NUR 643E Advanced Health Assessment
Final Exam 2025 – Actual Exam, 2
Verified Versions (A & B), Questions with
100% Correct Answers and Detailed
Rationales | Graded A+
Actual Exam, 2 Verified Versions (A & B), Questions with 100% Correct Answers and
Detailed Rationales | Graded A+
Version A (Questions 1-25)
1 A 65-year-old male presents with a left-sided neck mass for 5 months, growing in size. He
endorses smoking 1 ppd x 45 years, no dysphagia or fever. Priority assessment? Assess size,
shape, mobility, and location of the mass Rationale: Neck masses in smokers raise suspicion
for malignancy (e.g., squamous cell CA); palpation evaluates for fixation/invasion (Bates' Head
& Neck, Ch. 9; Seidel's HEENT, p. 245). NGN bow-tie: Cue (smoking history) → Hypothesis
(cancer) → Action (palpate for nodes/fixation). Differential: Lymphadenopathy vs. thyroid
nodule.
2 A 50-year-old machine operator reports hearing loss over 2 years, worse in right ear. No
tinnitus or vertigo. Physical exam finding most likely? Tender right tragus with erythematous
canal Rationale: Occupational noise exposure suggests NIHL, but tender tragus/erythema
indicates otitis externa (swimmer's ear); otoscopy key (Seidel's Ear, p. 312; Bates' HEENT, Ch.
10). SATA: Not shoddy lymph nodes (mono) or injected TM (OM). Differential: NIHL vs.
cerumen impaction.
3 A 14-year-old male with sore throat, dysphagia, fever 102°F x2 days. No cough or URI.
Priority exam? Rapid strep antigen test + throat culture Rationale: Centor criteria (fever, no
cough) suggest GAS pharyngitis; test to rule out rheumatic fever risk (Bates' Throat, Ch. 9; GCU
Diagnostic Rubric). NGN case study: Cue (fever/dysphagia) → Analyze (streptococcal) → Plan
(centor score, test). Differential: Strep vs. viral.
4 A 59-year-old patient suspects ulcerative colitis with "black stools" x24 hours. Best
documentation for chief complaint? Melena for 24 hours Rationale: OLDCARTS for HPI;
"black stools" = melena (GI bleed); document facts, not interpretation (Bates' GI, Ch. 12;
Seidel's Abdomen, p. 456). Rationale: Avoid bias; assess for H. pylori/NSAIDs. NGN: Cue
(melena) → Hypothesis (UGIB) → Action (guaiac test).
Final Exam 2025 – Actual Exam, 2
Verified Versions (A & B), Questions with
100% Correct Answers and Detailed
Rationales | Graded A+
Actual Exam, 2 Verified Versions (A & B), Questions with 100% Correct Answers and
Detailed Rationales | Graded A+
Version A (Questions 1-25)
1 A 65-year-old male presents with a left-sided neck mass for 5 months, growing in size. He
endorses smoking 1 ppd x 45 years, no dysphagia or fever. Priority assessment? Assess size,
shape, mobility, and location of the mass Rationale: Neck masses in smokers raise suspicion
for malignancy (e.g., squamous cell CA); palpation evaluates for fixation/invasion (Bates' Head
& Neck, Ch. 9; Seidel's HEENT, p. 245). NGN bow-tie: Cue (smoking history) → Hypothesis
(cancer) → Action (palpate for nodes/fixation). Differential: Lymphadenopathy vs. thyroid
nodule.
2 A 50-year-old machine operator reports hearing loss over 2 years, worse in right ear. No
tinnitus or vertigo. Physical exam finding most likely? Tender right tragus with erythematous
canal Rationale: Occupational noise exposure suggests NIHL, but tender tragus/erythema
indicates otitis externa (swimmer's ear); otoscopy key (Seidel's Ear, p. 312; Bates' HEENT, Ch.
10). SATA: Not shoddy lymph nodes (mono) or injected TM (OM). Differential: NIHL vs.
cerumen impaction.
3 A 14-year-old male with sore throat, dysphagia, fever 102°F x2 days. No cough or URI.
Priority exam? Rapid strep antigen test + throat culture Rationale: Centor criteria (fever, no
cough) suggest GAS pharyngitis; test to rule out rheumatic fever risk (Bates' Throat, Ch. 9; GCU
Diagnostic Rubric). NGN case study: Cue (fever/dysphagia) → Analyze (streptococcal) → Plan
(centor score, test). Differential: Strep vs. viral.
4 A 59-year-old patient suspects ulcerative colitis with "black stools" x24 hours. Best
documentation for chief complaint? Melena for 24 hours Rationale: OLDCARTS for HPI;
"black stools" = melena (GI bleed); document facts, not interpretation (Bates' GI, Ch. 12;
Seidel's Abdomen, p. 456). Rationale: Avoid bias; assess for H. pylori/NSAIDs. NGN: Cue
(melena) → Hypothesis (UGIB) → Action (guaiac test).
