,D453 Advanced Nursing Skills Exam
Prep — Comprehensive Review +
Practice MCQs — Western Governors
University 2025/2026
1. A nurse is assessing cervical lymph nodes on an adult client. Which technique is most appropriate?
A. Apply firm, deep pressure using the palms
B. Use fingertips in gentle circular motions along the sternocleidomastoid muscles
C. Palpate only one side to avoid discomfort
D. Have the client hyperextend the neck during palpation
Correct Answer: B
Rationale: Cervical lymph node assessment requires gentle, circular palpation with the fingertips along the
sternocleidomastoid muscles. Firm pressure and hyperextension are inappropriate and may cause discomfort
or miss findings. Bilateral comparison is essential.
2. During auscultation of the chest, the nurse hears fine crackles in the bilateral lower lobes. What is the most
likely pathophysiologic cause?
A. Air trapping in small airways
B. Fluid accumulation in the alveoli
C. Constriction of the bronchial tubes
D. Pleural inflammation
,Correct Answer: B
Rationale: Fine crackles result from air passing through small airways containing fluid. Bilateral lower lobe
crackles are classic for pulmonary edema or pneumonia. Air trapping produces wheezing; pleural inflammation
produces friction rubs.
3. A client's pupils are unequal in size. What is the nurse's most appropriate initial action?
A. Immediately notify the provider of a neurological emergency
B. Document the finding and compare with previous assessments
C. Perform a complete neurological assessment and check for history of anisocoria
D. Apply artificial tears to the larger pupil
Correct Answer: C
Rationale: Anisocoria may be benign or pathological. The nurse should first complete a full neurological
assessment and determine whether the client has chronic anisocoria before assuming emergency. Only after
ruling out benign causes and identifying other deficits would notification be warranted.
4. A nurse identifies a grade III/VI systolic murmur at the right upper sternal border radiating to the carotids.
What does the Levine grading scale indicate about this murmur?
A. Barely audible
B. Soft but easily heard
C. Louder than normal heart sounds without a thrill
D. Associated with a palpable thrill
, Correct Answer: C
Rationale: Grade III murmurs are louder than normal heart sounds without a palpable thrill. Grade I is barely
audible; Grade II is soft but easily heard; Grade IV introduces a palpable thrill. Aortic stenosis classically
presents with a systolic murmur radiating to the carotids.
5. The nurse assesses an S3 gallop at the apex. What condition is most associated with this finding?
A. Pericardial tamponade
B. Heart failure exacerbation with volume overload
C. Aortic stenosis
D. Mitral valve prolapse
Correct Answer: B
Rationale: S3 is a low-frequency ventricular gallop heard immediately after S2 at the apex with the bell. It
occurs during rapid ventricular filling and is associated with volume overload and decreased left ventricular
systolic function, commonly in heart failure.
6. During a respiratory assessment, the nurse observes use of accessory muscles and nasal flaring. What is the
priority interpretation?
A. Normal finding in adults
B. Increased work of breathing requiring immediate intervention
C. Expected finding in clients with COPD
D. Sign of anxiety requiring reassurance
Prep — Comprehensive Review +
Practice MCQs — Western Governors
University 2025/2026
1. A nurse is assessing cervical lymph nodes on an adult client. Which technique is most appropriate?
A. Apply firm, deep pressure using the palms
B. Use fingertips in gentle circular motions along the sternocleidomastoid muscles
C. Palpate only one side to avoid discomfort
D. Have the client hyperextend the neck during palpation
Correct Answer: B
Rationale: Cervical lymph node assessment requires gentle, circular palpation with the fingertips along the
sternocleidomastoid muscles. Firm pressure and hyperextension are inappropriate and may cause discomfort
or miss findings. Bilateral comparison is essential.
2. During auscultation of the chest, the nurse hears fine crackles in the bilateral lower lobes. What is the most
likely pathophysiologic cause?
A. Air trapping in small airways
B. Fluid accumulation in the alveoli
C. Constriction of the bronchial tubes
D. Pleural inflammation
,Correct Answer: B
Rationale: Fine crackles result from air passing through small airways containing fluid. Bilateral lower lobe
crackles are classic for pulmonary edema or pneumonia. Air trapping produces wheezing; pleural inflammation
produces friction rubs.
3. A client's pupils are unequal in size. What is the nurse's most appropriate initial action?
A. Immediately notify the provider of a neurological emergency
B. Document the finding and compare with previous assessments
C. Perform a complete neurological assessment and check for history of anisocoria
D. Apply artificial tears to the larger pupil
Correct Answer: C
Rationale: Anisocoria may be benign or pathological. The nurse should first complete a full neurological
assessment and determine whether the client has chronic anisocoria before assuming emergency. Only after
ruling out benign causes and identifying other deficits would notification be warranted.
4. A nurse identifies a grade III/VI systolic murmur at the right upper sternal border radiating to the carotids.
What does the Levine grading scale indicate about this murmur?
A. Barely audible
B. Soft but easily heard
C. Louder than normal heart sounds without a thrill
D. Associated with a palpable thrill
, Correct Answer: C
Rationale: Grade III murmurs are louder than normal heart sounds without a palpable thrill. Grade I is barely
audible; Grade II is soft but easily heard; Grade IV introduces a palpable thrill. Aortic stenosis classically
presents with a systolic murmur radiating to the carotids.
5. The nurse assesses an S3 gallop at the apex. What condition is most associated with this finding?
A. Pericardial tamponade
B. Heart failure exacerbation with volume overload
C. Aortic stenosis
D. Mitral valve prolapse
Correct Answer: B
Rationale: S3 is a low-frequency ventricular gallop heard immediately after S2 at the apex with the bell. It
occurs during rapid ventricular filling and is associated with volume overload and decreased left ventricular
systolic function, commonly in heart failure.
6. During a respiratory assessment, the nurse observes use of accessory muscles and nasal flaring. What is the
priority interpretation?
A. Normal finding in adults
B. Increased work of breathing requiring immediate intervention
C. Expected finding in clients with COPD
D. Sign of anxiety requiring reassurance
