NR509 Advanced Physical Assessment
Final Exam Actual Exam 2026/2027 –
Complete Exam-Style Questions |
Detailed Rationales – Pass Guaranteed –
A+ Graded
Question 1
A 58-year-old man reports chest pressure when walking up stairs,
relieved by rest. On auscultation, you hear a mid-systolic click
followed by a late systolic murmur at the apex.
What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
D. Mitral regurgitation (chronic)
Correct ,,,,answer,,,: B
Rationale: A mid-systolic click followed by a late systolic murmur at
the apex is classic for mitral valve prolapse. The click represents
sudden tensing of the prolapsing leaflet. Chronic mitral
regurgitation produces a holosystolic murmur without a click. Aortic
stenosis is heard at the right upper sternal border. Hypertrophic
,cardiomyopathy produces a crescendo-decrescendo murmur at the
left sternal border.
Question 2
During a cardiovascular exam, you note a sustained, forceful point of
maximal impulse (PMI) displaced to the left 6th intercostal space.
This finding suggests:
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Pericardial effusion
D. Dilated cardiomyopathy
Correct ,,,,answer,,,: B
Rationale: A sustained, forceful PMI that is displaced laterally and
inferiorly indicates left ventricular hypertrophy, typically from
pressure overload such as hypertension or aortic stenosis. Right
ventricular hypertrophy produces a parasternal heave. Pericardial
effusion often diminishes or displaces the PMI medially. Dilated
cardiomyopathy gives a diffuse, weak, and often displaced PMI but
not a forceful one.
Question 3
A 72-year-old woman with hypertension has an S4 gallop on
auscultation.
What is the most likely cause?
,A. Heart failure
B. Mitral stenosis
C. Reduced ventricular compliance
D. Aortic regurgitation
Correct ,,,,answer,,,: C
Rationale: An S4 gallop occurs during atrial contraction into a non-
compliant (stiff) ventricle. This is often seen in hypertension,
hypertrophy, or myocardial ischemia. S3 suggests systolic heart
failure. Mitral stenosis produces an opening snap. Aortic
regurgitation causes a decrescendo diastolic murmur.
Question 4
On auscultation of the carotid arteries, you hear a medium-pitched,
non-radiating bruit in a 65-year-old smoker.
Best next step?
A. Anticoagulation
B. Carotid duplex ultrasound
C. Aspirin monotherapy
D. Reassurance
Correct ,,,,answer,,,: B
Rationale: A carotid bruit in a patient with vascular risk factors
(smoking, age) suggests atherosclerotic stenosis. Carotid duplex
ultrasound is noninvasive and determines the degree of stenosis,
guiding further management. Anticoagulation is not first-line
without confirmed high-risk source. Aspirin alone is insufficient
, without imaging. Reassurance is inappropriate given the risk of
stroke.
Question 5
A patient reports palpitations. On auscultation, heart rate is 150
bpm, irregularly irregular. No S1 intensity variation.
Most likely rhythm?
A. Atrial flutter with variable block
B. Multifocal atrial tachycardia
C. Atrial fibrillation
D. Frequent PACs
Correct ,,,,answer,,,: C
Rationale: An irregularly irregular rhythm without significant
variation in S1 intensity is classic for atrial fibrillation. Atrial flutter
with variable block may be irregular but often has some regularity.
Multifocal atrial tachycardia is also irregular but typically seen in
lung disease. Frequent PACs cause occasional irregularity, not a
sustained rate of 150.
Question 6
During respiratory exam, a 45-year-old with dyspnea has decreased
tactile fremitus and stony dullness to percussion at the left base.
Most likely diagnosis?
A. Lobar pneumonia
Final Exam Actual Exam 2026/2027 –
Complete Exam-Style Questions |
Detailed Rationales – Pass Guaranteed –
A+ Graded
Question 1
A 58-year-old man reports chest pressure when walking up stairs,
relieved by rest. On auscultation, you hear a mid-systolic click
followed by a late systolic murmur at the apex.
What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral valve prolapse
C. Hypertrophic cardiomyopathy
D. Mitral regurgitation (chronic)
Correct ,,,,answer,,,: B
Rationale: A mid-systolic click followed by a late systolic murmur at
the apex is classic for mitral valve prolapse. The click represents
sudden tensing of the prolapsing leaflet. Chronic mitral
regurgitation produces a holosystolic murmur without a click. Aortic
stenosis is heard at the right upper sternal border. Hypertrophic
,cardiomyopathy produces a crescendo-decrescendo murmur at the
left sternal border.
Question 2
During a cardiovascular exam, you note a sustained, forceful point of
maximal impulse (PMI) displaced to the left 6th intercostal space.
This finding suggests:
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy
C. Pericardial effusion
D. Dilated cardiomyopathy
Correct ,,,,answer,,,: B
Rationale: A sustained, forceful PMI that is displaced laterally and
inferiorly indicates left ventricular hypertrophy, typically from
pressure overload such as hypertension or aortic stenosis. Right
ventricular hypertrophy produces a parasternal heave. Pericardial
effusion often diminishes or displaces the PMI medially. Dilated
cardiomyopathy gives a diffuse, weak, and often displaced PMI but
not a forceful one.
Question 3
A 72-year-old woman with hypertension has an S4 gallop on
auscultation.
What is the most likely cause?
,A. Heart failure
B. Mitral stenosis
C. Reduced ventricular compliance
D. Aortic regurgitation
Correct ,,,,answer,,,: C
Rationale: An S4 gallop occurs during atrial contraction into a non-
compliant (stiff) ventricle. This is often seen in hypertension,
hypertrophy, or myocardial ischemia. S3 suggests systolic heart
failure. Mitral stenosis produces an opening snap. Aortic
regurgitation causes a decrescendo diastolic murmur.
Question 4
On auscultation of the carotid arteries, you hear a medium-pitched,
non-radiating bruit in a 65-year-old smoker.
Best next step?
A. Anticoagulation
B. Carotid duplex ultrasound
C. Aspirin monotherapy
D. Reassurance
Correct ,,,,answer,,,: B
Rationale: A carotid bruit in a patient with vascular risk factors
(smoking, age) suggests atherosclerotic stenosis. Carotid duplex
ultrasound is noninvasive and determines the degree of stenosis,
guiding further management. Anticoagulation is not first-line
without confirmed high-risk source. Aspirin alone is insufficient
, without imaging. Reassurance is inappropriate given the risk of
stroke.
Question 5
A patient reports palpitations. On auscultation, heart rate is 150
bpm, irregularly irregular. No S1 intensity variation.
Most likely rhythm?
A. Atrial flutter with variable block
B. Multifocal atrial tachycardia
C. Atrial fibrillation
D. Frequent PACs
Correct ,,,,answer,,,: C
Rationale: An irregularly irregular rhythm without significant
variation in S1 intensity is classic for atrial fibrillation. Atrial flutter
with variable block may be irregular but often has some regularity.
Multifocal atrial tachycardia is also irregular but typically seen in
lung disease. Frequent PACs cause occasional irregularity, not a
sustained rate of 150.
Question 6
During respiratory exam, a 45-year-old with dyspnea has decreased
tactile fremitus and stony dullness to percussion at the left base.
Most likely diagnosis?
A. Lobar pneumonia
