NU 650 COMPREHENSIVE EXAM 2026/2027 QUESTIONS
AND SOLUTIONS RATED A+
✔✔You find a bounding carotid pulse on a 62-year-old patient. Which murmur should
you search out?
A) Mitral valve prolapse
B) Pulmonic stenosis
C) Tricuspid insufficiency
D) Aortic insufficiency - ✔✔D
✔✔To hear a soft murmur or bruit, which of the following may be necessary?
A) Asking the patient to hold her breath
B) Asking the patient in the next bed to turn down the TV
C) Checking your stethoscope for air leaks
D) All of the above - ✔✔D
✔✔Which of the following may be missed unless the patient is placed in the left lateral
decubitus position and auscultated with the bell?
A) Mitral stenosis murmur
B) Opening snap of the mitral valve
C) S3 and S4 gallops
D) All of the above - ✔✔D
✔✔How should you determine whether a murmur is systolic or diastolic?
A) Palpate the carotid pulse.
B) Palpate the radial pulse.
C) Judge the relative length of systole and diastole by auscultation.
D) Correlate the murmur with a bedside heart monitor. - ✔✔A
✔✔Which of the following correlates with a sustained, high-amplitude PMI?
A) Hyperthyroidism
B) Anemia
C) Fever
D) Hypertension - ✔✔D
✔✔You are examining a patient with emphysema in exacerbation and are having
difficulty hearing his heart sounds. What should you do to obtain a good exam?
A) Listen in the epigastrium.
B) Listen to the patient in the left lateral decubitus position.
C) Ask the patient to hold his breath for 30 seconds.
D) Listen posteriorly. - ✔✔A
✔✔You are listening carefully for S2 splitting. Which of the following will help?
A) Using the diaphragm with light pressure over the 2nd right intercostal space
,B) Using the bell with light pressure over the 2nd left intercostal space
C) Using the diaphragm with firm pressure over the apex
D) Using the bell with firm pressure over the lower left sternal border - ✔✔B
✔✔Which of the following is true of a grade 4-intensity murmur?
A) It is moderately loud.
B) It can be heard with the stethoscope off the chest.
C) It can be heard with the stethoscope partially off the chest.
D) It is associated with a "thrill." - ✔✔D
✔✔Which valve lesion typically produces a murmur of equal intensity throughout
systole?
A) Aortic stenosis
B) Mitral insufficiency
C) Pulmonic stenosis
D) Aortic insufficiency - ✔✔B
✔✔You notice a patient has a strong pulse and then a weak pulse. This pattern
continues. Which of the following is likely?
A) Emphysema
B) Asthma exacerbation
C) Severe left heart failure
D) Cardiac tamponade - ✔✔C
✔✔Suzanne is a 20-year-old college student who complains of chest pain. This is
intermittent and is located to the left of her sternum. There are no associated symptoms.
On examination, you hear a short, high-pitched sound in systole, followed by a murmur
which increases in intensity until S2. This is heard best over the apex. When she
squats, this noise moves later in systole along with the murmur. Which of the following
is the most likely diagnosis?
A) Mitral stenosis
B) Mitral insufficiency
C) Mitral valve prolapse
D) Mitral valve papillary muscle ischemia - ✔✔C
✔✔A 57-year-old maintenance worker comes to your office for evaluation of pain in his
legs. He has smoked two packs per day since the age of 16, but he is otherwise
healthy. You are concerned that he may have peripheral vascular disease. Which of the
following is part of common or concerning symptoms for the peripheral vascular
system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain - ✔✔A
, ✔✔A 72-year-old teacher comes to your clinic for an annual examination. She is
concerned about her risk for peripheral vascular disease and states that there is a place
in town that does tests to let her know if she has this or not. Which of the following
disease process is a risk factor for peripheral vascular disease?
A) Gastroesophageal reflux disease
B) Coronary artery disease
C) Migraine headaches
D) Osteoarthritis - ✔✔B
✔✔A 68-year-old retired truck driver comes to your office for evaluation of swelling in
his legs. He is a smoker and has been taking medications to control his hypertension for
the past 25 years. You are concerned about his risk for peripheral vascular disease.
Which of the following tests are appropriate to order to initially evaluate for this
condition?
A) Venogram
B)CT scan of the lower legs
C) Ankle-brachial index (ABI)
D) PET sca - ✔✔C
✔✔A 55-year-old secretary with a recent history of breast cancer, for which she
underwent surgery and radiation therapy, and a history of hypertension comes to your
office for a routine checkup. Which of the following aspects of the physical are important
to note when assessing the patient for peripheral vascular disease in the arms?
A) Femoral pulse, popliteal pulse
B) Dorsalis pedis pulse, posterior tibial pulse
C) Carotid pulse
D) Radial pulse, brachial pulse - ✔✔D
✔✔You are a student in the vascular surgery clinic. You are asked to perform a physical
examination on a patient with known peripheral vascular disease in the legs. Which of
the following aspects is important to note when you perform your examination?
A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength - ✔✔A
✔✔You are assessing a patient for peripheral vascular disease in the arms, secondary
to a complaint of increased weakness and a history of coronary artery disease and
diabetes. You assess the brachial and radial pulses and note that they are bounding.
What does that translate to on a scale of 0 to 3?
A) 0
B) 3+
C) 2+
D) 1+ - ✔✔B
AND SOLUTIONS RATED A+
✔✔You find a bounding carotid pulse on a 62-year-old patient. Which murmur should
you search out?
A) Mitral valve prolapse
B) Pulmonic stenosis
C) Tricuspid insufficiency
D) Aortic insufficiency - ✔✔D
✔✔To hear a soft murmur or bruit, which of the following may be necessary?
A) Asking the patient to hold her breath
B) Asking the patient in the next bed to turn down the TV
C) Checking your stethoscope for air leaks
D) All of the above - ✔✔D
✔✔Which of the following may be missed unless the patient is placed in the left lateral
decubitus position and auscultated with the bell?
A) Mitral stenosis murmur
B) Opening snap of the mitral valve
C) S3 and S4 gallops
D) All of the above - ✔✔D
✔✔How should you determine whether a murmur is systolic or diastolic?
A) Palpate the carotid pulse.
B) Palpate the radial pulse.
C) Judge the relative length of systole and diastole by auscultation.
D) Correlate the murmur with a bedside heart monitor. - ✔✔A
✔✔Which of the following correlates with a sustained, high-amplitude PMI?
A) Hyperthyroidism
B) Anemia
C) Fever
D) Hypertension - ✔✔D
✔✔You are examining a patient with emphysema in exacerbation and are having
difficulty hearing his heart sounds. What should you do to obtain a good exam?
A) Listen in the epigastrium.
B) Listen to the patient in the left lateral decubitus position.
C) Ask the patient to hold his breath for 30 seconds.
D) Listen posteriorly. - ✔✔A
✔✔You are listening carefully for S2 splitting. Which of the following will help?
A) Using the diaphragm with light pressure over the 2nd right intercostal space
,B) Using the bell with light pressure over the 2nd left intercostal space
C) Using the diaphragm with firm pressure over the apex
D) Using the bell with firm pressure over the lower left sternal border - ✔✔B
✔✔Which of the following is true of a grade 4-intensity murmur?
A) It is moderately loud.
B) It can be heard with the stethoscope off the chest.
C) It can be heard with the stethoscope partially off the chest.
D) It is associated with a "thrill." - ✔✔D
✔✔Which valve lesion typically produces a murmur of equal intensity throughout
systole?
A) Aortic stenosis
B) Mitral insufficiency
C) Pulmonic stenosis
D) Aortic insufficiency - ✔✔B
✔✔You notice a patient has a strong pulse and then a weak pulse. This pattern
continues. Which of the following is likely?
A) Emphysema
B) Asthma exacerbation
C) Severe left heart failure
D) Cardiac tamponade - ✔✔C
✔✔Suzanne is a 20-year-old college student who complains of chest pain. This is
intermittent and is located to the left of her sternum. There are no associated symptoms.
On examination, you hear a short, high-pitched sound in systole, followed by a murmur
which increases in intensity until S2. This is heard best over the apex. When she
squats, this noise moves later in systole along with the murmur. Which of the following
is the most likely diagnosis?
A) Mitral stenosis
B) Mitral insufficiency
C) Mitral valve prolapse
D) Mitral valve papillary muscle ischemia - ✔✔C
✔✔A 57-year-old maintenance worker comes to your office for evaluation of pain in his
legs. He has smoked two packs per day since the age of 16, but he is otherwise
healthy. You are concerned that he may have peripheral vascular disease. Which of the
following is part of common or concerning symptoms for the peripheral vascular
system?
A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain - ✔✔A
, ✔✔A 72-year-old teacher comes to your clinic for an annual examination. She is
concerned about her risk for peripheral vascular disease and states that there is a place
in town that does tests to let her know if she has this or not. Which of the following
disease process is a risk factor for peripheral vascular disease?
A) Gastroesophageal reflux disease
B) Coronary artery disease
C) Migraine headaches
D) Osteoarthritis - ✔✔B
✔✔A 68-year-old retired truck driver comes to your office for evaluation of swelling in
his legs. He is a smoker and has been taking medications to control his hypertension for
the past 25 years. You are concerned about his risk for peripheral vascular disease.
Which of the following tests are appropriate to order to initially evaluate for this
condition?
A) Venogram
B)CT scan of the lower legs
C) Ankle-brachial index (ABI)
D) PET sca - ✔✔C
✔✔A 55-year-old secretary with a recent history of breast cancer, for which she
underwent surgery and radiation therapy, and a history of hypertension comes to your
office for a routine checkup. Which of the following aspects of the physical are important
to note when assessing the patient for peripheral vascular disease in the arms?
A) Femoral pulse, popliteal pulse
B) Dorsalis pedis pulse, posterior tibial pulse
C) Carotid pulse
D) Radial pulse, brachial pulse - ✔✔D
✔✔You are a student in the vascular surgery clinic. You are asked to perform a physical
examination on a patient with known peripheral vascular disease in the legs. Which of
the following aspects is important to note when you perform your examination?
A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength - ✔✔A
✔✔You are assessing a patient for peripheral vascular disease in the arms, secondary
to a complaint of increased weakness and a history of coronary artery disease and
diabetes. You assess the brachial and radial pulses and note that they are bounding.
What does that translate to on a scale of 0 to 3?
A) 0
B) 3+
C) 2+
D) 1+ - ✔✔B
