NURS 5220 Exam 2 Practice Test
Advanced Health Assessment ACTUAL
EXAM 2026/2027 | UTA Advanced
Assessment | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Head, Eyes, Ears, Nose, Throat (HEENT)
Q1: A 58-year-old male with a 20-year history of type 2 diabetes mellitus presents for routine eye
examination. On fundoscopic exam, you note scattered microaneurysms, several dot-blot hemorrhages,
and hard exudates in the macula of the right eye. No neovascularization or vitreous hemorrhage is
present. How should these findings be interpreted?
A. Normal age-related retinal changes requiring no intervention.
B. Nonproliferative diabetic retinopathy, moderate to severe grade. [CORRECT]
C. Hypertensive retinopathy with arteriovenous nicking and copper wiring.
D. Proliferative diabetic retinopathy requiring urgent ophthalmology referral.
Correct Answer: B
Rationale: The findings of microaneurysms, dot-blot hemorrhages, and hard exudates (lipid deposits) are
classic for nonproliferative diabetic retinopathy (NPDR). The absence of neovascularization rules out
proliferative diabetic retinopathy (PDR). The presence of macular exudates indicates clinically significant
macular edema risk, placing this at moderate to severe NPDR (ETDRS criteria). Diabetic patients require
annual dilated eye exams; this patient needs prompt ophthalmology referral for possible focal laser or
anti-VEGF therapy, though it is not an emergency. Clinical Pearl: Microaneurysms are the earliest clinical
sign of diabetic retinopathy.
,Q2: [Image-Based Question] Upon viewing the attached fundoscopic photograph of a 42-year-old female
reporting severe headaches and blurred vision, you note loss of the physiologic cup, blurred disc
margins, dilated tortuous retinal veins, and absence of spontaneous venous pulsations. What is the
primary pathophysiologic mechanism for these findings?
A. Chronic venous congestion secondary to right heart failure.
B. Increased intracranial pressure transmitted through the subarachnoid space. [CORRECT]
C. Microvascular occlusion from uncontrolled hyperglycemia.
D. Impaired arterial perfusion due to giant cell arteritis.
Correct Answer: B
Rationale: The image and description depict papilledema, which is swelling of the optic disc caused by
increased intracranial pressure (ICP). The optic nerve sheath is contiguous with the subarachnoid space,
allowing elevated CSF pressure to transmit directly to the optic disc, causing venous congestion, disc
edema, and loss of spontaneous venous pulsations. This is a neurological emergency requiring
immediate CNS imaging. Clinical Pearl: Papilledema is almost always bilateral; unilateral disc edema
suggests optic neuritis rather than increased ICP.
Q3: [Image-Based Question] You are evaluating an image of a right tympanic membrane obtained via
otoscopy on a 4-year-old child with acute ear pain and fever. The image demonstrates a markedly
erythematous, bulging tympanic membrane with loss of normal bony landmarks and a distinct
yellowish-white bulge in the posterior inferior quadrant. What is the most accurate clinical
interpretation?
A. Acute otitis externa with a fungal superinfection.
B. Acute otitis media with effusion (OME).
C. Acute otitis media (AOM) likely requiring antibacterial therapy. [CORRECT]
D. Chronic serous otitis media with retraction pockets.
Correct Answer: C
Rationale: A bulging, erythematous tympanic membrane with obscured landmarks and a localized
yellowish-white bulge (indicating a purulent effusion under pressure) is the hallmark of acute otitis
media (AOM). Otitis externa involves the ear canal, not the TM. OME implies fluid without signs of acute
,infection or bulging. This presentation meets the strict diagnostic criteria for AOM and typically warrants
antibiotic therapy in this age group. Clinical Pearl: A bulging TM is the strongest predictive finding for
bacterial AOM.
Q4: [Technique Order Question] You are performing a comprehensive head and neck examination on a
new patient. Which of the following sequences represents the correct order of assessment for the
thyroid gland?
A. Inspection from the side, auscultation for bruits, palpation from the front, swallow observation.
B. Auscultation for bruits, inspection from the front, palpation from the back, swallow observation.
C. Inspection from the front, observe swallowing, auscultation for bruits, palpation from behind or using
the anterior approach. [CORRECT]
D. Palpation from the front, observe swallowing, inspection from the side, auscultation for bruits.
Correct Answer: C
Rationale: The thyroid exam should always begin with inspection (looking for symmetry, masses, or
visible enlargement) while the patient swallows sips of water, which elevates the thyroid gland.
Auscultation using the bell of the stethoscope is performed next to listen for vascular bruits, as
palpation can artificially create noises. Palpation is performed last, either from behind (posterior
approach) or from the front (anterior approach), to assess size, symmetry, and nodularity. Clinical Pearl:
Always auscultate the thyroid before palpating to avoid creating a false bruit.
Q5: A 35-year-old female presents with palpitations and anxiety. During thyroid palpation using the
anterior approach, you feel a 2 cm solid, non-tender nodule in the right lobe that rises with deglutition.
There is no associated cervical lymphadenopathy. What is the most appropriate next step in the
diagnostic evaluation?
A. Reassure the patient and re-examine in 6 months, as benign nodules are common.
B. Order a thyroid ultrasound and a serum thyroid-stimulating hormone (TSH) level. [CORRECT]
C. Initiate high-dose levothyroxine to suppress the nodule.
D. Perform a fine-needle aspiration (FNA) biopsy in the clinic immediately.
Correct Answer: B
, Rationale: The discovery of a palpable thyroid nodule requires initial evaluation with a serum TSH to
assess functional status (hyperthyroid, euthyroid, or hypothyroid) and a thyroid ultrasound to
characterize the nodule's composition (solid vs. cystic) and features. FNA biopsy is indicated based on
ultrasound findings and size criteria (e.g., >1 cm with suspicious features), not immediately upon
palpation. Suppressive therapy is no longer routinely recommended. Clinical Pearl: A TSH level is the first
lab test to order for any thyroid nodule to determine if it is a "hot" or "cold" nodule.
Q6: A 68-year-old patient is undergoing cranial nerve assessment. You ask the patient to follow your
finger as you move it in an "H" pattern. You observe that the patient's left eye cannot adduct (move
medially) when looking toward the nose, but the right eye abducts normally. Additionally, the patient
exhibits a fine horizontal nystagmus in the abducting right eye. Which cranial nerve lesion is most likely
present?
A. Left oculomotor nerve (CN III) palsy.
B. Right abducens nerve (CN VI) palsy.
C. Left medial longitudinal fasciculus (MLF) lesion causing internuclear ophthalmoplegia (INO).
[CORRECT]
D. Left trochlear nerve (CN IV) palsy.
Correct Answer: C
Rationale: Internuclear ophthalmoplegia (INO) is caused by a lesion in the medial longitudinal fasciculus
(MLF), which coordinates horizontal eye movements between CN III and CN VI. The classic finding is
impaired adduction of the ipsilateral eye and abducting nystagmus of the contralateral eye. This is highly
associated with multiple sclerosis in younger patients and brainstem strokes in older patients. A CN III
palsy would present with ptosis, "down and out" eye position, and pupillary dilation. Clinical Pearl: INO
is a failure of conjugate gaze; the eye can abduct, but cannot adduct, with nystagmus in the abducting
eye.
Q7: During a routine physical on a 45-year-old male, you ask him to smile, raise his eyebrows, and puff
out his cheeks. You note asymmetrical facial droop on the right side, with an inability to raise the right
eyebrow and failure to close the right eye completely. He reports sudden onset of these symptoms
yesterday. Which cranial nerve is affected, and what is the most likely diagnosis?
A. Trigeminal nerve (CN V); trigeminal neuralgia.
B. Facial nerve (CN VII); peripheral Bell's palsy. [CORRECT]
Advanced Health Assessment ACTUAL
EXAM 2026/2027 | UTA Advanced
Assessment | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Head, Eyes, Ears, Nose, Throat (HEENT)
Q1: A 58-year-old male with a 20-year history of type 2 diabetes mellitus presents for routine eye
examination. On fundoscopic exam, you note scattered microaneurysms, several dot-blot hemorrhages,
and hard exudates in the macula of the right eye. No neovascularization or vitreous hemorrhage is
present. How should these findings be interpreted?
A. Normal age-related retinal changes requiring no intervention.
B. Nonproliferative diabetic retinopathy, moderate to severe grade. [CORRECT]
C. Hypertensive retinopathy with arteriovenous nicking and copper wiring.
D. Proliferative diabetic retinopathy requiring urgent ophthalmology referral.
Correct Answer: B
Rationale: The findings of microaneurysms, dot-blot hemorrhages, and hard exudates (lipid deposits) are
classic for nonproliferative diabetic retinopathy (NPDR). The absence of neovascularization rules out
proliferative diabetic retinopathy (PDR). The presence of macular exudates indicates clinically significant
macular edema risk, placing this at moderate to severe NPDR (ETDRS criteria). Diabetic patients require
annual dilated eye exams; this patient needs prompt ophthalmology referral for possible focal laser or
anti-VEGF therapy, though it is not an emergency. Clinical Pearl: Microaneurysms are the earliest clinical
sign of diabetic retinopathy.
,Q2: [Image-Based Question] Upon viewing the attached fundoscopic photograph of a 42-year-old female
reporting severe headaches and blurred vision, you note loss of the physiologic cup, blurred disc
margins, dilated tortuous retinal veins, and absence of spontaneous venous pulsations. What is the
primary pathophysiologic mechanism for these findings?
A. Chronic venous congestion secondary to right heart failure.
B. Increased intracranial pressure transmitted through the subarachnoid space. [CORRECT]
C. Microvascular occlusion from uncontrolled hyperglycemia.
D. Impaired arterial perfusion due to giant cell arteritis.
Correct Answer: B
Rationale: The image and description depict papilledema, which is swelling of the optic disc caused by
increased intracranial pressure (ICP). The optic nerve sheath is contiguous with the subarachnoid space,
allowing elevated CSF pressure to transmit directly to the optic disc, causing venous congestion, disc
edema, and loss of spontaneous venous pulsations. This is a neurological emergency requiring
immediate CNS imaging. Clinical Pearl: Papilledema is almost always bilateral; unilateral disc edema
suggests optic neuritis rather than increased ICP.
Q3: [Image-Based Question] You are evaluating an image of a right tympanic membrane obtained via
otoscopy on a 4-year-old child with acute ear pain and fever. The image demonstrates a markedly
erythematous, bulging tympanic membrane with loss of normal bony landmarks and a distinct
yellowish-white bulge in the posterior inferior quadrant. What is the most accurate clinical
interpretation?
A. Acute otitis externa with a fungal superinfection.
B. Acute otitis media with effusion (OME).
C. Acute otitis media (AOM) likely requiring antibacterial therapy. [CORRECT]
D. Chronic serous otitis media with retraction pockets.
Correct Answer: C
Rationale: A bulging, erythematous tympanic membrane with obscured landmarks and a localized
yellowish-white bulge (indicating a purulent effusion under pressure) is the hallmark of acute otitis
media (AOM). Otitis externa involves the ear canal, not the TM. OME implies fluid without signs of acute
,infection or bulging. This presentation meets the strict diagnostic criteria for AOM and typically warrants
antibiotic therapy in this age group. Clinical Pearl: A bulging TM is the strongest predictive finding for
bacterial AOM.
Q4: [Technique Order Question] You are performing a comprehensive head and neck examination on a
new patient. Which of the following sequences represents the correct order of assessment for the
thyroid gland?
A. Inspection from the side, auscultation for bruits, palpation from the front, swallow observation.
B. Auscultation for bruits, inspection from the front, palpation from the back, swallow observation.
C. Inspection from the front, observe swallowing, auscultation for bruits, palpation from behind or using
the anterior approach. [CORRECT]
D. Palpation from the front, observe swallowing, inspection from the side, auscultation for bruits.
Correct Answer: C
Rationale: The thyroid exam should always begin with inspection (looking for symmetry, masses, or
visible enlargement) while the patient swallows sips of water, which elevates the thyroid gland.
Auscultation using the bell of the stethoscope is performed next to listen for vascular bruits, as
palpation can artificially create noises. Palpation is performed last, either from behind (posterior
approach) or from the front (anterior approach), to assess size, symmetry, and nodularity. Clinical Pearl:
Always auscultate the thyroid before palpating to avoid creating a false bruit.
Q5: A 35-year-old female presents with palpitations and anxiety. During thyroid palpation using the
anterior approach, you feel a 2 cm solid, non-tender nodule in the right lobe that rises with deglutition.
There is no associated cervical lymphadenopathy. What is the most appropriate next step in the
diagnostic evaluation?
A. Reassure the patient and re-examine in 6 months, as benign nodules are common.
B. Order a thyroid ultrasound and a serum thyroid-stimulating hormone (TSH) level. [CORRECT]
C. Initiate high-dose levothyroxine to suppress the nodule.
D. Perform a fine-needle aspiration (FNA) biopsy in the clinic immediately.
Correct Answer: B
, Rationale: The discovery of a palpable thyroid nodule requires initial evaluation with a serum TSH to
assess functional status (hyperthyroid, euthyroid, or hypothyroid) and a thyroid ultrasound to
characterize the nodule's composition (solid vs. cystic) and features. FNA biopsy is indicated based on
ultrasound findings and size criteria (e.g., >1 cm with suspicious features), not immediately upon
palpation. Suppressive therapy is no longer routinely recommended. Clinical Pearl: A TSH level is the first
lab test to order for any thyroid nodule to determine if it is a "hot" or "cold" nodule.
Q6: A 68-year-old patient is undergoing cranial nerve assessment. You ask the patient to follow your
finger as you move it in an "H" pattern. You observe that the patient's left eye cannot adduct (move
medially) when looking toward the nose, but the right eye abducts normally. Additionally, the patient
exhibits a fine horizontal nystagmus in the abducting right eye. Which cranial nerve lesion is most likely
present?
A. Left oculomotor nerve (CN III) palsy.
B. Right abducens nerve (CN VI) palsy.
C. Left medial longitudinal fasciculus (MLF) lesion causing internuclear ophthalmoplegia (INO).
[CORRECT]
D. Left trochlear nerve (CN IV) palsy.
Correct Answer: C
Rationale: Internuclear ophthalmoplegia (INO) is caused by a lesion in the medial longitudinal fasciculus
(MLF), which coordinates horizontal eye movements between CN III and CN VI. The classic finding is
impaired adduction of the ipsilateral eye and abducting nystagmus of the contralateral eye. This is highly
associated with multiple sclerosis in younger patients and brainstem strokes in older patients. A CN III
palsy would present with ptosis, "down and out" eye position, and pupillary dilation. Clinical Pearl: INO
is a failure of conjugate gaze; the eye can abduct, but cannot adduct, with nystagmus in the abducting
eye.
Q7: During a routine physical on a 45-year-old male, you ask him to smile, raise his eyebrows, and puff
out his cheeks. You note asymmetrical facial droop on the right side, with an inability to raise the right
eyebrow and failure to close the right eye completely. He reports sudden onset of these symptoms
yesterday. Which cranial nerve is affected, and what is the most likely diagnosis?
A. Trigeminal nerve (CN V); trigeminal neuralgia.
B. Facial nerve (CN VII); peripheral Bell's palsy. [CORRECT]
