Exam 2: NUR631/ NUR 631 (Latest 2026/ 2027 Update) Advanced Health Assessment: History and Physical Examination Review| Practice Questions and Verified Answers| Complete Study Test| Grade A| 100% Correct (Verified Solutions) – Chamberlain

INSTANT PDF DOWNLOAD — This comprehensive exam preparation resource for NUR 631 Exam 2 at Chamberlain University covers Advanced Health Assessment for the 2026/2027 academic year second examination. It features practice questions with verified answers and detailed rationales in multiple-choice, select-all-that-apply (SATA), ordered response, and clinical judgment formats aligned with graduate-level advanced practice nursing standards. CARDIOVASCULAR ASSESSMENT (EXAM 2 FOCUS) Heart Sounds and Murmurs Question 1: S1 and S2 Heart Sounds A nurse practitioner is auscultating a patient's heart sounds. Which statement accurately describes the timing and cause of S1 and S2? A) S1 is caused by closure of the aortic and pulmonic valves; S2 is caused by closure of the mitral and tricuspid valves B) S1 coincides with the carotid pulse and marks the beginning of systole; S2 marks the end of systole and the beginning of diastole C) S1 is best heard at the base of the heart; S2 is best heard at the apex D) S1 is louder than S2 in patients with hypertension; S2 is louder than S1 in patients with heart failure Correct Answer: B Rationale: S1 ("lub") is caused by closure of the atrioventricular (mitral and tricuspid) valves at the beginning of ventricular systole. S1 coincides with the carotid artery pulsation. S2 ("dub") is caused by closure of the semilunar (aortic and pulmonic) valves at the end of systole, marking the beginning of diastole. S1 is best heard at the apex; S2 is best heard at the base. With normal splitting, S2 splits into A2 (aortic) and P2 (pulmonic) during inspiration. Question 2: S3 and S4 Gallops A nurse practitioner auscultates an extra heart sound immediately following S2 in a patient with heart failure. This extra sound is most likely: A) S3 gallop (ventricular gallop) B) S4 gallop (atrial gallop) C) Opening snap D) Ejection click Correct Answer: A Rationale: S3 (ventricular gallop) occurs early in diastole, just after S2 ("lub-dub-ah"). It is caused by rapid ventricular filling and is associated with decreased compliance of the ventricles. S3 is normal in children and young adults but is pathologic in older adults and indicates heart failure or volume overload. S4 (atrial gallop) occurs just before S1 ("ah-lub-dub") and is associated with reduced ventricular compliance, often seen in hypertensive heart disease, aortic stenosis, and hypertrophic cardiomyopathy. Question 3: Murmur Grading A nurse practitioner documents a cardiac murmur as Grade III/VI. This indicates: A) A murmur that is barely audible in a quiet room B) A moderately loud murmur easily audible with no palpable thrill C) A loud murmur with a palpable thrill D) A very loud murmur audible with the stethoscope partially off the chest Correct Answer: B Rationale: Murmur grading on a scale of I to VI (I-VI): Grade I: barely audible in a quiet room. Grade II: faint but clearly audible. Grade III: moderately loud, easily audible, no palpable thrill. Grade IV: loud murmur with a palpable thrill. Grade V: very loud, audible with stethoscope partially off the chest, thrill present. Grade VI: audible with stethoscope completely off the chest, thrill present. A thrill is a palpable vibration indicating a loud murmur (Grade IV or higher). Question 4: Murmur Timing A patient presents with a holosystolic murmur best heard at the apex with radiation to the axilla. This murmur is characteristic of: A) Aortic stenosis B) Mitral regurgitation C) Mitral valve prolapse D) Aortic regurgitation Correct Answer: B Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur best heard at the apex (5th intercostal space, left midclavicular line) that radiates to the axilla or left scapula. Aortic stenosis produces a systolic ejection murmur at the right upper sternal border radiating to the carotids. Mitral valve prolapse produces a mid-systolic click with a late systolic murmur. Aortic regurgitation produces an early diastolic decrescendo murmur at the left upper sternal border or right upper sternal border. Question 5: Murmur Maneuvers A patient's systolic murmur becomes softer when the patient stands and louder when the patient squats. This murmur is most likely: A) Aortic stenosis B) Hypertrophic cardiomyopathy (HOCM) C) Mitral regurgitation D) Pulmonic stenosis Correct Answer: B Rationale: In hypertrophic obstructive cardiomyopathy (HOCM), standing decreases venous return (decreased preload) and increases obstruction, making the murmur louder. Squatting increases venous return (increased preload) and decreases obstruction, making the murmur softer. Maneuvers that alter preload, afterload, and heart rate are essential for differentiating systolic murmurs. Valsalva (phase II) also increases HOCM murmur intensity because decreased venous return worsens obstruction. Question 6: Carotid Artery Auscultation A nurse practitioner auscultates the carotid arteries in an older adult patient. Which finding would be abnormal and warrant further investigation? A) A continuous venous hum that disappears when the patient turns their head B) A bruit (whooshing sound) in the mid-cervical region C) A clear, distinct sound with no audible bruits D) Symmetric pulses bilaterally with no thrills Correct Answer: B Rationale: A carotid bruit is a whooshing or blowing sound caused by turbulent blood flow, often due to atherosclerosis and stenosis of the carotid artery. It suggests increased risk of transient ischemic attack (TIA) or stroke and warrants further evaluation with carotid ultrasound or duplex imaging. A continuous venous hum (common in children and young adults, disappears with head turning) is benign. Absence of bruits and symmetric pulses are normal findings. Jugular Venous Assessment Question 7: Jugular Venous Distention (JVD) A patient presents with jugular venous distention (JVD) while sitting upright at 45 degrees. This finding is most consistent with: A) Hypovolemia B) Dehydration C) Right-sided heart failure D) Hemorrhage Correct Answer: C Rationale: Jugular venous distention (JVD) indicates elevated central venous pressure (CVP) and is a key sign of right