NUR-631 Advanced Health Assessment Exam LATEST 2026
GRADED A+ (QUESTION AND ANSWERS WITH RATIONALES)
When performing a neurologic examination on an elderly patient, which
finding is most likely a normal age‑related change rather than
pathological?
A. Asymmetric pupillary response.
B. Absent ankle jerk reflex.
C. Unilateral Babinski sign.
D. Positive Romberg test.
ANS: B. Absent ankle jerk reflex.
Rationale: Diminished or absent ankle jerks are common in older adults
due to age‑related peripheral neuropathy; asymmetric or pathological
reflexes warrant further investigation.
When assessing a patient for possible carotid artery bruits, which
technique is correct?
A. Auscultate with the bell of the stethoscope while the patient holds a
deep breath.
B. Auscultate with the diaphragm while the patient holds a breath after
exhalation.
C. Auscultate with the bell while the patient exhales and holds it.
,D. Auscultate with the diaphragm while the patient takes a deep breath
and holds it.
ANS: A. Auscultate with the bell of the stethoscope while the patient
holds a deep breath.
Rationale: The bell is best for low‑pitched bruits. Holding a breath
eliminates respiratory noise and allows better detection.
Which of the following breath sounds is considered normal in children
but abnormal in adults?
A. Bronchial breath sounds over the trachea.
B. Vesicular breath sounds over the lung periphery.
C. Bronchovesicular breath sounds over the major bronchi.
D. Bronchovesicular breath sounds over the peripheral lung fields.
ANS: D. Bronchovesicular breath sounds over the peripheral lung fields.
Rationale: In children, a thinner chest wall allows transmission of
bronchovesicular sounds to peripheral areas; in adults, this suggests
consolidation or atelectasis.
When performing an ophthalmoscopic examination, you note that the
optic disc appears pale with sharp margins and the cup‑to‑disc ratio is
0.3. This finding is most consistent with:
A. Glaucomatous cupping.
,B. Optic atrophy.
C. Papilledema.
D. Normal optic disc.
ANS: B. Optic atrophy.
Rationale: Optic atrophy presents as a pale disc with sharp margins.
Glaucomatous cupping typically enlarges the cup‑to‑disc ratio;
papilledema causes disc swelling with blurred margins.
Which of the following is the most reliable physical examination finding
for diagnosing a rotator cuff tear?
A. Pain with active abduction.
B. Positive Neer impingement sign.
C. Positive drop arm test.
D. Tenderness over the bicipital groove.
ANS: C. Positive drop arm test.
Rationale: The drop arm test (inability to maintain abduction after the
arm is passively raised to 90°) is highly suggestive of a rotator cuff
tear, especially of the supraspinatus.
What would you do to differentiate clubbed nails from curved nails?
A. Palpate the nail beds.
, B. Inspect the shape of the nail.
C. Inspect the nail plate.
D. Inspect the nail/base angle.
ANS: D. Inspect the nail/base angle.
Rationale: The normal nail base angle is about 160°. In clubbing, the
angle flattens or exceeds 180°, and the nail bed feels spongy
(Schamroth technique).
Clubbing of the fingernail is commonly associated with:
A. anemia.
B. respiratory disorders.
C. cancer.
D. trauma.
ANS: B. respiratory disorders.
Rationale: Clubbing is linked to chronic hypoxemia from pulmonary
diseases (e.g., bronchiectasis, interstitial fibrosis), cyanotic heart
disease, cirrhosis, and inflammatory bowel disease.
Skin color in a newborn is partly determined by:
A. gestational age.
B. amount of fat.
C. composition of the vernix caseosa.
GRADED A+ (QUESTION AND ANSWERS WITH RATIONALES)
When performing a neurologic examination on an elderly patient, which
finding is most likely a normal age‑related change rather than
pathological?
A. Asymmetric pupillary response.
B. Absent ankle jerk reflex.
C. Unilateral Babinski sign.
D. Positive Romberg test.
ANS: B. Absent ankle jerk reflex.
Rationale: Diminished or absent ankle jerks are common in older adults
due to age‑related peripheral neuropathy; asymmetric or pathological
reflexes warrant further investigation.
When assessing a patient for possible carotid artery bruits, which
technique is correct?
A. Auscultate with the bell of the stethoscope while the patient holds a
deep breath.
B. Auscultate with the diaphragm while the patient holds a breath after
exhalation.
C. Auscultate with the bell while the patient exhales and holds it.
,D. Auscultate with the diaphragm while the patient takes a deep breath
and holds it.
ANS: A. Auscultate with the bell of the stethoscope while the patient
holds a deep breath.
Rationale: The bell is best for low‑pitched bruits. Holding a breath
eliminates respiratory noise and allows better detection.
Which of the following breath sounds is considered normal in children
but abnormal in adults?
A. Bronchial breath sounds over the trachea.
B. Vesicular breath sounds over the lung periphery.
C. Bronchovesicular breath sounds over the major bronchi.
D. Bronchovesicular breath sounds over the peripheral lung fields.
ANS: D. Bronchovesicular breath sounds over the peripheral lung fields.
Rationale: In children, a thinner chest wall allows transmission of
bronchovesicular sounds to peripheral areas; in adults, this suggests
consolidation or atelectasis.
When performing an ophthalmoscopic examination, you note that the
optic disc appears pale with sharp margins and the cup‑to‑disc ratio is
0.3. This finding is most consistent with:
A. Glaucomatous cupping.
,B. Optic atrophy.
C. Papilledema.
D. Normal optic disc.
ANS: B. Optic atrophy.
Rationale: Optic atrophy presents as a pale disc with sharp margins.
Glaucomatous cupping typically enlarges the cup‑to‑disc ratio;
papilledema causes disc swelling with blurred margins.
Which of the following is the most reliable physical examination finding
for diagnosing a rotator cuff tear?
A. Pain with active abduction.
B. Positive Neer impingement sign.
C. Positive drop arm test.
D. Tenderness over the bicipital groove.
ANS: C. Positive drop arm test.
Rationale: The drop arm test (inability to maintain abduction after the
arm is passively raised to 90°) is highly suggestive of a rotator cuff
tear, especially of the supraspinatus.
What would you do to differentiate clubbed nails from curved nails?
A. Palpate the nail beds.
, B. Inspect the shape of the nail.
C. Inspect the nail plate.
D. Inspect the nail/base angle.
ANS: D. Inspect the nail/base angle.
Rationale: The normal nail base angle is about 160°. In clubbing, the
angle flattens or exceeds 180°, and the nail bed feels spongy
(Schamroth technique).
Clubbing of the fingernail is commonly associated with:
A. anemia.
B. respiratory disorders.
C. cancer.
D. trauma.
ANS: B. respiratory disorders.
Rationale: Clubbing is linked to chronic hypoxemia from pulmonary
diseases (e.g., bronchiectasis, interstitial fibrosis), cyanotic heart
disease, cirrhosis, and inflammatory bowel disease.
Skin color in a newborn is partly determined by:
A. gestational age.
B. amount of fat.
C. composition of the vernix caseosa.
