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 62-year-old man presents to clinic with 3 hours of sudden-onset, midsternal chest
pressure that radiates to the left jaw. He is diaphoretic and nauseated. Vital signs: BP
90/60, HR 105, RR 22, SpO₂ 94% on room air. Auscultation reveals an S₄ gallop but no
murmur or rub. Lungs are clear.
Which additional physical-exam maneuver is MOST critical to perform next?
A. Active-assistive shoulder abduction
B. Pain score with palpation of costochondral junctions
C. Elicit pulsus paradoxus
D. Bilateral arm BP comparison
Correct Answer: D
Rationale: Radiation to jaw, diaphoresis, and hypotension raise concern for acute aortic
dissection. A ≥20 mm Hg inter-arm difference strongly supports dissection and guides
immediate imaging. Costochondral pain is unlikely with jaw radiation; pulsus paradoxus
is useful for tamponade, not dissection.
, 2.
A 28-year-old woman with lupus reports 2 weeks of increasing dyspnea and facial
swelling. On exam, JVP is 14 cm H₂O and rises further on inspiration. Heart sounds are
distant; there is 2+ pitting edema bilaterally.
Which finding is MOST specific for the suspected diagnosis?
A. Kussmaul sign
B. Pulsus paradoxus >20 mm Hg
C. Positive ANA
D. Bibasilar crackles
Correct Answer: A
Rationale: Rising JVP on inspiration (Kussmaul sign) is pathognomonic for constrictive
pericarditis or restrictive cardiomyopathy, both consistent with lupus. Pulsus paradoxus
suggests tamponade, not constriction. ANA supports lupus but is nonspecific.
3.
A 4-day-old breast-fed infant is brought in jaundiced to the chest. Total bilirubin is 19
mg/dL. The infant is sleepy but arousable. On exam, you note poor skin turgor and a
sunken anterior fontanel.
Which assessment finding BEST supports the diagnosis of dehydration rather than
hemolytic disease?
A. Weight loss >10% from birth weight
B. Splenomegaly
,C. Positive Coombs test
D. Hematocrit 32%
Correct Answer: A
Rationale: >10% weight loss indicates significant dehydration, common in
breast-feeding jaundice. Splenomegaly, positive Coombs, and low Hct suggest
hemolysis.
4.
A 34-week-pregnant woman reports sudden bright-red vaginal bleeding and mild
cramping. On exam, fundal height is 35 cm; fetal heart rate is 150 bpm; no uterine
tenderness. Digital cervical exam is deferred.
Which finding on sterile speculum exam is MOST concerning for placenta previa?
A. Bloody show with mucous plug
B. Visible placental vessels at the os
C. Cervical dilation 2 cm
D. Ferning of amniotic fluid
Correct Answer: B
Rationale: Visible vessels over the cervix confirm previa and mandate immediate
cesarean planning. Bloody show is common; ferning indicates rupture, not previa.
5.
, An 81-year-old woman is seen 5 days after a fall on her outstretched right hand. She has
right wrist swelling and 7/10 pain with pronation. On exam, anatomic snuff-box
tenderness is present; no obvious deformity.
Which next assessment is MOST urgent?
A. Phalen maneuver
B. Thumb abduction strength
C. Neurovascular check of radial pulse
D. Ottawa wrist X-ray criteria
Correct Answer: C
Rationale: Snuff-box tenderness raises scaphoid fracture risk; compromised radial
artery flow can lead to avascular necrosis. Neurovascular status precedes imaging
decisions.
6.
A 55-year-old man with 40 pack-year history reports 4 months of progressive knee pain
worse with stairs. On exam, crepitus is palpable with knee flexion; there is no warmth or
effusion. Varus alignment is noted.
Which finding BEST differentiates osteoarthritis from rheumatoid arthritis?
A. Morning stiffness <30 min
B. Symmetric small-joint involvement
C. Positive anti-CCP
D. Soft, boggy synovium
University | Midterm Exam 2026/2027 Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
1.
A 62-year-old man presents to clinic with 3 hours of sudden-onset, midsternal chest
pressure that radiates to the left jaw. He is diaphoretic and nauseated. Vital signs: BP
90/60, HR 105, RR 22, SpO₂ 94% on room air. Auscultation reveals an S₄ gallop but no
murmur or rub. Lungs are clear.
Which additional physical-exam maneuver is MOST critical to perform next?
A. Active-assistive shoulder abduction
B. Pain score with palpation of costochondral junctions
C. Elicit pulsus paradoxus
D. Bilateral arm BP comparison
Correct Answer: D
Rationale: Radiation to jaw, diaphoresis, and hypotension raise concern for acute aortic
dissection. A ≥20 mm Hg inter-arm difference strongly supports dissection and guides
immediate imaging. Costochondral pain is unlikely with jaw radiation; pulsus paradoxus
is useful for tamponade, not dissection.
, 2.
A 28-year-old woman with lupus reports 2 weeks of increasing dyspnea and facial
swelling. On exam, JVP is 14 cm H₂O and rises further on inspiration. Heart sounds are
distant; there is 2+ pitting edema bilaterally.
Which finding is MOST specific for the suspected diagnosis?
A. Kussmaul sign
B. Pulsus paradoxus >20 mm Hg
C. Positive ANA
D. Bibasilar crackles
Correct Answer: A
Rationale: Rising JVP on inspiration (Kussmaul sign) is pathognomonic for constrictive
pericarditis or restrictive cardiomyopathy, both consistent with lupus. Pulsus paradoxus
suggests tamponade, not constriction. ANA supports lupus but is nonspecific.
3.
A 4-day-old breast-fed infant is brought in jaundiced to the chest. Total bilirubin is 19
mg/dL. The infant is sleepy but arousable. On exam, you note poor skin turgor and a
sunken anterior fontanel.
Which assessment finding BEST supports the diagnosis of dehydration rather than
hemolytic disease?
A. Weight loss >10% from birth weight
B. Splenomegaly
,C. Positive Coombs test
D. Hematocrit 32%
Correct Answer: A
Rationale: >10% weight loss indicates significant dehydration, common in
breast-feeding jaundice. Splenomegaly, positive Coombs, and low Hct suggest
hemolysis.
4.
A 34-week-pregnant woman reports sudden bright-red vaginal bleeding and mild
cramping. On exam, fundal height is 35 cm; fetal heart rate is 150 bpm; no uterine
tenderness. Digital cervical exam is deferred.
Which finding on sterile speculum exam is MOST concerning for placenta previa?
A. Bloody show with mucous plug
B. Visible placental vessels at the os
C. Cervical dilation 2 cm
D. Ferning of amniotic fluid
Correct Answer: B
Rationale: Visible vessels over the cervix confirm previa and mandate immediate
cesarean planning. Bloody show is common; ferning indicates rupture, not previa.
5.
, An 81-year-old woman is seen 5 days after a fall on her outstretched right hand. She has
right wrist swelling and 7/10 pain with pronation. On exam, anatomic snuff-box
tenderness is present; no obvious deformity.
Which next assessment is MOST urgent?
A. Phalen maneuver
B. Thumb abduction strength
C. Neurovascular check of radial pulse
D. Ottawa wrist X-ray criteria
Correct Answer: C
Rationale: Snuff-box tenderness raises scaphoid fracture risk; compromised radial
artery flow can lead to avascular necrosis. Neurovascular status precedes imaging
decisions.
6.
A 55-year-old man with 40 pack-year history reports 4 months of progressive knee pain
worse with stairs. On exam, crepitus is palpable with knee flexion; there is no warmth or
effusion. Varus alignment is noted.
Which finding BEST differentiates osteoarthritis from rheumatoid arthritis?
A. Morning stiffness <30 min
B. Symmetric small-joint involvement
C. Positive anti-CCP
D. Soft, boggy synovium
