NUR 634 ADVANCED HEALTH ASSESSMENT MIDTERM
EXAM 2025-2026 GRAND CANYON UNIVERSITY| REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH RATIONALES(NEWEST!!!)
An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting
her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling
or inflammation. There are no hair shafts visible. Based on this description, what is your most likely
diagnosis?
A.Alopecia areata
B. Trichotillomania
C.Tinea capitis
D. Traction alopecia
ANS: A
Feedback: This is a typical description for alopecia areata. There are no risk factors for
trichotillomania or for traction alopecia. The physical examination is not consistent with tinea capitis
because the skin is intact.
A 46-year-old former salesman presents to the ER, complaining of black stools for the past few
weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially
around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk
approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in
the past. He denies any recent use. He is currently unemployed and has never been married. On
examination you find a man appearing older than his stated age. His skin has a yellowish tint and he
is thin, with a prominent abdomen. You note multiple "spider angiomas" at the base of his neck.
Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his
umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness
that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive
fluid wave. He is positive for occult blood on his rectal examination. What cause of black stools most
likely describes his symptoms and signs?
A.Infectious diarrhea
B. Mallory-Weiss tear
C.Esophageal varices
D. Ulcerative colitis
ANS: C
Page 1
,Varices are often found in alcoholic patients, but only when they have a diagnosis of significant
cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider hemangiomas,
and dilated veins on his abdomen (caput medusa).
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect
that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with
hypothyroidism?
A.Moist and smooth
B.Moist and rough
C.Dry and smooth
D. Dry and rough
ANS: D
42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months.
She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any
recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new
medications. During the review of systems you note that she has felt fatigued, had some weight gain,
has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal
delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary
artery disease. There is no family history of cancers. On examination she appears her stated age. Her
vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her
cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is
negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the
Achilles tendons. What is the best choice for the cause of her constipation?
A. Large bowel obstruction
B. Irritable bowel syndrome
C. Rectal cancer
D.
Hypothyroidism
ANS: D
A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion,
and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most
likely?
Page 2
,A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
ANS: A
Feedback: The lack of contact with blood and body fluids makes hepatitis B, C, and D unlikely. She
regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is
recommended for daycare workers
A young man comes to you with an extremely pruritic rash over his knees and elbows which has
come and gone for several years. It seems to be worse in the winter and improves with some sun
exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are
observant enough to notice small "pits" in his nails. What would account for these findings?
A. Eczema
B. Pityriasis rosea
C. Psoriasis
D. Tinea infection
ANS: C
Feedback: This is a classic presentation of plaque psoriasis. Eczema is usually over the flexor surfaces
and does not scale, whereas psoriasis affects the extensor surfaces. Pityriasis usually is limited to the
trunk and proximal extremities. Tinea has a much finer scale associated with it, almost like powder,
and is found in dark and moist areas
Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with
deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you
do next?
B. Reassess by examination in 6 months
C. Reassess by examination in 3 months
D. Refer to a vascular surgeon
ANS: A
Feedback: A pulsatile mass in this man should be followed up with ultrasound as soon as possible.
His risk of aortic rupture is at least 15 times greater if his aorta measures more than 4 centimeters. It
Page 3
, would be inappropriate to recheck him at a later time without taking action. Likewise, referral to a
vascular surgeon before ultrasound may be premature.
**Aortic Aneurysm**
A 8-year-old patient presents to the office for evaluation of a rash. At first, there was only one large
patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical
examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety
of erythematous papules and macules on the cleavage lines of the back. Based on this description,
what is the most likely diagnosis?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
ANS: A
A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large
patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical
examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety
of erythematous papules and macules on the cleavage lines of the back. Based on this description,
what is the most likely diagnosis?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
ANS: A
Feedback: This is a classic description of pityriasis rosea. The description of a large single or “herald”
patch preceding the eruption is a good way to distinguish this rash from other conditions.
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as
well, though it is not exposed to bright light. Which of the following terms describes this latter
phenomenon?
Page 4
EXAM 2025-2026 GRAND CANYON UNIVERSITY| REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS
WITH RATIONALES(NEWEST!!!)
An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting
her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On
physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling
or inflammation. There are no hair shafts visible. Based on this description, what is your most likely
diagnosis?
A.Alopecia areata
B. Trichotillomania
C.Tinea capitis
D. Traction alopecia
ANS: A
Feedback: This is a typical description for alopecia areata. There are no risk factors for
trichotillomania or for traction alopecia. The physical examination is not consistent with tinea capitis
because the skin is intact.
A 46-year-old former salesman presents to the ER, complaining of black stools for the past few
weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially
around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk
approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in
the past. He denies any recent use. He is currently unemployed and has never been married. On
examination you find a man appearing older than his stated age. His skin has a yellowish tint and he
is thin, with a prominent abdomen. You note multiple "spider angiomas" at the base of his neck.
Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his
umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness
that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive
fluid wave. He is positive for occult blood on his rectal examination. What cause of black stools most
likely describes his symptoms and signs?
A.Infectious diarrhea
B. Mallory-Weiss tear
C.Esophageal varices
D. Ulcerative colitis
ANS: C
Page 1
,Varices are often found in alcoholic patients, but only when they have a diagnosis of significant
cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites, spider hemangiomas,
and dilated veins on his abdomen (caput medusa).
You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited
that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect
that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with
hypothyroidism?
A.Moist and smooth
B.Moist and rough
C.Dry and smooth
D. Dry and rough
ANS: D
42-year-old florist comes to your office, complaining of chronic constipation for the last 6 months.
She has had no nausea, vomiting, or diarrhea and no abdominal pain or cramping. She denies any
recent illnesses or injuries. She denies any changes to her diet or exercise program. She is on no new
medications. During the review of systems you note that she has felt fatigued, had some weight gain,
has irregular periods, and has cold intolerance. Her past medical history is significant for one vaginal
delivery and two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has coronary
artery disease. There is no family history of cancers. On examination she appears her stated age. Her
vital signs are normal. Her head, eyes, ears, nose, throat, and neck examinations are normal. Her
cardiac, lung, and abdominal examinations are also unremarkable. Her rectal occult blood test is
negative. Her deep tendon reflexes are delayed in response to a blow with the hammer, especially the
Achilles tendons. What is the best choice for the cause of her constipation?
A. Large bowel obstruction
B. Irritable bowel syndrome
C. Rectal cancer
D.
Hypothyroidism
ANS: D
A daycare worker presents to your office with jaundice. She denies IV drug use, blood transfusion,
and travel and has not been sexually active for the past 10 months. Which type of hepatitis is most
likely?
Page 2
,A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
ANS: A
Feedback: The lack of contact with blood and body fluids makes hepatitis B, C, and D unlikely. She
regularly changes the diapers of her clients and is at risk for hepatitis A. Vaccine against hepatitis A is
recommended for daycare workers
A young man comes to you with an extremely pruritic rash over his knees and elbows which has
come and gone for several years. It seems to be worse in the winter and improves with some sun
exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are
observant enough to notice small "pits" in his nails. What would account for these findings?
A. Eczema
B. Pityriasis rosea
C. Psoriasis
D. Tinea infection
ANS: C
Feedback: This is a classic presentation of plaque psoriasis. Eczema is usually over the flexor surfaces
and does not scale, whereas psoriasis affects the extensor surfaces. Pityriasis usually is limited to the
trunk and proximal extremities. Tinea has a much finer scale associated with it, almost like powder,
and is found in dark and moist areas
Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with
deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you
do next?
B. Reassess by examination in 6 months
C. Reassess by examination in 3 months
D. Refer to a vascular surgeon
ANS: A
Feedback: A pulsatile mass in this man should be followed up with ultrasound as soon as possible.
His risk of aortic rupture is at least 15 times greater if his aorta measures more than 4 centimeters. It
Page 3
, would be inappropriate to recheck him at a later time without taking action. Likewise, referral to a
vascular surgeon before ultrasound may be premature.
**Aortic Aneurysm**
A 8-year-old patient presents to the office for evaluation of a rash. At first, there was only one large
patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical
examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety
of erythematous papules and macules on the cleavage lines of the back. Based on this description,
what is the most likely diagnosis?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
ANS: A
A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large
patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical
examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety
of erythematous papules and macules on the cleavage lines of the back. Based on this description,
what is the most likely diagnosis?
A. Pityriasis rosea
B. Tinea versicolor
C. Psoriasis
D. Atopic eczema
ANS: A
Feedback: This is a classic description of pityriasis rosea. The description of a large single or “herald”
patch preceding the eruption is a good way to distinguish this rash from other conditions.
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as
well, though it is not exposed to bright light. Which of the following terms describes this latter
phenomenon?
Page 4
