Maryville University NURS 612 Actual
Exam Questions and Answers with
Rationales 2026/2027 | Advanced Health
Assessment Exam 2 | Pass Guarantee
Question 1 During cardiac auscultation, you hear an S3 gallop in a 68-year-old patient. This
finding is most suggestive of:
A. Normal finding in older adults B. Left ventricular systolic dysfunction C. Mitral valve
prolapse D. Aortic regurgitation
Answer: B Rationale: An S3 gallop in adults older than 40 years is pathologic and most
commonly indicates left ventricular volume overload or systolic dysfunction (heart failure). S3 is
not normal in this age group.
Question 2 A 58-year-old male presents with exertional chest pain. On auscultation you hear a
crescendo-decrescendo systolic murmur best heard at the right 2nd intercostal space, radiating to
the carotids. What is the most likely valvular abnormality?
A. Mitral regurgitation B. Aortic stenosis C. Pulmonic stenosis D. Tricuspid regurgitation
Answer: B Rationale: The classic murmur of aortic stenosis is a crescendo-decrescendo
(diamond-shaped) systolic ejection murmur heard best at the right upper sternal border (2nd ICS)
with radiation to the carotids.
Question 3 When assessing jugular venous pressure (JVP), the highest point of visible pulsation
is measured at 9 cm above the sternal angle with the patient at 45°. This finding indicates:
A. Normal JVP B. Elevated central venous pressure C. Hypovolemia D. Superior vena cava
obstruction
Answer: B Rationale: Normal JVP is ≤4 cm above the sternal angle (approximately 9 cm total
above the right atrium). A measurement of 9 cm above the sternal angle = elevated JVP (≈14 cm
, above RA), indicating increased central venous pressure (e.g., right heart failure, volume
overload).
Question 4 A 72-year-old patient has bilateral basilar crackles, JVD, and 3+ pitting edema of the
lower extremities. These findings are most consistent with:
A. Left-sided heart failure B. Right-sided heart failure C. Pulmonary embolism D. Chronic
obstructive pulmonary disease
Answer: B Rationale: JVD, peripheral edema, and systemic congestion are hallmark signs of
right-sided heart failure. Basilar crackles can occur secondary to backup into the pulmonary
circulation.
Question 5 During lung auscultation, you hear bronchial breath sounds over the right lower lobe
with increased tactile fremitus. These findings are most consistent with:
A. Normal lung tissue B. Consolidation (pneumonia) C. Pleural effusion D. Emphysema
Answer: B Rationale: Consolidation transmits high-frequency sounds better → bronchial breath
sounds over consolidated lung tissue + increased tactile fremitus (vibration felt on chest wall).
Question 6 A patient has a positive straight-leg raise test at 35 degrees with radicular pain down
the posterior thigh. This finding is most suggestive of:
A. Hip osteoarthritis B. Lumbar disc herniation with nerve root compression C. Piriformis
syndrome D. Sacroiliac joint dysfunction
Answer: B Rationale: Straight-leg raise (Lasègue test) positive at <60° with radicular pain is
highly suggestive of lumbar radiculopathy, most commonly L5–S1 disc herniation.
Question 7 During abdominal assessment, which sequence is correct?
A. Inspection → Auscultation → Percussion → Palpation B. Auscultation → Inspection →
Palpation → Percussion C. Palpation → Percussion → Auscultation → Inspection D. Percussion
→ Palpation → Inspection → Auscultation
Answer: A Rationale: Correct order is inspection → auscultation (before percussion/palpation
disturbs bowel sounds) → percussion → palpation (least to most invasive).
Exam Questions and Answers with
Rationales 2026/2027 | Advanced Health
Assessment Exam 2 | Pass Guarantee
Question 1 During cardiac auscultation, you hear an S3 gallop in a 68-year-old patient. This
finding is most suggestive of:
A. Normal finding in older adults B. Left ventricular systolic dysfunction C. Mitral valve
prolapse D. Aortic regurgitation
Answer: B Rationale: An S3 gallop in adults older than 40 years is pathologic and most
commonly indicates left ventricular volume overload or systolic dysfunction (heart failure). S3 is
not normal in this age group.
Question 2 A 58-year-old male presents with exertional chest pain. On auscultation you hear a
crescendo-decrescendo systolic murmur best heard at the right 2nd intercostal space, radiating to
the carotids. What is the most likely valvular abnormality?
A. Mitral regurgitation B. Aortic stenosis C. Pulmonic stenosis D. Tricuspid regurgitation
Answer: B Rationale: The classic murmur of aortic stenosis is a crescendo-decrescendo
(diamond-shaped) systolic ejection murmur heard best at the right upper sternal border (2nd ICS)
with radiation to the carotids.
Question 3 When assessing jugular venous pressure (JVP), the highest point of visible pulsation
is measured at 9 cm above the sternal angle with the patient at 45°. This finding indicates:
A. Normal JVP B. Elevated central venous pressure C. Hypovolemia D. Superior vena cava
obstruction
Answer: B Rationale: Normal JVP is ≤4 cm above the sternal angle (approximately 9 cm total
above the right atrium). A measurement of 9 cm above the sternal angle = elevated JVP (≈14 cm
, above RA), indicating increased central venous pressure (e.g., right heart failure, volume
overload).
Question 4 A 72-year-old patient has bilateral basilar crackles, JVD, and 3+ pitting edema of the
lower extremities. These findings are most consistent with:
A. Left-sided heart failure B. Right-sided heart failure C. Pulmonary embolism D. Chronic
obstructive pulmonary disease
Answer: B Rationale: JVD, peripheral edema, and systemic congestion are hallmark signs of
right-sided heart failure. Basilar crackles can occur secondary to backup into the pulmonary
circulation.
Question 5 During lung auscultation, you hear bronchial breath sounds over the right lower lobe
with increased tactile fremitus. These findings are most consistent with:
A. Normal lung tissue B. Consolidation (pneumonia) C. Pleural effusion D. Emphysema
Answer: B Rationale: Consolidation transmits high-frequency sounds better → bronchial breath
sounds over consolidated lung tissue + increased tactile fremitus (vibration felt on chest wall).
Question 6 A patient has a positive straight-leg raise test at 35 degrees with radicular pain down
the posterior thigh. This finding is most suggestive of:
A. Hip osteoarthritis B. Lumbar disc herniation with nerve root compression C. Piriformis
syndrome D. Sacroiliac joint dysfunction
Answer: B Rationale: Straight-leg raise (Lasègue test) positive at <60° with radicular pain is
highly suggestive of lumbar radiculopathy, most commonly L5–S1 disc herniation.
Question 7 During abdominal assessment, which sequence is correct?
A. Inspection → Auscultation → Percussion → Palpation B. Auscultation → Inspection →
Palpation → Percussion C. Palpation → Percussion → Auscultation → Inspection D. Percussion
→ Palpation → Inspection → Auscultation
Answer: A Rationale: Correct order is inspection → auscultation (before percussion/palpation
disturbs bowel sounds) → percussion → palpation (least to most invasive).
