NURS 6512
Advanced Health Assessment &
Diagnostic Reasoning
Complete Midterms Review
(Questions & Solutions)
2025
1
,1. A 55-year-old man presents with sudden right‐sided weakness and
facial droop. Which neurological test BEST identifies upper motor
neuron dysfunction?
A. Rapid alternating finger tapping
B. Plantar reflex (Babinski)
C. Light touch on the forearm
D. Two‐point discrimination on fingertips
ANS: B
Rationale: A positive Babinski (upward toe escape) indicates
corticospinal tract involvement typical of upper motor neuron
lesions.
2. A patient with chronic heart failure has jugular venous distention
(JVD) and an S3 gallop. Which finding most strongly correlates with
elevated left ventricular filling pressures?
A. Diminished first heart sound (S1)
B. S3 gallop on apex auscultation
C. Point of maximal impulse (PMI) displaced laterally
D. PMI with sustained impulse
ANS: B
Rationale: An S3 reflects rapid deceleration of blood against a stiff
ventricle, correlating with increased filling pressures.
3. A 30-year-old woman complains of sharp, pleuritic chest pain that
improves when leaning forward. Which auscultatory finding supports
acute pericarditis rather than myocardial ischemia?
A. Harsh systolic ejection murmur
B. Triphasic (S4–S1–S2) rhythm
C. Friction rub with positional variation
D. Loud S2 splitting
2
, ANS: C
Rationale: A pericardial friction rub that changes with posture is
pathognomonic for pericarditis.
4. A 68-year-old man with emphysema shows a barrel chest. Which
chest wall measurement confirms increased anteroposterior (AP)
diameter?
A. AP/transverse ratio >1:2
B. AP/transverse ratio ~1:1
C. Chest circumference difference ≤2 cm on inspiration
D. Diaphragmatic excursion >6 cm
ANS: B
Rationale: Barrel chest is defined by an AP/transverse diameter
ratio approaching 1:1, rather than the normal 1:2.
5. A 42-year-old woman presents with severe abdominal pain and
rebound tenderness. Rebound tenderness indicates which peritoneal
finding?
A. Visceral distention
B. Parietal peritoneum inflammation
C. Intramural hemorrhage
D. Smooth muscle spasm
ANS: B
Rationale: Pain on release (rebound) reflects parietal peritoneum
irritation, a marker of peritonitis.
6. A patient with unilateral leg swelling is suspected of deep vein
thrombosis (DVT). Which bedside test aids early detection?
A. Ankle‐brachial index measurement
B. Homans’ sign (calf pain on dorsiflexion)
C. Peripheral capillary refill
D. Trendelenburg test
3
Advanced Health Assessment &
Diagnostic Reasoning
Complete Midterms Review
(Questions & Solutions)
2025
1
,1. A 55-year-old man presents with sudden right‐sided weakness and
facial droop. Which neurological test BEST identifies upper motor
neuron dysfunction?
A. Rapid alternating finger tapping
B. Plantar reflex (Babinski)
C. Light touch on the forearm
D. Two‐point discrimination on fingertips
ANS: B
Rationale: A positive Babinski (upward toe escape) indicates
corticospinal tract involvement typical of upper motor neuron
lesions.
2. A patient with chronic heart failure has jugular venous distention
(JVD) and an S3 gallop. Which finding most strongly correlates with
elevated left ventricular filling pressures?
A. Diminished first heart sound (S1)
B. S3 gallop on apex auscultation
C. Point of maximal impulse (PMI) displaced laterally
D. PMI with sustained impulse
ANS: B
Rationale: An S3 reflects rapid deceleration of blood against a stiff
ventricle, correlating with increased filling pressures.
3. A 30-year-old woman complains of sharp, pleuritic chest pain that
improves when leaning forward. Which auscultatory finding supports
acute pericarditis rather than myocardial ischemia?
A. Harsh systolic ejection murmur
B. Triphasic (S4–S1–S2) rhythm
C. Friction rub with positional variation
D. Loud S2 splitting
2
, ANS: C
Rationale: A pericardial friction rub that changes with posture is
pathognomonic for pericarditis.
4. A 68-year-old man with emphysema shows a barrel chest. Which
chest wall measurement confirms increased anteroposterior (AP)
diameter?
A. AP/transverse ratio >1:2
B. AP/transverse ratio ~1:1
C. Chest circumference difference ≤2 cm on inspiration
D. Diaphragmatic excursion >6 cm
ANS: B
Rationale: Barrel chest is defined by an AP/transverse diameter
ratio approaching 1:1, rather than the normal 1:2.
5. A 42-year-old woman presents with severe abdominal pain and
rebound tenderness. Rebound tenderness indicates which peritoneal
finding?
A. Visceral distention
B. Parietal peritoneum inflammation
C. Intramural hemorrhage
D. Smooth muscle spasm
ANS: B
Rationale: Pain on release (rebound) reflects parietal peritoneum
irritation, a marker of peritonitis.
6. A patient with unilateral leg swelling is suspected of deep vein
thrombosis (DVT). Which bedside test aids early detection?
A. Ankle‐brachial index measurement
B. Homans’ sign (calf pain on dorsiflexion)
C. Peripheral capillary refill
D. Trendelenburg test
3
