NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
GCU NUR 634 Midterm EXAM LATEST 2025/2026
ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the
hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the
ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin
condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage
to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a
pressure ulcer. What is the stage of this ulcer?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
ANS: C
A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You elicit
the information that the dizziness is a spinning sensation of sudden onset, worse with head
position changes. The episodes last a few seconds and then go away, and they are accompanied
by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical
examination of the head and neck and note that the patient's hearing is intact to Weber and
Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the
most likely diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
,NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
C. Ménière's disease
D. Acoustic neuroma
ANS: A
Feedback: This is a classic description of benign positional vertigo. The vertigo is episodic,
lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is
no tinnitus or sensorineural hearing loss as occurs in Ménière's disease and acoustic neuroma.
You may choose to learn about Hallpike maneuvers, which are also helpful in the evaluation of
vertigo.
A young woman comes to you with a cut on her finger caused by the lid of a can she was
opening. She is pacing about the room, crying loudly, and through her sobs she says, "My career
as a pianist is finished!" Which personality type exhibits these features?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Avoidant
ANS: C
Feedback: The theatrical nature of her behavior as well as her overreaction leads to a diagnosis
of histrionic character disorder.
,NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
When writing a SOAP note, what part would you put in quotes? Considered to be the patient's
own words
Chief Complaint
A patient states she is feeling just blah, nothing is going her way, nothing good ever happens,
she states that her life sucks, what type of disorder would you say this is?
Dysthymic Mood
Dysthymia is a milder, but long-lasting form of depression. Patients can present with the
following symptoms poor appetite or overeating; insomnia or excessive sleep; low energy or
fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness
A 38-year-old accountant presents to the office with a series of generalized complaints. He
relates that he feels a loss of pleasure in daily activities, has difficulty sleeping, and is
experiencing problems making decisions. Which of the following best explains the patient's
presentation?
a. Substance abuse with anhedonia
b. Bipolar disorder in the early pre-excitatory phase
c. Histrionic personality
d. Depression
e. Antisocial personality
ANS: D
, NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
You order an EKG on your patient in bay #1, patient is a 25 year old male who appears healthy
except his complaint today of a runny nose and cough. The nurse brings the EKG and it shows a
HR of 25, what is your next step?
Have the nurse re-do the EKG
A 61-year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise
healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a
cough and some mild shortness of breath for the past couple of days. She now presents to the
clinic complaining of pain and swelling in her right groin and leg, which she says has been there
for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the
thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant
erythema are noted. What is the chief concern with this patient?
A. Acute arterial occlusion
B. Ovarian metastasis
C. Pulmonary embolism (PE)
D. Acute Lymphangitis
ANS: C
Cancer patient are at high risk of deep venous thrombosis (DVT) and, with the presenting
symptoms of swelling and pain in her groin, along with recent history of cough and shortness of
breath, this patient’s presentation is suspicious for PE. Patients with DVT in the proximal leg
veins are at high risk of thromboembolism.
**if an ultrasound of the leg does NOT reveal a clot the next place to check is the lungs**
GCU NUR 634 Midterm EXAM LATEST 2025/2026
ACTUAL SUMMER-FALL SEMESTER EXAM GRADED A
A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the
hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the
ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin
condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage
to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a
pressure ulcer. What is the stage of this ulcer?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
ANS: C
A 49-year-old administrative assistant comes to your office for evaluation of dizziness. You elicit
the information that the dizziness is a spinning sensation of sudden onset, worse with head
position changes. The episodes last a few seconds and then go away, and they are accompanied
by intense nausea. She has vomited one time. She denies tinnitus. You perform a physical
examination of the head and neck and note that the patient's hearing is intact to Weber and
Rinne and that there is nystagmus. Her gait is normal. Based on this description, what is the
most likely diagnosis?
A. Benign positional vertigo
B. Vestibular neuronitis
,NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
C. Ménière's disease
D. Acoustic neuroma
ANS: A
Feedback: This is a classic description of benign positional vertigo. The vertigo is episodic,
lasting a few seconds to minutes, instead of continuous as in vestibular neuronitis. Also, there is
no tinnitus or sensorineural hearing loss as occurs in Ménière's disease and acoustic neuroma.
You may choose to learn about Hallpike maneuvers, which are also helpful in the evaluation of
vertigo.
A young woman comes to you with a cut on her finger caused by the lid of a can she was
opening. She is pacing about the room, crying loudly, and through her sobs she says, "My career
as a pianist is finished!" Which personality type exhibits these features?
A. Narcissistic
B. Paranoid
C. Histrionic
D. Avoidant
ANS: C
Feedback: The theatrical nature of her behavior as well as her overreaction leads to a diagnosis
of histrionic character disorder.
,NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
When writing a SOAP note, what part would you put in quotes? Considered to be the patient's
own words
Chief Complaint
A patient states she is feeling just blah, nothing is going her way, nothing good ever happens,
she states that her life sucks, what type of disorder would you say this is?
Dysthymic Mood
Dysthymia is a milder, but long-lasting form of depression. Patients can present with the
following symptoms poor appetite or overeating; insomnia or excessive sleep; low energy or
fatigue; low self-esteem; poor concentration or indecisiveness; and hopelessness
A 38-year-old accountant presents to the office with a series of generalized complaints. He
relates that he feels a loss of pleasure in daily activities, has difficulty sleeping, and is
experiencing problems making decisions. Which of the following best explains the patient's
presentation?
a. Substance abuse with anhedonia
b. Bipolar disorder in the early pre-excitatory phase
c. Histrionic personality
d. Depression
e. Antisocial personality
ANS: D
, NUR-634 Advanced Health Assessment and Diagnostic Reasoning With Skills Lab
You order an EKG on your patient in bay #1, patient is a 25 year old male who appears healthy
except his complaint today of a runny nose and cough. The nurse brings the EKG and it shows a
HR of 25, what is your next step?
Have the nurse re-do the EKG
A 61-year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise
healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a
cough and some mild shortness of breath for the past couple of days. She now presents to the
clinic complaining of pain and swelling in her right groin and leg, which she says has been there
for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the
thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant
erythema are noted. What is the chief concern with this patient?
A. Acute arterial occlusion
B. Ovarian metastasis
C. Pulmonary embolism (PE)
D. Acute Lymphangitis
ANS: C
Cancer patient are at high risk of deep venous thrombosis (DVT) and, with the presenting
symptoms of swelling and pain in her groin, along with recent history of cough and shortness of
breath, this patient’s presentation is suspicious for PE. Patients with DVT in the proximal leg
veins are at high risk of thromboembolism.
**if an ultrasound of the leg does NOT reveal a clot the next place to check is the lungs**
