NR509 Advanced Physical Assessment Exam 2 v2
Questions with Correct Answers and Expert
Explanation for Each Question
1. When assessing for a carotid bruit, which part of the stethoscope should be used and what
should the patient be instructed to do?
A. Use the diaphragm and ask the patient to breathe deeply.
B. Use the bell and ask the patient to hold their breath.
C. Use the bell and ask the patient to cough.
D. Use the diaphragm and ask the patient to speak.
Correct Answer: B
Expert Explanation: The bell of the stethoscope is best suited for detecting low-pitched
sounds like bruits. Asking the patient to hold their breath prevents tracheal breath sounds
from masking the vascular sounds. A bruit indicates turbulent blood flow, which may
suggest carotid artery stenosis.
2. Which heart sound is considered a normal finding in children and young adults but often
pathological in older adults?
A. S1
B. S2
C. S4
D. S3
Correct Answer: D
Expert Explanation: The S3 heart sound, or ventricular gallop, occurs early in diastole
during rapid ventricular filling. In older adults, it frequently signifies heart failure or
volume overload. In younger populations, it is often a normal physiological finding due to
rapid filling in a compliant ventricle.
3. During a respiratory exam, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Lobar pneumonia
C. Asthma
D. Pleural effusion
,Correct Answer: B
Expert Explanation: Tactile fremitus is increased when there is consolidation in the lung
tissue, such as in pneumonia. Liquid or solid material conducts vibrations better than air-
filled space. Conversely, conditions like pneumothorax or pleural effusion decrease
fremitus by creating a barrier between the lung and the chest wall.
4. Where is the best location to auscultate the mitral valve?
A. Second intercostal space at the right sternal border.
B. Second intercostal space at the left sternal border.
C. Fourth intercostal space at the left sternal border.
D. Fifth intercostal space at the left midclavicular line.
Correct Answer: D
Expert Explanation: The mitral valve is best heard at the apex of the heart. This
anatomical landmark is located at the fifth intercostal space along the midclavicular line.
Auscultating this area allows for the clearest detection of mitral murmurs and the S1 heart
sound.
5. A patient presents with sharp, stabbing chest pain that increases with deep inspiration and
coughing. Which respiratory condition is most likely?
A. Pulmonary embolism
B. Pleurisy
C. Chronic bronchitis
D. Emphysema
Correct Answer: B
Expert Explanation: Pleurisy involves inflammation of the pleura, which causes friction
between the layers during respiration. This results in sharp, localized chest pain
aggravated by breathing movements. It is typically associated with a pleural friction rub
during auscultation.
6. When performing an abdominal assessment, what is the correct sequence of techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Percussion, Auscultation, Inspection, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
, Expert Explanation: Auscultation must be performed before percussion and palpation to
ensure bowel sounds are not altered by physical manipulation. Physical contact with the
abdomen can stimulate peristalsis, leading to false assessment findings. Following
inspection with auscultation provides the most accurate clinical picture.
7. A positive Murphy’s sign is most indicative of which condition?
A. Appendicitis
B. Pancreatitis
C. Acute cholecystitis
D. Splenomegaly
Correct Answer: C
Expert Explanation: Murphy’s sign is tested by asking the patient to inhale while the
examiner applies pressure under the right costal margin. If the patient experiences sharp
pain and ceases inspiration, the test is positive. This finding is a classic indicator of
inflammation of the gallbladder.
8. During percussion of the lungs, a hyperresonant note is typically heard in patients with:
A. Pneumothorax
B. Atelectasis
C. Pneumonia
D. Pleural effusion
Correct Answer: A
Expert Explanation: Hyperresonance occurs when there is an excessive amount of air in
the pleural space or lungs. This is a common finding in patients with pneumothorax or
emphysema. Resonance is the normal sound, while dullness indicates fluid or solid tissue.
9. Which murmur is typically heard during diastole at the second right intercostal space?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: C
Expert Explanation: Aortic regurgitation is a diastolic murmur that occurs when the aortic
valve fails to close properly. While it can be heard at the second right intercostal space, it is
often best heard at the left sternal border. Diastolic murmurs are generally considered
pathological and require further investigation.
Questions with Correct Answers and Expert
Explanation for Each Question
1. When assessing for a carotid bruit, which part of the stethoscope should be used and what
should the patient be instructed to do?
A. Use the diaphragm and ask the patient to breathe deeply.
B. Use the bell and ask the patient to hold their breath.
C. Use the bell and ask the patient to cough.
D. Use the diaphragm and ask the patient to speak.
Correct Answer: B
Expert Explanation: The bell of the stethoscope is best suited for detecting low-pitched
sounds like bruits. Asking the patient to hold their breath prevents tracheal breath sounds
from masking the vascular sounds. A bruit indicates turbulent blood flow, which may
suggest carotid artery stenosis.
2. Which heart sound is considered a normal finding in children and young adults but often
pathological in older adults?
A. S1
B. S2
C. S4
D. S3
Correct Answer: D
Expert Explanation: The S3 heart sound, or ventricular gallop, occurs early in diastole
during rapid ventricular filling. In older adults, it frequently signifies heart failure or
volume overload. In younger populations, it is often a normal physiological finding due to
rapid filling in a compliant ventricle.
3. During a respiratory exam, the nurse practitioner notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Lobar pneumonia
C. Asthma
D. Pleural effusion
,Correct Answer: B
Expert Explanation: Tactile fremitus is increased when there is consolidation in the lung
tissue, such as in pneumonia. Liquid or solid material conducts vibrations better than air-
filled space. Conversely, conditions like pneumothorax or pleural effusion decrease
fremitus by creating a barrier between the lung and the chest wall.
4. Where is the best location to auscultate the mitral valve?
A. Second intercostal space at the right sternal border.
B. Second intercostal space at the left sternal border.
C. Fourth intercostal space at the left sternal border.
D. Fifth intercostal space at the left midclavicular line.
Correct Answer: D
Expert Explanation: The mitral valve is best heard at the apex of the heart. This
anatomical landmark is located at the fifth intercostal space along the midclavicular line.
Auscultating this area allows for the clearest detection of mitral murmurs and the S1 heart
sound.
5. A patient presents with sharp, stabbing chest pain that increases with deep inspiration and
coughing. Which respiratory condition is most likely?
A. Pulmonary embolism
B. Pleurisy
C. Chronic bronchitis
D. Emphysema
Correct Answer: B
Expert Explanation: Pleurisy involves inflammation of the pleura, which causes friction
between the layers during respiration. This results in sharp, localized chest pain
aggravated by breathing movements. It is typically associated with a pleural friction rub
during auscultation.
6. When performing an abdominal assessment, what is the correct sequence of techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Percussion, Auscultation, Inspection, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
, Expert Explanation: Auscultation must be performed before percussion and palpation to
ensure bowel sounds are not altered by physical manipulation. Physical contact with the
abdomen can stimulate peristalsis, leading to false assessment findings. Following
inspection with auscultation provides the most accurate clinical picture.
7. A positive Murphy’s sign is most indicative of which condition?
A. Appendicitis
B. Pancreatitis
C. Acute cholecystitis
D. Splenomegaly
Correct Answer: C
Expert Explanation: Murphy’s sign is tested by asking the patient to inhale while the
examiner applies pressure under the right costal margin. If the patient experiences sharp
pain and ceases inspiration, the test is positive. This finding is a classic indicator of
inflammation of the gallbladder.
8. During percussion of the lungs, a hyperresonant note is typically heard in patients with:
A. Pneumothorax
B. Atelectasis
C. Pneumonia
D. Pleural effusion
Correct Answer: A
Expert Explanation: Hyperresonance occurs when there is an excessive amount of air in
the pleural space or lungs. This is a common finding in patients with pneumothorax or
emphysema. Resonance is the normal sound, while dullness indicates fluid or solid tissue.
9. Which murmur is typically heard during diastole at the second right intercostal space?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral stenosis
Correct Answer: C
Expert Explanation: Aortic regurgitation is a diastolic murmur that occurs when the aortic
valve fails to close properly. While it can be heard at the second right intercostal space, it is
often best heard at the left sternal border. Diastolic murmurs are generally considered
pathological and require further investigation.
