NUR 643E ADVANCED HEALTH ASSESSMENT NEWLY RELEASED QUESTIONS AND
ACCURATE ANSWERS FOR THE MOST RECENT EXAM VERSION TO SUPPORT A
GUARANTEED PASS OUTCOME
1. Q: What are the five areas for cardiac auscultation? ANSWER Aortic
(2nd ICS right sternal border), Pulmonic (2nd ICS left sternal border), Erb's
point (3rd ICS left sternal border), Tricuspid (4th ICS left sternal border),
Mitral/Apical (5th ICS midclavicular line).
2. Q: What does the S1 heart sound represent? ANSWER Closure of the
mitral and tricuspid valves (AV valves) at the beginning of systole. Best heard
at the apex.
3. Q: What does the S2 heart sound represent? ANSWER Closure of the
aortic and pulmonic valves (semilunar valves) at the end of systole. Best heard
at the base.
4. Q: What is an S3 heart sound and what does it indicate? ANSWER A
low-pitched sound heard early in diastole after S2. In adults over 40, it indicates
ventricular failure, volume overload, or decreased compliance (abnormal). May
be normal in children and young adults.
5. Q: What is an S4 heart sound and what does it indicate? ANSWER A
low-pitched sound heard late in diastole just before S1. It indicates decreased
ventricular compliance, hypertension, or coronary artery disease (always
abnormal).
6. Q: How do you differentiate between a systolic and diastolic murmur?
ANSWER Systolic murmurs occur between S1 and S2. Diastolic murmurs
occur between S2 and S1. Time the murmur by palpating the carotid pulse
simultaneously.
7. Q: What are the six characteristics used to describe a murmur?
ANSWER Timing (systolic/diastolic), location, radiation, intensity (grade 1-6),
pitch (high/medium/low), and quality (blowing, harsh, rumbling).
, 8. Q: What is the grading scale for murmurs? ANSWER Grade 1 (barely
audible), Grade 2 (quiet but heard), Grade 3 (moderately loud), Grade 4 (loud
with palpable thrill), Grade 5 (very loud, heard with stethoscope partially off
chest), Grade 6 (heard without stethoscope).
9. Q: What does jugular venous distension (JVD) indicate? ANSWER
Elevated right atrial pressure, suggesting right-sided heart failure, fluid
overload, or tricuspid valve disease.
10. Q: How do you properly assess JVD? ANSWER Position patient at 30-45
degrees, measure vertical distance from sternal angle to top of venous pulsation.
Normal is ≤3 cm above sternal angle.
11. Q: What is pulsus paradoxus? ANSWER An abnormal drop in systolic
BP >10 mmHg during inspiration. Seen in cardiac tamponade, severe asthma, or
constrictive pericarditis.
12. Q: What is pulsus alternans? ANSWER Alternating strong and weak
pulses with regular rhythm. Indicates severe left ventricular dysfunction.
13. Q: What are the classic symptoms of acute coronary syndrome?
ANSWER Chest pain/pressure (substernal), dyspnea, diaphoresis, nausea,
radiation to left arm/jaw/back, and sense of impending doom.
14. Q: What is the point of maximal impulse (PMI) and where is it
normally located? ANSWER The PMI is the apex beat of the heart, normally
located at the 5th intercostal space at the midclavicular line, about the size of a
quarter.
15. Q: What does a laterally displaced PMI indicate? ANSWER Left
ventricular hypertrophy or cardiomegaly.
16. Q: What are the key components of peripheral vascular assessment?
ANSWER Inspection for color/temperature/edema, palpation of pulses (rate,
rhythm, amplitude), capillary refill, edema assessment, and Allen test if
indicated.
17. Q: How do you grade peripheral pulses? ANSWER 0 (absent), 1+
(diminished/weak), 2+ (normal), 3+ (increased), 4+ (bounding).
18. Q: What is the ankle-brachial index (ABI) and what do values indicate?
ANSWER Ratio of ankle to brachial systolic BP. Normal: 0.9-1.3, Mild PAD:
0.7-0.9, Moderate PAD: 0.4-0.7, Severe PAD: <0.4.
ACCURATE ANSWERS FOR THE MOST RECENT EXAM VERSION TO SUPPORT A
GUARANTEED PASS OUTCOME
1. Q: What are the five areas for cardiac auscultation? ANSWER Aortic
(2nd ICS right sternal border), Pulmonic (2nd ICS left sternal border), Erb's
point (3rd ICS left sternal border), Tricuspid (4th ICS left sternal border),
Mitral/Apical (5th ICS midclavicular line).
2. Q: What does the S1 heart sound represent? ANSWER Closure of the
mitral and tricuspid valves (AV valves) at the beginning of systole. Best heard
at the apex.
3. Q: What does the S2 heart sound represent? ANSWER Closure of the
aortic and pulmonic valves (semilunar valves) at the end of systole. Best heard
at the base.
4. Q: What is an S3 heart sound and what does it indicate? ANSWER A
low-pitched sound heard early in diastole after S2. In adults over 40, it indicates
ventricular failure, volume overload, or decreased compliance (abnormal). May
be normal in children and young adults.
5. Q: What is an S4 heart sound and what does it indicate? ANSWER A
low-pitched sound heard late in diastole just before S1. It indicates decreased
ventricular compliance, hypertension, or coronary artery disease (always
abnormal).
6. Q: How do you differentiate between a systolic and diastolic murmur?
ANSWER Systolic murmurs occur between S1 and S2. Diastolic murmurs
occur between S2 and S1. Time the murmur by palpating the carotid pulse
simultaneously.
7. Q: What are the six characteristics used to describe a murmur?
ANSWER Timing (systolic/diastolic), location, radiation, intensity (grade 1-6),
pitch (high/medium/low), and quality (blowing, harsh, rumbling).
, 8. Q: What is the grading scale for murmurs? ANSWER Grade 1 (barely
audible), Grade 2 (quiet but heard), Grade 3 (moderately loud), Grade 4 (loud
with palpable thrill), Grade 5 (very loud, heard with stethoscope partially off
chest), Grade 6 (heard without stethoscope).
9. Q: What does jugular venous distension (JVD) indicate? ANSWER
Elevated right atrial pressure, suggesting right-sided heart failure, fluid
overload, or tricuspid valve disease.
10. Q: How do you properly assess JVD? ANSWER Position patient at 30-45
degrees, measure vertical distance from sternal angle to top of venous pulsation.
Normal is ≤3 cm above sternal angle.
11. Q: What is pulsus paradoxus? ANSWER An abnormal drop in systolic
BP >10 mmHg during inspiration. Seen in cardiac tamponade, severe asthma, or
constrictive pericarditis.
12. Q: What is pulsus alternans? ANSWER Alternating strong and weak
pulses with regular rhythm. Indicates severe left ventricular dysfunction.
13. Q: What are the classic symptoms of acute coronary syndrome?
ANSWER Chest pain/pressure (substernal), dyspnea, diaphoresis, nausea,
radiation to left arm/jaw/back, and sense of impending doom.
14. Q: What is the point of maximal impulse (PMI) and where is it
normally located? ANSWER The PMI is the apex beat of the heart, normally
located at the 5th intercostal space at the midclavicular line, about the size of a
quarter.
15. Q: What does a laterally displaced PMI indicate? ANSWER Left
ventricular hypertrophy or cardiomegaly.
16. Q: What are the key components of peripheral vascular assessment?
ANSWER Inspection for color/temperature/edema, palpation of pulses (rate,
rhythm, amplitude), capillary refill, edema assessment, and Allen test if
indicated.
17. Q: How do you grade peripheral pulses? ANSWER 0 (absent), 1+
(diminished/weak), 2+ (normal), 3+ (increased), 4+ (bounding).
18. Q: What is the ankle-brachial index (ABI) and what do values indicate?
ANSWER Ratio of ankle to brachial systolic BP. Normal: 0.9-1.3, Mild PAD:
0.7-0.9, Moderate PAD: 0.4-0.7, Severe PAD: <0.4.
