WILKES UNIVERSITY
Graduate Nursing Program
NSG500 Advanced Health Assessment
Academic Year: 2026/2027 Exam 2 · Comprehensive Review
▪ Question 1
What is the S4 heart sound?
A. "Ken-tuck-y" sound, occurs during early diastole
B. "Ten-nes-see" sound, atrial gallop, occurs during late diastole with decreased ventricular
compliance
C. Systolic ejection murmur heard in aortic stenosis
D. Diastolic rumble heard in mitral stenosis
CORRECT ANSWER
B. "Ten-nes-see" sound, atrial gallop, occurs during late diastole with decreased
ventricular compliance
RATIONALE: S4 is a low-frequency sound occurring in late diastole during atrial
contraction. It is described as "Ten-nes-see" and is associated with decreased ventricular
compliance, such as in hypertension, myocardial ischemia, or hypertrophic cardiomyopathy. It
indicates a stiff, non-compliant ventricle.
,▪ Question 2
What is the diagnosis for syncope?
A. H&P, arrhythmia most common, vasovagal most likely without structural abnormality
B. ECG and cardiac enzymes
C. CT head and MRI
D. Stress testing and echocardiogram
CORRECT ANSWER
A. H&P, arrhythmia most common, vasovagal most likely without structural
abnormality
RATIONALE: Evaluation of syncope begins with a thorough history and physical exam.
Cardiac arrhythmias are the most common cause, while vasovagal syncope is the most likely
etiology in patients without structural heart disease. Diagnostic tests may include ECG, Holter
monitoring, echocardiogram, and tilt-table testing.
▪ Question 3
What are signs and symptoms of hypercortisolism?
A. Central obesity with full face, slender extremities, muscle weakness, back pain, mental
changes, thin fragile skin, poor wound healing, acne, menstrual disorders, hypertension
B. Weight gain, cold intolerance, dry skin, constipation
C. Hair loss, bulging eyes, goiter, heart palpitations
D. Weakness, fatigue, orthostatic hypotension, anorexia, weight loss, tan appearance to skin
CORRECT ANSWER
A. Central obesity with full face, slender extremities, muscle weakness, back pain,
mental changes, thin fragile skin, poor wound healing, acne, menstrual disorders,
hypertension
RATIONALE: Hypercortisolism (Cushing's syndrome) presents with central obesity, moon
face, buffalo hump, muscle weakness, thin fragile skin, poor wound healing, acne, menstrual
disorders, and hypertension. These are due to excess glucocorticoid exposure.
,▪ Question 4
What are diagnostic tests for asthma?
A. PFTs (spirometry), physical exam (airway patency, hyperinflation, breath sounds, pulses
paradoxus, FEV1/FVC ratio)
B. Chest X-ray and CT scan
C. Bronchoscopy and lung biopsy
D. Arterial blood gas and sputum culture
CORRECT ANSWER
A. PFTs (spirometry), physical exam (airway patency, hyperinflation, breath sounds,
pulses paradoxus, FEV1/FVC ratio)
RATIONALE: Asthma diagnosis involves pulmonary function tests (spirometry) showing
reversible airflow obstruction (FEV1/FVC ratio < 0.75, improvement with bronchodilator).
Physical exam may reveal hyperinflation, wheezing, prolonged expiration, and pulsus
paradoxus. Methacholine challenge may be used when spirometry is normal.
▪ Question 5
What is the characteristic murmur of mitral valve stenosis?
A. Snap then diastolic rumble
B. Holosystolic murmur
C. Systolic ejection murmur
D. Early decrescendo murmur
CORRECT ANSWER A. Snap then diastolic rumble
RATIONALE: Mitral stenosis produces an opening snap followed by a low-frequency
diastolic rumble, best heard at the apex with the patient in the left lateral decubitus position.
The opening snap is caused by the sudden opening of the stenotic mitral valve, and the rumble
is due to turbulent flow across the valve during diastole.
, ▪ Question 6
What is the DAWN phenomenon?
A. Early morning glucose elevation produced by the release of growth hormone, which
decreases peripheral uptake of glucose
B. Hypoglycemia followed by rebound hyperglycemia due to stress hormone release after
insulin
C. Nocturnal hypoglycemia leading to morning hyperglycemia
D. Postprandial hyperglycemia after breakfast
CORRECT ANSWER
A. Early morning glucose elevation produced by the release of growth hormone,
which decreases peripheral uptake of glucose
RATIONALE: The Dawn phenomenon is an early morning rise in blood glucose due to the
nocturnal release of growth hormone and other counterregulatory hormones, which increases
hepatic glucose production and decreases peripheral glucose uptake. It is common in type 2
diabetes and may require adjustments in medication or lifestyle.
▪ Question 7
What is the Frank-Starling law?
A. The greater the stretch, the stronger is the heart's contraction
B. The heart rate determines cardiac output
C. Increased afterload decreases stroke volume
D. Decreased preload increases stroke volume
CORRECT ANSWER A. The greater the stretch, the stronger is the heart's contraction
RATIONALE: The Frank-Starling law states that the stroke volume of the heart increases
with increased preload, up to a point. This is due to the increased stretch of the myocardial
fibers, which results in a more forceful contraction. Thus, decreased myocardial contractility may
result from the left ventricle's inability to fill to capacity.
Graduate Nursing Program
NSG500 Advanced Health Assessment
Academic Year: 2026/2027 Exam 2 · Comprehensive Review
▪ Question 1
What is the S4 heart sound?
A. "Ken-tuck-y" sound, occurs during early diastole
B. "Ten-nes-see" sound, atrial gallop, occurs during late diastole with decreased ventricular
compliance
C. Systolic ejection murmur heard in aortic stenosis
D. Diastolic rumble heard in mitral stenosis
CORRECT ANSWER
B. "Ten-nes-see" sound, atrial gallop, occurs during late diastole with decreased
ventricular compliance
RATIONALE: S4 is a low-frequency sound occurring in late diastole during atrial
contraction. It is described as "Ten-nes-see" and is associated with decreased ventricular
compliance, such as in hypertension, myocardial ischemia, or hypertrophic cardiomyopathy. It
indicates a stiff, non-compliant ventricle.
,▪ Question 2
What is the diagnosis for syncope?
A. H&P, arrhythmia most common, vasovagal most likely without structural abnormality
B. ECG and cardiac enzymes
C. CT head and MRI
D. Stress testing and echocardiogram
CORRECT ANSWER
A. H&P, arrhythmia most common, vasovagal most likely without structural
abnormality
RATIONALE: Evaluation of syncope begins with a thorough history and physical exam.
Cardiac arrhythmias are the most common cause, while vasovagal syncope is the most likely
etiology in patients without structural heart disease. Diagnostic tests may include ECG, Holter
monitoring, echocardiogram, and tilt-table testing.
▪ Question 3
What are signs and symptoms of hypercortisolism?
A. Central obesity with full face, slender extremities, muscle weakness, back pain, mental
changes, thin fragile skin, poor wound healing, acne, menstrual disorders, hypertension
B. Weight gain, cold intolerance, dry skin, constipation
C. Hair loss, bulging eyes, goiter, heart palpitations
D. Weakness, fatigue, orthostatic hypotension, anorexia, weight loss, tan appearance to skin
CORRECT ANSWER
A. Central obesity with full face, slender extremities, muscle weakness, back pain,
mental changes, thin fragile skin, poor wound healing, acne, menstrual disorders,
hypertension
RATIONALE: Hypercortisolism (Cushing's syndrome) presents with central obesity, moon
face, buffalo hump, muscle weakness, thin fragile skin, poor wound healing, acne, menstrual
disorders, and hypertension. These are due to excess glucocorticoid exposure.
,▪ Question 4
What are diagnostic tests for asthma?
A. PFTs (spirometry), physical exam (airway patency, hyperinflation, breath sounds, pulses
paradoxus, FEV1/FVC ratio)
B. Chest X-ray and CT scan
C. Bronchoscopy and lung biopsy
D. Arterial blood gas and sputum culture
CORRECT ANSWER
A. PFTs (spirometry), physical exam (airway patency, hyperinflation, breath sounds,
pulses paradoxus, FEV1/FVC ratio)
RATIONALE: Asthma diagnosis involves pulmonary function tests (spirometry) showing
reversible airflow obstruction (FEV1/FVC ratio < 0.75, improvement with bronchodilator).
Physical exam may reveal hyperinflation, wheezing, prolonged expiration, and pulsus
paradoxus. Methacholine challenge may be used when spirometry is normal.
▪ Question 5
What is the characteristic murmur of mitral valve stenosis?
A. Snap then diastolic rumble
B. Holosystolic murmur
C. Systolic ejection murmur
D. Early decrescendo murmur
CORRECT ANSWER A. Snap then diastolic rumble
RATIONALE: Mitral stenosis produces an opening snap followed by a low-frequency
diastolic rumble, best heard at the apex with the patient in the left lateral decubitus position.
The opening snap is caused by the sudden opening of the stenotic mitral valve, and the rumble
is due to turbulent flow across the valve during diastole.
, ▪ Question 6
What is the DAWN phenomenon?
A. Early morning glucose elevation produced by the release of growth hormone, which
decreases peripheral uptake of glucose
B. Hypoglycemia followed by rebound hyperglycemia due to stress hormone release after
insulin
C. Nocturnal hypoglycemia leading to morning hyperglycemia
D. Postprandial hyperglycemia after breakfast
CORRECT ANSWER
A. Early morning glucose elevation produced by the release of growth hormone,
which decreases peripheral uptake of glucose
RATIONALE: The Dawn phenomenon is an early morning rise in blood glucose due to the
nocturnal release of growth hormone and other counterregulatory hormones, which increases
hepatic glucose production and decreases peripheral glucose uptake. It is common in type 2
diabetes and may require adjustments in medication or lifestyle.
▪ Question 7
What is the Frank-Starling law?
A. The greater the stretch, the stronger is the heart's contraction
B. The heart rate determines cardiac output
C. Increased afterload decreases stroke volume
D. Decreased preload increases stroke volume
CORRECT ANSWER A. The greater the stretch, the stronger is the heart's contraction
RATIONALE: The Frank-Starling law states that the stroke volume of the heart increases
with increased preload, up to a point. This is due to the increased stretch of the myocardial
fibers, which results in a more forceful contraction. Thus, decreased myocardial contractility may
result from the left ventricle's inability to fill to capacity.
