Advanced Health Assessment Midterm Review– Quiz
Questions | Nursing Program | Graded A comprehensive
review.
INTRODUCTION:
This Advanced Health Assessment Midterm Review is designed for graduate-level nursing students and Nurse
Practitioner candidates to assess and reinforce core competencies for the midterm examination. The quiz
questions reflect a "GRADED A" standard, requiring synthesis of anatomy, physiology, pathophysiology, and
clinical reasoning. Content covers comprehensive health history techniques, advanced physical examination skills
across body systems, diagnostic reasoning, and evidence
-based assessment findings.se
U this review to identify
knowledge gaps and refine clinical judgment in patient assessment.
QUIZ QUESTIONS (100 TOTAL):
1. During a cardiovascular assessment, you auscultate -pitched,
a high blowing decrescendo diastolic murmur best
heard at the left 3rd intercostal space. This finding is most indicative of:
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
Answer: D
Rationale: A high -pitched, blowing decrescendo diastolic murmur at the left 3rd intercostal space (Erb's point) is
classic for aortic regurgitation. The murmur begins with S2 as blood flows back into the left ventricle during
diastole. Mitral stenosis (A) produces a diastolic rumble. Aortic stenosis (B) is a systolic murmur. Mitral
regurgitation (C) is a holosystolic murmur.
2. A 55-year-old patient presents with unilateral pulsatile tinnitus and hearing loss. Otoscopic examination reveals
a reddish-blue mass behind the tympanic membrane. The most appropriate initial action is:
A. Prescribe a course of oral steroids
B. Schedule an audiogram in-64weeks
C. Immediately refer to Otolaryngology for further evaluation
D. Perform pneumatic otoscopy to assess mobility
Answer: C
,Rationale: This presentation is classic for a glomus tympanicum tumor (a vascular middle ear tumor). Immediate
referral to Otolaryngology is warranted due to the risk of hemorrhage and the need for diagnostic imaging
(CT/MRI). Manipulation (D) could cause bleeding. Steroids (A) or delay (B) are inappropriate for this potentially
serious vascular lesion.
3. When assessing for asterixis (liver flap) in a patient with suspected hepatic encephalopathy, the correct
technique is to have the patient:
A. Extend their arms and spread their fingers wide
B. Flex their wrists and hyperextend their fingers
C. Pronate their forearms on a flat surface
D. Tap their thumb rapidly against each fingertip
Answer: B
Rationale: Asterixis is assessed by having the patient extend their arms, flex their wrists, and hyperextend their
fingers ("stop traffic" position). The characteristic irregular, flapping tremor is seen as the patient maintains this
posture. This technique specifically elicits the metabolic tremor associated with hepatic, renal, or CO2
encephalopathy.
4. A 62-year-old patient reports progressive dysphagia to solids initially, then liquids. Barium swallow shows a
"bird's beak" appearance at the gastroesophageal junction. This finding is pathognomonic for:
A. Esophageal stricture secondary to reflux
B. Achalasia
C. Diffuse esophageal spasm
D. Zenker's diverticulum
Answer: B
Rationale: The "bird's beak" or "rat tail" appearance on barium swallow is pathognomonic for achalasia, caused
by failure of the lower esophageal sphincter to relax due to loss of inhibitory neurons. Progressive dysphagia to
solids then liquids (vs. solids
only in mechanical obstruction) supports this neuromuscular disorder. Manometry
confirms the diagnosis.
5. During percussion of the posterior chest, you note a dullness that persists when the patient changes from sitting
to supine position. This finding most likely represents:
A. Pleural effusion
B. Consolidation
C. Atelectasis
,D. Pneumothorax
Answer: A
Rationale: Pleural effusion produces dullness to percussion that remains dependent (shifts with gravity).
Consolidation (B) and atelectasis (C) typically remain fixed in location regardless of position. Pneumothorax (D)
produces hyperresonance. The shiftin
g dullness test helps differentiate free fluid from parenchymal disease.
6. When assessing a patient with suspected temporal arteritis, the most critical question to ask during the history
is:
A. "Have you noticed any joint swelling in your knees?"
B. "Have you experienced any sudden vision changes or jaw pain when chewing?"
C. "Do you have a family history of migraines?"
D. "Have you noticed any skin rashes on your trunk?"
Answer: B
Rationale: Jaw claudication (pain with chewing) and visual disturbances (amaurosis fugax, diplopia) are ischemic
symptoms requiring immediate intervention to prevent irreversible blindness. Temporal arteritis is a medical
emergency; prompt recognition of hese
t symptoms guides immediate corticosteroid therapy and temporal artery
biopsy.
7. A patient exhibits a positive Trendelenburg sign when standing on the right leg. This indicates weakness of the:
A. Right gluteus medius
B. Left gluteus medius
C. Right gluteus maximus
D. Left hip adductors
Answer: A
Rationale: The Trendelenburg sign indicates weakness of the hip abductors (primarily gluteus medius) on the
weight-bearing side. When standing on the right leg, if the left pelvis drops, it signifies right gluteus medius
weakness. This is crucial for asses
sing hip stability and gait abnormalities.
8. During fundoscopic examination, you observe cotton -wool spots, flame-shaped hemorrhages, and hard
exudates in a "macular star" pattern. These findings are most consistent with:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Papilledema
, D. Retinal detachment
Answer: B
Rationale: The combination of cotton
-wool spots (ischemic infarcts), flame
-shaped hemorrhages (nerve fiber
layer bleeding), and hard exudates forming a macular star is characteristic of-4
Grade
hypertensive
3 retinopathy.
Diabetic retinopathy (A) features
microaneurysms and dot-blot hemorrhages primarily.
9. A 45-year-old patient presents with acute unilateral facial droop involving the forehead, inability to close the
eye, and hyperacusis. Taste is diminished anteriorly on the tongue. These findings localize the lesion to:
A. Upper motor neuron facial pathway
B. Facial nerve distal to the chorda tympani
C. Facial nerve proximal to the chorda tympani at the geniculate ganglion
D. Trigeminal nerve mandibular branch
Answer: C
Rationale: Involvement of lacrimation (eye closure), stapedius (hyperacusis), and taste (chorda tympani)
indicates a facial nerve lesion proximal to the geniculate ganglion (Bell's palsy). Upper motor neuron lesions (A)
spare the forehead. Distal lesions
B) would
( spare taste and hyperacusis.
10. When performing the Lachman test on a patient's knee, you observe significant anterior translation of the
tibia relative to the femur with a soft endpoint. This finding confirms:
A. Posterior cruciate ligament tear
B. Anterior cruciate ligament tear
C. Medial meniscus tear
D. Medial collateral ligament tear
Answer: B
Rationale: The Lachman test is the most sensitive examination for ACL integrity (>95% sensitivity). Anterior
tibial translation with a soft endpoint indicates complete ACL disruption. The PCL (A) is tested with the posterior
drawer test. Meniscal tears (C)produce joint line tenderness and positive McMurray test.
11. A patient with chronic obstructive pulmonary disease exhibits pursed -lip breathing. The primary
physiological benefit of this technique is:
A. Increasing respiratory rate to improve minute ventilation
B. Creating positive end
-expiratory pressure to prevent airway collapse
C. Maximizing inspiratory volume through nasal resistance
Questions | Nursing Program | Graded A comprehensive
review.
INTRODUCTION:
This Advanced Health Assessment Midterm Review is designed for graduate-level nursing students and Nurse
Practitioner candidates to assess and reinforce core competencies for the midterm examination. The quiz
questions reflect a "GRADED A" standard, requiring synthesis of anatomy, physiology, pathophysiology, and
clinical reasoning. Content covers comprehensive health history techniques, advanced physical examination skills
across body systems, diagnostic reasoning, and evidence
-based assessment findings.se
U this review to identify
knowledge gaps and refine clinical judgment in patient assessment.
QUIZ QUESTIONS (100 TOTAL):
1. During a cardiovascular assessment, you auscultate -pitched,
a high blowing decrescendo diastolic murmur best
heard at the left 3rd intercostal space. This finding is most indicative of:
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
Answer: D
Rationale: A high -pitched, blowing decrescendo diastolic murmur at the left 3rd intercostal space (Erb's point) is
classic for aortic regurgitation. The murmur begins with S2 as blood flows back into the left ventricle during
diastole. Mitral stenosis (A) produces a diastolic rumble. Aortic stenosis (B) is a systolic murmur. Mitral
regurgitation (C) is a holosystolic murmur.
2. A 55-year-old patient presents with unilateral pulsatile tinnitus and hearing loss. Otoscopic examination reveals
a reddish-blue mass behind the tympanic membrane. The most appropriate initial action is:
A. Prescribe a course of oral steroids
B. Schedule an audiogram in-64weeks
C. Immediately refer to Otolaryngology for further evaluation
D. Perform pneumatic otoscopy to assess mobility
Answer: C
,Rationale: This presentation is classic for a glomus tympanicum tumor (a vascular middle ear tumor). Immediate
referral to Otolaryngology is warranted due to the risk of hemorrhage and the need for diagnostic imaging
(CT/MRI). Manipulation (D) could cause bleeding. Steroids (A) or delay (B) are inappropriate for this potentially
serious vascular lesion.
3. When assessing for asterixis (liver flap) in a patient with suspected hepatic encephalopathy, the correct
technique is to have the patient:
A. Extend their arms and spread their fingers wide
B. Flex their wrists and hyperextend their fingers
C. Pronate their forearms on a flat surface
D. Tap their thumb rapidly against each fingertip
Answer: B
Rationale: Asterixis is assessed by having the patient extend their arms, flex their wrists, and hyperextend their
fingers ("stop traffic" position). The characteristic irregular, flapping tremor is seen as the patient maintains this
posture. This technique specifically elicits the metabolic tremor associated with hepatic, renal, or CO2
encephalopathy.
4. A 62-year-old patient reports progressive dysphagia to solids initially, then liquids. Barium swallow shows a
"bird's beak" appearance at the gastroesophageal junction. This finding is pathognomonic for:
A. Esophageal stricture secondary to reflux
B. Achalasia
C. Diffuse esophageal spasm
D. Zenker's diverticulum
Answer: B
Rationale: The "bird's beak" or "rat tail" appearance on barium swallow is pathognomonic for achalasia, caused
by failure of the lower esophageal sphincter to relax due to loss of inhibitory neurons. Progressive dysphagia to
solids then liquids (vs. solids
only in mechanical obstruction) supports this neuromuscular disorder. Manometry
confirms the diagnosis.
5. During percussion of the posterior chest, you note a dullness that persists when the patient changes from sitting
to supine position. This finding most likely represents:
A. Pleural effusion
B. Consolidation
C. Atelectasis
,D. Pneumothorax
Answer: A
Rationale: Pleural effusion produces dullness to percussion that remains dependent (shifts with gravity).
Consolidation (B) and atelectasis (C) typically remain fixed in location regardless of position. Pneumothorax (D)
produces hyperresonance. The shiftin
g dullness test helps differentiate free fluid from parenchymal disease.
6. When assessing a patient with suspected temporal arteritis, the most critical question to ask during the history
is:
A. "Have you noticed any joint swelling in your knees?"
B. "Have you experienced any sudden vision changes or jaw pain when chewing?"
C. "Do you have a family history of migraines?"
D. "Have you noticed any skin rashes on your trunk?"
Answer: B
Rationale: Jaw claudication (pain with chewing) and visual disturbances (amaurosis fugax, diplopia) are ischemic
symptoms requiring immediate intervention to prevent irreversible blindness. Temporal arteritis is a medical
emergency; prompt recognition of hese
t symptoms guides immediate corticosteroid therapy and temporal artery
biopsy.
7. A patient exhibits a positive Trendelenburg sign when standing on the right leg. This indicates weakness of the:
A. Right gluteus medius
B. Left gluteus medius
C. Right gluteus maximus
D. Left hip adductors
Answer: A
Rationale: The Trendelenburg sign indicates weakness of the hip abductors (primarily gluteus medius) on the
weight-bearing side. When standing on the right leg, if the left pelvis drops, it signifies right gluteus medius
weakness. This is crucial for asses
sing hip stability and gait abnormalities.
8. During fundoscopic examination, you observe cotton -wool spots, flame-shaped hemorrhages, and hard
exudates in a "macular star" pattern. These findings are most consistent with:
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Papilledema
, D. Retinal detachment
Answer: B
Rationale: The combination of cotton
-wool spots (ischemic infarcts), flame
-shaped hemorrhages (nerve fiber
layer bleeding), and hard exudates forming a macular star is characteristic of-4
Grade
hypertensive
3 retinopathy.
Diabetic retinopathy (A) features
microaneurysms and dot-blot hemorrhages primarily.
9. A 45-year-old patient presents with acute unilateral facial droop involving the forehead, inability to close the
eye, and hyperacusis. Taste is diminished anteriorly on the tongue. These findings localize the lesion to:
A. Upper motor neuron facial pathway
B. Facial nerve distal to the chorda tympani
C. Facial nerve proximal to the chorda tympani at the geniculate ganglion
D. Trigeminal nerve mandibular branch
Answer: C
Rationale: Involvement of lacrimation (eye closure), stapedius (hyperacusis), and taste (chorda tympani)
indicates a facial nerve lesion proximal to the geniculate ganglion (Bell's palsy). Upper motor neuron lesions (A)
spare the forehead. Distal lesions
B) would
( spare taste and hyperacusis.
10. When performing the Lachman test on a patient's knee, you observe significant anterior translation of the
tibia relative to the femur with a soft endpoint. This finding confirms:
A. Posterior cruciate ligament tear
B. Anterior cruciate ligament tear
C. Medial meniscus tear
D. Medial collateral ligament tear
Answer: B
Rationale: The Lachman test is the most sensitive examination for ACL integrity (>95% sensitivity). Anterior
tibial translation with a soft endpoint indicates complete ACL disruption. The PCL (A) is tested with the posterior
drawer test. Meniscal tears (C)produce joint line tenderness and positive McMurray test.
11. A patient with chronic obstructive pulmonary disease exhibits pursed -lip breathing. The primary
physiological benefit of this technique is:
A. Increasing respiratory rate to improve minute ventilation
B. Creating positive end
-expiratory pressure to prevent airway collapse
C. Maximizing inspiratory volume through nasal resistance
