NCLEX Practice Questions Physical Assessment

Correct Answer: C

Rationale: To determine whether a murmur is systolic or diastolic, you should judge the relative length of systole and diastole by auscultation. Systolic murmurs occur during systole, which is the phase of the cardiac cycle when the heart is contracting and pushing blood out of the chambers. Diastolic murmurs occur during diastole, which is the phase when the heart is relaxing and filling with blood. By carefully listening to the timing of the murmur in relation to the cardiac cycle, you can determine if it is systolic or diastolic. Palpating the carotid pulse (Choice A) or radial pulse (Choice B) can help assess the pulse characteristics, but it does not directly determine whether a murmur is systolic or diastolic. Correlating the murmur with a bedside heart monitor (Choice D) may provide additional information about heart rate or rhythm, but it does not specifically indicate

Correct Answer: A

Rationale: Ethnicity is one of the factors used to estimate the 10-year risk of developing coronary heart disease. Different ethnic groups may have varying risks for heart disease based on genetic predisposition, lifestyle factors, and cultural practices. For example, individuals of South Asian descent have been found to have a higher risk of heart disease compared to other ethnic groups. Therefore, considering ethnicity is essential when assessing the overall risk of developing heart disease in an individual.

Correct Answer: A

Rationale: Mr. Patel's case involves an enlarged liver, which warrants further investigation to determine the underlying cause. An ultrasound of the liver would provide valuable information regarding the size, shape, and texture of the liver, helping to identify any potential abnormalities such as liver cirrhosis, fatty liver disease, or liver tumors. This imaging study can also help differentiate between different conditions that may be causing the liver enlargement, guiding subsequent diagnostic and treatment decisions. Therefore, obtaining an ultrasound of the liver is the most appropriate next step in evaluating Mr. Patel's condition.

Correct Answer: A

Rationale: The presentation of pain that is markedly worse when the left arm is drawn across the chest (adduction) is characteristic of a rotator cuff tear. This is because when the arm is adducted, it puts stress on the torn rotator cuff tendons, causing pain. In contrast, subacromial bursitis typically presents with pain during overhead movements, acromioclavicular joint involvement may present with pain localized to the joint itself, and adhesive capsulitis (frozen shoulder) typically presents with pain and stiffness that worsens with all movements.

Correct Answer: C

Rationale: Splitting of the second heart sound is when the aortic and pulmonic valves close at slightly different times, resulting in two distinct components to the sound. This split is best heard over the apex of the heart, typically with the diaphragm of the stethoscope. The aortic component is heard first and represents closure of the aortic valve, followed by the pulmonic component, representing closure of the pulmonic valve. The split can narrow during inspiration and widen during expiration, which is important to keep in mind during assessment.