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NUR2092 HEALTH ASSESSMENT EXAM 3
REVIEW Actual Exam 2026/2027 65 Questions with
Verified Answers and Detailed Rationales Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR ASSESSMENT (Questions 1-15)
Q1: During cardiac auscultation, the nurse places the stethoscope at the 5th intercostal space,
midclavicular line. This location corresponds to which cardiac area?
A. Aortic area
B. Pulmonic area
C. Tricuspid area
D. Mitral area. [CORRECT]
Correct Answer: D
Rationale: The mitral area (apex) is located at the 5th intercostal space, midclavicular line. This
is where the apical impulse (PMI) is normally palpated and where sounds from the mitral valve
are best heard. The aortic area is at the 2nd ICS, right sternal border. The pulmonic area is at the
2nd ICS, left sternal border. The tricuspid area is at the 4th ICS, left sternal border.
Q2: The nurse auscultates the heart and hears a high-pitched sound immediately after S2 during
inspiration. This sound disappears during expiration. What is this finding?
A. Opening snap of mitral stenosis
B. Physiologic splitting of S2 [CORRECT]
C. Paradoxical splitting of S2
D. Pericardial friction rub
Correct Answer: B
Rationale: Physiologic splitting of S2 occurs during inspiration when increased venous return to
the right heart delays pulmonic valve closure (P2), creating an audible split between aortic (A2)
and pulmonic (P2) components. The split disappears during expiration. Paradoxical splitting
(split on expiration) indicates pathology such as left bundle branch block. Opening snaps occur
in early diastole. Pericardial friction rubs are systolic and diastolic scratchy sounds unrelated to
respiratory phase.
,2
Q3: A patient with heart failure presents with an extra heart sound heard in early diastole,
immediately after S2. The sound is low-pitched and best heard with the bell at the apex. What is
this sound?
A. S4 gallop
B. Opening snap
C. S3 gallop [CORRECT]
D. Ejection click
Correct Answer: C
Rationale: The S3 gallop (ventricular gallop) is a low-pitched sound in early diastole caused by
rapid ventricular filling into a compliant, volume-overloaded ventricle. It is best heard with the
bell at the apex in the left lateral position. S3 is normal in children/young adults but pathologic in
adults >40 years, indicating heart failure or volume overload. S4 occurs in late diastole (atrial
contraction). Opening snaps occur with mitral stenosis. Ejection clicks are systolic.
Q4: The nurse is assessing jugular venous pressure (JVP). The patient is positioned at 45
degrees, and the highest point of venous pulsation is observed 4 cm above the sternal angle.
What is the estimated central venous pressure?
A. 4 cm H2O
B. 9 cm H2O [CORRECT]
C. 14 cm H2O
D. 19 cm H2O
Correct Answer: B
Rationale: JVP is estimated by adding 5 cm (distance from sternal angle to right atrium) to the
vertical height above the sternal angle. Here: 4 cm + 5 cm = 9 cm H2O. Normal JVP is <8 cm
H2O. Elevated JVP (>8 cm) suggests right heart failure, volume overload, or cardiac tamponade.
The 5 cm constant accounts for the fixed anatomic distance from the sternal angle to the center
of the right atrium regardless of patient position.
Q5: During assessment of the carotid arteries, which technique is correct?
A. Palpate both carotids simultaneously to compare amplitude
B. Palpate one carotid at a time, noting rate, rhythm, and contour [CORRECT]
C. Auscultate the carotids after palpating to confirm patency
D. Compress the carotid for 30 seconds to assess cerebral perfusion
, 3
Correct Answer: B
Rationale: Carotid arteries should be palpated ONE AT A TIME to avoid compromising cerebral
blood flow or triggering baroreceptor reflex (bradycardia/hypotension). Assess rate, rhythm,
upstroke (brisk or delayed), and amplitude (normal, diminished, or bounding). Auscultate
BEFORE palpating if bruit suspected; palpation after auscultation is acceptable but never
compress both simultaneously. Carotid compression (option D) is dangerous and contraindicated.
Q6: The nurse documents a grade 3/6 systolic murmur. What does this grading indicate?
A. Very faint, heard only in quiet room
B. Loud but no thrill palpable
C. Loud with palpable thrill [CORRECT]
D. Loud with thrill and audible with stethoscope off chest
Correct Answer: C
Rationale: The Levine grading system for murmurs: Grade 1 (very faint), Grade 2 (quiet but
immediately audible), Grade 3 (moderately loud, NO thrill), Grade 4 (loud WITH palpable
thrill), Grade 5 (very loud with thrill, heard with stethoscope partially off chest), Grade 6
(audible without stethoscope). Grade 3/6 indicates a moderately loud murmur without thrill. The
presence of a thrill begins at Grade 4.
Q7: A patient has a blood pressure of 150/90 mmHg in the right arm and 130/82 mmHg in the
left arm. What is the appropriate nursing action?
A. Document the lower reading as the accurate pressure
B. Document the higher reading and assess for subclavian stenosis or aortic dissection
[CORRECT]
C. Average both readings and document as 140/86 mmHg
D. Repeat measurement in the left arm only as it is closer to the heart
Correct Answer: B
Rationale: A systolic difference >10-15 mmHg between arms is abnormal and suggests
subclavian artery stenosis, aortic dissection, or coarctation of the aorta. The higher pressure
reflects the true systemic pressure; the lower pressure indicates downstream obstruction. This
finding requires further evaluation (pulse examination, imaging). Averaging masks pathology.
The left arm is not inherently more accurate.
Q8: The nurse auscultates a harsh, crescendo-decrescendo systolic murmur at the right upper
sternal border radiating to the carotids. What valvular disorder does this describe?
NUR2092 HEALTH ASSESSMENT EXAM 3
REVIEW Actual Exam 2026/2027 65 Questions with
Verified Answers and Detailed Rationales Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR ASSESSMENT (Questions 1-15)
Q1: During cardiac auscultation, the nurse places the stethoscope at the 5th intercostal space,
midclavicular line. This location corresponds to which cardiac area?
A. Aortic area
B. Pulmonic area
C. Tricuspid area
D. Mitral area. [CORRECT]
Correct Answer: D
Rationale: The mitral area (apex) is located at the 5th intercostal space, midclavicular line. This
is where the apical impulse (PMI) is normally palpated and where sounds from the mitral valve
are best heard. The aortic area is at the 2nd ICS, right sternal border. The pulmonic area is at the
2nd ICS, left sternal border. The tricuspid area is at the 4th ICS, left sternal border.
Q2: The nurse auscultates the heart and hears a high-pitched sound immediately after S2 during
inspiration. This sound disappears during expiration. What is this finding?
A. Opening snap of mitral stenosis
B. Physiologic splitting of S2 [CORRECT]
C. Paradoxical splitting of S2
D. Pericardial friction rub
Correct Answer: B
Rationale: Physiologic splitting of S2 occurs during inspiration when increased venous return to
the right heart delays pulmonic valve closure (P2), creating an audible split between aortic (A2)
and pulmonic (P2) components. The split disappears during expiration. Paradoxical splitting
(split on expiration) indicates pathology such as left bundle branch block. Opening snaps occur
in early diastole. Pericardial friction rubs are systolic and diastolic scratchy sounds unrelated to
respiratory phase.
,2
Q3: A patient with heart failure presents with an extra heart sound heard in early diastole,
immediately after S2. The sound is low-pitched and best heard with the bell at the apex. What is
this sound?
A. S4 gallop
B. Opening snap
C. S3 gallop [CORRECT]
D. Ejection click
Correct Answer: C
Rationale: The S3 gallop (ventricular gallop) is a low-pitched sound in early diastole caused by
rapid ventricular filling into a compliant, volume-overloaded ventricle. It is best heard with the
bell at the apex in the left lateral position. S3 is normal in children/young adults but pathologic in
adults >40 years, indicating heart failure or volume overload. S4 occurs in late diastole (atrial
contraction). Opening snaps occur with mitral stenosis. Ejection clicks are systolic.
Q4: The nurse is assessing jugular venous pressure (JVP). The patient is positioned at 45
degrees, and the highest point of venous pulsation is observed 4 cm above the sternal angle.
What is the estimated central venous pressure?
A. 4 cm H2O
B. 9 cm H2O [CORRECT]
C. 14 cm H2O
D. 19 cm H2O
Correct Answer: B
Rationale: JVP is estimated by adding 5 cm (distance from sternal angle to right atrium) to the
vertical height above the sternal angle. Here: 4 cm + 5 cm = 9 cm H2O. Normal JVP is <8 cm
H2O. Elevated JVP (>8 cm) suggests right heart failure, volume overload, or cardiac tamponade.
The 5 cm constant accounts for the fixed anatomic distance from the sternal angle to the center
of the right atrium regardless of patient position.
Q5: During assessment of the carotid arteries, which technique is correct?
A. Palpate both carotids simultaneously to compare amplitude
B. Palpate one carotid at a time, noting rate, rhythm, and contour [CORRECT]
C. Auscultate the carotids after palpating to confirm patency
D. Compress the carotid for 30 seconds to assess cerebral perfusion
, 3
Correct Answer: B
Rationale: Carotid arteries should be palpated ONE AT A TIME to avoid compromising cerebral
blood flow or triggering baroreceptor reflex (bradycardia/hypotension). Assess rate, rhythm,
upstroke (brisk or delayed), and amplitude (normal, diminished, or bounding). Auscultate
BEFORE palpating if bruit suspected; palpation after auscultation is acceptable but never
compress both simultaneously. Carotid compression (option D) is dangerous and contraindicated.
Q6: The nurse documents a grade 3/6 systolic murmur. What does this grading indicate?
A. Very faint, heard only in quiet room
B. Loud but no thrill palpable
C. Loud with palpable thrill [CORRECT]
D. Loud with thrill and audible with stethoscope off chest
Correct Answer: C
Rationale: The Levine grading system for murmurs: Grade 1 (very faint), Grade 2 (quiet but
immediately audible), Grade 3 (moderately loud, NO thrill), Grade 4 (loud WITH palpable
thrill), Grade 5 (very loud with thrill, heard with stethoscope partially off chest), Grade 6
(audible without stethoscope). Grade 3/6 indicates a moderately loud murmur without thrill. The
presence of a thrill begins at Grade 4.
Q7: A patient has a blood pressure of 150/90 mmHg in the right arm and 130/82 mmHg in the
left arm. What is the appropriate nursing action?
A. Document the lower reading as the accurate pressure
B. Document the higher reading and assess for subclavian stenosis or aortic dissection
[CORRECT]
C. Average both readings and document as 140/86 mmHg
D. Repeat measurement in the left arm only as it is closer to the heart
Correct Answer: B
Rationale: A systolic difference >10-15 mmHg between arms is abnormal and suggests
subclavian artery stenosis, aortic dissection, or coarctation of the aorta. The higher pressure
reflects the true systemic pressure; the lower pressure indicates downstream obstruction. This
finding requires further evaluation (pulse examination, imaging). Averaging masks pathology.
The left arm is not inherently more accurate.
Q8: The nurse auscultates a harsh, crescendo-decrescendo systolic murmur at the right upper
sternal border radiating to the carotids. What valvular disorder does this describe?
