NR 667/ NR 667 CHAMBERLAIN CEA FINAL
EXAM (LATEST 2026): MOST
COMPREHENSIVE QS & ANS - TO PASS THE
EXAM, 100% VERIFIED
1. The nurse practitioner assessing a patient with a rapid cardiac
rhythm may assess for a pulse deficit by auscultating heart sounds
while observing the EKG. Where does the S1 heart sound correlate
on the electrocardiogram?
A. At the end of the T wave
B. At the start of the T wave
C. At the peak of the R wave
D. At the start of the P wave
Rationale:
The S1 heart sound represents closure of the mitral and tricuspid valves at the onset
of ventricular systole. Ventricular depolarization is represented by the QRS complex,
with mechanical contraction following electrical activity. The peak of the R wave most
closely correlates with the onset of ventricular contraction and therefore aligns with
S1. This correlation is essential when assessing for pulse deficits in dysrhythmias such
as atrial fibrillation.
2. A 72-year-old male with stable angina develops ST-segment
depression in V3–V4 during a stress test with chest discomfort.
Which of the following is NOT a priority medical decision?
A. Prescribe metoprolol 12.5 mg PO BID
B. Prescribe aspirin 81 mg PO daily
C. Refer to cardiology for angiography
D. Initiate anti-ischemic therapy
Rationale:
ST-segment depression during stress testing indicates myocardial ischemia and
warrants aggressive medical management. Beta-blockers and aspirin are first-line
,therapies to reduce myocardial oxygen demand and prevent thrombosis. Immediate
referral for angiography is not always the first priority unless symptoms are refractory
or high-risk features are present. Initial optimization of medical therapy is appropriate
before invasive evaluation.
3. While auscultating breath sounds, the patient says “ee” and you
hear a nasal “a” sound. What finding is present?
A. Positive stereognosis
B. Positive egophony
C. Negative bronchophony
D. Negative egophony
Rationale:
Egophony is assessed by having the patient say “ee” while auscultating lung fields.
Normally, the sound is muffled, but when lung consolidation is present, the sound
changes to a nasal “a.” This finding suggests underlying pathology such as pneumonia
or pulmonary consolidation. Positive egophony is an important indicator of abnormal
lung tissue density.
4. During evaluation of a patient with CHF and a new murmur,
during which phase of the cardiac cycle are S3 and S4 heart sounds
heard?
A. Diastole
B. S3 in systole, S4 in diastole
C. Systole
D. S4 in systole, S3 in diastole
Rationale:
Both S3 and S4 occur during diastole. S3 is associated with rapid ventricular filling and
is often seen in heart failure or volume overload. S4 occurs during atrial contraction
,against a stiff ventricle, commonly in hypertension or ischemic heart disease.
Identifying these sounds helps differentiate cardiac pathology.
5. Where is the point of maximal impulse (PMI) most commonly
palpated in a healthy adult?
A. Left 2nd intercostal space, midaxillary line
B. Right 5th intercostal space, sternal border
C. Left 5th intercostal space at the midclavicular line
D. Left 6th intercostal space, anterior axillary line
Rationale:
The PMI reflects the apex of the left ventricle striking the chest wall during systole. In
healthy adults, it is typically located at the left 5th intercostal space along the
midclavicular line. Displacement of the PMI may indicate cardiomegaly or ventricular
hypertrophy. Proper identification aids in cardiovascular assessment.
6. How does percussion of the thorax assist during the physical
examination?
A. Confirm cardiac origin of angina
B. Assess for deep tumors
C. Assess pain prior to palpation
D. Identify air-filled, fluid-filled, or consolidated tissue
Rationale:
Thoracic percussion helps determine the density of underlying tissue. Resonant
sounds indicate normal air-filled lungs, while dullness suggests consolidation or fluid.
Hyperresonance may indicate conditions like pneumothorax. This technique enhances
diagnostic accuracy in respiratory assessment.
, 7. What diaphragmatic excursion finding is expected in interstitial
lung disease?
A. Equal bilateral movement with decreased overall excursion
B. 8–12 inches of ascension bilaterally
C. Greater right-sided descent
D. No diaphragmatic movement
Rationale:
Interstitial lung disease restricts lung expansion, leading to reduced diaphragmatic
excursion. Movement remains symmetrical but diminished due to decreased lung
compliance. This finding helps differentiate restrictive from obstructive pulmonary
diseases. Reduced excursion correlates with reduced inspiratory capacity.
8. Sparse lateral eyebrows and periorbital edema suggest which
condition?
A. Severe hypothyroidism
B. Addison’s disease
C. Graves’ disease
D. Alzheimer’s disease
Rationale:
Loss of the lateral third of the eyebrows (Queen Anne sign) is classic for
hypothyroidism. Myxedema causes periorbital puffiness due to mucopolysaccharide
deposition. These findings reflect reduced metabolic activity and are important
diagnostic clues. Early recognition prevents systemic complications.
EXAM (LATEST 2026): MOST
COMPREHENSIVE QS & ANS - TO PASS THE
EXAM, 100% VERIFIED
1. The nurse practitioner assessing a patient with a rapid cardiac
rhythm may assess for a pulse deficit by auscultating heart sounds
while observing the EKG. Where does the S1 heart sound correlate
on the electrocardiogram?
A. At the end of the T wave
B. At the start of the T wave
C. At the peak of the R wave
D. At the start of the P wave
Rationale:
The S1 heart sound represents closure of the mitral and tricuspid valves at the onset
of ventricular systole. Ventricular depolarization is represented by the QRS complex,
with mechanical contraction following electrical activity. The peak of the R wave most
closely correlates with the onset of ventricular contraction and therefore aligns with
S1. This correlation is essential when assessing for pulse deficits in dysrhythmias such
as atrial fibrillation.
2. A 72-year-old male with stable angina develops ST-segment
depression in V3–V4 during a stress test with chest discomfort.
Which of the following is NOT a priority medical decision?
A. Prescribe metoprolol 12.5 mg PO BID
B. Prescribe aspirin 81 mg PO daily
C. Refer to cardiology for angiography
D. Initiate anti-ischemic therapy
Rationale:
ST-segment depression during stress testing indicates myocardial ischemia and
warrants aggressive medical management. Beta-blockers and aspirin are first-line
,therapies to reduce myocardial oxygen demand and prevent thrombosis. Immediate
referral for angiography is not always the first priority unless symptoms are refractory
or high-risk features are present. Initial optimization of medical therapy is appropriate
before invasive evaluation.
3. While auscultating breath sounds, the patient says “ee” and you
hear a nasal “a” sound. What finding is present?
A. Positive stereognosis
B. Positive egophony
C. Negative bronchophony
D. Negative egophony
Rationale:
Egophony is assessed by having the patient say “ee” while auscultating lung fields.
Normally, the sound is muffled, but when lung consolidation is present, the sound
changes to a nasal “a.” This finding suggests underlying pathology such as pneumonia
or pulmonary consolidation. Positive egophony is an important indicator of abnormal
lung tissue density.
4. During evaluation of a patient with CHF and a new murmur,
during which phase of the cardiac cycle are S3 and S4 heart sounds
heard?
A. Diastole
B. S3 in systole, S4 in diastole
C. Systole
D. S4 in systole, S3 in diastole
Rationale:
Both S3 and S4 occur during diastole. S3 is associated with rapid ventricular filling and
is often seen in heart failure or volume overload. S4 occurs during atrial contraction
,against a stiff ventricle, commonly in hypertension or ischemic heart disease.
Identifying these sounds helps differentiate cardiac pathology.
5. Where is the point of maximal impulse (PMI) most commonly
palpated in a healthy adult?
A. Left 2nd intercostal space, midaxillary line
B. Right 5th intercostal space, sternal border
C. Left 5th intercostal space at the midclavicular line
D. Left 6th intercostal space, anterior axillary line
Rationale:
The PMI reflects the apex of the left ventricle striking the chest wall during systole. In
healthy adults, it is typically located at the left 5th intercostal space along the
midclavicular line. Displacement of the PMI may indicate cardiomegaly or ventricular
hypertrophy. Proper identification aids in cardiovascular assessment.
6. How does percussion of the thorax assist during the physical
examination?
A. Confirm cardiac origin of angina
B. Assess for deep tumors
C. Assess pain prior to palpation
D. Identify air-filled, fluid-filled, or consolidated tissue
Rationale:
Thoracic percussion helps determine the density of underlying tissue. Resonant
sounds indicate normal air-filled lungs, while dullness suggests consolidation or fluid.
Hyperresonance may indicate conditions like pneumothorax. This technique enhances
diagnostic accuracy in respiratory assessment.
, 7. What diaphragmatic excursion finding is expected in interstitial
lung disease?
A. Equal bilateral movement with decreased overall excursion
B. 8–12 inches of ascension bilaterally
C. Greater right-sided descent
D. No diaphragmatic movement
Rationale:
Interstitial lung disease restricts lung expansion, leading to reduced diaphragmatic
excursion. Movement remains symmetrical but diminished due to decreased lung
compliance. This finding helps differentiate restrictive from obstructive pulmonary
diseases. Reduced excursion correlates with reduced inspiratory capacity.
8. Sparse lateral eyebrows and periorbital edema suggest which
condition?
A. Severe hypothyroidism
B. Addison’s disease
C. Graves’ disease
D. Alzheimer’s disease
Rationale:
Loss of the lateral third of the eyebrows (Queen Anne sign) is classic for
hypothyroidism. Myxedema causes periorbital puffiness due to mucopolysaccharide
deposition. These findings reflect reduced metabolic activity and are important
diagnostic clues. Early recognition prevents systemic complications.
