NURS 5220 ADVANCED HEALTH ASSESSMENT EXAM 1
COMPREHENSIVE QUESTION BANK WITH RATIONALES
1. A 72-year-old male presents with a chief complaint of frequent urination,
nocturia, and a sensation of incomplete bladder emptying. The nurse
practitioner should suspect which of the following conditions?
A. Urinary tract infection
B. Bladder cancer
C. Benign prostatic hyperplasia
D. Nephrolithiasis
Correct Answer: C. Benign prostatic hyperplasia
Rationale: Benign prostatic hyperplasia (BPH) is a common condition in older men
characterized by prostate enlargement, leading to lower urinary tract symptoms
such as frequency, nocturia, and a feeling of incomplete bladder emptying . While
other options can cause urinary symptoms, the triad of frequency, nocturia, and
incomplete emptying in an older male is classic for BPH.
2. A patient presents with an S3 heart sound early in diastole. This finding is
most commonly associated with which of the following conditions?
A. Hypertrophic cardiomyopathy
B. Heart failure
C. Aortic stenosis
D. Pericarditis
Correct Answer: B. Heart failure
,Rationale: An S3 gallop is an extra heart sound heard early in diastole and is
caused by rapid ventricular filling. It is often a sign of volume overload and
decreased ventricular compliance, most commonly associated with systolic heart
failure .
3. The nurse practitioner is performing a digital rectal exam and palpates a firm,
irregularly shaped, and fixed mass on the prostate. What is the most
appropriate next step?
A. Reassure the patient that this is a normal finding.
B. Document the finding and schedule a follow-up in one month.
C. Report the finding and refer the patient for further evaluation.
D. Prescribe antibiotics for a suspected prostate infection.
Correct Answer: C. Report the finding and refer the patient for further
evaluation.
Rationale: A firm, irregular, and fixed prostate mass is suspicious for prostate
cancer. The NP must report the finding and refer the patient to a specialist (e.g.,
urology) for further diagnostic testing, such as a biopsy .
4. During an abdominal assessment, why is auscultation performed before
percussion and palpation?
A. To assess for areas of tenderness before deeper palpation.
B. To prevent distortion of bowel sounds that could be caused by palpation or
percussion.
C. To give the patient time to relax during the examination.
D. To assess for vascular sounds like bruits before they are masked by palpation.
Correct Answer: B. To prevent distortion of bowel sounds that could be caused
by palpation or percussion.
Rationale: Auscultation is performed first in the abdominal exam because
percussion and palpation can stimulate the bowel and increase peristalsis, leading
to a false interpretation of bowel sounds .
,5. A 60-year-old man is concerned that his newly diagnosed benign prostatic
hypertrophy (BPH) will turn into cancer, as it did for a friend. What is the nurse
practitioner's best response?
A. "The swelling is temporary and will resolve on its own."
B. "We will start chemotherapy to control the cancer."
C. "It would be highly unusual for a man your age to have prostate cancer."
D. "The enlargement is caused by hormone changes and is not cancer."
Correct Answer: D. "The enlargement is caused by hormone changes and is not
cancer."
Rationale: BPH is a non-cancerous enlargement of the prostate caused by
hormonal changes. It is important to reassure the patient that BPH is not cancer
and to provide education about the condition .
6. A nurse practitioner notes a liver span of 11 cm in a tall, male patient during
percussion. What is the most appropriate action?
A. Document the finding as a sign of hepatomegaly.
B. Refer the patient for an ultrasound.
C. Ask additional questions about alcohol intake.
D. Consider this a normal finding and proceed with the exam.
Correct Answer: D. Consider this a normal finding and proceed with the exam.
Rationale: The normal liver span is larger in men and taller individuals. A span of
11 cm is within normal limits and does not indicate hepatomegaly .
7. A nurse is palpating a patient's abdomen and notes a pulsation between the
xiphoid process and the umbilicus. This finding is most consistent with which of
the following?
A. Aortic aneurysm
B. Pulsations of the inferior vena cava
C. Normal aortic pulsations
D. Increased peristalsis
, Correct Answer: C. Normal aortic pulsations
Rationale: In thin patients with good abdominal wall relaxation, it is normal to
observe the pulsations of the abdominal aorta in the epigastric area .
8. During a routine physical exam, a 90-year-old woman is found to have a Grade
II/VI, low-pitched diastolic murmur at the fifth intercostal space, midclavicular
line. What is the most likely diagnosis?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral regurgitation
D. Tricuspid regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis is a diastolic murmur best heard at the apex (fifth
intercostal space, midclavicular line). A low-pitched, rumbling diastolic murmur
with an opening snap is classic for mitral stenosis .
9. An adolescent is reluctant to talk during a health interview. Which action is
most effective for the nurse practitioner to take?
A. Tell the patient that they must provide straight answers.
B. Ensure confidentiality regarding the information discussed.
C. Inform the patient that adolescents have trouble expressing feelings.
D. Obtain the history from a parent or family member.
Correct Answer: B. Ensure confidentiality regarding the information discussed.
Rationale: Adolescents often need reassurance that their information will be kept
confidential. This is key to building trust and encouraging open communication
during the interview .
10. An open-ended question is best described as one that:
A. Asks for specific, one-word answers.
B. Gives the patient discretion about the extent of the answer.
COMPREHENSIVE QUESTION BANK WITH RATIONALES
1. A 72-year-old male presents with a chief complaint of frequent urination,
nocturia, and a sensation of incomplete bladder emptying. The nurse
practitioner should suspect which of the following conditions?
A. Urinary tract infection
B. Bladder cancer
C. Benign prostatic hyperplasia
D. Nephrolithiasis
Correct Answer: C. Benign prostatic hyperplasia
Rationale: Benign prostatic hyperplasia (BPH) is a common condition in older men
characterized by prostate enlargement, leading to lower urinary tract symptoms
such as frequency, nocturia, and a feeling of incomplete bladder emptying . While
other options can cause urinary symptoms, the triad of frequency, nocturia, and
incomplete emptying in an older male is classic for BPH.
2. A patient presents with an S3 heart sound early in diastole. This finding is
most commonly associated with which of the following conditions?
A. Hypertrophic cardiomyopathy
B. Heart failure
C. Aortic stenosis
D. Pericarditis
Correct Answer: B. Heart failure
,Rationale: An S3 gallop is an extra heart sound heard early in diastole and is
caused by rapid ventricular filling. It is often a sign of volume overload and
decreased ventricular compliance, most commonly associated with systolic heart
failure .
3. The nurse practitioner is performing a digital rectal exam and palpates a firm,
irregularly shaped, and fixed mass on the prostate. What is the most
appropriate next step?
A. Reassure the patient that this is a normal finding.
B. Document the finding and schedule a follow-up in one month.
C. Report the finding and refer the patient for further evaluation.
D. Prescribe antibiotics for a suspected prostate infection.
Correct Answer: C. Report the finding and refer the patient for further
evaluation.
Rationale: A firm, irregular, and fixed prostate mass is suspicious for prostate
cancer. The NP must report the finding and refer the patient to a specialist (e.g.,
urology) for further diagnostic testing, such as a biopsy .
4. During an abdominal assessment, why is auscultation performed before
percussion and palpation?
A. To assess for areas of tenderness before deeper palpation.
B. To prevent distortion of bowel sounds that could be caused by palpation or
percussion.
C. To give the patient time to relax during the examination.
D. To assess for vascular sounds like bruits before they are masked by palpation.
Correct Answer: B. To prevent distortion of bowel sounds that could be caused
by palpation or percussion.
Rationale: Auscultation is performed first in the abdominal exam because
percussion and palpation can stimulate the bowel and increase peristalsis, leading
to a false interpretation of bowel sounds .
,5. A 60-year-old man is concerned that his newly diagnosed benign prostatic
hypertrophy (BPH) will turn into cancer, as it did for a friend. What is the nurse
practitioner's best response?
A. "The swelling is temporary and will resolve on its own."
B. "We will start chemotherapy to control the cancer."
C. "It would be highly unusual for a man your age to have prostate cancer."
D. "The enlargement is caused by hormone changes and is not cancer."
Correct Answer: D. "The enlargement is caused by hormone changes and is not
cancer."
Rationale: BPH is a non-cancerous enlargement of the prostate caused by
hormonal changes. It is important to reassure the patient that BPH is not cancer
and to provide education about the condition .
6. A nurse practitioner notes a liver span of 11 cm in a tall, male patient during
percussion. What is the most appropriate action?
A. Document the finding as a sign of hepatomegaly.
B. Refer the patient for an ultrasound.
C. Ask additional questions about alcohol intake.
D. Consider this a normal finding and proceed with the exam.
Correct Answer: D. Consider this a normal finding and proceed with the exam.
Rationale: The normal liver span is larger in men and taller individuals. A span of
11 cm is within normal limits and does not indicate hepatomegaly .
7. A nurse is palpating a patient's abdomen and notes a pulsation between the
xiphoid process and the umbilicus. This finding is most consistent with which of
the following?
A. Aortic aneurysm
B. Pulsations of the inferior vena cava
C. Normal aortic pulsations
D. Increased peristalsis
, Correct Answer: C. Normal aortic pulsations
Rationale: In thin patients with good abdominal wall relaxation, it is normal to
observe the pulsations of the abdominal aorta in the epigastric area .
8. During a routine physical exam, a 90-year-old woman is found to have a Grade
II/VI, low-pitched diastolic murmur at the fifth intercostal space, midclavicular
line. What is the most likely diagnosis?
A. Aortic regurgitation
B. Mitral stenosis
C. Mitral regurgitation
D. Tricuspid regurgitation
Correct Answer: B. Mitral stenosis
Rationale: Mitral stenosis is a diastolic murmur best heard at the apex (fifth
intercostal space, midclavicular line). A low-pitched, rumbling diastolic murmur
with an opening snap is classic for mitral stenosis .
9. An adolescent is reluctant to talk during a health interview. Which action is
most effective for the nurse practitioner to take?
A. Tell the patient that they must provide straight answers.
B. Ensure confidentiality regarding the information discussed.
C. Inform the patient that adolescents have trouble expressing feelings.
D. Obtain the history from a parent or family member.
Correct Answer: B. Ensure confidentiality regarding the information discussed.
Rationale: Adolescents often need reassurance that their information will be kept
confidential. This is key to building trust and encouraging open communication
during the interview .
10. An open-ended question is best described as one that:
A. Asks for specific, one-word answers.
B. Gives the patient discretion about the extent of the answer.
