NSG 500 Exam 3 - Advanced Health Assessment Complete Review
NSG500 / NSG 500 Exam 3 (Latest 2026/2027)
Advanced Health Assessment Complete Review
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing
Section 1: Cardiovascular Assessment and Peripheral Vascular System (Q1-Q25)
Q1: A nurse practitioner is performing a cardiac assessment on a 58-year-old patient. The point of maximum impulse
(PMI) is located at which anatomical landmark?
A. Second intercostal space, right sternal border
B. Fifth intercostal space, midclavicular line
C. Fourth intercostal space, left sternal border
D. Third intercostal space, parasternal line
Correct Answer: B
Rationale: The PMI, also known as the apical impulse, is normally located at the fifth intercostal space at the midclavicular line
(MCL). This corresponds to the apex of the heart, where the left ventricle is closest to the chest wall. The second intercostal space
right sternal border is the aortic area, the fourth intercostal space left sternal border is the tricuspid area, and the third intercostal
space parasternal is not a standard auscultation landmark.
Q2: During cardiac auscultation of a patient with suspected aortic stenosis, the nurse practitioner identifies a systolic
ejection murmur. Which description best characterizes the murmur of aortic stenosis?
A. Holosystolic, high-pitched, heard best at the apex radiating to the axilla
B. Diastolic decrescendo, heard best at the left sternal border
C. Crescendo-decrescendo systolic murmur, heard best at the right second intercostal space
D. Diastolic rumbling murmur with an opening snap, heard best at the apex
Correct Answer: C
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur best heard at the right second intercostal
space (aortic area) that may radiate to the carotid arteries. Holosystolic murmur at the apex radiating to the axilla is characteristic
of mitral regurgitation. Diastolic decrescendo murmur at the left sternal border is aortic regurgitation. Diastolic rumble with
opening snap at the apex is mitral stenosis.
Q3: A 65-year-old patient presents with jugular venous distension (JVD), peripheral edema, and hepatomegaly.
Which type of heart failure is most consistent with these findings?
A. Left-sided heart failure
B. Right-sided heart failure
C. Biventricular heart failure with predominantly left-sided symptoms
D. Acute myocardial infarction
Correct Answer: B
Rationale: Right-sided heart failure manifests with systemic venous congestion, producing JVD, peripheral edema (pitting),
hepatomegaly, and ascites. The right ventricle cannot effectively pump blood to the pulmonary circulation, causing backup into
the systemic venous system. Left-sided heart failure presents with pulmonary congestion (dyspnea, orthopnea, crackles, S3
gallop). Although biventricular failure can occur, the described findings are classic for right-sided failure.
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, NSG 500 Exam 3 - Advanced Health Assessment Complete Review
Q4: A patient with mitral regurgitation is being evaluated. Which auscultatory finding is most characteristic of this
valvular lesion?
A. Crescendo-decrescendo systolic murmur at the right upper sternal border
B. Holosystolic murmur at the apex radiating to the left axilla
C. Diastolic decrescendo murmur at the left sternal border
D. Early diastolic rumble at the apex with an opening snap
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur that is heard best at the cardiac apex (fifth ICS,
MCL) and radiates to the left axilla. The murmur is caused by blood flowing back into the left atrium during systole through the
incompetent mitral valve. A crescendo-decrescendo systolic murmur at the right upper sternal border suggests aortic stenosis, a
diastolic decrescendo murmur at the left sternal border indicates aortic regurgitation, and a diastolic rumble with opening snap is
characteristic of mitral stenosis.
Q5: During a peripheral vascular assessment, the nurse practitioner notes shiny, atrophic skin on the patient's toes
with a small ulcer near the nail bed. Capillary refill is 4 seconds. Which condition is most likely?
A. Venous insufficiency
B. Arterial insufficiency
C. Deep vein thrombosis
D. Cellulitis
Correct Answer: B
Rationale: Arterial insufficiency is characterized by pain with exercise (claudication), shiny and atrophic skin, hair loss on the
lower extremities, ulcers on the toes or feet (not medial malleolus), and delayed capillary refill (normal is less than 2 seconds).
Venous insufficiency presents with edema, brown skin discoloration (stasis dermatitis), ulcers at the medial malleolus, and
varicose veins. Deep vein thrombosis presents with unilateral leg swelling, warmth, and tenderness along the vein.
Q6: The nurse practitioner auscultates S3 at the apex of a 72-year-old patient with progressive dyspnea and
orthopnea. What does this finding most likely indicate?
A. Aortic stenosis
B. Mitral valve prolapse
C. Left ventricular failure
D. Pericarditis
Correct Answer: C
Rationale: S3 (ventricular gallop) is an early diastolic sound heard best at the apex with the patient in the left lateral decubitus
position. It is caused by rapid ventricular filling into a stiff, noncompliant left ventricle and is a classic sign of left ventricular
failure (heart failure). S3 is also associated with volume overload states. Aortic stenosis produces a systolic ejection murmur.
Pericarditis produces a pericardial friction rub (high-pitched, scratchy sound).
Q7: A 55-year-old patient is found to have a wide pulse pressure of 75 mmHg, bounding peripheral pulses, and a
diastolic decrescendo murmur at the left sternal border. Which valvular pathology is most likely present?
A. Mitral stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Correct Answer: B
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, NSG 500 Exam 3 - Advanced Health Assessment Complete Review
Rationale: Aortic regurgitation produces a diastolic decrescendo murmur heard best at the left sternal border (third or fourth
intercostal space). The regurgitant flow back into the left ventricle during diastole causes increased stroke volume and wide pulse
pressure. Bounding peripheral pulses (water-hammer or Corrigan's pulse) are another classic finding. Mitral stenosis produces a
diastolic rumble at the apex with opening snap, not a wide pulse pressure.
Q8: During assessment of a patient with suspected peripheral arterial disease (PAD), the nurse practitioner grades
the dorsalis pedis pulse as 1+. What does this grade indicate?
A. Absent pulse
B. Diminished, barely palpable pulse
C. Normal pulse
D. Bounding, increased pulse
Correct Answer: B
Rationale: The pulse grading scale ranges from 0 (absent) to 4+ (bounding). A 1+ pulse is diminished and barely palpable,
indicating reduced arterial perfusion. Grade 0 is absent, grade 2+ is normal, grade 3+ is increased and full, and grade 4+ is
bounding. A 1+ dorsalis pedis pulse in a patient with risk factors for PAD warrants further evaluation, such as ankle-brachial
index (ABI) measurement.
Q9: The nurse practitioner is performing a cardiovascular assessment and identifies a pericardial friction rub. Which
statement best describes this finding?
A. Low-pitched rumbling sound heard during diastole at the apex
B. High-pitched, scratchy sound heard best with the diaphragm at the left sternal border
C. Blowing, holosystolic murmur at the apex radiating to the axilla
D. Crescendo-decrescendo sound heard best at the right second intercostal space
Correct Answer: B
Rationale: A pericardial friction rub is a high-pitched, scratchy, grating sound caused by inflammation of the pericardial layers
rubbing against each other. It is best heard with the diaphragm of the stethoscope at the left sternal border and may have three
components (atrial systole, ventricular systole, and ventricular diastole). It is associated with pericarditis. A low-pitched diastolic
rumble at the apex suggests mitral stenosis, and a blowing holosystolic murmur at the apex is mitral regurgitation.
Q10: A 48-year-old male presents with episodic severe headaches, palpitations, and diaphoresis. His blood pressure
is markedly elevated at 210/130 mmHg during episodes. Which adrenal pathology should the nurse practitioner
suspect?
A. Cushing syndrome
B. Addison disease
C. Pheochromocytoma
D. Conn syndrome
Correct Answer: C
Rationale: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla that causes episodic or severe
hypertension, palpitations, diaphoresis, and headache (the classic triad). These episodes are often paroxysmal. Cushing syndrome
presents with sustained hypertension, moon face, buffalo hump, and central obesity. Addison disease presents with hypotension,
hyperpigmentation, and electrolyte abnormalities. Conn syndrome (primary hyperaldosteronism) causes hypertension with
hypokalemia.
Q11: During cardiac auscultation, the nurse practitioner hears S4 at the left sternal border in a patient with a history
of long-standing hypertension. What does S4 represent?
A. Early diastolic sound from rapid ventricular filling
Page 3
NSG500 / NSG 500 Exam 3 (Latest 2026/2027)
Advanced Health Assessment Complete Review
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing
Section 1: Cardiovascular Assessment and Peripheral Vascular System (Q1-Q25)
Q1: A nurse practitioner is performing a cardiac assessment on a 58-year-old patient. The point of maximum impulse
(PMI) is located at which anatomical landmark?
A. Second intercostal space, right sternal border
B. Fifth intercostal space, midclavicular line
C. Fourth intercostal space, left sternal border
D. Third intercostal space, parasternal line
Correct Answer: B
Rationale: The PMI, also known as the apical impulse, is normally located at the fifth intercostal space at the midclavicular line
(MCL). This corresponds to the apex of the heart, where the left ventricle is closest to the chest wall. The second intercostal space
right sternal border is the aortic area, the fourth intercostal space left sternal border is the tricuspid area, and the third intercostal
space parasternal is not a standard auscultation landmark.
Q2: During cardiac auscultation of a patient with suspected aortic stenosis, the nurse practitioner identifies a systolic
ejection murmur. Which description best characterizes the murmur of aortic stenosis?
A. Holosystolic, high-pitched, heard best at the apex radiating to the axilla
B. Diastolic decrescendo, heard best at the left sternal border
C. Crescendo-decrescendo systolic murmur, heard best at the right second intercostal space
D. Diastolic rumbling murmur with an opening snap, heard best at the apex
Correct Answer: C
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic ejection murmur best heard at the right second intercostal
space (aortic area) that may radiate to the carotid arteries. Holosystolic murmur at the apex radiating to the axilla is characteristic
of mitral regurgitation. Diastolic decrescendo murmur at the left sternal border is aortic regurgitation. Diastolic rumble with
opening snap at the apex is mitral stenosis.
Q3: A 65-year-old patient presents with jugular venous distension (JVD), peripheral edema, and hepatomegaly.
Which type of heart failure is most consistent with these findings?
A. Left-sided heart failure
B. Right-sided heart failure
C. Biventricular heart failure with predominantly left-sided symptoms
D. Acute myocardial infarction
Correct Answer: B
Rationale: Right-sided heart failure manifests with systemic venous congestion, producing JVD, peripheral edema (pitting),
hepatomegaly, and ascites. The right ventricle cannot effectively pump blood to the pulmonary circulation, causing backup into
the systemic venous system. Left-sided heart failure presents with pulmonary congestion (dyspnea, orthopnea, crackles, S3
gallop). Although biventricular failure can occur, the described findings are classic for right-sided failure.
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, NSG 500 Exam 3 - Advanced Health Assessment Complete Review
Q4: A patient with mitral regurgitation is being evaluated. Which auscultatory finding is most characteristic of this
valvular lesion?
A. Crescendo-decrescendo systolic murmur at the right upper sternal border
B. Holosystolic murmur at the apex radiating to the left axilla
C. Diastolic decrescendo murmur at the left sternal border
D. Early diastolic rumble at the apex with an opening snap
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur that is heard best at the cardiac apex (fifth ICS,
MCL) and radiates to the left axilla. The murmur is caused by blood flowing back into the left atrium during systole through the
incompetent mitral valve. A crescendo-decrescendo systolic murmur at the right upper sternal border suggests aortic stenosis, a
diastolic decrescendo murmur at the left sternal border indicates aortic regurgitation, and a diastolic rumble with opening snap is
characteristic of mitral stenosis.
Q5: During a peripheral vascular assessment, the nurse practitioner notes shiny, atrophic skin on the patient's toes
with a small ulcer near the nail bed. Capillary refill is 4 seconds. Which condition is most likely?
A. Venous insufficiency
B. Arterial insufficiency
C. Deep vein thrombosis
D. Cellulitis
Correct Answer: B
Rationale: Arterial insufficiency is characterized by pain with exercise (claudication), shiny and atrophic skin, hair loss on the
lower extremities, ulcers on the toes or feet (not medial malleolus), and delayed capillary refill (normal is less than 2 seconds).
Venous insufficiency presents with edema, brown skin discoloration (stasis dermatitis), ulcers at the medial malleolus, and
varicose veins. Deep vein thrombosis presents with unilateral leg swelling, warmth, and tenderness along the vein.
Q6: The nurse practitioner auscultates S3 at the apex of a 72-year-old patient with progressive dyspnea and
orthopnea. What does this finding most likely indicate?
A. Aortic stenosis
B. Mitral valve prolapse
C. Left ventricular failure
D. Pericarditis
Correct Answer: C
Rationale: S3 (ventricular gallop) is an early diastolic sound heard best at the apex with the patient in the left lateral decubitus
position. It is caused by rapid ventricular filling into a stiff, noncompliant left ventricle and is a classic sign of left ventricular
failure (heart failure). S3 is also associated with volume overload states. Aortic stenosis produces a systolic ejection murmur.
Pericarditis produces a pericardial friction rub (high-pitched, scratchy sound).
Q7: A 55-year-old patient is found to have a wide pulse pressure of 75 mmHg, bounding peripheral pulses, and a
diastolic decrescendo murmur at the left sternal border. Which valvular pathology is most likely present?
A. Mitral stenosis
B. Aortic regurgitation
C. Tricuspid regurgitation
D. Pulmonic stenosis
Correct Answer: B
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, NSG 500 Exam 3 - Advanced Health Assessment Complete Review
Rationale: Aortic regurgitation produces a diastolic decrescendo murmur heard best at the left sternal border (third or fourth
intercostal space). The regurgitant flow back into the left ventricle during diastole causes increased stroke volume and wide pulse
pressure. Bounding peripheral pulses (water-hammer or Corrigan's pulse) are another classic finding. Mitral stenosis produces a
diastolic rumble at the apex with opening snap, not a wide pulse pressure.
Q8: During assessment of a patient with suspected peripheral arterial disease (PAD), the nurse practitioner grades
the dorsalis pedis pulse as 1+. What does this grade indicate?
A. Absent pulse
B. Diminished, barely palpable pulse
C. Normal pulse
D. Bounding, increased pulse
Correct Answer: B
Rationale: The pulse grading scale ranges from 0 (absent) to 4+ (bounding). A 1+ pulse is diminished and barely palpable,
indicating reduced arterial perfusion. Grade 0 is absent, grade 2+ is normal, grade 3+ is increased and full, and grade 4+ is
bounding. A 1+ dorsalis pedis pulse in a patient with risk factors for PAD warrants further evaluation, such as ankle-brachial
index (ABI) measurement.
Q9: The nurse practitioner is performing a cardiovascular assessment and identifies a pericardial friction rub. Which
statement best describes this finding?
A. Low-pitched rumbling sound heard during diastole at the apex
B. High-pitched, scratchy sound heard best with the diaphragm at the left sternal border
C. Blowing, holosystolic murmur at the apex radiating to the axilla
D. Crescendo-decrescendo sound heard best at the right second intercostal space
Correct Answer: B
Rationale: A pericardial friction rub is a high-pitched, scratchy, grating sound caused by inflammation of the pericardial layers
rubbing against each other. It is best heard with the diaphragm of the stethoscope at the left sternal border and may have three
components (atrial systole, ventricular systole, and ventricular diastole). It is associated with pericarditis. A low-pitched diastolic
rumble at the apex suggests mitral stenosis, and a blowing holosystolic murmur at the apex is mitral regurgitation.
Q10: A 48-year-old male presents with episodic severe headaches, palpitations, and diaphoresis. His blood pressure
is markedly elevated at 210/130 mmHg during episodes. Which adrenal pathology should the nurse practitioner
suspect?
A. Cushing syndrome
B. Addison disease
C. Pheochromocytoma
D. Conn syndrome
Correct Answer: C
Rationale: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla that causes episodic or severe
hypertension, palpitations, diaphoresis, and headache (the classic triad). These episodes are often paroxysmal. Cushing syndrome
presents with sustained hypertension, moon face, buffalo hump, and central obesity. Addison disease presents with hypotension,
hyperpigmentation, and electrolyte abnormalities. Conn syndrome (primary hyperaldosteronism) causes hypertension with
hypokalemia.
Q11: During cardiac auscultation, the nurse practitioner hears S4 at the left sternal border in a patient with a history
of long-standing hypertension. What does S4 represent?
A. Early diastolic sound from rapid ventricular filling
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