NURS 5220 Exam 2 V3 | NURS 5220
Advanced Health Assessment and
Diagnostic Reasoning Review | Actual
Q&A with Rationale (NURS5220 Exam 2) |
The University of Texas at Arlington
1. When assessing the jugular venous pressure (JVP), the clinician knows that a height of how
many centimeters above the sternal angle is considered abnormal?
A. Between 1 and 2 cm
B. Less than 2 cm
C. Exactly 5 cm
D. Greater than 3 to 4 cm
Answer: D
Rationale: A jugular venous pressure measured at more than 3 to 4 centimeters above the
sternal angle is indicative of elevated central venous pressure. This finding often correlates
with conditions such as right-sided heart failure or fluid volume overload. Accurate
measurement requires the patient to be positioned at a 30 to 45-degree angle.
2. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the second right intercostal space. Which condition is most likely?
A. Mitral Regurgitation
,B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B
Rationale: Aortic stenosis typically produces a midsystolic ejection murmur that radiates
to the carotid arteries. The second right intercostal space is the primary auscultatory point
for the aortic valve. This murmur is often described as having a harsh quality due to the
high-pressure gradient across the stenotic valve.
3. During a respiratory assessment, the clinician notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which of the following?
A. Pneumothorax
B. Lobar Pneumonia
C. Pleural Effusion
D. Asthma
Answer: B
Rationale: Tactile fremitus increases when there is consolidation in the lung tissue, such as
in lobar pneumonia, which facilitates the transmission of sound vibrations. In contrast,
conditions that put air or fluid in the pleural space, like pneumothorax or effusion, will
, decrease or absent fremitus. The clinician must compare symmetrical areas of the chest to
identify these deviations.
4. Which heart sound is frequently associated with decreased ventricular compliance and is
often referred to as an ‘atrial gallop’?
A. S1
B. S2
C. S3
D. S4
Answer: D
Rationale: The S4 heart sound occurs late in diastole, just before S1, and is caused by atria
contracting into a stiff, non-compliant ventricle. It is commonly seen in patients with
hypertensive heart disease or cardiomyopathy. Unlike S3, which is a ventricular gallop, S4
is always pathological in most adult clinical settings.
5. A patient exhibits a ‘pigeon chest’ appearance where the sternum is displaced anteriorly.
This is documented as:
A. Pectus carinatum
B. Pectus excavatum
C. Barrel chest
D. Kyphosis
Advanced Health Assessment and
Diagnostic Reasoning Review | Actual
Q&A with Rationale (NURS5220 Exam 2) |
The University of Texas at Arlington
1. When assessing the jugular venous pressure (JVP), the clinician knows that a height of how
many centimeters above the sternal angle is considered abnormal?
A. Between 1 and 2 cm
B. Less than 2 cm
C. Exactly 5 cm
D. Greater than 3 to 4 cm
Answer: D
Rationale: A jugular venous pressure measured at more than 3 to 4 centimeters above the
sternal angle is indicative of elevated central venous pressure. This finding often correlates
with conditions such as right-sided heart failure or fluid volume overload. Accurate
measurement requires the patient to be positioned at a 30 to 45-degree angle.
2. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the second right intercostal space. Which condition is most likely?
A. Mitral Regurgitation
,B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: B
Rationale: Aortic stenosis typically produces a midsystolic ejection murmur that radiates
to the carotid arteries. The second right intercostal space is the primary auscultatory point
for the aortic valve. This murmur is often described as having a harsh quality due to the
high-pressure gradient across the stenotic valve.
3. During a respiratory assessment, the clinician notes increased tactile fremitus over the
right lower lobe. This finding is most consistent with which of the following?
A. Pneumothorax
B. Lobar Pneumonia
C. Pleural Effusion
D. Asthma
Answer: B
Rationale: Tactile fremitus increases when there is consolidation in the lung tissue, such as
in lobar pneumonia, which facilitates the transmission of sound vibrations. In contrast,
conditions that put air or fluid in the pleural space, like pneumothorax or effusion, will
, decrease or absent fremitus. The clinician must compare symmetrical areas of the chest to
identify these deviations.
4. Which heart sound is frequently associated with decreased ventricular compliance and is
often referred to as an ‘atrial gallop’?
A. S1
B. S2
C. S3
D. S4
Answer: D
Rationale: The S4 heart sound occurs late in diastole, just before S1, and is caused by atria
contracting into a stiff, non-compliant ventricle. It is commonly seen in patients with
hypertensive heart disease or cardiomyopathy. Unlike S3, which is a ventricular gallop, S4
is always pathological in most adult clinical settings.
5. A patient exhibits a ‘pigeon chest’ appearance where the sternum is displaced anteriorly.
This is documented as:
A. Pectus carinatum
B. Pectus excavatum
C. Barrel chest
D. Kyphosis
