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 man presents to urgent care with acute chest pressure that began
2 h ago while shoveling snow. The pain radiates to the left jaw, is “crushing,” and
is associated with nausea. Vital signs: BP 148/92, HR 104, RR 22, O₂ sat 96 % on
room air. Past history: hyperlipidemia, 40 pack-year smoking. On inspection he is
diaphoretic; auscultation reveals an S4 gallop and a soft II/VI systolic murmur at
the apex that radiates to the axilla. Lung fields are clear.
Which physical finding is most specific for acute myocardial ischemia in this
patient?
A. S4 gallop
B. II/VI apical murmur
C. Diaphoresis
D. Pain radiating to jaw
Correct Answer: A
Rationale: An S4 reflects decreased ventricular compliance from acute ischemia;
murmur could be chronic, diaphoresis and jaw pain are supportive but less specific.
2. A 19-year-old woman is seen for a 3-day history of pleuritic chest pain and
dyspnea. She uses combined oral contraceptives and reports a 4-h car ride 10
days ago. Vital signs: HR 112, RR 24, BP 100/60, O₂ sat 91 % on room air.
Inspection reveals asymmetric calf swelling; palpation of the right calf elicits
tenderness and a 3-cm circumference increase. Lung auscultation is clear
bilaterally. You suspect pulmonary embolism.
Which assessment maneuver is most critical to perform next?
A. Homans’ sign
, B. Measurement of calf circumference with the patient prone
C. Auscultation for pleural friction rub
D. Evaluation for Wells criteria
Correct Answer: D
Rationale: Wells score guides pre-test probability and need for D-dimer/imaging;
Homans’ sign is nonspecific and no longer recommended.
3. A 6-year-old boy is brought in with a barking cough and hoarseness that started
overnight. He has mild inspiratory stridor at rest but no cyanosis. Temperature is
37.8 °C. He is fully immunized.
Which finding best supports a diagnosis of spasmodic croup rather than viral
croup?
A. Presence of fever
B. Sudden midnight onset in a well-appearing child
C. Subglottic narrowing on neck X-ray
D. Barking cough
Correct Answer: B
Rationale: Spasmodic croup is sudden at night, low-grade or no fever, and often recurs;
viral croup has prodrome and fever.
4. A 77-year-old woman is evaluated for a 4-month history of low back pain that
worsens with weight-bearing and is relieved by sitting. History: osteoporosis
since age 65, prior wrist fracture. Examination reveals tenderness over the lower
thoracic spinous processes, height loss of 4 cm since age 60, and negative
straight-leg-raise test bilaterally.
Which finding is most concerning for acute vertebral compression fracture?
A. Negative straight-leg-raise test
B. Midline spinous tenderness with height loss
C. Paraspinal muscle spasm
D. Pain relieved by sitting
Correct Answer: B
, Rationale: Spinous tenderness + documented height loss is highly specific; other
findings are nonspecific.
5. A 34-week pregnant 28-year-old primigravida reports sudden painless bright-red
vaginal bleeding that started 1 h ago. Fetal heart tracing is 140 bpm with
accelerations; uterus is soft and nontender; BP 118/74.
Which assessment action is most urgent?
A. Sterile speculum examination to visualize cervix
B. Digital cervical examination to assess dilation
C. Trans-abdominal ultrasound to locate placenta
D. Pelvic CT to rule out trauma
Correct Answer: C
Rationale: Rule out placenta previa before any digital exam (could trigger hemorrhage).
CT is contraindicated.
6. A 54-year-old man with cirrhosis due to HCV presents with increasing abdominal
girth and 3-day confusion. Temperature 37.9 °C, BP 95/58, HR 110, RR 24.
Ascites is tense; flapping tremor is present. Paracentesis shows PMN count 280
cells/mm³.
Which finding is diagnostic for spontaneous bacterial peritonitis?
A. PMN > 250 cells/mm³
B. Positive ascitic culture
C. Total protein < 1 g/dL
D. LDH > serum LDH
Correct Answer: A
Rationale: PMN ≥ 250 is criterion for empiric diagnosis; cultures may be negative early.
7. A 15-month-old girl is seen for delayed walking. Parents note she began pulling
to stand at 13 months. Growth parameters are normal. When held standing she
bears weight briefly; hips are flexed 30° and knees 20°. Deep tendon reflexes are
3+ bilaterally; ankle clonus is sustained 4 beats; Babinski is upgoing.
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1. A 58-year-old man presents to urgent care with acute chest pressure that began
2 h ago while shoveling snow. The pain radiates to the left jaw, is “crushing,” and
is associated with nausea. Vital signs: BP 148/92, HR 104, RR 22, O₂ sat 96 % on
room air. Past history: hyperlipidemia, 40 pack-year smoking. On inspection he is
diaphoretic; auscultation reveals an S4 gallop and a soft II/VI systolic murmur at
the apex that radiates to the axilla. Lung fields are clear.
Which physical finding is most specific for acute myocardial ischemia in this
patient?
A. S4 gallop
B. II/VI apical murmur
C. Diaphoresis
D. Pain radiating to jaw
Correct Answer: A
Rationale: An S4 reflects decreased ventricular compliance from acute ischemia;
murmur could be chronic, diaphoresis and jaw pain are supportive but less specific.
2. A 19-year-old woman is seen for a 3-day history of pleuritic chest pain and
dyspnea. She uses combined oral contraceptives and reports a 4-h car ride 10
days ago. Vital signs: HR 112, RR 24, BP 100/60, O₂ sat 91 % on room air.
Inspection reveals asymmetric calf swelling; palpation of the right calf elicits
tenderness and a 3-cm circumference increase. Lung auscultation is clear
bilaterally. You suspect pulmonary embolism.
Which assessment maneuver is most critical to perform next?
A. Homans’ sign
, B. Measurement of calf circumference with the patient prone
C. Auscultation for pleural friction rub
D. Evaluation for Wells criteria
Correct Answer: D
Rationale: Wells score guides pre-test probability and need for D-dimer/imaging;
Homans’ sign is nonspecific and no longer recommended.
3. A 6-year-old boy is brought in with a barking cough and hoarseness that started
overnight. He has mild inspiratory stridor at rest but no cyanosis. Temperature is
37.8 °C. He is fully immunized.
Which finding best supports a diagnosis of spasmodic croup rather than viral
croup?
A. Presence of fever
B. Sudden midnight onset in a well-appearing child
C. Subglottic narrowing on neck X-ray
D. Barking cough
Correct Answer: B
Rationale: Spasmodic croup is sudden at night, low-grade or no fever, and often recurs;
viral croup has prodrome and fever.
4. A 77-year-old woman is evaluated for a 4-month history of low back pain that
worsens with weight-bearing and is relieved by sitting. History: osteoporosis
since age 65, prior wrist fracture. Examination reveals tenderness over the lower
thoracic spinous processes, height loss of 4 cm since age 60, and negative
straight-leg-raise test bilaterally.
Which finding is most concerning for acute vertebral compression fracture?
A. Negative straight-leg-raise test
B. Midline spinous tenderness with height loss
C. Paraspinal muscle spasm
D. Pain relieved by sitting
Correct Answer: B
, Rationale: Spinous tenderness + documented height loss is highly specific; other
findings are nonspecific.
5. A 34-week pregnant 28-year-old primigravida reports sudden painless bright-red
vaginal bleeding that started 1 h ago. Fetal heart tracing is 140 bpm with
accelerations; uterus is soft and nontender; BP 118/74.
Which assessment action is most urgent?
A. Sterile speculum examination to visualize cervix
B. Digital cervical examination to assess dilation
C. Trans-abdominal ultrasound to locate placenta
D. Pelvic CT to rule out trauma
Correct Answer: C
Rationale: Rule out placenta previa before any digital exam (could trigger hemorrhage).
CT is contraindicated.
6. A 54-year-old man with cirrhosis due to HCV presents with increasing abdominal
girth and 3-day confusion. Temperature 37.9 °C, BP 95/58, HR 110, RR 24.
Ascites is tense; flapping tremor is present. Paracentesis shows PMN count 280
cells/mm³.
Which finding is diagnostic for spontaneous bacterial peritonitis?
A. PMN > 250 cells/mm³
B. Positive ascitic culture
C. Total protein < 1 g/dL
D. LDH > serum LDH
Correct Answer: A
Rationale: PMN ≥ 250 is criterion for empiric diagnosis; cultures may be negative early.
7. A 15-month-old girl is seen for delayed walking. Parents note she began pulling
to stand at 13 months. Growth parameters are normal. When held standing she
bears weight briefly; hips are flexed 30° and knees 20°. Deep tendon reflexes are
3+ bilaterally; ankle clonus is sustained 4 beats; Babinski is upgoing.
