First, I changed the title of your post so that you would get more responses.
PA in the US means pulmonary artery in terms of assessment, or physician assistant.
The biggest problems that I see with many of the international nurses coming to the US is having to teach them assessment skills as we do them in the US.
In the US, a nurse is required to do a head to toe assessment at least every shift on their patient, and that includes heart tones as well as breath sounds. In other countries, it is the physician's responsibility to do the assessment. In the US, the nurse is responsible for her or his own assessments.
Problems would be not cathcing a change in the respiratory status fast enough or the beginning of pulmonary edema or fluid on the lungs.
Hope that this helps.....................