UNIVERSITY OF CENTRAL FLORIDA
NUR3065 HEALTH ASSESSMENT
MIDTERM EXAM PRACTICE
2026
A nurse is performing a comprehensive physical assessment on a 62-year-old male with a 40
pack-year smoking history who presents with a chronic productive cough, barrel chest, and
dyspnea on exertion. On auscultation, the nurse notes prolonged expiratory phase and
diffuse expiratory wheezing. Percussion of the thorax reveals hyperresonance throughout all
lung fields. Which pathophysiological mechanism most accurately explains the hyperresonant
percussion note in this patient?
A) Consolidation of lung tissue with fluid-filled alveoli B) Air trapping and hyperinflation of
alveoli due to loss of elastic recoil C) Pleural effusion compressing underlying lung tissue D)
Atelectasis with collapse of alveolar units
Correct Answer: B
Rationale: Hyperresonance on percussion indicates increased air relative to tissue density, which
occurs in conditions like emphysema and pneumothorax. In COPD with an emphysematous
component, destruction of alveolar walls (loss of elastic recoil) leads to air trapping and
hyperinflation. This increases the ratio of air to tissue, producing a hyperresonant or tympanic
percussion note. Consolidation and pleural effusion produce dullness on percussion. Atelectasis
produces flatness. The barrel chest configuration (increased AP-to-lateral diameter ratio greater
than 1:1) and prolonged expiration are hallmark findings of obstructive lung disease that nurses
at UCF clinical affiliates are expected to recognize and document accurately.
A nurse is assessing a 71-year-old woman admitted with new-onset confusion and urinary
incontinence. Her vital signs are: BP 138/86 mmHg, HR 88 bpm, RR 18 breaths/min, Temp
38.1°C. Her family reports she was independent at baseline two days ago. During the Mini-
Mental State Examination (MMSE), she scores 18/30. She is oriented to person only and
cannot recall three objects after five minutes. Which type of cognitive alteration does this
presentation most likely represent, and what is the most critical differentiating feature?
A) Dementia; characterized by gradual progressive onset over months to years B) Delirium;
characterized by acute onset with fluctuating course and identifiable precipitating cause C)
Depression-related pseudodementia; characterized by subjective memory complaints without
objective deficits D) Mild cognitive impairment; characterized by preserved functional
independence
Correct Answer: B
Rationale: The hallmark feature distinguishing delirium from dementia is the acuity and
fluctuating nature of the cognitive change. This patient was functionally independent 48 hours
ago and now presents with disorientation, memory impairment, and incontinence, strongly
suggesting delirium with a likely precipitant such as urinary tract infection (fever, new
incontinence). The Confusion Assessment Method (CAM) criteria for delirium requires: acute
onset and fluctuating course, inattention, and either disorganized thinking or altered level of
,consciousness. Dementia is insidious and progressive. Nurses must differentiate these
presentations because delirium signals an underlying medical emergency requiring immediate
investigation, while dementia management is long-term.
A nurse auscultates a patient's heart and identifies a high-pitched, blowing, holosystolic
murmur heard best at the cardiac apex with radiation to the left axilla. The patient has a
history of rheumatic fever. Which valvular abnormality does this murmur most likely
represent, and at which auscultation site is it best heard?
A) Aortic stenosis; heard best at the second right intercostal space, right sternal border B)
Mitral regurgitation; heard best at the fifth intercostal space, midclavicular line (mitral area) C)
Tricuspid stenosis; heard best at the fourth intercostal space, left sternal border D) Pulmonic
regurgitation; heard best at the second left intercostal space
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur because blood
regurgitates through the incompetent mitral valve throughout the entire systolic phase when
left ventricular pressure exceeds left atrial pressure. It is heard best at the apex (fifth ICS,
midclavicular line) and classically radiates to the left axilla due to the direction of the
regurgitant jet. Rheumatic fever is the most common cause of mitral valve disease globally.
Aortic stenosis produces a crescendo-decrescendo (diamond-shaped) systolic murmur heard at
the right second ICS with radiation to the carotids. Nurses must be able to characterize murmurs
by timing, quality, intensity (Levine scale 1 to 6), location, and radiation.
During an abdominal assessment of a 45-year-old male with a history of alcohol use disorder,
the nurse observes abdominal distension with a protruding umbilicus and visible abdominal
veins radiating outward from the umbilicus. Percussion reveals shifting dullness, and the fluid
wave test is positive. Which condition do these findings collectively indicate, and what is the
correct order of abdominal assessment techniques the nurse should have used?
A) Bowel obstruction; inspect, percuss, auscultate, palpate B) Ascites due to portal
hypertension; inspect, auscultate, percuss, palpate C) Peritonitis; inspect, palpate, percuss,
auscultate D) Hepatomegaly; inspect, auscultate, palpate, percuss
Correct Answer: B
Rationale: The combination of abdominal distension, caput medusae (venous dilation radiating
from umbilicus indicating portal hypertension), shifting dullness, and a positive fluid wave test
confirms the presence of ascites, a complication of portal hypertension caused by cirrhosis from
chronic alcohol use. The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and palpation. This order differs from other body systems because palpation and
percussion stimulate bowel motility and can alter bowel sounds if performed before
auscultation. UCF nursing students are expected to demonstrate this modified sequence during
physical assessment laboratory examinations and clinical practicums.
A nurse is assessing a 58-year-old female with type 2 diabetes during her annual wellness
visit. On fundoscopic examination performed by the provider, soft exudates (cotton-wool
spots), flame-shaped hemorrhages, and arteriovenous nicking are noted. The nurse correlates
these findings with which systemic condition, and what do AV nicking specifically indicate
about the vasculature?
A) Hypothyroidism; indicating edema within the optic disk B) Hypertensive retinopathy;
indicating arterial wall thickening compressing crossing venous vessels C) Glaucoma; indicating
,increased intraocular pressure compressing the optic nerve D) Diabetic macular degeneration;
indicating ischemia of the macula specifically
Correct Answer: B
Rationale: AV nicking (or nipping) is a hallmark sign of longstanding hypertension where
thickened, sclerotic arteriolar walls compress the underlying venous vessel at arteriovenous
crossings, causing apparent narrowing or banking of the vein. Cotton-wool spots represent focal
ischemic infarcts of the nerve fiber layer from arteriolar occlusion. Flame-shaped hemorrhages
occur in the superficial retinal nerve fiber layer, characteristic of hypertensive rather than
diabetic retinopathy. Together, these findings indicate Grade III hypertensive retinopathy per
the Keith-Wagener-Barker classification. Nurses must understand these findings as signs of end-
organ damage from poorly controlled hypertension.
A nurse is performing a musculoskeletal assessment on a 67-year-old female who reports
bilateral knee pain worsening with activity and relieved by rest. On inspection, the nurse
notes bony enlargement at the distal interphalangeal joints of both hands. Crepitus is present
with passive range of motion of the knees bilaterally. Morning stiffness lasts approximately
10 minutes. Which condition is most consistent with these findings, and what are the
characteristic bony nodules at the DIP joints called?
A) Rheumatoid arthritis; Bouchard's nodes at the DIP joints B) Osteoarthritis; Heberden's nodes
at the DIP joints C) Gout; tophi deposits at the DIP joints D) Psoriatic arthritis; sausage digits
affecting the DIP joints
Correct Answer: B
Rationale: Osteoarthritis (OA) is a degenerative joint disease causing bony proliferation at joint
margins. Heberden's nodes are bony enlargements at the DIP joints and are pathognomonic for
OA. Bouchard's nodes occur at the PIP joints in OA. Key distinguishing features from rheumatoid
arthritis include: DIP involvement (RA spares DIP joints), asymmetric distribution, minimal
morning stiffness (less than 30 minutes vs. greater than 1 hour in RA), and worsening with
activity rather than improvement. Crepitus reflects cartilage degeneration and bone-on-bone
contact. Tophi are urate crystal deposits seen in gout, typically at the ear helix, olecranon, and
first MTP joint.
A nurse is assessing a 23-year-old male college athlete who reports acute right ankle pain
after rolling his ankle during basketball practice. The OTTAWA ankle rules are applied. Which
assessment finding would indicate the necessity for ankle radiographs according to these
rules?
A) Presence of ecchymosis around the lateral malleolus B) Inability to bear weight for four steps
both immediately after injury and during the current assessment C) Point tenderness along the
anterior talofibular ligament D) Mild swelling over the lateral aspect of the ankle
Correct Answer: B
Rationale: The Ottawa Ankle Rules are a validated clinical decision tool used to determine the
need for ankle radiographs to rule out fracture. Radiographs are indicated if there is bony
tenderness at the posterior edge or tip of either malleolus (not just ligament tenderness) OR
inability to bear weight for four steps both immediately after the injury and at the time of
assessment. Ligament tenderness, ecchymosis, and soft tissue swelling alone do not meet
Ottawa criteria for radiography. These rules have a sensitivity approaching 100% for detecting
clinically significant fractures and reduce unnecessary radiation exposure. Nurses conducting
sports or urgent care assessments must be proficient in their application.
, A nurse is performing a cranial nerve assessment on a patient who sustained a closed head
injury. When the nurse asks the patient to follow a penlight through the six cardinal positions
of gaze, the patient's left eye fails to adduct and the right eye has nystagmus on right lateral
gaze. Which cranial nerve dysfunction does the adduction failure of the left eye most likely
indicate?
A) Cranial Nerve IV (trochlear nerve) dysfunction on the left B) Cranial Nerve VI (abducens
nerve) dysfunction on the left C) Cranial Nerve III (oculomotor nerve) dysfunction on the left D)
Cranial Nerve II (optic nerve) dysfunction bilaterally
Correct Answer: C
Rationale: Adduction of the eye (movement toward the nose) is controlled by the medial rectus
muscle, which is innervated by CN III (oculomotor nerve). Failure to adduct the left eye indicates
a left CN III palsy. CN III also controls elevation, depression from the adducted position, pupillary
constriction, and eyelid elevation. A CN III palsy classically presents with ptosis, a "down and
out" eye position, and a dilated fixed pupil. CN VI controls lateral gaze (abduction) via the lateral
rectus muscle. CN IV controls the superior oblique muscle (intorsion and depression in
adduction). Nurses must systematically test each of the 12 cranial nerves following head
trauma.
A nurse is assessing an 18-month-old during a well-child visit. The parent reports the child is
not yet walking independently. On developmental screening using the Denver Developmental
Screening Test II (DDST-II), the child passes items for pulling to stand and cruising but fails
independent walking. The nurse correctly determines that independent walking is typically
achieved by which age, and how does the nurse classify this finding?
A) 18 months; this finding is within normal developmental limits and requires only routine
monitoring B) 12 months; this finding represents a developmental delay requiring immediate
referral to pediatric neurology C) 15 months; this finding is a potential developmental delay and
warrants re-screening in one month and possible referral D) 24 months; this finding is early
achievement and no further assessment is needed
Correct Answer: C
Rationale: According to the DDST-II and CDC developmental milestone guidelines, 90% of
children walk independently by 14 to 15 months, with the range of normal extending to 15
months. An 18-month-old who is not yet walking independently falls outside the expected range
and represents a developmental delay requiring further evaluation. The child should be re-
screened within one month and referred to a developmental pediatrician or pediatric
neurologist if walking has not been achieved. The fact that the child can cruise and pull to stand
is reassuring and suggests motor development is progressing but delayed. Nurses are often the
first to identify developmental concerns during well-child assessments.
A nurse is assessing a 55-year-old male with obesity who presents with loud snoring reported
by his partner, excessive daytime somnolence, and morning headaches. During the health
history, he reports waking frequently during the night feeling as though he is choking. His
neck circumference measures 43 cm. The nurse uses the STOP-BANG screening tool. Which
score on this tool indicates high risk for obstructive sleep apnea, and which finding in this
patient contributes most significantly to his anatomical risk?
A) Score of 3 or above indicates high risk; BMI greater than 35 is the primary anatomical risk
factor B) Score of 5 or above indicates high risk; neck circumference greater than 40 cm is the
NUR3065 HEALTH ASSESSMENT
MIDTERM EXAM PRACTICE
2026
A nurse is performing a comprehensive physical assessment on a 62-year-old male with a 40
pack-year smoking history who presents with a chronic productive cough, barrel chest, and
dyspnea on exertion. On auscultation, the nurse notes prolonged expiratory phase and
diffuse expiratory wheezing. Percussion of the thorax reveals hyperresonance throughout all
lung fields. Which pathophysiological mechanism most accurately explains the hyperresonant
percussion note in this patient?
A) Consolidation of lung tissue with fluid-filled alveoli B) Air trapping and hyperinflation of
alveoli due to loss of elastic recoil C) Pleural effusion compressing underlying lung tissue D)
Atelectasis with collapse of alveolar units
Correct Answer: B
Rationale: Hyperresonance on percussion indicates increased air relative to tissue density, which
occurs in conditions like emphysema and pneumothorax. In COPD with an emphysematous
component, destruction of alveolar walls (loss of elastic recoil) leads to air trapping and
hyperinflation. This increases the ratio of air to tissue, producing a hyperresonant or tympanic
percussion note. Consolidation and pleural effusion produce dullness on percussion. Atelectasis
produces flatness. The barrel chest configuration (increased AP-to-lateral diameter ratio greater
than 1:1) and prolonged expiration are hallmark findings of obstructive lung disease that nurses
at UCF clinical affiliates are expected to recognize and document accurately.
A nurse is assessing a 71-year-old woman admitted with new-onset confusion and urinary
incontinence. Her vital signs are: BP 138/86 mmHg, HR 88 bpm, RR 18 breaths/min, Temp
38.1°C. Her family reports she was independent at baseline two days ago. During the Mini-
Mental State Examination (MMSE), she scores 18/30. She is oriented to person only and
cannot recall three objects after five minutes. Which type of cognitive alteration does this
presentation most likely represent, and what is the most critical differentiating feature?
A) Dementia; characterized by gradual progressive onset over months to years B) Delirium;
characterized by acute onset with fluctuating course and identifiable precipitating cause C)
Depression-related pseudodementia; characterized by subjective memory complaints without
objective deficits D) Mild cognitive impairment; characterized by preserved functional
independence
Correct Answer: B
Rationale: The hallmark feature distinguishing delirium from dementia is the acuity and
fluctuating nature of the cognitive change. This patient was functionally independent 48 hours
ago and now presents with disorientation, memory impairment, and incontinence, strongly
suggesting delirium with a likely precipitant such as urinary tract infection (fever, new
incontinence). The Confusion Assessment Method (CAM) criteria for delirium requires: acute
onset and fluctuating course, inattention, and either disorganized thinking or altered level of
,consciousness. Dementia is insidious and progressive. Nurses must differentiate these
presentations because delirium signals an underlying medical emergency requiring immediate
investigation, while dementia management is long-term.
A nurse auscultates a patient's heart and identifies a high-pitched, blowing, holosystolic
murmur heard best at the cardiac apex with radiation to the left axilla. The patient has a
history of rheumatic fever. Which valvular abnormality does this murmur most likely
represent, and at which auscultation site is it best heard?
A) Aortic stenosis; heard best at the second right intercostal space, right sternal border B)
Mitral regurgitation; heard best at the fifth intercostal space, midclavicular line (mitral area) C)
Tricuspid stenosis; heard best at the fourth intercostal space, left sternal border D) Pulmonic
regurgitation; heard best at the second left intercostal space
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur because blood
regurgitates through the incompetent mitral valve throughout the entire systolic phase when
left ventricular pressure exceeds left atrial pressure. It is heard best at the apex (fifth ICS,
midclavicular line) and classically radiates to the left axilla due to the direction of the
regurgitant jet. Rheumatic fever is the most common cause of mitral valve disease globally.
Aortic stenosis produces a crescendo-decrescendo (diamond-shaped) systolic murmur heard at
the right second ICS with radiation to the carotids. Nurses must be able to characterize murmurs
by timing, quality, intensity (Levine scale 1 to 6), location, and radiation.
During an abdominal assessment of a 45-year-old male with a history of alcohol use disorder,
the nurse observes abdominal distension with a protruding umbilicus and visible abdominal
veins radiating outward from the umbilicus. Percussion reveals shifting dullness, and the fluid
wave test is positive. Which condition do these findings collectively indicate, and what is the
correct order of abdominal assessment techniques the nurse should have used?
A) Bowel obstruction; inspect, percuss, auscultate, palpate B) Ascites due to portal
hypertension; inspect, auscultate, percuss, palpate C) Peritonitis; inspect, palpate, percuss,
auscultate D) Hepatomegaly; inspect, auscultate, palpate, percuss
Correct Answer: B
Rationale: The combination of abdominal distension, caput medusae (venous dilation radiating
from umbilicus indicating portal hypertension), shifting dullness, and a positive fluid wave test
confirms the presence of ascites, a complication of portal hypertension caused by cirrhosis from
chronic alcohol use. The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and palpation. This order differs from other body systems because palpation and
percussion stimulate bowel motility and can alter bowel sounds if performed before
auscultation. UCF nursing students are expected to demonstrate this modified sequence during
physical assessment laboratory examinations and clinical practicums.
A nurse is assessing a 58-year-old female with type 2 diabetes during her annual wellness
visit. On fundoscopic examination performed by the provider, soft exudates (cotton-wool
spots), flame-shaped hemorrhages, and arteriovenous nicking are noted. The nurse correlates
these findings with which systemic condition, and what do AV nicking specifically indicate
about the vasculature?
A) Hypothyroidism; indicating edema within the optic disk B) Hypertensive retinopathy;
indicating arterial wall thickening compressing crossing venous vessels C) Glaucoma; indicating
,increased intraocular pressure compressing the optic nerve D) Diabetic macular degeneration;
indicating ischemia of the macula specifically
Correct Answer: B
Rationale: AV nicking (or nipping) is a hallmark sign of longstanding hypertension where
thickened, sclerotic arteriolar walls compress the underlying venous vessel at arteriovenous
crossings, causing apparent narrowing or banking of the vein. Cotton-wool spots represent focal
ischemic infarcts of the nerve fiber layer from arteriolar occlusion. Flame-shaped hemorrhages
occur in the superficial retinal nerve fiber layer, characteristic of hypertensive rather than
diabetic retinopathy. Together, these findings indicate Grade III hypertensive retinopathy per
the Keith-Wagener-Barker classification. Nurses must understand these findings as signs of end-
organ damage from poorly controlled hypertension.
A nurse is performing a musculoskeletal assessment on a 67-year-old female who reports
bilateral knee pain worsening with activity and relieved by rest. On inspection, the nurse
notes bony enlargement at the distal interphalangeal joints of both hands. Crepitus is present
with passive range of motion of the knees bilaterally. Morning stiffness lasts approximately
10 minutes. Which condition is most consistent with these findings, and what are the
characteristic bony nodules at the DIP joints called?
A) Rheumatoid arthritis; Bouchard's nodes at the DIP joints B) Osteoarthritis; Heberden's nodes
at the DIP joints C) Gout; tophi deposits at the DIP joints D) Psoriatic arthritis; sausage digits
affecting the DIP joints
Correct Answer: B
Rationale: Osteoarthritis (OA) is a degenerative joint disease causing bony proliferation at joint
margins. Heberden's nodes are bony enlargements at the DIP joints and are pathognomonic for
OA. Bouchard's nodes occur at the PIP joints in OA. Key distinguishing features from rheumatoid
arthritis include: DIP involvement (RA spares DIP joints), asymmetric distribution, minimal
morning stiffness (less than 30 minutes vs. greater than 1 hour in RA), and worsening with
activity rather than improvement. Crepitus reflects cartilage degeneration and bone-on-bone
contact. Tophi are urate crystal deposits seen in gout, typically at the ear helix, olecranon, and
first MTP joint.
A nurse is assessing a 23-year-old male college athlete who reports acute right ankle pain
after rolling his ankle during basketball practice. The OTTAWA ankle rules are applied. Which
assessment finding would indicate the necessity for ankle radiographs according to these
rules?
A) Presence of ecchymosis around the lateral malleolus B) Inability to bear weight for four steps
both immediately after injury and during the current assessment C) Point tenderness along the
anterior talofibular ligament D) Mild swelling over the lateral aspect of the ankle
Correct Answer: B
Rationale: The Ottawa Ankle Rules are a validated clinical decision tool used to determine the
need for ankle radiographs to rule out fracture. Radiographs are indicated if there is bony
tenderness at the posterior edge or tip of either malleolus (not just ligament tenderness) OR
inability to bear weight for four steps both immediately after the injury and at the time of
assessment. Ligament tenderness, ecchymosis, and soft tissue swelling alone do not meet
Ottawa criteria for radiography. These rules have a sensitivity approaching 100% for detecting
clinically significant fractures and reduce unnecessary radiation exposure. Nurses conducting
sports or urgent care assessments must be proficient in their application.
, A nurse is performing a cranial nerve assessment on a patient who sustained a closed head
injury. When the nurse asks the patient to follow a penlight through the six cardinal positions
of gaze, the patient's left eye fails to adduct and the right eye has nystagmus on right lateral
gaze. Which cranial nerve dysfunction does the adduction failure of the left eye most likely
indicate?
A) Cranial Nerve IV (trochlear nerve) dysfunction on the left B) Cranial Nerve VI (abducens
nerve) dysfunction on the left C) Cranial Nerve III (oculomotor nerve) dysfunction on the left D)
Cranial Nerve II (optic nerve) dysfunction bilaterally
Correct Answer: C
Rationale: Adduction of the eye (movement toward the nose) is controlled by the medial rectus
muscle, which is innervated by CN III (oculomotor nerve). Failure to adduct the left eye indicates
a left CN III palsy. CN III also controls elevation, depression from the adducted position, pupillary
constriction, and eyelid elevation. A CN III palsy classically presents with ptosis, a "down and
out" eye position, and a dilated fixed pupil. CN VI controls lateral gaze (abduction) via the lateral
rectus muscle. CN IV controls the superior oblique muscle (intorsion and depression in
adduction). Nurses must systematically test each of the 12 cranial nerves following head
trauma.
A nurse is assessing an 18-month-old during a well-child visit. The parent reports the child is
not yet walking independently. On developmental screening using the Denver Developmental
Screening Test II (DDST-II), the child passes items for pulling to stand and cruising but fails
independent walking. The nurse correctly determines that independent walking is typically
achieved by which age, and how does the nurse classify this finding?
A) 18 months; this finding is within normal developmental limits and requires only routine
monitoring B) 12 months; this finding represents a developmental delay requiring immediate
referral to pediatric neurology C) 15 months; this finding is a potential developmental delay and
warrants re-screening in one month and possible referral D) 24 months; this finding is early
achievement and no further assessment is needed
Correct Answer: C
Rationale: According to the DDST-II and CDC developmental milestone guidelines, 90% of
children walk independently by 14 to 15 months, with the range of normal extending to 15
months. An 18-month-old who is not yet walking independently falls outside the expected range
and represents a developmental delay requiring further evaluation. The child should be re-
screened within one month and referred to a developmental pediatrician or pediatric
neurologist if walking has not been achieved. The fact that the child can cruise and pull to stand
is reassuring and suggests motor development is progressing but delayed. Nurses are often the
first to identify developmental concerns during well-child assessments.
A nurse is assessing a 55-year-old male with obesity who presents with loud snoring reported
by his partner, excessive daytime somnolence, and morning headaches. During the health
history, he reports waking frequently during the night feeling as though he is choking. His
neck circumference measures 43 cm. The nurse uses the STOP-BANG screening tool. Which
score on this tool indicates high risk for obstructive sleep apnea, and which finding in this
patient contributes most significantly to his anatomical risk?
A) Score of 3 or above indicates high risk; BMI greater than 35 is the primary anatomical risk
factor B) Score of 5 or above indicates high risk; neck circumference greater than 40 cm is the
