NURS 612 ADVANCED HEALTH ASSESSMENT
EXAM 4 Actual Exam 2026/2027 | Official Exam –
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Musculoskeletal Assessment | Q1 – Q10
Section 2 | Neurologic Examination | Q11 – Q20
Section 3 | Mental Status and Psychiatric Assessment | Q21 – Q30
Section 4 | Geriatric Assessment Considerations | Q31 – Q40
Section 5 | Clinical Documentation and Differential Diagnosis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: MUSCULOSKELETAL ASSESSMENT Q1 – Q10
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Question 1 of 50
A 34-year-old carpenter presents to the occupational health clinic with right shoulder
pain that worsens when reaching overhead. On examination, active abduction is limited
to 120 degrees, but passive abduction reaches 180 degrees. There is no atrophy of the
supraspinatus fossa.
A. A complete rotator cuff tear with significant muscle atrophy
B. Adhesive capsulitis with restricted passive range of motion ✓ CORRECT
C. Subacromial impingement syndrome with intact active motion
D. Glenohumeral osteoarthritis with crepitus on passive movement
Correct Answer: B
Rationale: The preserved passive range of motion with limited active motion suggests a
soft-tissue problem rather than a capsular or joint issue. Adhesive capsulitis would
,characteristically restrict both active and passive range of motion, making this the key
distinguishing finding that points away from that diagnosis. In clinical practice, the
painful arc between 60 and 120 degrees of abduction often helps localize the pathology
to the subacromial space.
Question 2 of 50
During a preparticipation sports physical, a 17-year-old high school basketball player
reports intermittent left knee pain that occurs when descending stairs. Examination
reveals tenderness along the inferior pole of the patella and pain with resisted knee
extension. There is no joint effusion or ligamentous laxity.
A. Prepatellar bursitis from chronic kneeling on hardwood floors
B. Anterior cruciate ligament sprain with positive Lachman test
C. Medial meniscus tear with clicking on McMurray maneuver
D. Patellar tendinopathy from repetitive jumping activities ✓ CORRECT
Correct Answer: D
Rationale: Pain localized to the inferior patellar pole that worsens with resisted
extension and eccentric loading is the classic presentation of patellar tendinopathy,
often called jumper's knee in adolescent athletes. A meniscal tear would more likely
produce joint line tenderness, effusion, or mechanical symptoms such as locking or
catching rather than isolated inferior pole tenderness. Coaches and athletic trainers
frequently see this condition during preseason conditioning when training volume
increases rapidly.
Question 3 of 50
A 68-year-old woman with a 10-year history of rheumatoid arthritis arrives for her annual
musculoskeletal review. She reports increased stiffness in her hands that now lasts
nearly three hours each morning. Examination reveals ulnar deviation at the
metacarpophalangeal joints and swan-neck deformities of several fingers.
,A. The prolonged morning stiffness indicates worsening inflammatory disease activity
✓ CORRECT
B. The deformities suggest osteoarthritis with Heberden nodes developing
C. Her symptoms reflect fibromyalgia with widespread tender points
D. The ulnar deviation is caused by chronic gouty tophaceous changes
Correct Answer: A
Rationale: Morning stiffness lasting more than one hour is a hallmark feature of
inflammatory arthritis and serves as a reliable indicator of disease activity in
rheumatoid arthritis. Osteoarthritis typically produces brief stiffness lasting less than 30
minutes and affects the distal interphalangeal joints with bony enlargement rather than
ulnar deviation. Monitoring morning stiffness duration helps clinicians assess treatment
response and guides decisions about adjusting disease-modifying antirheumatic drugs.
Question 4 of 50
A 45-year-old marathon runner presents with aching pain along the posteromedial
border of the left tibia that began three weeks after increasing weekly mileage. The pain
is sharp at the start of a run, gradually becomes dull, and resolves with rest. Palpation
reveals tenderness over a five-centimeter length of the tibial shaft without focal
swelling.
A. Acute compartment syndrome requiring immediate surgical consultation
B. Stress fracture of the tibial shaft with point tenderness on single-finger palpation
C. Medial tibial stress syndrome with diffuse tenderness along the posteromedial edge
✓ CORRECT
D. Deep venous thrombosis with calf swelling and Homans sign positivity
Correct Answer: C
Rationale: Diffuse tenderness extending several centimeters along the posteromedial
tibial border in a runner who recently increased training volume is the characteristic
presentation of medial tibial stress syndrome. A stress fracture would typically produce
more localized, pinpoint tenderness that is exquisitely painful with single-site palpation
, rather than spread over a longer area. Runners transitioning from soft surfaces to
pavement or rapidly increasing mileage are particularly vulnerable to this overuse injury
during base-building phases.
Question 5 of 50
In the emergency department, a 28-year-old man who fell from a ladder lands on his
outstretched right hand. He holds the wrist in a protective flexed position and refuses to
extend it. The distal forearm has a dinner-fork deformity, and the radial styloid process
is prominently displaced dorsally.
A. Smith fracture with volar displacement of the distal fragment
B. Colles fracture with dorsal displacement and possible median nerve compromise ✓
CORRECT
C. Scaphoid fracture with tenderness in the anatomical snuffbox
D. Galeazzi fracture with dislocation of the distal radioulnar joint
Correct Answer: B
Rationale: The dinner-fork deformity with dorsal displacement of the distal radial
fragment is pathognomonic for a Colles fracture, the most common distal radial
fracture from a fall on an outstretched hand. A Smith fracture would produce a reverse
deformity with volar displacement, often called a garden-spade deformity, which is not
consistent with the dorsal prominence described here. Emergency providers must
always assess median nerve function before and after reduction because the displaced
fragment can compress the nerve within the carpal tunnel.
Question 6 of 50
A 52-year-old warehouse worker reports low back pain that radiates down the posterior
left thigh to the calf. Straight leg raising on the left reproduces the radicular pain at 35
degrees, while the right leg remains negative. The patient has diminished left ankle jerk
reflex and reports occasional foot drop when walking long distances.
EXAM 4 Actual Exam 2026/2027 | Official Exam –
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Musculoskeletal Assessment | Q1 – Q10
Section 2 | Neurologic Examination | Q11 – Q20
Section 3 | Mental Status and Psychiatric Assessment | Q21 – Q30
Section 4 | Geriatric Assessment Considerations | Q31 – Q40
Section 5 | Clinical Documentation and Differential Diagnosis | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MUSCULOSKELETAL ASSESSMENT Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old carpenter presents to the occupational health clinic with right shoulder
pain that worsens when reaching overhead. On examination, active abduction is limited
to 120 degrees, but passive abduction reaches 180 degrees. There is no atrophy of the
supraspinatus fossa.
A. A complete rotator cuff tear with significant muscle atrophy
B. Adhesive capsulitis with restricted passive range of motion ✓ CORRECT
C. Subacromial impingement syndrome with intact active motion
D. Glenohumeral osteoarthritis with crepitus on passive movement
Correct Answer: B
Rationale: The preserved passive range of motion with limited active motion suggests a
soft-tissue problem rather than a capsular or joint issue. Adhesive capsulitis would
,characteristically restrict both active and passive range of motion, making this the key
distinguishing finding that points away from that diagnosis. In clinical practice, the
painful arc between 60 and 120 degrees of abduction often helps localize the pathology
to the subacromial space.
Question 2 of 50
During a preparticipation sports physical, a 17-year-old high school basketball player
reports intermittent left knee pain that occurs when descending stairs. Examination
reveals tenderness along the inferior pole of the patella and pain with resisted knee
extension. There is no joint effusion or ligamentous laxity.
A. Prepatellar bursitis from chronic kneeling on hardwood floors
B. Anterior cruciate ligament sprain with positive Lachman test
C. Medial meniscus tear with clicking on McMurray maneuver
D. Patellar tendinopathy from repetitive jumping activities ✓ CORRECT
Correct Answer: D
Rationale: Pain localized to the inferior patellar pole that worsens with resisted
extension and eccentric loading is the classic presentation of patellar tendinopathy,
often called jumper's knee in adolescent athletes. A meniscal tear would more likely
produce joint line tenderness, effusion, or mechanical symptoms such as locking or
catching rather than isolated inferior pole tenderness. Coaches and athletic trainers
frequently see this condition during preseason conditioning when training volume
increases rapidly.
Question 3 of 50
A 68-year-old woman with a 10-year history of rheumatoid arthritis arrives for her annual
musculoskeletal review. She reports increased stiffness in her hands that now lasts
nearly three hours each morning. Examination reveals ulnar deviation at the
metacarpophalangeal joints and swan-neck deformities of several fingers.
,A. The prolonged morning stiffness indicates worsening inflammatory disease activity
✓ CORRECT
B. The deformities suggest osteoarthritis with Heberden nodes developing
C. Her symptoms reflect fibromyalgia with widespread tender points
D. The ulnar deviation is caused by chronic gouty tophaceous changes
Correct Answer: A
Rationale: Morning stiffness lasting more than one hour is a hallmark feature of
inflammatory arthritis and serves as a reliable indicator of disease activity in
rheumatoid arthritis. Osteoarthritis typically produces brief stiffness lasting less than 30
minutes and affects the distal interphalangeal joints with bony enlargement rather than
ulnar deviation. Monitoring morning stiffness duration helps clinicians assess treatment
response and guides decisions about adjusting disease-modifying antirheumatic drugs.
Question 4 of 50
A 45-year-old marathon runner presents with aching pain along the posteromedial
border of the left tibia that began three weeks after increasing weekly mileage. The pain
is sharp at the start of a run, gradually becomes dull, and resolves with rest. Palpation
reveals tenderness over a five-centimeter length of the tibial shaft without focal
swelling.
A. Acute compartment syndrome requiring immediate surgical consultation
B. Stress fracture of the tibial shaft with point tenderness on single-finger palpation
C. Medial tibial stress syndrome with diffuse tenderness along the posteromedial edge
✓ CORRECT
D. Deep venous thrombosis with calf swelling and Homans sign positivity
Correct Answer: C
Rationale: Diffuse tenderness extending several centimeters along the posteromedial
tibial border in a runner who recently increased training volume is the characteristic
presentation of medial tibial stress syndrome. A stress fracture would typically produce
more localized, pinpoint tenderness that is exquisitely painful with single-site palpation
, rather than spread over a longer area. Runners transitioning from soft surfaces to
pavement or rapidly increasing mileage are particularly vulnerable to this overuse injury
during base-building phases.
Question 5 of 50
In the emergency department, a 28-year-old man who fell from a ladder lands on his
outstretched right hand. He holds the wrist in a protective flexed position and refuses to
extend it. The distal forearm has a dinner-fork deformity, and the radial styloid process
is prominently displaced dorsally.
A. Smith fracture with volar displacement of the distal fragment
B. Colles fracture with dorsal displacement and possible median nerve compromise ✓
CORRECT
C. Scaphoid fracture with tenderness in the anatomical snuffbox
D. Galeazzi fracture with dislocation of the distal radioulnar joint
Correct Answer: B
Rationale: The dinner-fork deformity with dorsal displacement of the distal radial
fragment is pathognomonic for a Colles fracture, the most common distal radial
fracture from a fall on an outstretched hand. A Smith fracture would produce a reverse
deformity with volar displacement, often called a garden-spade deformity, which is not
consistent with the dorsal prominence described here. Emergency providers must
always assess median nerve function before and after reduction because the displaced
fragment can compress the nerve within the carpal tunnel.
Question 6 of 50
A 52-year-old warehouse worker reports low back pain that radiates down the posterior
left thigh to the calf. Straight leg raising on the left reproduces the radicular pain at 35
degrees, while the right leg remains negative. The patient has diminished left ankle jerk
reflex and reports occasional foot drop when walking long distances.
