D444 NURS 3117
Adult Health I
Final Assessment Review
(Questions & Solutions)
2025
1
, I. Multiple Choice Questions
Question 1
Case Scenario: A 58‑year‑old male with a history of hypertension and
hyperlipidemia presents with intermittent chest discomfort on exertion.
On auscultation, an S4 gallop is heard.
Question: Which underlying cardiac condition is most likely associated
with the presence of this S4 gallop?
- A) Aortic stenosis
- B) Left ventricular hypertrophy secondary to myocardial ischemia
- C) Mitral regurgitation
- D) Pericardial friction rub
Correct ANS: B
Rationale: An S4 gallop is typically associated with a stiff, noncompliant
left ventricle often due to myocardial ischemia and resultant
hypertrophy. This finding indicates decreased compliance during diastole.
---
Question 2
Case Scenario: A 62‑year‑old female with a history of congestive heart
failure presents with acute shortness of breath. Examination reveals
bilateral basal crackles and an S3 gallop.
Question: What is the best explanation for these findings?
- A) Diastolic dysfunction with preserved systolic function
- B) Systolic dysfunction with volume overload
- C) Mitral valve prolapse
- D) Constrictive pericarditis
Correct ANS: B
Rationale: An S3 gallop in the setting of basal crackles is highly
suggestive of systolic heart failure. The S3 sound results from rapid filling
2
,of a dilated ventricle and is indicative of volume overload.
---
Question 3
Case Scenario: A 70‑year‑old male with a history of type 2 diabetes and
chronic kidney disease complains of fatigue, pallor, and exertional
dyspnea. Laboratory tests reveal a low hemoglobin level.
Question: Which type of anemia is most likely in this patient?
- A) Iron‑deficiency anemia
- B) Anemia of chronic disease
- C) Hemolytic anemia
- D) Vitamin B12 deficiency
Correct ANS: B
Rationale: In adults with chronic kidney disease, anemia of chronic
disease (also called anemia of inflammation) is common due to
inadequate erythropoietin production, leading to normocytic or mildly
microcytic anemia.
---
Question 4
Case Scenario: A 65‑year‑old long‑term smoker presents with chronic
cough and progressive dyspnea. Lung examination demonstrates
hyperresonance on percussion with diminished breath sounds and a
prolonged expiratory phase.
Question: What condition is most consistent with these pulmonary
findings?
- A) Asthma
- B) Chronic bronchitis
- C) Emphysema
- D) Pulmonary edema
Correct ANS: C
3
, Rationale: Emphysema, a type of COPD, is characterized by destruction
of alveolar walls leading to air trapping (hyperresonance) and a
prolonged expiratory phase. A history of smoking supports this diagnosis.
---
Question 5
Case Scenario: A 72‑year‑old female with a history of cerebrovascular
accident is brought in with altered mental status. The nurse needs to
assess her level of consciousness.
Question: Which assessment tool is best suited to objectively measure
her level of consciousness?
- A) Mini-Mental State Examination (MMSE)
- B) Glasgow Coma Scale (GCS)
- C) NIH Stroke Scale
- D) Rancho Los Amigos Scale
Correct ANS: B
Rationale: The Glasgow Coma Scale is a standardized instrument that
quantifies eye, verbal, and motor responses, making it ideal for assessing
a patient’s level of consciousness—even in the setting of stroke.
---
Question 6
Case Scenario: A 50‑year‑old woman presents with palpitations, weight
loss, heat intolerance, and anxiety. On examination, she has a diffusely
enlarged thyroid with a firm, irregular surface, fine tremors, and
exophthalmos.
Question: Which diagnosis is most consistent with these findings?
- A) Graves’ disease
- B) Hashimoto’s thyroiditis
- C) Subacute thyroiditis
- D) Toxic multinodular goiter
4
Adult Health I
Final Assessment Review
(Questions & Solutions)
2025
1
, I. Multiple Choice Questions
Question 1
Case Scenario: A 58‑year‑old male with a history of hypertension and
hyperlipidemia presents with intermittent chest discomfort on exertion.
On auscultation, an S4 gallop is heard.
Question: Which underlying cardiac condition is most likely associated
with the presence of this S4 gallop?
- A) Aortic stenosis
- B) Left ventricular hypertrophy secondary to myocardial ischemia
- C) Mitral regurgitation
- D) Pericardial friction rub
Correct ANS: B
Rationale: An S4 gallop is typically associated with a stiff, noncompliant
left ventricle often due to myocardial ischemia and resultant
hypertrophy. This finding indicates decreased compliance during diastole.
---
Question 2
Case Scenario: A 62‑year‑old female with a history of congestive heart
failure presents with acute shortness of breath. Examination reveals
bilateral basal crackles and an S3 gallop.
Question: What is the best explanation for these findings?
- A) Diastolic dysfunction with preserved systolic function
- B) Systolic dysfunction with volume overload
- C) Mitral valve prolapse
- D) Constrictive pericarditis
Correct ANS: B
Rationale: An S3 gallop in the setting of basal crackles is highly
suggestive of systolic heart failure. The S3 sound results from rapid filling
2
,of a dilated ventricle and is indicative of volume overload.
---
Question 3
Case Scenario: A 70‑year‑old male with a history of type 2 diabetes and
chronic kidney disease complains of fatigue, pallor, and exertional
dyspnea. Laboratory tests reveal a low hemoglobin level.
Question: Which type of anemia is most likely in this patient?
- A) Iron‑deficiency anemia
- B) Anemia of chronic disease
- C) Hemolytic anemia
- D) Vitamin B12 deficiency
Correct ANS: B
Rationale: In adults with chronic kidney disease, anemia of chronic
disease (also called anemia of inflammation) is common due to
inadequate erythropoietin production, leading to normocytic or mildly
microcytic anemia.
---
Question 4
Case Scenario: A 65‑year‑old long‑term smoker presents with chronic
cough and progressive dyspnea. Lung examination demonstrates
hyperresonance on percussion with diminished breath sounds and a
prolonged expiratory phase.
Question: What condition is most consistent with these pulmonary
findings?
- A) Asthma
- B) Chronic bronchitis
- C) Emphysema
- D) Pulmonary edema
Correct ANS: C
3
, Rationale: Emphysema, a type of COPD, is characterized by destruction
of alveolar walls leading to air trapping (hyperresonance) and a
prolonged expiratory phase. A history of smoking supports this diagnosis.
---
Question 5
Case Scenario: A 72‑year‑old female with a history of cerebrovascular
accident is brought in with altered mental status. The nurse needs to
assess her level of consciousness.
Question: Which assessment tool is best suited to objectively measure
her level of consciousness?
- A) Mini-Mental State Examination (MMSE)
- B) Glasgow Coma Scale (GCS)
- C) NIH Stroke Scale
- D) Rancho Los Amigos Scale
Correct ANS: B
Rationale: The Glasgow Coma Scale is a standardized instrument that
quantifies eye, verbal, and motor responses, making it ideal for assessing
a patient’s level of consciousness—even in the setting of stroke.
---
Question 6
Case Scenario: A 50‑year‑old woman presents with palpitations, weight
loss, heat intolerance, and anxiety. On examination, she has a diffusely
enlarged thyroid with a firm, irregular surface, fine tremors, and
exophthalmos.
Question: Which diagnosis is most consistent with these findings?
- A) Graves’ disease
- B) Hashimoto’s thyroiditis
- C) Subacute thyroiditis
- D) Toxic multinodular goiter
4
