NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
NURS 5220 Exam 2 (2026/2027)
Advanced Health Assessment | UTA Graduate Nursing
This comprehensive exam contains 110 multiple-choice questions spanning the nine core domains of NURS
5220 Exam 2 (Advanced Health Assessment), calibrated to the 2026/2027 academic cycle at the University of
Texas at Arlington. Each question is labeled with a competency tag (e.g., Cardiovascular – S3 Heart Sound) and
a cognitive level (Recall, Application, Analysis) so that you can target review efficiently. The cognitive
distribution is approximately 30% recall, 50% application, and 20% analysis, mirroring the structure of a
graduate-level advanced health assessment midterm. Approximately 75% of items are scenario-based and 25%
test direct recall of assessment techniques and findings. Each rationale doubles as study content: it explains why
the correct answer is correct and why each distractor is wrong, including assessment technique rationale, normal
vs. abnormal findings, and clinical significance. Use this document as a self-assessment, then return to the
rationales for targeted study.
How to use this exam:
1. Answer all 110 questions before consulting the rationales to simulate exam conditions.
2. After completing, review rationales for items you missed; pay attention to the assessment technique, normal vs.
abnormal findings, and clinical significance flagged in the rationale.
3. Watch for commonly confused pairs: S1 vs. S2 vs. S3 vs. S4, crackles vs. wheezes vs. rhonchi, arterial vs.
venous insufficiency, and upper vs. lower motor neuron signs.
4. Each section heading below lists the competencies covered for targeted review.
Section 1: Advanced Cardiovascular Assessment
Heart Sounds, Murmurs, JVD, & Peripheral Vascular (Q1–Q16)
Competencies covered: S1–S4 Identification; Systolic vs. Diastolic Murmurs; Thrills & Heaves; JVP
Measurement; Arterial vs. Venous Insufficiency; Edema Grading; Peripheral Pulses.
Q1. [Cardiovascular – S1 vs. S2] Cognitive: Recall
Which statement correctly distinguishes S1 from S2 heart sounds?
A. S1 is caused by closure of the semilunar valves and marks the beginning of diastole; S2 is caused by
closure of the AV valves and marks the beginning of systole
B. S1 is caused by closure of the mitral and tricuspid (AV) valves and marks the beginning of
systole; S2 is caused by closure of the aortic and pulmonic (semilunar) valves and marks the
beginning of diastole [CORRECT]
C. S1 is always louder than S2 at the apex; S2 is always louder than S1 at the base
D. S1 is best heard at the second intercostal space right sternal border; S2 is best heard at the apex
Correct Answer: B
Rationale: S1 ("lub") results from closure of the mitral and tricuspid (AV) valves and signals the onset of systole. S2
("dub") results from closure of the aortic and pulmonic (semilunar) valves and signals the onset of diastole. Option A
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,NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
reverses the valves and phases. Option C is a partial truth but not the defining distinction. Option D mislocates the
auscultation sites: the aortic area is at 2nd ICS RSB; the apex is the mitral area where S1 is typically loudest.
Q2. [Cardiovascular – S3 Heart Sound] Cognitive: Application
A 68-year-old male with a history of hypertension presents with dyspnea on exertion and bilateral
crackles. Auscultation at the apex reveals a low-frequency sound immediately following S2, best
heard with the bell with the patient in the left lateral position. This sound is most consistent with:
A. A normal physiologic S3 in a healthy young adult
B. An S3 gallop indicative of increased ventricular filling pressure and probable heart failure
[CORRECT]
C. A pericardial friction rub
D. A split S2
Correct Answer: B
Rationale: An S3 (ventricular gallop) occurs in early diastole, immediately after S2, and is caused by rapid ventricular
filling into a noncompliant, volume-overloaded ventricle. In a patient older than 40, an S3 strongly suggests heart
failure. A physiologic S3 may be normal in children and young adults (Option A) but is pathologic in older adults.
Pericardial friction rubs (Option C) have a leathery, three-component quality. A split S2 (Option D) is two
components of S2, not a third heart sound.
Q3. [Cardiovascular – S4 Heart Sound] Cognitive: Application
A 72-year-old with long-standing hypertension has a low-frequency sound just before S1, heard best
with the bell at the apex in the left lateral position. This finding most likely represents:
A. An S4 indicating a stiff, noncompliant left ventricle due to chronic hypertension [CORRECT]
B. An S3 indicating volume overload
C. A systolic ejection click
D. A diastolic murmur of mitral stenosis
Correct Answer: A
Rationale: An S4 occurs in late diastole, just before S1, due to atrial contraction pushing blood into a stiff,
hypertrophied, noncompliant ventricle. It is classic in chronic hypertension, aortic stenosis, and hypertrophic
cardiomyopathy. S3 (Option B) is in early diastole after S2 and reflects volume overload. Ejection clicks (Option C)
occur in early systole. Mitral stenosis (Option D) produces a diastolic rumble after an opening snap, not an S4.
Q4. [Cardiovascular – Systolic Murmurs] Cognitive: Application
A 75-year-old male has a crescendo-decrescendo systolic murmur heard best at the second right
intercostal space, radiating to the carotids. The murmur begins after S1 and ends before S2. What is
the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral valve prolapse
D. Aortic regurgitation
Correct Answer: B
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,NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
Rationale: A crescendo-decrescendo systolic murmur at the 2nd right ICS (aortic area) radiating to the carotids is the
classic auscultatory finding of aortic stenosis. The murmur of mitral regurgitation (A) is holosystolic, best heard at the
apex, radiating to the axilla. Mitral valve prolapse (C) has a mid-systolic click ± late systolic murmur. Aortic
regurgitation (D) is an early diastolic decrescendo murmur at the left sternal border.
Q5. [Cardiovascular – Diastolic Murmurs] Cognitive: Application
A 55-year-old with a history of rheumatic fever has a low-pitched diastolic rumble heard best at the
apex with the bell, with the patient in the left lateral position. An opening snap precedes the
murmur. This is most consistent with:
A. Mitral stenosis [CORRECT]
B. Aortic regurgitation
C. Pulmonic stenosis
D. Ventricular septal defect
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched diastolic rumble at the apex best heard with the bell in the left
lateral position, preceded by an opening snap. It is most often caused by rheumatic heart disease. Aortic regurgitation
(B) is a blowing early diastolic murmur at the left sternal border. Pulmonic stenosis (C) is a systolic murmur at the left
upper sternal border. VSD (D) produces a harsh holosystolic murmur at the left lower sternal border.
Q6. [Cardiovascular – Murmur Grading] Cognitive: Recall
A murmur described as "Grade 4/6" is characterized by:
A. A faint murmur heard only after patient leaning forward
B. A loud murmur with an associated palpable thrill [CORRECT]
C. A very soft murmur heard only in a quiet room
D. A murmur that can be heard with the stethoscope just off the chest wall
Correct Answer: B
Rationale: Murmurs are graded 1/6 (very faint, may be missed) through 6/6 (audible with stethoscope off the chest).
A grade 4/6 murmur is loud and accompanied by a palpable thrill — the defining feature separating grades 4–6 from
grades 1–3. Grade 1/6 (Option A and C) is faint; grade 6/6 (Option D) is audible with the stethoscope off the chest.
Q7. [Cardiovascular – Thrills] Cognitive: Recall
A thrill on precordial palpation is defined as:
A. A diffuse, gentle outward movement of the precordium during systole
B. A palpable vibration accompanying a loud murmur, indicating turbulence of grade 4/6 or higher
[CORRECT]
C. A palpable impulse at the apex measuring less than 2 cm in diameter
D. A substernal impulse that decreases with inspiration
Correct Answer: B
Rationale: A thrill is a palpable vibratory sensation felt over the precordium that corresponds to a loud (≥ grade 4/6)
murmur, analogous to feeling a purring cat. It indicates significant turbulence. Option A describes a heave (sustained
lift). Option C describes a normal point of maximal impulse (PMI). Option D is not a standard precordial finding.
Q8. [Cardiovascular – JVD Measurement] Cognitive: Application
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, NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
When assessing jugular venous pressure (JVP), the patient is positioned at a 30–45 degree angle
with the head turned slightly away. The top of the venous pulsation is identified and measured
vertically above the sternal angle. Which measurement is the upper limit of normal JVP?
A. 1 cm above the sternal angle
B. 3–4 cm above the sternal angle [CORRECT]
C. 10 cm above the sternal angle
D. At the level of the earlobes
Correct Answer: B
Rationale: The sternal angle (angle of Louis) is approximately 5 cm above the right atrium regardless of patient
position. Normal JVP is ≤ 3–4 cm above the sternal angle, corresponding to a total venous pressure ≤ 8–9 cm H2O.
Values above 3–4 cm indicate elevated JVP, suggesting right-heart failure, volume overload, tricuspid regurgitation, or
pericardial disease. Option C is markedly elevated; Options A and D describe incorrect landmarks.
Q9. [Cardiovascular – JVD vs. Carotid Pulse] Cognitive: Analysis
While inspecting the neck, the examiner must distinguish jugular venous pulsations from carotid
arterial pulsations. Which feature most reliably indicates a venous pulsation?
A. A single, brisk, outward impulse that does not vary with position
B. A biphasic (two visible waves per heartbeat) pulsation that disappears when pressure is applied
lightly and varies with patient position [CORRECT]
C. A palpable, brisk tapping impulse that is unaffected by respiration
D. A pulsation that becomes more prominent when the patient sits upright
Correct Answer: B
Rationale: Jugular venous pulsations are biphasic (a and v waves), non-palpable, occludable with light pressure, and
vary with position and respiration. Carotid pulsations (A, C) are single, brisk, palpable, not occluded by light pressure,
and do not vary with position. Option D is wrong because JVP normally decreases when the patient sits upright; if JVP
rises with upright positioning, suspect elevated venous pressure.
Q10. [Cardiovascular – Peripheral Pulses] Cognitive: Application
A 65-year-old male with diabetes presents with absent dorsalis pedis and posterior tibial pulses in
the right foot, dependent rubor, and cool skin. The left foot has palpable pulses. These findings
suggest:
A. Acute venous thrombosis
B. Chronic arterial insufficiency [CORRECT]
C. Lymphedema
D. Peripheral neuropathy
Correct Answer: B
Rationale: Absent peripheral pulses, dependent rubor (redness when the foot is dependent), and cool skin are
hallmarks of chronic arterial insufficiency. Diabetes accelerates atherosclerosis and increases risk. Acute venous
thrombosis (A) presents with warmth and edema. Lymphedema (C) causes non-pitting edema without pulse changes.
Neuropathy (D) causes sensory changes but not pulse abnormalities.
Q11. [Cardiovascular – Arterial vs. Venous Insufficiency] Cognitive: Analysis
Page 4
NURS 5220 Exam 2 (2026/2027)
Advanced Health Assessment | UTA Graduate Nursing
This comprehensive exam contains 110 multiple-choice questions spanning the nine core domains of NURS
5220 Exam 2 (Advanced Health Assessment), calibrated to the 2026/2027 academic cycle at the University of
Texas at Arlington. Each question is labeled with a competency tag (e.g., Cardiovascular – S3 Heart Sound) and
a cognitive level (Recall, Application, Analysis) so that you can target review efficiently. The cognitive
distribution is approximately 30% recall, 50% application, and 20% analysis, mirroring the structure of a
graduate-level advanced health assessment midterm. Approximately 75% of items are scenario-based and 25%
test direct recall of assessment techniques and findings. Each rationale doubles as study content: it explains why
the correct answer is correct and why each distractor is wrong, including assessment technique rationale, normal
vs. abnormal findings, and clinical significance. Use this document as a self-assessment, then return to the
rationales for targeted study.
How to use this exam:
1. Answer all 110 questions before consulting the rationales to simulate exam conditions.
2. After completing, review rationales for items you missed; pay attention to the assessment technique, normal vs.
abnormal findings, and clinical significance flagged in the rationale.
3. Watch for commonly confused pairs: S1 vs. S2 vs. S3 vs. S4, crackles vs. wheezes vs. rhonchi, arterial vs.
venous insufficiency, and upper vs. lower motor neuron signs.
4. Each section heading below lists the competencies covered for targeted review.
Section 1: Advanced Cardiovascular Assessment
Heart Sounds, Murmurs, JVD, & Peripheral Vascular (Q1–Q16)
Competencies covered: S1–S4 Identification; Systolic vs. Diastolic Murmurs; Thrills & Heaves; JVP
Measurement; Arterial vs. Venous Insufficiency; Edema Grading; Peripheral Pulses.
Q1. [Cardiovascular – S1 vs. S2] Cognitive: Recall
Which statement correctly distinguishes S1 from S2 heart sounds?
A. S1 is caused by closure of the semilunar valves and marks the beginning of diastole; S2 is caused by
closure of the AV valves and marks the beginning of systole
B. S1 is caused by closure of the mitral and tricuspid (AV) valves and marks the beginning of
systole; S2 is caused by closure of the aortic and pulmonic (semilunar) valves and marks the
beginning of diastole [CORRECT]
C. S1 is always louder than S2 at the apex; S2 is always louder than S1 at the base
D. S1 is best heard at the second intercostal space right sternal border; S2 is best heard at the apex
Correct Answer: B
Rationale: S1 ("lub") results from closure of the mitral and tricuspid (AV) valves and signals the onset of systole. S2
("dub") results from closure of the aortic and pulmonic (semilunar) valves and signals the onset of diastole. Option A
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,NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
reverses the valves and phases. Option C is a partial truth but not the defining distinction. Option D mislocates the
auscultation sites: the aortic area is at 2nd ICS RSB; the apex is the mitral area where S1 is typically loudest.
Q2. [Cardiovascular – S3 Heart Sound] Cognitive: Application
A 68-year-old male with a history of hypertension presents with dyspnea on exertion and bilateral
crackles. Auscultation at the apex reveals a low-frequency sound immediately following S2, best
heard with the bell with the patient in the left lateral position. This sound is most consistent with:
A. A normal physiologic S3 in a healthy young adult
B. An S3 gallop indicative of increased ventricular filling pressure and probable heart failure
[CORRECT]
C. A pericardial friction rub
D. A split S2
Correct Answer: B
Rationale: An S3 (ventricular gallop) occurs in early diastole, immediately after S2, and is caused by rapid ventricular
filling into a noncompliant, volume-overloaded ventricle. In a patient older than 40, an S3 strongly suggests heart
failure. A physiologic S3 may be normal in children and young adults (Option A) but is pathologic in older adults.
Pericardial friction rubs (Option C) have a leathery, three-component quality. A split S2 (Option D) is two
components of S2, not a third heart sound.
Q3. [Cardiovascular – S4 Heart Sound] Cognitive: Application
A 72-year-old with long-standing hypertension has a low-frequency sound just before S1, heard best
with the bell at the apex in the left lateral position. This finding most likely represents:
A. An S4 indicating a stiff, noncompliant left ventricle due to chronic hypertension [CORRECT]
B. An S3 indicating volume overload
C. A systolic ejection click
D. A diastolic murmur of mitral stenosis
Correct Answer: A
Rationale: An S4 occurs in late diastole, just before S1, due to atrial contraction pushing blood into a stiff,
hypertrophied, noncompliant ventricle. It is classic in chronic hypertension, aortic stenosis, and hypertrophic
cardiomyopathy. S3 (Option B) is in early diastole after S2 and reflects volume overload. Ejection clicks (Option C)
occur in early systole. Mitral stenosis (Option D) produces a diastolic rumble after an opening snap, not an S4.
Q4. [Cardiovascular – Systolic Murmurs] Cognitive: Application
A 75-year-old male has a crescendo-decrescendo systolic murmur heard best at the second right
intercostal space, radiating to the carotids. The murmur begins after S1 and ends before S2. What is
the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral valve prolapse
D. Aortic regurgitation
Correct Answer: B
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,NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
Rationale: A crescendo-decrescendo systolic murmur at the 2nd right ICS (aortic area) radiating to the carotids is the
classic auscultatory finding of aortic stenosis. The murmur of mitral regurgitation (A) is holosystolic, best heard at the
apex, radiating to the axilla. Mitral valve prolapse (C) has a mid-systolic click ± late systolic murmur. Aortic
regurgitation (D) is an early diastolic decrescendo murmur at the left sternal border.
Q5. [Cardiovascular – Diastolic Murmurs] Cognitive: Application
A 55-year-old with a history of rheumatic fever has a low-pitched diastolic rumble heard best at the
apex with the bell, with the patient in the left lateral position. An opening snap precedes the
murmur. This is most consistent with:
A. Mitral stenosis [CORRECT]
B. Aortic regurgitation
C. Pulmonic stenosis
D. Ventricular septal defect
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched diastolic rumble at the apex best heard with the bell in the left
lateral position, preceded by an opening snap. It is most often caused by rheumatic heart disease. Aortic regurgitation
(B) is a blowing early diastolic murmur at the left sternal border. Pulmonic stenosis (C) is a systolic murmur at the left
upper sternal border. VSD (D) produces a harsh holosystolic murmur at the left lower sternal border.
Q6. [Cardiovascular – Murmur Grading] Cognitive: Recall
A murmur described as "Grade 4/6" is characterized by:
A. A faint murmur heard only after patient leaning forward
B. A loud murmur with an associated palpable thrill [CORRECT]
C. A very soft murmur heard only in a quiet room
D. A murmur that can be heard with the stethoscope just off the chest wall
Correct Answer: B
Rationale: Murmurs are graded 1/6 (very faint, may be missed) through 6/6 (audible with stethoscope off the chest).
A grade 4/6 murmur is loud and accompanied by a palpable thrill — the defining feature separating grades 4–6 from
grades 1–3. Grade 1/6 (Option A and C) is faint; grade 6/6 (Option D) is audible with the stethoscope off the chest.
Q7. [Cardiovascular – Thrills] Cognitive: Recall
A thrill on precordial palpation is defined as:
A. A diffuse, gentle outward movement of the precordium during systole
B. A palpable vibration accompanying a loud murmur, indicating turbulence of grade 4/6 or higher
[CORRECT]
C. A palpable impulse at the apex measuring less than 2 cm in diameter
D. A substernal impulse that decreases with inspiration
Correct Answer: B
Rationale: A thrill is a palpable vibratory sensation felt over the precordium that corresponds to a loud (≥ grade 4/6)
murmur, analogous to feeling a purring cat. It indicates significant turbulence. Option A describes a heave (sustained
lift). Option C describes a normal point of maximal impulse (PMI). Option D is not a standard precordial finding.
Q8. [Cardiovascular – JVD Measurement] Cognitive: Application
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, NURS 5220 Exam 2 (2026/2027) | Advanced Health Assessment | UTA Graduate Nursing
When assessing jugular venous pressure (JVP), the patient is positioned at a 30–45 degree angle
with the head turned slightly away. The top of the venous pulsation is identified and measured
vertically above the sternal angle. Which measurement is the upper limit of normal JVP?
A. 1 cm above the sternal angle
B. 3–4 cm above the sternal angle [CORRECT]
C. 10 cm above the sternal angle
D. At the level of the earlobes
Correct Answer: B
Rationale: The sternal angle (angle of Louis) is approximately 5 cm above the right atrium regardless of patient
position. Normal JVP is ≤ 3–4 cm above the sternal angle, corresponding to a total venous pressure ≤ 8–9 cm H2O.
Values above 3–4 cm indicate elevated JVP, suggesting right-heart failure, volume overload, tricuspid regurgitation, or
pericardial disease. Option C is markedly elevated; Options A and D describe incorrect landmarks.
Q9. [Cardiovascular – JVD vs. Carotid Pulse] Cognitive: Analysis
While inspecting the neck, the examiner must distinguish jugular venous pulsations from carotid
arterial pulsations. Which feature most reliably indicates a venous pulsation?
A. A single, brisk, outward impulse that does not vary with position
B. A biphasic (two visible waves per heartbeat) pulsation that disappears when pressure is applied
lightly and varies with patient position [CORRECT]
C. A palpable, brisk tapping impulse that is unaffected by respiration
D. A pulsation that becomes more prominent when the patient sits upright
Correct Answer: B
Rationale: Jugular venous pulsations are biphasic (a and v waves), non-palpable, occludable with light pressure, and
vary with position and respiration. Carotid pulsations (A, C) are single, brisk, palpable, not occluded by light pressure,
and do not vary with position. Option D is wrong because JVP normally decreases when the patient sits upright; if JVP
rises with upright positioning, suspect elevated venous pressure.
Q10. [Cardiovascular – Peripheral Pulses] Cognitive: Application
A 65-year-old male with diabetes presents with absent dorsalis pedis and posterior tibial pulses in
the right foot, dependent rubor, and cool skin. The left foot has palpable pulses. These findings
suggest:
A. Acute venous thrombosis
B. Chronic arterial insufficiency [CORRECT]
C. Lymphedema
D. Peripheral neuropathy
Correct Answer: B
Rationale: Absent peripheral pulses, dependent rubor (redness when the foot is dependent), and cool skin are
hallmarks of chronic arterial insufficiency. Diabetes accelerates atherosclerosis and increases risk. Acute venous
thrombosis (A) presents with warmth and edema. Lymphedema (C) causes non-pitting edema without pulse changes.
Neuropathy (D) causes sensory changes but not pulse abnormalities.
Q11. [Cardiovascular – Arterial vs. Venous Insufficiency] Cognitive: Analysis
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