NSG 500 Exam 3 (Latest )
Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing
2026-2027 Curriculum Standards
Section 1: Cardiovascular Assessment and Peripheral Vascular System (Q1-Q20)
Q1. A 62-year-old patient presents with complaints of dyspnea on exertion and orthopnea. During cardiac
auscultation, the advanced practice nurse identifies an S3 gallop sound. What is the most likely clinical significance of
this finding?
A. Aortic stenosis progression with left ventricular outflow obstruction
B. Ventricular septal defect with left-to-right shunting
C. Left ventricular systolic dysfunction consistent with heart failure [CORRECT]
D. Pericardial inflammation with friction rub development
Correct Answer: C
Rationale: The S3 (ventricular gallop) is a low-frequency sound heard in early diastole, caused by rapid ventricular filling into a
stiff, noncompliant left ventricle. It is the hallmark clinical finding of heart failure and indicates reduced left ventricular systolic
function. Aortic stenosis produces a systolic ejection murmur, not an S3. A VSD typically produces a holosystolic murmur at the lower
left sternal border. Pericarditis produces a friction rub, which is a high-pitched scratchy sound, not a gallop rhythm. This finding is a
core competency in NSG 500 cardiac auscultation at Wilkes University.
Q2. During a cardiovascular assessment, the nurse identifies the point of maximal impulse (PMI) at the 5th intercostal
space, midclavicular line. Which chamber of the heart is responsible for this finding?
A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle [CORRECT]
Correct Answer: D
Rationale: The PMI corresponds to the apical impulse of the left ventricle and is normally located at the 5th intercostal space at the
midclavicular line. It is typically 1-2 cm in diameter. The right atrium and right ventricle are located on the right side of the heart and
do not produce the apical impulse. The left atrium is the most posterior chamber and its impulse is not palpable on the anterior chest
wall. Accurate PMI localization is fundamental to the NSG 500 cardiovascular physical examination at Wilkes University.
Wilkes University Passan School of Nursing | 2026-2027 Academic Year
, Q3. A 55-year-old patient is found to have jugular venous distension (JVD) elevated at 8 cm above the sternal angle
when positioned at 45 degrees. Which condition is most strongly associated with this finding?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with increased venous pressure [CORRECT]
C. Aortic stenosis with left ventricular hypertrophy
D. Mitral regurgitation with volume overload
Correct Answer: B
Rationale: JVD elevation above the sternal angle reflects increased right atrial pressure, which is the hemodynamic hallmark of
right-sided heart failure. Normal JVP is 2-3 cm above the sternal angle at 45 degrees. Left-sided heart failure primarily causes
pulmonary symptoms (dyspnea, crackles) rather than systemic venous congestion. Aortic stenosis and mitral regurgitation are
left-heart valvular lesions that do not directly cause JVD unless they progress to biventricular failure. Recognition of JVD patterns is
a critical NSG 500 assessment skill.
Q4. A 70-year-old patient presents with a crescendo-decrescendo systolic ejection murmur heard best at the right
second intercostal space (aortic area) that radiates to the carotid arteries. The nurse also notes a delayed and weak
carotid upstroke (parvus et tardus). What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic regurgitation
C. Aortic stenosis [CORRECT]
D. Mitral stenosis
Correct Answer: C
Rationale: Aortic stenosis classically produces a crescendo-decrescendo systolic ejection murmur best heard at the right second
intercostal space (aortic area) with radiation to the carotids. The parvus et tardus (weak and delayed) carotid upstroke is a hallmark
physical finding caused by the obstructive narrowing of the aortic valve. Mitral regurgitation produces a holosystolic murmur at the
apex radiating to the axilla. Aortic regurgitation produces a diastolic decrescendo murmur. Mitral stenosis produces a diastolic rumble
at the apex with an opening snap. These valvular distinctions are essential in the NSG 500 advanced assessment curriculum.
Q5. During peripheral vascular assessment of a patient with suspected peripheral arterial disease (PAD), the nurse
notes shiny, atrophic skin on the lower extremities, hair loss, and a small ulcer located on the tip of the great toe.
Capillary refill is 5 seconds. These findings are most consistent with which condition?
A. Venous insufficiency with stasis dermatitis
B. Arterial insufficiency with tissue ischemia [CORRECT]
C. Deep vein thrombosis with post-phlebitic syndrome
D. Cellulitis with localized infection
Correct Answer: B
Rationale: The findings of shiny atrophic skin, hair loss, toe ulcer location, and delayed capillary refill (>2 seconds) are classic signs
of arterial insufficiency. Arterial ulcers typically occur on the toes, feet, or distal areas where perfusion is most compromised. Venous
insufficiency, by contrast, presents with edema, brown pigmentation (stasis dermatitis), and ulcers near the medial malleolus. DVT
presents with acute swelling, warmth, and tenderness. Cellulitis presents with erythema, warmth, and tenderness. Differentiating
arterial from venous insufficiency is a key NSG 500 competency at Wilkes University.
NSG 500 Exam 3 - Advanced Health Assessment | Wilkes University Page 2
, Q6. A patient with known mitral regurgitation presents for follow-up. During auscultation, the nurse identifies a
holosystolic murmur at the cardiac apex that radiates to the left axilla. Which pathophysiologic mechanism best
explains this murmur?
A. Turbulent forward flow across a narrowed orifice during systole
B. Regurgitant flow from the left ventricle back into the left atrium through an incompetent valve during
systole [CORRECT]
C. Increased flow across the aortic valve during diastole due to valve leaflet retraction
D. Obstructed flow from the left atrium to the left ventricle during diastole
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur because the incompetent mitral valve allows blood to
flow backward from the high-pressure left ventricle into the left atrium throughout all of systole. The murmur is loudest at the apex
and radiates to the left axilla due to the direction of the regurgitant jet. A narrowed orifice (stenosis) produces a
crescendo-decrescendo murmur, not holosystolic. Diastolic murmurs are associated with aortic regurgitation or mitral stenosis.
Understanding murmur timing and radiation patterns is fundamental to NSG 500 cardiovascular assessment at Wilkes.
Q7. A 45-year-old patient with a history of hypertension presents with a wide pulse pressure, bounding peripheral
pulses (water-hammer pulses), and a diastolic decrescendo murmur heard best at the left third intercostal space along
the sternal border. What valvular pathology is most likely present?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation [CORRECT]
D. Tricuspid regurgitation
Correct Answer: C
Rationale: Aortic regurgitation classically produces a diastolic decrescendo murmur at the left sternal border (third intercostal space)
caused by retrograde flow from the aorta back into the left ventricle during diastole. The wide pulse pressure (elevated systolic and
decreased diastolic) and bounding water-hammer pulses (Corrigan pulse) result from the combined effects of increased stroke volume
and rapid diastolic run-off. Aortic stenosis produces a systolic ejection murmur, not diastolic. Mitral regurgitation produces a
holosystolic murmur at the apex. Tricuspid regurgitation produces a holosystolic murmur at the lower left sternal border that increases
with inspiration (Carvallo sign).
Q8. While performing cardiac auscultation on a patient with suspected pericarditis, the nurse hears a high-pitched,
scratchy, grating sound that is heard throughout the cardiac cycle. The sound does not change significantly with
respiration. What is this finding?
A. S3 gallop
B. S4 gallop
C. Pericardial friction rub [CORRECT]
D. Pleural friction rub
Correct Answer: C
Rationale: A pericardial friction rub is a high-pitched, scratchy, grating sound caused by inflammation of the pericardial layers
rubbing against each other. Unlike pleural friction rubs, pericardial friction rubs are heard throughout the cardiac cycle (systole and
diastole) and are best heard with the diaphragm of the stethoscope at the left lower sternal border. An S3 is a low-frequency sound in
early diastole associated with heart failure. An S4 is a low-frequency sound in late diastole associated with decreased ventricular
compliance. A pleural friction rub changes with respiration and is heard only during inspiration and expiration, not throughout the
cardiac cycle.
NSG 500 Exam 3 - Advanced Health Assessment | Wilkes University Page 3
Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Wilkes University Passan School of Nursing
2026-2027 Curriculum Standards
Section 1: Cardiovascular Assessment and Peripheral Vascular System (Q1-Q20)
Q1. A 62-year-old patient presents with complaints of dyspnea on exertion and orthopnea. During cardiac
auscultation, the advanced practice nurse identifies an S3 gallop sound. What is the most likely clinical significance of
this finding?
A. Aortic stenosis progression with left ventricular outflow obstruction
B. Ventricular septal defect with left-to-right shunting
C. Left ventricular systolic dysfunction consistent with heart failure [CORRECT]
D. Pericardial inflammation with friction rub development
Correct Answer: C
Rationale: The S3 (ventricular gallop) is a low-frequency sound heard in early diastole, caused by rapid ventricular filling into a
stiff, noncompliant left ventricle. It is the hallmark clinical finding of heart failure and indicates reduced left ventricular systolic
function. Aortic stenosis produces a systolic ejection murmur, not an S3. A VSD typically produces a holosystolic murmur at the lower
left sternal border. Pericarditis produces a friction rub, which is a high-pitched scratchy sound, not a gallop rhythm. This finding is a
core competency in NSG 500 cardiac auscultation at Wilkes University.
Q2. During a cardiovascular assessment, the nurse identifies the point of maximal impulse (PMI) at the 5th intercostal
space, midclavicular line. Which chamber of the heart is responsible for this finding?
A. Right atrium
B. Right ventricle
C. Left atrium
D. Left ventricle [CORRECT]
Correct Answer: D
Rationale: The PMI corresponds to the apical impulse of the left ventricle and is normally located at the 5th intercostal space at the
midclavicular line. It is typically 1-2 cm in diameter. The right atrium and right ventricle are located on the right side of the heart and
do not produce the apical impulse. The left atrium is the most posterior chamber and its impulse is not palpable on the anterior chest
wall. Accurate PMI localization is fundamental to the NSG 500 cardiovascular physical examination at Wilkes University.
Wilkes University Passan School of Nursing | 2026-2027 Academic Year
, Q3. A 55-year-old patient is found to have jugular venous distension (JVD) elevated at 8 cm above the sternal angle
when positioned at 45 degrees. Which condition is most strongly associated with this finding?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with increased venous pressure [CORRECT]
C. Aortic stenosis with left ventricular hypertrophy
D. Mitral regurgitation with volume overload
Correct Answer: B
Rationale: JVD elevation above the sternal angle reflects increased right atrial pressure, which is the hemodynamic hallmark of
right-sided heart failure. Normal JVP is 2-3 cm above the sternal angle at 45 degrees. Left-sided heart failure primarily causes
pulmonary symptoms (dyspnea, crackles) rather than systemic venous congestion. Aortic stenosis and mitral regurgitation are
left-heart valvular lesions that do not directly cause JVD unless they progress to biventricular failure. Recognition of JVD patterns is
a critical NSG 500 assessment skill.
Q4. A 70-year-old patient presents with a crescendo-decrescendo systolic ejection murmur heard best at the right
second intercostal space (aortic area) that radiates to the carotid arteries. The nurse also notes a delayed and weak
carotid upstroke (parvus et tardus). What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic regurgitation
C. Aortic stenosis [CORRECT]
D. Mitral stenosis
Correct Answer: C
Rationale: Aortic stenosis classically produces a crescendo-decrescendo systolic ejection murmur best heard at the right second
intercostal space (aortic area) with radiation to the carotids. The parvus et tardus (weak and delayed) carotid upstroke is a hallmark
physical finding caused by the obstructive narrowing of the aortic valve. Mitral regurgitation produces a holosystolic murmur at the
apex radiating to the axilla. Aortic regurgitation produces a diastolic decrescendo murmur. Mitral stenosis produces a diastolic rumble
at the apex with an opening snap. These valvular distinctions are essential in the NSG 500 advanced assessment curriculum.
Q5. During peripheral vascular assessment of a patient with suspected peripheral arterial disease (PAD), the nurse
notes shiny, atrophic skin on the lower extremities, hair loss, and a small ulcer located on the tip of the great toe.
Capillary refill is 5 seconds. These findings are most consistent with which condition?
A. Venous insufficiency with stasis dermatitis
B. Arterial insufficiency with tissue ischemia [CORRECT]
C. Deep vein thrombosis with post-phlebitic syndrome
D. Cellulitis with localized infection
Correct Answer: B
Rationale: The findings of shiny atrophic skin, hair loss, toe ulcer location, and delayed capillary refill (>2 seconds) are classic signs
of arterial insufficiency. Arterial ulcers typically occur on the toes, feet, or distal areas where perfusion is most compromised. Venous
insufficiency, by contrast, presents with edema, brown pigmentation (stasis dermatitis), and ulcers near the medial malleolus. DVT
presents with acute swelling, warmth, and tenderness. Cellulitis presents with erythema, warmth, and tenderness. Differentiating
arterial from venous insufficiency is a key NSG 500 competency at Wilkes University.
NSG 500 Exam 3 - Advanced Health Assessment | Wilkes University Page 2
, Q6. A patient with known mitral regurgitation presents for follow-up. During auscultation, the nurse identifies a
holosystolic murmur at the cardiac apex that radiates to the left axilla. Which pathophysiologic mechanism best
explains this murmur?
A. Turbulent forward flow across a narrowed orifice during systole
B. Regurgitant flow from the left ventricle back into the left atrium through an incompetent valve during
systole [CORRECT]
C. Increased flow across the aortic valve during diastole due to valve leaflet retraction
D. Obstructed flow from the left atrium to the left ventricle during diastole
Correct Answer: B
Rationale: Mitral regurgitation produces a holosystolic (pansystolic) murmur because the incompetent mitral valve allows blood to
flow backward from the high-pressure left ventricle into the left atrium throughout all of systole. The murmur is loudest at the apex
and radiates to the left axilla due to the direction of the regurgitant jet. A narrowed orifice (stenosis) produces a
crescendo-decrescendo murmur, not holosystolic. Diastolic murmurs are associated with aortic regurgitation or mitral stenosis.
Understanding murmur timing and radiation patterns is fundamental to NSG 500 cardiovascular assessment at Wilkes.
Q7. A 45-year-old patient with a history of hypertension presents with a wide pulse pressure, bounding peripheral
pulses (water-hammer pulses), and a diastolic decrescendo murmur heard best at the left third intercostal space along
the sternal border. What valvular pathology is most likely present?
A. Aortic stenosis
B. Mitral regurgitation
C. Aortic regurgitation [CORRECT]
D. Tricuspid regurgitation
Correct Answer: C
Rationale: Aortic regurgitation classically produces a diastolic decrescendo murmur at the left sternal border (third intercostal space)
caused by retrograde flow from the aorta back into the left ventricle during diastole. The wide pulse pressure (elevated systolic and
decreased diastolic) and bounding water-hammer pulses (Corrigan pulse) result from the combined effects of increased stroke volume
and rapid diastolic run-off. Aortic stenosis produces a systolic ejection murmur, not diastolic. Mitral regurgitation produces a
holosystolic murmur at the apex. Tricuspid regurgitation produces a holosystolic murmur at the lower left sternal border that increases
with inspiration (Carvallo sign).
Q8. While performing cardiac auscultation on a patient with suspected pericarditis, the nurse hears a high-pitched,
scratchy, grating sound that is heard throughout the cardiac cycle. The sound does not change significantly with
respiration. What is this finding?
A. S3 gallop
B. S4 gallop
C. Pericardial friction rub [CORRECT]
D. Pleural friction rub
Correct Answer: C
Rationale: A pericardial friction rub is a high-pitched, scratchy, grating sound caused by inflammation of the pericardial layers
rubbing against each other. Unlike pleural friction rubs, pericardial friction rubs are heard throughout the cardiac cycle (systole and
diastole) and are best heard with the diaphragm of the stethoscope at the left lower sternal border. An S3 is a low-frequency sound in
early diastole associated with heart failure. An S4 is a low-frequency sound in late diastole associated with decreased ventricular
compliance. A pleural friction rub changes with respiration and is heard only during inspiration and expiration, not throughout the
cardiac cycle.
NSG 500 Exam 3 - Advanced Health Assessment | Wilkes University Page 3
