NSG 500 Exam 2 Actual Exam V3 | NSG 500 Advanced Health
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. A 72-year-old male patient presents with complaints of exertional chest pain and
occasional syncope. During auscultation, you note a harsh, crescendo-decrescendo systolic
murmur at the second right intercostal space that radiates to the carotid arteries. What is the
most likely clinical finding?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Pulmonic Stenosis
D. Aortic Regurgitation
Answer: A
Rationale: The description of a harsh systolic crescendo-decrescendo murmur at the right
second intercostal space is classic for aortic stenosis. This condition often leads to
symptoms such as angina and syncope due to decreased cardiac output and left ventricular
outflow obstruction. Radiation to the carotids further supports the diagnosis of a stenotic
aortic valve.
2. When assessing an 80-year-old female, the nurse practitioner notes an increase in the
anteroposterior (AP) diameter of the chest, resulting in a barrel-shaped appearance. Which of
the following is the most likely cause of this finding in the absence of chronic lung disease?
A. Increased elasticity of the alveoli
B. Weakening of the diaphragm muscle
C. Hyperinflation due to acute bacterial pneumonia
D. Loss of skeletal muscle strength and calcification of costal cartilages
Answer: D
Rationale: As part of the normal aging process, the costal cartilages become calcified and
less mobile, which can lead to a slight increase in the AP diameter. This change, combined
with age-related kyphosis and loss of muscle strength, creates a barrel-chest appearance. It
is important to distinguish this normal physiological change from the hyperinflation seen
in obstructive lung diseases like COPD.
3. A patient presents with sudden onset of shortness of breath and pleuritic chest pain. Upon
physical examination, the clinician finds decreased tactile fremitus and hyperresonance on
percussion over the left lower lobe. These findings are most suggestive of:
A. Lobar Pneumonia
,B. Pleural Effusion
C. Pulmonary Edema
D. Pneumothorax
Answer: D
Rationale: Hyperresonance on percussion indicates an excess of air within the pleural
space or lung tissue, which is characteristic of a pneumothorax. Decreased tactile fremitus
occurs because the air in the pleural space acts as a barrier to sound vibrations from the
lung to the chest wall. In contrast, pneumonia would typically present with dullness on
percussion and increased tactile fremitus due to consolidation.
4. During a cardiovascular assessment, the clinician observes a visible double impulse on the
chest wall and a displaced Point of Maximal Impulse (PMI) to the left 6th intercostal space at
the anterior axillary line. This most likely indicates:
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy or dilation
C. Normal cardiac positioning
D. Pericardial effusion
Answer: B
Rationale: The Point of Maximal Impulse is normally found at the 5th intercostal space at
the midclavicular line. Displacement of the PMI laterally and inferiorly is a strong clinical
indicator of left ventricular enlargement or dilation. This finding often correlates with
conditions such as chronic hypertension or congestive heart failure.
5. While performing a respiratory assessment on a patient with suspected pneumonia, the
clinician asks the patient to say ‘EEEEE’ while auscultating the lungs. The clinician hears
‘AAAAA’ through the stethoscope. This finding is known as:
A. Egophony
B. Whispered Pectoriloquy
C. Bronchophony
D. Tactile Fremitus
Answer: A
Rationale: Egophony is a physical exam finding where the spoken ‘E’ sound is heard as an
‘A’ sound through the stethoscope over areas of consolidated lung tissue. This occurs
because sound travels better through solid or fluid-filled media than through air. It is a
highly specific sign for pneumonia or pulmonary consolidation.
, 6. A 55-year-old smoker with a history of hypertension presents with ‘cramping’ in his calves
that occurs after walking two blocks and is relieved by rest. What is the most appropriate
next step in the physical examination?
A. Perform the Homan’s sign test
B. Check for the presence of a Murphy’s sign
C. Evaluate for the presence of pitting edema
D. Calculate the Ankle-Brachial Index (ABI)
Answer: D
Rationale: Intermittent claudication is a classic symptom of Peripheral Artery Disease
(PAD), characterized by pain induced by exercise and relieved by rest. The Ankle-Brachial
Index is the standard non-invasive diagnostic test to screen for and assess the severity of
PAD. Given the patient’s risk factors of smoking and hypertension, checking the ABI is the
most appropriate clinical step.
7. The clinician is auscultating the heart sounds of a 22-year-old athlete and notes a low-
pitched sound early in diastole, immediately following S2. The sound disappears when the
patient stands up. This sound is likely:
A. An ejection click
B. A pathological S4
C. A physiological S3
D. A friction rub
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, can be a physiological finding in
children, young adults, and athletes. It occurs during the rapid filling phase of diastole and
is usually heard best at the apex. Because it can also be a sign of heart failure in older
adults, the clinical context and the disappearance of the sound with position changes help
confirm its physiological nature.
8. To correctly measure Jugular Venous Distension (JVD), the head of the bed should be at
what angle, and what is the maximum normal vertical distance from the sternal angle?
A. 0 degrees; 5 cm
B. 30 to 45 degrees; 3 cm
C. 90 degrees; 2 cm
D. 30 to 45 degrees; 5 cm
Answer: B
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. A 72-year-old male patient presents with complaints of exertional chest pain and
occasional syncope. During auscultation, you note a harsh, crescendo-decrescendo systolic
murmur at the second right intercostal space that radiates to the carotid arteries. What is the
most likely clinical finding?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Pulmonic Stenosis
D. Aortic Regurgitation
Answer: A
Rationale: The description of a harsh systolic crescendo-decrescendo murmur at the right
second intercostal space is classic for aortic stenosis. This condition often leads to
symptoms such as angina and syncope due to decreased cardiac output and left ventricular
outflow obstruction. Radiation to the carotids further supports the diagnosis of a stenotic
aortic valve.
2. When assessing an 80-year-old female, the nurse practitioner notes an increase in the
anteroposterior (AP) diameter of the chest, resulting in a barrel-shaped appearance. Which of
the following is the most likely cause of this finding in the absence of chronic lung disease?
A. Increased elasticity of the alveoli
B. Weakening of the diaphragm muscle
C. Hyperinflation due to acute bacterial pneumonia
D. Loss of skeletal muscle strength and calcification of costal cartilages
Answer: D
Rationale: As part of the normal aging process, the costal cartilages become calcified and
less mobile, which can lead to a slight increase in the AP diameter. This change, combined
with age-related kyphosis and loss of muscle strength, creates a barrel-chest appearance. It
is important to distinguish this normal physiological change from the hyperinflation seen
in obstructive lung diseases like COPD.
3. A patient presents with sudden onset of shortness of breath and pleuritic chest pain. Upon
physical examination, the clinician finds decreased tactile fremitus and hyperresonance on
percussion over the left lower lobe. These findings are most suggestive of:
A. Lobar Pneumonia
,B. Pleural Effusion
C. Pulmonary Edema
D. Pneumothorax
Answer: D
Rationale: Hyperresonance on percussion indicates an excess of air within the pleural
space or lung tissue, which is characteristic of a pneumothorax. Decreased tactile fremitus
occurs because the air in the pleural space acts as a barrier to sound vibrations from the
lung to the chest wall. In contrast, pneumonia would typically present with dullness on
percussion and increased tactile fremitus due to consolidation.
4. During a cardiovascular assessment, the clinician observes a visible double impulse on the
chest wall and a displaced Point of Maximal Impulse (PMI) to the left 6th intercostal space at
the anterior axillary line. This most likely indicates:
A. Right ventricular hypertrophy
B. Left ventricular hypertrophy or dilation
C. Normal cardiac positioning
D. Pericardial effusion
Answer: B
Rationale: The Point of Maximal Impulse is normally found at the 5th intercostal space at
the midclavicular line. Displacement of the PMI laterally and inferiorly is a strong clinical
indicator of left ventricular enlargement or dilation. This finding often correlates with
conditions such as chronic hypertension or congestive heart failure.
5. While performing a respiratory assessment on a patient with suspected pneumonia, the
clinician asks the patient to say ‘EEEEE’ while auscultating the lungs. The clinician hears
‘AAAAA’ through the stethoscope. This finding is known as:
A. Egophony
B. Whispered Pectoriloquy
C. Bronchophony
D. Tactile Fremitus
Answer: A
Rationale: Egophony is a physical exam finding where the spoken ‘E’ sound is heard as an
‘A’ sound through the stethoscope over areas of consolidated lung tissue. This occurs
because sound travels better through solid or fluid-filled media than through air. It is a
highly specific sign for pneumonia or pulmonary consolidation.
, 6. A 55-year-old smoker with a history of hypertension presents with ‘cramping’ in his calves
that occurs after walking two blocks and is relieved by rest. What is the most appropriate
next step in the physical examination?
A. Perform the Homan’s sign test
B. Check for the presence of a Murphy’s sign
C. Evaluate for the presence of pitting edema
D. Calculate the Ankle-Brachial Index (ABI)
Answer: D
Rationale: Intermittent claudication is a classic symptom of Peripheral Artery Disease
(PAD), characterized by pain induced by exercise and relieved by rest. The Ankle-Brachial
Index is the standard non-invasive diagnostic test to screen for and assess the severity of
PAD. Given the patient’s risk factors of smoking and hypertension, checking the ABI is the
most appropriate clinical step.
7. The clinician is auscultating the heart sounds of a 22-year-old athlete and notes a low-
pitched sound early in diastole, immediately following S2. The sound disappears when the
patient stands up. This sound is likely:
A. An ejection click
B. A pathological S4
C. A physiological S3
D. A friction rub
Answer: C
Rationale: An S3 heart sound, or ventricular gallop, can be a physiological finding in
children, young adults, and athletes. It occurs during the rapid filling phase of diastole and
is usually heard best at the apex. Because it can also be a sign of heart failure in older
adults, the clinical context and the disappearance of the sound with position changes help
confirm its physiological nature.
8. To correctly measure Jugular Venous Distension (JVD), the head of the bed should be at
what angle, and what is the maximum normal vertical distance from the sternal angle?
A. 0 degrees; 5 cm
B. 30 to 45 degrees; 3 cm
C. 90 degrees; 2 cm
D. 30 to 45 degrees; 5 cm
Answer: B
