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NUR 516 ADVANCED HEALTH ASSESSMENT
EXAM 2025 QUESTIONS AND ANSWERS
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You are assessing a patient with Wilson's disease and you see a golden/brown ring around the iris. This is called:
A) chalazion
B) pterygium
C) pinguecula
D) Kayser-Fleischer ring
A ring around the iris from Wilson's disease is called a Kayser-Fleischer ring and it is from excessive copper (Bates, p276).
If a patient is reporting light, gray colored stool, it is likely that ________ is missing from the stool.
A) bile
B) fiber
C) bacteria
D) mucus
Bile is what gives stools a darker color, so lighter, gray colored stools may indicate a bile duct obstruction (Bates, p461).
Kidney pain is commonly described as "flank pain." Which of the following would be considered in the flank area?
A) periumbilical
B) costovertebral angle
C) suprapubic
D) epigastric
Costovertabal angle (CVA) pain or tenderness with percussion is a common test for kidney pain (Bates, p463-464).
At what age is colorectal cancer screening started in those with "average risk?"
A) 50
B) 45
C) 25
D) 35
The recommendation for colorectal cancer screening starts at 50 years old for those with "average risk." Bates, p 469
While performing a fundoscopic examination on a 38 year old African American female, the color of the fundus is a grayish brown, almost purple. You determine:
A) this is a sign of diabetic retinopathy
B) this is a sign of hypertensive retinopathy
A) half that of men in the same age group
B) greater than that of men in the same age group
C) women have less strokes, but more heart attacks than men the same age
D) none of the above
Women have about 60% of the total number of strokes in the 45-54 years old age group, which is important when evaluating their health risks (Bates, p361).
Normal blood pressure would be best described as:
A) < 130/
B) < 120/
C) < 100/
D) 110/
Normal blood pressure is 120/80 (Bates, p130)
Which of the following is a vesicular lesion?
A) psoriasis
B) nevus
C) café au lait spots
D) herpes simplex
Herpes simplex presents initially as a vesicle/vesicles. Café au lait spots are macules, psoriasis is a plaque or papule, a nevus is a papule (Bates, p290).
Generalized lymphadenopathy is seen in
A) lymphoma
B) infectious mononucleosis
C) leukemia
D) all of the above
All of the above can cause generalized lymphadenopathy (Bates, p261)
A 53-year-old obese man comes in for an exam. When he starts to sit up, you notice a ridge/bulge vertically just under the sternum that resolves once he sits up. This is most likely:
A) lipoma
B) diastasis recti
C) a direct hernia
D) an indirect hernia
A diastasis recti is the separation of the two rectus abdominus muscles that happens when the head and shoulders are raised in some patients, especially obese, chronic lung disease, or after repeated pregnancies (Bates, p499).
A patient has come in for an examination and states, "I have this spot in front of my ear lobe here on my cheek that seems to be getting bigger and is tender. What do you think it is?" The NP notes swelling above the angle of the jaw and suspects it could be an inflammation of his:
A) occipital node
Frank blood or clear watery drainage (cerebrospinal leak) after trauma suggest a basal skull fracture and warrants immediate referral. Purulent drainage indicates otitis externa or otitis media. (Bates, 245-246)
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student preparing to go into the examination room to interview her. Which of the following is the most logical sequence for the patient-provider interview?
A) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's story.
B) Invite the patient's story, negotiate a plan, establish the agenda, and establish rapport.
C) Greet the patient, establish rapport, invite the patient's story, establish the agenda, expand and clarify the patient's story, and negotiate a plan.
D) Negotiate a plan, establish an agenda, invite the patient's story, and establish rapport.
The sequence of the interview: Greeting the patient and establishing rapport. Taking notes. Establishing the agenda for the interview. Inviting the patient's story. Expanding and clarifying the patient's story. Sharing the treatment plan.
A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely?
A) CN IX lesion on the left
B) CN X lesion on the left
C) CN IX lesion on the right
D) CN X lesion on the right
In cranial nerve X paralysis, the soft palate fails to rise and the uvula deviates to the opposite side.
When performing posterior palpation of the thyroid gland, you should do all fo the following, EXCEPT:
A) Have the patient tip his or her head forward and slightly to the side.
B) Place your index fingers above the cricoid cartilage.
C) Palpate between the sternocleidomastoid muscle and the trachea for the lobes of the thyroid.
D) Move your fingers laterally to palpate for the thyroid lobes.
Place the fingers of both hands on the patient's neck so that your index fingers are just BELOW the cricoid cartilage.
You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is NOT a component of guided questioning?
A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer.
B) Offering the patient multiple choices in order to clarify the character of the urinary symptoms she is experiencing.
C) Asking her to tell you what she means when she states that she has a urinary tract infection.
D) Directed questioning starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer.
A) Reassuring the patient that the urinary symptoms are benign and that she doesn't need to worry about it being a sign of cancer.
Bates p 59, 69-
A 59 year old patients tells the nurse practitioner that he thinks he must have ulcerative colitis. He has been having "black stools" for the last 24 hours. How would the nurse practitioner best document THE FACTS for his reason for seeking care?
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
Inquire about the effects of pain on the patient's daily activities, mood, sleep, work, and sexual activity.
In recording the childhood illnesses of a patient who denies having had any, which of the following notes by the nurse would be most accurate?
A) Patient denies usual childhood illnesses.
B) Patient states he was a "very healthy" child.
C) Patient states sister had measles, but he didn't.
D) Patient denies measles, mumps, rubella, chickenpox, pertussis, rheumatic fever, and polio.
Childhood illnesses include measles, rubella, mumps, whooping cough, rheumatic fever, scarlet fever, and polio. They are included in the past history.
A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information?
A) "Are you allergic to any other drugs?"
B) "How often have you received penicillin?"
C) "I'll write your allergy on your chart so you won't receive any."
D) "Please describe what happens to you when you take penicillin."
D) "Please describe what happens to you when you take penicillin."
Allergies, including specific reactions to each medication, such as rash or nausea, must be recorded.
The nurse is taking a family history. Important diseases or problems to ask the patient about include:
A) emphysema.
B) head trauma.
C) mental illness.
D) fractured bones.
C) mental illness.
Specifically ask for any family history of heart disease, high blood pressure, stroke, diabetes, obesity, blood disorders, ovarian cancer, colon cancer, sickle cell anemia, arthritis, allergies, alcohol or drug addiction, mental illness, suicide, seizure disorder, kidney disease, and tuberculosis. The other answers are acquired.
The following information is recorded in the health history: "Patient denies chest pain, palpitations, orthopnea, and paroxysmal nocturnal dyspnea." Which category does it belong to?
A) Chief complaint
B) Present illness
C) Personal and social history
D) Review of systems
D) Review of systems
Most review of systems questions pertain to systems. You may also draw on Review of Systems questions related to the Chief Complaint to establish positives and negatives that help clarify the diagnosis.
Which of the following statements represents subjective data obtained from the patient regarding his skin?
A) Skin appears dry.
C) phagocytes
D) fungacytes
A) pigmentation
Hair undergoes a series of changes. Scalp hair loses its pigment (functioning of melanocytes) so the hair looks gray or white and feels thin and fine. The other options are not correct.
You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs?
A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution
D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution
B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
You are examining the skin on a 22 year old female when you notice a circumscribed superficial lesion that is elevated approximately 0.5cm in diameter, filled with serous fluid. What type of lesion is this?
A) macule
B) papule
C) vesicle
D) spider angioma
C) vesicle
Vesicle - up to 1.0 cm filled with serous fluid
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 a ventilator for 3 weeks. The nurse is completing an initial assessment and evaluating the client's 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. What is the stage of this pressure ulcer?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
C) Stage 3
A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through underlying muscle.
Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash?
A) Insect bites
B) Wheals, urticaria, or hives
C) Psoriasis
D) Purpura
B) Wheals, urticaria, or hives
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
C) Psoriasis
Psoriasis: silvery scaly papules or plaques, mainly on the extensor surfaces. Pitting: punctate depressions of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. Usually associated with psoriasis.
Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?
A) Allow the patient to speak uninterrupted for the duration of the appointment.
B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.
B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
Give the patient free rein for the first 5-10 minutes, listening closely to the conversation. Focus on what seems most important to the patient. Learn to set limits when needed. A brief summary may help you change the subject yet validate any concerns. Do no show your impatience.
Which of the following will help to optimize success from a pediatric examination?
A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc.
B) Being very orderly, so as not to miss a portion of the examination.
C) Using firmness throughout your examination, letting the child know you are in charge.
D) Making sure to place the infant on the table during the examination while Mom watches close by.
A) Doing the examination out of order if necessary to take advantage of quiet periods for auscultation, etc.
With certain exceptions, physical examination does not require use of the examining table, or with the child in a parent's lap. Plan the examination to start with the least distressing procedures and end with the most distressing, usually involving the throat and ears. Patience, distraction, play flexibility in the order of the examination, and caring but firm approach are all key to successfully examining the young child.
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis?
A) Epicanthus
B) Ptosis
C) Exophthalmos
D) Ectropion
Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area. The pupil is not affected, vision is not affected and the cornea is clear. May result from trauma, bleeding disorders, or sudden increase in venous pressure, as from a cough.
The nurse practitioner is reviewing for a class in age-related changes in the eye. Which of these physiological changes is responsible for presbyopia?
A) degeneration of the cornea
B) decreased adaptation to darkness
C) decreased distance vision abilities
D) loss of lens elasticity
D) loss of lens elasticity
The lens gradually loses its elasticity, and the eye grows progressively less able to accommodate and focus on nearby objects. Ensuing presbyopia usually becomes noticeable during the fifth decade. (Bates, p 959, 991)
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem?
A) You are an alcoholic, aren't you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
B) When was your last drink?
Positive answers to two additional questions are highly suspicious for problem drinking: "Have you every had a drinking problem?" and "When was your last drink?" especially if the night before (Bates, p 96-97)
A patient's vision is recorded as 20/30 when the Snellen eye chart is used. The nurse interprets these results to indicate that:
A) the patient can read at 20 feet what a person with normal vision can read at 30 feet.
B) at 30 feet the patient can read the entire chart.
C) the patient can read the chart from 20 feet in the left eye and 30 feet in the right eye,
D) the patient can read from 30 feet what a person with normal vision can read from 20 feet.
A) the patient can read at 20 feet what a person with normal vision can read at 30 feet.
Visual acuity is expressed as 2 numbers (e.g. 20/30): the first indicates the distance of the patient from the chart, and the second the distance at which a normal eye can read the line of letters (Bates, p 231).
Which of the following enables optimal examination of the adult's tympanic membrane?
A) Grasp the auricle firmly and pull it downward, backward, and pressed close to the head.
B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head.
C) Pull the ear lobe toward the chin and keep the auricle pulled away from the head.
D) Grasp the auricle keeping it in normal position and pressed close to the head.
B) Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head.
To straighten the ear canal, grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head (Bates, p 245).
