NUR 6001 Exam 2 Advanced Health Assessment – (2026/2027)
Actual Questions, Verified Answers with Rationales (WPU) |
Guarantee Pass
SECTION 1: CARDIOVASCULAR SYSTEM
Q1: A nurse practitioner auscultates a high-pitched, blowing, decrescendo
diastolic murmur at the left third intercostal space. This is the classic description
for:
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral stenosis
Answer: C) Aortic regurgitation
Rationale: Aortic regurgitation produces a high-pitched, blowing, decrescendo
diastolic murmur best heard at the left third and fourth intercostal spaces at the
sternal border (Erb's point). This occurs due to incompetent aortic valve allowing
backflow of blood from the aorta into the left ventricle during diastole.
Q2: The normal point of maximal impulse (PMI) is located at:
A) The 2nd ICS, left sternal border
B) The 5th ICS, midclavicular line
C) The 4th ICS, left sternal border
D) The 2nd ICS, right sternal border
Answer: B) The 5th ICS, midclavicular line
Rationale: The normal PMI is located at the 5th intercostal space, midclavicular
line, corresponding to the apex of the heart. This is where the left ventricle is
most prominent against the chest wall during systole. Displacement may indicate
cardiomegaly.
,Q3: Physiologic splitting of S2 is best heard during:
A) Expiration
B) Inspiration
C) Both inspiration and expiration equally
D) Neither inspiration nor expiration
Answer: B) Inspiration
Rationale: Physiologic splitting of S2 occurs during inspiration when the pulmonic
valve closes later than the aortic valve due to increased venous return to the right
ventricle, prolonging right ventricular ejection. The split typically disappears
during expiration.
Q4: A fourth heart sound (S4) is best described as:
A) A sound heard in early diastole
B) A sound heard in late diastole (just before S1)
C) A systolic murmur
D) A diastolic murmur
Answer: B) A sound heard in late diastole (just before S1)
Rationale: S4 is a low-pitched sound heard in late diastole, just before S1. Often
called an atrial gallop, it is associated with decreased ventricular compliance, as
seen in hypertension, aortic stenosis, and myocardial ischemia. It occurs when the
atria contract against a stiff ventricle.
Q5: An S4 heart sound is most consistent with:
A) Aortic stenosis
B) A normal variant in older adults
C) Reduced ventricular compliance (stiff ventricle)
D) Volume overload from mitral regurgitation
Answer: C) Reduced ventricular compliance (stiff ventricle)
,Rationale: An S4 gallop occurs during atrial contraction, forcing blood into a non-
compliant (stiff) ventricle. It is often associated with left ventricular hypertrophy,
ischemia, or fibrosis. It is NEVER a normal finding and always indicates pathology.
Q6: Jugular venous distension (JVD) is most commonly associated with:
A) Left-sided heart failure
B) Right-sided heart failure
C) Aortic stenosis
D) Pericarditis
Answer: B) Right-sided heart failure
Rationale: JVD is a classic sign of right-sided heart failure, indicating elevated
central venous pressure. Left-sided heart failure typically presents with
pulmonary congestion (dyspnea, crackles). Pericarditis may also cause JVD but is
less common.
Q7: Paroxysmal nocturnal dyspnea (PND) is characterized by:
A) Shortness of breath that awakens the patient from sleep
B) Shortness of breath with exertion
C) Shortness of breath when lying flat
D) Shortness of breath with inspiration
Answer: A) Shortness of breath that awakens the patient from sleep
Rationale: PND is a classic symptom of left-sided heart failure where the patient
awakens suddenly at night with severe shortness of breath, often requiring sitting
up or standing to relieve symptoms. This occurs due to fluid redistribution from
the lower extremities to the lungs in the recumbent position.
Q8: Orthopnea is defined as:
A) Shortness of breath when lying flat
B) Shortness of breath with exertion
, C) Shortness of breath at night
D) Shortness of breath with inspiration
Answer: A) Shortness of breath when lying flat
Rationale: Orthopnea is dyspnea that occurs when the patient is lying flat and is
relieved by sitting up. It is a key symptom of left-sided heart failure, indicating
pulmonary venous congestion. The number of pillows needed (e.g., 2-pillow
orthopnea) quantifies severity.
Q9: A patient with heart failure with reduced ejection fraction. Which symptom
is most specific to this diagnosis?
A) Exertional dyspnea
B) Peripheral edema
C) Paroxysmal nocturnal dyspnea (PND)
D) Fatigue
Answer: C) Paroxysmal nocturnal dyspnea (PND)
Rationale: While all are symptoms of heart failure, PND is highly specific. It occurs
when the patient is recumbent, causing fluid redistribution into the pulmonary
circulation, leading to sudden awakening with severe breathlessness. Exertional
dyspnea can occur in many conditions.
Q10: The proper sequence for cardiac auscultation points is:
A) Aortic, Pulmonic, Tricuspid, Mitral (APTM)
B) Mitral, Tricuspid, Pulmonic, Aortic
C) Pulmonic, Aortic, Tricuspid, Mitral
D) Tricuspid, Mitral, Pulmonic, Aortic
Answer: A) Aortic, Pulmonic, Tricuspid, Mitral (APTM)
Rationale: The mnemonic "All Physicians Take Money" helps recall: Aortic (2nd
ICS, RSB), Pulmonic (2nd ICS, LSB), Tricuspid (4th ICS, LSB), Mitral/Apex (5th ICS,
MCL). This sequence follows the direction of blood flow.
Actual Questions, Verified Answers with Rationales (WPU) |
Guarantee Pass
SECTION 1: CARDIOVASCULAR SYSTEM
Q1: A nurse practitioner auscultates a high-pitched, blowing, decrescendo
diastolic murmur at the left third intercostal space. This is the classic description
for:
A) Mitral regurgitation
B) Aortic stenosis
C) Aortic regurgitation
D) Mitral stenosis
Answer: C) Aortic regurgitation
Rationale: Aortic regurgitation produces a high-pitched, blowing, decrescendo
diastolic murmur best heard at the left third and fourth intercostal spaces at the
sternal border (Erb's point). This occurs due to incompetent aortic valve allowing
backflow of blood from the aorta into the left ventricle during diastole.
Q2: The normal point of maximal impulse (PMI) is located at:
A) The 2nd ICS, left sternal border
B) The 5th ICS, midclavicular line
C) The 4th ICS, left sternal border
D) The 2nd ICS, right sternal border
Answer: B) The 5th ICS, midclavicular line
Rationale: The normal PMI is located at the 5th intercostal space, midclavicular
line, corresponding to the apex of the heart. This is where the left ventricle is
most prominent against the chest wall during systole. Displacement may indicate
cardiomegaly.
,Q3: Physiologic splitting of S2 is best heard during:
A) Expiration
B) Inspiration
C) Both inspiration and expiration equally
D) Neither inspiration nor expiration
Answer: B) Inspiration
Rationale: Physiologic splitting of S2 occurs during inspiration when the pulmonic
valve closes later than the aortic valve due to increased venous return to the right
ventricle, prolonging right ventricular ejection. The split typically disappears
during expiration.
Q4: A fourth heart sound (S4) is best described as:
A) A sound heard in early diastole
B) A sound heard in late diastole (just before S1)
C) A systolic murmur
D) A diastolic murmur
Answer: B) A sound heard in late diastole (just before S1)
Rationale: S4 is a low-pitched sound heard in late diastole, just before S1. Often
called an atrial gallop, it is associated with decreased ventricular compliance, as
seen in hypertension, aortic stenosis, and myocardial ischemia. It occurs when the
atria contract against a stiff ventricle.
Q5: An S4 heart sound is most consistent with:
A) Aortic stenosis
B) A normal variant in older adults
C) Reduced ventricular compliance (stiff ventricle)
D) Volume overload from mitral regurgitation
Answer: C) Reduced ventricular compliance (stiff ventricle)
,Rationale: An S4 gallop occurs during atrial contraction, forcing blood into a non-
compliant (stiff) ventricle. It is often associated with left ventricular hypertrophy,
ischemia, or fibrosis. It is NEVER a normal finding and always indicates pathology.
Q6: Jugular venous distension (JVD) is most commonly associated with:
A) Left-sided heart failure
B) Right-sided heart failure
C) Aortic stenosis
D) Pericarditis
Answer: B) Right-sided heart failure
Rationale: JVD is a classic sign of right-sided heart failure, indicating elevated
central venous pressure. Left-sided heart failure typically presents with
pulmonary congestion (dyspnea, crackles). Pericarditis may also cause JVD but is
less common.
Q7: Paroxysmal nocturnal dyspnea (PND) is characterized by:
A) Shortness of breath that awakens the patient from sleep
B) Shortness of breath with exertion
C) Shortness of breath when lying flat
D) Shortness of breath with inspiration
Answer: A) Shortness of breath that awakens the patient from sleep
Rationale: PND is a classic symptom of left-sided heart failure where the patient
awakens suddenly at night with severe shortness of breath, often requiring sitting
up or standing to relieve symptoms. This occurs due to fluid redistribution from
the lower extremities to the lungs in the recumbent position.
Q8: Orthopnea is defined as:
A) Shortness of breath when lying flat
B) Shortness of breath with exertion
, C) Shortness of breath at night
D) Shortness of breath with inspiration
Answer: A) Shortness of breath when lying flat
Rationale: Orthopnea is dyspnea that occurs when the patient is lying flat and is
relieved by sitting up. It is a key symptom of left-sided heart failure, indicating
pulmonary venous congestion. The number of pillows needed (e.g., 2-pillow
orthopnea) quantifies severity.
Q9: A patient with heart failure with reduced ejection fraction. Which symptom
is most specific to this diagnosis?
A) Exertional dyspnea
B) Peripheral edema
C) Paroxysmal nocturnal dyspnea (PND)
D) Fatigue
Answer: C) Paroxysmal nocturnal dyspnea (PND)
Rationale: While all are symptoms of heart failure, PND is highly specific. It occurs
when the patient is recumbent, causing fluid redistribution into the pulmonary
circulation, leading to sudden awakening with severe breathlessness. Exertional
dyspnea can occur in many conditions.
Q10: The proper sequence for cardiac auscultation points is:
A) Aortic, Pulmonic, Tricuspid, Mitral (APTM)
B) Mitral, Tricuspid, Pulmonic, Aortic
C) Pulmonic, Aortic, Tricuspid, Mitral
D) Tricuspid, Mitral, Pulmonic, Aortic
Answer: A) Aortic, Pulmonic, Tricuspid, Mitral (APTM)
Rationale: The mnemonic "All Physicians Take Money" helps recall: Aortic (2nd
ICS, RSB), Pulmonic (2nd ICS, LSB), Tricuspid (4th ICS, LSB), Mitral/Apex (5th ICS,
MCL). This sequence follows the direction of blood flow.
