NSG 3160 Exam 2 V3 | NSG 3160 Health
Assessment | Actual Q&A with Rationale (NSG3160
Exam 2) | Galen
1. A nurse is performing a respiratory assessment on a patient with suspected lobar
pneumonia. Which of the following findings would the nurse expect to encounter during the
physical examination? (Select all that apply)
A. Increased tactile fremitus over the affected area
B. Dullness to percussion over the consolidated lung tissue
C. Hyperresonance to percussion over the affected lobe
D. Bronchial breath sounds heard in the peripheral lung fields
E. Decreased chest expansion on the affected side
F. Presence of crackles or rales upon auscultation
Correct Answer: A, B, D, E, F
Explanation: Pneumonia causes consolidation in the lung tissue which increases the
density of the lung. This increased density leads to increased tactile fremitus and dullness
to percussion because sound and vibration travel better through solid or fluid-filled
medium than air. Bronchial breath sounds in the periphery are abnormal and indicate that
the air is passing through a consolidated area. Crackles are also common due to fluid in the
alveoli, and expansion is often limited by the infection.
,2. The nurse is preparing to assess the abdomen of a patient reporting right lower quadrant
pain. In which order should the nurse perform the assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Percussion, Auscultation, Inspection, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Explanation: The correct sequence for abdominal assessment is inspection followed by
auscultation. Percussion and palpation are performed last because they can stimulate
peristalsis and alter the natural bowel sounds. Following this specific order ensures the
accuracy of the bowel sound assessment.
3. When auscultating the heart, the nurse identifies the S1 sound. Which physiological event
is responsible for this sound?
A. Closure of the aortic and pulmonic valves
B. Opening of the mitral and tricuspid valves
C. The beginning of atrial contraction
D. Closure of the mitral and tricuspid valves
Correct Answer: D
, Explanation: The S1 heart sound, often described as ‘lub’, signifies the closure of the
atrioventricular (AV) valves, which are the mitral and tricuspid valves. This sound marks
the beginning of ventricular systole as the pressure in the ventricles rises above the
pressure in the atria. It is usually heard loudest at the apex of the heart using the
diaphragm of the stethoscope.
4. A patient presents with a ‘barrel chest’ during a physical examination. The nurse recognizes
that this finding is characterized by an anteroposterior-to-transverse diameter ratio of:
A. 1:2
B. 3:4
C. 2:1
D. 1:1
Correct Answer: D
Explanation: A normal adult chest has an anteroposterior (AP) diameter that is roughly
half the transverse diameter, a ratio of 1:2. In patients with chronic obstructive pulmonary
disease (COPD) or chronic asthma, air trapping leads to hyperinflation, resulting in a 1:1
ratio known as barrel chest. This physical finding indicates significant chronic underlying
respiratory pathology.
5. While assessing the carotid arteries, the nurse hears a blowing, swishing sound with the
bell of the stethoscope. How should the nurse document this finding?
A. A thrill
Assessment | Actual Q&A with Rationale (NSG3160
Exam 2) | Galen
1. A nurse is performing a respiratory assessment on a patient with suspected lobar
pneumonia. Which of the following findings would the nurse expect to encounter during the
physical examination? (Select all that apply)
A. Increased tactile fremitus over the affected area
B. Dullness to percussion over the consolidated lung tissue
C. Hyperresonance to percussion over the affected lobe
D. Bronchial breath sounds heard in the peripheral lung fields
E. Decreased chest expansion on the affected side
F. Presence of crackles or rales upon auscultation
Correct Answer: A, B, D, E, F
Explanation: Pneumonia causes consolidation in the lung tissue which increases the
density of the lung. This increased density leads to increased tactile fremitus and dullness
to percussion because sound and vibration travel better through solid or fluid-filled
medium than air. Bronchial breath sounds in the periphery are abnormal and indicate that
the air is passing through a consolidated area. Crackles are also common due to fluid in the
alveoli, and expansion is often limited by the infection.
,2. The nurse is preparing to assess the abdomen of a patient reporting right lower quadrant
pain. In which order should the nurse perform the assessment techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Percussion, Auscultation, Inspection, Palpation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Auscultation, Percussion, Palpation
Correct Answer: D
Explanation: The correct sequence for abdominal assessment is inspection followed by
auscultation. Percussion and palpation are performed last because they can stimulate
peristalsis and alter the natural bowel sounds. Following this specific order ensures the
accuracy of the bowel sound assessment.
3. When auscultating the heart, the nurse identifies the S1 sound. Which physiological event
is responsible for this sound?
A. Closure of the aortic and pulmonic valves
B. Opening of the mitral and tricuspid valves
C. The beginning of atrial contraction
D. Closure of the mitral and tricuspid valves
Correct Answer: D
, Explanation: The S1 heart sound, often described as ‘lub’, signifies the closure of the
atrioventricular (AV) valves, which are the mitral and tricuspid valves. This sound marks
the beginning of ventricular systole as the pressure in the ventricles rises above the
pressure in the atria. It is usually heard loudest at the apex of the heart using the
diaphragm of the stethoscope.
4. A patient presents with a ‘barrel chest’ during a physical examination. The nurse recognizes
that this finding is characterized by an anteroposterior-to-transverse diameter ratio of:
A. 1:2
B. 3:4
C. 2:1
D. 1:1
Correct Answer: D
Explanation: A normal adult chest has an anteroposterior (AP) diameter that is roughly
half the transverse diameter, a ratio of 1:2. In patients with chronic obstructive pulmonary
disease (COPD) or chronic asthma, air trapping leads to hyperinflation, resulting in a 1:1
ratio known as barrel chest. This physical finding indicates significant chronic underlying
respiratory pathology.
5. While assessing the carotid arteries, the nurse hears a blowing, swishing sound with the
bell of the stethoscope. How should the nurse document this finding?
A. A thrill
