NSG 500 Exam 2 Actual Exam V2 | NSG 500 Advanced Health
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. A 68-year-old male presents with increasing dyspnea on exertion. Upon examination of the
neck, you estimate the jugular venous pressure (JVP) to be 6 cm above the sternal angle.
What is the most likely clinical significance of this finding?
A. Normal central venous pressure
B. Elevated right atrial pressure
C. Hypovolemic state
D. Superior vena cava obstruction
Answer: B
Rationale: A JVP measured at 6 cm above the sternal angle is considered elevated, as the
normal threshold is typically 3 to 4 cm. This elevation suggests increased pressure in the
right atrium, which is commonly associated with right-sided heart failure or fluid overload.
Assessing the JVP provides a non-invasive estimate of central venous pressure and is a
critical component of the cardiovascular examination.
2. While auscultating the heart of a 45-year-old female, you hear a mid-systolic click followed
by a late systolic murmur at the apex. Which valvular condition is most consistent with these
findings?
A. Mitral valve prolapse
B. Aortic stenosis
C. Mitral regurgitation
D. Tricuspid stenosis
Answer: A
Rationale: The presence of a mid-systolic click is the hallmark clinical sign of mitral valve
prolapse. The subsequent late systolic murmur indicates that regurgitation is occurring
after the valve leaflets have prolapsed into the left atrium. This finding is best heard at the
apex and can vary with positional changes like standing or squatting.
3. During a respiratory assessment of a patient with suspected lobar pneumonia, you perform
tactile fremitus. What result do you expect to find over the affected area?
A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Absent tactile fremitus
,D. Normal tactile fremitus
Answer: A
Rationale: Tactile fremitus is increased over areas of lung consolidation, such as in lobar
pneumonia, because sound waves travel better through solid or fluid-filled medium than
through air. In contrast, conditions that increase the space between the lung and the chest
wall, like a pneumothorax, would decrease fremitus. The clinician should compare
symmetrical areas of the chest to identify these localized changes.
4. You are evaluating a 72-year-old smoker with a history of COPD. Percussion over the lung
fields reveals hyperresonance. This finding is most likely due to:
A. Fluid in the pleural space
B. Lung tissue consolidation
C. Alveolar air trapping
D. A large pulmonary tumor
Answer: C
Rationale: Hyperresonance is a lower-pitched, booming sound produced when there is an
abnormal increase in the amount of air within the lungs. This is a classic finding in patients
with emphysema or chronic obstructive pulmonary disease due to alveolar air trapping
and hyperinflation. Normal lung tissue typically produces a resonant sound during
percussion.
5. When performing the Allen test on a patient before radial artery cannulation, you observe
that the palm remains pale for 15 seconds after releasing the ulnar artery. How should you
interpret this?
A. The test is positive, and the radial artery is safe to use.
B. The test is negative, indicating adequate collateral circulation.
C. The test is inconclusive and should be repeated on the other hand.
D. The test is positive, indicating inadequate collateral circulation.
Answer: D
Rationale: A positive Allen test occurs when the color does not return to the hand within 5
to 10 seconds, suggesting that the ulnar artery does not provide sufficient collateral
circulation. This finding indicates a high risk for ischemia if the radial artery is cannulated
or damaged. The clinician must choose a different site for the procedure to ensure hand
perfusion is maintained.
, 6. A patient complains of calf pain that occurs during walking and is relieved by rest. On
examination, the skin of the lower legs is cool and pale, with diminished pedal pulses. What is
the most likely diagnosis?
A. Venous insufficiency
B. Deep vein thrombosis
C. Peripheral arterial disease
D. Lymphedema
Answer: C
Rationale: Intermittent claudication, characterized by pain during activity that resolves
with rest, is a primary symptom of peripheral arterial disease (PAD). Physical findings such
as coolness, pallor, and weakened pulses further support the diagnosis of arterial
insufficiency. In contrast, venous insufficiency usually presents with edema, brownish
discoloration, and aching pain.
7. While auscultating the lungs, you hear a high-pitched, musical sound primarily during
expiration. This sound is best described as:
A. Crackles
B. Stridor
C. Rhonchi
D. Wheezes
Answer: D
Rationale: Wheezes are continuous, high-pitched musical sounds produced as air flows
through narrowed or obstructed small airways. They are most commonly heard during
expiration but can also occur during inspiration in severe cases. This finding is frequently
associated with conditions like asthma and chronic bronchitis.
8. A 55-year-old patient with a history of hypertension presents for a routine check-up. You
detect a soft, low-pitched sound early in diastole at the apex using the bell of the
stethoscope. This is likely:
A. An S3 gallop
B. An S4 gallop
C. An opening snap
D. An ejection click
Answer: A
Assessment (NSG500 Exam 2) [PDF] | Wilkes University
1. A 68-year-old male presents with increasing dyspnea on exertion. Upon examination of the
neck, you estimate the jugular venous pressure (JVP) to be 6 cm above the sternal angle.
What is the most likely clinical significance of this finding?
A. Normal central venous pressure
B. Elevated right atrial pressure
C. Hypovolemic state
D. Superior vena cava obstruction
Answer: B
Rationale: A JVP measured at 6 cm above the sternal angle is considered elevated, as the
normal threshold is typically 3 to 4 cm. This elevation suggests increased pressure in the
right atrium, which is commonly associated with right-sided heart failure or fluid overload.
Assessing the JVP provides a non-invasive estimate of central venous pressure and is a
critical component of the cardiovascular examination.
2. While auscultating the heart of a 45-year-old female, you hear a mid-systolic click followed
by a late systolic murmur at the apex. Which valvular condition is most consistent with these
findings?
A. Mitral valve prolapse
B. Aortic stenosis
C. Mitral regurgitation
D. Tricuspid stenosis
Answer: A
Rationale: The presence of a mid-systolic click is the hallmark clinical sign of mitral valve
prolapse. The subsequent late systolic murmur indicates that regurgitation is occurring
after the valve leaflets have prolapsed into the left atrium. This finding is best heard at the
apex and can vary with positional changes like standing or squatting.
3. During a respiratory assessment of a patient with suspected lobar pneumonia, you perform
tactile fremitus. What result do you expect to find over the affected area?
A. Increased tactile fremitus
B. Decreased tactile fremitus
C. Absent tactile fremitus
,D. Normal tactile fremitus
Answer: A
Rationale: Tactile fremitus is increased over areas of lung consolidation, such as in lobar
pneumonia, because sound waves travel better through solid or fluid-filled medium than
through air. In contrast, conditions that increase the space between the lung and the chest
wall, like a pneumothorax, would decrease fremitus. The clinician should compare
symmetrical areas of the chest to identify these localized changes.
4. You are evaluating a 72-year-old smoker with a history of COPD. Percussion over the lung
fields reveals hyperresonance. This finding is most likely due to:
A. Fluid in the pleural space
B. Lung tissue consolidation
C. Alveolar air trapping
D. A large pulmonary tumor
Answer: C
Rationale: Hyperresonance is a lower-pitched, booming sound produced when there is an
abnormal increase in the amount of air within the lungs. This is a classic finding in patients
with emphysema or chronic obstructive pulmonary disease due to alveolar air trapping
and hyperinflation. Normal lung tissue typically produces a resonant sound during
percussion.
5. When performing the Allen test on a patient before radial artery cannulation, you observe
that the palm remains pale for 15 seconds after releasing the ulnar artery. How should you
interpret this?
A. The test is positive, and the radial artery is safe to use.
B. The test is negative, indicating adequate collateral circulation.
C. The test is inconclusive and should be repeated on the other hand.
D. The test is positive, indicating inadequate collateral circulation.
Answer: D
Rationale: A positive Allen test occurs when the color does not return to the hand within 5
to 10 seconds, suggesting that the ulnar artery does not provide sufficient collateral
circulation. This finding indicates a high risk for ischemia if the radial artery is cannulated
or damaged. The clinician must choose a different site for the procedure to ensure hand
perfusion is maintained.
, 6. A patient complains of calf pain that occurs during walking and is relieved by rest. On
examination, the skin of the lower legs is cool and pale, with diminished pedal pulses. What is
the most likely diagnosis?
A. Venous insufficiency
B. Deep vein thrombosis
C. Peripheral arterial disease
D. Lymphedema
Answer: C
Rationale: Intermittent claudication, characterized by pain during activity that resolves
with rest, is a primary symptom of peripheral arterial disease (PAD). Physical findings such
as coolness, pallor, and weakened pulses further support the diagnosis of arterial
insufficiency. In contrast, venous insufficiency usually presents with edema, brownish
discoloration, and aching pain.
7. While auscultating the lungs, you hear a high-pitched, musical sound primarily during
expiration. This sound is best described as:
A. Crackles
B. Stridor
C. Rhonchi
D. Wheezes
Answer: D
Rationale: Wheezes are continuous, high-pitched musical sounds produced as air flows
through narrowed or obstructed small airways. They are most commonly heard during
expiration but can also occur during inspiration in severe cases. This finding is frequently
associated with conditions like asthma and chronic bronchitis.
8. A 55-year-old patient with a history of hypertension presents for a routine check-up. You
detect a soft, low-pitched sound early in diastole at the apex using the bell of the
stethoscope. This is likely:
A. An S3 gallop
B. An S4 gallop
C. An opening snap
D. An ejection click
Answer: A
