NURS 612 – ADVANCED HEALTH ASSESSMENT
Official Exam 2026/2027
Total Questions: 300
Time Limit: 4 hours
Each question = 1 point
1. A 68-year-old male reports episodic chest pressure with exertion that resolves with rest. What is the
most likely description of this pain?
A) Sharp, pleuritic, positional
B) Dull, aching, constant for hours
C) Tightness, substernal, lasting <10 minutes
D) Burning, epigastric, relieved by antacids
Rationale: C – This describes stable angina: substernal tightness/pressure, provoked by exertion,
relieved by rest/short duration. Pleuritic pain suggests pericarditis/pneumothorax (A). Constant aching
for hours is more musculoskeletal or atypical (B). Burning relieved by antacids suggests GERD (D).
2. During a cardiac exam, you palpate a thrill at the left sternal border. This finding is most consistent
with:
A) Mitral stenosis
B) Aortic regurgitation
C) Ventricular septal defect
D) Benign flow murmur
Rationale: C – A thrill is a palpable vibration from a loud murmur (grade 4–6). VSD often produces a
harsh holosystolic murmur with a palpable thrill at LSB. Mitral stenosis gives a diastolic thrill at apex (A).
Aortic regurgitation is diastolic but thrill less common (B). Benign murmurs have no thrill (D).
3. A 45-year-old female has a blood pressure of 148/92 mmHg in the right arm and 130/86 mmHg in the
left arm. What should you suspect?
A) Normal variant
B) Coarctation of the aorta
C) Subclavian steal syndrome
D) Atherosclerotic plaque
Rationale: D – A difference >10 mmHg suggests subclavian artery stenosis due to atherosclerosis.
Coarctation (B) typically causes lower extremity hypotension, not arm difference. Subclavian steal (C)
can cause difference but often with neurological symptoms. Normal variant (A) is <5–10 mmHg.
,4. When auscultating lung sounds, you hear high-pitched, continuous musical sounds during inspiration
and expiration. This is:
A) Fine crackles
B) Rhonchi
C) Stridor
D) Wheezes
Rationale: D – Wheezes are continuous, musical, high-pitched, heard in asthma/COPD. Fine crackles (A)
are intermittent, non-musical. Rhonchi (B) are low-pitched snoring sounds. Stridor (C) is a harsh
monophonic sound heard mainly during inspiration, indicating upper airway obstruction.
5. A patient with heart failure has jugular venous distension (JVD) and hepatomegaly. You elicit
hepatojugular reflux. This is performed by:
A) Pressing on the liver for 30 seconds and watching JVP rise
B) Tilting the bed to 45° and measuring internal jugular height
C) Asking patient to hold breath and bear down
D) Palpating the liver edge during inspiration
Rationale: A – Hepatojugular reflux: sustained pressure over right upper quadrant for 30 sec →
increased venous return → JVP eleva on in right heart failure or preload-sensitive states. B describes
JVP measurement. C is Valsalva. D is liver palpation technique.
6. Which cranial nerve is tested by asking the patient to shrug shoulders against resistance?
A) CN XI (accessory)
B) CN X (vagus)
C) CN XII (hypoglossal)
D) CN V (trigeminal)
Rationale: A – Spinal accessory nerve (CN XI) innervates trapezius (shoulder shrug) and
sternocleidomastoid. CN X (B) – pharynx/larynx. CN XII (C) – tongue movements. CN V (D) – mastication
and facial sensation.
7. A 72-year-old reports chronic “heaviness” in legs, worse at day’s end, with brown discoloration and
varicose veins. Most likely diagnosis:
A) Arterial insufficiency
B) Lymphedema
C) Chronic venous insufficiency
D) Deep vein thrombosis
,Rationale: C – Venous stasis changes: brown hemosiderin deposition, varicosities, edema worse with
dependency. Arterial insufficiency (A) causes hair loss, cool skin, claudication. Lymphedema (B) is non-
pitting, often from obstruction. DVT (D) acute unilateral swelling/pain.
8. On auscultation of the carotid arteries, you hear a low-pitched, non-radiating bruit. The patient is
asymptomatic. Next step:
A) Immediate anticoagulation
B) Carotid duplex ultrasound
C) Refer for endarterectomy
D) Reassure and recheck in 1 year
Rationale: B – Asymptomatic carotid bruit requires duplex ultrasound to quantify stenosis. Immediate
anticoagulation (A) not indicated. Endarterectomy (C) only for symptomatic severe stenosis or select
asymptomatic >70% stenosis. Reassure (D) is unsafe without imaging.
9. When assessing a toddler’s vision, which test is most appropriate?
A) Snellen chart
B) Allen cards
C) Cover-uncover test
D) Visual acuity with Tumbling E
Rationale: B – Allen picture cards are for preliterate children (~2–4 years). Snellen (A) for older children
who know letters. Tumbling E (D) for non-English speakers or older. Cover-uncover (C) tests strabismus,
not acuity.
10. A patient has a positive McMurray test. This indicates:
A) Anterior cruciate ligament tear
B) Posterior cruciate ligament injury
C) Medial meniscal tear
D) Lateral collateral ligament sprain
Rationale: C – McMurray test (click or pain with knee flexion/extension and rotation) indicates meniscal
tear. ACL – Lachman/ anterior drawer (A). PCL – posterior drawer (B). LCL – varus stress test (D).
11. A 55-year-old with diabetes has diminished vibration sense at the great toe. This is most consistent
with:
A) Peripheral neuropathy
B) Radiculopathy
C) Myelopathy
D) Myopathy
, Rationale: A – Distal, symmetric loss of vibration (large fiber) is common in diabetic neuropathy.
Radiculopathy (B) dermatomal. Myelopathy (C) upper motor neuron signs. Myopathy (D) proximal
weakness, sensory usually intact.
12. Which of the following is a normal finding in a newborn’s hips?
A) Positive Ortolani sign
B) Asymmetric gluteal folds
C) Negative Barlow test
D) Limited abduction to 30°
Rationale: C – Negative Barlow (hip stable) is normal. Positive Ortolani (A) indicates dislocated hip
reducing. Asymmetric folds (B) suspicious for DDH. Limited abduction <60° (D) abnormal.
13. A 30-year-old presents with acute onset of severe, throbbing pain in the left great toe, with redness
and swelling. Serum uric acid is 9.5 mg/dL (normal <6.8). Most likely diagnosis:
A) Pseudogout
B) Septic arthritis
C) Gout
D) Rheumatoid arthritis
Rationale: C – Acute monoarthritis of 1st MTP + hyperuricemia = gout (podagra). Pseudogout (A) usually
knee, calcium pyrophosphate crystals. Septic arthritis (B) acute, but systemic symptoms more common.
RA (D) polyarticular, symmetric.
14. When palpating the thyroid, you feel a smooth, diffuse, nontender enlargement without nodules.
This suggests:
A) Multinodular goiter
B) Graves’ disease
C) Thyroid cancer
D) Hashimoto’s thyroiditis
Rationale: B – Diffuse smooth enlargement suggests Graves’ (hyperthyroidism). Multinodular goiter (A)
has irregular nodules. Cancer (C) typically firm, fixed nodule. Hashimoto’s (D) may be firm or lobulated,
often tender.
15. A patient reports double vision that resolves when either eye is covered. This is:
A) Monocular diplopia
B) Binocular diplopia
C) Convergence insufficiency
D) Third nerve palsy
Official Exam 2026/2027
Total Questions: 300
Time Limit: 4 hours
Each question = 1 point
1. A 68-year-old male reports episodic chest pressure with exertion that resolves with rest. What is the
most likely description of this pain?
A) Sharp, pleuritic, positional
B) Dull, aching, constant for hours
C) Tightness, substernal, lasting <10 minutes
D) Burning, epigastric, relieved by antacids
Rationale: C – This describes stable angina: substernal tightness/pressure, provoked by exertion,
relieved by rest/short duration. Pleuritic pain suggests pericarditis/pneumothorax (A). Constant aching
for hours is more musculoskeletal or atypical (B). Burning relieved by antacids suggests GERD (D).
2. During a cardiac exam, you palpate a thrill at the left sternal border. This finding is most consistent
with:
A) Mitral stenosis
B) Aortic regurgitation
C) Ventricular septal defect
D) Benign flow murmur
Rationale: C – A thrill is a palpable vibration from a loud murmur (grade 4–6). VSD often produces a
harsh holosystolic murmur with a palpable thrill at LSB. Mitral stenosis gives a diastolic thrill at apex (A).
Aortic regurgitation is diastolic but thrill less common (B). Benign murmurs have no thrill (D).
3. A 45-year-old female has a blood pressure of 148/92 mmHg in the right arm and 130/86 mmHg in the
left arm. What should you suspect?
A) Normal variant
B) Coarctation of the aorta
C) Subclavian steal syndrome
D) Atherosclerotic plaque
Rationale: D – A difference >10 mmHg suggests subclavian artery stenosis due to atherosclerosis.
Coarctation (B) typically causes lower extremity hypotension, not arm difference. Subclavian steal (C)
can cause difference but often with neurological symptoms. Normal variant (A) is <5–10 mmHg.
,4. When auscultating lung sounds, you hear high-pitched, continuous musical sounds during inspiration
and expiration. This is:
A) Fine crackles
B) Rhonchi
C) Stridor
D) Wheezes
Rationale: D – Wheezes are continuous, musical, high-pitched, heard in asthma/COPD. Fine crackles (A)
are intermittent, non-musical. Rhonchi (B) are low-pitched snoring sounds. Stridor (C) is a harsh
monophonic sound heard mainly during inspiration, indicating upper airway obstruction.
5. A patient with heart failure has jugular venous distension (JVD) and hepatomegaly. You elicit
hepatojugular reflux. This is performed by:
A) Pressing on the liver for 30 seconds and watching JVP rise
B) Tilting the bed to 45° and measuring internal jugular height
C) Asking patient to hold breath and bear down
D) Palpating the liver edge during inspiration
Rationale: A – Hepatojugular reflux: sustained pressure over right upper quadrant for 30 sec →
increased venous return → JVP eleva on in right heart failure or preload-sensitive states. B describes
JVP measurement. C is Valsalva. D is liver palpation technique.
6. Which cranial nerve is tested by asking the patient to shrug shoulders against resistance?
A) CN XI (accessory)
B) CN X (vagus)
C) CN XII (hypoglossal)
D) CN V (trigeminal)
Rationale: A – Spinal accessory nerve (CN XI) innervates trapezius (shoulder shrug) and
sternocleidomastoid. CN X (B) – pharynx/larynx. CN XII (C) – tongue movements. CN V (D) – mastication
and facial sensation.
7. A 72-year-old reports chronic “heaviness” in legs, worse at day’s end, with brown discoloration and
varicose veins. Most likely diagnosis:
A) Arterial insufficiency
B) Lymphedema
C) Chronic venous insufficiency
D) Deep vein thrombosis
,Rationale: C – Venous stasis changes: brown hemosiderin deposition, varicosities, edema worse with
dependency. Arterial insufficiency (A) causes hair loss, cool skin, claudication. Lymphedema (B) is non-
pitting, often from obstruction. DVT (D) acute unilateral swelling/pain.
8. On auscultation of the carotid arteries, you hear a low-pitched, non-radiating bruit. The patient is
asymptomatic. Next step:
A) Immediate anticoagulation
B) Carotid duplex ultrasound
C) Refer for endarterectomy
D) Reassure and recheck in 1 year
Rationale: B – Asymptomatic carotid bruit requires duplex ultrasound to quantify stenosis. Immediate
anticoagulation (A) not indicated. Endarterectomy (C) only for symptomatic severe stenosis or select
asymptomatic >70% stenosis. Reassure (D) is unsafe without imaging.
9. When assessing a toddler’s vision, which test is most appropriate?
A) Snellen chart
B) Allen cards
C) Cover-uncover test
D) Visual acuity with Tumbling E
Rationale: B – Allen picture cards are for preliterate children (~2–4 years). Snellen (A) for older children
who know letters. Tumbling E (D) for non-English speakers or older. Cover-uncover (C) tests strabismus,
not acuity.
10. A patient has a positive McMurray test. This indicates:
A) Anterior cruciate ligament tear
B) Posterior cruciate ligament injury
C) Medial meniscal tear
D) Lateral collateral ligament sprain
Rationale: C – McMurray test (click or pain with knee flexion/extension and rotation) indicates meniscal
tear. ACL – Lachman/ anterior drawer (A). PCL – posterior drawer (B). LCL – varus stress test (D).
11. A 55-year-old with diabetes has diminished vibration sense at the great toe. This is most consistent
with:
A) Peripheral neuropathy
B) Radiculopathy
C) Myelopathy
D) Myopathy
, Rationale: A – Distal, symmetric loss of vibration (large fiber) is common in diabetic neuropathy.
Radiculopathy (B) dermatomal. Myelopathy (C) upper motor neuron signs. Myopathy (D) proximal
weakness, sensory usually intact.
12. Which of the following is a normal finding in a newborn’s hips?
A) Positive Ortolani sign
B) Asymmetric gluteal folds
C) Negative Barlow test
D) Limited abduction to 30°
Rationale: C – Negative Barlow (hip stable) is normal. Positive Ortolani (A) indicates dislocated hip
reducing. Asymmetric folds (B) suspicious for DDH. Limited abduction <60° (D) abnormal.
13. A 30-year-old presents with acute onset of severe, throbbing pain in the left great toe, with redness
and swelling. Serum uric acid is 9.5 mg/dL (normal <6.8). Most likely diagnosis:
A) Pseudogout
B) Septic arthritis
C) Gout
D) Rheumatoid arthritis
Rationale: C – Acute monoarthritis of 1st MTP + hyperuricemia = gout (podagra). Pseudogout (A) usually
knee, calcium pyrophosphate crystals. Septic arthritis (B) acute, but systemic symptoms more common.
RA (D) polyarticular, symmetric.
14. When palpating the thyroid, you feel a smooth, diffuse, nontender enlargement without nodules.
This suggests:
A) Multinodular goiter
B) Graves’ disease
C) Thyroid cancer
D) Hashimoto’s thyroiditis
Rationale: B – Diffuse smooth enlargement suggests Graves’ (hyperthyroidism). Multinodular goiter (A)
has irregular nodules. Cancer (C) typically firm, fixed nodule. Hashimoto’s (D) may be firm or lobulated,
often tender.
15. A patient reports double vision that resolves when either eye is covered. This is:
A) Monocular diplopia
B) Binocular diplopia
C) Convergence insufficiency
D) Third nerve palsy
