NSG500 / NSG 500 Exam 2 (Latest ):
Advanced Health Assessment | Questions and Verified
Answers | 100% Correct | Grade A - Wilkes
Section 1: Cardiovascular & Peripheral Vascular Assessment
Q1: A 78-year-old patient with a history of coronary artery disease presents for evaluation.
During auscultation, a high-pitched, atrial gallop sound is heard immediately before S1. This
sound is best described as which of the following?
A. S3
B. S4 [CORRECT]
C. Ejection click
D. Opening snap
Correct Answer: B
Rationale: An S4 is a high-pitched sound heard immediately before S1 (late diastole) caused by
atrial contraction against a stiff, non-compliant ventricle, commonly seen in hypertension or
coronary artery disease. An S3 occurs after S2, an ejection click occurs after S1, and an opening
snap occurs after S2 in mitral stenosis.
Q2: A patient with a known heart murmur is assessed. The nurse hears a blowing, decrescendo
murmur that begins immediately after S2 and is best heard at the left sternal border with the
patient leaning forward and holding expiration. Which valve lesion is this?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation [CORRECT]
D. Mitral stenosis
Correct Answer: C
Rationale: Aortic regurgitation produces a high-pitched, blowing, decrescendo diastolic murmur
best heard at the left sternal border (Erb's point) with the patient leaning forward. Mitral
,regurgitation causes a systolic murmur, while mitral stenosis causes a diastolic rumble heard at
the apex.
Q3: A patient with severe asthma exacerbation has their blood pressure taken. The systolic
pressure drops by 18 mmHg during inspiration compared to expiration. What is this finding
called, and what does it indicate?
A. Pulsus alternans; indicating left ventricular failure
B. Pulsus paradoxus; indicating severe air trapping [CORRECT]
C. Wide pulse pressure; indicating aortic regurgitation
D. Narrow pulse pressure; indicating cardiac tamponade
Correct Answer: B
Rationale: Pulsus paradoxus is an abnormally large drop (>10 mmHg) in systolic blood pressure
during inspiration, classic in severe asthma, COPD, or cardiac tamponade due to increased
intrathoracic pressure. Pulsus alternans is beat-to-beat variation in pulse amplitude.
Q4: An advanced practice nurse calculates an Ankle-Brachial Index (ABI) for a patient
complaining of calf claudication. The right ankle systolic pressure is 100 mmHg, and the right
brachial systolic pressure is 140 mmHg. How is this result interpreted?
A. Normal (0.91 - 0.99)
B. Mild peripheral artery disease (0.71) [CORRECT]
C. Moderate peripheral artery disease (0.50)
D. Severe peripheral artery disease (0.30)
Correct Answer: B
Rationale: The ABI is calculated by dividing the ankle pressure by the brachial pressure
(100/140 = 0.71). An ABI of 0.71 falls into the mild peripheral artery disease category. Normal is
1.00 - 1.40, moderate is 0.41 - 0.70, and severe is < 0.40.
Q5: A nurse assesses capillary refill on the toes of a patient with suspected Raynaud's
phenomenon. The patient's toes are white and cold. After applying warmth, the toes turn blue
before becoming red and painful. What is the correct term for the blue phase?
A. Pallor
, B. Rubor
C. Cyanosis
D. Livedo reticularis
Correct Answer: C
Rationale: The classic triad of Raynaud's phenomenon includes pallor (white due to vasospasm),
cyanosis (blue due to deoxygenated blood in stagnant capillaries), and rubor (red due to reactive
hyperemia). Livedo reticularis is a lacy, mottled discoloration.
Q6: Under the 2022 ACC/AHA/HFSA guidelines utilized in 2026-2027 practice, a patient who
experiences marked limitation of physical activity, becoming comfortable only at rest, is
classified as which NYHA functional class?
A. Class I
B. Class II
C. Class III [CORRECT]
D. Class IV
Correct Answer: C
Rationale: NYHA Class III is defined by marked limitation of physical activity; patients are
comfortable only at rest. Class II involves slight limitation, Class IV involves symptoms at rest,
and Class I has no limitation.
Q7: During a cardiac assessment, the nurse palpates a thrill at the second left intercostal space.
What does a thrill signify?
A. Normal turbulent flow across the aortic valve
B. A palpable murmur indicating severe valvular disease [CORRECT]
C. A hyperdynamic left ventricle
D. Aortic aneurysm pulsation
Correct Answer: B
Rationale: A thrill is a palpable vibration felt over the chest wall that corresponds to a severe,
turbulent blood flow, usually grade 4 or higher on the murmur grading scale. It is never a normal
finding and indicates significant cardiac pathology.
Advanced Health Assessment | Questions and Verified
Answers | 100% Correct | Grade A - Wilkes
Section 1: Cardiovascular & Peripheral Vascular Assessment
Q1: A 78-year-old patient with a history of coronary artery disease presents for evaluation.
During auscultation, a high-pitched, atrial gallop sound is heard immediately before S1. This
sound is best described as which of the following?
A. S3
B. S4 [CORRECT]
C. Ejection click
D. Opening snap
Correct Answer: B
Rationale: An S4 is a high-pitched sound heard immediately before S1 (late diastole) caused by
atrial contraction against a stiff, non-compliant ventricle, commonly seen in hypertension or
coronary artery disease. An S3 occurs after S2, an ejection click occurs after S1, and an opening
snap occurs after S2 in mitral stenosis.
Q2: A patient with a known heart murmur is assessed. The nurse hears a blowing, decrescendo
murmur that begins immediately after S2 and is best heard at the left sternal border with the
patient leaning forward and holding expiration. Which valve lesion is this?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation [CORRECT]
D. Mitral stenosis
Correct Answer: C
Rationale: Aortic regurgitation produces a high-pitched, blowing, decrescendo diastolic murmur
best heard at the left sternal border (Erb's point) with the patient leaning forward. Mitral
,regurgitation causes a systolic murmur, while mitral stenosis causes a diastolic rumble heard at
the apex.
Q3: A patient with severe asthma exacerbation has their blood pressure taken. The systolic
pressure drops by 18 mmHg during inspiration compared to expiration. What is this finding
called, and what does it indicate?
A. Pulsus alternans; indicating left ventricular failure
B. Pulsus paradoxus; indicating severe air trapping [CORRECT]
C. Wide pulse pressure; indicating aortic regurgitation
D. Narrow pulse pressure; indicating cardiac tamponade
Correct Answer: B
Rationale: Pulsus paradoxus is an abnormally large drop (>10 mmHg) in systolic blood pressure
during inspiration, classic in severe asthma, COPD, or cardiac tamponade due to increased
intrathoracic pressure. Pulsus alternans is beat-to-beat variation in pulse amplitude.
Q4: An advanced practice nurse calculates an Ankle-Brachial Index (ABI) for a patient
complaining of calf claudication. The right ankle systolic pressure is 100 mmHg, and the right
brachial systolic pressure is 140 mmHg. How is this result interpreted?
A. Normal (0.91 - 0.99)
B. Mild peripheral artery disease (0.71) [CORRECT]
C. Moderate peripheral artery disease (0.50)
D. Severe peripheral artery disease (0.30)
Correct Answer: B
Rationale: The ABI is calculated by dividing the ankle pressure by the brachial pressure
(100/140 = 0.71). An ABI of 0.71 falls into the mild peripheral artery disease category. Normal is
1.00 - 1.40, moderate is 0.41 - 0.70, and severe is < 0.40.
Q5: A nurse assesses capillary refill on the toes of a patient with suspected Raynaud's
phenomenon. The patient's toes are white and cold. After applying warmth, the toes turn blue
before becoming red and painful. What is the correct term for the blue phase?
A. Pallor
, B. Rubor
C. Cyanosis
D. Livedo reticularis
Correct Answer: C
Rationale: The classic triad of Raynaud's phenomenon includes pallor (white due to vasospasm),
cyanosis (blue due to deoxygenated blood in stagnant capillaries), and rubor (red due to reactive
hyperemia). Livedo reticularis is a lacy, mottled discoloration.
Q6: Under the 2022 ACC/AHA/HFSA guidelines utilized in 2026-2027 practice, a patient who
experiences marked limitation of physical activity, becoming comfortable only at rest, is
classified as which NYHA functional class?
A. Class I
B. Class II
C. Class III [CORRECT]
D. Class IV
Correct Answer: C
Rationale: NYHA Class III is defined by marked limitation of physical activity; patients are
comfortable only at rest. Class II involves slight limitation, Class IV involves symptoms at rest,
and Class I has no limitation.
Q7: During a cardiac assessment, the nurse palpates a thrill at the second left intercostal space.
What does a thrill signify?
A. Normal turbulent flow across the aortic valve
B. A palpable murmur indicating severe valvular disease [CORRECT]
C. A hyperdynamic left ventricle
D. Aortic aneurysm pulsation
Correct Answer: B
Rationale: A thrill is a palpable vibration felt over the chest wall that corresponds to a severe,
turbulent blood flow, usually grade 4 or higher on the murmur grading scale. It is never a normal
finding and indicates significant cardiac pathology.
