NSG 500 Exam 2 V3 | NSG 500 Advanced
Health Assessment | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG500
Exam 2 2026)
1. During a cardiac assessment, the nurse practitioner notes a mid-systolic murmur heard
best at the second right intercostal space that radiates to the neck. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Pulmonic Stenosis
C. Aortic Stenosis
D. Aortic Regurgitation
Answer: C
Rationale: Aortic stenosis typically presents as a mid-systolic ejection murmur located at
the right second intercostal space. This specific murmur often radiates toward the carotid
arteries in the neck. Clinical assessment of valvular disorders is a core competency for
advanced health practitioners to differentiate between systolic and diastolic events.
2. When assessing for a carotid bruit, which technique is most appropriate to ensure accurate
findings?
A. Use the diaphragm of the stethoscope while the patient breathes deeply.
,B. Palpate the carotid pulse simultaneously with the bell of the stethoscope.
C. Apply firm pressure with the diaphragm over the carotid bulb.
D. Use the bell of the stethoscope while the patient holds their breath.
Answer: D
Rationale: The bell of the stethoscope is best suited for detecting low-pitched vascular
sounds like bruits. Asking the patient to hold their breath prevents respiratory sounds
from masking the potential bruit. Accurate detection of a bruit may indicate underlying
carotid artery stenosis which requires further diagnostic imaging.
3. A patient presents with an S3 heart sound during the physical exam. In which of the
following populations is this considered a physiological rather than pathological finding?
A. A 70-year-old male with hypertension.
B. A 45-year-old female with obesity.
C. A 55-year-old patient with diabetes.
D. A 22-year-old healthy athlete.
Answer: D
Rationale: An S3 heart sound, or ventricular gallop, can be a normal physiological finding
in children and young adults or athletes. However, in older adults, it often signifies fluid
volume overload or heart failure. Distinguishing between physiological and pathological S3
is critical for appropriate clinical management.
, 4. When measuring the Jugular Venous Pressure (JVP), the vertical distance from the sternal
angle to the highest point of pulsation is 4 cm. What is the estimated total JVP?
A. 4 cm H2O
B. 9 cm H2O
C. 7 cm H2O
D. 12 cm H2O
Answer: B
Rationale: To estimate total JVP, the distance from the sternal angle is added to the 5 cm
distance from the sternal angle to the center of the right atrium. In this case, 4 cm plus 5 cm
equals 9 cm H2O. Elevated JVP values are indicative of right-sided heart failure or
increased central venous pressure.
5. Which physical exam maneuver is specifically used to assess for a suspected abdominal
aortic aneurysm (AAA)?
A. Deep palpation in the left lower quadrant.
B. Palpation of the periumbilical area for widened pulsations.
C. Percussion for splenic dullness.
D. Assessment for rebound tenderness at McBurney’s point.
Answer: B
Health Assessment | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG500
Exam 2 2026)
1. During a cardiac assessment, the nurse practitioner notes a mid-systolic murmur heard
best at the second right intercostal space that radiates to the neck. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Pulmonic Stenosis
C. Aortic Stenosis
D. Aortic Regurgitation
Answer: C
Rationale: Aortic stenosis typically presents as a mid-systolic ejection murmur located at
the right second intercostal space. This specific murmur often radiates toward the carotid
arteries in the neck. Clinical assessment of valvular disorders is a core competency for
advanced health practitioners to differentiate between systolic and diastolic events.
2. When assessing for a carotid bruit, which technique is most appropriate to ensure accurate
findings?
A. Use the diaphragm of the stethoscope while the patient breathes deeply.
,B. Palpate the carotid pulse simultaneously with the bell of the stethoscope.
C. Apply firm pressure with the diaphragm over the carotid bulb.
D. Use the bell of the stethoscope while the patient holds their breath.
Answer: D
Rationale: The bell of the stethoscope is best suited for detecting low-pitched vascular
sounds like bruits. Asking the patient to hold their breath prevents respiratory sounds
from masking the potential bruit. Accurate detection of a bruit may indicate underlying
carotid artery stenosis which requires further diagnostic imaging.
3. A patient presents with an S3 heart sound during the physical exam. In which of the
following populations is this considered a physiological rather than pathological finding?
A. A 70-year-old male with hypertension.
B. A 45-year-old female with obesity.
C. A 55-year-old patient with diabetes.
D. A 22-year-old healthy athlete.
Answer: D
Rationale: An S3 heart sound, or ventricular gallop, can be a normal physiological finding
in children and young adults or athletes. However, in older adults, it often signifies fluid
volume overload or heart failure. Distinguishing between physiological and pathological S3
is critical for appropriate clinical management.
, 4. When measuring the Jugular Venous Pressure (JVP), the vertical distance from the sternal
angle to the highest point of pulsation is 4 cm. What is the estimated total JVP?
A. 4 cm H2O
B. 9 cm H2O
C. 7 cm H2O
D. 12 cm H2O
Answer: B
Rationale: To estimate total JVP, the distance from the sternal angle is added to the 5 cm
distance from the sternal angle to the center of the right atrium. In this case, 4 cm plus 5 cm
equals 9 cm H2O. Elevated JVP values are indicative of right-sided heart failure or
increased central venous pressure.
5. Which physical exam maneuver is specifically used to assess for a suspected abdominal
aortic aneurysm (AAA)?
A. Deep palpation in the left lower quadrant.
B. Palpation of the periumbilical area for widened pulsations.
C. Percussion for splenic dullness.
D. Assessment for rebound tenderness at McBurney’s point.
Answer: B
