NU552 Final Exam

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Purdue University Globle 

NU552 Advanced Health Assessment and Diagnostic Reasoning

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Comprehensive Study Guide with Practice Questions

Preparing for an Advanced Health Assessment and Diagnostic Reasoning final examination requires a solid understanding of clinical assessment, diagnostic reasoning, differential diagnosis, physical examination techniques, laboratory interpretation, and patient-centered care. This guide reorganizes the examination content into an easy-to-follow study resource, helping nursing students review essential concepts while strengthening clinical decision-making skills for written exams and clinical practice.

Understanding the Examination Structure

The examination is divided into three sections that evaluate theoretical knowledge, clinical reasoning, and practical application.

Students should complete the examination under timed conditions without notes to simulate the actual testing environment.

Clinical Case Overview

The examination revolves around the assessment of K.B., a 30-year-old female presenting with a dermatological complaint.

Patient Profile

• Age: 30 years

• Occupation: Bank teller

• Chief complaint: Two-week history of an itchy, scaly rash

• Rash distribution:

  • Knees

  • Scalp

  • Face

• Additional concern:

  • Social embarrassment

  • Isolation due to facial lesions

Medical History

• Hypertension

• Allergic rhinitis

• Total hysterectomy secondary to uterine fibroids

Current Medications

• Lisinopril 20 mg daily

• Loratadine 10 mg daily

Family History

• Hypertension in mother

• Hypertension in brother

Differential Diagnosis for the Rash

Accurate diagnostic reasoning begins with identifying appropriate differential diagnoses.

Potential diagnoses include:

• Psoriasis

• Contact dermatitis

• Tinea corporis

Among these conditions, psoriasis is considered the most likely diagnosis because of its classic presentation involving:

• Well-demarcated scaly plaques

• Extensor surfaces such as the knees

• Scalp involvement

• Chronic inflammatory characteristics

The facial lesions and psychosocial distress further emphasize the importance of prompt evaluation and management.

Medication Review During Health Assessment

Medication history is an important component of dermatological assessment because some drugs may contribute to skin manifestations.

Potential medication considerations include:

• ACE inhibitors such as Lisinopril, which have been associated with dermatitis-like reactions and scalp irritation in susceptible individuals.

• Loratadine is generally prescribed for allergic rhinitis and is less commonly associated with skin inflammation.

Evaluating medication-related adverse effects helps clinicians distinguish between primary dermatologic disease and drug-induced skin conditions.

Laboratory Investigations Used in Psoriasis Assessment

Laboratory testing assists in evaluating inflammation, infection, and factors that may influence treatment planning.

Complete Blood Count (CBC)

A CBC is commonly performed to assess:

• White blood cell count

• Infection risk

• Overall immune response

Hemoglobin A1c (HbA1c)

HbA1c provides information about average blood glucose control over the previous two to three months and helps determine healing potential, particularly before initiating long-term treatment.

Inflammatory Markers

Additional laboratory studies include:

• Erythrocyte Sedimentation Rate (ESR)

• C-Reactive Protein (CRP)

These tests help determine the degree of systemic inflammation and may support assessment of inflammatory skin diseases.

Health History Components Evaluated

Comprehensive history-taking includes much more than identifying physical symptoms.

Important assessment areas include:

• Chief complaint

• History of present illness

• Medication history

• Family history

• Social history

• Psychosocial impact

• Review of systems

For this patient, the emotional distress caused by facial lesions should be documented within the History of Present Illness, including its effect on social interaction, confidence, and daily functioning.

Review of Systems Findings

The patient reports:

• Sneezing

• Nasal itching

• Clear nasal drainage

These symptoms are consistent with her previous diagnosis of allergic rhinitis rather than adverse medication effects.

Physical Examination Techniques

A thorough physical examination integrates multiple body systems.

Respiratory Assessment

Posterior respiratory examination includes:

• Inspection of chest symmetry

• Assessment of respiratory effort

• Palpation for chest expansion

• Evaluation of tactile fremitus

• Percussion of lung fields

• Auscultation of breath sounds

Normal lungs typically produce resonant percussion notes.

Respiratory excursion is assessed by placing the examiner’s thumbs at approximately the tenth ribs while observing thumb movement during inspiration.

Thyroid Examination

The thyroid examination includes:

• Inspection

• Palpation

• Observation while swallowing

Patients are instructed to extend the neck slightly and swallow so the clinician can observe thyroid movement and identify enlargement or nodules.

Cardiovascular Examination

Important cardiovascular findings include:

• S1 heart sound is normally loudest at the apex.

• Heart sounds should be evaluated systematically over all valve areas.

• Pulse characteristics should also be assessed.

Abdominal Assessment

The abdominal examination follows the standard sequence:

1. Inspection

2. Auscultation

3. Percussion

4. Palpation

Auscultation is performed before palpation because palpation may alter bowel activity.

Neurological Examination

Motor function assessment includes:

• Muscle strength testing

• Shoulder shrug against resistance to evaluate Cranial Nerve XI (Spinal Accessory)

Balance testing includes:

• Romberg test

Vision assessment includes:

• Ophthalmoscopic examination for papilledema

Clinicians inspect the optic disc for blurred margins that may indicate increased intracranial pressure.

Hearing Assessment

Two commonly used bedside hearing tests include:

Musculoskeletal Examination

Assessment includes:

• Joint inspection

• Range of motion

• Muscle strength

• Knee examination for joint effusion using the bulge sign

• Lower extremity neurological assessment

Coordination testing may include:

• Finger-to-nose testing

• Rapid alternating movements

• Heel-to-shin testing

Skin Examination and Diagnostic Procedures

When evaluating inflammatory skin disease, clinicians assess:

• Lesion distribution

• Scaling

• Plaque characteristics

• Symmetry

• Nail changes

• Joint symptoms

If uncertainty remains regarding the diagnosis, a skin biopsy may be performed to:

• Confirm psoriasis

• Exclude infectious conditions

• Differentiate inflammatory skin disorders

Management of Psoriasis

Treatment combines pharmacologic therapy with skin care education.

Topical Corticosteroid Therapy

Desoximetasone (Topicort) is commonly prescribed.

Patients should receive education regarding:

• Correct application technique

• Appropriate frequency of use

• Avoiding excessive application

• Monitoring for adverse effects

General Skin Care

Recommended practices include:

• Regular moisturization

• Avoiding skin trauma

• Gentle cleansing

• Identifying personal triggers

• Maintaining follow-up appointments

Psychosocial Impact of Chronic Skin Disease

Visible skin disorders often affect much more than physical health.

Patients may experience:

• Reduced self-esteem

• Anxiety

• Depression

• Social withdrawal

• Occupational challenges

• Reduced quality of life

Assessment should include emotional well-being and the patient’s ability to perform normal daily activities.

Clinical Reasoning in Diagnostic Assessment

Effective diagnostic reasoning requires integrating:

• Patient history

• Physical examination

• Laboratory findings

• Medication review

• Differential diagnosis

• Psychosocial assessment

Rather than relying on a single finding, clinicians combine multiple sources of information to arrive at the most appropriate diagnosis and treatment plan.

Key Examination Concepts to Remember

Students preparing for advanced health assessment examinations should focus on the following high-yield concepts:

• Characteristics of psoriasis

• Differential diagnosis of skin disorders

• Comprehensive health history

• Respiratory assessment sequence

• Cardiovascular examination findings

• Thyroid examination techniques

• Cranial nerve assessment

• Hearing tests

• Neurological examination

• Musculoskeletal assessment

• Laboratory interpretation

• Skin biopsy indications

• Psychosocial assessment

• Patient education regarding topical corticosteroids

Quick Clinical Review

Frequently Asked Questions

What is the most likely diagnosis for an itchy, scaly rash on the knees and scalp?

Psoriasis is the most likely diagnosis because it commonly presents as well-defined, erythematous plaques with silvery scales on extensor surfaces such as the knees and scalp.

Why is HbA1c ordered in patients with inflammatory skin conditions?

HbA1c evaluates average blood glucose levels over the previous two to three months. Good glycemic control supports wound healing and may influence treatment planning.

Which laboratory test helps identify infection?

The white blood cell count within the Complete Blood Count (CBC) is primarily used to evaluate possible infection.

Why is psychosocial assessment important in dermatology?

Visible skin disorders can significantly affect self-esteem, emotional health, relationships, work performance, and overall quality of life. A comprehensive assessment addresses both physical and psychological well-being.

What is the correct sequence of an abdominal examination?

The correct sequence is inspection, auscultation, percussion, and palpation. Auscultation is performed before percussion and palpation to avoid altering bowel sounds.

Which physical examination evaluates balance?

The Romberg test evaluates balance by assessing proprioception and vestibular function while the patient stands with their eyes closed.

Early recognition of psoriasis through a detailed history, focused physical examination, and appropriate diagnostic testing enables clinicians to develop effective treatment plans while addressing the physical and psychosocial challenges associated with chronic inflammatory skin disease.

Healthcare providers should integrate clinical findings, laboratory results, medication history, and patient-reported symptoms to support accurate diagnosis and evidence-based management. Comprehensive assessment remains the foundation of advanced nursing practice and diagnostic reasoning.

References

American Academy of Dermatology Association. (2024). Psoriasis: Diagnosis and treatment. https://www.aad.org/public/diseases/psoriasis/treatment

Bickley, L. S. (2024). Bates’ guide to physical examination and history taking (14th ed.). Wolters Kluwer. https://shop.lww.com/Bates–Guide-to-Physical-Examination-and-History-Taking/p/9781975210879

Hinkle, J. L., & Cheever, K. H. (2021). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer. https://shop.lww.com/

Jarvis, C. (2023). Physical examination and health assessment (9th ed.). Elsevier. https://evolve.elsevier.com/

NU552 Final Exam

Menter, A., Strober, B. E., Kaplan, D. H., et al. (2019). Joint AAD–NPF guidelines of care for the management and treatment of psoriasis. Journal of the American Academy of Dermatology, 80(4), 1029–1072. https://doi.org/10.1016/j.jaad.2018.11.057

Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2024). Current Medical Diagnosis & Treatment 2024. McGraw-Hill. https://accessmedicine.mhmedical.com