Galen College NSG 3160 Exam 3 (pdf) | 2026/2027 | Health Assess
Q&A | Health Assessment
1. The nurse auscultates a patient's heart and hears a split S2 that widens on
inspiration and narrows on expiration. This finding is:
A) Paradoxical splitting
B) Fixed splitting
C) Physiologic (normal) splitting
D) Reverse splitting
Correct Answer: Physiologic (normal) splitting
Rationale: Normal splitting of S2 occurs because inspiration increases venous
return to the right ventricle, delaying pulmonic valve closure. This causes the
split to widen on inspiration and narrow on expiration. Fixed splitting does
not vary with respiration and is seen in atrial septal defects.
2. A patient with heart failure has an S3 gallop. The nurse knows that S3 is
best heard with the:
A) Bell of the stethoscope at the apex, with the patient lying on the left side
B) Diaphragm at the base, with the patient sitting forward
C) Bell at the left sternal border
D) Diaphragm at the right second intercostal space
Correct Answer: Bell of the stethoscope at the apex, with the patient lying on
the left side
Rationale: S3 is a low-frequency sound best heard with the bell of the
stethoscope at the apex in the left lateral decubitus position. S3 occurs
during rapid ventricular filling and is often associated with heart failure or
volume overload.
,3. A patient with a history of hypertension has a sustained, heaving point of
maximal impulse (PMI) at the 6th intercostal space, anterior axillary line. This
suggests:
A) Right ventricular hypertrophy
B) Left ventricular hypertrophy (pressure overload)
C) Dilated cardiomyopathy
D) Pericardial effusion
Correct Answer: Left ventricular hypertrophy (pressure overload)
Rationale: A sustained, forceful PMI displaced laterally and inferiorly indicates
left ventricular hypertrophy from chronic hypertension. The normal PMI is
located at the 5th intercostal space at the midclavicular line.
4. The nurse palpates the precordium and feels a thrill at the right second
intercostal space. This is most consistent with:
A) Aortic stenosis
B) Mitral regurgitation
C) Ventricular septal defect
D) Pulmonary stenosis
Correct Answer: Aortic stenosis
Rationale: A thrill is a palpable vibration caused by turbulent blood flow. A
thrill at the right second intercostal space (the aortic area) is most consistent
with aortic stenosis, which produces a systolic ejection murmur and palpable
thrill in that location.
,5. A patient with chronic obstructive pulmonary disease (COPD) has an
increased pulmonic component of S2 (loud P2). This indicates:
A) Normal finding in COPD
B) Pulmonary hypertension
C) Left ventricular failure
D) Atrial septal defect
Correct Answer: Pulmonary hypertension
Rationale: A loud P2 (pulmonic valve closure) suggests elevated pulmonary
artery pressure, often due to cor pulmonale from COPD. This indicates that
the right ventricle is pumping against increased resistance.
6. The nurse assesses a patient's jugular venous pressure (JVP) and
measures it at 12 cm H₂O above the sternal angle. This is:
A) Normal
B) Mildly elevated (normal <8-9 cm)
C) Severely elevated
D) Cannot determine without angle of Louis
Correct Answer: Mildly elevated (normal <8-9 cm)
Rationale: Normal JVP is ≤8-9 cm H₂O above the sternal angle. An elevated
JVP indicates right atrial pressure elevation, commonly seen in heart failure,
fluid overload, or pulmonary hypertension.
7. A patient with a new murmur also has fever, anorexia, and weight loss.
The nurse should consider:
A) Infective endocarditis
, B) Rheumatic heart disease
C) Myxoma
D) Acute rheumatic fever
Correct Answer: Infective endocarditis
Rationale: Fever with a new or changing murmur is suspicious for infective
endocarditis. This condition involves infection of the endocardial surface of
the heart, often affecting the valves, and requires prompt diagnosis and
treatment.
8. The nurse auscultates the carotid arteries and hears a bruit. Which of the
following is true?
A) All bruits indicate significant stenosis
B) Bruits may be present with minimal stenosis or in high-output states
C) Carotid bruits are always pathological
D) Bruits are best heard with the bell
Correct Answer: Bruits may be present with minimal stenosis or in high-
output states
Rationale: Carotid bruits are sensitive but not specific; they occur with ≥50%
stenosis but also with hyperthyroidism, anemia, or tortuous vessels. Further
evaluation is needed to determine the clinical significance.
9. A patient with pericarditis has a pericardial friction rub. The rub is best
heard when the patient:
A) Leans forward, holds breath, uses diaphragm
B) Lies supine with legs raised
Q&A | Health Assessment
1. The nurse auscultates a patient's heart and hears a split S2 that widens on
inspiration and narrows on expiration. This finding is:
A) Paradoxical splitting
B) Fixed splitting
C) Physiologic (normal) splitting
D) Reverse splitting
Correct Answer: Physiologic (normal) splitting
Rationale: Normal splitting of S2 occurs because inspiration increases venous
return to the right ventricle, delaying pulmonic valve closure. This causes the
split to widen on inspiration and narrow on expiration. Fixed splitting does
not vary with respiration and is seen in atrial septal defects.
2. A patient with heart failure has an S3 gallop. The nurse knows that S3 is
best heard with the:
A) Bell of the stethoscope at the apex, with the patient lying on the left side
B) Diaphragm at the base, with the patient sitting forward
C) Bell at the left sternal border
D) Diaphragm at the right second intercostal space
Correct Answer: Bell of the stethoscope at the apex, with the patient lying on
the left side
Rationale: S3 is a low-frequency sound best heard with the bell of the
stethoscope at the apex in the left lateral decubitus position. S3 occurs
during rapid ventricular filling and is often associated with heart failure or
volume overload.
,3. A patient with a history of hypertension has a sustained, heaving point of
maximal impulse (PMI) at the 6th intercostal space, anterior axillary line. This
suggests:
A) Right ventricular hypertrophy
B) Left ventricular hypertrophy (pressure overload)
C) Dilated cardiomyopathy
D) Pericardial effusion
Correct Answer: Left ventricular hypertrophy (pressure overload)
Rationale: A sustained, forceful PMI displaced laterally and inferiorly indicates
left ventricular hypertrophy from chronic hypertension. The normal PMI is
located at the 5th intercostal space at the midclavicular line.
4. The nurse palpates the precordium and feels a thrill at the right second
intercostal space. This is most consistent with:
A) Aortic stenosis
B) Mitral regurgitation
C) Ventricular septal defect
D) Pulmonary stenosis
Correct Answer: Aortic stenosis
Rationale: A thrill is a palpable vibration caused by turbulent blood flow. A
thrill at the right second intercostal space (the aortic area) is most consistent
with aortic stenosis, which produces a systolic ejection murmur and palpable
thrill in that location.
,5. A patient with chronic obstructive pulmonary disease (COPD) has an
increased pulmonic component of S2 (loud P2). This indicates:
A) Normal finding in COPD
B) Pulmonary hypertension
C) Left ventricular failure
D) Atrial septal defect
Correct Answer: Pulmonary hypertension
Rationale: A loud P2 (pulmonic valve closure) suggests elevated pulmonary
artery pressure, often due to cor pulmonale from COPD. This indicates that
the right ventricle is pumping against increased resistance.
6. The nurse assesses a patient's jugular venous pressure (JVP) and
measures it at 12 cm H₂O above the sternal angle. This is:
A) Normal
B) Mildly elevated (normal <8-9 cm)
C) Severely elevated
D) Cannot determine without angle of Louis
Correct Answer: Mildly elevated (normal <8-9 cm)
Rationale: Normal JVP is ≤8-9 cm H₂O above the sternal angle. An elevated
JVP indicates right atrial pressure elevation, commonly seen in heart failure,
fluid overload, or pulmonary hypertension.
7. A patient with a new murmur also has fever, anorexia, and weight loss.
The nurse should consider:
A) Infective endocarditis
, B) Rheumatic heart disease
C) Myxoma
D) Acute rheumatic fever
Correct Answer: Infective endocarditis
Rationale: Fever with a new or changing murmur is suspicious for infective
endocarditis. This condition involves infection of the endocardial surface of
the heart, often affecting the valves, and requires prompt diagnosis and
treatment.
8. The nurse auscultates the carotid arteries and hears a bruit. Which of the
following is true?
A) All bruits indicate significant stenosis
B) Bruits may be present with minimal stenosis or in high-output states
C) Carotid bruits are always pathological
D) Bruits are best heard with the bell
Correct Answer: Bruits may be present with minimal stenosis or in high-
output states
Rationale: Carotid bruits are sensitive but not specific; they occur with ≥50%
stenosis but also with hyperthyroidism, anemia, or tortuous vessels. Further
evaluation is needed to determine the clinical significance.
9. A patient with pericarditis has a pericardial friction rub. The rub is best
heard when the patient:
A) Leans forward, holds breath, uses diaphragm
B) Lies supine with legs raised
