NSG 500 Exam 2 Actual Exam V1 | NSG 500 Advanced Health
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. When assessing the jugular venous pressure (JVP), the nurse practitioner knows that a
persistent elevation is most indicative of which condition?
A. Left-sided heart failure
B. Mitral valve prolapse
C. Right-sided heart failure
D. Pulmonary fibrosis
Answer: C
Rationale: The jugular venous pressure reflects the pressure in the right atrium and is an
excellent clinical indicator of right ventricular function. An elevated JVP suggests that the
right side of the heart is struggling to pump blood effectively, leading to backup in the
systemic circulation. This finding is a hallmark of right-sided heart failure or fluid overload.
2. A 68-year-old patient presents with sudden onset of ‘ripping’ chest pain that radiates to
the back. Which condition should the clinician prioritize for immediate evaluation?
A. Myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pneumothorax
Answer: C
Rationale: Chest pain described as ‘ripping’ or ‘tearing’ that radiates to the back is highly
characteristic of an aortic dissection. This is a medical emergency that requires rapid
diagnosis with imaging such as a CT angiogram. Failure to identify this condition quickly
can lead to catastrophic consequences for the patient.
3. During cardiac auscultation, a low-pitched extra heart sound is heard in early diastole at
the apex using the bell of the stethoscope. This sound is most likely:
A. An S4 heart sound
B. An S3 heart sound
C. An ejection click
D. An opening snap
Answer: B
,Rationale: The S3 heart sound, also known as a ventricular gallop, occurs during the early
rapid filling phase of diastole. It is best heard at the apex with the patient in the left lateral
decubitus position using the bell. In older adults, an S3 often signifies heart failure or
volume overload.
4. A patient exhibits diminished breath sounds and dullness to percussion at the right lung
base. Which of the following is the most likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Simple pneumothorax
C. Acute bronchitis
D. Large pleural effusion
Answer: D
Rationale: Dullness to percussion is a sign that fluid or solid tissue has replaced air-filled
lung space. In the case of a pleural effusion, fluid accumulates in the pleural space,
dampening both sound and vibrations. This results in decreased tactile fremitus and
diminished breath sounds over the affected area.
5. Which physical exam finding is most consistent with a diagnosis of lobar pneumonia?
A. Hyperresonance on percussion
B. Increased tactile fremitus
C. Decreased tactile fremitus
D. Tracheal deviation to the opposite side
Answer: B
Rationale: Lobar pneumonia causes consolidation of the lung tissue with fluid and cells,
which conducts sound vibrations more efficiently. Therefore, tactile fremitus will be
increased over the area of consolidation during the physical exam. Clinicians should also
listen for bronchial breath sounds and crackles in the same region.
6. The nurse practitioner is assessing a patient’s peripheral pulses and notes a ‘weak and
thready’ pulse. This finding is typically associated with:
A. Shock or severe dehydration
B. Aortic regurgitation
C. Hypervolemia
D. Peripheral vascular disease
Answer: A
, Rationale: A weak or thready pulse (1+) indicates a low stroke volume or increased
peripheral resistance. This finding is commonly seen in patients experiencing shock, heart
failure, or severe volume depletion. It reflects the body’s inability to maintain a strong
arterial pressure wave.
7. A 55-year-old male smoker complains of pain in his calves when walking that is relieved by
rest. This symptom is known as:
A. Raynaud’s phenomenon
B. Venous insufficiency
C. Deep vein thrombosis
D. Intermittent claudication
Answer: D
Rationale: Intermittent claudication is the classic symptom of peripheral arterial disease
(PAD) resulting from muscle ischemia. The pain is triggered by activity because the
narrowed arteries cannot supply enough oxygenated blood to the muscles. The pain
typically resolves within minutes of stopping the activity.
8. During an exam, the NP asks the patient to say ‘ninety-nine’ while auscultating the lungs
and hears the words clearly and loudly. This is documented as:
A. Egophony
B. Whispered pectoriloquy
C. Bronchophony
D. Vesicular breathing
Answer: C
Rationale: Bronchophony occurs when spoken words are heard clearly through the
stethoscope rather than being muffled. This indicates that the underlying lung tissue is
consolidated, as in pneumonia. Normally, air-filled lungs filter out the higher frequencies of
speech, making the words sound faint and indistinct.
9. Which heart sound is associated with the ‘atrial kick’ and is heard just before S1?
A. S4
B. S3
C. S2
D. Summation gallop
Answer: A
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. When assessing the jugular venous pressure (JVP), the nurse practitioner knows that a
persistent elevation is most indicative of which condition?
A. Left-sided heart failure
B. Mitral valve prolapse
C. Right-sided heart failure
D. Pulmonary fibrosis
Answer: C
Rationale: The jugular venous pressure reflects the pressure in the right atrium and is an
excellent clinical indicator of right ventricular function. An elevated JVP suggests that the
right side of the heart is struggling to pump blood effectively, leading to backup in the
systemic circulation. This finding is a hallmark of right-sided heart failure or fluid overload.
2. A 68-year-old patient presents with sudden onset of ‘ripping’ chest pain that radiates to
the back. Which condition should the clinician prioritize for immediate evaluation?
A. Myocardial infarction
B. Pericarditis
C. Aortic dissection
D. Pneumothorax
Answer: C
Rationale: Chest pain described as ‘ripping’ or ‘tearing’ that radiates to the back is highly
characteristic of an aortic dissection. This is a medical emergency that requires rapid
diagnosis with imaging such as a CT angiogram. Failure to identify this condition quickly
can lead to catastrophic consequences for the patient.
3. During cardiac auscultation, a low-pitched extra heart sound is heard in early diastole at
the apex using the bell of the stethoscope. This sound is most likely:
A. An S4 heart sound
B. An S3 heart sound
C. An ejection click
D. An opening snap
Answer: B
,Rationale: The S3 heart sound, also known as a ventricular gallop, occurs during the early
rapid filling phase of diastole. It is best heard at the apex with the patient in the left lateral
decubitus position using the bell. In older adults, an S3 often signifies heart failure or
volume overload.
4. A patient exhibits diminished breath sounds and dullness to percussion at the right lung
base. Which of the following is the most likely diagnosis?
A. Chronic obstructive pulmonary disease
B. Simple pneumothorax
C. Acute bronchitis
D. Large pleural effusion
Answer: D
Rationale: Dullness to percussion is a sign that fluid or solid tissue has replaced air-filled
lung space. In the case of a pleural effusion, fluid accumulates in the pleural space,
dampening both sound and vibrations. This results in decreased tactile fremitus and
diminished breath sounds over the affected area.
5. Which physical exam finding is most consistent with a diagnosis of lobar pneumonia?
A. Hyperresonance on percussion
B. Increased tactile fremitus
C. Decreased tactile fremitus
D. Tracheal deviation to the opposite side
Answer: B
Rationale: Lobar pneumonia causes consolidation of the lung tissue with fluid and cells,
which conducts sound vibrations more efficiently. Therefore, tactile fremitus will be
increased over the area of consolidation during the physical exam. Clinicians should also
listen for bronchial breath sounds and crackles in the same region.
6. The nurse practitioner is assessing a patient’s peripheral pulses and notes a ‘weak and
thready’ pulse. This finding is typically associated with:
A. Shock or severe dehydration
B. Aortic regurgitation
C. Hypervolemia
D. Peripheral vascular disease
Answer: A
, Rationale: A weak or thready pulse (1+) indicates a low stroke volume or increased
peripheral resistance. This finding is commonly seen in patients experiencing shock, heart
failure, or severe volume depletion. It reflects the body’s inability to maintain a strong
arterial pressure wave.
7. A 55-year-old male smoker complains of pain in his calves when walking that is relieved by
rest. This symptom is known as:
A. Raynaud’s phenomenon
B. Venous insufficiency
C. Deep vein thrombosis
D. Intermittent claudication
Answer: D
Rationale: Intermittent claudication is the classic symptom of peripheral arterial disease
(PAD) resulting from muscle ischemia. The pain is triggered by activity because the
narrowed arteries cannot supply enough oxygenated blood to the muscles. The pain
typically resolves within minutes of stopping the activity.
8. During an exam, the NP asks the patient to say ‘ninety-nine’ while auscultating the lungs
and hears the words clearly and loudly. This is documented as:
A. Egophony
B. Whispered pectoriloquy
C. Bronchophony
D. Vesicular breathing
Answer: C
Rationale: Bronchophony occurs when spoken words are heard clearly through the
stethoscope rather than being muffled. This indicates that the underlying lung tissue is
consolidated, as in pneumonia. Normally, air-filled lungs filter out the higher frequencies of
speech, making the words sound faint and indistinct.
9. Which heart sound is associated with the ‘atrial kick’ and is heard just before S1?
A. S4
B. S3
C. S2
D. Summation gallop
Answer: A
