NURS 5220: ADVANCED HEALTH ASSESSMENT EXAM
300 ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST UPDATE ALREADY
GRADED A+ ASSURED PASS
This comprehensive NURS 5220 exam bank covers 300 unique, multiple-
choice questions spanning advanced health assessment across the lifespan.
The content systematically addresses history-taking, physical examination
techniques, and clinical reasoning for all major body systems. Key focus areas
include differential diagnosis of common presentations such as chest pain,
headaches, and rashes, along with recognition of red-flag findings. Special
populations are emphasized, including pediatric, geriatric, obstetric, and
psychiatric patients. Each question features a detailed rationale explaining
both the correct answer and the clinical reasoning behind incorrect options.
The questions also integrate pharmacology, risk factor identification,
appropriate diagnostic testing, and urgent versus routine management
decisions for advanced practice nursing.
Question 1
A 68-year-old male reports a gradual onset of difficulty starting his urine stream
and a feeling of incomplete bladder emptying. On digital rectal examination, the
prostate is symmetrically enlarged, firm, and non-tender. Which of the following is
the most likely diagnosis?
A) Acute bacterial prostatitis
B) Benign prostatic hyperplasia
C) Prostate cancer
D) Urethral stricture
Answer: B
Rationale: Benign prostatic hyperplasia typically presents in older men with a
gradual onset of lower urinary tract symptoms, including hesitancy and incomplete
emptying. The physical finding of a symmetrically enlarged, firm, non-tender
prostate is classic for BPH. Acute prostatitis would present with a tender, boggy
,prostate and systemic signs. Prostate cancer often presents with a hard, nodular,
asymmetric gland, not a symmetric enlargement. Urethral stricture is less common
and usually results from prior trauma or infection.
Question 2
A 45-year-old woman presents with episodes of severe, unilateral throbbing
headache, accompanied by nausea, vomiting, and photophobia. She reports that the
headaches are preceded by visual disturbances such as flashing lights. What is the
most appropriate initial diagnostic step?
A) Order a non-contrast CT of the head
B) Prescribe sumatriptan and recommend a headache diary
C) Perform a lumbar puncture to rule out meningitis
D) Order an MRI of the brain with contrast
Answer: B
Rationale: The presentation is classic for migraine with aura. In a patient with a
typical history and no concerning features like sudden onset or neurologic deficits,
the most appropriate initial step is symptomatic treatment and lifestyle
documentation. Neuroimaging is not routinely indicated for classic migraines
without red flags. A lumbar puncture is for suspected infection or subarachnoid
hemorrhage, not typical migraines.
Question 3
During a cardiovascular examination, you palpate the point of maximal impulse
(PMI) at the fifth intercostal space, midclavicular line. Which of the following best
describes this finding?
A) Normal finding
B) Left ventricular hypertrophy
C) Dextrocardia
D) Pericardial effusion
Answer: A
Rationale: The normal PMI is located at the fifth intercostal space in the
midclavicular line. A displaced PMI can indicate left ventricular hypertrophy or
dilation, while a PMI that is not palpable may suggest obesity, emphysema, or
pericardial effusion. Dextrocardia would place the PMI on the right side.
Question 4
A 72-year-old patient with a history of hypertension reports a new onset of a non-
productive cough and hoarseness. On auscultation, you hear a high-pitched,
monophonic wheeze that is louder during expiration. Which of the following is the
most likely cause?
,A) Asthma exacerbation
B) Foreign body aspiration
C) Left-sided heart failure
D) Bronchogenic carcinoma
Answer: D
Rationale: A fixed, monophonic wheeze, especially when associated with
hoarseness and a non-productive cough in an older patient, raises concern for an
endobronchial obstruction, such as a tumor. Asthma typically presents with
polyphonic, bilateral wheezing. Foreign body aspiration is more acute. Left-sided
heart failure often presents with crackles and orthopnea.
Question 5
A 23-year-old college student presents with a sore throat, fever, and fatigue. On
examination, you note pharyngeal erythema, tonsillar exudate, and tender anterior
cervical lymphadenopathy. There is no cough. What is the most important
diagnostic test to order?
A) Rapid antigen detection test for Group A Streptococcus
B) Complete blood count with differential
C) Monospot test for Epstein-Barr virus
D) Throat culture for fungal organisms
Answer: A
Rationale: The Centor criteria (fever, tonsillar exudate, tender anterior cervical
adenopathy, absence of cough) strongly suggest streptococcal pharyngitis. A rapid
antigen detection test is the most appropriate initial test to confirm Group A
Streptococcus so that antibiotics can be started. A Monospot test is for infectious
mononucleosis, which typically presents with posterior cervical adenopathy,
splenomegaly, and fatigue, but the primary consideration here is bacterial.
Question 6
A 55-year-old male with a history of smoking presents with a painful, red, swollen
right great toe. He denies any trauma. The joint is warm and tender to touch. What
is the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
Answer: C
Rationale: The acute onset of a painful, swollen, red great toe (podagra) is classic
for gout. This is caused by monosodium urate crystal deposition. Rheumatoid
arthritis usually involves multiple joints symmetrically. Osteoarthritis is chronic
, and degenerative. Septic arthritis is a possibility but is more common in the knee
and usually involves systemic signs.
Question 7
A 30-year-old woman complains of double vision that is worse when she looks to
the left. On examination, you note that her left eye does not abduct past the
midline. What is the most likely cranial nerve involved?
A) Cranial nerve III (Oculomotor)
B) Cranial nerve IV (Trochlear)
C) Cranial nerve VI (Abducens)
D) Cranial nerve II (Optic)
Answer: C
Rationale: Cranial nerve VI innervates the lateral rectus muscle, which abducts the
eye. A failure of abduction indicates a CN VI palsy. CN III palsy causes the eye to
be "down and out" with ptosis and pupillary dilation. CN IV palsy affects
downward gaze, especially during adduction. CN II affects vision, not eye
movement.
Question 8
A 62-year-old female with type 2 diabetes presents for a routine examination.
Fundoscopic examination reveals microaneurysms, dot-blot hemorrhages, and hard
exudates in the retina. What is the most appropriate next step?
A) Refer to ophthalmology for a dilated eye exam
B) Reassure the patient that these are normal age-related changes
C) Start the patient on aspirin to prevent retinal vein occlusion
D) Order a carotid ultrasound to check for stenosis
Answer: A
Rationale: The fundoscopic findings are classic for non-proliferative diabetic
retinopathy. Diabetic patients require annual dilated eye exams to monitor for
progression, and any signs of retinopathy warrant prompt ophthalmology referral.
These are not normal changes. Aspirin does not treat retinopathy, and carotid
ultrasound is not indicated for retinal findings.
Question 9
On abdominal examination of a 40-year-old male, you note a bluish discoloration
around the umbilicus. What is the name of this sign and its significance?
A) Grey-Turner sign, indicating retroperitoneal hemorrhage
B) Cullen's sign, indicating intra-abdominal hemorrhage
C) Murphy's sign, indicating cholecystitis
D) McBurney's sign, indicating appendicitis
300 ACTUAL QUESTIONS AND CORRECT ANSWERS
WITH RATIONALE LATEST UPDATE ALREADY
GRADED A+ ASSURED PASS
This comprehensive NURS 5220 exam bank covers 300 unique, multiple-
choice questions spanning advanced health assessment across the lifespan.
The content systematically addresses history-taking, physical examination
techniques, and clinical reasoning for all major body systems. Key focus areas
include differential diagnosis of common presentations such as chest pain,
headaches, and rashes, along with recognition of red-flag findings. Special
populations are emphasized, including pediatric, geriatric, obstetric, and
psychiatric patients. Each question features a detailed rationale explaining
both the correct answer and the clinical reasoning behind incorrect options.
The questions also integrate pharmacology, risk factor identification,
appropriate diagnostic testing, and urgent versus routine management
decisions for advanced practice nursing.
Question 1
A 68-year-old male reports a gradual onset of difficulty starting his urine stream
and a feeling of incomplete bladder emptying. On digital rectal examination, the
prostate is symmetrically enlarged, firm, and non-tender. Which of the following is
the most likely diagnosis?
A) Acute bacterial prostatitis
B) Benign prostatic hyperplasia
C) Prostate cancer
D) Urethral stricture
Answer: B
Rationale: Benign prostatic hyperplasia typically presents in older men with a
gradual onset of lower urinary tract symptoms, including hesitancy and incomplete
emptying. The physical finding of a symmetrically enlarged, firm, non-tender
prostate is classic for BPH. Acute prostatitis would present with a tender, boggy
,prostate and systemic signs. Prostate cancer often presents with a hard, nodular,
asymmetric gland, not a symmetric enlargement. Urethral stricture is less common
and usually results from prior trauma or infection.
Question 2
A 45-year-old woman presents with episodes of severe, unilateral throbbing
headache, accompanied by nausea, vomiting, and photophobia. She reports that the
headaches are preceded by visual disturbances such as flashing lights. What is the
most appropriate initial diagnostic step?
A) Order a non-contrast CT of the head
B) Prescribe sumatriptan and recommend a headache diary
C) Perform a lumbar puncture to rule out meningitis
D) Order an MRI of the brain with contrast
Answer: B
Rationale: The presentation is classic for migraine with aura. In a patient with a
typical history and no concerning features like sudden onset or neurologic deficits,
the most appropriate initial step is symptomatic treatment and lifestyle
documentation. Neuroimaging is not routinely indicated for classic migraines
without red flags. A lumbar puncture is for suspected infection or subarachnoid
hemorrhage, not typical migraines.
Question 3
During a cardiovascular examination, you palpate the point of maximal impulse
(PMI) at the fifth intercostal space, midclavicular line. Which of the following best
describes this finding?
A) Normal finding
B) Left ventricular hypertrophy
C) Dextrocardia
D) Pericardial effusion
Answer: A
Rationale: The normal PMI is located at the fifth intercostal space in the
midclavicular line. A displaced PMI can indicate left ventricular hypertrophy or
dilation, while a PMI that is not palpable may suggest obesity, emphysema, or
pericardial effusion. Dextrocardia would place the PMI on the right side.
Question 4
A 72-year-old patient with a history of hypertension reports a new onset of a non-
productive cough and hoarseness. On auscultation, you hear a high-pitched,
monophonic wheeze that is louder during expiration. Which of the following is the
most likely cause?
,A) Asthma exacerbation
B) Foreign body aspiration
C) Left-sided heart failure
D) Bronchogenic carcinoma
Answer: D
Rationale: A fixed, monophonic wheeze, especially when associated with
hoarseness and a non-productive cough in an older patient, raises concern for an
endobronchial obstruction, such as a tumor. Asthma typically presents with
polyphonic, bilateral wheezing. Foreign body aspiration is more acute. Left-sided
heart failure often presents with crackles and orthopnea.
Question 5
A 23-year-old college student presents with a sore throat, fever, and fatigue. On
examination, you note pharyngeal erythema, tonsillar exudate, and tender anterior
cervical lymphadenopathy. There is no cough. What is the most important
diagnostic test to order?
A) Rapid antigen detection test for Group A Streptococcus
B) Complete blood count with differential
C) Monospot test for Epstein-Barr virus
D) Throat culture for fungal organisms
Answer: A
Rationale: The Centor criteria (fever, tonsillar exudate, tender anterior cervical
adenopathy, absence of cough) strongly suggest streptococcal pharyngitis. A rapid
antigen detection test is the most appropriate initial test to confirm Group A
Streptococcus so that antibiotics can be started. A Monospot test is for infectious
mononucleosis, which typically presents with posterior cervical adenopathy,
splenomegaly, and fatigue, but the primary consideration here is bacterial.
Question 6
A 55-year-old male with a history of smoking presents with a painful, red, swollen
right great toe. He denies any trauma. The joint is warm and tender to touch. What
is the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
Answer: C
Rationale: The acute onset of a painful, swollen, red great toe (podagra) is classic
for gout. This is caused by monosodium urate crystal deposition. Rheumatoid
arthritis usually involves multiple joints symmetrically. Osteoarthritis is chronic
, and degenerative. Septic arthritis is a possibility but is more common in the knee
and usually involves systemic signs.
Question 7
A 30-year-old woman complains of double vision that is worse when she looks to
the left. On examination, you note that her left eye does not abduct past the
midline. What is the most likely cranial nerve involved?
A) Cranial nerve III (Oculomotor)
B) Cranial nerve IV (Trochlear)
C) Cranial nerve VI (Abducens)
D) Cranial nerve II (Optic)
Answer: C
Rationale: Cranial nerve VI innervates the lateral rectus muscle, which abducts the
eye. A failure of abduction indicates a CN VI palsy. CN III palsy causes the eye to
be "down and out" with ptosis and pupillary dilation. CN IV palsy affects
downward gaze, especially during adduction. CN II affects vision, not eye
movement.
Question 8
A 62-year-old female with type 2 diabetes presents for a routine examination.
Fundoscopic examination reveals microaneurysms, dot-blot hemorrhages, and hard
exudates in the retina. What is the most appropriate next step?
A) Refer to ophthalmology for a dilated eye exam
B) Reassure the patient that these are normal age-related changes
C) Start the patient on aspirin to prevent retinal vein occlusion
D) Order a carotid ultrasound to check for stenosis
Answer: A
Rationale: The fundoscopic findings are classic for non-proliferative diabetic
retinopathy. Diabetic patients require annual dilated eye exams to monitor for
progression, and any signs of retinopathy warrant prompt ophthalmology referral.
These are not normal changes. Aspirin does not treat retinopathy, and carotid
ultrasound is not indicated for retinal findings.
Question 9
On abdominal examination of a 40-year-old male, you note a bluish discoloration
around the umbilicus. What is the name of this sign and its significance?
A) Grey-Turner sign, indicating retroperitoneal hemorrhage
B) Cullen's sign, indicating intra-abdominal hemorrhage
C) Murphy's sign, indicating cholecystitis
D) McBurney's sign, indicating appendicitis
