• NURS 190 PA 09/16/2026
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
Physiologic splitting of the S2 in the 2nd and 3rd interspace, which is usually accentuated by inspiration, is caused
by:
A) the closing of the aortic and pulmonic valves
B) the addition of the S4 sound
C) the addition of the S3 sound
D) the closing of the tricuspid and mitral valves - Correct Answer :A) the closing of the aortic and pulmonic
valves
P 1
, • NURS 190 PA 09/16/2026
Midterm
Physiologic splitting of the S2 = closing of the aortic and pulmonic valves. Usually, the pulmonic valve closure is
too faint to be heart but at the apex. The split is accentuated upon inspiration and disappears on expiration
(Bates, p405).
When assessing a patient's lungs, the nurse recalls that the left lung:
A) is shorter than the right lung because of the underlying stomach.
B) is divided by the horizontal fissure.
C) consists of 2 lobes.
D) consists primarily of an upper lobe on the posterior chest. - Correct Answer :C) consists of 2 lobes.
The left lung has 2 lobes, and the right lung has 3 lobes. The right lung is shorter than the left lung because of the
underlying LIVER. The left lung is narrower than the right lung because the heart bulges to the left. The posterior
chest is almost all lower lobe (Bates, p307).
The primary muscles of respiration include the :
A) trapezius and rectus abdominis.
B) sternomastoids and scaleni.
C) diaphragm and intercostals.
D) external obliques and pectoralis major. - Correct Answer :C) diaphragm and intercostals.
The major muscle of respiration is the diaphragm. The intercostal muscles life the sternum and elevate the ribs
during inspiration, increasing the anteroposterior diameter. Expiration is primarily passive. Forced inspiration
involves the use of other muscles, such as the accessory neck muscles (sternomastoids, scalene, trapazii).
Forced expiration involves the abdominal muscles (Bates, p309).
When auscultating the lungs of an adult patient, the nurse practitioner notes that over the posterior lower lobes
low-pitched, soft breath sounds are heard, with inspiration being longer than expiration. The nurse interprets
that these are:
A) bronchial breath sounds and are normal in that location
B) sounds normally auscultated over the trachea
P 2
, • NURS 190 PA 09/16/2026
Midterm
C) vesicular breath sounds and are normal in that location
D) bronchovesicular breath sounds and are normal in that location - Correct Answer :C) vesicular breath sounds
and are normal in that location
Vesicular breath sounds are low-pitched, soft sounds with inspiration being longer than expiration. These breath
sounds are expected over peripheral lung fields where air flows through smaller bronchioles and alveoli (Bates,
p324)
The nurse practitioner is auscultating the chest in an adult. Which technique is correct?
A) Instruct the patient to breathe in and out only through his or her nose.
B) Use the diaphragm of the stethoscope held firmly against the chest.
C) Instruct the patient to take deep, rapid breaths.
D) Use the bell of the stethoscope held lightly against the chest to avoid friction. - Correct Answer :B) Use the
diaphragm of the stethoscope held firmly against the chest.
The diaphragm of the stethoscope held firmly against the chest is the correct way to auscultate breath sounds.
The patient should be instructed to breathe through his or her mouth, a little deeper than usual, but not to
hyperventilate. (Bates, p323)
You can tell that you hear bronchovesicular sounds by the:
A) soft, low pitch sound you hear over most of both lung. The inspiratory sounds last longer than the expiratory
sounds.
B) very loud and relatively high pitch of the sounds heard over the trachea in the neck
C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st
and 2nd interspaces anteriorly and between the scapulae
D) crepitus palpated at the costochrondral junctions - Correct Answer :C) inspiratory and expiratory sounds are
equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and
between the scapulae
Bronchovesicular breath sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae.
They are intermediate in intensity. Inspiration to expiration periods are equal. Inspiration and expiration are
equal. (Bates, p324)
P 3
, • NURS 190 PA 09/16/2026
Midterm
The NP knows that normal newborn lung sounds:
A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the
sounds
B) are vesicular
C) are easily auscultated without the stethoscope
D) are quiet in the infant compared to the adult - Correct Answer :A) are harsh and loud in the upper airway of
the infant because the stethoscope is closer to the origin of the sounds
Fine crackles are commonly heard in the immediate newborn period as a result of the opening of the airways and
learning of fluid. Persistent fine crackles would be noticed with pneumonia, bronchiolitis, or atelectasis. (Bates, p
831)
During an assessment of an adult, the nurse practitioner has noted abnormally located bronchovesicular breath
sounds and asks the patient to say "ee" which sounds like "a." Which of the following is true?
A) The NP suspects the patient has had a pneumothorax.
B) The NP suspects the patient is in the early phases of COPD.
C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia.
D) The NP concludes that there is only a low likelihood that the patient has pneumonia. - Correct Answer :C) The
NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia.
If "ee" sounds like "a" then egophony is present and it could be a sign of pneumonia. (Bates, p327).
A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in
my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the
right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the
left. This description is consistent with:
A) acute pneumonia
B) an asthmatic attack
C) a pneumothorax
D) bronchitis - Correct Answer :C) a pneumothorax
P 4
Midterm
NURS 190 PA Midterm Exam | Questions and
Answers – spring 2026| 100% Correct – WCU
2026–2027 | Review & Next Gen Practice
Questions with Answers, Detailed Rationales
Physiologic splitting of the S2 in the 2nd and 3rd interspace, which is usually accentuated by inspiration, is caused
by:
A) the closing of the aortic and pulmonic valves
B) the addition of the S4 sound
C) the addition of the S3 sound
D) the closing of the tricuspid and mitral valves - Correct Answer :A) the closing of the aortic and pulmonic
valves
P 1
, • NURS 190 PA 09/16/2026
Midterm
Physiologic splitting of the S2 = closing of the aortic and pulmonic valves. Usually, the pulmonic valve closure is
too faint to be heart but at the apex. The split is accentuated upon inspiration and disappears on expiration
(Bates, p405).
When assessing a patient's lungs, the nurse recalls that the left lung:
A) is shorter than the right lung because of the underlying stomach.
B) is divided by the horizontal fissure.
C) consists of 2 lobes.
D) consists primarily of an upper lobe on the posterior chest. - Correct Answer :C) consists of 2 lobes.
The left lung has 2 lobes, and the right lung has 3 lobes. The right lung is shorter than the left lung because of the
underlying LIVER. The left lung is narrower than the right lung because the heart bulges to the left. The posterior
chest is almost all lower lobe (Bates, p307).
The primary muscles of respiration include the :
A) trapezius and rectus abdominis.
B) sternomastoids and scaleni.
C) diaphragm and intercostals.
D) external obliques and pectoralis major. - Correct Answer :C) diaphragm and intercostals.
The major muscle of respiration is the diaphragm. The intercostal muscles life the sternum and elevate the ribs
during inspiration, increasing the anteroposterior diameter. Expiration is primarily passive. Forced inspiration
involves the use of other muscles, such as the accessory neck muscles (sternomastoids, scalene, trapazii).
Forced expiration involves the abdominal muscles (Bates, p309).
When auscultating the lungs of an adult patient, the nurse practitioner notes that over the posterior lower lobes
low-pitched, soft breath sounds are heard, with inspiration being longer than expiration. The nurse interprets
that these are:
A) bronchial breath sounds and are normal in that location
B) sounds normally auscultated over the trachea
P 2
, • NURS 190 PA 09/16/2026
Midterm
C) vesicular breath sounds and are normal in that location
D) bronchovesicular breath sounds and are normal in that location - Correct Answer :C) vesicular breath sounds
and are normal in that location
Vesicular breath sounds are low-pitched, soft sounds with inspiration being longer than expiration. These breath
sounds are expected over peripheral lung fields where air flows through smaller bronchioles and alveoli (Bates,
p324)
The nurse practitioner is auscultating the chest in an adult. Which technique is correct?
A) Instruct the patient to breathe in and out only through his or her nose.
B) Use the diaphragm of the stethoscope held firmly against the chest.
C) Instruct the patient to take deep, rapid breaths.
D) Use the bell of the stethoscope held lightly against the chest to avoid friction. - Correct Answer :B) Use the
diaphragm of the stethoscope held firmly against the chest.
The diaphragm of the stethoscope held firmly against the chest is the correct way to auscultate breath sounds.
The patient should be instructed to breathe through his or her mouth, a little deeper than usual, but not to
hyperventilate. (Bates, p323)
You can tell that you hear bronchovesicular sounds by the:
A) soft, low pitch sound you hear over most of both lung. The inspiratory sounds last longer than the expiratory
sounds.
B) very loud and relatively high pitch of the sounds heard over the trachea in the neck
C) inspiratory and expiratory sounds are equal in duration and pitch is intermediate. Sounds are heard in the 1st
and 2nd interspaces anteriorly and between the scapulae
D) crepitus palpated at the costochrondral junctions - Correct Answer :C) inspiratory and expiratory sounds are
equal in duration and pitch is intermediate. Sounds are heard in the 1st and 2nd interspaces anteriorly and
between the scapulae
Bronchovesicular breath sounds are heard in the 1st and 2nd interspaces anteriorly and between the scapulae.
They are intermediate in intensity. Inspiration to expiration periods are equal. Inspiration and expiration are
equal. (Bates, p324)
P 3
, • NURS 190 PA 09/16/2026
Midterm
The NP knows that normal newborn lung sounds:
A) are harsh and loud in the upper airway of the infant because the stethoscope is closer to the origin of the
sounds
B) are vesicular
C) are easily auscultated without the stethoscope
D) are quiet in the infant compared to the adult - Correct Answer :A) are harsh and loud in the upper airway of
the infant because the stethoscope is closer to the origin of the sounds
Fine crackles are commonly heard in the immediate newborn period as a result of the opening of the airways and
learning of fluid. Persistent fine crackles would be noticed with pneumonia, bronchiolitis, or atelectasis. (Bates, p
831)
During an assessment of an adult, the nurse practitioner has noted abnormally located bronchovesicular breath
sounds and asks the patient to say "ee" which sounds like "a." Which of the following is true?
A) The NP suspects the patient has had a pneumothorax.
B) The NP suspects the patient is in the early phases of COPD.
C) The NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia.
D) The NP concludes that there is only a low likelihood that the patient has pneumonia. - Correct Answer :C) The
NP documents that there is positive egophony and he/she becomes highly suspicious of pneumonia.
If "ee" sounds like "a" then egophony is present and it could be a sign of pneumonia. (Bates, p327).
A teenage patient comes to the emergency room with complaints of an "inability to breathe and a sharp pain in
my left chest." Your assessment findings include the following: Cyanosis, tachypnea, tracheal deviation to the
right, decreased tactile fremitus on the left, hyperresonance on the left, and decreased breath sounds on the
left. This description is consistent with:
A) acute pneumonia
B) an asthmatic attack
C) a pneumothorax
D) bronchitis - Correct Answer :C) a pneumothorax
P 4
