MSN Advanced Health Assessment 2 — Questions and Answers
Question 1: The apical pulse is most accurately auscultated at which anatomical landmark?
- Second intercostal space, right sternal border
- Fifth intercostal space, midclavicular line (Correct answer)
- Third intercostal space, left sternal border
- Fourth intercostal space, right midaxillary line
Correct answer: Fifth intercostal space, midclavicular line
The cardiac apex is located at the fifth intercostal space at the midclavicular line, the point of maximal impulse (PMI).
Question 2: Bronchial breath sounds auscultated over peripheral lung fields are abnormal and most commonly indicate:
- Normal bronchovesicular sounds
- Pulmonary consolidation (Correct answer)
- Emphysema with air trapping
- Pleural rub
Correct answer: Pulmonary consolidation
Bronchial sounds in peripheral fields indicate consolidation, where solid tissue transmits tracheal sounds that are normally dampened by air-filled alveoli.
Question 3: Which constellation of assessment findings is most consistent with right-sided heart failure?
- Pulmonary edema, orthopnea, and paroxysmal nocturnal dyspnea
- Jugular venous distension, hepatomegaly, and dependent edema (Correct answer)
- S3 gallop, pink frothy sputum, and bilateral crackles
- Pulsus paradoxus, distant heart sounds, and hypotension
Correct answer: Jugular venous distension, hepatomegaly, and dependent edema
Right heart failure causes systemic venous congestion manifesting as JVD, hepatomegaly, and dependent (peripheral) edema.
Question 4: The CAGE questionnaire is a validated brief screening tool used to identify:
- Cognitive impairment in older adults
- Depression and suicidal ideation
- Alcohol use disorder (Correct answer)
- Anxiety and panic disorder
Correct answer: Alcohol use disorder
The CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener) screens for problematic alcohol use with high sensitivity.
Question 5: A patient presents with neck stiffness, photophobia, and fever. Which assessment maneuvers should the advanced practice nurse perform to evaluate for meningeal irritation?
- Romberg test and finger-to-nose test
- Kernig's sign and Brudzinski's sign (Correct answer)
- Battle's sign and raccoon eyes assessment
- Babinski reflex and Hoffman's sign
Correct answer: Kernig's sign and Brudzinski's sign
Kernig's sign (resistance to knee extension with hip flexed) and Brudzinski's sign (involuntary hip flexion with neck flexion) indicate meningeal irritation.
Question 6: The Ottawa Ankle Rules are a validated clinical decision tool used to determine:
- Surgical intervention need for displaced ankle fractures
- Which patients require radiographic imaging after ankle trauma (Correct answer)
- Severity grading of lateral ankle ligament sprains
- Return-to-play criteria after ankle injury
Correct answer: Which patients require radiographic imaging after ankle trauma
The Ottawa Ankle Rules identify specific clinical findings that indicate the need for ankle and foot radiographs, reducing unnecessary imaging.
Question 7: When assessing cranial nerve II (optic nerve), the most comprehensive evaluation includes:
- Corneal light reflex and extraocular movements
- Visual acuity, visual fields by confrontation, and fundoscopic examination (Correct answer)
- Pupillary light reflex and accommodation
- Stereognosis and two-point discrimination
Correct answer: Visual acuity, visual fields by confrontation, and fundoscopic examination
CN II assessment requires testing visual acuity (Snellen chart), visual fields (confrontation), and fundoscopic examination of the optic disc.
MSN Advanced Health Assessment 2
The apical pulse is most accurately auscultated at which anatomical landmark?