GCU NUR 634 Midterm Exam Study Bank
Grand Canyon University — Advanced Health Assessment & Diagnostic Reasoning (Questions & Key)
--- Section: Comprehensive Health History & Clinical Interviewing ---
Question 1: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 2: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
Question 3: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 4: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the cardiac
apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology does
this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
, position using the bell of the stethoscope.
Question 5: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is positive when deep palpation in the left lower quadrant elicits pain in the right lower
quadrant, indicating peritoneal irritation associated with appendicitis.
Question 6: An APRN tests a patient's cranial nerves. Asking the patient to puff out their cheeks, smile,
frown, and raise their eyebrows evaluates the integrity of which cranial nerve?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN IX (Glossopharyngeal)
D. CN XII (Hypoglossal)
Correct Answer: B. CN VII (Facial)
Rationale: Cranial Nerve VII (Facial) controls motor function of the muscles of facial expression, tested by smiling,
frowning, puffing cheeks, and raising eyebrows.
Question 7: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 8: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
,Question 9: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 10: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the
cardiac apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology
does this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
position using the bell of the stethoscope.
Question 11: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is positive when deep palpation in the left lower quadrant elicits pain in the right lower
quadrant, indicating peritoneal irritation associated with appendicitis.
Question 12: An APRN tests a patient's cranial nerves. Asking the patient to puff out their cheeks, smile,
frown, and raise their eyebrows evaluates the integrity of which cranial nerve?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN IX (Glossopharyngeal)
D. CN XII (Hypoglossal)
Correct Answer: B. CN VII (Facial)
Rationale: Cranial Nerve VII (Facial) controls motor function of the muscles of facial expression, tested by smiling,
frowning, puffing cheeks, and raising eyebrows.
Question 13: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
, C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 14: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
Question 15: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 16: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the
cardiac apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology
does this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
position using the bell of the stethoscope.
Question 17: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
Grand Canyon University — Advanced Health Assessment & Diagnostic Reasoning (Questions & Key)
--- Section: Comprehensive Health History & Clinical Interviewing ---
Question 1: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 2: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
Question 3: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 4: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the cardiac
apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology does
this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
, position using the bell of the stethoscope.
Question 5: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is positive when deep palpation in the left lower quadrant elicits pain in the right lower
quadrant, indicating peritoneal irritation associated with appendicitis.
Question 6: An APRN tests a patient's cranial nerves. Asking the patient to puff out their cheeks, smile,
frown, and raise their eyebrows evaluates the integrity of which cranial nerve?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN IX (Glossopharyngeal)
D. CN XII (Hypoglossal)
Correct Answer: B. CN VII (Facial)
Rationale: Cranial Nerve VII (Facial) controls motor function of the muscles of facial expression, tested by smiling,
frowning, puffing cheeks, and raising eyebrows.
Question 7: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 8: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
,Question 9: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 10: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the
cardiac apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology
does this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
position using the bell of the stethoscope.
Question 11: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
Rationale: Rovsing's sign is positive when deep palpation in the left lower quadrant elicits pain in the right lower
quadrant, indicating peritoneal irritation associated with appendicitis.
Question 12: An APRN tests a patient's cranial nerves. Asking the patient to puff out their cheeks, smile,
frown, and raise their eyebrows evaluates the integrity of which cranial nerve?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN IX (Glossopharyngeal)
D. CN XII (Hypoglossal)
Correct Answer: B. CN VII (Facial)
Rationale: Cranial Nerve VII (Facial) controls motor function of the muscles of facial expression, tested by smiling,
frowning, puffing cheeks, and raising eyebrows.
Question 13: When obtaining a comprehensive history from an adult patient presenting with a new
complaint of acute chest tightness, which component of the clinical interview is essential for structuring
the present illness narrative?
A. Family history of chronic illness
B. OLDCARTS / OPQRST framework for symptom characterization
, C. CAGE questionnaire screening
D. Review of past surgical procedures
Correct Answer: B. OLDCARTS / OPQRST framework for symptom characterization
Rationale: The OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation,
Timing, Severity) or OPQRST framework provides a systematic structure to evaluate Chief Complaints and History of
Present Illness (HPI).
Question 14: When performing an ophthalmoscopic exam on a patient presenting with hypertension, the
advanced practice registered nurse (APRN) notes arteriolar narrowing, copper wiring, and AV nicking.
These physical findings are characteristic of:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Age-related macular degeneration
D. Open-angle glaucoma
Correct Answer: B. Hypertensive retinopathy
Rationale: Hypertensive retinopathy is characterized on fundoscopic exam by vascular changes including focal
arteriolar narrowing, copper/silver wiring, AV nicking, cotton wool spots, and flame hemorrhages.
Question 15: During thoracic percussion on a patient experiencing an acute asthma exacerbation with
severe air trapping, which percussion note is expected over the hyperinflated lung fields?
A. Dullness
B. Tympany
C. Hyperresonance
D. Flatness
Correct Answer: C. Hyperresonance
Rationale: Hyperresonance is a hyper-resonant, booming sound heard over areas of hyperinflated lung tissue, such
as in acute asthma attacks or emphysema.
Question 16: An APRN auscultates a low-pitched, mid-diastolic rumbling murmur heard best at the
cardiac apex in the left lateral decubitus position with the bell of the stethoscope. Which valve pathology
does this indicate?
A. Aortic stenosis
B. Mitral stenosis
C. Mitral regurgitation
D. Pulmonic regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis produces a low-pitched, diastolic rumble heard best at the apex in the left lateral decubitus
position using the bell of the stethoscope.
Question 17: Which examination technique is evaluated by pressing deeply in the left lower quadrant and
observing whether the patient experiences referred pain in the right lower quadrant, indicating acute
appendicitis?
A. Psoas sign
B. Obturator sign
C. Rovsing's sign
D. Blumberg's sign
Correct Answer: C. Rovsing's sign
