Exam 2: NR 304 Health Assessment II - Integration
of Advanced Assessment & Clinical Judgment
(2026/2027 Edition)
Chamberlain University | 2026/2027 Academic Year
Exam Instructions: This exam consists of 50 questions based on the 2026/2027 NR 304
curriculum. It evaluates your ability to synthesize advanced physical examination data,
differentiate between normal and abnormal findings, and formulate appropriate clinical
judgments. Select the single best answer reflecting accurate assessment or next step.
1. A 68-year-old man with NYHA Class III heart failure presents with sudden onset
of orthopnea and bibasilar crackles to mid-thorax. BP 162/94, HR 112 irregularly
irregular, JVP 7 cm above sternal angle. Which finding best differentiates acute
decompensation from chronic overload?
A) JVP elevation alone
B) Presence of third heart sound [CORRECT]
C) Irregularly irregular rhythm
D) BP 162/94
Rationale: B is correct. A newly audible S₃ in acute decompensation indicates rapid
ventricular filling and acute volume overload (2026 ESC heart failure guideline). JVP (A)
is chronically elevated. AF rhythm (C) is baseline. BP (D) reflects afterload, not acuity.
2. A 55-year-old woman with HTN is found to have a mid-systolic click followed by a
late systolic murmur at the apex. Which maneuver best confirms mitral-valve
prolapse?
A) Auscultate only in supine position
B) Have patient exhale fully and hold breath
C) Ask patient to squat, then stand; murmur lengthens with standing
D) Palpate carotid pulse simultaneously
,Rationale: C is correct. MVP murmur lengthens with decreased preload (standing) due
to earlier leaflet prolapse (2026 ACC valvular disease guideline). Supine only (A) misses
dynamic changes. Breath-holding (B) is for pericardial rubs. Palpation (D) is unrelated.
3. A 45-year-old man post-MI has a new pansystolic murmur at the left sternal edge,
loudest at end-expiration. BP 90/60, HR 110. Which assessment is priority?
A) Check for JVP cannon waves
B) Auscultate for S₃ at apex
C) Measure ankle-brachial index
D) Palpate for ventricular heave
Rationale: B is correct. New pansystolic murmur with hypotension suggests
ventricular-septal rupture; S₃ indicates acute LV failure (2026 AHA post-MI guideline).
Cannon waves (A) are AV dissociation. ABI (C) is peripheral. Heave (D) is chronic.
4. A 70-year-old woman with peripheral vascular disease has ankle-brachial index
0.65 bilaterally. Which symptom correlates most strongly with this finding?
A) Nocturnal leg cramps
B) Hair loss on shins [CORRECT]
C) Varicose veins
D) Unilateral calf edema
Rationale: B is correct. ABI <0.9 indicates significant stenosis; hair loss reflects chronic
hypoperfusion (2026 SVS PVD guideline). Cramps (A) are neuro-muscular. Varicosities
(C) are venous. Unilateral edema (D) suggests DVT.
5. A 60-year-old man with atrial fibrillation has new unilateral leg edema and pain.
Homans’ sign negative. Which exam finding best supports DVT diagnosis?
A) Negative Homans’ sign
B) Mild erythema
C) Low-grade fever and palpable cord
D) Dorsalis pedis pulse 1+
Rationale: C is correct. Low-grade fever and palpable cord indicate inflammatory
thrombosis; Homans’ is unreliable (2026 CHEST DVT guideline). Negative Homans (A)
does not rule out DVT. Erythema (B) is non-specific. Pulse (D) is arterial.
, 6. A 58-year-old woman with COPD has BP 150/90, HR 96, RR 24, SpO₂ 91 % on 2 L.
Chest is hyperinflated, breath sounds distant. Which finding signals impending
respiratory failure?
A) HR 96
B) Use of accessory muscles at rest [CORRECT]
C) BP 150/90
D) Hyperinflated chest
Rationale: B is correct. Accessory muscle use at rest indicates increased work of
breathing and fatigue (2026 GOLD COPD guideline). Tachycardia (A) and hypertension
(C) are compensatory. Hyperinflation (D) is chronic.
7. A 72-year-old man with pneumonia has bronchial breath sounds over the right
lower lobe. Which additional finding confirms consolidation?
A) Hyperresonance to percussion
B) Decreased tactile fremitus
C) Egophony on auscultation
D) Absent breath sounds
Rationale: C is correct. Egophony (E → A change) indicates lung tissue density
(consolidation) (2026 IDSA pneumonia guideline). Hyperresonance (A) is air. Decreased
fremitus (B) is pleural effusion. Absent sounds (D) is atelectasis or effusion.
8. A 55-year-old woman post-thyroidectomy has stridor and hoarseness 4 h
post-op. Which immediate assessment is priority?
A) Check for bleeding by removing dressing
B) Auscultate lungs for crackles
C) Inspect the neck for expanding hematoma and check vocal cord movement
D) Measure blood glucose
Rationale: C is correct. Stridor + hoarseness suggest airway compromise from
hematoma or recurrent laryngeal nerve injury (2026 ATA thyroidectomy guideline).
Removing dressing (A) is premature. Lung auscultation (B) is unrelated. Glucose (D) is
irrelevant.
of Advanced Assessment & Clinical Judgment
(2026/2027 Edition)
Chamberlain University | 2026/2027 Academic Year
Exam Instructions: This exam consists of 50 questions based on the 2026/2027 NR 304
curriculum. It evaluates your ability to synthesize advanced physical examination data,
differentiate between normal and abnormal findings, and formulate appropriate clinical
judgments. Select the single best answer reflecting accurate assessment or next step.
1. A 68-year-old man with NYHA Class III heart failure presents with sudden onset
of orthopnea and bibasilar crackles to mid-thorax. BP 162/94, HR 112 irregularly
irregular, JVP 7 cm above sternal angle. Which finding best differentiates acute
decompensation from chronic overload?
A) JVP elevation alone
B) Presence of third heart sound [CORRECT]
C) Irregularly irregular rhythm
D) BP 162/94
Rationale: B is correct. A newly audible S₃ in acute decompensation indicates rapid
ventricular filling and acute volume overload (2026 ESC heart failure guideline). JVP (A)
is chronically elevated. AF rhythm (C) is baseline. BP (D) reflects afterload, not acuity.
2. A 55-year-old woman with HTN is found to have a mid-systolic click followed by a
late systolic murmur at the apex. Which maneuver best confirms mitral-valve
prolapse?
A) Auscultate only in supine position
B) Have patient exhale fully and hold breath
C) Ask patient to squat, then stand; murmur lengthens with standing
D) Palpate carotid pulse simultaneously
,Rationale: C is correct. MVP murmur lengthens with decreased preload (standing) due
to earlier leaflet prolapse (2026 ACC valvular disease guideline). Supine only (A) misses
dynamic changes. Breath-holding (B) is for pericardial rubs. Palpation (D) is unrelated.
3. A 45-year-old man post-MI has a new pansystolic murmur at the left sternal edge,
loudest at end-expiration. BP 90/60, HR 110. Which assessment is priority?
A) Check for JVP cannon waves
B) Auscultate for S₃ at apex
C) Measure ankle-brachial index
D) Palpate for ventricular heave
Rationale: B is correct. New pansystolic murmur with hypotension suggests
ventricular-septal rupture; S₃ indicates acute LV failure (2026 AHA post-MI guideline).
Cannon waves (A) are AV dissociation. ABI (C) is peripheral. Heave (D) is chronic.
4. A 70-year-old woman with peripheral vascular disease has ankle-brachial index
0.65 bilaterally. Which symptom correlates most strongly with this finding?
A) Nocturnal leg cramps
B) Hair loss on shins [CORRECT]
C) Varicose veins
D) Unilateral calf edema
Rationale: B is correct. ABI <0.9 indicates significant stenosis; hair loss reflects chronic
hypoperfusion (2026 SVS PVD guideline). Cramps (A) are neuro-muscular. Varicosities
(C) are venous. Unilateral edema (D) suggests DVT.
5. A 60-year-old man with atrial fibrillation has new unilateral leg edema and pain.
Homans’ sign negative. Which exam finding best supports DVT diagnosis?
A) Negative Homans’ sign
B) Mild erythema
C) Low-grade fever and palpable cord
D) Dorsalis pedis pulse 1+
Rationale: C is correct. Low-grade fever and palpable cord indicate inflammatory
thrombosis; Homans’ is unreliable (2026 CHEST DVT guideline). Negative Homans (A)
does not rule out DVT. Erythema (B) is non-specific. Pulse (D) is arterial.
, 6. A 58-year-old woman with COPD has BP 150/90, HR 96, RR 24, SpO₂ 91 % on 2 L.
Chest is hyperinflated, breath sounds distant. Which finding signals impending
respiratory failure?
A) HR 96
B) Use of accessory muscles at rest [CORRECT]
C) BP 150/90
D) Hyperinflated chest
Rationale: B is correct. Accessory muscle use at rest indicates increased work of
breathing and fatigue (2026 GOLD COPD guideline). Tachycardia (A) and hypertension
(C) are compensatory. Hyperinflation (D) is chronic.
7. A 72-year-old man with pneumonia has bronchial breath sounds over the right
lower lobe. Which additional finding confirms consolidation?
A) Hyperresonance to percussion
B) Decreased tactile fremitus
C) Egophony on auscultation
D) Absent breath sounds
Rationale: C is correct. Egophony (E → A change) indicates lung tissue density
(consolidation) (2026 IDSA pneumonia guideline). Hyperresonance (A) is air. Decreased
fremitus (B) is pleural effusion. Absent sounds (D) is atelectasis or effusion.
8. A 55-year-old woman post-thyroidectomy has stridor and hoarseness 4 h
post-op. Which immediate assessment is priority?
A) Check for bleeding by removing dressing
B) Auscultate lungs for crackles
C) Inspect the neck for expanding hematoma and check vocal cord movement
D) Measure blood glucose
Rationale: C is correct. Stridor + hoarseness suggest airway compromise from
hematoma or recurrent laryngeal nerve injury (2026 ATA thyroidectomy guideline).
Removing dressing (A) is premature. Lung auscultation (B) is unrelated. Glucose (D) is
irrelevant.
