MSN572 Advanced Health & Physical Assessment - Midterm Exam Review

MSN572

Advanced Health & Physical
Assessment

Final Exam Review

(Questions & Solutions)

2025




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, I. Multiple Choice Questions

Question 1
Case Scenario: A 3‑day‑old preterm neonate in the NICU demonstrates
increased work of breathing with nasal flaring and subcostal retractions.
During auscultation, you note fine crackles bilaterally with diminished air
entry.
Question: Which finding best supports the diagnosis of neonatal
respiratory distress syndrome secondary to surfactant deficiency?
- A) Diffuse wheezing throughout both lung fields
- B) Fine crackles with decreased air entry
- C) Inspiratory stridor
- D) Bronchial breath sounds over unilateral lung fields

Correct ANS: B
Rationale: In surfactant deficiency, typical in preterm infants,
diminished lung compliance leads to atelectasis with fine crackles and
decreased air entry. Wheezing or stridor are more consistent with airway
narrowing rather than alveolar instability.

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Question 2
Case Scenario: A 5‑year‑old child undergoing a comprehensive
cardiovascular assessment is noted to have a harsh systolic murmur best
heard at the left upper sternal border. The murmur decreases in intensity
when the child squats.
Question: Which congenital cardiac condition is most consistent with
this murmur behavior?
- A) Ventricular septal defect
- B) Atrial septal defect
- C) Tetralogy of Fallot
- D) Patent ductus arteriosus
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, Correct ANS: C
Rationale: In Tetralogy of Fallot, increasing afterload by squatting
reduces right ventricular outflow tract obstruction, thereby diminishing
the murmur's intensity. This dynamic change helps distinguish it from
defects like VSDs.

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Question 3
Case Scenario: A 35‑year‑old adult is evaluated for chest pain. During
the cardiovascular assessment, you note diminished and delayed pulses
in one upper extremity compared to the other.
Question: Which physical exam finding is most concerning for aortic
dissection?
- A) Bilateral equal pulses
- B) A pulse deficit between upper extremities
- C) Regular, strong peripheral pulses
- D) Presence of a third heart sound

Correct ANS: B
Rationale: A pulse deficit, especially when asymmetric blood pressures
are detected between the arms, is a classic indicator of aortic dissection
and warrants urgent further evaluation.

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Question 4
Case Scenario: A 50‑year‑old diabetic patient presents with foot ulcers
during a comprehensive examination. On assessment, you note
diminished pedal pulses and reduced peripheral sensation.
Question: Which assessment method is most appropriate to evaluate
peripheral arterial disease in this patient?
- A) Capillary refill time
- B) Palpation of dorsalis pedis pulses only
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, - C) Ankle‑brachial index (ABI) measurement
- D) Auscultation for vascular bruits

Correct ANS: C
Rationale: The Ankle‑Brachial Index is a reliable, noninvasive technique
for assessing the extent of peripheral arterial disease, especially in
diabetic patients where vascular compromise is common.

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Question 5
Case Scenario: During a health assessment of a 65‑year‑old patient, you
perform a detailed neurological exam and identify a stocking‑glove
distribution of decreased sensation.
Question: Which underlying condition is most commonly associated
with this finding?
- A) Chronic hypertension
- B) Diabetes mellitus
- C) Hyperthyroidism
- D) Peripheral vascular disease

Correct ANS: B
Rationale: Diabetes mellitus is a leading cause of peripheral
neuropathy, characterized by a symmetric sensory loss in a
stocking‑glove distribution.

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Question 6
Case Scenario: A 40‑year‑old woman with known asthma presents for
an assessment during an exacerbation. You note the use of accessory
muscles along with diffuse wheezing and a markedly prolonged
expiratory phase.
Question: Which additional finding would most likely be present in an
acute asthma exacerbation?
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