NUR 504 EXAM 4 – ADVANCED HEALTH ASSESSMENT –ACTUAL QUESTIONS COMPLETE ANSWERS WITH DETAILED RATIONALES | UNIVERSITY OF ST. THOMAS

NUR 504 EXAM 4 – ADVANCED HEALTH ASSESSMENT –ACTUAL QUESTIONS COMPLETE ANSWERS WITH DETAILED RATIONALES | UNIVERSITY OF ST. THOMAS 1. During palpation of the thyroid gland, the examiner should position themselves: A. Behind the patient with fingers on the trachea B. In front of the patient with thumbs on the trachea C. To the side of the patient with one hand on the neck D. Behind the patient with fingers on the sternocleidomastoid Correct Answer: A. Behind the patient with fingers on the trachea Rationale: The examiner should stand behind the patient and place fingers on either side of the trachea below the cricoid cartilage. The patient is asked to swallow, and the thyroid gland moves upward with swallowing, allowing palpation of the isthmus and lobes. This position provides the best access for palpation of the thyroid. ________________________________________ 2. A patient's carotid pulse is described as "water hammer" or bounding. This is most characteristic of: A. Aortic stenosis B. Aortic regurgitation C. Mitral stenosis D. Hypertension Correct Answer: B. Aortic regurgitation Rationale: A "water hammer" or bounding carotid pulse is classic for aortic regurgitation. The rapid upstroke and collapse of the pulse occurs because blood regurgitates back into the left ventricle during diastole, causing a wide pulse pressure. Aortic stenosis causes a weak, delayed carotid upstroke (pulsus parvus et tardus). ________________________________________ 3. When assessing jugular venous pressure, the patient should be positioned at: A. 0 degrees (supine) B. 30-45 degrees C. 90 degrees (sitting) D. 15 degrees Correct Answer: B. 30-45 degrees Rationale: The jugular venous pressure is best assessed with the patient positioned at 30-45 degrees. This angle allows visualization of the internal jugular vein pulsations in the neck. The vertical distance between the sternal angle and the highest visible pulsation is measured, with normal JVP being less than 3 cm H2O. ________________________________________ 4. A patient presents with chest pain that is relieved by leaning forward. This is most consistent with: A. Myocardial infarction B. Pericarditis C. Pulmonary embolism D. Aortic dissection Correct Answer: B. Pericarditis Rationale: Pericarditis pain is typically relieved when the patient leans forward and is worsened when lying supine. This positional relief occurs because leaning forward reduces pressure on the inflamed pericardium. The pain is usually sharp and pleuritic, differentiating it from myocardial infarction pain. ________________________________________ 5. Which heart sound is best heard at the apex with the bell of the stethoscope in the left lateral decubitus position? A. S1 B. S2 C. S3 D. S4 Correct Answer: C. S3 Rationale: An S3 heart sound is best heard at the cardiac apex with the patient in the left lateral decubitus position using the bell of the stethoscope. This position brings the left ventricle closer to the chest wall, making the low-frequency S3 more audible. S3 is normal in children and young adults but pathologic in older adults. ________________________________________ 6. The murmur of mitral stenosis is best described as: A. Systolic, harsh, crescendo-decrescendo B. Diastolic, rumbling, low-pitched C. Systolic, blowing, high-pitched D. Continuous, machinery-like Correct Answer: B. Diastolic, rumbling, low-pitched