NSG 550 Exam 3 2026/2027 | Questions and Answers with
Rationales | Wilkes University - Guaranteed Pass
Advanced Clinical Assessment
1. Which finding is most concerning in a patient presenting with chest
pain?
A. Pain reproducible with palpation
B. Crushing substernal pressure with diaphoresis
C. Mild pain after eating
D. Brief pain lasting two seconds
Answer: B
Rationale: Crushing substernal pressure with autonomic symptoms is
concerning for acute coronary syndrome and requires urgent
evaluation.
2. Which finding is most suggestive of peripheral arterial disease?
A. Warm legs with bilateral edema
B. Diminished pedal pulses and exertional calf pain
C. Bounding pulses
D. Dependent edema that improves with walking
Answer: B
Rationale: Claudication and diminished peripheral pulses are classic
findings of arterial insufficiency.
3. A patient reports calf swelling, warmth, and unilateral pain. What
diagnosis should be considered?
A. Deep vein thrombosis
B. Osteoporosis
C. Cellulitis only
D. Peripheral neuropathy
,Answer: A
Rationale: Unilateral swelling, warmth, and pain are concerning for
DVT.
4. Which finding is most concerning for acute arterial occlusion?
A. Chronic bilateral edema
B. Pain, pallor, pulselessness, paresthesia, and coolness
C. Mild varicose veins
D. Symmetric warm feet
Answer: B
Rationale: The classic “6 Ps” of acute limb ischemia include pain, pallor,
pulselessness, paresthesia, paralysis, and poikilothermia.
5. Which assessment finding suggests dehydration?
A. Orthostatic hypotension and dry mucous membranes
B. Pulmonary crackles
C. Peripheral edema
D. Elevated jugular venous pressure
Answer: A
Rationale: Volume depletion commonly produces dry mucous
membranes, orthostatic changes, tachycardia, and reduced urine
output.
6. Which finding is most consistent with fluid overload?
A. Flat neck veins
B. Crackles, edema, and rapid weight gain
C. Dry tongue
D. Orthostatic hypotension
Answer: B
Rationale: Excess extracellular fluid can produce pulmonary congestion,
peripheral edema, and rapid weight gain.
,7. A patient has a new systolic murmur. Which finding should increase
concern for significant valvular disease?
A. Syncope with exertion
B. Mild fatigue after a long day
C. Normal exercise tolerance
D. Occasional hiccups
Answer: A
Rationale: Exertional syncope can occur with severe outflow
obstruction such as significant aortic stenosis.
8. Which heart sound is associated with ventricular volume overload?
A. S3
B. S1 only
C. Fixed S2 only
D. Opening snap only
Answer: A
Rationale: An S3 may occur with increased ventricular filling and is
often associated with systolic heart failure in adults.
9. An S4 is associated with:
A. A stiff, noncompliant ventricle
B. Severe volume depletion exclusively
C. Acute pneumothorax
D. Normal pregnancy only
Answer: A
Rationale: S4 occurs when atrial contraction forces blood into a stiff
ventricle.
10. Which respiratory finding suggests increased work of breathing?
A. Accessory muscle use
B. Quiet effortless breathing
, C. Normal respiratory rate
D. Clear speech without dyspnea
Answer: A
Rationale: Accessory muscle recruitment indicates increased
respiratory effort.
11. Which finding is most concerning in a patient with respiratory
distress?
A. Ability to speak in full sentences
B. Altered mental status
C. Mild cough
D. Respiratory rate of 16/min
Answer: B
Rationale: Altered mental status can indicate hypoxemia, hypercapnia,
or impending respiratory failure.
12. A patient has unilateral absent breath sounds and sudden dyspnea.
What should be considered?
A. Pneumothorax
B. GERD
C. Sinusitis
D. Anemia
Answer: A
Rationale: Sudden dyspnea with unilateral absent breath sounds is
highly concerning for pneumothorax.
13. Which symptom is a classic red flag for spinal cord compression?
A. New bowel or bladder dysfunction
B. Mild chronic back stiffness
C. Occasional muscle soreness
D. Stable posture
Rationales | Wilkes University - Guaranteed Pass
Advanced Clinical Assessment
1. Which finding is most concerning in a patient presenting with chest
pain?
A. Pain reproducible with palpation
B. Crushing substernal pressure with diaphoresis
C. Mild pain after eating
D. Brief pain lasting two seconds
Answer: B
Rationale: Crushing substernal pressure with autonomic symptoms is
concerning for acute coronary syndrome and requires urgent
evaluation.
2. Which finding is most suggestive of peripheral arterial disease?
A. Warm legs with bilateral edema
B. Diminished pedal pulses and exertional calf pain
C. Bounding pulses
D. Dependent edema that improves with walking
Answer: B
Rationale: Claudication and diminished peripheral pulses are classic
findings of arterial insufficiency.
3. A patient reports calf swelling, warmth, and unilateral pain. What
diagnosis should be considered?
A. Deep vein thrombosis
B. Osteoporosis
C. Cellulitis only
D. Peripheral neuropathy
,Answer: A
Rationale: Unilateral swelling, warmth, and pain are concerning for
DVT.
4. Which finding is most concerning for acute arterial occlusion?
A. Chronic bilateral edema
B. Pain, pallor, pulselessness, paresthesia, and coolness
C. Mild varicose veins
D. Symmetric warm feet
Answer: B
Rationale: The classic “6 Ps” of acute limb ischemia include pain, pallor,
pulselessness, paresthesia, paralysis, and poikilothermia.
5. Which assessment finding suggests dehydration?
A. Orthostatic hypotension and dry mucous membranes
B. Pulmonary crackles
C. Peripheral edema
D. Elevated jugular venous pressure
Answer: A
Rationale: Volume depletion commonly produces dry mucous
membranes, orthostatic changes, tachycardia, and reduced urine
output.
6. Which finding is most consistent with fluid overload?
A. Flat neck veins
B. Crackles, edema, and rapid weight gain
C. Dry tongue
D. Orthostatic hypotension
Answer: B
Rationale: Excess extracellular fluid can produce pulmonary congestion,
peripheral edema, and rapid weight gain.
,7. A patient has a new systolic murmur. Which finding should increase
concern for significant valvular disease?
A. Syncope with exertion
B. Mild fatigue after a long day
C. Normal exercise tolerance
D. Occasional hiccups
Answer: A
Rationale: Exertional syncope can occur with severe outflow
obstruction such as significant aortic stenosis.
8. Which heart sound is associated with ventricular volume overload?
A. S3
B. S1 only
C. Fixed S2 only
D. Opening snap only
Answer: A
Rationale: An S3 may occur with increased ventricular filling and is
often associated with systolic heart failure in adults.
9. An S4 is associated with:
A. A stiff, noncompliant ventricle
B. Severe volume depletion exclusively
C. Acute pneumothorax
D. Normal pregnancy only
Answer: A
Rationale: S4 occurs when atrial contraction forces blood into a stiff
ventricle.
10. Which respiratory finding suggests increased work of breathing?
A. Accessory muscle use
B. Quiet effortless breathing
, C. Normal respiratory rate
D. Clear speech without dyspnea
Answer: A
Rationale: Accessory muscle recruitment indicates increased
respiratory effort.
11. Which finding is most concerning in a patient with respiratory
distress?
A. Ability to speak in full sentences
B. Altered mental status
C. Mild cough
D. Respiratory rate of 16/min
Answer: B
Rationale: Altered mental status can indicate hypoxemia, hypercapnia,
or impending respiratory failure.
12. A patient has unilateral absent breath sounds and sudden dyspnea.
What should be considered?
A. Pneumothorax
B. GERD
C. Sinusitis
D. Anemia
Answer: A
Rationale: Sudden dyspnea with unilateral absent breath sounds is
highly concerning for pneumothorax.
13. Which symptom is a classic red flag for spinal cord compression?
A. New bowel or bladder dysfunction
B. Mild chronic back stiffness
C. Occasional muscle soreness
D. Stable posture
