?”
C. “Have you ever felt you should cut down on your
drinking?” (CAGE question)
D. “Does alcohol affect your work?”
Answer: C
Rationale: The CAGE questionnaire (Cut down, Annoyed,
Guilty, Eye-opener) is a validated screening tool.
5. A 72-year-old woman reports forgetting appointments
and getting lost in familiar places. The next best step is:
A. Order brain MRI immediately
B. Administer the Mini-Cog or MoCA
C. Refer to neurology
D. Reassure her that age-related memory loss is normal
3
, Answer: B j6
Rationale: Cognitive screening should precede advanced
j6 j6 j6 j6 j6
j6 imaging or specialtyreferralto establish baseline cognitive
j6 j6 j6 j6 j6 j6 j6
function.
j6
6. When a patient uses the term “dizzy,” the provider
j6 j6 j6 j6 j6 j6 j6 j6
j6 shouldfirst: j6
A. Assume it means vertigo j6 j6 j6
B. Ask the patient to describe exactly what is felt
j6 j6 j6 j6 j6 j6 j6 j6
j6 (lightheaded, spinning, off-balance) j6 j6
C. Order a CT head j6 j6 j6
D. Check orthostatic vital signs j6 j6 j6
j6 Answer: B j6
Rationale: “Dizzy” is nonspecific; clarifying the sensation
j6 j6 j6 j6 j6 j6
j6 (vertigo, presyncope, disequilibrium, lightheadedness)
j6 j6 j6
j6 guides differential diagnosis.
j6 j6
7. A patientreportsurinaryfrequencyand nocturia. Which
j6 j6 j6 j6 j6 j6 j6
j6 associated symptom most suggests benign prostatic
j6 j6 j6 j6 j6
j6 hyperplasia versus infection? j6 j6
4
