NUR 504 EXAM 4 QUESTIONS & ANSWERS| GRADE A| 100% CORRECT
(VERIFIED SOLUTIONS)
1. During an advanced health assessment, a patient reports progressive
shortness of breath that initially occurred only while climbing stairs but now
occurs while walking across the room, and the examiner notes an elevated
respiratory rate with use of accessory muscles. Which additional finding
would most strongly suggest significant respiratory compromise requiring
prompt evaluation?
A. Mild nasal congestion
B. Symmetric chest expansion with normal breath sounds
C. Increasing central cyanosis accompanied by altered mental status
D. Occasional nonproductive cough
Answer: C
2. A patient presents with several weeks of cough, intermittent wheezing, and
chest tightness that become worse after exposure to dust and improve
when away from the environment. During the physical examination, which
finding would most strongly support an obstructive airway process?
A. Prolonged expiratory phase with diffuse expiratory wheezes
B. Dullness to percussion over both posterior lung bases
C. Bilateral bronchial breath sounds over the peripheral lung fields
D. Completely absent tactile fremitus throughout both lungs
Answer: A
3. During cardiovascular assessment of an adult patient, the examiner
identifies a sustained apical impulse displaced laterally from the expected
location. Which interpretation is most appropriate?
A. It always represents a normal variation
B. It may suggest left ventricular enlargement or remodeling
C. It indicates isolated right atrial enlargement
D. It is diagnostic of acute myocardial infarction
Answer: B
pg. 1
, 4. A patient reports intermittent chest discomfort occurring predictably during
brisk walking and resolving after several minutes of rest. The discomfort is
described as pressure rather than sharp pain. Which additional
characteristic would most strongly support an ischemic cardiac origin?
A. Pain reproducible with palpation of the chest wall
B. Pain occurring exclusively after meals
C. Radiation toward the jaw or left arm during exertion
D. Pain lasting continuously for several days without change
Answer: C
5. During auscultation, the clinician hears a harsh systolic murmur best heard
at the right second intercostal space with radiation toward the carotids.
Which valvular abnormality is most consistent with this finding?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid stenosis
D. Pulmonic regurgitation
Answer: B
6. A patient with a history of hypertension presents for cardiovascular
assessment. The examiner notes a sustained apical impulse and an S4
gallop. Which underlying process most likely explains these findings?
A. Reduced left ventricular compliance associated with ventricular
hypertrophy
B. Acute right-sided volume overload
C. Severe tricuspid valve regurgitation
D. Complete absence of ventricular contraction
Answer: A
7. A patient complains of episodic palpitations accompanied by dizziness.
Which component of the history would be most important for determining
the clinical significance of the episodes?
A. Whether the patient prefers caffeinated beverages
pg. 2
, B. The patient's usual bedtime
C. The exact onset, duration, frequency, associated symptoms, and
precipitating factors
D. Whether the patient has experienced seasonal allergies
Answer: C
8. During respiratory assessment, a patient has increased tactile fremitus over
a localized area of the right lower lung field. Which condition could produce
this finding?
A. Pleural effusion
B. Pneumothorax
C. Consolidation from pneumonia
D. Severe emphysema
Answer: C
9. A patient with sudden unilateral pleuritic chest pain and dyspnea develops
tachycardia and mild hypoxemia. Which history finding would increase
concern for pulmonary embolism?
A. Recent prolonged immobilization following major surgery
B. Long-standing seasonal allergic rhinitis
C. Occasional tension headaches
D. Remote history of childhood otitis media
Answer: A
10. During lung auscultation, the examiner hears a high-pitched musical sound
predominantly during expiration. Which finding is being described?
A. Pleural friction rub
B. Wheezing
C. Crackles
D. Bronchophony
Answer: B
pg. 3
, 11. A patient reports orthopnea and states that sleeping on three pillows
significantly improves breathing. Which underlying condition should receive
particular consideration?
A. Left-sided heart failure
B. Acute appendicitis
C. Migraine disorder
D. Uncomplicated allergic rhinitis
Answer: A
12. During assessment of jugular venous pressure, the clinician observes an
elevated venous column while the patient is positioned appropriately.
Which condition can produce persistent jugular venous distention?
A. Isolated left wrist arthritis
B. Right-sided heart failure
C. Mild dehydration
D. Uncomplicated tension headache
Answer: B
13. A patient presents with bilateral lower-extremity edema, increasing
abdominal girth, and exertional fatigue. Which additional assessment
finding would provide important evidence of systemic venous congestion?
A. Flat neck veins
B. Increased jugular venous pressure
C. Hyperactive bowel sounds
D. Decreased tactile fremitus
Answer: B
14. A patient reports a cough that has persisted for several months. Which
aspect of the cough history is most important when distinguishing among
possible pulmonary causes?
A. The patient's favorite beverage
B. Whether the patient prefers morning or evening showers
C. Duration, character, sputum production, triggers, associated symptoms,
pg. 4
(VERIFIED SOLUTIONS)
1. During an advanced health assessment, a patient reports progressive
shortness of breath that initially occurred only while climbing stairs but now
occurs while walking across the room, and the examiner notes an elevated
respiratory rate with use of accessory muscles. Which additional finding
would most strongly suggest significant respiratory compromise requiring
prompt evaluation?
A. Mild nasal congestion
B. Symmetric chest expansion with normal breath sounds
C. Increasing central cyanosis accompanied by altered mental status
D. Occasional nonproductive cough
Answer: C
2. A patient presents with several weeks of cough, intermittent wheezing, and
chest tightness that become worse after exposure to dust and improve
when away from the environment. During the physical examination, which
finding would most strongly support an obstructive airway process?
A. Prolonged expiratory phase with diffuse expiratory wheezes
B. Dullness to percussion over both posterior lung bases
C. Bilateral bronchial breath sounds over the peripheral lung fields
D. Completely absent tactile fremitus throughout both lungs
Answer: A
3. During cardiovascular assessment of an adult patient, the examiner
identifies a sustained apical impulse displaced laterally from the expected
location. Which interpretation is most appropriate?
A. It always represents a normal variation
B. It may suggest left ventricular enlargement or remodeling
C. It indicates isolated right atrial enlargement
D. It is diagnostic of acute myocardial infarction
Answer: B
pg. 1
, 4. A patient reports intermittent chest discomfort occurring predictably during
brisk walking and resolving after several minutes of rest. The discomfort is
described as pressure rather than sharp pain. Which additional
characteristic would most strongly support an ischemic cardiac origin?
A. Pain reproducible with palpation of the chest wall
B. Pain occurring exclusively after meals
C. Radiation toward the jaw or left arm during exertion
D. Pain lasting continuously for several days without change
Answer: C
5. During auscultation, the clinician hears a harsh systolic murmur best heard
at the right second intercostal space with radiation toward the carotids.
Which valvular abnormality is most consistent with this finding?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid stenosis
D. Pulmonic regurgitation
Answer: B
6. A patient with a history of hypertension presents for cardiovascular
assessment. The examiner notes a sustained apical impulse and an S4
gallop. Which underlying process most likely explains these findings?
A. Reduced left ventricular compliance associated with ventricular
hypertrophy
B. Acute right-sided volume overload
C. Severe tricuspid valve regurgitation
D. Complete absence of ventricular contraction
Answer: A
7. A patient complains of episodic palpitations accompanied by dizziness.
Which component of the history would be most important for determining
the clinical significance of the episodes?
A. Whether the patient prefers caffeinated beverages
pg. 2
, B. The patient's usual bedtime
C. The exact onset, duration, frequency, associated symptoms, and
precipitating factors
D. Whether the patient has experienced seasonal allergies
Answer: C
8. During respiratory assessment, a patient has increased tactile fremitus over
a localized area of the right lower lung field. Which condition could produce
this finding?
A. Pleural effusion
B. Pneumothorax
C. Consolidation from pneumonia
D. Severe emphysema
Answer: C
9. A patient with sudden unilateral pleuritic chest pain and dyspnea develops
tachycardia and mild hypoxemia. Which history finding would increase
concern for pulmonary embolism?
A. Recent prolonged immobilization following major surgery
B. Long-standing seasonal allergic rhinitis
C. Occasional tension headaches
D. Remote history of childhood otitis media
Answer: A
10. During lung auscultation, the examiner hears a high-pitched musical sound
predominantly during expiration. Which finding is being described?
A. Pleural friction rub
B. Wheezing
C. Crackles
D. Bronchophony
Answer: B
pg. 3
, 11. A patient reports orthopnea and states that sleeping on three pillows
significantly improves breathing. Which underlying condition should receive
particular consideration?
A. Left-sided heart failure
B. Acute appendicitis
C. Migraine disorder
D. Uncomplicated allergic rhinitis
Answer: A
12. During assessment of jugular venous pressure, the clinician observes an
elevated venous column while the patient is positioned appropriately.
Which condition can produce persistent jugular venous distention?
A. Isolated left wrist arthritis
B. Right-sided heart failure
C. Mild dehydration
D. Uncomplicated tension headache
Answer: B
13. A patient presents with bilateral lower-extremity edema, increasing
abdominal girth, and exertional fatigue. Which additional assessment
finding would provide important evidence of systemic venous congestion?
A. Flat neck veins
B. Increased jugular venous pressure
C. Hyperactive bowel sounds
D. Decreased tactile fremitus
Answer: B
14. A patient reports a cough that has persisted for several months. Which
aspect of the cough history is most important when distinguishing among
possible pulmonary causes?
A. The patient's favorite beverage
B. Whether the patient prefers morning or evening showers
C. Duration, character, sputum production, triggers, associated symptoms,
pg. 4
