NURS 6512 Advanced Health Assessment | Walden
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old male presents to urgent care with acute midsternal chest pressure
that began 45 minutes ago while shoveling snow. He rates the pain 9/10,
describes radiation to the left jaw, and admits to diaphoresis and nausea. Vital
signs: BP 160/94, HR 105, RR 22, O₂ sat 96 % on room air. Lungs are clear to
auscultation bilaterally; heart rhythm is regular with an S₄ gallop and no
murmurs/rubs. Which physical-exam maneuver/findings best increase the
probability that his pain is cardiac in origin?
A. Pain reproduced with chest-wall palpation
B. Pain unchanged during deep inspiration
C. Pain decreases when patient sits up and leans forward
D. Pain completely relieved with one sublingual nitroglycerin tablet
Correct Answer: B
Rationale: Cardiac ischemic pain is typically NOT pleuritic; reproduction with respiration
(B) argues against pericarditis or musculoskeletal causes. Chest-wall tenderness (A)
suggests musculoskeletal etiology. Relief with leaning forward (C) is classic for
pericarditis, and NTG relief (D) is supportive but not diagnostic.
2. A 68-year-old woman with DM-2, HTN, and 40 pack-year smoking history reports
progressive exertional dyspnea over 6 months and new bilateral ankle edema.
She now notes dyspnea while talking. JVP is 12 cm H₂O at 45°; there are bibasilar
fine late-inspiratory crackles and a soft S₃. No wheezes. Which finding best
, differentiates heart failure with preserved EF from COPD exacerbation as the
cause of her dyspnea?
A. Presence of an S₃ gallop
B. Prolonged expiratory phase
C. Hyper-resonant percussion
D. Accessory muscle use
Correct Answer: A
Rationale: S₃ and elevated JVP reflect volume overload—hallmarks of HF. Prolonged
expiration, hyper-resonance, and accessory muscle use favor obstructive pulmonary
disease.
3. A 4-year-old boy is brought in with a barking cough that started last night. He is
afebrile, sits quietly on his mother’s lap, and has mild inspiratory stridor at rest.
Which next assessment maneuver is most critical?
A. Obtain an AP and lateral neck X-ray
B. Have him cry to better hear lung sounds
C. Observe for chest-wall retractions while resting and during agitation
D. Apply a pulse oximeter on the toe immediately
Correct Answer: C
Rationale: Croup severity is gauged by work of breathing at rest vs. agitation;
observation guides need for steroids/epinephrine. Provoking cry (B) may worsen airway
obstruction. Imaging (A) is unnecessary unless epiglottitis suspected.
4. A 22-year-old primigravida at 30 weeks gestation reports new-onset RUQ pain,
nausea, and a frontal headache. BP 148/96, HR 92, RR 18. Deep-tendon reflexes
are 3+ with 2 beats of clonus. Which focused physical-exam finding best
supports the diagnosis of preeclampsia with severe features?
A. Scleral icterus
B. Epigastric/RUQ tenderness
C. Right costovertebral angle tenderness
D. Hyper-active bowel sounds
, Correct Answer: B
Rationale: Hepatic capsule stretching from HELLP syndrome produces RUQ pain. CVA
tenderness (C) suggests pyelonephritis; scleral icterus (A) is not typical for
preeclampsia.
5. A 71-year-old man with a 20-year history of benign prostatic hyperplasia (BPH)
presents to establish care. On abdominal exam you note a rounded, dull
suprapubic mass that is non-tender and measures 12 cm. The patient denies
pain but feels “I have to push to urinate.” Which assessment is most urgent to
perform next?
A. Digital rectal exam for prostate size
B. Bladder ultrasound for post-void residual (PVR)
C. PSA blood test
D. Renal percussion for costovertebral tenderness
Correct Answer: B
Rationale: Large suprapubic dull mass with voiding symptoms = chronic urinary
retention; PVR confirms diagnosis and need for catheterization.
6. A 35-year-old woman with seropositive rheumatoid arthritis reports 3 weeks of
increasing hand pain and new nodules on her forearms. Exam reveals warm,
boggy MCP and PIP joints bilaterally plus firm 2-cm subcutaneous nodules on
the olecranon areas. Which exam finding best indicates active synovitis rather
than degenerative changes?
A. Bony hard enlargement of DIPs
B. Sausage-shaped swelling of the fingers
C. Heberden’s nodes
D. Dry, scaly skin over knuckles
Correct Answer: B
Rationale: Diffuse, symmetric fusiform swelling reflects inflammatory pannus. DIP
changes (A/C) are osteoarthritic; psoriasis (D) is not specific for RA synovitis.
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old male presents to urgent care with acute midsternal chest pressure
that began 45 minutes ago while shoveling snow. He rates the pain 9/10,
describes radiation to the left jaw, and admits to diaphoresis and nausea. Vital
signs: BP 160/94, HR 105, RR 22, O₂ sat 96 % on room air. Lungs are clear to
auscultation bilaterally; heart rhythm is regular with an S₄ gallop and no
murmurs/rubs. Which physical-exam maneuver/findings best increase the
probability that his pain is cardiac in origin?
A. Pain reproduced with chest-wall palpation
B. Pain unchanged during deep inspiration
C. Pain decreases when patient sits up and leans forward
D. Pain completely relieved with one sublingual nitroglycerin tablet
Correct Answer: B
Rationale: Cardiac ischemic pain is typically NOT pleuritic; reproduction with respiration
(B) argues against pericarditis or musculoskeletal causes. Chest-wall tenderness (A)
suggests musculoskeletal etiology. Relief with leaning forward (C) is classic for
pericarditis, and NTG relief (D) is supportive but not diagnostic.
2. A 68-year-old woman with DM-2, HTN, and 40 pack-year smoking history reports
progressive exertional dyspnea over 6 months and new bilateral ankle edema.
She now notes dyspnea while talking. JVP is 12 cm H₂O at 45°; there are bibasilar
fine late-inspiratory crackles and a soft S₃. No wheezes. Which finding best
, differentiates heart failure with preserved EF from COPD exacerbation as the
cause of her dyspnea?
A. Presence of an S₃ gallop
B. Prolonged expiratory phase
C. Hyper-resonant percussion
D. Accessory muscle use
Correct Answer: A
Rationale: S₃ and elevated JVP reflect volume overload—hallmarks of HF. Prolonged
expiration, hyper-resonance, and accessory muscle use favor obstructive pulmonary
disease.
3. A 4-year-old boy is brought in with a barking cough that started last night. He is
afebrile, sits quietly on his mother’s lap, and has mild inspiratory stridor at rest.
Which next assessment maneuver is most critical?
A. Obtain an AP and lateral neck X-ray
B. Have him cry to better hear lung sounds
C. Observe for chest-wall retractions while resting and during agitation
D. Apply a pulse oximeter on the toe immediately
Correct Answer: C
Rationale: Croup severity is gauged by work of breathing at rest vs. agitation;
observation guides need for steroids/epinephrine. Provoking cry (B) may worsen airway
obstruction. Imaging (A) is unnecessary unless epiglottitis suspected.
4. A 22-year-old primigravida at 30 weeks gestation reports new-onset RUQ pain,
nausea, and a frontal headache. BP 148/96, HR 92, RR 18. Deep-tendon reflexes
are 3+ with 2 beats of clonus. Which focused physical-exam finding best
supports the diagnosis of preeclampsia with severe features?
A. Scleral icterus
B. Epigastric/RUQ tenderness
C. Right costovertebral angle tenderness
D. Hyper-active bowel sounds
, Correct Answer: B
Rationale: Hepatic capsule stretching from HELLP syndrome produces RUQ pain. CVA
tenderness (C) suggests pyelonephritis; scleral icterus (A) is not typical for
preeclampsia.
5. A 71-year-old man with a 20-year history of benign prostatic hyperplasia (BPH)
presents to establish care. On abdominal exam you note a rounded, dull
suprapubic mass that is non-tender and measures 12 cm. The patient denies
pain but feels “I have to push to urinate.” Which assessment is most urgent to
perform next?
A. Digital rectal exam for prostate size
B. Bladder ultrasound for post-void residual (PVR)
C. PSA blood test
D. Renal percussion for costovertebral tenderness
Correct Answer: B
Rationale: Large suprapubic dull mass with voiding symptoms = chronic urinary
retention; PVR confirms diagnosis and need for catheterization.
6. A 35-year-old woman with seropositive rheumatoid arthritis reports 3 weeks of
increasing hand pain and new nodules on her forearms. Exam reveals warm,
boggy MCP and PIP joints bilaterally plus firm 2-cm subcutaneous nodules on
the olecranon areas. Which exam finding best indicates active synovitis rather
than degenerative changes?
A. Bony hard enlargement of DIPs
B. Sausage-shaped swelling of the fingers
C. Heberden’s nodes
D. Dry, scaly skin over knuckles
Correct Answer: B
Rationale: Diffuse, symmetric fusiform swelling reflects inflammatory pannus. DIP
changes (A/C) are osteoarthritic; psoriasis (D) is not specific for RA synovitis.
