• NURS 190 PA 09/16/2026
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in
my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the
right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the
left. This description is consistent with:
A) acute pneumonia
B) an asthmatic attack
C) a pneumothorax
P 1
, • NURS 190 PA 09/16/2026
Midterm
D) bronchitis - Correct Answer :C) a pneumothorax
With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax
is large then tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus,
tracheal deviation to the unaffected side, decreased chest expansion, hyperresonnant percussion tones, and
decreased or absent breath sounds are found with the presence of a pneumothorax. (Bates, p 340)
The diameter of the PMI is approximately:
A) 1-2.5 cm in diameter and any larger is evidence of mitral valve prolapse
B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy
C) .5-1 cm in diameter and any larger is evidence supporting left ventricular hypertrophy
D) .5-1 cm in diameter and any larger is evidence of mitral valve prolapse - Correct Answer :B) 1-2.5 cm in
diameter and any larger is evidence of left ventricular hypertrophy
(Bates p 344)
The direction of blood flow through the heart is best described by which of the following?
A) Aorta - R atrium - R ventricle - lungs - pulmonary vein - L atrium - L ventricle - vena cava
B) R atrium - R ventricle - pulmonary vein - lungs - pulmonary artery - L atrium - L ventricle
C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle
D) Vena cava - R atrium - R ventricle - lungs - pulmonary artery- L atrium - L ventricle –
Correct Answer :C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle
Returning blood from the body empties into the R atrium and flows into the R ventricle, then goes to the lungs
through the pulmonary artery. The lungs oxygenate the blood and it is then returned to the L atrium by the
pulmonary vein. It goes from there to the L ventricle and then out to the body through the aorta (Bates, pg 345)
When listening to heart sounds, the nurse knows that the valve closures that can be heard for S2 is:
A) pulmonic
P 2
, • NURS 190 PA 09/16/2026
Midterm
B) aortic
C) tricuspid
D) mitral - Correct Answer :B) aortic
The second heart sound (S2) occurs with the closure of the aortic valve and signals the end of systole. Although
it is heard over all the precordium, S2 is loudest at the base of the heart. (Bates, p347)
A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having
difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't catch my breath." His symptoms
indicates sleep related symptoms of a certain type of disease, so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - Correct Answer :B) Do you have any history of problems with
your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of intrathoracic blood,
and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours
of sleep, arises, and flings open a window with the perception of needing fresh air. (Bates, p357)
In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a
history?
A) Personality type, high cholesterol, diabetes, smoking
B) Family history, hypertension, stress, age
C) Alcohol consumption, obesity, diabetes, stress, high cholesterol
D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history –
Correct Answer :D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history
For major risk factors for coronary artery disease, collect data regarding elevated serum cholesterol, elevated
blood pressure, blood glucose levels above 130 mg/dL or known diabetes mellitus, obesity, cigarette smoking,
low activity level (Bates, p358)
P 3
, • NURS 190 PA 09/16/2026
Midterm
In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:
A) palpate the artery in the upper one third of the neck.
B) listen with the bell of the stethoscope to assess for bruits.
C) palpate both arteries simultaneously to compare amplitude.
D) instruct the patient to take slow deep breaths during inspiration. –
Correct Answer :B) listen with the bell of the stethoscope to assess for bruits.
If cardiovascular disease is suspected, the nurse should auscultate each carotid artery for the presence of a bruit.
The NP should avoid compressing the artery because this could create an artificial bruit, and it could compromise
circulation if the carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the carotid
sinus area higher in the neck; excessive vagal stimulation here could slow down the heart rate, especially in older
adults. Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain. The bell of the
stethoscope is best for picking up bruits. The diaphragm is more attuned to relatively high-pitched sounds; the
bell is more sensitive to low-pitched sounds like bruits. (Bates, 381)
All of the following are true about assessing the jugular venous pressure EXCEPT:
A) The jugular venous pressure is affected by changes in the right atrial filling.
B) The pulsation from the internal jugular vein reflects the left ventricle pressure.
C) The jugular venous pressure is determined by the highest point of oscillation in the internal jugular vein.
D) The jugular venous pressure is considered abnormal if it is greater than 4 cm above the sternal angle or
greater than 9 cm above the right atrium.
- Correct Answer :B) The pulsation from the internal jugular vein reflects the left ventricle pressure.
The jugular venous pressure is affected by changes in R atrial filling. The JVP is abnormal at a height greater than
4 cm and is determined by the highest point of oscillation. The pulsation from the internal jugular vein is not
palpable. (Bates, p354-355)
During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?
P 4
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in
my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the
right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the
left. This description is consistent with:
A) acute pneumonia
B) an asthmatic attack
C) a pneumothorax
P 1
, • NURS 190 PA 09/16/2026
Midterm
D) bronchitis - Correct Answer :C) a pneumothorax
With a pneumothorax, free air in the pleural space causes partial or complete lung collapse. If the pneumothorax
is large then tachypnea and cyanosis are seen. Unequal chest expansion, decreased or absent tactile fremitus,
tracheal deviation to the unaffected side, decreased chest expansion, hyperresonnant percussion tones, and
decreased or absent breath sounds are found with the presence of a pneumothorax. (Bates, p 340)
The diameter of the PMI is approximately:
A) 1-2.5 cm in diameter and any larger is evidence of mitral valve prolapse
B) 1-2.5 cm in diameter and any larger is evidence of left ventricular hypertrophy
C) .5-1 cm in diameter and any larger is evidence supporting left ventricular hypertrophy
D) .5-1 cm in diameter and any larger is evidence of mitral valve prolapse - Correct Answer :B) 1-2.5 cm in
diameter and any larger is evidence of left ventricular hypertrophy
(Bates p 344)
The direction of blood flow through the heart is best described by which of the following?
A) Aorta - R atrium - R ventricle - lungs - pulmonary vein - L atrium - L ventricle - vena cava
B) R atrium - R ventricle - pulmonary vein - lungs - pulmonary artery - L atrium - L ventricle
C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle
D) Vena cava - R atrium - R ventricle - lungs - pulmonary artery- L atrium - L ventricle –
Correct Answer :C) R atrium - R ventricle - pulmonary artery - lungs - pulmonary vein - L atrium - L ventricle
Returning blood from the body empties into the R atrium and flows into the R ventricle, then goes to the lungs
through the pulmonary artery. The lungs oxygenate the blood and it is then returned to the L atrium by the
pulmonary vein. It goes from there to the L ventricle and then out to the body through the aorta (Bates, pg 345)
When listening to heart sounds, the nurse knows that the valve closures that can be heard for S2 is:
A) pulmonic
P 2
, • NURS 190 PA 09/16/2026
Midterm
B) aortic
C) tricuspid
D) mitral - Correct Answer :B) aortic
The second heart sound (S2) occurs with the closure of the aortic valve and signals the end of systole. Although
it is heard over all the precordium, S2 is loudest at the base of the heart. (Bates, p347)
A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having
difficulty sleeping. "I'll be sleeping great and then I wake up and feel like I can't catch my breath." His symptoms
indicates sleep related symptoms of a certain type of disease, so which question would the NP want to ask?
A) Have you had a recent sinus infection or URI?
B) Do you have any history of problems with your heart?
C) Do you think it is because it's been so hot at night?
D) When was your last electroencephalogram? - Correct Answer :B) Do you have any history of problems with
your heart?
Paroxysmal nocturnal dyspnea occurs with heart failure. Lying down increases volume of intrathoracic blood,
and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours
of sleep, arises, and flings open a window with the perception of needing fresh air. (Bates, p357)
In assessing a patient's major risk factors for heart disease, which would the nurse want to include when taking a
history?
A) Personality type, high cholesterol, diabetes, smoking
B) Family history, hypertension, stress, age
C) Alcohol consumption, obesity, diabetes, stress, high cholesterol
D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history –
Correct Answer :D) Smoking, hypertension, obesity, diabetes, and high cholesterol, activity level, family history
For major risk factors for coronary artery disease, collect data regarding elevated serum cholesterol, elevated
blood pressure, blood glucose levels above 130 mg/dL or known diabetes mellitus, obesity, cigarette smoking,
low activity level (Bates, p358)
P 3
, • NURS 190 PA 09/16/2026
Midterm
In assessing the carotid arteries of an older patient with cardiovascular disease, the nurse would:
A) palpate the artery in the upper one third of the neck.
B) listen with the bell of the stethoscope to assess for bruits.
C) palpate both arteries simultaneously to compare amplitude.
D) instruct the patient to take slow deep breaths during inspiration. –
Correct Answer :B) listen with the bell of the stethoscope to assess for bruits.
If cardiovascular disease is suspected, the nurse should auscultate each carotid artery for the presence of a bruit.
The NP should avoid compressing the artery because this could create an artificial bruit, and it could compromise
circulation if the carotid artery is already narrowed by atherosclerosis. Avoid excessive pressure on the carotid
sinus area higher in the neck; excessive vagal stimulation here could slow down the heart rate, especially in older
adults. Palpate only one carotid artery at a time to avoid compromising arterial blood to the brain. The bell of the
stethoscope is best for picking up bruits. The diaphragm is more attuned to relatively high-pitched sounds; the
bell is more sensitive to low-pitched sounds like bruits. (Bates, 381)
All of the following are true about assessing the jugular venous pressure EXCEPT:
A) The jugular venous pressure is affected by changes in the right atrial filling.
B) The pulsation from the internal jugular vein reflects the left ventricle pressure.
C) The jugular venous pressure is determined by the highest point of oscillation in the internal jugular vein.
D) The jugular venous pressure is considered abnormal if it is greater than 4 cm above the sternal angle or
greater than 9 cm above the right atrium.
- Correct Answer :B) The pulsation from the internal jugular vein reflects the left ventricle pressure.
The jugular venous pressure is affected by changes in R atrial filling. The JVP is abnormal at a height greater than
4 cm and is determined by the highest point of oscillation. The pulsation from the internal jugular vein is not
palpable. (Bates, p354-355)
During an assessment of a healthy adult, where would the nurse expect to palpate the apical impulse?
P 4
