NR-302 – Health Assessment II Advanced health
assessment focusing on comprehensive
examinations, clinical reasoning, diagnostic
interpretation, and complex patient evaluations.
1. A 58-year-old male presents with acute onset of severe, tearing chest pain
radiating to the back. His blood pressure is 160/90 in the right arm and 100/60
in the left arm. What is the priority differential diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with tearing chest/back pain and
asymmetric blood pressures (due to differential involvement of subclavian
arteries). Myocardial infarction pain is more often substernal pressure; pulmonary
embolism presents with dyspnea/pleuritic pain; pericarditis pain is sharp,
positional.
2. A 34-year-old woman reports episodic palpitations, sweating, headache, and
anxiety. During a episode, her blood pressure is 210/110. Between episodes,
exam is normal. Which diagnosis should the nurse prioritize?
A. Panic disorder
B. Pheochromocytoma
C. Hyperthyroidism
D. Mitral valve prolapse
Correct Answer: B
Rationale: Pheochromocytoma (adrenal medulla tumor) causes paroxysmal
hypertension, headache, palpitations, diaphoresis. Panic disorder does not cause
severe hypertension. Hyperthyroidism causes persistent tachycardia, not episodic.
MVP may cause palpitations but not severe BP spikes.
3. A 72-year-old male with history of hypertension presents with acute onset
of right-sided weakness and aphasia. His symptoms began 90 minutes ago.
What is the most time-sensitive diagnostic step?
,A. Lumbar puncture
B. Non-contrast head CT
C. EEG
D. Carotid ultrasound
Correct Answer: B
Rationale: For acute stroke, non-contrast head CT is the first test to rule out
hemorrhage before thrombolytics. Time window for tPA is within 3-4.5 hours.
Lumbar puncture is for meningitis/SAH after imaging. EEG for seizures.
4. A 45-year-old homeless client presents with cough, night sweats, weight loss,
and hemoptysis. Which finding on chest auscultation is most consistent with
advanced tuberculosis?
A. Vesicular breath sounds
B. Bronchial breath sounds and crackles in the upper lobes
C. Diminished breath sounds at bases
D. Wheezing throughout
Correct Answer: B
Rationale: TB typically involves upper lobes, causing consolidation (bronchial
breath sounds) and post-tussive crackles. Vesicular sounds are normal. Diminished
bases suggest effusion or COPD. Wheezing suggests airway narrowing.
5. A 28-year-old female reports progressive weakness, double vision that
worsens at the end of the day, and ptosis. What physical exam finding would
confirm the suspected diagnosis of myasthenia gravis?
A. Hyperreflexia
B. Positive ice pack test (improved ptosis after cooling)
C. Babinski sign
D. Clonus
Correct Answer: B
Rationale: The ice pack test (ice on eyelids for 2 minutes) temporarily improves
ptosis in myasthenia gravis due to improved neuromuscular transmission at lower
temperature. Hyperreflexia and Babinski suggest upper motor neuron lesion;
clonus is also UMN.
6. A client with known cirrhosis presents with confusion, asterixis, and
jaundice. The nurse suspects hepatic encephalopathy. Which laboratory
finding best supports this diagnosis?
A. Elevated serum ammonia
,B. Elevated creatinine
C. Low platelet count
D. Elevated amylase
Correct Answer: A
Rationale: Hepatic encephalopathy is associated with elevated ammonia (though
not perfectly correlated). Creatinine indicates renal function; low platelets suggest
portal hypertension hypersplenism; amylase suggests pancreatitis.
7. A 55-year-old diabetic male presents with a painful, red, swollen right great
toe. He denies trauma. The nurse suspects gout. The definitive diagnostic test
is:
A. Serum uric acid level
B. Joint aspiration showing needle-shaped negatively birefringent crystals
C. X-ray of the foot
D. C-reactive protein
Correct Answer: B
Rationale: Definitive diagnosis of gout is arthrocentesis with polarized light
microscopy showing monosodium urate crystals (needle-shaped, negatively
birefringent). Serum uric acid can be normal during acute attack. X-ray shows
chronic changes.
8. A 62-year-old smoker reports hoarseness for 6 weeks. Laryngoscopy reveals
a left vocal cord paralysis. This finding should raise suspicion for:
A. Laryngitis
B. Lung cancer (recurrent laryngeal nerve involvement)
C. Gastroesophageal reflux
D. Thyroid nodule
Correct Answer: B
Rationale: Left recurrent laryngeal nerve runs through the aortopulmonary
window; lung cancer (especially left upper lobe) can compress it, causing vocal
cord paralysis. Unilateral cord paralysis in a smoker is cancer until proven
otherwise.
9. A 30-year-old female reports fatigue, joint pain, and a butterfly rash on her
face. Which antibody test is most specific for systemic lupus erythematosus?
A. Rheumatoid factor
B. Anti-dsDNA and anti-Smith (Sm) antibodies
C. ANA (antinuclear antibody)
, D. Anti-CCP
Correct Answer: B
Rationale: Anti-dsDNA and anti-Smith are highly specific for SLE. ANA is
sensitive but not specific (positive in many conditions). RF and anti-CCP are for
rheumatoid arthritis.
10. A client presents with asymmetric weakness in the left leg, sensory level at
T10 on the right, and loss of pain/temperature on the left. This pattern is
consistent with:
A. Brown-Séquard syndrome (hemisection of spinal cord)
B. Anterior cord syndrome
C. Central cord syndrome
D. Cauda equina syndrome
Correct Answer: A
Rationale: Brown-Séquard syndrome (spinal cord hemisection) causes ipsilateral
weakness (corticospinal) and contralateral loss of pain/temperature (spinothalamic
crossing). Sensory level on the opposite side. Anterior cord loses motor and
pain/temp bilateral; central affects upper extremities more.
11. A 50-year-old with hypertension and diabetes presents with sudden,
painless vision loss in the right eye described as “a curtain coming down.”
This suggests:
A. Retinal detachment
B. Optic neuritis
C. Central retinal artery occlusion
D. Vitreous hemorrhage
Correct Answer: A
Rationale: “Curtain coming down” is classic for retinal detachment. CRAO causes
sudden, painless, complete vision loss; optic neuritis (MS) causes painful vision
loss; vitreous hemorrhage has floaters/flashes.
12. A 68-year-old male reports urinary hesitancy, weak stream, and nocturia.
Digital rectal exam reveals a symmetrically enlarged, firm, rubbery prostate
without nodules. This is most consistent with:
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Prostatitis
D. Neurogenic bladder
assessment focusing on comprehensive
examinations, clinical reasoning, diagnostic
interpretation, and complex patient evaluations.
1. A 58-year-old male presents with acute onset of severe, tearing chest pain
radiating to the back. His blood pressure is 160/90 in the right arm and 100/60
in the left arm. What is the priority differential diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with tearing chest/back pain and
asymmetric blood pressures (due to differential involvement of subclavian
arteries). Myocardial infarction pain is more often substernal pressure; pulmonary
embolism presents with dyspnea/pleuritic pain; pericarditis pain is sharp,
positional.
2. A 34-year-old woman reports episodic palpitations, sweating, headache, and
anxiety. During a episode, her blood pressure is 210/110. Between episodes,
exam is normal. Which diagnosis should the nurse prioritize?
A. Panic disorder
B. Pheochromocytoma
C. Hyperthyroidism
D. Mitral valve prolapse
Correct Answer: B
Rationale: Pheochromocytoma (adrenal medulla tumor) causes paroxysmal
hypertension, headache, palpitations, diaphoresis. Panic disorder does not cause
severe hypertension. Hyperthyroidism causes persistent tachycardia, not episodic.
MVP may cause palpitations but not severe BP spikes.
3. A 72-year-old male with history of hypertension presents with acute onset
of right-sided weakness and aphasia. His symptoms began 90 minutes ago.
What is the most time-sensitive diagnostic step?
,A. Lumbar puncture
B. Non-contrast head CT
C. EEG
D. Carotid ultrasound
Correct Answer: B
Rationale: For acute stroke, non-contrast head CT is the first test to rule out
hemorrhage before thrombolytics. Time window for tPA is within 3-4.5 hours.
Lumbar puncture is for meningitis/SAH after imaging. EEG for seizures.
4. A 45-year-old homeless client presents with cough, night sweats, weight loss,
and hemoptysis. Which finding on chest auscultation is most consistent with
advanced tuberculosis?
A. Vesicular breath sounds
B. Bronchial breath sounds and crackles in the upper lobes
C. Diminished breath sounds at bases
D. Wheezing throughout
Correct Answer: B
Rationale: TB typically involves upper lobes, causing consolidation (bronchial
breath sounds) and post-tussive crackles. Vesicular sounds are normal. Diminished
bases suggest effusion or COPD. Wheezing suggests airway narrowing.
5. A 28-year-old female reports progressive weakness, double vision that
worsens at the end of the day, and ptosis. What physical exam finding would
confirm the suspected diagnosis of myasthenia gravis?
A. Hyperreflexia
B. Positive ice pack test (improved ptosis after cooling)
C. Babinski sign
D. Clonus
Correct Answer: B
Rationale: The ice pack test (ice on eyelids for 2 minutes) temporarily improves
ptosis in myasthenia gravis due to improved neuromuscular transmission at lower
temperature. Hyperreflexia and Babinski suggest upper motor neuron lesion;
clonus is also UMN.
6. A client with known cirrhosis presents with confusion, asterixis, and
jaundice. The nurse suspects hepatic encephalopathy. Which laboratory
finding best supports this diagnosis?
A. Elevated serum ammonia
,B. Elevated creatinine
C. Low platelet count
D. Elevated amylase
Correct Answer: A
Rationale: Hepatic encephalopathy is associated with elevated ammonia (though
not perfectly correlated). Creatinine indicates renal function; low platelets suggest
portal hypertension hypersplenism; amylase suggests pancreatitis.
7. A 55-year-old diabetic male presents with a painful, red, swollen right great
toe. He denies trauma. The nurse suspects gout. The definitive diagnostic test
is:
A. Serum uric acid level
B. Joint aspiration showing needle-shaped negatively birefringent crystals
C. X-ray of the foot
D. C-reactive protein
Correct Answer: B
Rationale: Definitive diagnosis of gout is arthrocentesis with polarized light
microscopy showing monosodium urate crystals (needle-shaped, negatively
birefringent). Serum uric acid can be normal during acute attack. X-ray shows
chronic changes.
8. A 62-year-old smoker reports hoarseness for 6 weeks. Laryngoscopy reveals
a left vocal cord paralysis. This finding should raise suspicion for:
A. Laryngitis
B. Lung cancer (recurrent laryngeal nerve involvement)
C. Gastroesophageal reflux
D. Thyroid nodule
Correct Answer: B
Rationale: Left recurrent laryngeal nerve runs through the aortopulmonary
window; lung cancer (especially left upper lobe) can compress it, causing vocal
cord paralysis. Unilateral cord paralysis in a smoker is cancer until proven
otherwise.
9. A 30-year-old female reports fatigue, joint pain, and a butterfly rash on her
face. Which antibody test is most specific for systemic lupus erythematosus?
A. Rheumatoid factor
B. Anti-dsDNA and anti-Smith (Sm) antibodies
C. ANA (antinuclear antibody)
, D. Anti-CCP
Correct Answer: B
Rationale: Anti-dsDNA and anti-Smith are highly specific for SLE. ANA is
sensitive but not specific (positive in many conditions). RF and anti-CCP are for
rheumatoid arthritis.
10. A client presents with asymmetric weakness in the left leg, sensory level at
T10 on the right, and loss of pain/temperature on the left. This pattern is
consistent with:
A. Brown-Séquard syndrome (hemisection of spinal cord)
B. Anterior cord syndrome
C. Central cord syndrome
D. Cauda equina syndrome
Correct Answer: A
Rationale: Brown-Séquard syndrome (spinal cord hemisection) causes ipsilateral
weakness (corticospinal) and contralateral loss of pain/temperature (spinothalamic
crossing). Sensory level on the opposite side. Anterior cord loses motor and
pain/temp bilateral; central affects upper extremities more.
11. A 50-year-old with hypertension and diabetes presents with sudden,
painless vision loss in the right eye described as “a curtain coming down.”
This suggests:
A. Retinal detachment
B. Optic neuritis
C. Central retinal artery occlusion
D. Vitreous hemorrhage
Correct Answer: A
Rationale: “Curtain coming down” is classic for retinal detachment. CRAO causes
sudden, painless, complete vision loss; optic neuritis (MS) causes painful vision
loss; vitreous hemorrhage has floaters/flashes.
12. A 68-year-old male reports urinary hesitancy, weak stream, and nocturia.
Digital rectal exam reveals a symmetrically enlarged, firm, rubbery prostate
without nodules. This is most consistent with:
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Prostatitis
D. Neurogenic bladder
