Advanced Health Assessment Exam
A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse is aware that which of
these findings would be consistent with an acute infection?
A) Tonsils 3+/1-4+ with large white spots
B) Tonsils 1+/1-4+ with pale coloring
C) Tonsils 1+/1-4+ and pink, same color as oral mucosa
D) Tonsils 2+/1-4+ and pink with white particles inside deep crypts - ANS -A) Tonsils 3+/1-4+
with large white spots
With an acute infection, tonsils are bright red and swollen and may have exudate or large white
spots. Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection.
\A 15 month old is brought to you for a fever of 101 F and fussiness. The ear examination is as
follows: external ear - normal appearance and no tenderness with manipulation; canal - normal
diameter without evidence of inflammation; tympanic membrane - bulging, erythematous, and
the light reflex is dull. Insufflation is deferred due to pain. What is your diagnosis?
A) ruptured tympanic membrane
B) cholesteatoma
C) otitis media
D) otitis externa - ANS -C) otitis media
Acute otitis media in a symptomatic child typically has a red, bulging tympanic membrane, with a
dull or absent light reflex.
\A 15-year-old high school sophomore presents to the emergency room with his mother for
evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing
forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at
the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what
is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage - ANS -D) Subconjunctival hemorrhage
Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red
area. The pupil is not affected, vision is not affected and the cornea is clear. May result from
trauma, bleeding disorders, or sudden increase in venous pressure, as from a cough.
\A 27 year old female patient has three furuncles connected around a hair follicle. You use the
following term in your charting:
A) nodules
B) carbuncle
,C) macules
D) bulla - ANS -B) carbuncle
Multiple furuncles around a hair follicle form a carbuncle.
\A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation,
the right eyeball appears to be protruding forward. Based on this description, what is the most
likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion - ANS -C) Exophthalmos
Eye protrusion (proptosis or exophthalmos)
\A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the
following would be an appropriate response by the nurse to her statement?
A) "How does your family react to your pain?"
B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating."
D) "How would you say the pain affects your ability to do your daily activities?" - ANS -D) "How
would you say the pain affects your ability to do your daily activities?"
Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual
activity.
\A 45-year-old man is in the clinic for a routine physical. During history the patient states he has
been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't
catch my breath." His symptoms indicates sleep related symptoms of a certain type of disease,
so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - ANS -B) Do you have any history of problems
with your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of
intrathoracic blood, and the weakened heart cannot accommodate the increased load.
Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the
perception of needing fresh air. (Bates, p357)
\A 46 year old female patient is in the clinic with a chief complaint of chest pain. You are wanting
to best understand the patient's perception of the chest pain. Which fo the following questions
would you ask first?
A) How do you rate your pain on a scale of 0-10?
B) Is the pain related to exertion?
C) Tell me about your chest discomfort.
D) Are you taking all of your medications? - ANS -C) Tell me about your chest discomfort.
, Move from open ended to focused questions to allow for the flow of ideas and thoughts from the
patient.
\A 53-year-old obese man comes in for an exam. When he starts to sit up, you notice a
ridge/bulge vertically just under the sternum that resolves once he sits up. This is most likely:
A) lipoma
B) diastasis recti
C) a direct hernia
D) an indirect hernia - ANS -B) diastasis recti
A diastasis recti is the separation of the two rectus abdominus muscles that happens when the
head and shoulders are raised in some patients, especially obese, chronic lung disease, or after
repeated pregnancies (Bates, p499).
\A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis.
He has been having "black stools" for the last 24 hours. How would the nurse practitioner best
document THE FACTS for his reason for seeking care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. - ANS -A) JM is
a 59 year old male here for having "black stools" for the past 24 hours.
Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care.
Make every effort to quote the patient's own words.
\A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the
hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a
ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's
skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter with
damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of
this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4 - ANS -C) Stage 3
A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of
subcutaneous tissue that may extend to, but not through underlying muscle.
\A patient has come in for an examination and states, "I have this spot in front of my ear lobe
here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The
NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his:
A) occipital node
B) thyroid gland
C) parotid gland
D) none of the above - ANS -C) parotid gland
A 10-year-old is at the clinic for "a sore throat lasting 6 days." The nurse is aware that which of
these findings would be consistent with an acute infection?
A) Tonsils 3+/1-4+ with large white spots
B) Tonsils 1+/1-4+ with pale coloring
C) Tonsils 1+/1-4+ and pink, same color as oral mucosa
D) Tonsils 2+/1-4+ and pink with white particles inside deep crypts - ANS -A) Tonsils 3+/1-4+
with large white spots
With an acute infection, tonsils are bright red and swollen and may have exudate or large white
spots. Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection.
\A 15 month old is brought to you for a fever of 101 F and fussiness. The ear examination is as
follows: external ear - normal appearance and no tenderness with manipulation; canal - normal
diameter without evidence of inflammation; tympanic membrane - bulging, erythematous, and
the light reflex is dull. Insufflation is deferred due to pain. What is your diagnosis?
A) ruptured tympanic membrane
B) cholesteatoma
C) otitis media
D) otitis externa - ANS -C) otitis media
Acute otitis media in a symptomatic child typically has a red, bulging tympanic membrane, with a
dull or absent light reflex.
\A 15-year-old high school sophomore presents to the emergency room with his mother for
evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing
forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye.
On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply demarcated area at
the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what
is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage - ANS -D) Subconjunctival hemorrhage
Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red
area. The pupil is not affected, vision is not affected and the cornea is clear. May result from
trauma, bleeding disorders, or sudden increase in venous pressure, as from a cough.
\A 27 year old female patient has three furuncles connected around a hair follicle. You use the
following term in your charting:
A) nodules
B) carbuncle
,C) macules
D) bulla - ANS -B) carbuncle
Multiple furuncles around a hair follicle form a carbuncle.
\A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation,
the right eyeball appears to be protruding forward. Based on this description, what is the most
likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion - ANS -C) Exophthalmos
Eye protrusion (proptosis or exophthalmos)
\A 29-year-old woman tells the nurse that she has "excruciating pain" in her back. Which of the
following would be an appropriate response by the nurse to her statement?
A) "How does your family react to your pain?"
B) "That must be terrible. You probably pinched a nerve."
C) "I've had back pain myself and it can be excruciating."
D) "How would you say the pain affects your ability to do your daily activities?" - ANS -D) "How
would you say the pain affects your ability to do your daily activities?"
Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual
activity.
\A 45-year-old man is in the clinic for a routine physical. During history the patient states he has
been having difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't
catch my breath." His symptoms indicates sleep related symptoms of a certain type of disease,
so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - ANS -B) Do you have any history of problems
with your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of
intrathoracic blood, and the weakened heart cannot accommodate the increased load.
Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the
perception of needing fresh air. (Bates, p357)
\A 46 year old female patient is in the clinic with a chief complaint of chest pain. You are wanting
to best understand the patient's perception of the chest pain. Which fo the following questions
would you ask first?
A) How do you rate your pain on a scale of 0-10?
B) Is the pain related to exertion?
C) Tell me about your chest discomfort.
D) Are you taking all of your medications? - ANS -C) Tell me about your chest discomfort.
, Move from open ended to focused questions to allow for the flow of ideas and thoughts from the
patient.
\A 53-year-old obese man comes in for an exam. When he starts to sit up, you notice a
ridge/bulge vertically just under the sternum that resolves once he sits up. This is most likely:
A) lipoma
B) diastasis recti
C) a direct hernia
D) an indirect hernia - ANS -B) diastasis recti
A diastasis recti is the separation of the two rectus abdominus muscles that happens when the
head and shoulders are raised in some patients, especially obese, chronic lung disease, or after
repeated pregnancies (Bates, p499).
\A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis.
He has been having "black stools" for the last 24 hours. How would the nurse practitioner best
document THE FACTS for his reason for seeking care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked. - ANS -A) JM is
a 59 year old male here for having "black stools" for the past 24 hours.
Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care.
Make every effort to quote the patient's own words.
\A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the
hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on a
ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's
skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter with
damage to the subcutaneous tissue. The underlying muscle is not affected. What is the stage of
this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4 - ANS -C) Stage 3
A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of
subcutaneous tissue that may extend to, but not through underlying muscle.
\A patient has come in for an examination and states, "I have this spot in front of my ear lobe
here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The
NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his:
A) occipital node
B) thyroid gland
C) parotid gland
D) none of the above - ANS -C) parotid gland
