NUR 634 MIDTERM EXAMINATION 2025/2026 UPDATE |QUESTIONS AND
ANSWERS (LATEST VERSION): GRAND CANYON UNIVERSITY
Question 1
During an assessment, a patient becomes erratic and begins sharing a high volume of personal
information that is not directly related to their physical complaints. What is the most appropriate
action for the provider?
A) Interrupt the patient and ask them to speak more slowly.
B) Leave the room and wait for the patient to calm down.
C) Summarize what the patient has said to clarify her needs and the purpose of the visit.
D) Document the patient as non-compliant and proceed with the physical exam.
E) Refer the patient to psychiatry immediately without further assessment.
Correct Answer: C) summarize what the patient is here for to clarify her needs
Rationale: Summarizing is an essential therapeutic communication technique. It helps the
provider redirect an over-talkative or erratic patient, focuses the interview on the chief
complaint, and ensures that both the patient and provider agree on the goals of the visit.
Question 2
A patient complains of shortness of breath and a persistent cough that worsens at night. Physical
examination reveals audible wheezing upon expiration. What is the most likely diagnosis?
A) Chronic Bronchitis
B) Pneumonia
C) Asthma
D) Congestive Heart Failure
E) Pulmonary Embolism
Correct Answer: C) asthma
Rationale: The classic triad of asthma includes cough (often nocturnal), dyspnea (shortness
of breath), and expiratory wheezing. Wheezing occurs due to the narrowing of the lower
airways and bronchoconstriction characteristic of an asthma flare.
Question 3
A patient presents with a visible collection of blood around the sclera of the eye. The patient
denies pain, trauma, or vision changes but mentions they "coughed all night long." What is the
most likely diagnosis?
A) Acute Glaucoma
B) Retinal Detachment
C) Subconjunctival hemorrhage
D) Hyphema
E) Conjunctivitis
Correct Answer: C) subconjunctival hemorrhage
Rationale: A subconjunctival hemorrhage is often a painless, benign finding caused by a
rupture of small blood vessels in the conjunctiva. Common triggers include high-pressure
events such as severe coughing, sneezing, or vomiting.
, 2
Question 4
When providing dietary education to a patient diagnosed with Gastroesophageal Reflux Disease
(GERD), which of the following should the nurse recommend avoiding?
A) High-fiber vegetables and lean proteins
B) Spicy foods, fatty foods, acidic foods, sweets, and caffeine
C) Distilled water and complex carbohydrates
D) Cold liquids and fermented foods
E) Only alcohol and tobacco
Correct Answer: B) avoid spicy, fatty, acidic, sweets and caffeine
Rationale: GERD management involves avoiding triggers that relax the lower esophageal
sphincter (LES) or increase gastric acid production. Fatty foods slow gastric emptying,
while caffeine and sweets can weaken the LES.
Question 5
What modification to meal patterns is recommended for a patient with symptomatic GERD?
A) Increasing the size of the evening meal
B) Eating only once a day
C) Consuming three large meals daily
D) Reducing meal size and increasing frequency
E) Drinking large amounts of water with each meal
Correct Answer: D) reduced meal size
Rationale: Large meals increase intra-abdominal pressure and gastric distention, which can
overcome the pressure of the LES and lead to reflux. Smaller, more frequent meals are
better tolerated.
Question 6
Which of the following lifestyle modifications is essential for a patient with GERD?
A) Wearing tight-fitting abdominal binders
B) Bending over immediately after meals to improve digestion
C) Avoiding recumbence for at least 2 hours after a meal
D) Sleeping in a completely flat position
E) Increasing alcohol intake to relax the stomach
Correct Answer: C) avoid recumbence until 2 hours after meal
Rationale: Lying down too soon after eating allows gravity to facilitate the movement of
stomach contents back into the esophagus. Waiting two hours ensures the meal has largely
moved into the small intestine.
Question 7
What is the recommended sleeping position for a patient struggling with nocturnal GERD
symptoms?
A) Prone with the head turned to the right
, 3
B) Supine with the feet elevated above the heart
C) Head of bed elevated with the entire chest up
D) Left lateral decubitus with a pillow between the knees
E) Using a high-velocity fan to improve breathing
Correct Answer: C) HOB elevated with entire chest up
Rationale: Elevating the head of the bed (using a wedge or blocks) uses gravity to keep
stomach acid in the stomach. Elevating only the head with pillows can cause bending at the
waist, which actually increases gastric pressure.
Question 8
Which lifestyle choice should a provider prioritize for a patient with GERD to improve long-
term outcomes?
A) Increased intake of vitamin supplements
B) Smoking cessation and reduction of alcohol intake
C) Sedentary lifestyle to avoid abdominal strain
D) High-protein, high-fat diet
E) Frequent use of OTC laxatives
Correct Answer: B) smoking cessation and reduce alcohol
Rationale: Smoking and alcohol both decrease LES tone and irritate the esophageal
mucosa, worsening GERD symptoms and increasing the risk for Barrett’s esophagus.
Question 9
While performing percussion on a patient's chest, the provider notes a "dull" sound over the right
lower lobe. What is the clinical significance of this finding?
A) Healthy, air-filled lung tissue
B) A large pneumothorax
C) Consolidated pneumonia
D) Chronic Obstructive Pulmonary Disease (COPD)
E) Normal gastric bubble
Correct Answer: C) consolidated pneumonia, unilateral or bilateral
Rationale: Dullness on percussion occurs when fluid or solid tissue replaces air-containing
lung space. This is characteristic of lobar pneumonia (consolidation), pleural effusion, or a
tumor.
Question 10
An elderly patient complains of difficulty reading small print. The provider identifies this as a
normal physiological change in vision related to aging. What is the medical term for this?
A) Myopia
B) Hyperopia
C) Presbyopia
D) Cataracts
, 4
E) Macular Degeneration
Correct Answer: C) presbyopia
Rationale: Presbyopia is the age-related loss of the eye's ability to focus on nearby objects
due to the hardening of the lens. It typically begins in the early to mid-40s.
Question 11
Upon physical examination, a provider feels palpable nodules located behind the
sternocleidomastoid muscle. Which lymph nodes are these?
A) Anterior cervical nodes
B) Submandibular nodes
C) Posterior cervical lymph nodes
D) Preauricular nodes
E) Supraclavicular nodes
Correct Answer: C) posterior cervical lymph nodes
Rationale: The posterior cervical lymph nodes are located along the posterior border of the
sternocleidomastoid muscle and are often inflamed in viral infections like mononucleosis.
Question 12
A female patient presents with generalized body aches and persistent fatigue for two months.
After ruling out physical ailments, the provider should consider which psychological differential
diagnosis?
A) Histrionic behavior disorder
B) Major Depression
C) Generalized Anxiety Disorder
D) Schizophrenia
E) Bipolar Disorder
Correct Answer: B) depression
Rationale: Depression often presents with somatic (physical) complaints such as chronic
pain, tiredness, and lack of energy. If these symptoms persist for two months or more
without an organic cause, depression is a primary consideration.
Question 13
A patient presents with double vision specifically in one eye. Which cranial nerve (CN) is
primarily associated with the control of extraocular movements that, if damaged, could cause
diplopia?
A) CN 1 (Olfactory)
B) CN 2 (Optic)
C) CN 3 (Oculomotor)
D) CN 5 (Trigeminal)
E) CN 8 (Vestibulocochlear)
Correct Answer: C) CN 3
ANSWERS (LATEST VERSION): GRAND CANYON UNIVERSITY
Question 1
During an assessment, a patient becomes erratic and begins sharing a high volume of personal
information that is not directly related to their physical complaints. What is the most appropriate
action for the provider?
A) Interrupt the patient and ask them to speak more slowly.
B) Leave the room and wait for the patient to calm down.
C) Summarize what the patient has said to clarify her needs and the purpose of the visit.
D) Document the patient as non-compliant and proceed with the physical exam.
E) Refer the patient to psychiatry immediately without further assessment.
Correct Answer: C) summarize what the patient is here for to clarify her needs
Rationale: Summarizing is an essential therapeutic communication technique. It helps the
provider redirect an over-talkative or erratic patient, focuses the interview on the chief
complaint, and ensures that both the patient and provider agree on the goals of the visit.
Question 2
A patient complains of shortness of breath and a persistent cough that worsens at night. Physical
examination reveals audible wheezing upon expiration. What is the most likely diagnosis?
A) Chronic Bronchitis
B) Pneumonia
C) Asthma
D) Congestive Heart Failure
E) Pulmonary Embolism
Correct Answer: C) asthma
Rationale: The classic triad of asthma includes cough (often nocturnal), dyspnea (shortness
of breath), and expiratory wheezing. Wheezing occurs due to the narrowing of the lower
airways and bronchoconstriction characteristic of an asthma flare.
Question 3
A patient presents with a visible collection of blood around the sclera of the eye. The patient
denies pain, trauma, or vision changes but mentions they "coughed all night long." What is the
most likely diagnosis?
A) Acute Glaucoma
B) Retinal Detachment
C) Subconjunctival hemorrhage
D) Hyphema
E) Conjunctivitis
Correct Answer: C) subconjunctival hemorrhage
Rationale: A subconjunctival hemorrhage is often a painless, benign finding caused by a
rupture of small blood vessels in the conjunctiva. Common triggers include high-pressure
events such as severe coughing, sneezing, or vomiting.
, 2
Question 4
When providing dietary education to a patient diagnosed with Gastroesophageal Reflux Disease
(GERD), which of the following should the nurse recommend avoiding?
A) High-fiber vegetables and lean proteins
B) Spicy foods, fatty foods, acidic foods, sweets, and caffeine
C) Distilled water and complex carbohydrates
D) Cold liquids and fermented foods
E) Only alcohol and tobacco
Correct Answer: B) avoid spicy, fatty, acidic, sweets and caffeine
Rationale: GERD management involves avoiding triggers that relax the lower esophageal
sphincter (LES) or increase gastric acid production. Fatty foods slow gastric emptying,
while caffeine and sweets can weaken the LES.
Question 5
What modification to meal patterns is recommended for a patient with symptomatic GERD?
A) Increasing the size of the evening meal
B) Eating only once a day
C) Consuming three large meals daily
D) Reducing meal size and increasing frequency
E) Drinking large amounts of water with each meal
Correct Answer: D) reduced meal size
Rationale: Large meals increase intra-abdominal pressure and gastric distention, which can
overcome the pressure of the LES and lead to reflux. Smaller, more frequent meals are
better tolerated.
Question 6
Which of the following lifestyle modifications is essential for a patient with GERD?
A) Wearing tight-fitting abdominal binders
B) Bending over immediately after meals to improve digestion
C) Avoiding recumbence for at least 2 hours after a meal
D) Sleeping in a completely flat position
E) Increasing alcohol intake to relax the stomach
Correct Answer: C) avoid recumbence until 2 hours after meal
Rationale: Lying down too soon after eating allows gravity to facilitate the movement of
stomach contents back into the esophagus. Waiting two hours ensures the meal has largely
moved into the small intestine.
Question 7
What is the recommended sleeping position for a patient struggling with nocturnal GERD
symptoms?
A) Prone with the head turned to the right
, 3
B) Supine with the feet elevated above the heart
C) Head of bed elevated with the entire chest up
D) Left lateral decubitus with a pillow between the knees
E) Using a high-velocity fan to improve breathing
Correct Answer: C) HOB elevated with entire chest up
Rationale: Elevating the head of the bed (using a wedge or blocks) uses gravity to keep
stomach acid in the stomach. Elevating only the head with pillows can cause bending at the
waist, which actually increases gastric pressure.
Question 8
Which lifestyle choice should a provider prioritize for a patient with GERD to improve long-
term outcomes?
A) Increased intake of vitamin supplements
B) Smoking cessation and reduction of alcohol intake
C) Sedentary lifestyle to avoid abdominal strain
D) High-protein, high-fat diet
E) Frequent use of OTC laxatives
Correct Answer: B) smoking cessation and reduce alcohol
Rationale: Smoking and alcohol both decrease LES tone and irritate the esophageal
mucosa, worsening GERD symptoms and increasing the risk for Barrett’s esophagus.
Question 9
While performing percussion on a patient's chest, the provider notes a "dull" sound over the right
lower lobe. What is the clinical significance of this finding?
A) Healthy, air-filled lung tissue
B) A large pneumothorax
C) Consolidated pneumonia
D) Chronic Obstructive Pulmonary Disease (COPD)
E) Normal gastric bubble
Correct Answer: C) consolidated pneumonia, unilateral or bilateral
Rationale: Dullness on percussion occurs when fluid or solid tissue replaces air-containing
lung space. This is characteristic of lobar pneumonia (consolidation), pleural effusion, or a
tumor.
Question 10
An elderly patient complains of difficulty reading small print. The provider identifies this as a
normal physiological change in vision related to aging. What is the medical term for this?
A) Myopia
B) Hyperopia
C) Presbyopia
D) Cataracts
, 4
E) Macular Degeneration
Correct Answer: C) presbyopia
Rationale: Presbyopia is the age-related loss of the eye's ability to focus on nearby objects
due to the hardening of the lens. It typically begins in the early to mid-40s.
Question 11
Upon physical examination, a provider feels palpable nodules located behind the
sternocleidomastoid muscle. Which lymph nodes are these?
A) Anterior cervical nodes
B) Submandibular nodes
C) Posterior cervical lymph nodes
D) Preauricular nodes
E) Supraclavicular nodes
Correct Answer: C) posterior cervical lymph nodes
Rationale: The posterior cervical lymph nodes are located along the posterior border of the
sternocleidomastoid muscle and are often inflamed in viral infections like mononucleosis.
Question 12
A female patient presents with generalized body aches and persistent fatigue for two months.
After ruling out physical ailments, the provider should consider which psychological differential
diagnosis?
A) Histrionic behavior disorder
B) Major Depression
C) Generalized Anxiety Disorder
D) Schizophrenia
E) Bipolar Disorder
Correct Answer: B) depression
Rationale: Depression often presents with somatic (physical) complaints such as chronic
pain, tiredness, and lack of energy. If these symptoms persist for two months or more
without an organic cause, depression is a primary consideration.
Question 13
A patient presents with double vision specifically in one eye. Which cranial nerve (CN) is
primarily associated with the control of extraocular movements that, if damaged, could cause
diplopia?
A) CN 1 (Olfactory)
B) CN 2 (Optic)
C) CN 3 (Oculomotor)
D) CN 5 (Trigeminal)
E) CN 8 (Vestibulocochlear)
Correct Answer: C) CN 3
