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NURS 631 ADVANCED HEALTH ASSESSMENT
EXAM 2025/2026 SUMMER-FALL QUESTIONS
AND CORRECT ANSWERS D’YOUVILLE
UNIVERSITY
A 27 year old female patient has three furuncles connected around a hair follicle. You use the following term in your charting:
A) nodules
B) carbuncle
C) macules
D) bulla
B) carbuncle
Multiple furuncles around a hair follicle form a carbuncle.
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.
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.
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) Move your fingers laterally to palpate for the thyroid lobes.
B) Place your index fingers above the cricoid cartilage.
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.
B) JM came into the clinic complaining of black stools for the past 24 hours.
C) JM is a 59 year old male here for "ulcerative colitis."
D) JM, a 59 year old male, states he has ulcerative colitis and wants it checked.
A) JM is a 59 year old male here for having "black stools" for the past 24 hours.
Chief Complaint(s) The one or more symptoms or concerns causing the patient to seek care. Make every effort to quote the patient's own words.
A patient tells the nurse practitioner that she has had abdominal pain for the past week. What would be the best response by the nurse practitioner?
A) We'll talk more about that later in the interview."
B) "Have you ever had any children?"
C) "What have you had to eat in the last 4 hours?"
D) "Can you point to where it hurts?"
D) "Can you point to where it hurts?"
Each principle symptom should be well-characterized, with descriptions of location; along with the other seven attributes. Location: Ask the patient to point to the pain because lay terms may not be specific enough to localize the site of origin.
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.
B) No obvious lesions
C) Denies color change
A) pigmentation
B) thyroid stimulating hormone
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 > 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) solar lentigos
solar lentigos are from sun damage, are more common on the face, shoulders, and hands.
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 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
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
C) Exophthalmos
Eye protrusion (proptosis or exophthalmos)
The nurse practitioner is performing an eye examination using the ophthalmoscope. Which component is NOT part of the ophthalmoscope?
A) lens disc
B) aperature
C) indicator of diopters
D) speculum
D) speculum
See picture of ophthalmoscope (Bates p 238)
A 15-year-old high school sophomore presents to the emergency room with his mother for evaluation of an area of blood in the left eye. He denies trauma or injury but has been coughing forcefully with a recent cold. He denies visual disturbances, eye pain, or discharge from the eye. On physical examination, the pupils are equal, round, and reactive to light, with a visual acuity of 20/20 in each eye and 20/ bilaterally. There is a homogeneous, sharply demarcated area at the lateral aspect of the base of the left eye. The cornea is clear. Based on this description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage
D) Subconjunctival hemorrhage
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
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).
In using the ophthalmoscope to assess a patient's eyes, the nurse notices a red glow in the patient's pupils. On the basis of this finding, the nurse would:
A) check the light source of the ophthalmoscope to verify that it is functioning.
B) consider this a normal reflection of the ophthalmoscope light off the inner retina.
C) continue with the ophthalmoscopic examination and refer the patient for further evaluation.
D) suspect that there is an opacity in the lens or cornea.
B) consider this a normal reflection of the ophthalmoscope light off the inner retina.
Shine the light beam on the pupil and look for the orange glow in the pupil - the red reflex. (Bates, p239). The other responses are not correct.
A 15 month old is brought to you for a fever of 101 F and fussiness. The ear examination is as follows: external ear - normal appearance and no tenderness with manipulation; canal - normal diameter without evidence of inflammation; tympanic membrane - bulging, erythematous, and the light reflex is dull. Insufflation is deferred due to pain. What is your diagnosis?
A) ruptured tympanic membrane
