GRAND CANYON UNIVERSITY | COLLEGE OF NURSING & HEALTH CARE
PROFESSIONS
NUR-634 ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING
MIDTERM EXAM
GCU NUR 634 MIDTERM EXAM 2026/2027
200 Comprehensive Practice Questions, Key Answers & In-Depth Clinical
Rationales
Modules 1–4 Assessment, OLDCARTS History, HEENT, Cardiovascular, &
Respiratory Diagnostics
Advanced Practice Registered Nurse (APRN) Preparation & Master's Level Diagnostic Decision-
Making
GCU NUR-634 MIDTERM CURRICULUM & MODULE DOMAINS
• Module 1: Comprehensive Health History, Cultural Competence, & Differential Diagnosis (Q1 – Q25)
• Module 2: Skin, Hair, Nails, Head, Neck, & Lymphatic System Examination (Q26 – Q50)
• Module 3: Eyes, Ears, Nose, Throat (HEENT) & Cranial Nerve Assessment (Q51 – Q100)
• Module 4: Advanced Cardiovascular System & Peripheral Vascular Diagnostics (Q101 – Q150)
• Respiratory, Thoracic Assessment, & Clinical Diagnostic Reasoning Integration (Q151 – Q200)
QUESTION COUNT COURSE EXAM VERSION
200 Questions GCU NUR-634 2026/2027 Midterm Prep
,GCU NUR 634 MIDTERM EXAM QUESTION BANK (Q1 - Q200)
Question 1 [Q1] An APRN is conducting a health history using the OLDCARTS framework.
When asking a client, 'Does the pain radiate to your shoulder or back?', which specific
OLDCARTS component is being evaluated?
(A) Characteristics
(B) Location
(C) Onset
(D) Radiation
CORRECT ANSWER: (D) Radiation
Diagnostic Rationale: In the OLDCARTS framework (Onset, Location, Duration, Characteristics,
Aggravating/Relieving, Radiation, Timing, Severity), asking about pain spreading to other anatomical areas
directly assesses Radiation.
Question 2 [Q2] Which interviewing technique is most appropriate when an APRN wants to
encourage a client to elaborate on a vague symptom such as 'feeling tired all the time'?
(A) Using open-ended questions and facilitation
(B) Reassuring the patient immediately
(C) Asking compound multiple-choice questions
(D) Asking direct yes/no questions
CORRECT ANSWER: (A) Using open-ended questions and facilitation
Diagnostic Rationale: Open-ended questions and facilitation encourage patients to describe symptoms in
their own words, providing rich context and preventing clinician-induced bias during early history taking.
Question 3 [Q3] During palpation of the neck, the APRN notes a firm, non-tender, immobile
(fixed) supraclavicular lymph node on the left side (Virchow node). What primary diagnostic
concern does this finding raise?
(A) Localized bacterial lymphadenitis
(B) Benign reactive lymphadenopathy
(C) Acute viral pharyngitis
(D) Metastatic abdominal or thoracic malignancy
CORRECT ANSWER: (D) Metastatic abdominal or thoracic malignancy
Diagnostic Rationale: A enlarged, hard, non-tender left supraclavicular node (Virchow node) receives
lymphatic drainage from the abdominal cavity and thorax, raising high suspicion for metastatic malignancy
(e.g., gastric or lung adenocarcinoma).
Question 4 [Q4] An APRN assesses an asymmetrical pigmented skin lesion with irregular
borders, color variation (shades of brown and black), and a diameter of 7 mm on a patient's
,back. Applying the ABCDE rule, what is the most appropriate next clinical action?
(A) Advise the patient to recheck the lesion in 12 months
(B) Reassure the client that it is a benign seborrheic keratosis
(C) Perform or refer for a dermoscopic evaluation and skin biopsy
(D) Prescribe topical hydrocortisone cream for 2 weeks
CORRECT ANSWER: (C) Perform or refer for a dermoscopic evaluation and skin biopsy
Diagnostic Rationale: The lesion meets ABCDE criteria for high suspicion of malignant melanoma
(Asymmetry, Border irregularity, Color variation, Diameter > 6mm, Evolving). Prompt dermoscopy and biopsy
are required.
Question 5 [Q5] During an otoscopic examination in an adult, how should the APRN
manipulate the auricle (pinna) to straighten the external auditory canal?
(A) Pull the pinna down and back
(B) Pull the pinna up and back
(C) Pull the pinna straight forward
(D) Press the tragus firmly inward
CORRECT ANSWER: (B) Pull the pinna up and back
Diagnostic Rationale: In adults, pulling the pinna up and back straightens the S-shaped external auditory
canal; in infants and children under 3 years, the pinna is pulled down and back.
Question 6 [Q6] During a Weber tuning fork test (512 Hz), the client reports that the sound
lateralizes distinctly to the right ear. Air conduction is greater than bone conduction bilaterally
in the Rinne test (AC > BC). What type of hearing loss is present?
(A) Left-sided sensorineural hearing loss
(B) Right-sided sensorineural hearing loss
(C) Bilateral conductive hearing loss
(D) Right-sided conductive hearing loss
CORRECT ANSWER: (A) Left-sided sensorineural hearing loss
Diagnostic Rationale: Lateralization to the right ear during the Weber test, combined with normal/positive
Rinne tests (AC > BC) bilaterally, indicates sensorineural hearing loss in the opposite (left) ear.
Question 7 [Q7] When assessing cranial nerve III, IV, and VI (oculomotor, trochlear,
abducens), the APRN observes horizontal nystagmus and an inability of the left eye to adduct
toward the nose during lateral gaze testing. Which specific nerve is affected if the eye cannot
abduct laterally?
(A) Cranial Nerve VI (Abducens)
(B) Cranial Nerve V (Trigeminal)
(C) Cranial Nerve III (Oculomotor)
(D) Cranial Nerve IV (Trochlear)
, CORRECT ANSWER: (A) Cranial Nerve VI (Abducens)
Diagnostic Rationale: Cranial Nerve VI (Abducens) innervates the lateral rectus muscle, responsible for
abduction (outward movement) of the eye.
Question 8 [Q8] An APRN performs cardiac auscultation and identifies a high-pitched, mid-
systolic click followed by a late systolic crescendo-decrescendo murmur at the apex. The
murmur increases in intensity when the patient stands up. What is the most likely diagnosis?
(A) Mitral regurgitation
(B) Aortic stenosis
(C) Mitral valve prolapse (MVP)
(D) Hypertrophic cardiomyopathy
CORRECT ANSWER: (C) Mitral valve prolapse (MVP)
Diagnostic Rationale: Mitral valve prolapse classically presents with a mid-systolic click and late systolic
murmur. Maneuvers that decrease venous return (like standing or Valsalva) cause earlier click onset and
increased murmur intensity/duration.
Question 9 [Q9] While assessing peripheral arterial pulses, the APRN calculates an Ankle-
Brachial Index (ABI) of 0.65 in a client reporting calf pain with walking. How should this ABI
result be interpreted?
(A) Normal lower extremity arterial perfusion
(B) Moderate peripheral artery disease (PAD)
(C) Severe non-compressible calcified arteries
(D) Venous insufficiency without arterial disease
CORRECT ANSWER: (B) Moderate peripheral artery disease (PAD)
Diagnostic Rationale: An ABI between 0.41 and 0.90 indicates mild-to-moderate peripheral artery disease
(PAD), causing intermittent claudication.
Question 10 [Q10] The APRN performs chest percussion on a patient presenting with severe
dyspnea and tracheal deviation to the left. Percussion over the right hemithorax yields
hyperresonance with absent breath sounds. What immediate condition is present?
(A) Right tension pneumothorax
(B) Right pleural effusion
(C) Bilateral pulmonary edema
(D) Left lobar pneumonia
CORRECT ANSWER: (A) Right tension pneumothorax
Diagnostic Rationale: Hyperresonance to percussion with absent breath sounds and tracheal deviation away
from the affected side (to the left) signifies a right-sided tension pneumothorax requiring emergency
decompression.
PROFESSIONS
NUR-634 ADVANCED HEALTH ASSESSMENT & DIAGNOSTIC REASONING
MIDTERM EXAM
GCU NUR 634 MIDTERM EXAM 2026/2027
200 Comprehensive Practice Questions, Key Answers & In-Depth Clinical
Rationales
Modules 1–4 Assessment, OLDCARTS History, HEENT, Cardiovascular, &
Respiratory Diagnostics
Advanced Practice Registered Nurse (APRN) Preparation & Master's Level Diagnostic Decision-
Making
GCU NUR-634 MIDTERM CURRICULUM & MODULE DOMAINS
• Module 1: Comprehensive Health History, Cultural Competence, & Differential Diagnosis (Q1 – Q25)
• Module 2: Skin, Hair, Nails, Head, Neck, & Lymphatic System Examination (Q26 – Q50)
• Module 3: Eyes, Ears, Nose, Throat (HEENT) & Cranial Nerve Assessment (Q51 – Q100)
• Module 4: Advanced Cardiovascular System & Peripheral Vascular Diagnostics (Q101 – Q150)
• Respiratory, Thoracic Assessment, & Clinical Diagnostic Reasoning Integration (Q151 – Q200)
QUESTION COUNT COURSE EXAM VERSION
200 Questions GCU NUR-634 2026/2027 Midterm Prep
,GCU NUR 634 MIDTERM EXAM QUESTION BANK (Q1 - Q200)
Question 1 [Q1] An APRN is conducting a health history using the OLDCARTS framework.
When asking a client, 'Does the pain radiate to your shoulder or back?', which specific
OLDCARTS component is being evaluated?
(A) Characteristics
(B) Location
(C) Onset
(D) Radiation
CORRECT ANSWER: (D) Radiation
Diagnostic Rationale: In the OLDCARTS framework (Onset, Location, Duration, Characteristics,
Aggravating/Relieving, Radiation, Timing, Severity), asking about pain spreading to other anatomical areas
directly assesses Radiation.
Question 2 [Q2] Which interviewing technique is most appropriate when an APRN wants to
encourage a client to elaborate on a vague symptom such as 'feeling tired all the time'?
(A) Using open-ended questions and facilitation
(B) Reassuring the patient immediately
(C) Asking compound multiple-choice questions
(D) Asking direct yes/no questions
CORRECT ANSWER: (A) Using open-ended questions and facilitation
Diagnostic Rationale: Open-ended questions and facilitation encourage patients to describe symptoms in
their own words, providing rich context and preventing clinician-induced bias during early history taking.
Question 3 [Q3] During palpation of the neck, the APRN notes a firm, non-tender, immobile
(fixed) supraclavicular lymph node on the left side (Virchow node). What primary diagnostic
concern does this finding raise?
(A) Localized bacterial lymphadenitis
(B) Benign reactive lymphadenopathy
(C) Acute viral pharyngitis
(D) Metastatic abdominal or thoracic malignancy
CORRECT ANSWER: (D) Metastatic abdominal or thoracic malignancy
Diagnostic Rationale: A enlarged, hard, non-tender left supraclavicular node (Virchow node) receives
lymphatic drainage from the abdominal cavity and thorax, raising high suspicion for metastatic malignancy
(e.g., gastric or lung adenocarcinoma).
Question 4 [Q4] An APRN assesses an asymmetrical pigmented skin lesion with irregular
borders, color variation (shades of brown and black), and a diameter of 7 mm on a patient's
,back. Applying the ABCDE rule, what is the most appropriate next clinical action?
(A) Advise the patient to recheck the lesion in 12 months
(B) Reassure the client that it is a benign seborrheic keratosis
(C) Perform or refer for a dermoscopic evaluation and skin biopsy
(D) Prescribe topical hydrocortisone cream for 2 weeks
CORRECT ANSWER: (C) Perform or refer for a dermoscopic evaluation and skin biopsy
Diagnostic Rationale: The lesion meets ABCDE criteria for high suspicion of malignant melanoma
(Asymmetry, Border irregularity, Color variation, Diameter > 6mm, Evolving). Prompt dermoscopy and biopsy
are required.
Question 5 [Q5] During an otoscopic examination in an adult, how should the APRN
manipulate the auricle (pinna) to straighten the external auditory canal?
(A) Pull the pinna down and back
(B) Pull the pinna up and back
(C) Pull the pinna straight forward
(D) Press the tragus firmly inward
CORRECT ANSWER: (B) Pull the pinna up and back
Diagnostic Rationale: In adults, pulling the pinna up and back straightens the S-shaped external auditory
canal; in infants and children under 3 years, the pinna is pulled down and back.
Question 6 [Q6] During a Weber tuning fork test (512 Hz), the client reports that the sound
lateralizes distinctly to the right ear. Air conduction is greater than bone conduction bilaterally
in the Rinne test (AC > BC). What type of hearing loss is present?
(A) Left-sided sensorineural hearing loss
(B) Right-sided sensorineural hearing loss
(C) Bilateral conductive hearing loss
(D) Right-sided conductive hearing loss
CORRECT ANSWER: (A) Left-sided sensorineural hearing loss
Diagnostic Rationale: Lateralization to the right ear during the Weber test, combined with normal/positive
Rinne tests (AC > BC) bilaterally, indicates sensorineural hearing loss in the opposite (left) ear.
Question 7 [Q7] When assessing cranial nerve III, IV, and VI (oculomotor, trochlear,
abducens), the APRN observes horizontal nystagmus and an inability of the left eye to adduct
toward the nose during lateral gaze testing. Which specific nerve is affected if the eye cannot
abduct laterally?
(A) Cranial Nerve VI (Abducens)
(B) Cranial Nerve V (Trigeminal)
(C) Cranial Nerve III (Oculomotor)
(D) Cranial Nerve IV (Trochlear)
, CORRECT ANSWER: (A) Cranial Nerve VI (Abducens)
Diagnostic Rationale: Cranial Nerve VI (Abducens) innervates the lateral rectus muscle, responsible for
abduction (outward movement) of the eye.
Question 8 [Q8] An APRN performs cardiac auscultation and identifies a high-pitched, mid-
systolic click followed by a late systolic crescendo-decrescendo murmur at the apex. The
murmur increases in intensity when the patient stands up. What is the most likely diagnosis?
(A) Mitral regurgitation
(B) Aortic stenosis
(C) Mitral valve prolapse (MVP)
(D) Hypertrophic cardiomyopathy
CORRECT ANSWER: (C) Mitral valve prolapse (MVP)
Diagnostic Rationale: Mitral valve prolapse classically presents with a mid-systolic click and late systolic
murmur. Maneuvers that decrease venous return (like standing or Valsalva) cause earlier click onset and
increased murmur intensity/duration.
Question 9 [Q9] While assessing peripheral arterial pulses, the APRN calculates an Ankle-
Brachial Index (ABI) of 0.65 in a client reporting calf pain with walking. How should this ABI
result be interpreted?
(A) Normal lower extremity arterial perfusion
(B) Moderate peripheral artery disease (PAD)
(C) Severe non-compressible calcified arteries
(D) Venous insufficiency without arterial disease
CORRECT ANSWER: (B) Moderate peripheral artery disease (PAD)
Diagnostic Rationale: An ABI between 0.41 and 0.90 indicates mild-to-moderate peripheral artery disease
(PAD), causing intermittent claudication.
Question 10 [Q10] The APRN performs chest percussion on a patient presenting with severe
dyspnea and tracheal deviation to the left. Percussion over the right hemithorax yields
hyperresonance with absent breath sounds. What immediate condition is present?
(A) Right tension pneumothorax
(B) Right pleural effusion
(C) Bilateral pulmonary edema
(D) Left lobar pneumonia
CORRECT ANSWER: (A) Right tension pneumothorax
Diagnostic Rationale: Hyperresonance to percussion with absent breath sounds and tracheal deviation away
from the affected side (to the left) signifies a right-sided tension pneumothorax requiring emergency
decompression.
