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NR509 Week 4 Midterm Exam Due March 2025-2026 Complete
Actual Exam Questions 1- 100 NR-509 Advanced Physical
Assessment NR 509 Midterm and Finals Examplify Online
Proctored Exam Questions and Answers | 100% Pass
Guaranteed | Graded A+ |
NR509 Week 4 Midterm Exam Practice Questions
Cardiovascular Assessment
1. A 62-year-old male with a 40-pack-year smoking history presents with a 3-month history of
exertional dyspnea, orthopnea, and bilateral lower extremity edema. During the cardiac
examination, you hear an S3 gallop at the apex. The S3 gallop is best described as:
A. A high-pitched sound heard in early diastole caused by rapid ventricular filling
B. A low-pitched sound heard in late diastole due to atrial contraction against a stiff ventricle
C. A mid-systolic click followed by a late systolic murmur
D. A diastolic rumbling murmur heard best at the apex with the patient in the left lateral
decubitus position
Correct Answer: A
Full Clinical Reasoning Rotation:
An S3 gallop (ventricular gallop) is a low-pitched sound (not high-pitched) heard in early
diastole during the rapid passive filling phase of the ventricle. It occurs when a large volume of
blood rushes into a noncompliant ventricle, as in heart failure. The sound is produced by the
sudden deceleration of blood against the ventricular wall. In this patient with dyspnea,
orthopnea, and edema, the S3 strongly suggests volume overload and reduced left ventricular
compliance typical of systolic heart failure.
• Why B is incorrect: An S4 gallop (atrial gallop) is a low-pitched sound heard in late
diastole (presystole) caused by atrial contraction forcing blood into a stiff, noncompliant
ventricle. It is common in hypertensive heart disease and diastolic dysfunction, not
acute volume overload.
pg. 1
,2
• Why C is incorrect: A mid-systolic click with a late systolic murmur is characteristic of
mitral valve prolapse, unrelated to heart failure.
• Why D is incorrect: A diastolic rumbling murmur at the apex is characteristic of mitral
stenosis, heard best in the left lateral decubitus position. While it may cause similar
symptoms of dyspnea and edema in advanced stages, it does not produce an S3;
instead, the murmur itself is the hallmark.
2. A 70-year-old woman with long-standing hypertension presents for a routine exam. You
auscultate the heart and hear a harsh, crescendo-decrescendo systolic murmur best at the
right second intercostal space radiating to the carotids. There is a palpable thrill in the same
area. Which of the following is the most likely valvular abnormality?
A. Mitral regurgitation
B. Aortic stenosis
C. Pulmonic stenosis
D. Tricuspid regurgitation
Correct Answer: B
Full Clinical Reasoning Rotation:
The murmur is a systolic ejection murmur best heard at the right second intercostal
space (aortic area) radiating to the carotids. The crescendo-decrescendo quality and radiation
to the carotids are classic for aortic stenosis. A palpable thrill at the base confirms severity (at
least moderate stenosis). The history of hypertension is a risk factor for calcific aortic stenosis in
the elderly.
• Why A is incorrect: Mitral regurgitation produces a holosystolic murmur heard best at
the apex, radiating to the axilla, not the carotids. It does not typically have a thrill at the
base.
• Why C is incorrect: Pulmonic stenosis is also a systolic ejection murmur but heard best
at the left second intercostal space, often with a wide split S2, and usually a congenital
lesion, not acquired in late age.
• Why D is incorrect: Tricuspid regurgitation is a holosystolic murmur heard at the left
lower sternal border, increases with inspiration (Carvallo sign), and is associated with
elevated jugular venous pressure and hepatic pulsations.
3. A 45-year-old woman presents with episodes of palpitations, lightheadedness, and atypical
chest pain. Auscultation reveals a mid-systolic click followed by a late systolic murmur at the
pg. 2
,3
apex. Which maneuver would most likely increase the intensity of the click and the duration
of the murmur?
A. Squatting
B. Handgrip (isometric exercise)
C. Standing from a squatting position
D. Amyl nitrite inhalation
Correct Answer: C
Full Clinical Reasoning Rotation:
The findings are classic for mitral valve prolapse (MVP). The click is the sound of the redundant
mitral valve leaflets prolapsing into the left atrium. The murmur is due to mitral regurgitation.
Maneuvers that decrease left ventricular volume (e.g., standing, Valsalva strain phase) cause
the prolapse to occur earlier in systole, moving the click closer to S1 and increasing the murmur
duration. Standing from a squatting position reduces venous return (decreased preload),
making the left ventricle smaller and the prolapse more pronounced.
• Why A is incorrect: Squatting increases venous return (preload) and afterload,
increasing left ventricular volume, which delays the onset of prolapse, moving the click
later and decreasing murmur intensity.
• Why B is incorrect: Handgrip increases afterload, which increases left ventricular
volume and may also reduce the prolapse and murmur.
• Why D is incorrect: Amyl nitrite is a vasodilator that reduces afterload and can cause an
increase in the intensity of the murmur of mitral regurgitation (including MVP) but does
not have the same effect as standing on the click. However, the question specifically
asks about duration and intensity of the click; standing is the classic maneuver taught
for MVP.
4. During a cardiac examination, you auscultate a continuous "machinery-like" murmur heard
in both systole and diastole, loudest at the left infraclavicular area. The patient is a 22-year-
old asymptomatic woman. What is the most likely diagnosis?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Aorticopulmonary window
D. Ruptured sinus of Valsalva aneurysm
Correct Answer: B
Full Clinical Reasoning Rotation:
The classic continuous murmur described as "machinery" is pathognomonic for patent ductus
pg. 3
, 4
arteriosus (PDA). The murmur is continuous because blood flows from the high-pressure aorta
into the lower-pressure pulmonary artery throughout the cardiac cycle. It is loudest at the left
infraclavicular area (the "ductal area"). In young adults, it may be asymptomatic if the shunt is
small.
• Why A is incorrect: A ventricular septal defect produces a harsh holosystolic murmur at
the lower left sternal border, not continuous.
• Why C is incorrect: An aorticopulmonary window is a rare congenital defect that also
produces a continuous murmur but is usually associated with other anomalies and is not
the typical presentation.
• Why D is incorrect: A ruptured sinus of Valsalva aneurysm causes a sudden continuous
murmur and acute heart failure symptoms, not asymptomatic.
Respiratory Assessment
5. A 65-year-old man with a 50-pack-year history presents with a productive cough,
exertional dyspnea, and weight loss. On percussion of the chest, you note hyperresonance.
Breath sounds are decreased with a prolonged expiratory phase, and you hear coarse crackles
and wheezes. What is the most likely underlying pulmonary pathophysiology?
A. Consolidation of the alveoli with inflammatory exudate
B. Destruction of alveolar walls with loss of elastic recoil and air trapping
C. Bronchoconstriction and airway inflammation
D. Accumulation of fluid in the pleural space
Correct Answer: B
Full Clinical Reasoning Rotation:
The history (smoking, chronic cough, dyspnea, weight loss) and physical findings
(hyperresonance, decreased breath sounds, prolonged expiration, crackles, wheezes) are classic
for emphysema (a form of COPD). The pathophysiology is destruction of alveolar walls and loss
of elastic recoil, leading to air trapping and hyperinflation. Hyperresonance reflects increased
air in the lungs. Prolonged expiration results from airway collapse due to loss of radial traction.
• Why A is incorrect: Consolidation (pneumonia) would produce dullness on percussion,
bronchial breath sounds, and egophony, not hyperresonance.
• Why C is incorrect: Bronchoconstriction and inflammation (asthma) would present with
wheezing, but percussion is usually resonant (not hyperresonant), and breath sounds
may be decreased but not typically with the same degree of hyperinflation. The
chronicity and smoking history point to COPD.
pg. 4
NR509 Week 4 Midterm Exam Due March 2025-2026 Complete
Actual Exam Questions 1- 100 NR-509 Advanced Physical
Assessment NR 509 Midterm and Finals Examplify Online
Proctored Exam Questions and Answers | 100% Pass
Guaranteed | Graded A+ |
NR509 Week 4 Midterm Exam Practice Questions
Cardiovascular Assessment
1. A 62-year-old male with a 40-pack-year smoking history presents with a 3-month history of
exertional dyspnea, orthopnea, and bilateral lower extremity edema. During the cardiac
examination, you hear an S3 gallop at the apex. The S3 gallop is best described as:
A. A high-pitched sound heard in early diastole caused by rapid ventricular filling
B. A low-pitched sound heard in late diastole due to atrial contraction against a stiff ventricle
C. A mid-systolic click followed by a late systolic murmur
D. A diastolic rumbling murmur heard best at the apex with the patient in the left lateral
decubitus position
Correct Answer: A
Full Clinical Reasoning Rotation:
An S3 gallop (ventricular gallop) is a low-pitched sound (not high-pitched) heard in early
diastole during the rapid passive filling phase of the ventricle. It occurs when a large volume of
blood rushes into a noncompliant ventricle, as in heart failure. The sound is produced by the
sudden deceleration of blood against the ventricular wall. In this patient with dyspnea,
orthopnea, and edema, the S3 strongly suggests volume overload and reduced left ventricular
compliance typical of systolic heart failure.
• Why B is incorrect: An S4 gallop (atrial gallop) is a low-pitched sound heard in late
diastole (presystole) caused by atrial contraction forcing blood into a stiff, noncompliant
ventricle. It is common in hypertensive heart disease and diastolic dysfunction, not
acute volume overload.
pg. 1
,2
• Why C is incorrect: A mid-systolic click with a late systolic murmur is characteristic of
mitral valve prolapse, unrelated to heart failure.
• Why D is incorrect: A diastolic rumbling murmur at the apex is characteristic of mitral
stenosis, heard best in the left lateral decubitus position. While it may cause similar
symptoms of dyspnea and edema in advanced stages, it does not produce an S3;
instead, the murmur itself is the hallmark.
2. A 70-year-old woman with long-standing hypertension presents for a routine exam. You
auscultate the heart and hear a harsh, crescendo-decrescendo systolic murmur best at the
right second intercostal space radiating to the carotids. There is a palpable thrill in the same
area. Which of the following is the most likely valvular abnormality?
A. Mitral regurgitation
B. Aortic stenosis
C. Pulmonic stenosis
D. Tricuspid regurgitation
Correct Answer: B
Full Clinical Reasoning Rotation:
The murmur is a systolic ejection murmur best heard at the right second intercostal
space (aortic area) radiating to the carotids. The crescendo-decrescendo quality and radiation
to the carotids are classic for aortic stenosis. A palpable thrill at the base confirms severity (at
least moderate stenosis). The history of hypertension is a risk factor for calcific aortic stenosis in
the elderly.
• Why A is incorrect: Mitral regurgitation produces a holosystolic murmur heard best at
the apex, radiating to the axilla, not the carotids. It does not typically have a thrill at the
base.
• Why C is incorrect: Pulmonic stenosis is also a systolic ejection murmur but heard best
at the left second intercostal space, often with a wide split S2, and usually a congenital
lesion, not acquired in late age.
• Why D is incorrect: Tricuspid regurgitation is a holosystolic murmur heard at the left
lower sternal border, increases with inspiration (Carvallo sign), and is associated with
elevated jugular venous pressure and hepatic pulsations.
3. A 45-year-old woman presents with episodes of palpitations, lightheadedness, and atypical
chest pain. Auscultation reveals a mid-systolic click followed by a late systolic murmur at the
pg. 2
,3
apex. Which maneuver would most likely increase the intensity of the click and the duration
of the murmur?
A. Squatting
B. Handgrip (isometric exercise)
C. Standing from a squatting position
D. Amyl nitrite inhalation
Correct Answer: C
Full Clinical Reasoning Rotation:
The findings are classic for mitral valve prolapse (MVP). The click is the sound of the redundant
mitral valve leaflets prolapsing into the left atrium. The murmur is due to mitral regurgitation.
Maneuvers that decrease left ventricular volume (e.g., standing, Valsalva strain phase) cause
the prolapse to occur earlier in systole, moving the click closer to S1 and increasing the murmur
duration. Standing from a squatting position reduces venous return (decreased preload),
making the left ventricle smaller and the prolapse more pronounced.
• Why A is incorrect: Squatting increases venous return (preload) and afterload,
increasing left ventricular volume, which delays the onset of prolapse, moving the click
later and decreasing murmur intensity.
• Why B is incorrect: Handgrip increases afterload, which increases left ventricular
volume and may also reduce the prolapse and murmur.
• Why D is incorrect: Amyl nitrite is a vasodilator that reduces afterload and can cause an
increase in the intensity of the murmur of mitral regurgitation (including MVP) but does
not have the same effect as standing on the click. However, the question specifically
asks about duration and intensity of the click; standing is the classic maneuver taught
for MVP.
4. During a cardiac examination, you auscultate a continuous "machinery-like" murmur heard
in both systole and diastole, loudest at the left infraclavicular area. The patient is a 22-year-
old asymptomatic woman. What is the most likely diagnosis?
A. Ventricular septal defect
B. Patent ductus arteriosus
C. Aorticopulmonary window
D. Ruptured sinus of Valsalva aneurysm
Correct Answer: B
Full Clinical Reasoning Rotation:
The classic continuous murmur described as "machinery" is pathognomonic for patent ductus
pg. 3
, 4
arteriosus (PDA). The murmur is continuous because blood flows from the high-pressure aorta
into the lower-pressure pulmonary artery throughout the cardiac cycle. It is loudest at the left
infraclavicular area (the "ductal area"). In young adults, it may be asymptomatic if the shunt is
small.
• Why A is incorrect: A ventricular septal defect produces a harsh holosystolic murmur at
the lower left sternal border, not continuous.
• Why C is incorrect: An aorticopulmonary window is a rare congenital defect that also
produces a continuous murmur but is usually associated with other anomalies and is not
the typical presentation.
• Why D is incorrect: A ruptured sinus of Valsalva aneurysm causes a sudden continuous
murmur and acute heart failure symptoms, not asymptomatic.
Respiratory Assessment
5. A 65-year-old man with a 50-pack-year history presents with a productive cough,
exertional dyspnea, and weight loss. On percussion of the chest, you note hyperresonance.
Breath sounds are decreased with a prolonged expiratory phase, and you hear coarse crackles
and wheezes. What is the most likely underlying pulmonary pathophysiology?
A. Consolidation of the alveoli with inflammatory exudate
B. Destruction of alveolar walls with loss of elastic recoil and air trapping
C. Bronchoconstriction and airway inflammation
D. Accumulation of fluid in the pleural space
Correct Answer: B
Full Clinical Reasoning Rotation:
The history (smoking, chronic cough, dyspnea, weight loss) and physical findings
(hyperresonance, decreased breath sounds, prolonged expiration, crackles, wheezes) are classic
for emphysema (a form of COPD). The pathophysiology is destruction of alveolar walls and loss
of elastic recoil, leading to air trapping and hyperinflation. Hyperresonance reflects increased
air in the lungs. Prolonged expiration results from airway collapse due to loss of radial traction.
• Why A is incorrect: Consolidation (pneumonia) would produce dullness on percussion,
bronchial breath sounds, and egophony, not hyperresonance.
• Why C is incorrect: Bronchoconstriction and inflammation (asthma) would present with
wheezing, but percussion is usually resonant (not hyperresonant), and breath sounds
may be decreased but not typically with the same degree of hyperinflation. The
chronicity and smoking history point to COPD.
pg. 4
