NUR 504 Exam 4: Advanced Health
Assessment & Diagnostic Reasoning
Questions with Correct Answers &
Rationales | 2026 Update
Key Topic Areas Covered:
• Advanced physical examination techniques (inspection, palpation, percussion,
auscultation)
• Cardiovascular assessment (heart sounds, murmurs, JVD, pulses)
• Respiratory assessment (breath sounds, consolidation, effusion)
• Neurological assessment (cranial nerves, reflexes, motor strength)
• Musculoskeletal assessment (special tests, joint evaluation)
• Abdominal/GI assessment (organs, signs, special tests)
• Diagnostic reasoning and clinical decision-making
• Special population considerations
1. A 2-day postoperative patient develops sudden shortness of breath and
pleuritic chest pain. Which type of assessment should the nurse perform first?
A. Comprehensive head-to-toe admission assessment
B. Focused problem-oriented assessment of respiratory and cardiovascular systems
C. Detailed neurological assessment
D. Full medication reconciliation and allergy review
Correct answer: B
Rationale: A focused problem-oriented assessment targets the systems related to
new symptoms (respiratory/cardiovascular), rapidly gathering data to detect
potential complications like pulmonary embolism. This is time-sensitive and
appropriate for acute changes.
2. A patient has crackles bilaterally at the lung bases, elevated JVP, and 3+
lower extremity edema. Which diagnosis is most likely?
,A. Pneumonia
B. Pulmonary embolism
C. Right-sided heart failure
D. Left-sided heart failure
Correct answer: D
Rationale: Crackles at lung bases (pulmonary congestion), elevated JVP, and
edema indicate left-sided heart failure causing pulmonary decompensation and
secondary right-sided symptoms.
3. [Image: Inspection of abdominal distension with bulging flanks.] Which
assessment technique is most appropriate to evaluate for fluid in the
abdomen?
A. Palpation
B. Percussion
C. Auscultation
D. Deep palpation
Correct answer: B
Rationale: Percussion assesses for fluid (ascites) by detecting shifting dullness;
bulging flanks suggest fluid accumulation requiring percussion for confirmation.
4. A patient has a blood pressure of 168/98 mmHg in the right arm and 142/86
mmHg in the left arm. What is the most appropriate next action?
A. Repeat measurement in both arms immediately
B. Document the higher reading and continue assessment
C. Auscultate for bruits and evaluate for aortic dissection
D. Administer antihypertensive medication
Correct answer: C
Rationale: A significant BP difference (>20 mmHg systolic) between arms may
indicate aortic dissection or arterial occlusion; assess for bruits and vascular
compromise urgently.
,5. Which cranial nerve is tested when a patient follows your finger through all
six cardinal fields of vision?
A. CN I (Olfactory)
B. CN II (Optic)
C. CN III (Oculomotor)
D. CN VI (Abducens)
Correct answer: B
Rationale: CN II (Optic) is tested via visual field assessment; CN III, IV, and VI
control eye movement, not visual fields.
6. A patient has a firm, non-tender, fixed mass in the upper outer quadrant of
the breast. Which diagnosis is most concerning?
A. Fibroadenoma
B. Breast cyst
C. Breast cancer
D. Mastitis
Correct answer: C
Rationale: Firm, non-tender, fixed breast masses are classic for breast cancer;
fibroadenomas are mobile and cysts are tender.
7. [Image: Auscultation of heart sounds at the 5th intercostal space, left
midclavicular line.] Which heart valve is best heard at this location?
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
Correct answer: D
Rationale: The 5th intercostal space at the left midclavicular line is the mitral area
(apex), best for hearing mitral valve sounds and S1.
, 8. A patient has unilateral facial droop, inability to close the eye, and forehead
involvement. Which diagnosis is most likely?
A. Central stroke
B. Bell's palsy (peripheral CN VII)
C. Myasthenia gravis
D. Trigeminal neuropathy
Correct answer: B
Rationale: Bell's palsy (peripheral CN VII) affects the entire half of the face
including the forehead; central stroke preserves forehead movement due to
bilateral innervation.
9. Which assessment finding indicates acute somatic dysfunction in
osteopathic evaluation?
A. Fibrosis
B. Bogginess
C. Asymmetry
D. Restriction
Correct answer: B
Rationale: Bogginess (edematous tissue texture) indicates acute somatic
dysfunction; fibrosis indicates chronic dysfunction.
10. A patient has decreased breath sounds, dullness to percussion, and
decreased tactile fremitus on the right side. Which diagnosis is most likely?
A. Pneumonia
B. Pleural effusion
C. Pneumothorax
D. Asthma
Correct answer: B
Rationale: Decreased breath sounds + dullness to percussion + decreased fremitus
= pleural effusion; pneumothorax causes hyperresonance.
Assessment & Diagnostic Reasoning
Questions with Correct Answers &
Rationales | 2026 Update
Key Topic Areas Covered:
• Advanced physical examination techniques (inspection, palpation, percussion,
auscultation)
• Cardiovascular assessment (heart sounds, murmurs, JVD, pulses)
• Respiratory assessment (breath sounds, consolidation, effusion)
• Neurological assessment (cranial nerves, reflexes, motor strength)
• Musculoskeletal assessment (special tests, joint evaluation)
• Abdominal/GI assessment (organs, signs, special tests)
• Diagnostic reasoning and clinical decision-making
• Special population considerations
1. A 2-day postoperative patient develops sudden shortness of breath and
pleuritic chest pain. Which type of assessment should the nurse perform first?
A. Comprehensive head-to-toe admission assessment
B. Focused problem-oriented assessment of respiratory and cardiovascular systems
C. Detailed neurological assessment
D. Full medication reconciliation and allergy review
Correct answer: B
Rationale: A focused problem-oriented assessment targets the systems related to
new symptoms (respiratory/cardiovascular), rapidly gathering data to detect
potential complications like pulmonary embolism. This is time-sensitive and
appropriate for acute changes.
2. A patient has crackles bilaterally at the lung bases, elevated JVP, and 3+
lower extremity edema. Which diagnosis is most likely?
,A. Pneumonia
B. Pulmonary embolism
C. Right-sided heart failure
D. Left-sided heart failure
Correct answer: D
Rationale: Crackles at lung bases (pulmonary congestion), elevated JVP, and
edema indicate left-sided heart failure causing pulmonary decompensation and
secondary right-sided symptoms.
3. [Image: Inspection of abdominal distension with bulging flanks.] Which
assessment technique is most appropriate to evaluate for fluid in the
abdomen?
A. Palpation
B. Percussion
C. Auscultation
D. Deep palpation
Correct answer: B
Rationale: Percussion assesses for fluid (ascites) by detecting shifting dullness;
bulging flanks suggest fluid accumulation requiring percussion for confirmation.
4. A patient has a blood pressure of 168/98 mmHg in the right arm and 142/86
mmHg in the left arm. What is the most appropriate next action?
A. Repeat measurement in both arms immediately
B. Document the higher reading and continue assessment
C. Auscultate for bruits and evaluate for aortic dissection
D. Administer antihypertensive medication
Correct answer: C
Rationale: A significant BP difference (>20 mmHg systolic) between arms may
indicate aortic dissection or arterial occlusion; assess for bruits and vascular
compromise urgently.
,5. Which cranial nerve is tested when a patient follows your finger through all
six cardinal fields of vision?
A. CN I (Olfactory)
B. CN II (Optic)
C. CN III (Oculomotor)
D. CN VI (Abducens)
Correct answer: B
Rationale: CN II (Optic) is tested via visual field assessment; CN III, IV, and VI
control eye movement, not visual fields.
6. A patient has a firm, non-tender, fixed mass in the upper outer quadrant of
the breast. Which diagnosis is most concerning?
A. Fibroadenoma
B. Breast cyst
C. Breast cancer
D. Mastitis
Correct answer: C
Rationale: Firm, non-tender, fixed breast masses are classic for breast cancer;
fibroadenomas are mobile and cysts are tender.
7. [Image: Auscultation of heart sounds at the 5th intercostal space, left
midclavicular line.] Which heart valve is best heard at this location?
A. Aortic valve
B. Pulmonic valve
C. Tricuspid valve
D. Mitral valve
Correct answer: D
Rationale: The 5th intercostal space at the left midclavicular line is the mitral area
(apex), best for hearing mitral valve sounds and S1.
, 8. A patient has unilateral facial droop, inability to close the eye, and forehead
involvement. Which diagnosis is most likely?
A. Central stroke
B. Bell's palsy (peripheral CN VII)
C. Myasthenia gravis
D. Trigeminal neuropathy
Correct answer: B
Rationale: Bell's palsy (peripheral CN VII) affects the entire half of the face
including the forehead; central stroke preserves forehead movement due to
bilateral innervation.
9. Which assessment finding indicates acute somatic dysfunction in
osteopathic evaluation?
A. Fibrosis
B. Bogginess
C. Asymmetry
D. Restriction
Correct answer: B
Rationale: Bogginess (edematous tissue texture) indicates acute somatic
dysfunction; fibrosis indicates chronic dysfunction.
10. A patient has decreased breath sounds, dullness to percussion, and
decreased tactile fremitus on the right side. Which diagnosis is most likely?
A. Pneumonia
B. Pleural effusion
C. Pneumothorax
D. Asthma
Correct answer: B
Rationale: Decreased breath sounds + dullness to percussion + decreased fremitus
= pleural effusion; pneumothorax causes hyperresonance.
