Graduate Nursing Program
2 MAXE · 005 GSN
★ ★
Rx College of Nursing — Advanced Practice
NURSING
ASSESSMENT · DIAGNOSIS · CLINICAL EXCELLENCE
NSG 500: Exam 2 — Advanced Health Assessment
C A R D I OVA S CU L A R , R E S P I RATO RY, A B D O M I N A L , H E E N T, B R E A ST & G Y N E CO LO G I C
E X A M I N AT I O N
INSTITUTION Graduate Nursing Program PROGRAM MSN — Advanced Practice
Registered Nurse
COURSE CODE NSG 500 COURSE TITLE Advanced Health Assessment
Across the Lifespan
ACADEMIC YEAR EXAM TITLE NSG 500: Exam 2 — Advanced
Health Assessment
TOTAL QUESTIONS 170 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans cardiovascular, respiratory, abdominal, HEENT, breast, gynecologic, and male
genitourinary examination techniques and findings.
▸ Questions reflect advanced health assessment competencies for graduate nursing practice.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — NSG 500 ADVANCED HEALTH ASSESSMENT
Questions 1 – 170
COMPREHENSIVE EXAMINATION
1. What is the normal respiratory rate to heart rate ratio?
A. 1:2
B. 1:4
C. 1:6
D. 1:8
CORRECT ANSWER B — 1:4
RATIONALE The normal respiratory rate to heart rate ratio is approximately 1:4. For example, a
patient with a heart rate of 80 bpm would typically have a respiratory rate of
approximately 20 breaths per minute. This ratio reflects the physiological
coupling between cardiac output and ventilation — as metabolic demand
increases, both heart rate and respiratory rate increase proportionally. Deviation
from this ratio may indicate primary cardiac or pulmonary pathology.
Understanding this relationship helps the advanced practice nurse identify
abnormal patterns during the physical examination.
,2. How much should the lower border of the liver drop with deep inspiration?
A. 1 cm
B. 2-3 cm
C. 4-5 cm
D. 6-7 cm
CORRECT ANSWER B — 2-3 cm
RATIONALE During deep inspiration, the diaphragm contracts and descends, pushing the liver
downward. A normal liver should descend 2-3 cm below the costal margin on
deep inspiration. This finding indicates normal liver mobility and diaphragmatic
excursion. Decreased or absent descent may indicate conditions such as
emphysema (hyperinflated lungs flatten the diaphragm), massive ascites, or a
tumor preventing normal diaphragmatic movement. Assessment of liver descent
is performed by palpating the liver edge at the right costal margin during quiet
breathing and then asking the patient to take a deep breath while continuing to
palpate.
3. What is the normal size of the liver?
A. 3-5 cm
B. 6-12 cm
C. 14-18 cm
D. 20-24 cm
CORRECT ANSWER B — 6-12 cm (2.5-4.5 inches)
RATIONALE Normal liver span is 6-12 cm (approximately 2.5-4.5 inches) as measured by
percussion at the right midclavicular line. The upper border is typically at the 5th
intercostal space, and the lower border is at the costal margin. A liver span greater
than 12 cm suggests hepatomegaly (liver enlargement), which can be caused by
hepatitis, cirrhosis, heart failure, or malignancy. A liver span less than 6 cm
suggests liver atrophy, which can occur with advanced cirrhosis. Accurate
measurement of liver size is an essential advanced assessment skill for detecting
hepatic pathology.
, 4. 20/20 vision means what?
A. The patient can see at 20 feet what a normal person can see at 20 feet
B. The patient needs to be 20 feet away to see what a normal person sees at 20 feet
C. The patient has perfect vision at all distances
D. The patient requires corrective lenses for distance vision
CORRECT ANSWER A — The patient can see at 20 feet what a normal person can see at 20 feet
RATIONALE The Snellen chart measures visual acuity. The notation 20/20 means that the
patient can read at 20 feet what a person with normal vision can read at 20 feet.
The numerator represents the distance from the chart (20 feet), and the
denominator represents the distance at which a normal eye can read that line. For
example, 20/40 vision means the patient can read at 20 feet what a normal person
can read at 40 feet — indicating worse-than-normal vision. Visual acuity testing is
a fundamental component of the physical examination and screening for
refractive errors and ocular pathology.
5. Abnormal breath sounds include all of the following EXCEPT:
A. Crackles
B. Rhonchi
C. Vesicular sounds
D. Wheezes
CORRECT ANSWER C — Vesicular sounds
RATIONALE Vesicular breath sounds are NORMAL — they are the soft, low-pitched sounds
heard over most of the lung fields during respiration. Abnormal (adventitious)
breath sounds include: crackles (rales — discontinuous, popping sounds
indicating fluid in alveoli or airway opening), rhonchi (continuous, low-pitched,
rattling sounds indicating secretions in larger airways), wheezes (continuous,
high-pitched, musical sounds indicating narrowed airways), friction rub (grating
sound indicating inflamed pleural surfaces), and mediastinal crunch (Hamman's
sign — crackling sound synchronous with heartbeat indicating air in the
mediastinum). Distinguishing normal from abnormal breath sounds is a core
auscultation skill.
2 MAXE · 005 GSN
★ ★
Rx College of Nursing — Advanced Practice
NURSING
ASSESSMENT · DIAGNOSIS · CLINICAL EXCELLENCE
NSG 500: Exam 2 — Advanced Health Assessment
C A R D I OVA S CU L A R , R E S P I RATO RY, A B D O M I N A L , H E E N T, B R E A ST & G Y N E CO LO G I C
E X A M I N AT I O N
INSTITUTION Graduate Nursing Program PROGRAM MSN — Advanced Practice
Registered Nurse
COURSE CODE NSG 500 COURSE TITLE Advanced Health Assessment
Across the Lifespan
ACADEMIC YEAR EXAM TITLE NSG 500: Exam 2 — Advanced
Health Assessment
TOTAL QUESTIONS 170 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Content spans cardiovascular, respiratory, abdominal, HEENT, breast, gynecologic, and male
genitourinary examination techniques and findings.
▸ Questions reflect advanced health assessment competencies for graduate nursing practice.
▸ Correct answers and clinical rationales appear below each question for comprehensive test preparation.
▸ Questions have been randomized to promote active recall and simulate authentic testing conditions.
, SECTION I — NSG 500 ADVANCED HEALTH ASSESSMENT
Questions 1 – 170
COMPREHENSIVE EXAMINATION
1. What is the normal respiratory rate to heart rate ratio?
A. 1:2
B. 1:4
C. 1:6
D. 1:8
CORRECT ANSWER B — 1:4
RATIONALE The normal respiratory rate to heart rate ratio is approximately 1:4. For example, a
patient with a heart rate of 80 bpm would typically have a respiratory rate of
approximately 20 breaths per minute. This ratio reflects the physiological
coupling between cardiac output and ventilation — as metabolic demand
increases, both heart rate and respiratory rate increase proportionally. Deviation
from this ratio may indicate primary cardiac or pulmonary pathology.
Understanding this relationship helps the advanced practice nurse identify
abnormal patterns during the physical examination.
,2. How much should the lower border of the liver drop with deep inspiration?
A. 1 cm
B. 2-3 cm
C. 4-5 cm
D. 6-7 cm
CORRECT ANSWER B — 2-3 cm
RATIONALE During deep inspiration, the diaphragm contracts and descends, pushing the liver
downward. A normal liver should descend 2-3 cm below the costal margin on
deep inspiration. This finding indicates normal liver mobility and diaphragmatic
excursion. Decreased or absent descent may indicate conditions such as
emphysema (hyperinflated lungs flatten the diaphragm), massive ascites, or a
tumor preventing normal diaphragmatic movement. Assessment of liver descent
is performed by palpating the liver edge at the right costal margin during quiet
breathing and then asking the patient to take a deep breath while continuing to
palpate.
3. What is the normal size of the liver?
A. 3-5 cm
B. 6-12 cm
C. 14-18 cm
D. 20-24 cm
CORRECT ANSWER B — 6-12 cm (2.5-4.5 inches)
RATIONALE Normal liver span is 6-12 cm (approximately 2.5-4.5 inches) as measured by
percussion at the right midclavicular line. The upper border is typically at the 5th
intercostal space, and the lower border is at the costal margin. A liver span greater
than 12 cm suggests hepatomegaly (liver enlargement), which can be caused by
hepatitis, cirrhosis, heart failure, or malignancy. A liver span less than 6 cm
suggests liver atrophy, which can occur with advanced cirrhosis. Accurate
measurement of liver size is an essential advanced assessment skill for detecting
hepatic pathology.
, 4. 20/20 vision means what?
A. The patient can see at 20 feet what a normal person can see at 20 feet
B. The patient needs to be 20 feet away to see what a normal person sees at 20 feet
C. The patient has perfect vision at all distances
D. The patient requires corrective lenses for distance vision
CORRECT ANSWER A — The patient can see at 20 feet what a normal person can see at 20 feet
RATIONALE The Snellen chart measures visual acuity. The notation 20/20 means that the
patient can read at 20 feet what a person with normal vision can read at 20 feet.
The numerator represents the distance from the chart (20 feet), and the
denominator represents the distance at which a normal eye can read that line. For
example, 20/40 vision means the patient can read at 20 feet what a normal person
can read at 40 feet — indicating worse-than-normal vision. Visual acuity testing is
a fundamental component of the physical examination and screening for
refractive errors and ocular pathology.
5. Abnormal breath sounds include all of the following EXCEPT:
A. Crackles
B. Rhonchi
C. Vesicular sounds
D. Wheezes
CORRECT ANSWER C — Vesicular sounds
RATIONALE Vesicular breath sounds are NORMAL — they are the soft, low-pitched sounds
heard over most of the lung fields during respiration. Abnormal (adventitious)
breath sounds include: crackles (rales — discontinuous, popping sounds
indicating fluid in alveoli or airway opening), rhonchi (continuous, low-pitched,
rattling sounds indicating secretions in larger airways), wheezes (continuous,
high-pitched, musical sounds indicating narrowed airways), friction rub (grating
sound indicating inflamed pleural surfaces), and mediastinal crunch (Hamman's
sign — crackling sound synchronous with heartbeat indicating air in the
mediastinum). Distinguishing normal from abnormal breath sounds is a core
auscultation skill.
