Page | 1
NURS 5220 Exam 2 (2026/2027)| Advanced Health
Assessment | UTA
Question 1
A 68-year-old patient with a history of hypertension presents for an advanced cardiovascular
assessment.
During auscultation, the examiner hears a low-frequency sound immediately after S2 that is best
appreciated at the cardiac apex with the bell. Which finding is most consistent with this
assessment?
A. Physiologic S2 splitting
B. S3 gallop associated with increased ventricular filling
C. S4 caused by atrial contraction
D. Pericardial friction rub
Answer: B. S3 gallop associated with increased ventricular filling
Explanation: S3 occurs shortly after S2 during early diastole and is associated with rapid
ventricular filling. Although an S3 can be physiologic in younger individuals, a new S3 in an
older adult—particularly one with dyspnea or other heart-failure findings—is concerning for
ventricular dysfunction or increased filling pressures.
, Question 2
A 72-year-old patient with longstanding hypertension is undergoing a cardiovascular
examination.
Page | 2
The examiner detects a low-frequency sound immediately before S1, creating an S4-S1-S2
sequence. Which interpretation is most appropriate?
A. S3 caused by rapid ventricular filling
B. S4 associated with a stiff or noncompliant ventricle
C. Physiologic splitting of S2
D. Pericardial friction rub
Answer: B. S4 associated with a stiff or noncompliant ventricle
Explanation: S4 is a late-diastolic sound that occurs immediately before S1 and reflects atrial
contraction against a relatively stiff ventricle. It may be associated with conditions such as
longstanding hypertension and diastolic dysfunction.
Question 3
During cardiac auscultation, a clinician identifies the first and second heart sounds and wants to
determine which valves are primarily responsible for each sound.
Which statement correctly describes S1 and S2?
A. S1 results primarily from semilunar valve closure, while S2 results from AV valve closure
B. S1 results primarily from mitral and tricuspid closure, while S2 results from aortic and
pulmonic closure
, C. S1 occurs at the beginning of diastole, while S2 occurs at the beginning of systole
D. S1 and S2 are produced primarily by ventricular contraction rather than valve closure
Answer: B. S1 results primarily from mitral and tricuspid closure, while S2 results from
Page | 3
aortic and pulmonic closure
Explanation: S1 is produced primarily by closure of the atrioventricular valves and marks the
beginning of ventricular systole. S2 results from closure of the aortic and pulmonic valves and
marks the beginning of diastole.
Question 4
A patient has a cardiac murmur that is clearly audible but is not associated with a palpable thrill.
The clinician documents the intensity of the murmur using the standard six-grade systolic
murmur scale. Which grade best describes a loud murmur without a thrill?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
Answer: C. Grade 3
Explanation: A grade 3 systolic murmur is loud but does not produce a palpable thrill. A grade 4
murmur is loud and is accompanied by a thrill. The six-grade system progresses from barely
audible at grade 1 to extremely loud at grade 6.
Question 5
, During a cardiovascular examination, the clinician observes distention of the jugular veins while
the patient is positioned appropriately.
The finding is particularly important when it occurs together with peripheral edema and dyspnea.
Page | 4
What does jugular venous distention most directly suggest?
A. Elevated right atrial pressure
B. Decreased left ventricular filling
C. Peripheral arterial obstruction
D. Reduced systemic venous pressure
Answer: A. Elevated right atrial pressure
Explanation: Jugular venous distention provides information about central venous pressure and
commonly reflects elevated right atrial pressure. In the appropriate clinical context, it can be an
important sign of heart failure or systemic venous congestion.
Question 6
A patient reports bilateral lower-extremity swelling, and the clinician performs a peripheral
vascular examination.
The examiner compares pulses on both sides and evaluates their intensity and symmetry. What is
the primary purpose of comparing peripheral pulses bilaterally?
A. To determine lung expansion
B. To identify possible differences in arterial perfusion
C. To evaluate bowel motility
D. To determine cranial nerve function
NURS 5220 Exam 2 (2026/2027)| Advanced Health
Assessment | UTA
Question 1
A 68-year-old patient with a history of hypertension presents for an advanced cardiovascular
assessment.
During auscultation, the examiner hears a low-frequency sound immediately after S2 that is best
appreciated at the cardiac apex with the bell. Which finding is most consistent with this
assessment?
A. Physiologic S2 splitting
B. S3 gallop associated with increased ventricular filling
C. S4 caused by atrial contraction
D. Pericardial friction rub
Answer: B. S3 gallop associated with increased ventricular filling
Explanation: S3 occurs shortly after S2 during early diastole and is associated with rapid
ventricular filling. Although an S3 can be physiologic in younger individuals, a new S3 in an
older adult—particularly one with dyspnea or other heart-failure findings—is concerning for
ventricular dysfunction or increased filling pressures.
, Question 2
A 72-year-old patient with longstanding hypertension is undergoing a cardiovascular
examination.
Page | 2
The examiner detects a low-frequency sound immediately before S1, creating an S4-S1-S2
sequence. Which interpretation is most appropriate?
A. S3 caused by rapid ventricular filling
B. S4 associated with a stiff or noncompliant ventricle
C. Physiologic splitting of S2
D. Pericardial friction rub
Answer: B. S4 associated with a stiff or noncompliant ventricle
Explanation: S4 is a late-diastolic sound that occurs immediately before S1 and reflects atrial
contraction against a relatively stiff ventricle. It may be associated with conditions such as
longstanding hypertension and diastolic dysfunction.
Question 3
During cardiac auscultation, a clinician identifies the first and second heart sounds and wants to
determine which valves are primarily responsible for each sound.
Which statement correctly describes S1 and S2?
A. S1 results primarily from semilunar valve closure, while S2 results from AV valve closure
B. S1 results primarily from mitral and tricuspid closure, while S2 results from aortic and
pulmonic closure
, C. S1 occurs at the beginning of diastole, while S2 occurs at the beginning of systole
D. S1 and S2 are produced primarily by ventricular contraction rather than valve closure
Answer: B. S1 results primarily from mitral and tricuspid closure, while S2 results from
Page | 3
aortic and pulmonic closure
Explanation: S1 is produced primarily by closure of the atrioventricular valves and marks the
beginning of ventricular systole. S2 results from closure of the aortic and pulmonic valves and
marks the beginning of diastole.
Question 4
A patient has a cardiac murmur that is clearly audible but is not associated with a palpable thrill.
The clinician documents the intensity of the murmur using the standard six-grade systolic
murmur scale. Which grade best describes a loud murmur without a thrill?
A. Grade 1
B. Grade 2
C. Grade 3
D. Grade 4
Answer: C. Grade 3
Explanation: A grade 3 systolic murmur is loud but does not produce a palpable thrill. A grade 4
murmur is loud and is accompanied by a thrill. The six-grade system progresses from barely
audible at grade 1 to extremely loud at grade 6.
Question 5
, During a cardiovascular examination, the clinician observes distention of the jugular veins while
the patient is positioned appropriately.
The finding is particularly important when it occurs together with peripheral edema and dyspnea.
Page | 4
What does jugular venous distention most directly suggest?
A. Elevated right atrial pressure
B. Decreased left ventricular filling
C. Peripheral arterial obstruction
D. Reduced systemic venous pressure
Answer: A. Elevated right atrial pressure
Explanation: Jugular venous distention provides information about central venous pressure and
commonly reflects elevated right atrial pressure. In the appropriate clinical context, it can be an
important sign of heart failure or systemic venous congestion.
Question 6
A patient reports bilateral lower-extremity swelling, and the clinician performs a peripheral
vascular examination.
The examiner compares pulses on both sides and evaluates their intensity and symmetry. What is
the primary purpose of comparing peripheral pulses bilaterally?
A. To determine lung expansion
B. To identify possible differences in arterial perfusion
C. To evaluate bowel motility
D. To determine cranial nerve function
