NUR 504 APEA FINAL EXAM ACTUAL EXAM 2026 | ALL QUESTIONS AND CORRECT
ANSWERS | GRADED A+ | VERIFIED ANSWERS | BRAND NEW VERSION
Question 1
Retractions are observed in all the following areas except the:
A) Supraventricular area
B) Hilar area
C) Intercostal area
D) Costal marginal area
E) Substernal area
Correct Answer: B) Hilar area
Rationale: Retractions occur when the muscles between or around the bones of the chest
pull inward, indicating respiratory distress. Common sites include the intercostal (between
ribs), suprasternal (above the sternum), supraclavicular (above the clavicles), and costal
marginal areas. The hilar area refers to the central region of the lungs where the bronchi
and blood vessels enter; it is an internal anatomical structure and not a surface area where
visible chest wall retractions can be observed.
Question 2
A 3-year-old presents with a history of fever and cough over the past 24 hours. Findings on exam
reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40
breaths/minute. Tachypnea in this child is most likely related to:
A) Paradoxical respirations
B) The child's febrile state
C) The child's age
D) An airway obstruction
E) Heart failure
Correct Answer: B) The child's febrile state
Rationale: In pediatric patients, fever significantly increases the metabolic rate, which in
turn increases oxygen demand and carbon dioxide production. To compensate, the body
increases the respiratory rate (tachypnea) and heart rate (tachycardia). While a respiratory
rate of 40 is high for a 3-year-old (normal is 20-30), the presence of a high fever (102°F) is
the most direct physiological explanation for the tachypnea in the absence of stridor or
wheezing.
Question 3
When percussing the lower posterior chest, the examiner should begin by:
A) Standing on the side rather than directly behind the patient
B) Having the patient lie supine on the examining table
C) Carefully palpating any area the patient has reported pain
D) Using the ball or the ulnar surface of the hand
E) Asking the patient to perform a Valsalva maneuver
Correct Answer: A) Standing on the side rather than directly behind the patient
, 2
Rationale: When performing percussion of the posterior chest, standing slightly to the side
allows the examiner to use a better "swing" motion of the percussing wrist and provides a
better angle for comparing symmetrical sides. Percussing directly from behind can limit the
examiner's range of motion and ergonomic efficiency, potentially leading to inaccurate
sounds.
Question 4
The palpation technique used to assess respiratory expansion of the chest is placing the hands on
the eighth or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand
medially and grasping a small fold of skin between the thumbs. Then:
A) Ask the patient to cough and note chest expansion
B) Ask the patient to take a deep breath and note any delay in expansion during inhalation
C) Have the patient hold his breath for 15 seconds then note chest expansion
D) Have the patient exhale forcefully noting expansion on expiration
E) Percuss the areas of the thumbs to check for resonance
Correct Answer: B) Ask the patient to take a deep breath and note any delay in expansion
during inhalation
Rationale: This technique assesses thoracic excursion. As the patient takes a deep breath,
the examiner’s thumbs should move symmetrically apart. Asymmetry or a delay in
movement on one side can indicate underlying pathology such as pleural effusion, lobar
pneumonia, or unilateral bronchial obstruction.
Question 5
When trying to differentiate between hemoptysis or blood-streaked material, which one of the
following observations is correct?
A) Hemoptysis is seen frequently in infants and children with allergic rhinitis
B) Blood originating in the stomach is usually brighter than blood originating from the
respiratory tract
C) Hemoptysis is common in children with cystic fibrosis
D) Blood-streaked material often originates from the gastrointestinal tract
E) Hemoptysis is always associated with a productive cough of yellow sputum
Correct Answer: C) Hemoptysis is common in children with cystic fibrosis
Rationale: Hemoptysis is the coughing up of blood from the lower respiratory tract. In
children, cystic fibrosis is a leading cause due to bronchiectasis and the hypertrophy of
bronchial arteries which can bleed. Conversely, blood from the GI tract (hematemesis) is
usually darker (coffee-ground appearance) due to stomach acid, while respiratory blood is
typically bright red and alkaline.
Question 6
When percussing the chest in a patient who has left-sided heart failure, the sound emanated
would be:
, 3
A) Resonant
B) Dull
C) Tympanic
D) Diffusely hyper-resonant
E) Flat
Correct Answer: A) Resonant
Rationale: In early left-sided heart failure, the primary issue is pulmonary congestion (fluid
in the interstitial spaces). Percussion remains resonant because the alveoli are still mostly
air-filled. Percussion only becomes "dull" when there is significant consolidation or large
pleural effusions. Late inspiratory crackles are the more common auscultatory finding in
heart failure, rather than changes in percussion notes.
Question 7
The line that extends through the inferior angle of the scapula when the arms are at the sides of
the body is the:
A) Mid-vertebral line
B) Scapular line
C) Mid-clavicular line
D) Mid-spinal line
E) Anterior axillary line
Correct Answer: B) Scapular line
Rationale: The scapular line is a vertical landmark used for documenting findings on the
posterior thorax. It passes through the inferior angle of the scapula. Understanding these
vertical lines (mid-sternal, mid-clavicular, axillary, scapular, vertebral) is essential for
accurate clinical communication of physical findings.
Question 8
A condition associated with a chronic cough that produces copious amounts of purulent sputum
is most likely:
A) Tracheobronchitis
B) Chronic bronchitis
C) Bronchiectasis
D) Laryngitis
E) Asthma
Correct Answer: C) Bronchiectasis
Rationale: Bronchiectasis involves the permanent dilation and destruction of the large
airways, leading to impaired clearance of secretions. This results in the "copious amounts
of purulent sputum" described, which is often foul-smelling. While chronic bronchitis
involves a productive cough, the volume and purulence are typically much higher in
bronchiectasis.
, 4
Question 9
A patient who walked into the examination room may be observed to be sitting and leaning
forward in his chair. Lips were pursed during exhalation and arms are supported on the table.
This position could be consistent with patients who have:
A) Pneumonia
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Croup
E) Pulmonary embolism
Correct Answer: B) Chronic obstructive pulmonary disease (COPD)
Rationale: This is the "tripod position." Patients with COPD use this position to stabilize
the scapula and use accessory muscles (like the pectoralis minor) to assist in breathing.
Pursed-lip breathing helps maintain positive airway pressure during expiration, preventing
alveolar collapse in patients with emphysema.
Question 10
Breath sounds heard over the periphery of the lung fields are:
A) Bronchial
B) Abnormal
C) Bronchovesicular
D) Vesicular
E) Tracheal
Correct Answer: D) Vesicular
Rationale: Vesicular breath sounds are the normal sounds heard over the majority of the
lungs (the periphery). They are soft and low-pitched, with an inspiratory phase that is
longer than the expiratory phase. Bronchial sounds are heard over the trachea, and
bronchovesicular sounds are heard over the major bronchi.
Question 11
When percussing the posterior chest, which one of the following techniques would be omitted?
A) When comparing two areas on the chest, use the same percussion technique in both areas
B) Percuss one side of the chest then the other at each level
C) Percuss the areas over the scapulae
D) If a louder note is needed, apply more pressure with the pleximeter finger
E) Ensure the plexor finger strikes the pleximeter finger at the DIP joint
Correct Answer: C) Percuss the areas over the scapulae
Rationale: Percussing over bone, such as the scapulae, produces a flat, dull sound that
provides no information about the underlying lung tissue. Therefore, the examiner should
avoid the scapulae and instead percuss in the intercostal spaces and the interscapular area
to accurately assess lung resonance.
ANSWERS | GRADED A+ | VERIFIED ANSWERS | BRAND NEW VERSION
Question 1
Retractions are observed in all the following areas except the:
A) Supraventricular area
B) Hilar area
C) Intercostal area
D) Costal marginal area
E) Substernal area
Correct Answer: B) Hilar area
Rationale: Retractions occur when the muscles between or around the bones of the chest
pull inward, indicating respiratory distress. Common sites include the intercostal (between
ribs), suprasternal (above the sternum), supraclavicular (above the clavicles), and costal
marginal areas. The hilar area refers to the central region of the lungs where the bronchi
and blood vessels enter; it is an internal anatomical structure and not a surface area where
visible chest wall retractions can be observed.
Question 2
A 3-year-old presents with a history of fever and cough over the past 24 hours. Findings on exam
reveal: temperature of 102°F, apical heart rate of 157 beats/minute, and respiratory rate of 40
breaths/minute. Tachypnea in this child is most likely related to:
A) Paradoxical respirations
B) The child's febrile state
C) The child's age
D) An airway obstruction
E) Heart failure
Correct Answer: B) The child's febrile state
Rationale: In pediatric patients, fever significantly increases the metabolic rate, which in
turn increases oxygen demand and carbon dioxide production. To compensate, the body
increases the respiratory rate (tachypnea) and heart rate (tachycardia). While a respiratory
rate of 40 is high for a 3-year-old (normal is 20-30), the presence of a high fever (102°F) is
the most direct physiological explanation for the tachypnea in the absence of stridor or
wheezing.
Question 3
When percussing the lower posterior chest, the examiner should begin by:
A) Standing on the side rather than directly behind the patient
B) Having the patient lie supine on the examining table
C) Carefully palpating any area the patient has reported pain
D) Using the ball or the ulnar surface of the hand
E) Asking the patient to perform a Valsalva maneuver
Correct Answer: A) Standing on the side rather than directly behind the patient
, 2
Rationale: When performing percussion of the posterior chest, standing slightly to the side
allows the examiner to use a better "swing" motion of the percussing wrist and provides a
better angle for comparing symmetrical sides. Percussing directly from behind can limit the
examiner's range of motion and ergonomic efficiency, potentially leading to inaccurate
sounds.
Question 4
The palpation technique used to assess respiratory expansion of the chest is placing the hands on
the eighth or tenth ribs posteriorly with the thumbs close to the vertebrae, sliding the hand
medially and grasping a small fold of skin between the thumbs. Then:
A) Ask the patient to cough and note chest expansion
B) Ask the patient to take a deep breath and note any delay in expansion during inhalation
C) Have the patient hold his breath for 15 seconds then note chest expansion
D) Have the patient exhale forcefully noting expansion on expiration
E) Percuss the areas of the thumbs to check for resonance
Correct Answer: B) Ask the patient to take a deep breath and note any delay in expansion
during inhalation
Rationale: This technique assesses thoracic excursion. As the patient takes a deep breath,
the examiner’s thumbs should move symmetrically apart. Asymmetry or a delay in
movement on one side can indicate underlying pathology such as pleural effusion, lobar
pneumonia, or unilateral bronchial obstruction.
Question 5
When trying to differentiate between hemoptysis or blood-streaked material, which one of the
following observations is correct?
A) Hemoptysis is seen frequently in infants and children with allergic rhinitis
B) Blood originating in the stomach is usually brighter than blood originating from the
respiratory tract
C) Hemoptysis is common in children with cystic fibrosis
D) Blood-streaked material often originates from the gastrointestinal tract
E) Hemoptysis is always associated with a productive cough of yellow sputum
Correct Answer: C) Hemoptysis is common in children with cystic fibrosis
Rationale: Hemoptysis is the coughing up of blood from the lower respiratory tract. In
children, cystic fibrosis is a leading cause due to bronchiectasis and the hypertrophy of
bronchial arteries which can bleed. Conversely, blood from the GI tract (hematemesis) is
usually darker (coffee-ground appearance) due to stomach acid, while respiratory blood is
typically bright red and alkaline.
Question 6
When percussing the chest in a patient who has left-sided heart failure, the sound emanated
would be:
, 3
A) Resonant
B) Dull
C) Tympanic
D) Diffusely hyper-resonant
E) Flat
Correct Answer: A) Resonant
Rationale: In early left-sided heart failure, the primary issue is pulmonary congestion (fluid
in the interstitial spaces). Percussion remains resonant because the alveoli are still mostly
air-filled. Percussion only becomes "dull" when there is significant consolidation or large
pleural effusions. Late inspiratory crackles are the more common auscultatory finding in
heart failure, rather than changes in percussion notes.
Question 7
The line that extends through the inferior angle of the scapula when the arms are at the sides of
the body is the:
A) Mid-vertebral line
B) Scapular line
C) Mid-clavicular line
D) Mid-spinal line
E) Anterior axillary line
Correct Answer: B) Scapular line
Rationale: The scapular line is a vertical landmark used for documenting findings on the
posterior thorax. It passes through the inferior angle of the scapula. Understanding these
vertical lines (mid-sternal, mid-clavicular, axillary, scapular, vertebral) is essential for
accurate clinical communication of physical findings.
Question 8
A condition associated with a chronic cough that produces copious amounts of purulent sputum
is most likely:
A) Tracheobronchitis
B) Chronic bronchitis
C) Bronchiectasis
D) Laryngitis
E) Asthma
Correct Answer: C) Bronchiectasis
Rationale: Bronchiectasis involves the permanent dilation and destruction of the large
airways, leading to impaired clearance of secretions. This results in the "copious amounts
of purulent sputum" described, which is often foul-smelling. While chronic bronchitis
involves a productive cough, the volume and purulence are typically much higher in
bronchiectasis.
, 4
Question 9
A patient who walked into the examination room may be observed to be sitting and leaning
forward in his chair. Lips were pursed during exhalation and arms are supported on the table.
This position could be consistent with patients who have:
A) Pneumonia
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Croup
E) Pulmonary embolism
Correct Answer: B) Chronic obstructive pulmonary disease (COPD)
Rationale: This is the "tripod position." Patients with COPD use this position to stabilize
the scapula and use accessory muscles (like the pectoralis minor) to assist in breathing.
Pursed-lip breathing helps maintain positive airway pressure during expiration, preventing
alveolar collapse in patients with emphysema.
Question 10
Breath sounds heard over the periphery of the lung fields are:
A) Bronchial
B) Abnormal
C) Bronchovesicular
D) Vesicular
E) Tracheal
Correct Answer: D) Vesicular
Rationale: Vesicular breath sounds are the normal sounds heard over the majority of the
lungs (the periphery). They are soft and low-pitched, with an inspiratory phase that is
longer than the expiratory phase. Bronchial sounds are heard over the trachea, and
bronchovesicular sounds are heard over the major bronchi.
Question 11
When percussing the posterior chest, which one of the following techniques would be omitted?
A) When comparing two areas on the chest, use the same percussion technique in both areas
B) Percuss one side of the chest then the other at each level
C) Percuss the areas over the scapulae
D) If a louder note is needed, apply more pressure with the pleximeter finger
E) Ensure the plexor finger strikes the pleximeter finger at the DIP joint
Correct Answer: C) Percuss the areas over the scapulae
Rationale: Percussing over bone, such as the scapulae, produces a flat, dull sound that
provides no information about the underlying lung tissue. Therefore, the examiner should
avoid the scapulae and instead percuss in the intercostal spaces and the interscapular area
to accurately assess lung resonance.
