NSG 351 Exam 2 V3 | NSG 351 Health
Assessment | Actual Q&A with Rationale
(NSG351 Exam 2) | James Madison
University
1. When assessing the respiratory system, the nurse notes an increased anteroposterior-to-
transverse diameter ratio of 1:1. How should this finding be documented?
A. Pectus excavatum
B. Pectus carinatum
C. Barrel chest
D. Kyphosis
Answer: C
Rationale: A barrel chest is characterized by an equal anteroposterior-to-transverse
diameter, often seen in chronic obstructive pulmonary disease (COPD). This physical
change occurs due to long-term hyperinflation of the lungs and air trapping within the
alveoli. The nurse must recognize this as a sign of chronic respiratory distress rather than
an acute skeletal deformity.
2. During an abdominal assessment, in which order should the nurse perform the
examination techniques?
A. Inspection, Palpation, Percussion, Auscultation
,B. Inspection, Auscultation, Percussion, Palpation
C. Inspection, Percussion, Auscultation, Palpation
D. Auscultation, Inspection, Percussion, Palpation
Answer: B
Rationale: The standard sequence for abdominal assessment is inspection followed by
auscultation before any manipulation occurs. This sequence is critical because percussion
and palpation can increase peristalsis, which would lead to false interpretations of bowel
sounds. By auscultating first, the nurse obtains the most accurate representation of the
patient’s baseline bowel activity.
3. Where is the best location for the nurse to auscultate the aortic valve area?
A. Fourth left intercostal space at the sternal border
B. Second left intercostal space at the sternal border
C. Fifth left intercostal space at the midclavicular line
D. Second right intercostal space at the sternal border
Answer: D
Rationale: The aortic valve is best heard at the second intercostal space to the right of the
sternum. This area allows the nurse to clearly hear the closure of the semilunar valves,
particularly S2. It is one of the five primary landmarks used during a comprehensive
cardiac auscultation exam.
, 4. A patient presents with a deep, productive cough and the nurse detects increased tactile
fremitus over the right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Emphysema
C. Pneumonia
D. Asthma
Answer: C
Rationale: Tactile fremitus increases with the consolidation of lung tissue, which occurs
when air-filled lungs become filled with fluid or blood as in pneumonia. In contrast,
conditions like pneumothorax or emphysema would cause a decrease in fremitus because
air or space blocks the vibration. The nurse uses the palmar base of the hand to feel these
vibrations while the patient repeats phrases like ‘ninety-nine’.
5. The nurse is assessing the peripheral vascular system and notes a ‘whooshing’ sound over
the carotid artery. This should be documented as a:
A. Murmur
B. Bruit
C. Heave
D. Thrill
Answer: B
Assessment | Actual Q&A with Rationale
(NSG351 Exam 2) | James Madison
University
1. When assessing the respiratory system, the nurse notes an increased anteroposterior-to-
transverse diameter ratio of 1:1. How should this finding be documented?
A. Pectus excavatum
B. Pectus carinatum
C. Barrel chest
D. Kyphosis
Answer: C
Rationale: A barrel chest is characterized by an equal anteroposterior-to-transverse
diameter, often seen in chronic obstructive pulmonary disease (COPD). This physical
change occurs due to long-term hyperinflation of the lungs and air trapping within the
alveoli. The nurse must recognize this as a sign of chronic respiratory distress rather than
an acute skeletal deformity.
2. During an abdominal assessment, in which order should the nurse perform the
examination techniques?
A. Inspection, Palpation, Percussion, Auscultation
,B. Inspection, Auscultation, Percussion, Palpation
C. Inspection, Percussion, Auscultation, Palpation
D. Auscultation, Inspection, Percussion, Palpation
Answer: B
Rationale: The standard sequence for abdominal assessment is inspection followed by
auscultation before any manipulation occurs. This sequence is critical because percussion
and palpation can increase peristalsis, which would lead to false interpretations of bowel
sounds. By auscultating first, the nurse obtains the most accurate representation of the
patient’s baseline bowel activity.
3. Where is the best location for the nurse to auscultate the aortic valve area?
A. Fourth left intercostal space at the sternal border
B. Second left intercostal space at the sternal border
C. Fifth left intercostal space at the midclavicular line
D. Second right intercostal space at the sternal border
Answer: D
Rationale: The aortic valve is best heard at the second intercostal space to the right of the
sternum. This area allows the nurse to clearly hear the closure of the semilunar valves,
particularly S2. It is one of the five primary landmarks used during a comprehensive
cardiac auscultation exam.
, 4. A patient presents with a deep, productive cough and the nurse detects increased tactile
fremitus over the right lower lobe. This finding is most consistent with:
A. Pneumothorax
B. Emphysema
C. Pneumonia
D. Asthma
Answer: C
Rationale: Tactile fremitus increases with the consolidation of lung tissue, which occurs
when air-filled lungs become filled with fluid or blood as in pneumonia. In contrast,
conditions like pneumothorax or emphysema would cause a decrease in fremitus because
air or space blocks the vibration. The nurse uses the palmar base of the hand to feel these
vibrations while the patient repeats phrases like ‘ninety-nine’.
5. The nurse is assessing the peripheral vascular system and notes a ‘whooshing’ sound over
the carotid artery. This should be documented as a:
A. Murmur
B. Bruit
C. Heave
D. Thrill
Answer: B
