NR 509 ADVANCED PHYSICAL
ASSESSMENT EXAM 2 -
COMPREHENSIVE REVIEW QUESTIONS
WITH VERIFIED ANSWERS (LATEST
2026/ 2027)- CHAMBERLAIN
1. While assessing a patient for a suspected aortic dissection, the clinician notes a significant
difference in systolic blood pressure between the right and left arms. What difference is
considered clinically significant for this condition?
A. Greater than 5 mmHg
B. Greater than 10 mmHg
C. Greater than 15 mmHg
D. Greater than 20 mmHg
Answer: D
Conceptual Explanation: A difference in systolic blood pressure of more than 20 mmHg
between the arms is a classic finding that increases the suspicion of an aortic dissection.
2. A 65-year-old patient presents with a ‘ripping’ chest pain radiating to the back. On
auscultation, a new diastolic murmur is heard at the right sternal border. This finding most
likely indicates:
A. Aortic Regurgitation due to proximal dissection
,B. Mitral Stenosis
C. Tricuspid Regurgitation
D. Pulmonary Embolism
Answer: A
Conceptual Explanation: A new diastolic murmur of aortic regurgitation in the setting of
chest/back pain is highly suggestive of a proximal aortic dissection involving the aortic
valve.
3. When assessing Jugular Venous Pressure (JVP), the vertical distance is measured from the
sternal angle. What is the normal upper limit for this distance to be considered non-elevated?
A. 3 cm
B. 2 cm
C. 5 cm
D. 8 cm
Answer: A
Conceptual Explanation: A JVP measured at more than 3 cm above the sternal angle (or
more than 8 cm total distance from the right atrium) is considered elevated.
4. Which heart sound is typically heard in late diastole, just before S1, and is often associated
with ventricular hypertrophy or ‘stiff’ ventricles?
A. S3 (Ventricular Gallop)
, B. S4 (Atrial Gallop)
C. Opening Snap
D. Ejection Click
Answer: B
Conceptual Explanation: S4 occurs during atrial contraction and is caused by blood being
forced into a stiff or non-compliant ventricle, often seen in hypertension or CAD.
5. A patient presents with a mid-systolic click followed by a late systolic murmur. Which
valvular abnormality is most likely?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Valve Prolapse
D. Tricuspid Stenosis
Answer: C
Conceptual Explanation: Mitral Valve Prolapse (MVP) is characterized by a mid-systolic
click, often followed by a murmur if regurgitation is present.
6. During the abdominal exam, the clinician performs the Rovsing’s sign. A positive test is
defined as:
A. Pain in the RUQ during deep palpation of the LUQ
B. Pain in the LLQ during deep palpation of the RLQ
ASSESSMENT EXAM 2 -
COMPREHENSIVE REVIEW QUESTIONS
WITH VERIFIED ANSWERS (LATEST
2026/ 2027)- CHAMBERLAIN
1. While assessing a patient for a suspected aortic dissection, the clinician notes a significant
difference in systolic blood pressure between the right and left arms. What difference is
considered clinically significant for this condition?
A. Greater than 5 mmHg
B. Greater than 10 mmHg
C. Greater than 15 mmHg
D. Greater than 20 mmHg
Answer: D
Conceptual Explanation: A difference in systolic blood pressure of more than 20 mmHg
between the arms is a classic finding that increases the suspicion of an aortic dissection.
2. A 65-year-old patient presents with a ‘ripping’ chest pain radiating to the back. On
auscultation, a new diastolic murmur is heard at the right sternal border. This finding most
likely indicates:
A. Aortic Regurgitation due to proximal dissection
,B. Mitral Stenosis
C. Tricuspid Regurgitation
D. Pulmonary Embolism
Answer: A
Conceptual Explanation: A new diastolic murmur of aortic regurgitation in the setting of
chest/back pain is highly suggestive of a proximal aortic dissection involving the aortic
valve.
3. When assessing Jugular Venous Pressure (JVP), the vertical distance is measured from the
sternal angle. What is the normal upper limit for this distance to be considered non-elevated?
A. 3 cm
B. 2 cm
C. 5 cm
D. 8 cm
Answer: A
Conceptual Explanation: A JVP measured at more than 3 cm above the sternal angle (or
more than 8 cm total distance from the right atrium) is considered elevated.
4. Which heart sound is typically heard in late diastole, just before S1, and is often associated
with ventricular hypertrophy or ‘stiff’ ventricles?
A. S3 (Ventricular Gallop)
, B. S4 (Atrial Gallop)
C. Opening Snap
D. Ejection Click
Answer: B
Conceptual Explanation: S4 occurs during atrial contraction and is caused by blood being
forced into a stiff or non-compliant ventricle, often seen in hypertension or CAD.
5. A patient presents with a mid-systolic click followed by a late systolic murmur. Which
valvular abnormality is most likely?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Valve Prolapse
D. Tricuspid Stenosis
Answer: C
Conceptual Explanation: Mitral Valve Prolapse (MVP) is characterized by a mid-systolic
click, often followed by a murmur if regurgitation is present.
6. During the abdominal exam, the clinician performs the Rovsing’s sign. A positive test is
defined as:
A. Pain in the RUQ during deep palpation of the LUQ
B. Pain in the LLQ during deep palpation of the RLQ
