NURS 6512 Advanced Health Assessment Midterm Exam
2026/2027 - Walden University Complete Midterm Examination |
Actual Questions & Verified Answers | Comprehensive Health
Assessment | Pass Guarantee
1. A 62-year-old man presents with 3 hours of crushing chest pain that radiates to
the left arm. HPI: pain started at rest, associated with diaphoresis and nausea.
PMH: HTN, 40 pack-year smoking. VS: BP 90/60, HR 110, RR 24, SpO₂ 94 % RA.
On auscultation you hear a soft, high-pitched systolic murmur at the apex
radiating to axilla and bilateral basal crackles. Which additional bedside
maneuver is MOST critical right now?
A. Passive leg raise to assess fluid responsiveness
B. Lung ultrasound (B-lines) to quantify pulmonary congestion
C. Focused cardiac echo to assess wall motion & papillary muscle function
D. Carotid sinus massage to differentiate murmur
Correct Answer: C
Rationale: New apical pansystolic murmur + acute pulmonary edema in setting of
inferior MI suggests papillary-muscle rupture with acute MR—life-threatening. Bedside
echo immediately identifies flail leaflet & wall-motion abnormality, guiding urgent
cardiology activation.
2. How would you document the heart sound described in Q1 in a SOAP note?
A. “Soft S3 gallop at apex”
B. “2/6 early-systolic murmur at LLSB”
C. “3/6 high-pitched holosystolic murmur at apex radiating to axilla”
D. “Mid-systolic click with late systolic murmur”
Correct Answer: C
,Rationale: Classic descriptors for acute MR—holosystolic, high-pitched, radiates to
axilla; grade 3/6 correlates with audible thrill.
3. A 24-year-old woman at 30 weeks gestation complains of dyspnea on exertion.
On exam you note a split S1 and a soft, mid-systolic murmur at LUSB that
disappears when she sits up. No pedal edema. Which finding BEST supports that
this is a physiologic murmur?
A. Split S1
B. Disappearance when sitting
C. Location at LUSB
D. Timing (mid-systolic)
Correct Answer: B
Rationale: Physiologic ejection murmurs diminish with positional change; pathologic
murmurs (e.g., MS, AS) persist.
4. A 78-year-old woman with HTN & DM presents with acute-onset aphasia and
R-sided weakness that resolved within 45 minutes. NIHSS now 0. Carotid duplex
shows 50-69 % L-ICA stenosis; no ulceration. Which assessment is MOST
appropriate next?
A. Transcranial Doppler to assess collateral flow
B. MRA or CTA to quantify stenosis & intracranial circulation
C. Immediate CEA referral
D. Reassurance and aspirin only
Correct Answer: B
Rationale: TIA with moderate stenosis needs vessel imaging to confirm degree & look
for intracranial disease before deciding on intervention.
5. A 6-year-old boy is brought in with 2 days of barking cough and stridor only when
crying. Temp 37.8 °C, no drooling. Which clinical finding distinguishes spasmodic
croup from viral croup?
A. Duration <3 days with abrupt midnight onset
B. High fever >39 °C
, C. Subcostal retractions at rest
D. Biphasic stridor
Correct Answer: A
Rationale: Spasmodic croup is sudden at night, recurrent, minimal fever; viral has
prodrome & fever.
6. A 55-year-old man with COPD (FEV₁ 45 %) presents with increased dyspnea and
purulent sputum. On exam you note prolonged expiration, diffuse wheezes, and a
new 2 cm tender right calf nodule. ABG on room air: pH 7.35, PaCO₂ 55, PaO₂ 58,
HCO₃ 30. Which finding is MOST urgent to address?
A. Hypercarbia
B. Hypoxemia
C. Right calf tenderness (possible DVT)
D. Metabolic alkalosis
Correct Answer: C
Rationale: COPD exacerbation with tender calf = high PE risk; needs urgent bilateral leg
ultrasound & possibly CTA chest.
7. You perform the Wells score for the patient in Q6. He receives 3 points for clinical
DVT, 3 for tachycardia, 1 for hemoptysis, 1 for malignancy (remote). Total 8.
Which next step is BEST?
A. Start apixaban and discharge
B. Order D-dimer
C. Proceed directly to CTA chest
D. Start heparin drip and obtain CTA
Correct Answer: D
Rationale: Wells >6 indicates high probability; anticoagulate empirically and image.
8. A 38-year-old woman with SLE presents with acute pleuritic chest pain and
dyspnea. On exam you note a fixed split S2 and a soft mid-diastolic murmur at
apex. Which additional finding supports atrial septal defect rather than
Libman-Sacks endocarditis?
2026/2027 - Walden University Complete Midterm Examination |
Actual Questions & Verified Answers | Comprehensive Health
Assessment | Pass Guarantee
1. A 62-year-old man presents with 3 hours of crushing chest pain that radiates to
the left arm. HPI: pain started at rest, associated with diaphoresis and nausea.
PMH: HTN, 40 pack-year smoking. VS: BP 90/60, HR 110, RR 24, SpO₂ 94 % RA.
On auscultation you hear a soft, high-pitched systolic murmur at the apex
radiating to axilla and bilateral basal crackles. Which additional bedside
maneuver is MOST critical right now?
A. Passive leg raise to assess fluid responsiveness
B. Lung ultrasound (B-lines) to quantify pulmonary congestion
C. Focused cardiac echo to assess wall motion & papillary muscle function
D. Carotid sinus massage to differentiate murmur
Correct Answer: C
Rationale: New apical pansystolic murmur + acute pulmonary edema in setting of
inferior MI suggests papillary-muscle rupture with acute MR—life-threatening. Bedside
echo immediately identifies flail leaflet & wall-motion abnormality, guiding urgent
cardiology activation.
2. How would you document the heart sound described in Q1 in a SOAP note?
A. “Soft S3 gallop at apex”
B. “2/6 early-systolic murmur at LLSB”
C. “3/6 high-pitched holosystolic murmur at apex radiating to axilla”
D. “Mid-systolic click with late systolic murmur”
Correct Answer: C
,Rationale: Classic descriptors for acute MR—holosystolic, high-pitched, radiates to
axilla; grade 3/6 correlates with audible thrill.
3. A 24-year-old woman at 30 weeks gestation complains of dyspnea on exertion.
On exam you note a split S1 and a soft, mid-systolic murmur at LUSB that
disappears when she sits up. No pedal edema. Which finding BEST supports that
this is a physiologic murmur?
A. Split S1
B. Disappearance when sitting
C. Location at LUSB
D. Timing (mid-systolic)
Correct Answer: B
Rationale: Physiologic ejection murmurs diminish with positional change; pathologic
murmurs (e.g., MS, AS) persist.
4. A 78-year-old woman with HTN & DM presents with acute-onset aphasia and
R-sided weakness that resolved within 45 minutes. NIHSS now 0. Carotid duplex
shows 50-69 % L-ICA stenosis; no ulceration. Which assessment is MOST
appropriate next?
A. Transcranial Doppler to assess collateral flow
B. MRA or CTA to quantify stenosis & intracranial circulation
C. Immediate CEA referral
D. Reassurance and aspirin only
Correct Answer: B
Rationale: TIA with moderate stenosis needs vessel imaging to confirm degree & look
for intracranial disease before deciding on intervention.
5. A 6-year-old boy is brought in with 2 days of barking cough and stridor only when
crying. Temp 37.8 °C, no drooling. Which clinical finding distinguishes spasmodic
croup from viral croup?
A. Duration <3 days with abrupt midnight onset
B. High fever >39 °C
, C. Subcostal retractions at rest
D. Biphasic stridor
Correct Answer: A
Rationale: Spasmodic croup is sudden at night, recurrent, minimal fever; viral has
prodrome & fever.
6. A 55-year-old man with COPD (FEV₁ 45 %) presents with increased dyspnea and
purulent sputum. On exam you note prolonged expiration, diffuse wheezes, and a
new 2 cm tender right calf nodule. ABG on room air: pH 7.35, PaCO₂ 55, PaO₂ 58,
HCO₃ 30. Which finding is MOST urgent to address?
A. Hypercarbia
B. Hypoxemia
C. Right calf tenderness (possible DVT)
D. Metabolic alkalosis
Correct Answer: C
Rationale: COPD exacerbation with tender calf = high PE risk; needs urgent bilateral leg
ultrasound & possibly CTA chest.
7. You perform the Wells score for the patient in Q6. He receives 3 points for clinical
DVT, 3 for tachycardia, 1 for hemoptysis, 1 for malignancy (remote). Total 8.
Which next step is BEST?
A. Start apixaban and discharge
B. Order D-dimer
C. Proceed directly to CTA chest
D. Start heparin drip and obtain CTA
Correct Answer: D
Rationale: Wells >6 indicates high probability; anticoagulate empirically and image.
8. A 38-year-old woman with SLE presents with acute pleuritic chest pain and
dyspnea. On exam you note a fixed split S2 and a soft mid-diastolic murmur at
apex. Which additional finding supports atrial septal defect rather than
Libman-Sacks endocarditis?
