NURS 190 | NURS190 Exam 2: Physical Assessment
- WCU Updated and Latest Questions and Correct
Answers with Rationale
1. When performing a physical assessment of the abdomen, in which order should the nurse
perform the examination steps?
A. Inspection, Palpation, Percussion, Auscultation
B. Palpation, Percussion, Auscultation, Inspection
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Rationale: The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and then palpation. This specific order is used because palpation and
percussion can stimulate bowel activity and alter the frequency of bowel sounds. By
auscultating before touching the abdomen, the nurse obtains the most accurate baseline of
intestinal motility. Any clinical findings obtained through palpation first might lead to an
incorrect interpretation of digestive health. This protocol ensures the integrity of the
objective data collected during the nursing exam.
2. Which heart sound is caused by the closure of the atrioventricular (AV) valves and signals
the beginning of systole?
A. S2
B. S1
C. S3
D. S4
Correct Answer: B
Rationale: The S1 heart sound is the first heart sound heard and is often described as a
‘lub’ sound. It occurs when the mitral and tricuspid valves close simultaneously at the start
of ventricular contraction. This sound is usually heard loudest at the apex of the heart
during auscultation. Understanding the timing of S1 helps the nurse differentiate between
the systolic and diastolic phases of the cardiac cycle. Identifying this sound accurately is
essential for detecting rhythmic abnormalities or valve dysfunctions.
3. A nurse notes a ‘blowing’ or ‘swishing’ sound when auscultating the carotid artery of an
older patient. This finding most likely indicates:
A. Normal blood flow
B. Tachycardia
,C. A carotid bruit
D. Venous hum
Correct Answer: C
Rationale: A bruit is an abnormal sound heard during auscultation that indicates turbulent
blood flow within an artery. In the carotid artery, this turbulence is often caused by
atherosclerotic narrowing or partial occlusion. The nurse should use the bell of the
stethoscope to detect these low-pitched sounds more clearly. Finding a bruit requires
immediate further investigation as it increases the risk of transient ischemic attacks or
strokes. It is a critical indicator of vascular health that must be documented and reported.
4. While percussing over the lungs of a healthy adult, what is the expected predominant
sound?
A. Dullness
B. Hyperresonance
C. Tympany
D. Resonance
Correct Answer: D
Rationale: Resonance is the low-pitched, clear, hollow sound heard over normal, air-filled
lung tissue. This sound signifies that the underlying tissue is healthy and properly aerated
without excessive fluid or consolidation. If the nurse hears dullness, it might suggest the
presence of a mass, fluid, or pneumonia. Conversely, hyperresonance would indicate
trapped air, such as in cases of emphysema or pneumothorax. Mastering these sounds
allows the nurse to determine the density of the thoracic contents.
5. To assess for the presence of Jugular Venous Distension (JVD), the nurse should position
the patient at what angle?
A. Flat (Supine)
B. Prone
C. 90 degrees (High-Fowler’s)
D. 30 to 45 degrees
Correct Answer: D
Rationale: Positioning the head of the bed between 30 and 45 degrees is standard for
assessing jugular venous pressure. At this angle, the nurse can visualize the pulsation of the
internal jugular vein above the clavicle. JVD is a classic sign of increased central venous
pressure, often associated with right-sided heart failure. If the veins are distended even at
higher angles, it suggests a more severe volume overload. This assessment provides vital
clues about the patient’s fluid status and cardiac efficiency.
, 6. Which assessment technique is used to evaluate for rebound tenderness (Blumberg sign) in
the abdomen?
A. Deeply palpating and then quickly releasing pressure
B. Percussing the costovertebral angle
C. Lightly stroking the skin of the abdomen
D. Auscultating for bruits over the renal arteries
Correct Answer: A
Rationale: Rebound tenderness involves pushing down slowly and deeply on a site away
from the painful area and then lifting up quickly. Pain that occurs upon the release of
pressure is a positive Blumberg sign, indicating peritoneal irritation. This clinical finding is
strongly suggestive of conditions such as appendicitis or generalized peritonitis. The nurse
should perform this test at the end of the assessment to avoid causing unnecessary patient
discomfort. Accurate identification of this sign is crucial for prioritizing surgical
emergencies.
7. A patient with chronic obstructive pulmonary disease (COPD) often displays which
characteristic chest shape?
A. Pectus excavatum
B. Barrel chest
C. Pectus carinatum
D. Kyphosis
Correct Answer: B
Rationale: A barrel chest is characterized by an increase in the anteroposterior (AP)
diameter of the thorax, making it equal to the transverse diameter. This condition results
from long-term air trapping in the lungs, which is common in diseases like emphysema.
Chronic hyperinflation causes the ribs to remain in a horizontal position rather than a
downward slope. During assessment, the nurse will note a ratio of 1:1 instead of the
normal 1:2. This anatomical change reflects the underlying physiological struggle for
effective gas exchange.
8. Where is the best location to auscultate the mitral valve (Apical pulse)?
A. Second intercostal space, right sternal border
B. Fifth intercostal space, left midclavicular line
C. Second intercostal space, left sternal border
D. Fourth intercostal space, left sternal border
Correct Answer: B
- WCU Updated and Latest Questions and Correct
Answers with Rationale
1. When performing a physical assessment of the abdomen, in which order should the nurse
perform the examination steps?
A. Inspection, Palpation, Percussion, Auscultation
B. Palpation, Percussion, Auscultation, Inspection
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Rationale: The correct sequence for abdominal assessment is inspection, auscultation,
percussion, and then palpation. This specific order is used because palpation and
percussion can stimulate bowel activity and alter the frequency of bowel sounds. By
auscultating before touching the abdomen, the nurse obtains the most accurate baseline of
intestinal motility. Any clinical findings obtained through palpation first might lead to an
incorrect interpretation of digestive health. This protocol ensures the integrity of the
objective data collected during the nursing exam.
2. Which heart sound is caused by the closure of the atrioventricular (AV) valves and signals
the beginning of systole?
A. S2
B. S1
C. S3
D. S4
Correct Answer: B
Rationale: The S1 heart sound is the first heart sound heard and is often described as a
‘lub’ sound. It occurs when the mitral and tricuspid valves close simultaneously at the start
of ventricular contraction. This sound is usually heard loudest at the apex of the heart
during auscultation. Understanding the timing of S1 helps the nurse differentiate between
the systolic and diastolic phases of the cardiac cycle. Identifying this sound accurately is
essential for detecting rhythmic abnormalities or valve dysfunctions.
3. A nurse notes a ‘blowing’ or ‘swishing’ sound when auscultating the carotid artery of an
older patient. This finding most likely indicates:
A. Normal blood flow
B. Tachycardia
,C. A carotid bruit
D. Venous hum
Correct Answer: C
Rationale: A bruit is an abnormal sound heard during auscultation that indicates turbulent
blood flow within an artery. In the carotid artery, this turbulence is often caused by
atherosclerotic narrowing or partial occlusion. The nurse should use the bell of the
stethoscope to detect these low-pitched sounds more clearly. Finding a bruit requires
immediate further investigation as it increases the risk of transient ischemic attacks or
strokes. It is a critical indicator of vascular health that must be documented and reported.
4. While percussing over the lungs of a healthy adult, what is the expected predominant
sound?
A. Dullness
B. Hyperresonance
C. Tympany
D. Resonance
Correct Answer: D
Rationale: Resonance is the low-pitched, clear, hollow sound heard over normal, air-filled
lung tissue. This sound signifies that the underlying tissue is healthy and properly aerated
without excessive fluid or consolidation. If the nurse hears dullness, it might suggest the
presence of a mass, fluid, or pneumonia. Conversely, hyperresonance would indicate
trapped air, such as in cases of emphysema or pneumothorax. Mastering these sounds
allows the nurse to determine the density of the thoracic contents.
5. To assess for the presence of Jugular Venous Distension (JVD), the nurse should position
the patient at what angle?
A. Flat (Supine)
B. Prone
C. 90 degrees (High-Fowler’s)
D. 30 to 45 degrees
Correct Answer: D
Rationale: Positioning the head of the bed between 30 and 45 degrees is standard for
assessing jugular venous pressure. At this angle, the nurse can visualize the pulsation of the
internal jugular vein above the clavicle. JVD is a classic sign of increased central venous
pressure, often associated with right-sided heart failure. If the veins are distended even at
higher angles, it suggests a more severe volume overload. This assessment provides vital
clues about the patient’s fluid status and cardiac efficiency.
, 6. Which assessment technique is used to evaluate for rebound tenderness (Blumberg sign) in
the abdomen?
A. Deeply palpating and then quickly releasing pressure
B. Percussing the costovertebral angle
C. Lightly stroking the skin of the abdomen
D. Auscultating for bruits over the renal arteries
Correct Answer: A
Rationale: Rebound tenderness involves pushing down slowly and deeply on a site away
from the painful area and then lifting up quickly. Pain that occurs upon the release of
pressure is a positive Blumberg sign, indicating peritoneal irritation. This clinical finding is
strongly suggestive of conditions such as appendicitis or generalized peritonitis. The nurse
should perform this test at the end of the assessment to avoid causing unnecessary patient
discomfort. Accurate identification of this sign is crucial for prioritizing surgical
emergencies.
7. A patient with chronic obstructive pulmonary disease (COPD) often displays which
characteristic chest shape?
A. Pectus excavatum
B. Barrel chest
C. Pectus carinatum
D. Kyphosis
Correct Answer: B
Rationale: A barrel chest is characterized by an increase in the anteroposterior (AP)
diameter of the thorax, making it equal to the transverse diameter. This condition results
from long-term air trapping in the lungs, which is common in diseases like emphysema.
Chronic hyperinflation causes the ribs to remain in a horizontal position rather than a
downward slope. During assessment, the nurse will note a ratio of 1:1 instead of the
normal 1:2. This anatomical change reflects the underlying physiological struggle for
effective gas exchange.
8. Where is the best location to auscultate the mitral valve (Apical pulse)?
A. Second intercostal space, right sternal border
B. Fifth intercostal space, left midclavicular line
C. Second intercostal space, left sternal border
D. Fourth intercostal space, left sternal border
Correct Answer: B
