NUR 2180 Physical Assessment - Quiz 2 Examination
NUR 2180 / NUR2180 Quiz 2 (Latest 2026/2027)
Physical Assessment - Rasmussen University
50 Multiple-Choice Questions | Comprehensive Examination with Rationales
Section 1: Cardiovascular Assessment (Questions 1-15)
1. The nurse is auscultating a patient's heart sounds. Which heart sound corresponds to the closure of the
atrioventricular (AV) valves and is best heard at the apex of the heart?
A. S2 ("dub"), heard loudest at the base of the heart
B. S1 ("lub"), heard loudest at the apex of the heart [CORRECT]
C. S3 (ventricular gallop), heard loudest at the left sternal border
D. S4 (atrial gallop), heard loudest at the right sternal border
Correct Answer: B
S1 ("lub") is produced by the closure of the mitral (bicuspid) and tricuspid valves, which are the atrioventricular (AV) valves,
and is best auscultated at the apex (5th ICS MCL). S2 ("dub") corresponds to closure of the semilunar valves (aortic and
pulmonic) and is loudest at the base. S3 is an extra heart sound heard in early diastole associated with heart failure or volume
overload, while S4 is heard in late diastole and is associated with a stiff, noncompliant ventricle such as in hypertension.
2. A nurse is performing cardiac auscultation on a 68-year-old patient with a history of hypertension. At the
mitral area, the nurse auscultates a low-frequency sound immediately before S1. This finding is most
consistent with which of the following?
A. S3 ventricular gallop indicating heart failure
B. S4 atrial gallop indicating a stiff, noncompliant left ventricle [CORRECT]
C. A systolic murmur indicative of mitral regurgitation
D. A pericardial friction rub indicating pericarditis
Correct Answer: B
An S4 (atrial gallop) occurs in late diastole, immediately before S1, and is caused by atrial contraction pushing blood into a
stiff, noncompliant ventricle. It is classically associated with hypertension, coronary artery disease, and left ventricular
hypertrophy. An S3 occurs in early diastole after S2 and is associated with heart failure and volume overload. A systolic
murmur occurs between S1 and S2, and a friction rub is a high-pitched, scratchy sound heard throughout the cardiac cycle.
3. During cardiovascular assessment, the nurse identifies the Point of Maximal Impulse (PMI). In a normal
adult, where should the PMI be located?
A. 2nd intercostal space, right sternal border
B. 2nd intercostal space, left sternal border
C. 5th intercostal space, midclavicular line [CORRECT]
D. 4th intercostal space, left sternal border
Correct Answer: C
The PMI, also known as the apical impulse, is normally located at the 5th intercostal space at the midclavicular line (MCL).
This corresponds to the apex of the heart where the left ventricle is closest to the chest wall. The 2nd ICS right sternal border
is the aortic area, the 2nd ICS left sternal border is the pulmonic area, and the 4th ICS left sternal border is the tricuspid area.
A displaced PMI may indicate cardiac enlargement or mediastinal shift.
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,NUR 2180 Physical Assessment - Quiz 2 Examination
4. A nurse palpates a vibration on the chest wall at the 2nd right intercostal space while assessing a patient.
This finding is known as a thrill and is best described as which of the following?
A. A normal finding associated with blood flow through healthy valves
B. A palpable murmur indicating turbulent blood flow, commonly seen with aortic stenosis
[CORRECT]
C. A forceful, sustained impulse indicating ventricular hypertrophy
D. A tapping sensation caused by an enlarged left atrium
Correct Answer: B
A thrill is a palpable vibration that feels like a purring cat on the chest wall and indicates turbulent blood flow, essentially a
palpable murmur. Thrills are most commonly associated with aortic stenosis at the 2nd right intercostal space (aortic area). A
heave or lift is a forceful, sustained systolic impulse that indicates ventricular hypertrophy, not a thrill. Thrills are always
abnormal findings and warrant further cardiac evaluation such as echocardiography.
5. While performing a peripheral vascular assessment, a nurse grades a patient's dorsalis pedis pulse as 1+.
Which of the following correctly describes this pulse grade?
A. Normal pulse strength, easily palpable
B. Weak and thready, difficult to palpate [CORRECT]
C. Full and bounding, increased above normal
D. Absent, no pulse palpable
Correct Answer: B
The pulse grading scale ranges from 0 to 4+: 0 indicates absent pulse, 1+ indicates weak and thready pulse that is difficult to
palpate, 2+ indicates normal pulse strength, 3+ indicates full and bounding pulse (increased), and 4+ indicates a very strong,
aneurysmal pulse. A 1+ dorsalis pedis pulse suggests diminished arterial perfusion to the foot and requires further assessment
for possible peripheral vascular disease, requiring comparison with the contralateral extremity.
6. A nurse auscultates a high-pitched, blowing sound at the mitral area that begins immediately after S1 and
extends throughout systole. The nurse correctly identifies this as which type of murmur, and which cardiac
condition is most likely present?
A. Diastolic murmur; mitral stenosis
B. Systolic murmur; mitral regurgitation [CORRECT]
C. Systolic murmur; aortic stenosis
D. Diastolic murmur; aortic regurgitation
Correct Answer: B
A murmur occurring between S1 and S2 is a systolic murmur. A holosystolic (pansystolic) murmur at the mitral area that
extends throughout systole is classic for mitral regurgitation, where blood flows backward from the left ventricle into the left
atrium during ventricular systole. Aortic stenosis produces a systolic murmur but is best heard at the 2nd right intercostal
space (aortic area). Diastolic murmurs occur between S2 and the next S1, with mitral stenosis and aortic regurgitation being
examples.
7. A nurse is assessing a patient's jugular venous pressure (JVP) and notes distension of the jugular veins when
the patient is seated at a 45-degree angle. This finding is most indicative of which condition?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with increased venous pressure [CORRECT]
C. Hypovolemia causing decreased venous return
D. Aortic stenosis causing increased afterload
Correct Answer: B
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, NUR 2180 Physical Assessment - Quiz 2 Examination
Jugular venous distension (JVD) at a 45-degree angle is an abnormal finding that indicates elevated right atrial pressure,
most commonly caused by right-sided heart failure. The jugular veins normally collapse when the patient is seated at 30 to 45
degrees. JVD reflects increased systemic venous pressure and may also be seen in conditions such as fluid overload,
pulmonary hypertension, and superior vena cava obstruction. Left-sided heart failure typically presents with pulmonary
symptoms such as crackles and shortness of breath rather than JVD.
8. When auscultating the heart, the nurse places the stethoscope at the 2nd intercostal space, left sternal border.
Which valve area is the nurse assessing?
A. Aortic area
B. Mitral area
C. Pulmonic area [CORRECT]
D. Tricuspid area
Correct Answer: C
The 2nd intercostal space at the left sternal border corresponds to the pulmonic valve area, where S2 is best heard. The aortic
area is located at the 2nd ICS right sternal border. Erb's point is at the 3rd ICS left sternal border. The tricuspid area is at the
4th ICS left sternal border. The mitral area (apex) is at the 5th ICS midclavicular line where S1 is best heard.
9. A nurse is measuring blood pressure and selects a blood pressure cuff that is too narrow for the patient's arm
circumference. What effect will this have on the blood pressure reading?
A. The reading will be falsely low
B. The reading will be falsely elevated [CORRECT]
C. The reading will be accurate regardless of cuff size
D. Only the diastolic reading will be affected
Correct Answer: B
Using a blood pressure cuff that is too narrow (bladder width less than 40% of arm circumference) results in a falsely
elevated blood pressure reading because the cuff must be inflated to a higher pressure to compress the brachial artery.
Conversely, a cuff that is too wide will produce a falsely low reading. The correct cuff size requires the bladder width to be
approximately 40% of the arm circumference and the bladder length to be approximately 80% of the arm circumference.
10. A nurse obtains orthostatic vital signs on a patient. The blood pressure drops from 130/80 mmHg while
supine to 105/65 mmHg upon standing, and the heart rate increases from 78 to 100 bpm. The nurse correctly
interprets these findings as which of the following?
A. Normal orthostatic changes that require no intervention
B. Positive orthostatic hypotension indicating volume depletion [CORRECT]
C. Negative orthostatic findings suggesting fluid overload
D. An abnormal vagal response requiring immediate intervention
Correct Answer: B
Positive orthostatic vital signs are defined as a drop in systolic blood pressure greater than 20 mmHg, a drop in diastolic
blood pressure greater than 10 mmHg, or an increase in heart rate greater than 20 bpm when moving from supine to
standing. This patient's systolic BP dropped by 25 mmHg (130 to 105) and heart rate increased by 22 bpm (78 to 100),
meeting the criteria for orthostatic hypotension. This finding suggests volume depletion, which may be caused by dehydration,
hemorrhage, or medication side effects such as diuretics or antihypertensives.
11. A patient presents with shiny, atrophic skin on the lower extremities, hair loss, and a painful ulcer on the
tip of the big toe. Capillary refill is 4 seconds. Which condition is most consistent with these findings?
A. Venous insufficiency
Rasmussen University - 2026/2027 Page 3
NUR 2180 / NUR2180 Quiz 2 (Latest 2026/2027)
Physical Assessment - Rasmussen University
50 Multiple-Choice Questions | Comprehensive Examination with Rationales
Section 1: Cardiovascular Assessment (Questions 1-15)
1. The nurse is auscultating a patient's heart sounds. Which heart sound corresponds to the closure of the
atrioventricular (AV) valves and is best heard at the apex of the heart?
A. S2 ("dub"), heard loudest at the base of the heart
B. S1 ("lub"), heard loudest at the apex of the heart [CORRECT]
C. S3 (ventricular gallop), heard loudest at the left sternal border
D. S4 (atrial gallop), heard loudest at the right sternal border
Correct Answer: B
S1 ("lub") is produced by the closure of the mitral (bicuspid) and tricuspid valves, which are the atrioventricular (AV) valves,
and is best auscultated at the apex (5th ICS MCL). S2 ("dub") corresponds to closure of the semilunar valves (aortic and
pulmonic) and is loudest at the base. S3 is an extra heart sound heard in early diastole associated with heart failure or volume
overload, while S4 is heard in late diastole and is associated with a stiff, noncompliant ventricle such as in hypertension.
2. A nurse is performing cardiac auscultation on a 68-year-old patient with a history of hypertension. At the
mitral area, the nurse auscultates a low-frequency sound immediately before S1. This finding is most
consistent with which of the following?
A. S3 ventricular gallop indicating heart failure
B. S4 atrial gallop indicating a stiff, noncompliant left ventricle [CORRECT]
C. A systolic murmur indicative of mitral regurgitation
D. A pericardial friction rub indicating pericarditis
Correct Answer: B
An S4 (atrial gallop) occurs in late diastole, immediately before S1, and is caused by atrial contraction pushing blood into a
stiff, noncompliant ventricle. It is classically associated with hypertension, coronary artery disease, and left ventricular
hypertrophy. An S3 occurs in early diastole after S2 and is associated with heart failure and volume overload. A systolic
murmur occurs between S1 and S2, and a friction rub is a high-pitched, scratchy sound heard throughout the cardiac cycle.
3. During cardiovascular assessment, the nurse identifies the Point of Maximal Impulse (PMI). In a normal
adult, where should the PMI be located?
A. 2nd intercostal space, right sternal border
B. 2nd intercostal space, left sternal border
C. 5th intercostal space, midclavicular line [CORRECT]
D. 4th intercostal space, left sternal border
Correct Answer: C
The PMI, also known as the apical impulse, is normally located at the 5th intercostal space at the midclavicular line (MCL).
This corresponds to the apex of the heart where the left ventricle is closest to the chest wall. The 2nd ICS right sternal border
is the aortic area, the 2nd ICS left sternal border is the pulmonic area, and the 4th ICS left sternal border is the tricuspid area.
A displaced PMI may indicate cardiac enlargement or mediastinal shift.
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,NUR 2180 Physical Assessment - Quiz 2 Examination
4. A nurse palpates a vibration on the chest wall at the 2nd right intercostal space while assessing a patient.
This finding is known as a thrill and is best described as which of the following?
A. A normal finding associated with blood flow through healthy valves
B. A palpable murmur indicating turbulent blood flow, commonly seen with aortic stenosis
[CORRECT]
C. A forceful, sustained impulse indicating ventricular hypertrophy
D. A tapping sensation caused by an enlarged left atrium
Correct Answer: B
A thrill is a palpable vibration that feels like a purring cat on the chest wall and indicates turbulent blood flow, essentially a
palpable murmur. Thrills are most commonly associated with aortic stenosis at the 2nd right intercostal space (aortic area). A
heave or lift is a forceful, sustained systolic impulse that indicates ventricular hypertrophy, not a thrill. Thrills are always
abnormal findings and warrant further cardiac evaluation such as echocardiography.
5. While performing a peripheral vascular assessment, a nurse grades a patient's dorsalis pedis pulse as 1+.
Which of the following correctly describes this pulse grade?
A. Normal pulse strength, easily palpable
B. Weak and thready, difficult to palpate [CORRECT]
C. Full and bounding, increased above normal
D. Absent, no pulse palpable
Correct Answer: B
The pulse grading scale ranges from 0 to 4+: 0 indicates absent pulse, 1+ indicates weak and thready pulse that is difficult to
palpate, 2+ indicates normal pulse strength, 3+ indicates full and bounding pulse (increased), and 4+ indicates a very strong,
aneurysmal pulse. A 1+ dorsalis pedis pulse suggests diminished arterial perfusion to the foot and requires further assessment
for possible peripheral vascular disease, requiring comparison with the contralateral extremity.
6. A nurse auscultates a high-pitched, blowing sound at the mitral area that begins immediately after S1 and
extends throughout systole. The nurse correctly identifies this as which type of murmur, and which cardiac
condition is most likely present?
A. Diastolic murmur; mitral stenosis
B. Systolic murmur; mitral regurgitation [CORRECT]
C. Systolic murmur; aortic stenosis
D. Diastolic murmur; aortic regurgitation
Correct Answer: B
A murmur occurring between S1 and S2 is a systolic murmur. A holosystolic (pansystolic) murmur at the mitral area that
extends throughout systole is classic for mitral regurgitation, where blood flows backward from the left ventricle into the left
atrium during ventricular systole. Aortic stenosis produces a systolic murmur but is best heard at the 2nd right intercostal
space (aortic area). Diastolic murmurs occur between S2 and the next S1, with mitral stenosis and aortic regurgitation being
examples.
7. A nurse is assessing a patient's jugular venous pressure (JVP) and notes distension of the jugular veins when
the patient is seated at a 45-degree angle. This finding is most indicative of which condition?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with increased venous pressure [CORRECT]
C. Hypovolemia causing decreased venous return
D. Aortic stenosis causing increased afterload
Correct Answer: B
Rasmussen University - 2026/2027 Page 2
, NUR 2180 Physical Assessment - Quiz 2 Examination
Jugular venous distension (JVD) at a 45-degree angle is an abnormal finding that indicates elevated right atrial pressure,
most commonly caused by right-sided heart failure. The jugular veins normally collapse when the patient is seated at 30 to 45
degrees. JVD reflects increased systemic venous pressure and may also be seen in conditions such as fluid overload,
pulmonary hypertension, and superior vena cava obstruction. Left-sided heart failure typically presents with pulmonary
symptoms such as crackles and shortness of breath rather than JVD.
8. When auscultating the heart, the nurse places the stethoscope at the 2nd intercostal space, left sternal border.
Which valve area is the nurse assessing?
A. Aortic area
B. Mitral area
C. Pulmonic area [CORRECT]
D. Tricuspid area
Correct Answer: C
The 2nd intercostal space at the left sternal border corresponds to the pulmonic valve area, where S2 is best heard. The aortic
area is located at the 2nd ICS right sternal border. Erb's point is at the 3rd ICS left sternal border. The tricuspid area is at the
4th ICS left sternal border. The mitral area (apex) is at the 5th ICS midclavicular line where S1 is best heard.
9. A nurse is measuring blood pressure and selects a blood pressure cuff that is too narrow for the patient's arm
circumference. What effect will this have on the blood pressure reading?
A. The reading will be falsely low
B. The reading will be falsely elevated [CORRECT]
C. The reading will be accurate regardless of cuff size
D. Only the diastolic reading will be affected
Correct Answer: B
Using a blood pressure cuff that is too narrow (bladder width less than 40% of arm circumference) results in a falsely
elevated blood pressure reading because the cuff must be inflated to a higher pressure to compress the brachial artery.
Conversely, a cuff that is too wide will produce a falsely low reading. The correct cuff size requires the bladder width to be
approximately 40% of the arm circumference and the bladder length to be approximately 80% of the arm circumference.
10. A nurse obtains orthostatic vital signs on a patient. The blood pressure drops from 130/80 mmHg while
supine to 105/65 mmHg upon standing, and the heart rate increases from 78 to 100 bpm. The nurse correctly
interprets these findings as which of the following?
A. Normal orthostatic changes that require no intervention
B. Positive orthostatic hypotension indicating volume depletion [CORRECT]
C. Negative orthostatic findings suggesting fluid overload
D. An abnormal vagal response requiring immediate intervention
Correct Answer: B
Positive orthostatic vital signs are defined as a drop in systolic blood pressure greater than 20 mmHg, a drop in diastolic
blood pressure greater than 10 mmHg, or an increase in heart rate greater than 20 bpm when moving from supine to
standing. This patient's systolic BP dropped by 25 mmHg (130 to 105) and heart rate increased by 22 bpm (78 to 100),
meeting the criteria for orthostatic hypotension. This finding suggests volume depletion, which may be caused by dehydration,
hemorrhage, or medication side effects such as diuretics or antihypertensives.
11. A patient presents with shiny, atrophic skin on the lower extremities, hair loss, and a painful ulcer on the
tip of the big toe. Capillary refill is 4 seconds. Which condition is most consistent with these findings?
A. Venous insufficiency
Rasmussen University - 2026/2027 Page 3
