Advanced Cardiovascular Physical Assessment (NURS
190) 2026 |WCU UPDATED ACTUAL Exam Questions and
CORRECT Answers
1. When auscultating the heart, the nurse recognizes that the first heart sound
(S1) is produced by the closure of which valves?
A. Mitral and Tricuspid valves
B. Aortic and Pulmonic valves
C. Mitral and Aortic valves
D. Tricuspid and Pulmonic valves
Answer: A
Rationale: S1 occurs at the beginning of systole and is caused by the closure of the
atrioventricular (AV) valves: the mitral and tricuspid valves.
2. Where is the best anatomical location to auscultate the Pulmonic valve area?
A. Second left intercostal space at the sternal border
B. Fifth intercostal space at the left midclavicular line
C. Second right intercostal space at the sternal border
D. Fourth left intercostal space at the sternal border
Answer: A
Rationale: The pulmonic valve area is located at the second intercostal space (ICS) to the
left of the sternal border.
,3. The nurse is assessing a patient with suspected left ventricular hypertrophy.
Which finding during palpation of the precordium would support this?
A. A thrill at the base of the heart
B. A palpable S2 at the pulmonic area
C. A sustained heave or lift at the apex
D. A displaced apical pulse at the 4th intercostal space
Answer: C
Rationale: A heave or lift is a sustained forceful thrusting of the ventricle during systole,
often occurring with ventricular hypertrophy.
4. An S3 heart sound is frequently associated with which clinical condition in
older adults?
A. Heart failure or fluid overload
B. Aortic stenosis
C. Ventricular resistance to filling (stiff wall)
D. Normal physiological finding in all ages
Answer: A
Rationale: In older adults, an S3 (ventricular gallop) is often an early sign of heart failure
due to volume overload or decreased compliance of the ventricles.
5. Which position is most effective for auscultating a low-pitched diastolic
murmur or an S3/S4 sound at the apex?
A. Supine position with the head of bed at 45 degrees
B. Sitting upright and leaning forward
C. Left lateral decubitus position
D. Prone position
Answer: C
Rationale: The left lateral decubitus position brings the apex of the heart closer to the
chest wall, making low-pitched sounds easier to hear with the bell of the stethoscope.
, 6. While assessing the carotid arteries, the nurse should use which technique to
avoid stimulating the carotid sinus?
A. Palpate both arteries simultaneously for comparison
B. Palpate only one artery at a time in the lower half of the neck
C. Palpate the arteries in the upper third of the neck
D. Apply firm pressure to ensure the pulse is felt
Answer: B
Rationale: Palpating one carotid artery at a time prevents compromised blood flow to the
brain, and palpating the lower half avoids the carotid sinus, which can cause reflex
bradycardia.
7. A ‘thrill’ felt during palpation of the precordium is most accurately described
as:
A. A palpable vibration signaling turbulent blood flow
B. A visible pulsation at the epigastric area
C. A blowing, swishing sound heard on auscultation
D. An exaggerated upward thrust of the heart
Answer: A
Rationale: A thrill is a palpable vibration that often accompanies loud murmurs, indicating
significant turbulent blood flow.
8. When grading a pulse, a ‘3+’ on a common 0-4 point scale is defined as:
A. Absent
B. Full, increased
C. Weak, thready
D. Bounding
Answer: B
Rationale: In the standard 4-point scale, 0 is absent, 1+ is weak/thready, 2+ is normal, 3+
is full/increased, and 4+ is bounding.
190) 2026 |WCU UPDATED ACTUAL Exam Questions and
CORRECT Answers
1. When auscultating the heart, the nurse recognizes that the first heart sound
(S1) is produced by the closure of which valves?
A. Mitral and Tricuspid valves
B. Aortic and Pulmonic valves
C. Mitral and Aortic valves
D. Tricuspid and Pulmonic valves
Answer: A
Rationale: S1 occurs at the beginning of systole and is caused by the closure of the
atrioventricular (AV) valves: the mitral and tricuspid valves.
2. Where is the best anatomical location to auscultate the Pulmonic valve area?
A. Second left intercostal space at the sternal border
B. Fifth intercostal space at the left midclavicular line
C. Second right intercostal space at the sternal border
D. Fourth left intercostal space at the sternal border
Answer: A
Rationale: The pulmonic valve area is located at the second intercostal space (ICS) to the
left of the sternal border.
,3. The nurse is assessing a patient with suspected left ventricular hypertrophy.
Which finding during palpation of the precordium would support this?
A. A thrill at the base of the heart
B. A palpable S2 at the pulmonic area
C. A sustained heave or lift at the apex
D. A displaced apical pulse at the 4th intercostal space
Answer: C
Rationale: A heave or lift is a sustained forceful thrusting of the ventricle during systole,
often occurring with ventricular hypertrophy.
4. An S3 heart sound is frequently associated with which clinical condition in
older adults?
A. Heart failure or fluid overload
B. Aortic stenosis
C. Ventricular resistance to filling (stiff wall)
D. Normal physiological finding in all ages
Answer: A
Rationale: In older adults, an S3 (ventricular gallop) is often an early sign of heart failure
due to volume overload or decreased compliance of the ventricles.
5. Which position is most effective for auscultating a low-pitched diastolic
murmur or an S3/S4 sound at the apex?
A. Supine position with the head of bed at 45 degrees
B. Sitting upright and leaning forward
C. Left lateral decubitus position
D. Prone position
Answer: C
Rationale: The left lateral decubitus position brings the apex of the heart closer to the
chest wall, making low-pitched sounds easier to hear with the bell of the stethoscope.
, 6. While assessing the carotid arteries, the nurse should use which technique to
avoid stimulating the carotid sinus?
A. Palpate both arteries simultaneously for comparison
B. Palpate only one artery at a time in the lower half of the neck
C. Palpate the arteries in the upper third of the neck
D. Apply firm pressure to ensure the pulse is felt
Answer: B
Rationale: Palpating one carotid artery at a time prevents compromised blood flow to the
brain, and palpating the lower half avoids the carotid sinus, which can cause reflex
bradycardia.
7. A ‘thrill’ felt during palpation of the precordium is most accurately described
as:
A. A palpable vibration signaling turbulent blood flow
B. A visible pulsation at the epigastric area
C. A blowing, swishing sound heard on auscultation
D. An exaggerated upward thrust of the heart
Answer: A
Rationale: A thrill is a palpable vibration that often accompanies loud murmurs, indicating
significant turbulent blood flow.
8. When grading a pulse, a ‘3+’ on a common 0-4 point scale is defined as:
A. Absent
B. Full, increased
C. Weak, thready
D. Bounding
Answer: B
Rationale: In the standard 4-point scale, 0 is absent, 1+ is weak/thready, 2+ is normal, 3+
is full/increased, and 4+ is bounding.
