ADVANCED HEALTH ASSESSMENT AND DIAGNOSTIC
REASONING (NURS 5220) COMPREHENSIVE PRACTICE
EXAMINATION
1. A 68-year-old male with a 45-pack-year smoking history presents with a
new-onset cough and hoarseness. On examination, you note a fixed,
immobile left vocal cord. Which cranial nerve is most likely affected by
this patient's underlying pathology?
A. Cranial Nerve IX (Glossopharyngeal)
B. Cranial Nerve X (Vagus)
C. Cranial Nerve XI (Accessory)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: B - The vagus nerve (CN X) provides motor innervation to
the laryngeal muscles via the recurrent laryngeal nerve. A fixed vocal cord
suggests recurrent laryngeal nerve palsy, which in a smoker is highly
concerning for malignancy (e.g., lung cancer) compressing the nerve.
2. A 45-year-old female presents with fatigue, weight gain, and cold
intolerance. Her TSH is elevated, and free T4 is low. Which of the following
physical examination findings would you most expect to find?
A. Brisk, hyperactive deep tendon reflexes
B. Delayed relaxation phase of the deep tendon reflexes
C. Fine, rapid tremor of the outstretched hands
D. Exophthalmos and lid lag
Correct Answer: B - Delayed relaxation phase of deep tendon reflexes (e.g.,
Achilles reflex) is a classic finding of hypothyroidism. The other options
, (hyperactive reflexes, tremor, exophthalmos) are associated with
hyperthyroidism.
3. A 72-year-old patient reports intermittent claudication in his calves after
walking one block. Which of the following pulse examination findings
would be most consistent with this diagnosis?
A. Bounding and forceful dorsalis pedis pulses
B. Absent or diminished femoral pulses with normal distal pulses
C. Diminished or absent popliteal and pedal pulses
D. Symmetrically weak radial and brachial pulses
Correct Answer: C - Intermittent claudication is a symptom of peripheral
arterial disease (PAD). Diminished or absent pulses distal to the obstruction
(popliteal and pedal) are hallmark physical exam findings.
4. During a cardiac auscultation, you hear a high-pitched, blowing,
decrescendo diastolic murmur best heard at the left sternal border. Which
of the following is the most likely diagnosis?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Tricuspid regurgitation
Correct Answer: C - Aortic regurgitation is characterized by a high-pitched,
blowing, decrescendo diastolic murmur best heard at the left upper sternal
border (Erb's point). The murmur is loudest with the patient leaning
forward and holding breath in expiration.
5. A 55-year-old with a history of hypertension presents with a headache,
palpitations, and diaphoresis. On examination, you find a blood pressure
of 190/110 mmHg in both arms. You suspect a pheochromocytoma. What
is the initial screening test of choice?
A. Serum electrolytes
B. 24-hour urine for metanephrines and catecholamines
C. Plasma aldosterone-to-renin ratio
D. Overnight dexamethasone suppression test
, Correct Answer: B - The 24-hour urine collection for fractionated
metanephrines and catecholamines is the gold standard initial screening
test for pheochromocytoma, offering high sensitivity and specificity.
6. You are performing a neurological examination on a patient with a
suspected stroke. You ask the patient to close their eyes and identify a
familiar object placed in their hand (e.g., a key). This tests which of the
following?
A. Graphesthesia
B. Stereognosis
C. Two-point discrimination
D. Proprioception
Correct Answer: B - Stereognosis is the ability to recognize an object by
touch alone. It tests the integrity of the parietal lobe (sensory cortex).
7. A 28-year-old woman presents with a chief complaint of "dizziness." She
describes a sensation that the room is spinning, which is exacerbated by
head movement. This is best described as:
A. Lightheadedness
B. Vertigo
C. Disequilibrium
D. Presyncope
Correct Answer: B - Vertigo is defined as an illusion of movement, often a
rotational sensation. It is distinct from lightheadedness (near-fainting),
disequilibrium (unsteadiness), or presyncope (feeling of impending faint).
8. Which of the following is the most specific physical examination
maneuver to assess for a meniscal tear of the knee?
A. Anterior drawer test
B. Lachman test
C. McMurray test
D. Valgus stress test
Correct Answer: C - The McMurray test is used to detect meniscal tears. A
, positive test involves a painful "click" or "clunk" with rotation of the tibia on
the femur.
9. A 65-year-old diabetic patient presents with a painful, red, swollen left
great toe. Joint aspiration reveals needle-shaped, negatively birefringent
crystals under polarized microscopy. What is the most likely diagnosis?
A. Pseudogout
B. Rheumatoid arthritis
C. Septic arthritis
D. Gout
Correct Answer: D - Monosodium urate crystals (needle-shaped, negatively
birefringent) are pathognomonic for gout.
10.On auscultation of the lungs, you hear continuous, high-pitched musical
sounds predominantly during expiration. These are most consistent with:
A. Pleural friction rub
B. Crackles (rales)
C. Rhonchi
D. Wheezes
Correct Answer: D - Wheezes are continuous, high-pitched, musical sounds
typically heard during expiration (though can be inspiratory). They indicate
narrowing of the airways (bronchospasm, edema, foreign body).
11.A patient presents with a headache that is described as "the worst
headache of my life," reaching maximal intensity within seconds. What is
the most important initial diagnostic test to order?
A. Non-contrast CT scan of the head
B. MRI of the brain
C. Lumbar puncture
D. Serum inflammatory markers (ESR, CRP)
Correct Answer: A - A sudden, severe "thunderclap" headache suggests
subarachnoid hemorrhage. A non-contrast CT head is the initial test of
choice due to high sensitivity for acute blood, though lumbar puncture is
often needed if CT is negative.
REASONING (NURS 5220) COMPREHENSIVE PRACTICE
EXAMINATION
1. A 68-year-old male with a 45-pack-year smoking history presents with a
new-onset cough and hoarseness. On examination, you note a fixed,
immobile left vocal cord. Which cranial nerve is most likely affected by
this patient's underlying pathology?
A. Cranial Nerve IX (Glossopharyngeal)
B. Cranial Nerve X (Vagus)
C. Cranial Nerve XI (Accessory)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: B - The vagus nerve (CN X) provides motor innervation to
the laryngeal muscles via the recurrent laryngeal nerve. A fixed vocal cord
suggests recurrent laryngeal nerve palsy, which in a smoker is highly
concerning for malignancy (e.g., lung cancer) compressing the nerve.
2. A 45-year-old female presents with fatigue, weight gain, and cold
intolerance. Her TSH is elevated, and free T4 is low. Which of the following
physical examination findings would you most expect to find?
A. Brisk, hyperactive deep tendon reflexes
B. Delayed relaxation phase of the deep tendon reflexes
C. Fine, rapid tremor of the outstretched hands
D. Exophthalmos and lid lag
Correct Answer: B - Delayed relaxation phase of deep tendon reflexes (e.g.,
Achilles reflex) is a classic finding of hypothyroidism. The other options
, (hyperactive reflexes, tremor, exophthalmos) are associated with
hyperthyroidism.
3. A 72-year-old patient reports intermittent claudication in his calves after
walking one block. Which of the following pulse examination findings
would be most consistent with this diagnosis?
A. Bounding and forceful dorsalis pedis pulses
B. Absent or diminished femoral pulses with normal distal pulses
C. Diminished or absent popliteal and pedal pulses
D. Symmetrically weak radial and brachial pulses
Correct Answer: C - Intermittent claudication is a symptom of peripheral
arterial disease (PAD). Diminished or absent pulses distal to the obstruction
(popliteal and pedal) are hallmark physical exam findings.
4. During a cardiac auscultation, you hear a high-pitched, blowing,
decrescendo diastolic murmur best heard at the left sternal border. Which
of the following is the most likely diagnosis?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Tricuspid regurgitation
Correct Answer: C - Aortic regurgitation is characterized by a high-pitched,
blowing, decrescendo diastolic murmur best heard at the left upper sternal
border (Erb's point). The murmur is loudest with the patient leaning
forward and holding breath in expiration.
5. A 55-year-old with a history of hypertension presents with a headache,
palpitations, and diaphoresis. On examination, you find a blood pressure
of 190/110 mmHg in both arms. You suspect a pheochromocytoma. What
is the initial screening test of choice?
A. Serum electrolytes
B. 24-hour urine for metanephrines and catecholamines
C. Plasma aldosterone-to-renin ratio
D. Overnight dexamethasone suppression test
, Correct Answer: B - The 24-hour urine collection for fractionated
metanephrines and catecholamines is the gold standard initial screening
test for pheochromocytoma, offering high sensitivity and specificity.
6. You are performing a neurological examination on a patient with a
suspected stroke. You ask the patient to close their eyes and identify a
familiar object placed in their hand (e.g., a key). This tests which of the
following?
A. Graphesthesia
B. Stereognosis
C. Two-point discrimination
D. Proprioception
Correct Answer: B - Stereognosis is the ability to recognize an object by
touch alone. It tests the integrity of the parietal lobe (sensory cortex).
7. A 28-year-old woman presents with a chief complaint of "dizziness." She
describes a sensation that the room is spinning, which is exacerbated by
head movement. This is best described as:
A. Lightheadedness
B. Vertigo
C. Disequilibrium
D. Presyncope
Correct Answer: B - Vertigo is defined as an illusion of movement, often a
rotational sensation. It is distinct from lightheadedness (near-fainting),
disequilibrium (unsteadiness), or presyncope (feeling of impending faint).
8. Which of the following is the most specific physical examination
maneuver to assess for a meniscal tear of the knee?
A. Anterior drawer test
B. Lachman test
C. McMurray test
D. Valgus stress test
Correct Answer: C - The McMurray test is used to detect meniscal tears. A
, positive test involves a painful "click" or "clunk" with rotation of the tibia on
the femur.
9. A 65-year-old diabetic patient presents with a painful, red, swollen left
great toe. Joint aspiration reveals needle-shaped, negatively birefringent
crystals under polarized microscopy. What is the most likely diagnosis?
A. Pseudogout
B. Rheumatoid arthritis
C. Septic arthritis
D. Gout
Correct Answer: D - Monosodium urate crystals (needle-shaped, negatively
birefringent) are pathognomonic for gout.
10.On auscultation of the lungs, you hear continuous, high-pitched musical
sounds predominantly during expiration. These are most consistent with:
A. Pleural friction rub
B. Crackles (rales)
C. Rhonchi
D. Wheezes
Correct Answer: D - Wheezes are continuous, high-pitched, musical sounds
typically heard during expiration (though can be inspiratory). They indicate
narrowing of the airways (bronchospasm, edema, foreign body).
11.A patient presents with a headache that is described as "the worst
headache of my life," reaching maximal intensity within seconds. What is
the most important initial diagnostic test to order?
A. Non-contrast CT scan of the head
B. MRI of the brain
C. Lumbar puncture
D. Serum inflammatory markers (ESR, CRP)
Correct Answer: A - A sudden, severe "thunderclap" headache suggests
subarachnoid hemorrhage. A non-contrast CT head is the initial test of
choice due to high sensitivity for acute blood, though lumbar puncture is
often needed if CT is negative.
