NSG 6020: Health Assessment Exam Prep with Detailed
Rationales
Course Code: NSG 6020
Course Name: Health Assessment
Topic: Advanced HEENT Assessment
Academic Year: 2026/2027
Question 1
A 45-year-old female presents with acute onset of severe unilateral eye pain, blurry
vision, and seeing halos around lights. On examination, the affected pupil is mid-
dilated and non-reactive to light, and the cornea appears hazy. Which of the
following is the most likely diagnosis?
A. Acute conjunctivitis
B. Acute angle-closure glaucoma
C. Central retinal artery occlusion
D. Primary open-angle glaucoma
, CORRECT ANSWER: B
RATIONALE: Acute angle-closure glaucoma is an ocular emergency caused
by a rapid narrowing or complete closure of the anterior chamber angle, leading to
an obstruction of aqueous humor outflow and a dramatic spike in intraocular
pressure (IOP). The classic presentation includes severe eye pain, visual halos, a
hazy cornea, and a fixed, mid-dilated pupil. Acute conjunctivitis presents with
injection and discharge but without severe pain, vision changes, or pupillary
changes. Central retinal artery occlusion causes sudden, painless vision loss.
Primary open-angle glaucoma is chronic, painless, and manifests as progressive
peripheral vision loss rather than acute distress.
Question 2
During a fundoscopic examination, the nurse practitioner visualizes the internal
structures of the posterior eye. Which of the following anatomical landmarks is
characterized as being located in the temporal region of the fundus, appearing
darker than the surrounding retina, and lacking visible retinal vessels?
A. Optic disc
B. Macula
C. Physiologic cup
D. Retinal arterioles
, CORRECT ANSWER: B
RATIONALE: The macula is located temporally relative to the optic disc and
is responsible for central, high-acuity vision. It naturally appears darker due to a
high concentration of carotenoid pigments and lacks large retinal vessels to prevent
light obstruction to the fovea. The optic disc is located nasally, appears as a bright
yellowish-pink circle, and serves as the entry/exit point for vessels and the optic
nerve. The physiologic cup is the lighter, central depression within the optic disc.
, Retinal arterioles are thin, bright red structures that radiate across the fundus but
do not cross the central macula.
Question 3
A 62-year-old male complains of a gradual, painless loss of central vision over the
past few years. He notes that straight lines on a grid now appear wavy.
Fundoscopic evaluation reveals accumulation of yellowish extracellular deposits
beneath the retinal pigment epithelium. What pathology is described?
A. Diabetic retinopathy
B. Age-related macular degeneration
C. Retinal detachment
D. Chronic open-angle glaucoma
CORRECT ANSWER: B
RATIONALE: The accumulation of yellowish extracellular deposits, known as
drusen, beneath the retinal pigment epithelium is the hallmark feature of dry age-
related macular degeneration (AMD). AMD selectively destroys the macula,
causing a progressive loss of central vision and characteristic metamorphopsia
(straight lines appearing wavy). Diabetic retinopathy is distinguished by
microaneurysms, cotton wool spots, and neovascularization. Retinal detachment
presents acutely with flashes of light, floaters, and a "curtain dropping" over the
visual field. Chronic open-angle glaucoma results in the loss of peripheral vision
rather than central vision.
Question 4
A nurse practitioner is performing an otoscopic exam on an adult patient with
suspected acute otitis media. To properly visualize the tympanic membrane, the
clinician should manipulate the auricle in which direction?
A. Downward and backward
B. Upward and backward
C. Straight forward
D. Upward and forward
CORRECT ANSWER: B
RATIONALE: In adults, the external auditory canal curves upward and
Rationales
Course Code: NSG 6020
Course Name: Health Assessment
Topic: Advanced HEENT Assessment
Academic Year: 2026/2027
Question 1
A 45-year-old female presents with acute onset of severe unilateral eye pain, blurry
vision, and seeing halos around lights. On examination, the affected pupil is mid-
dilated and non-reactive to light, and the cornea appears hazy. Which of the
following is the most likely diagnosis?
A. Acute conjunctivitis
B. Acute angle-closure glaucoma
C. Central retinal artery occlusion
D. Primary open-angle glaucoma
, CORRECT ANSWER: B
RATIONALE: Acute angle-closure glaucoma is an ocular emergency caused
by a rapid narrowing or complete closure of the anterior chamber angle, leading to
an obstruction of aqueous humor outflow and a dramatic spike in intraocular
pressure (IOP). The classic presentation includes severe eye pain, visual halos, a
hazy cornea, and a fixed, mid-dilated pupil. Acute conjunctivitis presents with
injection and discharge but without severe pain, vision changes, or pupillary
changes. Central retinal artery occlusion causes sudden, painless vision loss.
Primary open-angle glaucoma is chronic, painless, and manifests as progressive
peripheral vision loss rather than acute distress.
Question 2
During a fundoscopic examination, the nurse practitioner visualizes the internal
structures of the posterior eye. Which of the following anatomical landmarks is
characterized as being located in the temporal region of the fundus, appearing
darker than the surrounding retina, and lacking visible retinal vessels?
A. Optic disc
B. Macula
C. Physiologic cup
D. Retinal arterioles
, CORRECT ANSWER: B
RATIONALE: The macula is located temporally relative to the optic disc and
is responsible for central, high-acuity vision. It naturally appears darker due to a
high concentration of carotenoid pigments and lacks large retinal vessels to prevent
light obstruction to the fovea. The optic disc is located nasally, appears as a bright
yellowish-pink circle, and serves as the entry/exit point for vessels and the optic
nerve. The physiologic cup is the lighter, central depression within the optic disc.
, Retinal arterioles are thin, bright red structures that radiate across the fundus but
do not cross the central macula.
Question 3
A 62-year-old male complains of a gradual, painless loss of central vision over the
past few years. He notes that straight lines on a grid now appear wavy.
Fundoscopic evaluation reveals accumulation of yellowish extracellular deposits
beneath the retinal pigment epithelium. What pathology is described?
A. Diabetic retinopathy
B. Age-related macular degeneration
C. Retinal detachment
D. Chronic open-angle glaucoma
CORRECT ANSWER: B
RATIONALE: The accumulation of yellowish extracellular deposits, known as
drusen, beneath the retinal pigment epithelium is the hallmark feature of dry age-
related macular degeneration (AMD). AMD selectively destroys the macula,
causing a progressive loss of central vision and characteristic metamorphopsia
(straight lines appearing wavy). Diabetic retinopathy is distinguished by
microaneurysms, cotton wool spots, and neovascularization. Retinal detachment
presents acutely with flashes of light, floaters, and a "curtain dropping" over the
visual field. Chronic open-angle glaucoma results in the loss of peripheral vision
rather than central vision.
Question 4
A nurse practitioner is performing an otoscopic exam on an adult patient with
suspected acute otitis media. To properly visualize the tympanic membrane, the
clinician should manipulate the auricle in which direction?
A. Downward and backward
B. Upward and backward
C. Straight forward
D. Upward and forward
CORRECT ANSWER: B
RATIONALE: In adults, the external auditory canal curves upward and
