,Maryville NURS 612 Exam 2 | Advanced Health Assessment
(2026) Q&A
1. A 58-year-old male presents with a history of smoking and a chronic cough.
During the initial inspection of the chest, the nurse practitioner assesses for thoracic
landmarks. Which finding is most indicative of a tension pneumothorax with
mediastinal shift?
A) Distended neck veins
B) Asymmetric chest expansion
C) Tracheal deviation from the midline
D) Subcutaneous emphysema
Correct Answer: C) Tracheal deviation from the midline
Rationale: In a tension pneumothorax, air enters the pleural space but cannot
escape, causing pressure to build. This pressure can shift the mediastinum (including
the trachea) to the opposite side, which is a life-threatening sign. Distended neck
veins and asymmetric expansion are also present, but tracheal deviation is the classic
sign of mediastinal shift.
2. Which of the following is the most common cause of a midline shift of the
trachea?
A) Pleural effusion
B) Pneumothorax
C) Atelectasis
D) Thyroid enlargement
Correct Answer: B) Pneumothorax
,Rationale: A tension pneumothorax causes a buildup of pressure in the pleural
space, pushing the mediastinum and trachea to the contralateral side. A large pleural
effusion can also cause a shift, but a tension pneumothorax is the classic cause of an
acute, life-threatening tracheal deviation.
3. During a routine respiratory assessment, the examiner notes the patient's
respiratory rate is 16 breaths per minute and the heart rate is 68 beats per minute.
This ratio of respirations to heart rate is approximately:
A) 1:2
B) 1:4
C) 1:6
D) 1:8
Correct Answer: B) 1:4
Rationale: In a healthy adult at rest, the normal ratio of respiratory rate to heart rate
is approximately 1:4. For every one breath, there are about four heartbeats.
4. Which examination finding is most consistent with a diagnosis of emphysema?
A) Increased tactile fremitus
B) Dullness on percussion
C) Decreased tactile fremitus
D) Egophony
Correct Answer: C) Decreased tactile fremitus
, Rationale: Tactile fremitus is decreased when there is excess air in the lungs or
conditions that impede sound transmission, such as emphysema, pleural effusion, or
pneumothorax. Increased fremitus occurs with consolidation (e.g., pneumonia).
5. The two most important clinical signs that suggest a pleural effusion are:
A) Increased tactile fremitus and hyperresonance
B) Dullness to percussion and decreased tactile fremitus
C) Bronchophony and whispered pectoriloquy
D) Tracheal deviation and wheezing
Correct Answer: B) Dullness to percussion and decreased tactile fremitus
Rationale: A pleural effusion creates a fluid-filled space that dulls percussion sounds
and decreases the transmission of tactile fremitus. Increased tactile fremitus and
bronchophony are signs of consolidation.
6. A patient with long-standing COPD comes to the clinic reporting that his breathing
has been more difficult for the past two weeks. Which question would best help the
examiner understand the severity of the patient's hypoxia?
A) "What color is your sputum?"
B) "Have you had a fever?"
C) "In what way has your activity level been affected?"
D) "Are you coughing more than usual?"
Correct Answer: C) "In what way has your activity level been affected?"
Rationale: To understand the impact of hypoxia, it is crucial to assess its effect on
the patient's functional status. Asking about activity level (e.g., can they still walk to
(2026) Q&A
1. A 58-year-old male presents with a history of smoking and a chronic cough.
During the initial inspection of the chest, the nurse practitioner assesses for thoracic
landmarks. Which finding is most indicative of a tension pneumothorax with
mediastinal shift?
A) Distended neck veins
B) Asymmetric chest expansion
C) Tracheal deviation from the midline
D) Subcutaneous emphysema
Correct Answer: C) Tracheal deviation from the midline
Rationale: In a tension pneumothorax, air enters the pleural space but cannot
escape, causing pressure to build. This pressure can shift the mediastinum (including
the trachea) to the opposite side, which is a life-threatening sign. Distended neck
veins and asymmetric expansion are also present, but tracheal deviation is the classic
sign of mediastinal shift.
2. Which of the following is the most common cause of a midline shift of the
trachea?
A) Pleural effusion
B) Pneumothorax
C) Atelectasis
D) Thyroid enlargement
Correct Answer: B) Pneumothorax
,Rationale: A tension pneumothorax causes a buildup of pressure in the pleural
space, pushing the mediastinum and trachea to the contralateral side. A large pleural
effusion can also cause a shift, but a tension pneumothorax is the classic cause of an
acute, life-threatening tracheal deviation.
3. During a routine respiratory assessment, the examiner notes the patient's
respiratory rate is 16 breaths per minute and the heart rate is 68 beats per minute.
This ratio of respirations to heart rate is approximately:
A) 1:2
B) 1:4
C) 1:6
D) 1:8
Correct Answer: B) 1:4
Rationale: In a healthy adult at rest, the normal ratio of respiratory rate to heart rate
is approximately 1:4. For every one breath, there are about four heartbeats.
4. Which examination finding is most consistent with a diagnosis of emphysema?
A) Increased tactile fremitus
B) Dullness on percussion
C) Decreased tactile fremitus
D) Egophony
Correct Answer: C) Decreased tactile fremitus
, Rationale: Tactile fremitus is decreased when there is excess air in the lungs or
conditions that impede sound transmission, such as emphysema, pleural effusion, or
pneumothorax. Increased fremitus occurs with consolidation (e.g., pneumonia).
5. The two most important clinical signs that suggest a pleural effusion are:
A) Increased tactile fremitus and hyperresonance
B) Dullness to percussion and decreased tactile fremitus
C) Bronchophony and whispered pectoriloquy
D) Tracheal deviation and wheezing
Correct Answer: B) Dullness to percussion and decreased tactile fremitus
Rationale: A pleural effusion creates a fluid-filled space that dulls percussion sounds
and decreases the transmission of tactile fremitus. Increased tactile fremitus and
bronchophony are signs of consolidation.
6. A patient with long-standing COPD comes to the clinic reporting that his breathing
has been more difficult for the past two weeks. Which question would best help the
examiner understand the severity of the patient's hypoxia?
A) "What color is your sputum?"
B) "Have you had a fever?"
C) "In what way has your activity level been affected?"
D) "Are you coughing more than usual?"
Correct Answer: C) "In what way has your activity level been affected?"
Rationale: To understand the impact of hypoxia, it is crucial to assess its effect on
the patient's functional status. Asking about activity level (e.g., can they still walk to
