NURS 681 Valerie Miller Virtual SIM Lab —
100-Question Practice Exam Migraine
Without Aura | SOAP Documentation |
Patient Care Simulation (PCS) | 2026–2027
This original practice exam is designed to help you prepare for the Valerie Miller virtual
simulation and related NURS 681 assessments. It covers migraine diagnosis, history taking,
focused neurologic examination, differential diagnoses, SOAP documentation, pharmacologic
and nonpharmacologic management, patient education, and clinical decision-making.
Exam format
• 100 multiple-choice and select-all-that-apply (SATA) questions.
• Four options (A–D) for standard multiple-choice questions.
• Correct answer and rationale immediately after each question.
• Clinical scenarios and patient-safety questions throughout.
• Educational practice questions, not actual or secured course exam questions.
Section 1: Migraine assessment and history taking
(Questions 1–20)
Question 1
Which feature is most characteristic of migraine without aura?
A. Mild bilateral pressure that never interferes with activity B. Moderate-to-severe headache
with nausea or sensitivity to light and sound C. Headache occurring exclusively after head
trauma D. Headache accompanied by fever and a stiff neck in every attack
Correct answer: B
Rationale: Migraine commonly produces moderate-to-severe pain, aggravated by routine
activity, with nausea and/or vomiting or both photophobia and phonophobia. Fever and neck
stiffness suggest possible secondary causes.
Question 2
,Which tool helps organize a patient's headache history by onset, provocation, quality, region,
severity, and timing?
A. APGAR B. Glasgow Coma Scale C. OPQRST D. Braden Scale
Correct answer: C
Rationale: OPQRST structures symptom assessment and helps clinicians characterize the
headache and identify concerning changes.
Question 3
A patient reports that ordinary walking makes her headache worse. Which migraine criterion
does this support?
A. Aggravation by routine physical activity B. Presence of an aura C. Evidence of meningitis D.
Presence of papilledema
Correct answer: A
Rationale: Worsening with routine activity or avoiding activity because it worsens the pain is one
of the characteristic migraine pain features.
Question 4
Which symptom is associated with photophobia?
A. Increased sensitivity to sound B. Increased sensitivity to light C. Reduced sensation in the feet
D. Difficulty swallowing
Correct answer: B
Rationale: Photophobia refers to light sensitivity. Phonophobia refers to sound sensitivity.
Question 5
Which question best assesses headache onset?
A. "What medications do you take every morning?" B. "Does anyone in your family have
diabetes?" C. "When did this headache begin, and did it start suddenly or gradually?" D. "How
many glasses of water do you drink each week?"
Correct answer: C
Rationale: Establishing onset and speed of onset helps distinguish a typical migraine from
potentially dangerous secondary headaches.
,Question 6
Which description is most consistent with the typical duration of an untreated migraine attack?
A. Five minutes to ten minutes B. Four to 72 hours C. Seven to 14 days in every case D. Less
than 30 seconds
Correct answer: B
Rationale: A typical migraine without aura attack lasts 4–72 hours when untreated or
unsuccessfully treated, according to ICHD-3 criteria.
Question 7
Which associated symptom should the clinician specifically ask about during a migraine
assessment?
A. Nausea B. Hair texture C. Shoe size D. Hand dominance only
Correct answer: A
Rationale: Nausea or vomiting is a common associated migraine symptom and contributes to the
diagnostic criteria.
Question 8
A patient describes throbbing pain on one side of the head. How should this finding be
interpreted?
A. It proves that the patient has a brain tumor. B. It excludes migraine. C. It is one pain
characteristic that can support migraine. D. It confirms bacterial meningitis.
Correct answer: C
Rationale: Unilateral location and pulsating quality are two of the characteristic migraine pain
features. Neither finding alone establishes the diagnosis.
Question 9
Which question best assesses functional impairment?
A. "What is your favorite meal?" B. "How has the headache affected your ability to work, study,
or perform daily activities?" C. "What color are your shoes?" D. "Do you prefer morning or
evening appointments?"
Correct answer: B
, Rationale: Functional impact helps determine headache severity, treatment needs, and whether
preventive therapy should be considered.
Question 10
Which information is especially important when reviewing medications for recurrent headaches?
A. Only the color of each tablet B. The patient's preferred pharmacy decoration C. Frequency of
acute headache medication use D. The patient's favorite television program
Correct answer: C
Rationale: Frequent use of acute headache medications can contribute to medication-overuse
headache. The clinician should document the specific medication and number of days used.
Question 11
A patient reports recurrent headaches and a family history of migraine. What is the best
interpretation?
A. Family history may support migraine susceptibility but is not diagnostic by itself. B. Family
history confirms migraine without further assessment. C. Family history excludes secondary
headache. D. Family history means imaging is always mandatory.
Correct answer: A
Rationale: Migraine has a genetic component, but diagnosis depends on the patient's symptoms,
history, examination, and assessment for red flags.
Question 12
Which question is most appropriate when evaluating possible triggers?
A. "Have you noticed associations with sleep changes, missed meals, stress, or particular foods?"
B. "Can you stop sleeping for several nights to test your symptoms?" C. "Can you skip meals
until the headache resolves?" D. "Can you stop every prescribed medication without
consultation?"
Correct answer: A
Rationale: Identifying individual associations can guide practical lifestyle changes. Deliberately
provoking symptoms or stopping prescribed treatment without guidance is inappropriate.
Question 13
100-Question Practice Exam Migraine
Without Aura | SOAP Documentation |
Patient Care Simulation (PCS) | 2026–2027
This original practice exam is designed to help you prepare for the Valerie Miller virtual
simulation and related NURS 681 assessments. It covers migraine diagnosis, history taking,
focused neurologic examination, differential diagnoses, SOAP documentation, pharmacologic
and nonpharmacologic management, patient education, and clinical decision-making.
Exam format
• 100 multiple-choice and select-all-that-apply (SATA) questions.
• Four options (A–D) for standard multiple-choice questions.
• Correct answer and rationale immediately after each question.
• Clinical scenarios and patient-safety questions throughout.
• Educational practice questions, not actual or secured course exam questions.
Section 1: Migraine assessment and history taking
(Questions 1–20)
Question 1
Which feature is most characteristic of migraine without aura?
A. Mild bilateral pressure that never interferes with activity B. Moderate-to-severe headache
with nausea or sensitivity to light and sound C. Headache occurring exclusively after head
trauma D. Headache accompanied by fever and a stiff neck in every attack
Correct answer: B
Rationale: Migraine commonly produces moderate-to-severe pain, aggravated by routine
activity, with nausea and/or vomiting or both photophobia and phonophobia. Fever and neck
stiffness suggest possible secondary causes.
Question 2
,Which tool helps organize a patient's headache history by onset, provocation, quality, region,
severity, and timing?
A. APGAR B. Glasgow Coma Scale C. OPQRST D. Braden Scale
Correct answer: C
Rationale: OPQRST structures symptom assessment and helps clinicians characterize the
headache and identify concerning changes.
Question 3
A patient reports that ordinary walking makes her headache worse. Which migraine criterion
does this support?
A. Aggravation by routine physical activity B. Presence of an aura C. Evidence of meningitis D.
Presence of papilledema
Correct answer: A
Rationale: Worsening with routine activity or avoiding activity because it worsens the pain is one
of the characteristic migraine pain features.
Question 4
Which symptom is associated with photophobia?
A. Increased sensitivity to sound B. Increased sensitivity to light C. Reduced sensation in the feet
D. Difficulty swallowing
Correct answer: B
Rationale: Photophobia refers to light sensitivity. Phonophobia refers to sound sensitivity.
Question 5
Which question best assesses headache onset?
A. "What medications do you take every morning?" B. "Does anyone in your family have
diabetes?" C. "When did this headache begin, and did it start suddenly or gradually?" D. "How
many glasses of water do you drink each week?"
Correct answer: C
Rationale: Establishing onset and speed of onset helps distinguish a typical migraine from
potentially dangerous secondary headaches.
,Question 6
Which description is most consistent with the typical duration of an untreated migraine attack?
A. Five minutes to ten minutes B. Four to 72 hours C. Seven to 14 days in every case D. Less
than 30 seconds
Correct answer: B
Rationale: A typical migraine without aura attack lasts 4–72 hours when untreated or
unsuccessfully treated, according to ICHD-3 criteria.
Question 7
Which associated symptom should the clinician specifically ask about during a migraine
assessment?
A. Nausea B. Hair texture C. Shoe size D. Hand dominance only
Correct answer: A
Rationale: Nausea or vomiting is a common associated migraine symptom and contributes to the
diagnostic criteria.
Question 8
A patient describes throbbing pain on one side of the head. How should this finding be
interpreted?
A. It proves that the patient has a brain tumor. B. It excludes migraine. C. It is one pain
characteristic that can support migraine. D. It confirms bacterial meningitis.
Correct answer: C
Rationale: Unilateral location and pulsating quality are two of the characteristic migraine pain
features. Neither finding alone establishes the diagnosis.
Question 9
Which question best assesses functional impairment?
A. "What is your favorite meal?" B. "How has the headache affected your ability to work, study,
or perform daily activities?" C. "What color are your shoes?" D. "Do you prefer morning or
evening appointments?"
Correct answer: B
, Rationale: Functional impact helps determine headache severity, treatment needs, and whether
preventive therapy should be considered.
Question 10
Which information is especially important when reviewing medications for recurrent headaches?
A. Only the color of each tablet B. The patient's preferred pharmacy decoration C. Frequency of
acute headache medication use D. The patient's favorite television program
Correct answer: C
Rationale: Frequent use of acute headache medications can contribute to medication-overuse
headache. The clinician should document the specific medication and number of days used.
Question 11
A patient reports recurrent headaches and a family history of migraine. What is the best
interpretation?
A. Family history may support migraine susceptibility but is not diagnostic by itself. B. Family
history confirms migraine without further assessment. C. Family history excludes secondary
headache. D. Family history means imaging is always mandatory.
Correct answer: A
Rationale: Migraine has a genetic component, but diagnosis depends on the patient's symptoms,
history, examination, and assessment for red flags.
Question 12
Which question is most appropriate when evaluating possible triggers?
A. "Have you noticed associations with sleep changes, missed meals, stress, or particular foods?"
B. "Can you stop sleeping for several nights to test your symptoms?" C. "Can you skip meals
until the headache resolves?" D. "Can you stop every prescribed medication without
consultation?"
Correct answer: A
Rationale: Identifying individual associations can guide practical lifestyle changes. Deliberately
provoking symptoms or stopping prescribed treatment without guidance is inappropriate.
Question 13
