Rasmussen University · NUR2180 / NUR 2180
Quiz Module 7: Physical Assessment
Latest Update 2026/2027 — Questions and Verified Answers — 100% Correct — Grade A
Complete Study Guide — 75-Question Comprehensive Exam · 6 Domains
Instructions. This 75-question quiz covers the full NUR2180 Module 7 Physical Assessment curriculum across 6
domains: (1) Cardiovascular Assessment; (2) Peripheral Vascular Assessment; (3) Respiratory Assessment; (4)
Cardiovascular and Respiratory Abnormalities; (5) Special Populations and Focused Assessments; and (6)
Documentation, Clinical Reasoning, and Priority Actions. Each question is followed by the correct answer and a detailed
rationale with physical assessment-specific reasoning aligned with Rasmussen University NUR2180 standards. Cognitive
levels are approximately 30% recall, 50% application, and 20% analysis, with 70% scenario-based items and 30% direct
recall. Many questions use 'What should the nurse do FIRST?' and 'What is the priority action?' formats to reflect
real-world clinical decision-making.
Section 1 — Cardiovascular Assessment (Heart Sounds, Murmurs, Pulses, & Precordium)
Questions 1–16 cover cardiac landmarks, S1/S2, extra heart sounds (S3, S4), murmurs, pericardial friction rub, and carotid
assessment. Aligned with Rasmussen NUR2180 Module 7 Domain 1.
Q1: The nurse is auscultating the apical pulse. At which anatomical landmark should the stethoscope be placed
to best hear the mitral valve area?
A. Second intercostal space, right sternal border (aortic area)
B. Second intercostal space, left sternal border (pulmonic area)
C. Fifth intercostal space, midclavicular line (mitral/apex area — PMI) [CORRECT]
D. Third intercostal space, left sternal border (Erb's point)
Correct Answer: C. Fifth intercostal space, midclavicular line (mitral/apex area — PMI)
Rationale: The mitral area (apex/PMI) is located at the fifth intercostal space, midclavicular line, and is the best site to
auscultate S1 (mitral closure) and the apical impulse. The aortic area is 2nd ICS right sternal border; pulmonic is 2nd ICS
left sternal border; Erb's point is 3rd ICS left sternal border. Remembering 'All Patients Take Medicine' (Aortic, Pulmonic,
Tricuspid, Mitral) helps recall auscultation site order.
Q2: S1 (the 'lub') is produced primarily by closure of which valves?
A. Aortic and pulmonic valves
B. Mitral and tricuspid valves (AV valve closure marks the beginning of systole) [CORRECT]
C. Aortic and mitral valves
D. Pulmonic and tricuspid valves
Correct Answer: B. Mitral and tricuspid valves (AV valve closure marks the beginning of systole)
Rationale: S1 is produced by closure of the mitral and tricuspid (AV) valves at the onset of ventricular systole. S2 ('dub')
is produced by closure of the aortic and pulmonic (semilunar) valves at the end of systole. A common pitfall is reversing
these — 'lub' = AV closure, 'dub' = semilunar closure.
,Q3: While auscultating an adult patient's heart, the nurse hears a soft sound immediately after S2 that sounds
like 'lub-dub-dub.' The sound is best heard at the apex with the patient in the left lateral position. This sound is
most likely:
A. S4 gallop
B. S3 (ventricular gallop), often associated with heart failure or volume overload in adults [CORRECT]
C. A split S2
D. A pericardial friction rub
Correct Answer: B. S3 (ventricular gallop), often associated with heart failure or volume overload in adults
Rationale: An S3 occurs just after S2 ('lub-dub-dub'), is best heard at the apex with the patient in the left lateral position,
and in adults >40 often indicates heart failure or volume overload. S4 occurs just before S1 ('lub-lub-dub'); a split S2 is
two distinct components of S2; a friction rub is a scratching, leathery sound. S3 is normal in children and young adults but
abnormal in older adults.
Q4: The nurse auscultates a low-pitched sound just before S1 ('lub-lub-dub') at the apex in a patient with chronic
hypertension. This sound is most consistent with:
A. S3 ventricular gallop
B. S4 (atrial gallop), caused by increased resistance to ventricular filling from a stiff, noncompliant ventricle,
commonly heard in hypertension and CAD [CORRECT]
C. A grade II murmur
D. A pericardial friction rub
Correct Answer: B. S4 (atrial gallop), caused by increased resistance to ventricular filling from a stiff,
noncompliant ventricle, commonly heard in hypertension and CAD
Rationale: S4 occurs just before S1 ('lub-lub-dub') and reflects atrial contraction pushing blood into a stiff, noncompliant
ventricle — commonly caused by hypertension, CAD, aortic stenosis, or hypertrophic cardiomyopathy. It is best heard at
the apex with the bell. S3 follows S2; murmurs are longer, blowing sounds; friction rubs are scratching and leathery.
Q5: A nurse hears a murmur described as 'Grade III/VI, loud, medium-pitched, accompanied by a thrill.' This
description is best classified as which grade on the standard murmur scale?
A. Grade II — soft, easily heard, no thrill
B. Grade III — moderate to loud, with a palpable thrill [CORRECT]
C. Grade IV — very loud, with thrill audible with stethoscope off the chest
D. Grade I — barely audible, no thrill
Correct Answer: B. Grade III — moderate to loud, with a palpable thrill
Rationale: Grade III murmurs are moderate-to-loud and accompanied by a palpable thrill. The classic scale: I = barely
audible, II = soft but easily heard, III = moderate-loud with thrill, IV = loud with thrill, V = very loud (heard with
stethoscope edge off chest), VI = audible without stethoscope. The presence of a thrill (palpable murmur) indicates Grade
IV or higher; Grade III is the transition point where thrills may begin.
, Q6: A patient presents with a scratching, grating, high-pitched sound that increases when the patient leans
forward and exhales. It is heard best at the left sternal border, 3rd intercostal space. This finding is most
consistent with:
A. S3 gallop
B. Pericardial friction rub, suggesting pericardial inflammation (pericarditis) [CORRECT]
C. Pleural friction rub
D. Aortic regurgitation murmur
Correct Answer: B. Pericardial friction rub, suggesting pericardial inflammation (pericarditis)
Rationale: A pericardial friction rub is a scratching, grating, high-pitched sound best heard at the left sternal border (3rd
ICS) with the patient leaning forward and exhaling; it indicates pericardial inflammation (pericarditis). A pleural rub is
respiratory-related (stops with breath-holding); murmurs are longer and blowing. The position and quality distinguish
pericardial from pleural rubs.
Q7: When assessing the carotid arteries, the nurse should:
A. Auscultate and palpate both carotids simultaneously to compare.
B. Palpate one carotid at a time and auscultate for bruits; never palpate both simultaneously to avoid
reducing cerebral blood flow. [CORRECT]
C. Vigorously massage the carotid to stimulate the baroreceptor.
D. Auscultate only if a murmur is present.
Correct Answer: B. Palpate one carotid at a time and auscultate for bruits; never palpate both simultaneously to
avoid reducing cerebral blood flow.
Rationale: Palpate only one carotid at a time to avoid compromising cerebral perfusion. Auscultate for bruits (swishing
sounds from turbulent flow) using the bell of the stethoscope. Carotid massage is dangerous (can trigger vagal response).
Bruits suggest atherosclerosis; always auscultate in cardiac assessment.
Q8: Auscultating the carotid artery and hearing a blowing, swishing sound during systole is documented as a:
A. Murmur
B. Bruitt, indicating turbulent blood flow often from atherosclerotic narrowing [CORRECT]
C. S3 gallop
D. Pericardial friction rub
Correct Answer: B. Bruitt, indicating turbulent blood flow often from atherosclerotic narrowing
Rationale: A bruit is a blowing/swishing sound auscultated over an artery, indicating turbulent flow — often from
atherosclerotic narrowing. Murmurs are cardiac in origin; S3 and friction rubs are heart sounds. Bruits over the carotids
suggest cerebrovascular disease risk.
Quiz Module 7: Physical Assessment
Latest Update 2026/2027 — Questions and Verified Answers — 100% Correct — Grade A
Complete Study Guide — 75-Question Comprehensive Exam · 6 Domains
Instructions. This 75-question quiz covers the full NUR2180 Module 7 Physical Assessment curriculum across 6
domains: (1) Cardiovascular Assessment; (2) Peripheral Vascular Assessment; (3) Respiratory Assessment; (4)
Cardiovascular and Respiratory Abnormalities; (5) Special Populations and Focused Assessments; and (6)
Documentation, Clinical Reasoning, and Priority Actions. Each question is followed by the correct answer and a detailed
rationale with physical assessment-specific reasoning aligned with Rasmussen University NUR2180 standards. Cognitive
levels are approximately 30% recall, 50% application, and 20% analysis, with 70% scenario-based items and 30% direct
recall. Many questions use 'What should the nurse do FIRST?' and 'What is the priority action?' formats to reflect
real-world clinical decision-making.
Section 1 — Cardiovascular Assessment (Heart Sounds, Murmurs, Pulses, & Precordium)
Questions 1–16 cover cardiac landmarks, S1/S2, extra heart sounds (S3, S4), murmurs, pericardial friction rub, and carotid
assessment. Aligned with Rasmussen NUR2180 Module 7 Domain 1.
Q1: The nurse is auscultating the apical pulse. At which anatomical landmark should the stethoscope be placed
to best hear the mitral valve area?
A. Second intercostal space, right sternal border (aortic area)
B. Second intercostal space, left sternal border (pulmonic area)
C. Fifth intercostal space, midclavicular line (mitral/apex area — PMI) [CORRECT]
D. Third intercostal space, left sternal border (Erb's point)
Correct Answer: C. Fifth intercostal space, midclavicular line (mitral/apex area — PMI)
Rationale: The mitral area (apex/PMI) is located at the fifth intercostal space, midclavicular line, and is the best site to
auscultate S1 (mitral closure) and the apical impulse. The aortic area is 2nd ICS right sternal border; pulmonic is 2nd ICS
left sternal border; Erb's point is 3rd ICS left sternal border. Remembering 'All Patients Take Medicine' (Aortic, Pulmonic,
Tricuspid, Mitral) helps recall auscultation site order.
Q2: S1 (the 'lub') is produced primarily by closure of which valves?
A. Aortic and pulmonic valves
B. Mitral and tricuspid valves (AV valve closure marks the beginning of systole) [CORRECT]
C. Aortic and mitral valves
D. Pulmonic and tricuspid valves
Correct Answer: B. Mitral and tricuspid valves (AV valve closure marks the beginning of systole)
Rationale: S1 is produced by closure of the mitral and tricuspid (AV) valves at the onset of ventricular systole. S2 ('dub')
is produced by closure of the aortic and pulmonic (semilunar) valves at the end of systole. A common pitfall is reversing
these — 'lub' = AV closure, 'dub' = semilunar closure.
,Q3: While auscultating an adult patient's heart, the nurse hears a soft sound immediately after S2 that sounds
like 'lub-dub-dub.' The sound is best heard at the apex with the patient in the left lateral position. This sound is
most likely:
A. S4 gallop
B. S3 (ventricular gallop), often associated with heart failure or volume overload in adults [CORRECT]
C. A split S2
D. A pericardial friction rub
Correct Answer: B. S3 (ventricular gallop), often associated with heart failure or volume overload in adults
Rationale: An S3 occurs just after S2 ('lub-dub-dub'), is best heard at the apex with the patient in the left lateral position,
and in adults >40 often indicates heart failure or volume overload. S4 occurs just before S1 ('lub-lub-dub'); a split S2 is
two distinct components of S2; a friction rub is a scratching, leathery sound. S3 is normal in children and young adults but
abnormal in older adults.
Q4: The nurse auscultates a low-pitched sound just before S1 ('lub-lub-dub') at the apex in a patient with chronic
hypertension. This sound is most consistent with:
A. S3 ventricular gallop
B. S4 (atrial gallop), caused by increased resistance to ventricular filling from a stiff, noncompliant ventricle,
commonly heard in hypertension and CAD [CORRECT]
C. A grade II murmur
D. A pericardial friction rub
Correct Answer: B. S4 (atrial gallop), caused by increased resistance to ventricular filling from a stiff,
noncompliant ventricle, commonly heard in hypertension and CAD
Rationale: S4 occurs just before S1 ('lub-lub-dub') and reflects atrial contraction pushing blood into a stiff, noncompliant
ventricle — commonly caused by hypertension, CAD, aortic stenosis, or hypertrophic cardiomyopathy. It is best heard at
the apex with the bell. S3 follows S2; murmurs are longer, blowing sounds; friction rubs are scratching and leathery.
Q5: A nurse hears a murmur described as 'Grade III/VI, loud, medium-pitched, accompanied by a thrill.' This
description is best classified as which grade on the standard murmur scale?
A. Grade II — soft, easily heard, no thrill
B. Grade III — moderate to loud, with a palpable thrill [CORRECT]
C. Grade IV — very loud, with thrill audible with stethoscope off the chest
D. Grade I — barely audible, no thrill
Correct Answer: B. Grade III — moderate to loud, with a palpable thrill
Rationale: Grade III murmurs are moderate-to-loud and accompanied by a palpable thrill. The classic scale: I = barely
audible, II = soft but easily heard, III = moderate-loud with thrill, IV = loud with thrill, V = very loud (heard with
stethoscope edge off chest), VI = audible without stethoscope. The presence of a thrill (palpable murmur) indicates Grade
IV or higher; Grade III is the transition point where thrills may begin.
, Q6: A patient presents with a scratching, grating, high-pitched sound that increases when the patient leans
forward and exhales. It is heard best at the left sternal border, 3rd intercostal space. This finding is most
consistent with:
A. S3 gallop
B. Pericardial friction rub, suggesting pericardial inflammation (pericarditis) [CORRECT]
C. Pleural friction rub
D. Aortic regurgitation murmur
Correct Answer: B. Pericardial friction rub, suggesting pericardial inflammation (pericarditis)
Rationale: A pericardial friction rub is a scratching, grating, high-pitched sound best heard at the left sternal border (3rd
ICS) with the patient leaning forward and exhaling; it indicates pericardial inflammation (pericarditis). A pleural rub is
respiratory-related (stops with breath-holding); murmurs are longer and blowing. The position and quality distinguish
pericardial from pleural rubs.
Q7: When assessing the carotid arteries, the nurse should:
A. Auscultate and palpate both carotids simultaneously to compare.
B. Palpate one carotid at a time and auscultate for bruits; never palpate both simultaneously to avoid
reducing cerebral blood flow. [CORRECT]
C. Vigorously massage the carotid to stimulate the baroreceptor.
D. Auscultate only if a murmur is present.
Correct Answer: B. Palpate one carotid at a time and auscultate for bruits; never palpate both simultaneously to
avoid reducing cerebral blood flow.
Rationale: Palpate only one carotid at a time to avoid compromising cerebral perfusion. Auscultate for bruits (swishing
sounds from turbulent flow) using the bell of the stethoscope. Carotid massage is dangerous (can trigger vagal response).
Bruits suggest atherosclerosis; always auscultate in cardiac assessment.
Q8: Auscultating the carotid artery and hearing a blowing, swishing sound during systole is documented as a:
A. Murmur
B. Bruitt, indicating turbulent blood flow often from atherosclerotic narrowing [CORRECT]
C. S3 gallop
D. Pericardial friction rub
Correct Answer: B. Bruitt, indicating turbulent blood flow often from atherosclerotic narrowing
Rationale: A bruit is a blowing/swishing sound auscultated over an artery, indicating turbulent flow — often from
atherosclerotic narrowing. Murmurs are cardiac in origin; S3 and friction rubs are heart sounds. Bruits over the carotids
suggest cerebrovascular disease risk.
