NURS 6512 Advanced Health Assessment Midterm Exam
2026/2027 - Walden University Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
A 58-year-old man presents with acute 8/10 retrosternal chest pressure radiating to the left jaw, started 1 h
after shoveling snow. PMH: HTN, 40 pack-year smoking. VS: BP 148/92, HR 102, RR 22, O₂ sat 96 %
RA. On inspection he is diaphoretic; JVP is not visualized. Carotid pulses 2+ bilaterally, no bruit. Chest:
bilateral clear to auscultation. Heart: regular tachycardia, no gallop or murmur. EKG obtained: 2 mm
ST-segment elevation in leads V₂–V₄ with hyperacute T waves. You auscultate while the catheterization
lab is being activated and note a paradoxical drop in SBP of 18 mmHg during inspiration. Which
additional bedside assessment finding would most refine your preload estimate before possible
intubation?
A. Pulsus alternans
B. Pulsus paradoxus of 18 mmHg
C. Kussmaul sign
D. Hepatojugular reflux
Correct Answer: D
Rationale: Positive hepatojugular reflux (distended neck veins that rise >3 cm and stay elevated for >10 s
while compressing the RUQ) indicates elevated right-sided filling pressures even when JVP is not
initially visualized at 45°. In this STEMI patient, right ventricular involvement (often inferior) could
coexist, so assessing preload is critical before giving nitrates or fluids. Pulsus paradoxus >12 mmHg
supports cardiac tamponade or severe COPD, but does not quantify preload as directly as HJR.
A 19-year-old woman is seen for 2 days of right-sided chest pain and dyspnea after returning from a
6-week backpacking trip. She takes oral contraceptives. VS: BP 110/70, HR 104, RR 24, O₂ sat 92 % RA,
temp 37 °C. Inspection reveals subtle asymmetry in chest expansion. Palpation: R-sided fremitus is
slightly decreased; no crepitus. Percussion on the right is 1 cm higher at the 5th intercostal space
mid-axillary line vs left. Auscultation: R-sided breath sounds are diminished with transmitted
bronchophony. Which specialized maneuver performed at the bedside would most specifically
corroborate your leading differential?
A. Whispered pectoriloquy
B. Egophony
C. Tactile fremitus repeated after cough
D. Pulmonary-pleural scratch sign
Correct Answer: B
Rationale: Egophony (E-to-A change) over an area of dullness strongly suggests pleural effusion or
consolidation. In this high-risk patient, a pleural-based process (pulmonary embolism with infarction vs
effusion) is likely; egophony helps distinguish fluid vs solid lung. Whispered pectoriloquy also localizes
but is less specific for effusion.
A 6-year-old boy is brought for “noisy breathing” since age 2 weeks, worse with crying. His growth curve
is 25th percentile. No cyanosis. VS afebrile, O₂ sat 98 % RA. While seated you note high-pitched
,monotone stridor heard best over the neck; it does not change with neck position or swallowing. Lung
fields are clear. The sound is unchanged after a trial of nebulized racemic epinephrine. Flexible
laryngoscopy in your clinic reveals fixed adduction of the posterior vocal folds and a diamond-shaped
glottic opening. Which next assessment question to the parents is most urgent prior to referral?
A. “Has he ever had a sleep study?”
B. “Does he aspirate with thin liquids?”
C. “Any family history of sudden childhood death?”
D. “Has he received all routine immunizations?”
Correct Answer: A
Rationale: Fixed laryngeal anatomy with stridor since infancy suggests congenital laryngeal anomaly
(e.g., laryngomalacia vs posterior laryngeal cleft). Sleep-disordered breathing and hypoxemia are
common; polysomnography quantifies severity and guides surgical planning. Aspiration risk is important
but usually presents with coughing.
A 77-year-old woman is seen 4 days after a fall on her outstretched right hand. She has right-sided
anterior shoulder pain and ecchymosis. Neurovascularly intact. You perform the bulge sign for effusion
and note a fluid wave in the subacromial region. During the empty-can test she experiences pain at 70°
abduction. Rotator-cuff strength is 4/5. Which specific test performed next best clarifies a complete vs
partial tear?
A. Drop-arm test
B. Hawkins-Kennedy test
C. Apprehension test
D. Lift-off test
Correct Answer: A
Rationale: The drop-arm (Codman) test assesses supraspinatus integrity; inability to slowly lower the arm
from 90° to 0° or sudden drop suggests full-thickness tear. Empty-can pain without severe weakness could
indicate partial tear, but drop-arm distinguishes complete disruption.
A 32-year-old primigravida at 28 weeks gestation reports new-onset “racing heart” and occasional cough.
VS: BP 118/76, HR 108 regular, RR 18, O₂ sat 97 % RA. JVP is 4 cm above sternal angle at 45°. Cardiac
auscultation reveals a grade 2/6 systolic ejection murmur at the left sternal border that increases with
inspiration; no diastolic murmur or gallop. Lung fields clear. Lower-extremity pitting edema is 1+. Which
additional bedside finding would most specifically suggest a cardiac rather than physiologic etiology of
her symptoms?
A. Split S1
B. Pulsus paradoxus >12 mmHg
C. Diastolic murmur at apex
D. Carpal tunnel sign
Correct Answer: C
Rationale: A diastolic murmur (e.g., mitral stenosis) is always pathologic and would not occur with
normal pregnancy-induced flow murmur. Physiologic systolic murmurs are common; diastolic are not.
A 44-year-old man with alcohol-use disorder (last drink 36 h ago) presents with acute severe epigastric
pain radiating to the back, nausea, and vomiting. VS: BP 94/60, HR 118, RR 26, temp 38.2 °C. He
appears uncomfortable, leaning forward. Abdomen is rigid with guarding; bowel sounds absent.
Grey-Turner sign is noted. Which single bedside metric obtained during your initial exam best guides
immediate fluid-resuscitation volume?
, A. Passive-leg-raise stroke-volume change by finger plethysmography
B. Urine output via bladder scan
C. Skin-turgor time
D. Capillary refill at knee
Correct Answer: A
Rationale: Passive-leg-raise (PLR)–induced stroke-volume change ≥10 % predicts fluid responsiveness in
hypotensive patients. It is rapid, reversible, and avoids unnecessary fluid in severe pancreatitis where
third-spacing is extreme.
A 69-year-old retired teacher with HTN and DM type 2 is accompanied by his daughter for “increasing
forgetfulness.” MoCA scored 21/30 ( −2 visuospatial/executive, −2 delayed recall, −1 attention, −1
orientation). He is unable to perform serial-7 subtraction but can spell “world” backwards. Which
component of the MoCA most specifically localizes to executive dysfunction within the prefrontal cortex?
A. Alternating trail-making
B. Clock-drawing
C. Phonemic fluency (F-words)
D. Digit span backwards
Correct Answer: A
Rationale: Trail-making (1–A-2-B…) requires set-shifting and is sensitive to dorsolateral prefrontal
lesions. Clock-drawing also involves planning but is more visuospatial; fluency taps language-executive
overlap; digit span assesses working memory.
A 27-year-old woman with systemic lupus erythematosus on prednisone 15 mg daily presents with 2
weeks of fatigue and shortness of breath. VS: afebrile, HR 96, BP 108/68, RR 20, O₂ sat 93 % RA.
Conjunctiva are pale; no icterus. Cardiac exam normal. Lung fields clear. You perform the bedside
nail-bed pulsation test (Quincke sign) and note exaggerated capillary pulsation. Which echocardiographic
parameter described in the report would correlate with your suspected physical finding?
A. Left-ventricular ejection fraction 30 %
B. Moderate pericardial effusion
C. Holodiastolic flow reversal in descending aorta on PW Doppler
D. TAPSE 8 mm
Correct Answer: C
Rationale: Quincke sign (visible capillary pulsation) reflects widened pulse pressure, classically seen in
severe aortic regurgitation. Holodiastolic flow reversal in the descending aorta on pulsed-wave Doppler is
a specific echo sign of significant AR.
A 5-year-old boy is seen for fever (39.2 °C) and refusal to walk since this morning. His mother notes he
cried while holding his right knee 2 days ago but had no known trauma. He had URI symptoms 1 week
ago. He sits with the right knee flexed at 30°. VS: HR 122, BP 90/50, RR 24. Right knee appears mildly
swollen; no erythema. You perform the “squeeze test” (compression of proximal calf) and he winces.
Range of motion is limited by pain. Which priority assessment should you perform next?
A. Passive hip ROM log-roll test
B. Measurement of leg-length discrepancy
B. Anterior drawer of tibia
D. Patellar grind
Correct Answer: A
2026/2027 - Walden University Complete Midterm
Examination | Actual Questions & Verified Answers |
Comprehensive Health Assessment | Pass Guarantee
A 58-year-old man presents with acute 8/10 retrosternal chest pressure radiating to the left jaw, started 1 h
after shoveling snow. PMH: HTN, 40 pack-year smoking. VS: BP 148/92, HR 102, RR 22, O₂ sat 96 %
RA. On inspection he is diaphoretic; JVP is not visualized. Carotid pulses 2+ bilaterally, no bruit. Chest:
bilateral clear to auscultation. Heart: regular tachycardia, no gallop or murmur. EKG obtained: 2 mm
ST-segment elevation in leads V₂–V₄ with hyperacute T waves. You auscultate while the catheterization
lab is being activated and note a paradoxical drop in SBP of 18 mmHg during inspiration. Which
additional bedside assessment finding would most refine your preload estimate before possible
intubation?
A. Pulsus alternans
B. Pulsus paradoxus of 18 mmHg
C. Kussmaul sign
D. Hepatojugular reflux
Correct Answer: D
Rationale: Positive hepatojugular reflux (distended neck veins that rise >3 cm and stay elevated for >10 s
while compressing the RUQ) indicates elevated right-sided filling pressures even when JVP is not
initially visualized at 45°. In this STEMI patient, right ventricular involvement (often inferior) could
coexist, so assessing preload is critical before giving nitrates or fluids. Pulsus paradoxus >12 mmHg
supports cardiac tamponade or severe COPD, but does not quantify preload as directly as HJR.
A 19-year-old woman is seen for 2 days of right-sided chest pain and dyspnea after returning from a
6-week backpacking trip. She takes oral contraceptives. VS: BP 110/70, HR 104, RR 24, O₂ sat 92 % RA,
temp 37 °C. Inspection reveals subtle asymmetry in chest expansion. Palpation: R-sided fremitus is
slightly decreased; no crepitus. Percussion on the right is 1 cm higher at the 5th intercostal space
mid-axillary line vs left. Auscultation: R-sided breath sounds are diminished with transmitted
bronchophony. Which specialized maneuver performed at the bedside would most specifically
corroborate your leading differential?
A. Whispered pectoriloquy
B. Egophony
C. Tactile fremitus repeated after cough
D. Pulmonary-pleural scratch sign
Correct Answer: B
Rationale: Egophony (E-to-A change) over an area of dullness strongly suggests pleural effusion or
consolidation. In this high-risk patient, a pleural-based process (pulmonary embolism with infarction vs
effusion) is likely; egophony helps distinguish fluid vs solid lung. Whispered pectoriloquy also localizes
but is less specific for effusion.
A 6-year-old boy is brought for “noisy breathing” since age 2 weeks, worse with crying. His growth curve
is 25th percentile. No cyanosis. VS afebrile, O₂ sat 98 % RA. While seated you note high-pitched
,monotone stridor heard best over the neck; it does not change with neck position or swallowing. Lung
fields are clear. The sound is unchanged after a trial of nebulized racemic epinephrine. Flexible
laryngoscopy in your clinic reveals fixed adduction of the posterior vocal folds and a diamond-shaped
glottic opening. Which next assessment question to the parents is most urgent prior to referral?
A. “Has he ever had a sleep study?”
B. “Does he aspirate with thin liquids?”
C. “Any family history of sudden childhood death?”
D. “Has he received all routine immunizations?”
Correct Answer: A
Rationale: Fixed laryngeal anatomy with stridor since infancy suggests congenital laryngeal anomaly
(e.g., laryngomalacia vs posterior laryngeal cleft). Sleep-disordered breathing and hypoxemia are
common; polysomnography quantifies severity and guides surgical planning. Aspiration risk is important
but usually presents with coughing.
A 77-year-old woman is seen 4 days after a fall on her outstretched right hand. She has right-sided
anterior shoulder pain and ecchymosis. Neurovascularly intact. You perform the bulge sign for effusion
and note a fluid wave in the subacromial region. During the empty-can test she experiences pain at 70°
abduction. Rotator-cuff strength is 4/5. Which specific test performed next best clarifies a complete vs
partial tear?
A. Drop-arm test
B. Hawkins-Kennedy test
C. Apprehension test
D. Lift-off test
Correct Answer: A
Rationale: The drop-arm (Codman) test assesses supraspinatus integrity; inability to slowly lower the arm
from 90° to 0° or sudden drop suggests full-thickness tear. Empty-can pain without severe weakness could
indicate partial tear, but drop-arm distinguishes complete disruption.
A 32-year-old primigravida at 28 weeks gestation reports new-onset “racing heart” and occasional cough.
VS: BP 118/76, HR 108 regular, RR 18, O₂ sat 97 % RA. JVP is 4 cm above sternal angle at 45°. Cardiac
auscultation reveals a grade 2/6 systolic ejection murmur at the left sternal border that increases with
inspiration; no diastolic murmur or gallop. Lung fields clear. Lower-extremity pitting edema is 1+. Which
additional bedside finding would most specifically suggest a cardiac rather than physiologic etiology of
her symptoms?
A. Split S1
B. Pulsus paradoxus >12 mmHg
C. Diastolic murmur at apex
D. Carpal tunnel sign
Correct Answer: C
Rationale: A diastolic murmur (e.g., mitral stenosis) is always pathologic and would not occur with
normal pregnancy-induced flow murmur. Physiologic systolic murmurs are common; diastolic are not.
A 44-year-old man with alcohol-use disorder (last drink 36 h ago) presents with acute severe epigastric
pain radiating to the back, nausea, and vomiting. VS: BP 94/60, HR 118, RR 26, temp 38.2 °C. He
appears uncomfortable, leaning forward. Abdomen is rigid with guarding; bowel sounds absent.
Grey-Turner sign is noted. Which single bedside metric obtained during your initial exam best guides
immediate fluid-resuscitation volume?
, A. Passive-leg-raise stroke-volume change by finger plethysmography
B. Urine output via bladder scan
C. Skin-turgor time
D. Capillary refill at knee
Correct Answer: A
Rationale: Passive-leg-raise (PLR)–induced stroke-volume change ≥10 % predicts fluid responsiveness in
hypotensive patients. It is rapid, reversible, and avoids unnecessary fluid in severe pancreatitis where
third-spacing is extreme.
A 69-year-old retired teacher with HTN and DM type 2 is accompanied by his daughter for “increasing
forgetfulness.” MoCA scored 21/30 ( −2 visuospatial/executive, −2 delayed recall, −1 attention, −1
orientation). He is unable to perform serial-7 subtraction but can spell “world” backwards. Which
component of the MoCA most specifically localizes to executive dysfunction within the prefrontal cortex?
A. Alternating trail-making
B. Clock-drawing
C. Phonemic fluency (F-words)
D. Digit span backwards
Correct Answer: A
Rationale: Trail-making (1–A-2-B…) requires set-shifting and is sensitive to dorsolateral prefrontal
lesions. Clock-drawing also involves planning but is more visuospatial; fluency taps language-executive
overlap; digit span assesses working memory.
A 27-year-old woman with systemic lupus erythematosus on prednisone 15 mg daily presents with 2
weeks of fatigue and shortness of breath. VS: afebrile, HR 96, BP 108/68, RR 20, O₂ sat 93 % RA.
Conjunctiva are pale; no icterus. Cardiac exam normal. Lung fields clear. You perform the bedside
nail-bed pulsation test (Quincke sign) and note exaggerated capillary pulsation. Which echocardiographic
parameter described in the report would correlate with your suspected physical finding?
A. Left-ventricular ejection fraction 30 %
B. Moderate pericardial effusion
C. Holodiastolic flow reversal in descending aorta on PW Doppler
D. TAPSE 8 mm
Correct Answer: C
Rationale: Quincke sign (visible capillary pulsation) reflects widened pulse pressure, classically seen in
severe aortic regurgitation. Holodiastolic flow reversal in the descending aorta on pulsed-wave Doppler is
a specific echo sign of significant AR.
A 5-year-old boy is seen for fever (39.2 °C) and refusal to walk since this morning. His mother notes he
cried while holding his right knee 2 days ago but had no known trauma. He had URI symptoms 1 week
ago. He sits with the right knee flexed at 30°. VS: HR 122, BP 90/50, RR 24. Right knee appears mildly
swollen; no erythema. You perform the “squeeze test” (compression of proximal calf) and he winces.
Range of motion is limited by pain. Which priority assessment should you perform next?
A. Passive hip ROM log-roll test
B. Measurement of leg-length discrepancy
B. Anterior drawer of tibia
D. Patellar grind
Correct Answer: A
