NSG 6020 ADVANCED HEALTH ASSESSMENT COMPLETE COLLECTION OF
EXAM QUESTIONS AND ANSWERS, FULLY REVISED AND CURRENTLY UP
TO DATE
1. Q: What are the normal heart sounds and where are they best
heard? ANSWER S1 (lub) is best heard at the apex and represents
closure of mitral and tricuspid valves. S2 (dub) is best heard at the base
and represents closure of aortic and pulmonic valves.
2. Q: What does an S3 heart sound indicate? ANSWER S3 is a
ventricular gallop heard in early diastole. It may be normal in children
and young adults but indicates heart failure or volume overload in adults
over 40.
3. Q: What does an S4 heart sound indicate? ANSWER S4 is an atrial
gallop heard in late diastole. It indicates decreased ventricular compliance
and is associated with hypertension, coronary artery disease, and aortic
stenosis.
4. Q: Where is the point of maximal impulse (PMI) normally located?
ANSWER The PMI is normally located at the 5th intercostal space at the
midclavicular line and should be less than 2 cm in diameter.
5. Q: What is the difference between a thrill and a heave? ANSWER A
thrill is a palpable vibration caused by turbulent blood flow (palpable
murmur). A heave is a sustained lift of the chest wall indicating
ventricular hypertrophy.
6. Q: What are the characteristics of a systolic murmur? ANSWER
Systolic murmurs occur between S1 and S2. They can be innocent (flow
murmurs) or pathologic (mitral regurgitation, aortic stenosis, ventricular
septal defect).
7. Q: What are the characteristics of a diastolic murmur? ANSWER
Diastolic murmurs occur between S2 and S1. They are always pathologic
and include aortic regurgitation and mitral stenosis.
8. Q: How do you grade murmur intensity? ANSWER Grade 1: barely
audible; Grade 2: quiet but heard immediately; Grade 3: moderately loud;
, Grade 4: loud with palpable thrill; Grade 5: very loud, heard with
stethoscope partly off chest; Grade 6: heard with stethoscope off chest.
9. Q: What is the significance of jugular venous distention (JVD)?
ANSWER JVD indicates elevated central venous pressure and right-
sided heart failure. Measured at 45-degree angle; normal is less than 3 cm
above sternal angle.
10.Q: What is pulsus paradoxus? ANSWER An abnormal drop in
systolic blood pressure (>10 mmHg) during inspiration. Seen in cardiac
tamponade, severe asthma, and constrictive pericarditis.
11.Q: What is the difference between arteriosclerosis and
atherosclerosis? ANSWER Arteriosclerosis is general hardening and
loss of elasticity of arterial walls. Atherosclerosis is specific plaque
buildup in arteries causing narrowing.
12.Q: What are risk factors for coronary artery disease? ANSWER
Hypertension, hyperlipidemia, diabetes, smoking, family history, obesity,
sedentary lifestyle, age, male gender, and postmenopausal status in
women.
13.Q: How do you assess for peripheral arterial disease? ANSWER
Assess for diminished or absent pulses, cool extremities, hair loss, pallor
with elevation, rubor with dependency, delayed capillary refill, and
claudication history.
14.Q: What is the ankle-brachial index (ABI) and how is it interpreted?
ANSWER ABI is the ratio of ankle systolic BP to brachial systolic BP.
Normal: 1.0-1.4; borderline: 0.91-0.99; mild PAD: 0.70-0.90; moderate:
0.40-0.69; severe: <0.40.
15.Q: What are signs of deep vein thrombosis (DVT)? ANSWER
Unilateral leg swelling, warmth, erythema, tenderness, palpable cord,
positive Homans' sign (though unreliable), and dilated superficial veins.
16.Q: What is orthostatic hypotension? ANSWER A decrease in systolic
BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing,
often associated with dizziness or lightheadedness.
17.Q: What are the components of the cardiovascular history?
ANSWER Chest pain, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, edema, palpitations, syncope, claudication, and risk factors.
, 18.Q: What questions should you ask about chest pain? ANSWER Use
PQRST: Provocation/Palliation, Quality, Region/Radiation, Severity,
Timing. Also ask about associated symptoms like diaphoresis, nausea,
dyspnea.
19.Q: What is the difference between stable and unstable angina?
ANSWER Stable angina is predictable, occurs with exertion, relieved by
rest or nitroglycerin. Unstable angina occurs at rest, is new-onset severe,
or has a changing pattern.
20.Q: What cardiac findings are associated with hypertension?
ANSWER Displaced PMI laterally and inferiorly (left ventricular
hypertrophy), S4 gallop, loud A2 component of S2, and retinal changes
on fundoscopy.
21.Q: What are signs of right-sided heart failure? ANSWER JVD,
hepatojugular reflux, peripheral edema, hepatomegaly, ascites, and right
ventricular heave.
22.Q: What are signs of left-sided heart failure? ANSWER Crackles in
lungs, S3 gallop, dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
displaced PMI, and pulmonary edema.
23.Q: How do you assess capillary refill? ANSWER Press on nail bed for
5 seconds, release, and observe return of color. Normal is <2 seconds;
delayed suggests poor perfusion.
24.Q: What is the hepatojugular reflux test? ANSWER Apply firm
pressure over right upper quadrant for 30-60 seconds while observing
jugular veins. Sustained rise >3 cm indicates right heart failure.
25.Q: What are the characteristics of venous vs. arterial ulcers?
ANSWER Venous: irregular shape, shallow, at medial malleolus, with
edema and pigmentation. Arterial: well-demarcated, deep, on
toes/pressure points, with pale/cool skin.
26.Q: What medications should be reviewed in cardiovascular
assessment? ANSWER Antihypertensives, anticoagulants, antiplatelets,
statins, diuretics, antiarrhythmics, and nitrates.
27.Q: What is a cardiac friction rub? ANSWER A high-pitched, scratchy
sound best heard at left sternal border, indicating pericarditis. Has systolic
and diastolic components.
EXAM QUESTIONS AND ANSWERS, FULLY REVISED AND CURRENTLY UP
TO DATE
1. Q: What are the normal heart sounds and where are they best
heard? ANSWER S1 (lub) is best heard at the apex and represents
closure of mitral and tricuspid valves. S2 (dub) is best heard at the base
and represents closure of aortic and pulmonic valves.
2. Q: What does an S3 heart sound indicate? ANSWER S3 is a
ventricular gallop heard in early diastole. It may be normal in children
and young adults but indicates heart failure or volume overload in adults
over 40.
3. Q: What does an S4 heart sound indicate? ANSWER S4 is an atrial
gallop heard in late diastole. It indicates decreased ventricular compliance
and is associated with hypertension, coronary artery disease, and aortic
stenosis.
4. Q: Where is the point of maximal impulse (PMI) normally located?
ANSWER The PMI is normally located at the 5th intercostal space at the
midclavicular line and should be less than 2 cm in diameter.
5. Q: What is the difference between a thrill and a heave? ANSWER A
thrill is a palpable vibration caused by turbulent blood flow (palpable
murmur). A heave is a sustained lift of the chest wall indicating
ventricular hypertrophy.
6. Q: What are the characteristics of a systolic murmur? ANSWER
Systolic murmurs occur between S1 and S2. They can be innocent (flow
murmurs) or pathologic (mitral regurgitation, aortic stenosis, ventricular
septal defect).
7. Q: What are the characteristics of a diastolic murmur? ANSWER
Diastolic murmurs occur between S2 and S1. They are always pathologic
and include aortic regurgitation and mitral stenosis.
8. Q: How do you grade murmur intensity? ANSWER Grade 1: barely
audible; Grade 2: quiet but heard immediately; Grade 3: moderately loud;
, Grade 4: loud with palpable thrill; Grade 5: very loud, heard with
stethoscope partly off chest; Grade 6: heard with stethoscope off chest.
9. Q: What is the significance of jugular venous distention (JVD)?
ANSWER JVD indicates elevated central venous pressure and right-
sided heart failure. Measured at 45-degree angle; normal is less than 3 cm
above sternal angle.
10.Q: What is pulsus paradoxus? ANSWER An abnormal drop in
systolic blood pressure (>10 mmHg) during inspiration. Seen in cardiac
tamponade, severe asthma, and constrictive pericarditis.
11.Q: What is the difference between arteriosclerosis and
atherosclerosis? ANSWER Arteriosclerosis is general hardening and
loss of elasticity of arterial walls. Atherosclerosis is specific plaque
buildup in arteries causing narrowing.
12.Q: What are risk factors for coronary artery disease? ANSWER
Hypertension, hyperlipidemia, diabetes, smoking, family history, obesity,
sedentary lifestyle, age, male gender, and postmenopausal status in
women.
13.Q: How do you assess for peripheral arterial disease? ANSWER
Assess for diminished or absent pulses, cool extremities, hair loss, pallor
with elevation, rubor with dependency, delayed capillary refill, and
claudication history.
14.Q: What is the ankle-brachial index (ABI) and how is it interpreted?
ANSWER ABI is the ratio of ankle systolic BP to brachial systolic BP.
Normal: 1.0-1.4; borderline: 0.91-0.99; mild PAD: 0.70-0.90; moderate:
0.40-0.69; severe: <0.40.
15.Q: What are signs of deep vein thrombosis (DVT)? ANSWER
Unilateral leg swelling, warmth, erythema, tenderness, palpable cord,
positive Homans' sign (though unreliable), and dilated superficial veins.
16.Q: What is orthostatic hypotension? ANSWER A decrease in systolic
BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing,
often associated with dizziness or lightheadedness.
17.Q: What are the components of the cardiovascular history?
ANSWER Chest pain, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, edema, palpitations, syncope, claudication, and risk factors.
, 18.Q: What questions should you ask about chest pain? ANSWER Use
PQRST: Provocation/Palliation, Quality, Region/Radiation, Severity,
Timing. Also ask about associated symptoms like diaphoresis, nausea,
dyspnea.
19.Q: What is the difference between stable and unstable angina?
ANSWER Stable angina is predictable, occurs with exertion, relieved by
rest or nitroglycerin. Unstable angina occurs at rest, is new-onset severe,
or has a changing pattern.
20.Q: What cardiac findings are associated with hypertension?
ANSWER Displaced PMI laterally and inferiorly (left ventricular
hypertrophy), S4 gallop, loud A2 component of S2, and retinal changes
on fundoscopy.
21.Q: What are signs of right-sided heart failure? ANSWER JVD,
hepatojugular reflux, peripheral edema, hepatomegaly, ascites, and right
ventricular heave.
22.Q: What are signs of left-sided heart failure? ANSWER Crackles in
lungs, S3 gallop, dyspnea, orthopnea, paroxysmal nocturnal dyspnea,
displaced PMI, and pulmonary edema.
23.Q: How do you assess capillary refill? ANSWER Press on nail bed for
5 seconds, release, and observe return of color. Normal is <2 seconds;
delayed suggests poor perfusion.
24.Q: What is the hepatojugular reflux test? ANSWER Apply firm
pressure over right upper quadrant for 30-60 seconds while observing
jugular veins. Sustained rise >3 cm indicates right heart failure.
25.Q: What are the characteristics of venous vs. arterial ulcers?
ANSWER Venous: irregular shape, shallow, at medial malleolus, with
edema and pigmentation. Arterial: well-demarcated, deep, on
toes/pressure points, with pale/cool skin.
26.Q: What medications should be reviewed in cardiovascular
assessment? ANSWER Antihypertensives, anticoagulants, antiplatelets,
statins, diuretics, antiarrhythmics, and nitrates.
27.Q: What is a cardiac friction rub? ANSWER A high-pitched, scratchy
sound best heard at left sternal border, indicating pericarditis. Has systolic
and diastolic components.
