NUR 643E Advanced Health Assessment
Final Exam 2026/2027 Actual Exam – 2
Verified Versions (A & B) Questions with
100% Correct Answers and Detailed
Rationales | Graded A+
Version A
Q1 A 68-year-old male presents with progressive short-term memory loss, difficulty finding
words, and trouble managing finances over the past 18 months. On examination, he scores 22/30
on the MoCA with deficits in delayed recall and clock drawing. Which finding is most consistent
with early Alzheimer disease?
Answer: Impaired delayed recall of words and visuospatial deficits on clock drawing test
Rationale: Early Alzheimer disease classically presents with prominent anterograde amnesia
(impaired new learning/delayed recall) and visuospatial/executive dysfunction. Clock drawing is
particularly sensitive for detecting these deficits in mild cognitive impairment transitioning to
dementia.
Q2 During auscultation of heart sounds in a 45-year-old female, the nurse practitioner hears an
extra heart sound immediately after S2 that is best heard at the apex with the bell of the
stethoscope. This finding is most consistent with:
Answer: S3 gallop (ventricular gallop)
Rationale: An S3 is a low-pitched sound occurring early in diastole, best heard at the apex with
the bell in the left lateral decubitus position. It indicates increased ventricular filling pressure and
is commonly associated with heart failure, volume overload, or physiologic states in young
adults.
, Q3 A 32-year-old female presents with fatigue, weight gain, cold intolerance, constipation, and
dry skin. TSH is 12.4 mIU/L (elevated) and free T4 is 0.6 ng/dL (low). Which physical
examination finding is most characteristic of this condition?
Answer: Delayed relaxation phase of deep tendon reflexes
Rationale: In primary hypothyroidism, delayed relaxation of the Achilles reflex (hung-up reflex)
is a classic and relatively specific physical sign due to myxedema affecting muscle relaxation.
Q4 When assessing a patient’s abdomen, the nurse practitioner performs the following
maneuvers in which correct sequence?
Answer: Inspection, auscultation, percussion, palpation
Rationale: Auscultation must be performed before percussion and palpation because those
maneuvers can stimulate bowel sounds and alter the accuracy of auscultation.
Q5 A 55-year-old male with a 40-pack-year smoking history presents with chronic cough and
dyspnea on exertion. On examination, the nurse practitioner notes hyperresonance to percussion
and decreased breath sounds bilaterally. Which finding is most consistent with this presentation?
Answer: Increased anteroposterior diameter of the chest (barrel chest)
Rationale: Barrel chest (increased AP diameter) is a classic sign of chronic obstructive
pulmonary disease (COPD) due to air trapping and hyperinflation of the lungs.
Q6 A 28-year-old female presents with fatigue, heavy menstrual bleeding, and craving ice.
Hemoglobin is 8.1 g/dL, MCV 68 fL, ferritin 5 ng/mL. Which physical examination finding is
most specific for this diagnosis?
Answer: Pallor of conjunctiva and nail beds
Rationale: Pallor of mucous membranes (conjunctiva, nail beds) is highly specific for anemia
when present. Koilonychia (spoon nails) is also characteristic but less common and less
sensitive.
Q7 During cranial nerve assessment, a patient is unable to move the right eye laterally when
asked to look to the right. Which cranial nerve is most likely affected?
Final Exam 2026/2027 Actual Exam – 2
Verified Versions (A & B) Questions with
100% Correct Answers and Detailed
Rationales | Graded A+
Version A
Q1 A 68-year-old male presents with progressive short-term memory loss, difficulty finding
words, and trouble managing finances over the past 18 months. On examination, he scores 22/30
on the MoCA with deficits in delayed recall and clock drawing. Which finding is most consistent
with early Alzheimer disease?
Answer: Impaired delayed recall of words and visuospatial deficits on clock drawing test
Rationale: Early Alzheimer disease classically presents with prominent anterograde amnesia
(impaired new learning/delayed recall) and visuospatial/executive dysfunction. Clock drawing is
particularly sensitive for detecting these deficits in mild cognitive impairment transitioning to
dementia.
Q2 During auscultation of heart sounds in a 45-year-old female, the nurse practitioner hears an
extra heart sound immediately after S2 that is best heard at the apex with the bell of the
stethoscope. This finding is most consistent with:
Answer: S3 gallop (ventricular gallop)
Rationale: An S3 is a low-pitched sound occurring early in diastole, best heard at the apex with
the bell in the left lateral decubitus position. It indicates increased ventricular filling pressure and
is commonly associated with heart failure, volume overload, or physiologic states in young
adults.
, Q3 A 32-year-old female presents with fatigue, weight gain, cold intolerance, constipation, and
dry skin. TSH is 12.4 mIU/L (elevated) and free T4 is 0.6 ng/dL (low). Which physical
examination finding is most characteristic of this condition?
Answer: Delayed relaxation phase of deep tendon reflexes
Rationale: In primary hypothyroidism, delayed relaxation of the Achilles reflex (hung-up reflex)
is a classic and relatively specific physical sign due to myxedema affecting muscle relaxation.
Q4 When assessing a patient’s abdomen, the nurse practitioner performs the following
maneuvers in which correct sequence?
Answer: Inspection, auscultation, percussion, palpation
Rationale: Auscultation must be performed before percussion and palpation because those
maneuvers can stimulate bowel sounds and alter the accuracy of auscultation.
Q5 A 55-year-old male with a 40-pack-year smoking history presents with chronic cough and
dyspnea on exertion. On examination, the nurse practitioner notes hyperresonance to percussion
and decreased breath sounds bilaterally. Which finding is most consistent with this presentation?
Answer: Increased anteroposterior diameter of the chest (barrel chest)
Rationale: Barrel chest (increased AP diameter) is a classic sign of chronic obstructive
pulmonary disease (COPD) due to air trapping and hyperinflation of the lungs.
Q6 A 28-year-old female presents with fatigue, heavy menstrual bleeding, and craving ice.
Hemoglobin is 8.1 g/dL, MCV 68 fL, ferritin 5 ng/mL. Which physical examination finding is
most specific for this diagnosis?
Answer: Pallor of conjunctiva and nail beds
Rationale: Pallor of mucous membranes (conjunctiva, nail beds) is highly specific for anemia
when present. Koilonychia (spoon nails) is also characteristic but less common and less
sensitive.
Q7 During cranial nerve assessment, a patient is unable to move the right eye laterally when
asked to look to the right. Which cranial nerve is most likely affected?
