NUR 504 Exam 2 (PDF) | (Updated) Advanced Health
Assessment Exam Questions — 100 Questions
Section 1: Health History and Interviewing Techniques (Questions 1-10)
1 A clinician is conducting a health history with a patient who appears guarded and avoids eye contact. The
clinician notices the patient's hands are trembling. Which interviewing technique is most appropriate to build
rapport and reduce the patient's anxiety?
A) Direct the patient to relax and explain that the physical symptoms are likely due to anxiety.
B) Use open-ended questions while maintaining a neutral, non-confrontational posture and normalizing the
patient's emotions.
C) Proceed with a structured, close-ended questionnaire to minimize variability in responses.
D) Acknowledge the trembling and ask the patient directly whether they are feeling anxious or afraid.
Answer: B
Rationale: Option B uses open-ended questions and non-confrontational posture to reduce power differential and
anxiety. Directing (A) dismisses patient's experience; close-ended (C) may increase anxiety; direct
acknowledgment (D) risks escalating discomfort if patient is not ready.
2 A patient reports intermittent chest pain but cannot describe the quality, duration, or aggravating factors. Which
mnemonic is most appropriate to systematically explore this symptom?
A) OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity)
B) PQRST (Provocative/Palliative, Quality, Region/Radiation, Severity, Timing)
C) SOCRATES (Site, Onset, Character, Radiation, Associated features, Time course, Exacerbating/Relieving
factors, Severity)
D) OPQRST (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing)
Answer: D
Rationale: OPQRST is the standard mnemonic for pain assessment in advanced health history. OLDCARTS (A) and
SOCRATES (C) are also used but OPQRST is most common for acute pain. PQRST (B) lacks 'Onset' which is
critical.
3 During a sexual history interview, a patient becomes silent and looks away when asked about number of
partners. The clinician should:
A) Reassure the patient that the information is confidential and restate the question in a different way.
B) Acknowledge the discomfort, offer to skip the question, and note the behavior for later follow-up.
C) Proceed to the next question to avoid further embarrassment.
D) Explain that this information is necessary for a complete assessment and wait for a response.
Answer: B
Rationale: Trauma-informed care requires respecting patient cues of distress. Acknowledging discomfort and
offering to defer (B) builds trust. Reassuring (A) may pressure; proceeding (C) misses opportunity; insisting (D) is
authoritarian.
4 A clinician is interviewing a patient who is a recent immigrant and speaks limited English. A family member
offers to interpret. What is the best practice?
A) Accept the family member as interpreter to build trust and reduce barriers.
B) Use a professional medical interpreter, either in-person or via video, to ensure accuracy and confidentiality.
,C) Use simple English phrases and gestures to communicate directly with the patient.
D) Ask the family member to translate only the clinician's questions, not the patient's responses.
Answer: B
Rationale: Professional interpreters are recommended to avoid errors, breaches of confidentiality, and family bias.
Family members (A) may filter information. Simple English (C) risks misunderstanding. Limiting translation (D)
still compromises quality.
5 A patient with chronic pain describes their pain as 'a 7 out of 10' but appears calm, smiling, and watching TV
during the interview. Which approach is most appropriate?
A) Document the pain score as reported and note the discrepancy between verbal and nonverbal cues.
B) Ask the patient to clarify if the pain is truly 7/10 given their relaxed demeanor.
C) Lower the documented pain score based on observed behavior.
D) Explore the patient's pain experience further, including how they cope and what makes it tolerable.
Answer: D
Rationale: Pain is subjective; behavior may not correlate. Exploring coping mechanisms (D) provides a fuller
picture without judgment. Documenting discrepancy (A) is incomplete; questioning (B) may invalidate; lowering
(C) is inappropriate.
6 When taking a social history, a clinician asks 'Do you feel safe in your current relationship?' The patient pauses
and then says 'Yes.' Which follow-up is most appropriate?
A) Accept the answer and move on to the next topic.
B) Ask 'Has your partner ever hurt you or threatened you?'
C) Use a normalizing statement such as 'Many people have times when they don't feel safe. Is that true for you?'
D) Repeat the question because the pause suggests uncertainty.
Answer: C
Rationale: Normalizing statements (C) reduce stigma and encourage disclosure. Accepting (A) may miss IPV; direct
question (B) can be too abrupt; repeating (D) may increase pressure.
7 A clinician is using the BATHE technique during a health history. The patient responds to the 'H' (How does it
affect you?) by saying 'It's ruining my life.' The clinician should next:
A) Empathize and ask 'What does that mean for you?' to explore the impact.
B) Transition to the medical history to address the underlying condition.
C) Provide reassurance that the situation will improve.
D) Document the statement verbatim and move on.
Answer: A
Rationale: BATHE stands for Background, Affect, Trouble, Handling, Empathy. After 'H' (How does it affect you?),
the clinician should empathize and explore. Transitioning (B) cuts off therapeutic engagement; reassurance (C)
dismisses; documentation (D) misses opportunity.
8 A patient presents with vague symptoms of fatigue and malaise. Using the FIFE model, which question is most
appropriate to understand the patient's perspective?
A) What do you think is causing these symptoms?
B) How long have you been feeling tired?
C) Have you had any recent infections?
D) Does anyone in your family have similar symptoms?
Answer: A
, Rationale: FIFE stands for Feelings, Ideas, Function, Expectations. Asking about ideas (A) explores the patient's
explanatory model. Questions about duration (B), infections (C), or family (D) are biomedical and not part of FIFE.
9 A clinician notices that a patient consistently uses the phrase 'you know' and gestures vaguely when describing
symptoms. Which interviewing technique is most effective?
A) Ask the patient to be more specific and avoid vague language.
B) Use reflective listening: 'It sounds like you are having trouble describing what you feel.'
C) Ignore the vagueness and focus on yes/no questions.
D) Complete the patient's sentences to demonstrate understanding.
Answer: B
Rationale: Reflective listening (B) validates the patient's difficulty and encourages elaboration. Asking for
specificity (A) may feel critical; ignoring (C) loses information; completing sentences (D) may introduce bias.
10 When conducting a review of systems, a patient endorses 'occasional dizziness' but cannot recall when it
happens. Which response is most appropriate?
A) Ask 'Does it happen when you stand up quickly?' to narrow down orthostatic causes.
B) Document 'dizziness' as a symptom and move on to the next system.
C) Explain that dizziness is a common symptom and usually not serious.
D) Ask the patient to keep a symptom diary and return for follow-up.
Answer: A
Rationale: Using a specific, closed-ended question (A) helps characterize the symptom efficiently. Documenting (B)
is insufficient; reassurance (C) is premature; diary (D) delays assessment.
Section 2: Physical Examination Techniques and Equipment (Questions 11-20)
11 During cardiac auscultation, you hear a high-pitched, decrescendo diastolic murmur best heard at the left
sternal border with the patient leaning forward and holding breath in expiration. Which valve lesion is most
likely, and what is the optimal stethoscope bell/diaphragm selection?
A) Aortic regurgitation; use the diaphragm firmly pressed on the chest.
B) Mitral stenosis; use the bell lightly applied.
C) Pulmonic regurgitation; use the bell lightly applied.
D) Tricuspid regurgitation; use the diaphragm firmly pressed.
Answer: A
Rationale: Aortic regurgitation produces a high-pitched, decrescendo diastolic murmur best heard at the left sternal
border with the patient leaning forward in expiration. The diaphragm is optimal for high-pitched sounds. Mitral
stenosis produces a low-pitched diastolic rumble best heard with the bell. Pulmonic regurgitation is similar but
often increases with inspiration. Tricuspid regurgitation is systolic.
12 When using a transilluminator to evaluate a suspected hydrocele, the scrotum transilluminates uniformly.
However, you note that the light does not transilluminate through the upper portion of the scrotum. What is the
most likely explanation for this finding?
A) The presence of a spermatocele above the testis.
B) A varicocele causing shadowing from dilated veins.
C) The testis itself is opaque and blocks transmission.
D) Incarcerated inguinal hernia containing bowel.
Answer: C
Assessment Exam Questions — 100 Questions
Section 1: Health History and Interviewing Techniques (Questions 1-10)
1 A clinician is conducting a health history with a patient who appears guarded and avoids eye contact. The
clinician notices the patient's hands are trembling. Which interviewing technique is most appropriate to build
rapport and reduce the patient's anxiety?
A) Direct the patient to relax and explain that the physical symptoms are likely due to anxiety.
B) Use open-ended questions while maintaining a neutral, non-confrontational posture and normalizing the
patient's emotions.
C) Proceed with a structured, close-ended questionnaire to minimize variability in responses.
D) Acknowledge the trembling and ask the patient directly whether they are feeling anxious or afraid.
Answer: B
Rationale: Option B uses open-ended questions and non-confrontational posture to reduce power differential and
anxiety. Directing (A) dismisses patient's experience; close-ended (C) may increase anxiety; direct
acknowledgment (D) risks escalating discomfort if patient is not ready.
2 A patient reports intermittent chest pain but cannot describe the quality, duration, or aggravating factors. Which
mnemonic is most appropriate to systematically explore this symptom?
A) OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity)
B) PQRST (Provocative/Palliative, Quality, Region/Radiation, Severity, Timing)
C) SOCRATES (Site, Onset, Character, Radiation, Associated features, Time course, Exacerbating/Relieving
factors, Severity)
D) OPQRST (Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing)
Answer: D
Rationale: OPQRST is the standard mnemonic for pain assessment in advanced health history. OLDCARTS (A) and
SOCRATES (C) are also used but OPQRST is most common for acute pain. PQRST (B) lacks 'Onset' which is
critical.
3 During a sexual history interview, a patient becomes silent and looks away when asked about number of
partners. The clinician should:
A) Reassure the patient that the information is confidential and restate the question in a different way.
B) Acknowledge the discomfort, offer to skip the question, and note the behavior for later follow-up.
C) Proceed to the next question to avoid further embarrassment.
D) Explain that this information is necessary for a complete assessment and wait for a response.
Answer: B
Rationale: Trauma-informed care requires respecting patient cues of distress. Acknowledging discomfort and
offering to defer (B) builds trust. Reassuring (A) may pressure; proceeding (C) misses opportunity; insisting (D) is
authoritarian.
4 A clinician is interviewing a patient who is a recent immigrant and speaks limited English. A family member
offers to interpret. What is the best practice?
A) Accept the family member as interpreter to build trust and reduce barriers.
B) Use a professional medical interpreter, either in-person or via video, to ensure accuracy and confidentiality.
,C) Use simple English phrases and gestures to communicate directly with the patient.
D) Ask the family member to translate only the clinician's questions, not the patient's responses.
Answer: B
Rationale: Professional interpreters are recommended to avoid errors, breaches of confidentiality, and family bias.
Family members (A) may filter information. Simple English (C) risks misunderstanding. Limiting translation (D)
still compromises quality.
5 A patient with chronic pain describes their pain as 'a 7 out of 10' but appears calm, smiling, and watching TV
during the interview. Which approach is most appropriate?
A) Document the pain score as reported and note the discrepancy between verbal and nonverbal cues.
B) Ask the patient to clarify if the pain is truly 7/10 given their relaxed demeanor.
C) Lower the documented pain score based on observed behavior.
D) Explore the patient's pain experience further, including how they cope and what makes it tolerable.
Answer: D
Rationale: Pain is subjective; behavior may not correlate. Exploring coping mechanisms (D) provides a fuller
picture without judgment. Documenting discrepancy (A) is incomplete; questioning (B) may invalidate; lowering
(C) is inappropriate.
6 When taking a social history, a clinician asks 'Do you feel safe in your current relationship?' The patient pauses
and then says 'Yes.' Which follow-up is most appropriate?
A) Accept the answer and move on to the next topic.
B) Ask 'Has your partner ever hurt you or threatened you?'
C) Use a normalizing statement such as 'Many people have times when they don't feel safe. Is that true for you?'
D) Repeat the question because the pause suggests uncertainty.
Answer: C
Rationale: Normalizing statements (C) reduce stigma and encourage disclosure. Accepting (A) may miss IPV; direct
question (B) can be too abrupt; repeating (D) may increase pressure.
7 A clinician is using the BATHE technique during a health history. The patient responds to the 'H' (How does it
affect you?) by saying 'It's ruining my life.' The clinician should next:
A) Empathize and ask 'What does that mean for you?' to explore the impact.
B) Transition to the medical history to address the underlying condition.
C) Provide reassurance that the situation will improve.
D) Document the statement verbatim and move on.
Answer: A
Rationale: BATHE stands for Background, Affect, Trouble, Handling, Empathy. After 'H' (How does it affect you?),
the clinician should empathize and explore. Transitioning (B) cuts off therapeutic engagement; reassurance (C)
dismisses; documentation (D) misses opportunity.
8 A patient presents with vague symptoms of fatigue and malaise. Using the FIFE model, which question is most
appropriate to understand the patient's perspective?
A) What do you think is causing these symptoms?
B) How long have you been feeling tired?
C) Have you had any recent infections?
D) Does anyone in your family have similar symptoms?
Answer: A
, Rationale: FIFE stands for Feelings, Ideas, Function, Expectations. Asking about ideas (A) explores the patient's
explanatory model. Questions about duration (B), infections (C), or family (D) are biomedical and not part of FIFE.
9 A clinician notices that a patient consistently uses the phrase 'you know' and gestures vaguely when describing
symptoms. Which interviewing technique is most effective?
A) Ask the patient to be more specific and avoid vague language.
B) Use reflective listening: 'It sounds like you are having trouble describing what you feel.'
C) Ignore the vagueness and focus on yes/no questions.
D) Complete the patient's sentences to demonstrate understanding.
Answer: B
Rationale: Reflective listening (B) validates the patient's difficulty and encourages elaboration. Asking for
specificity (A) may feel critical; ignoring (C) loses information; completing sentences (D) may introduce bias.
10 When conducting a review of systems, a patient endorses 'occasional dizziness' but cannot recall when it
happens. Which response is most appropriate?
A) Ask 'Does it happen when you stand up quickly?' to narrow down orthostatic causes.
B) Document 'dizziness' as a symptom and move on to the next system.
C) Explain that dizziness is a common symptom and usually not serious.
D) Ask the patient to keep a symptom diary and return for follow-up.
Answer: A
Rationale: Using a specific, closed-ended question (A) helps characterize the symptom efficiently. Documenting (B)
is insufficient; reassurance (C) is premature; diary (D) delays assessment.
Section 2: Physical Examination Techniques and Equipment (Questions 11-20)
11 During cardiac auscultation, you hear a high-pitched, decrescendo diastolic murmur best heard at the left
sternal border with the patient leaning forward and holding breath in expiration. Which valve lesion is most
likely, and what is the optimal stethoscope bell/diaphragm selection?
A) Aortic regurgitation; use the diaphragm firmly pressed on the chest.
B) Mitral stenosis; use the bell lightly applied.
C) Pulmonic regurgitation; use the bell lightly applied.
D) Tricuspid regurgitation; use the diaphragm firmly pressed.
Answer: A
Rationale: Aortic regurgitation produces a high-pitched, decrescendo diastolic murmur best heard at the left sternal
border with the patient leaning forward in expiration. The diaphragm is optimal for high-pitched sounds. Mitral
stenosis produces a low-pitched diastolic rumble best heard with the bell. Pulmonic regurgitation is similar but
often increases with inspiration. Tricuspid regurgitation is systolic.
12 When using a transilluminator to evaluate a suspected hydrocele, the scrotum transilluminates uniformly.
However, you note that the light does not transilluminate through the upper portion of the scrotum. What is the
most likely explanation for this finding?
A) The presence of a spermatocele above the testis.
B) A varicocele causing shadowing from dilated veins.
C) The testis itself is opaque and blocks transmission.
D) Incarcerated inguinal hernia containing bowel.
Answer: C
