NSG 500 Exam 2: Advanced Health Assessment - Wilkes
University Updated and Latest Questions and Correct
Answers with Rationale
1. When auscultating the heart at the second right intercostal space, the nurse practitioner identifies a
systolic crescendo-decrescendo murmur. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Pulmonic Stenosis
D. Tricuspid Regurgitation
Correct Answer: B
Rationale: The aortic area is located at the second right intercostal space near the sternal border. A
systolic murmur with a crescendo-decrescendo pattern in this specific area is indicative of aortic
stenosis. This murmur often radiates to the carotid arteries in the neck. Clinical reasoning requires
differentiating this from mitral murmurs which are heard at the apex. Proper identification of valvular
disorders is critical for appropriate referral and management.
2. During a respiratory assessment, the clinician notes increased tactile fremitus over the right lower lobe.
Which condition is most consistent with this finding?
A. Lobar Pneumonia
B. Pleural Effusion
C. Pneumothorax
D. Emphysema
Correct Answer: A
,Rationale: Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary
system to the chest wall. Fremitus is increased when there is consolidation of lung tissue, such as in lobar
pneumonia. Conversely, air or fluid in the pleural space acts as a barrier that decreases vibrations.
Emphysema also decreases fremitus due to hyperinflation and loss of tissue density. Understanding these
physical principles allows for accurate interpretation of abnormal lung sounds.
3. A patient presents with sharp right upper quadrant pain that worsens during deep inspiration while the
clinician palpates under the rib cage. What is this sign called?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s sign
D. Psoas sign
Correct Answer: B
Rationale: Murphy’s sign is a clinical test used to assess for acute cholecystitis. The patient is asked to
inhale while the clinician applies pressure to the gallbladder area. A positive test occurs when the patient
abruptly stops inhaling due to pain. This finding suggests inflammation of the gallbladder reaching the
peritoneum. It is a key diagnostic tool in the gastrointestinal physical examination.
4. Which heart sound is frequently associated with fluid volume overload and heart failure in an older
adult?
A. Opening Snap
B. S4 (Atrial Gallop)
C. Ejection Click
D. S3 (Ventricular Gallop)
, Correct Answer: D
Rationale: The S3 heart sound occurs early in diastole during the rapid ventricular filling phase. In older
adults, it is often a sign of ventricular dysfunction or volume overload. It is colloquially known as a
ventricular gallop due to its rhythmic sound. While it can be normal in children and athletes, it is usually
pathological in the geriatric population. Monitoring for S3 is essential in patients suspected of having
congestive heart failure.
5. A clinician is assessing a patient’s Jugular Venous Pressure (JVP). An elevated JVP is most indicative of
which condition?
A. Left ventricular failure
B. Right-sided heart failure
C. Aortic dissection
D. Dehydration
Correct Answer: B
Rationale: Jugular Venous Pressure reflects the pressure in the right atrium and the central venous
system. An elevation in JVP is a clinical hallmark of right-sided heart failure or pulmonary hypertension.
It can also be seen in cases of fluid overload or cardiac tamponade. The measurement should be taken
from the sternal angle to the highest point of pulsation. This assessment provides a non-invasive window
into the patient’s hemodynamic status.
6. Percussion of the lungs in a patient with a large pneumothorax would most likely yield which sound?
A. Resonance
B. Dullness
C. Hyperresonance
University Updated and Latest Questions and Correct
Answers with Rationale
1. When auscultating the heart at the second right intercostal space, the nurse practitioner identifies a
systolic crescendo-decrescendo murmur. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Pulmonic Stenosis
D. Tricuspid Regurgitation
Correct Answer: B
Rationale: The aortic area is located at the second right intercostal space near the sternal border. A
systolic murmur with a crescendo-decrescendo pattern in this specific area is indicative of aortic
stenosis. This murmur often radiates to the carotid arteries in the neck. Clinical reasoning requires
differentiating this from mitral murmurs which are heard at the apex. Proper identification of valvular
disorders is critical for appropriate referral and management.
2. During a respiratory assessment, the clinician notes increased tactile fremitus over the right lower lobe.
Which condition is most consistent with this finding?
A. Lobar Pneumonia
B. Pleural Effusion
C. Pneumothorax
D. Emphysema
Correct Answer: A
,Rationale: Tactile fremitus refers to the palpable vibrations transmitted through the bronchopulmonary
system to the chest wall. Fremitus is increased when there is consolidation of lung tissue, such as in lobar
pneumonia. Conversely, air or fluid in the pleural space acts as a barrier that decreases vibrations.
Emphysema also decreases fremitus due to hyperinflation and loss of tissue density. Understanding these
physical principles allows for accurate interpretation of abnormal lung sounds.
3. A patient presents with sharp right upper quadrant pain that worsens during deep inspiration while the
clinician palpates under the rib cage. What is this sign called?
A. Rovsing’s sign
B. Murphy’s sign
C. McBurney’s sign
D. Psoas sign
Correct Answer: B
Rationale: Murphy’s sign is a clinical test used to assess for acute cholecystitis. The patient is asked to
inhale while the clinician applies pressure to the gallbladder area. A positive test occurs when the patient
abruptly stops inhaling due to pain. This finding suggests inflammation of the gallbladder reaching the
peritoneum. It is a key diagnostic tool in the gastrointestinal physical examination.
4. Which heart sound is frequently associated with fluid volume overload and heart failure in an older
adult?
A. Opening Snap
B. S4 (Atrial Gallop)
C. Ejection Click
D. S3 (Ventricular Gallop)
, Correct Answer: D
Rationale: The S3 heart sound occurs early in diastole during the rapid ventricular filling phase. In older
adults, it is often a sign of ventricular dysfunction or volume overload. It is colloquially known as a
ventricular gallop due to its rhythmic sound. While it can be normal in children and athletes, it is usually
pathological in the geriatric population. Monitoring for S3 is essential in patients suspected of having
congestive heart failure.
5. A clinician is assessing a patient’s Jugular Venous Pressure (JVP). An elevated JVP is most indicative of
which condition?
A. Left ventricular failure
B. Right-sided heart failure
C. Aortic dissection
D. Dehydration
Correct Answer: B
Rationale: Jugular Venous Pressure reflects the pressure in the right atrium and the central venous
system. An elevation in JVP is a clinical hallmark of right-sided heart failure or pulmonary hypertension.
It can also be seen in cases of fluid overload or cardiac tamponade. The measurement should be taken
from the sternal angle to the highest point of pulsation. This assessment provides a non-invasive window
into the patient’s hemodynamic status.
6. Percussion of the lungs in a patient with a large pneumothorax would most likely yield which sound?
A. Resonance
B. Dullness
C. Hyperresonance
