WILKES UNIVERSITY
Advanced Health Assessment
NSG500 — Advanced Health Assessment
Academic Year: 2026/2027
Exam 2 — Comprehensive Question Bank
Question 1
Nurse practitioner is palpating for the apical pulse. An apical impulse palpated
beyond the fifth intercostal space may indicate:
A. Left ventricular hypertrophy/cardiac enlargement
B. Right ventricular hypertrophy
C. Pericardial effusion
D. Aortic stenosis
Correct answer A. Left ventricular hypertrophy/cardiac enlargement
Rationale
The apical impulse is normally located in the fifth intercostal space at the
midclavicular line. Displacement beyond this point suggests left ventricular
enlargement or hypertrophy, often due to hypertension or valvular disease.
, Question 2
During an assessment of a 68-year-old man with a recent onset of right-sided
weakness, the NP hears a blowing, swishing sound with the bell of the
stethoscope over the left carotid artery. This finding would indicate:
A. Blood flow turbulence / atherosclerotic disease of the left carotid artery
B. Normal carotid artery flow
C. Venous hum
D. Aortic valve stenosis
Correct answer A. Blood flow turbulence / atherosclerotic disease of the left
carotid artery
Rationale
A bruit over the carotid artery indicates turbulent blood flow, often due to
atherosclerotic plaque. This finding in a patient with contralateral weakness raises
concern for significant carotid artery stenosis and possible stroke risk.
, Question 3
The patient complains of chest pain that comes on when he vacuums the house
or mows the lawn. It comes in a fairly consistent pattern, usually lasting about 1
minute. When he feels it, he drinks a glass of water, sits quietly on the couch,
and it typically goes away. What is the most likely type of problem?
A. Angina
B. Pericarditis
C. Gastroesophageal reflux
D. Musculoskeletal chest pain
Correct answer A. Angina
Rationale
This is classic stable angina: exertional chest pain that is relieved by rest. The
consistent pattern with physical activity and relief with rest strongly suggests
ischemic heart disease.
Question 4
The second heart sound (S2) occurs because of the closure of the:
A. Aortic and pulmonic valves
B. Mitral and tricuspid valves
C. Aortic and mitral valves
D. Pulmonic and tricuspid valves
Correct answer A. Aortic and pulmonic valves
Rationale
S2 is produced by the closure of the semilunar valves: the aortic and pulmonic
valves. It marks the beginning of ventricular diastole.
, Question 5
Xanthelasma is a skin condition that should alert the clinician to:
A. Familial hyperlipidemia/dyslipidemia
B. Diabetes mellitus
C. Hypertension
D. Thyroid disease
Correct answer A. Familial hyperlipidemia/dyslipidemia
Rationale
Xanthelasma are yellowish, cholesterol-rich plaques that appear on the eyelids. They
are associated with hyperlipidemia, particularly familial hypercholesterolemia, and
may indicate increased cardiovascular risk.
Question 6
The murmur of aortic stenosis is best heard in the:
A. Right second intercostal space, right sternal border
B. Left fifth intercostal space, midclavicular line
C. Left third intercostal space, left sternal border
D. Right fourth intercostal space, right sternal border
Correct answer A. Right second intercostal space, right sternal border
Rationale
Aortic stenosis produces a systolic ejection murmur best heard at the right second
intercostal space at the right sternal border (the aortic area). It may radiate to the
carotid arteries.
Advanced Health Assessment
NSG500 — Advanced Health Assessment
Academic Year: 2026/2027
Exam 2 — Comprehensive Question Bank
Question 1
Nurse practitioner is palpating for the apical pulse. An apical impulse palpated
beyond the fifth intercostal space may indicate:
A. Left ventricular hypertrophy/cardiac enlargement
B. Right ventricular hypertrophy
C. Pericardial effusion
D. Aortic stenosis
Correct answer A. Left ventricular hypertrophy/cardiac enlargement
Rationale
The apical impulse is normally located in the fifth intercostal space at the
midclavicular line. Displacement beyond this point suggests left ventricular
enlargement or hypertrophy, often due to hypertension or valvular disease.
, Question 2
During an assessment of a 68-year-old man with a recent onset of right-sided
weakness, the NP hears a blowing, swishing sound with the bell of the
stethoscope over the left carotid artery. This finding would indicate:
A. Blood flow turbulence / atherosclerotic disease of the left carotid artery
B. Normal carotid artery flow
C. Venous hum
D. Aortic valve stenosis
Correct answer A. Blood flow turbulence / atherosclerotic disease of the left
carotid artery
Rationale
A bruit over the carotid artery indicates turbulent blood flow, often due to
atherosclerotic plaque. This finding in a patient with contralateral weakness raises
concern for significant carotid artery stenosis and possible stroke risk.
, Question 3
The patient complains of chest pain that comes on when he vacuums the house
or mows the lawn. It comes in a fairly consistent pattern, usually lasting about 1
minute. When he feels it, he drinks a glass of water, sits quietly on the couch,
and it typically goes away. What is the most likely type of problem?
A. Angina
B. Pericarditis
C. Gastroesophageal reflux
D. Musculoskeletal chest pain
Correct answer A. Angina
Rationale
This is classic stable angina: exertional chest pain that is relieved by rest. The
consistent pattern with physical activity and relief with rest strongly suggests
ischemic heart disease.
Question 4
The second heart sound (S2) occurs because of the closure of the:
A. Aortic and pulmonic valves
B. Mitral and tricuspid valves
C. Aortic and mitral valves
D. Pulmonic and tricuspid valves
Correct answer A. Aortic and pulmonic valves
Rationale
S2 is produced by the closure of the semilunar valves: the aortic and pulmonic
valves. It marks the beginning of ventricular diastole.
, Question 5
Xanthelasma is a skin condition that should alert the clinician to:
A. Familial hyperlipidemia/dyslipidemia
B. Diabetes mellitus
C. Hypertension
D. Thyroid disease
Correct answer A. Familial hyperlipidemia/dyslipidemia
Rationale
Xanthelasma are yellowish, cholesterol-rich plaques that appear on the eyelids. They
are associated with hyperlipidemia, particularly familial hypercholesterolemia, and
may indicate increased cardiovascular risk.
Question 6
The murmur of aortic stenosis is best heard in the:
A. Right second intercostal space, right sternal border
B. Left fifth intercostal space, midclavicular line
C. Left third intercostal space, left sternal border
D. Right fourth intercostal space, right sternal border
Correct answer A. Right second intercostal space, right sternal border
Rationale
Aortic stenosis produces a systolic ejection murmur best heard at the right second
intercostal space at the right sternal border (the aortic area). It may radiate to the
carotid arteries.
