MVU NURS 612 Final Exam/ Maryville University NURS 612 Final Exam New Latest Version, Exams of Nursing

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MVU NURS 612 Final Exam/ Maryville University

NURS 612 Final Exam New Latest Version with All

Questions and Answers

A 6-month-old infant is brought to the clinic for immunizations. While examining the baby, the examiner notes that the anterior fontanel has not closed. What is the significance of this finding? a. This indicates a slight developmental delay b. There may be a nutritional deficiency c. This finding is consistent with hydrocephaly d. This is a normal finding -------- Correct Answer ---------- d. This is a normal finding Preterm infants often have a. Long, narrow heads b. Broad nose bridges c. Low-set ears d. Webbed necks -------- Correct Answer ---------- a. Long, narrow heads When evaluating respiratory complaints, what should you always ask the patient? -------- Correct Answer ---------- travel history & contact with sick people You have a 72 y/o male that comes in with the complaint of chest pain. What would you do if this is all the information that you have? -------- Correct Answer ---------- Obtain HPI/ OLDCARTS- Onset, Location, Duration, Character, Aggravating/ associated factors, relieving factors, temporal factors (other things going on), & severity of chest pain. What are some of the differential dx for SOB? -------- Correct Answer ---------- Asthma, COPD, pneumonia, bronchitis What are some physical findings of a patient that is SOB? -------- Correct Answer ---------

• *Use of accessory muscles *tripoding The presence of a nodular thyroid is a normal finding in a. Infants b. Adolescents c. Pregnant women d. Older adults -------- Correct Answer ---------- d. Older adults Webbing, excessive posterior cervical skin, and a short neck are signs associated with a. Asian heritage b. Chromosomal anomalies c. Cushing syndrome d. Malnutrition -------- Correct Answer ---------- b. Chromosomal anomalies

Transillumination of the skill should be performed a. In infants of mothers with diabetes b. In infants with a history of traumatic birth c. When an infant has a facial nerve palsy d. In infants with suspected intracranial lesions -------- Correct Answer ---------- d. In infants with suspected intracranial lesions Which of the following findings suggests an inflammation of the thyroid gland? a. Gritty sensation when the thyroid is palpated b. Movement of the thyroid when the patient swallows c. Vertical ridges palpated on the thyroid gland d. Swollen and red skin overlying the thyroid gland -------- Correct Answer ---------- a. Gritty sensation when the thyroid is palpated A patient demonstrates asymmetry of the mouth. The examiner suspects a problem with the a. Inferior facial nerve b. Thyroid gland c. Peripheral trigeminal nerve d. Salivary duct -------- Correct Answer ---------- c. Peripheral trigeminal nerve Mr. Andrews presents with complaints of a throbbing, unilateral pain in his head associated with nausea and vomiting. Which problem is suggested by these symptoms? a. Temporal arteritis b. Cluster headache c. Subarachnoid hemorrhage d. Migraine headaches -------- Correct Answer ---------- d. Migraine headaches You are palpating a thyroid gland and note that it is enlarged bilaterally. What is your next step in the examination process? a. Listen for vascular sounds over the thyroid lobes b. Examine the patient for enlarged lymph nodes c. Check for a deviated trachea d. Listen for a bruit over the carotids -------- Correct Answer ---------- a. Listen for vascular sounds over the thyroid lobes As the chest of a newborn is examined, bowel sounds are auscultated in the chest. Which of the following best describes the significance of this finding? a. A normal finding in newborns b. An abnormal but benign finding in children until 2 years of age c. Abnormal and possibly indicating an enlarged liver d. Abnormal and possibly indicating a diaphragmatic hernia -------- Correct Answer ------- --- d. Abnormal and possibly indicating a diaphragmatic hernia

Which of the following patients demonstrates the highest risk factor for respiratory disability? a. A patient with a history of hypertension b. A child who has had a previous respiratory infection c. A patient with paraplegia d. An extremely thin female patient -------- Correct Answer ---------- c. A patient with paraplegia A healthcare professional is examining the chest of a 22-year-old woman who is 8 months pregnant. The patient has a wide thoracic cage. Which of the following best explains this finding? a. She may have lung disease, such as emphysema b. She may be hypoxic and require oxygen supplementation c. She may be pregnant with twins, causing abdominal contents to be forced up and out d. This is considered a normal finding with advanced pregnancy -------- Correct Answer - --------- d. This is considered a normal finding with advanced pregnancy In which of the following conditions should the examiner expect the costal angle to be greater than 90 degrees? a. Chronic obstructive pulmonary disease b. Pneumothorax c. Infant respiratory distress syndrome d. Atelectasis -------- Correct Answer ---------- a. Chronic obstructive pulmonary disease Which of the following findings indicates respiratory distress in an infant or toddler? a. Respiratory rate of 30 breaths/minute b. Hyperresonance of the chest c. Observation of sternal retractions with breathing d. Auscultation of bronchovesicular sounds throughout the lung field -------- Correct Answer ---------- c. Observation of sternal retractions with breathing During percussion, the patient is asked to "fold your arms in front of you" in order to a. Expose maximum lung area b. Make the ribs protrude c. Prevent attacks of coughing d. Reduce discomfort -------- Correct Answer ---------- a. Expose maximum lung area Which of the following examination techniques is not typically done when examining the chest and lungs of a newborn? a. Palpation b. Inspection c. Percussion d. Auscultation -------- Correct Answer ---------- c. Percussion The patient tells the examiner, "I have been coughing up a lot of yellowish-green phlegm." The examiner should suspect

a. Viral infection b. Tuberculosis c. Pulmonary edema d. Bacterial pneumonia -------- Correct Answer ---------- d. Bacterial pneumonia To best visualize subtle retractions on a patient, the examiner should a. Place the patient in a supine position b. Stand directly behind the patient c. Ensure that the light source angles toward the patient d. Position the patient directly under a bright examination light -------- Correct Answer --- ------- c. Ensure that the light source angles toward the patient Which of the following findings may indicate a pulmonary infection? a. Malodorous breath b. Protrusion of the clavicle c. Clubbing of the nail beds d. Kussmal respirations -------- Correct Answer ---------- a. Malodorous breath Which finding is considered unusual for a newborn? a. Sneezing b. Coughing c. Silent hiccupping d. Nose breathing -------- Correct Answer ---------- b. Coughing In an older adult, which finding can occur in the absence of a disease as a result of age- related changes of the chest or lungs? a. Barrel chest b. Productive cough c. Increased vital capacity d. Pulmonary infiltrate -------- Correct Answer ---------- a. Barrel chest A newborn infant has a small chest-to-head size ratio. This finding is usually associated with a. Maternal diabetes b. Cocaine use during pregnancy c. Intrauterine growth restriction d. A normal variation of chest-to-head ratio -------- Correct Answer ---------- c. Intrauterine growth restriction Milia are an expected finding in which age group? a. Newborns b. Young children c. Adolescents d. Older adults -------- Correct Answer ---------- A. newborns

An older patient asks the examiner, "Is this spot on my chin a cancer?" Which of the following would indicate a need for further medical investigation? a. Reddish-brown color of the lesion b. Presence on his chin for 20 years c. Bleeds easily when it is touched d. Slightly raised and circumscribed -------- Correct Answer ---------- c. Bleeds easily when it is touched A 6-year-old girl has freckles over her nose and cheeks. Freckles are a type of a. Macule b. Papule c. Nodule d. Petechiae -------- Correct Answer ---------- a. Macule What grade should be assigned to a pressure ulcer over the coccyx that is open and shallow, showing a red-pink wound bed? a. Stage I b. Stage II c. Stage III d. Stage IV -------- Correct Answer ---------- b. Stage II Why do some infants develop a yellowish skin tone on the third or fourth day of life? a. Increased formation of subcutaneous tissues causes a yellow hue b. Capillaries broken during the birth process turn the skin yellow as bruises heal c. Yellowish color results from increased fat metabolism and heat production d. Red blood cells that hemolyze after birth may cause a yellow skin hue -------- Correct Answer ---------- d. Red blood cells that hemolyze after birth may cause a yellow skin hue An adolescent patient asks the examiner why teens have more problems with acne than children. Which of the following would be an appropriate response? a. Children have better hygiene habits than adolescents because of parental guidance b. Adolescents have reduced blood flow to the epidermal layer of the skin, making them more susceptible to infections c. At puberty, adolescents begin to secrete more oil from their sebaceous glands d. Children have very little skin mass, which prevents development of acne -------- Correct Answer ---------- c. At puberty, adolescents begin to secrete more oil from their sebaceous glands Chloasma is an expected finding in which of the following? a. Newborns b. Adolescents c. Pregnant women d. Older adults -------- Correct Answer ---------- c. Pregnant women

White examining the skin of an 87-year-old woman, the examiner observes significant tenting. Which of the following age-associated changes best explains this finding? a. Small skin tags form on the neck and back b. The skin becomes thin and takes on a parchment-like appearance c. The skin becomes dry, with significant flaking d. There is loss of adipose tissue and loss of elasticity -------- Correct Answer ---------- d. There is loss of adipose tissue and loss of elasticity When assessing for the presence of clubbing, the examiner specifically examines the a. Width of the nail base b. Angle of the nail base c. Thickness of the nail d. Color of the nail -------- Correct Answer ---------- b. Angle of the nail base Which type of lesion sometimes grows out of an already present nevus? a. Malignant melanoma b. Squamous cell carcinoma c. Basal cell carcinoma d. Kaposi sarcoma -------- Correct Answer ---------- a. Malignant melanoma In young and school-age children, the most common skin lesions are caused by a. Communicable disease and bacterial infection b. Changes in skin color and skin tone, which accompany puberty c. Maturation of melanocytes, aging changes in skin color d. Skin inflammation from sebaceous gland activity -------- Correct Answer ---------- a. Communicable disease and bacterial infection The examiner notes a large blue-black spot on the buttock of a 4-week-old black neonate. The mother states that the infant was born with it. The examiner should recognize that this a. Is a common finding b. May indicate child abuse c. Is related to birth trauma d. Suggest a congenital defect -------- Correct Answer ---------- a. Is a common finding Which of the following may be associated with neurofibromatosis or pulmonary stenosis? a. Café au lait patches b. Nevus vasculosus c. Port-wine limb stain d. Spider angioma -------- Correct Answer ---------- a. Café au lait patches Which lesion is an expected finding on the skin of healthy older adults? a. Acne vulgaris b. Cherry angioma c. Miliaria

d. Trichotillomania -------- Correct Answer ---------- b. Cherry angioma When palpating skin surfaces for temperature, the examiner should use the a. Palmar aspect of the hand b. Fingertips of the dominant hand c. Dorsal aspect of the hands or fingers d. Ulnar surface of the hand -------- Correct Answer ---------- c. Dorsal aspect of the hands or fingers Hyperkeratosis is noted on a patient's palms and soles. The examiner recognizes that this a. May be a sign of systemic disorder b. May be an indication of a congenital heart defect c. Is common among individuals with Down syndrome d. Is considered a normal finding -------- Correct Answer ---------- d. Is considered a normal finding A patient with diabetes presents to the clinic complaining of an infected foot. Upon removing the patient's sock, the examiner notes an odor that resembles rotting apples. This finding is consistent with what type of infection? a. Pseudomonas aeruginosa b. Proteus c. Viridans streptococci d. Clostridium perfringens -------- Correct Answer ---------- d. Clostridium perfringens Which finding is consistent with a physical abuse injury in a toddler? a. Burn to the skin with a splash pattern b. Bruising of the skin over soft tissue c. Bruising of the skin over a bony prominence d. Café au lait patches -------- Correct Answer ---------- b. Bruising of the skin over soft tissue Which of the following techniques helps the examiner determine whether a palpable skin mass is filled with fluid? a. Using a wood's lamp b. Palpating c. Transilluminating d. Noting the odor of the lesion -------- Correct Answer ---------- c. Transilluminating Which of the following findings suggests that a patient has a fungal infection of the nail beds? a. The nail bed is wide and thick b. The nail plate has a central depression, causing a spoon appearance c. Superficial white spots are present in the nail plate d. The nail plate is yellow and crumbling -------- Correct Answer ---------- d. The nail plate is yellow and crumbling

During an examination, which of the following questions would be most appropriate for the examiner to ask a patient to elicit information about the lymph system? a. Are you aware of any lumps? b. Have you had a change in appetite? c. Do your lymph nodes hurt? d. Where are your largest lymph nodes? -------- Correct Answer ---------- a. Are you aware of any lumps? While palpating lymph nodes on an adult, the examiner should remember that a. Tubercular nodes are hot and firm to the touch b. Nodes that are fixed and palpable are a normal finding c. Heavy pressure is required to locate and identify nodes d. Easily palpable nodes are generally not found in healthy adults -------- Correct Answer ---------- d. Easily palpable nodes are generally not found in healthy adults In comparison with those of a young adult, the lymph nodes of an older adult will be a. Large and soft b. Small and fatty c. Hard and irregular d. Large and hard -------- Correct Answer ---------- b. Small and fatty A 19-year-old man has a severe infection involving the fifth digit of his right hand. Where should the examiner expect to palpate enlarged and tender lymph nodes? a. Radial aspect of the right wrist b. Palmar aspect of the right hand c. Lateral aspect of the right forearm d. Medial aspect of the right elbow -------- Correct Answer ---------- d. Medial aspect of the right elbow Which of the following examination findings is cause for concern in an adult? a. A palpable fluctuant lymph node moveable under the examiner's fingers b. A palpable hard lymph node fixed in its setting c. A palpable soft lymph node approximately 2 mm in size d. Absence of any palpable lymph nodes -------- Correct Answer ---------- b. A palpable hard lymph node fixed in its setting The most common causes of acute suppurative lymphadenitis are which organisms? a. Pseudomonas and Clostridium spp. b. Streptococcus and Staphylococcus spp. c. Candida and Chlamydia spp. d. Aspergillus and Escherichia spp. -------- Correct Answer ---------- b. Streptococcus and Staphylococcus spp. The examiner typically assesses the lymph system using which of the following methods?

a. Assesses the entire lymph system as a unit, exploring all areas of accessible nodes b. Assesses both the superficial and deep nodes using palpation and a doppler study c. Assess the lymph system region by region as each body system is assessed d. Assess the lymph nodes only when the patient's history suggests a need to do so ----- --- Correct Answer ---------- c. Assess the lymph system region by region as each body system is assessed A 2-month-old infant is brought to the clinic for immunizations. The examiner palpates enlarged inguinal nodes. What additional findings might explain the enlarged nodes? a. The mother reports that the infant has colic b. The infant's length and weight are about the 85th percentile c. The infant has a severe diaper rash d. A port-wine stain is present on the infant's left thigh -------- Correct Answer ---------- c. The infant has a severe diaper rash As the examiner palpates an enlarged lymph node, the patient complains of pain. This is suggestive of a. An inflammatory process b. Hodgkin disease c. Immature lymph node development d. Toxoplasmosis -------- Correct Answer ---------- a. An inflammatory process Which examination method is used to differentiate an enlarged lymph node from a cyst? a. Palpation b. Auscultation c. Biopsy d. Transillumination -------- Correct Answer ---------- d. Transillumination Which of the following methods best describes how to assess supraclavicular lymph nodes? a. Have the patient assume a supine position and then hold his or her breath b. Place the patient in the Trendelenburg position and illuminate the lymph nodes with a bright light c. Palpate deeply behind the clavicles as the patient takes a deep breath d. Hook fingers over the clavicles with the patient in a sitting position with head flexed --- ----- Correct Answer ---------- d. Hook fingers over the clavicles with the patient in a sitting position with head flexed The examiner notes enlarged tonsils in a young child. The examiner should recognize that this a. Is an indication of a retropharyngeal abscess b. May be an early indication of Epstein-Barr virus c. Is an indication that the child has lymphoma d. May be a normal finding -------- Correct Answer ---------- d. May be a normal finding

In addition to the head, neck, axillae, and inguinal area, the examiner may also assess lymph nodes in which location? a. On the palmar aspect of the hands b. In the popliteal region c. In the patellar region d. On the dorsum of the foot -------- Correct Answer ---------- b. In the popliteal region Which of the following is an assessment technique that can differentiate mumps from cervical adenitis? a. Palpating for the angle of the jaw b. Palpating enlarged lymph nodes c. Noting painful lymph nodes d. Noting swelling of the face -------- Correct Answer ---------- a. Palpating for the angle of the jaw On examining a patient, you find matted occipital lymph nodes. What do you do to facilitate subsequent assessment for change in the matted nodes? a. Outline the mass with a skin pen b. Tattoo the center of the mass c. Mark 12, 3, 6, and 9 o'clock positions on the periphery of the mass with a skin pencil d. Use calipers to obtain the diameter of the mass -------- Correct Answer ---------- c. Mark 12, 3, 6, and 9 o'clock positions on the periphery of the mass with a skin pencil Mrs. Alberts presents to the office with a complaint of a lump in her neck. What would you expect to feel if the problem involved a cancer that had spread through the lymph system? a. A soft lymph node less than 0.5cm in size b. Multiple small, hard, nontender nodes c. A single, firm node affixed to underlying tissue d. Solitary, tender, matted node of variable size -------- Correct Answer ---------- c. A single, firm node affixed to underlying tissue Normal cervical lymph nodes are a. Matted b. Tender to palpation c. Rubbery d. Smaller than 1cm -------- Correct Answer ---------- d. Smaller than 1cm On examination of a patient, you palpate enlarged preauricular and submandibular lymph nodes. Which term can be sued to describe this finding? a. Lymphadenopathy b. Lymphadenitis c. Lymphangitis d. Lymphedema -------- Correct Answer ---------- a. Lymphadenopathy How should the patient be positioned when you palpate for left inguinal lymph nodes?

a. Standing, with weight on the right leg b. Sitting, with the legs dangling c. Supine, with knees slightly bent d. Supine, with the left leg externally rotated -------- Correct Answer ---------- c. Supine, with knees slightly bent Which finding is the most concerning? a. 3-mm occipital lymph node in a neonate b. 6-mm postauricular lymph node in a 1-year-old c. 0.5-cm cervical lymph node in a 3-year-old d. 0.8-cm supraclavicular lymph node in a 5-year-old -------- Correct Answer ---------- d. 0.8-cm supraclavicular lymph node in a 5-year-old In which group is a slight enlargement of the thyroid gland detected on ultrasound considered a normal finding? a. Infants b. Adolescents c. Pregnant women d. Native Americans or American Indians -------- Correct Answer ---------- c. Pregnant women Which of the following questions is most appropriate to ask a female patient with a suspected thyroid problem? a. How much alcohol do you drink? b. Have you noticed a change in your sleep pattern or energy level? c. Do you have headaches? d. Are you currently menstruating? -------- Correct Answer ---------- b. Have you noticed a change in your sleep pattern or energy level? An infant with an alcoholic other is admitted to the hospital with fetal alcohol syndrome. What assessment finding is consistent with this syndrome? a. Ear dysplasia b. Moon face c. Torticollis d. Thin upper lip -------- Correct Answer ---------- d. Thin upper lip Which of the following findings in an older patient would be considered a normal consequence of aging? a. Narrowed palpebral fissures b. Pulsating fontanels c. Uneven movement of the tongue d. Fibrosis of the thyroid gland -------- Correct Answer ---------- d. Fibrosis of the thyroid gland Assessment of an infant's fontanels is best performed while the infant is a. Calm and in an upright position

b. Sleeping in a lateral position c. Supine and awake d. Held at a 45-degree angle -------- Correct Answer ---------- a. Calm and in an upright position What problem is suggested by a positive Cardarelli sign? a. Ocular migraine b. Aortic aneurysm c. Hasimoto disease d. Thyroid cyst -------- Correct Answer ---------- b. Aortic aneurysm Hamman sign can best be heard when the patient is a. In a supine position b. Laying on the left side c. Sitting completely upright d. Positioned with the head elevated 30 degrees -------- Correct Answer ---------- b. Laying on the left side In addition to severe respiratory distress, which of the following findings may be indicative of a pneumothorax with mediastinal shift? a. Hemoptysis b. Pleural friction fremitus c. Vesicular lung sounds over the peripheral lung field d. Tracheal deviation away from midline position -------- Correct Answer ---------- d. Tracheal deviation away from midline position A mother tells the examiner that her 2-year-old child has a cough that "sounds just like a bark". Given this history, what other findings should the examiner anticipate during respiratory examination? a. Wheezing and coarse crackles bilaterally b. Labored breathing and inspiratory stridor c. Hyperresonance with percussion d. Productive, blood-tinged, or "rusty" sputum -------- Correct Answer ---------- b. Labored breathing and inspiratory stridor The examiner should expect the ratio of respiratory rate to heart rate in the adult to be approximately a. 1 to 2 b. 1 to 4 c. 1 to 6 d. 1 to 8 -------- Correct Answer ---------- b. 1 to 4 Which examination finding is consistent with emphysema? a. Decreased tactile fremitus b. Dullness with chest percussion c. Prolonged inspiration

d. An ammonia-like odor to the patient's breath -------- Correct Answer ---------- a. Decreased tactile fremitus The most important clinical signs for pleural effusion include which of the following? a. Bronchophony, yellow, frothy sputum b. Paroxysmal dyspnea, decreased breath sounds c. Shallow, rapid respirations d. Dullness to percussion, tactile fremitus -------- Correct Answer ---------- d. Dullness to percussion, tactile fremitus Sounds associated with mediastinal emphysema are synchronous with a. Heartbeat b. Inspiration c. Expiration d. Swallowing -------- Correct Answer ---------- a. Heartbeat Dextrocardia is a condition characterized by which of the following? a. The right side of the heart is enlarged b. The heart is positioned to the right of the stomach c. The heart is positioned to the right, either rotated or displaced d. Blood glucose level in the heart is higher than in other organs -------- Correct Answer - --------- c. The heart is positioned to the right, either rotated or displaced While auscultating the heart of an obese patient, the examiner should expect the heart sounds to be a. Louder and closer b. Softer and more distant c. Louder and more distant d. Softer and closer -------- Correct Answer ---------- b. Softer and more distant What disease process should the examiner consider if a patient reports a history of fever and has sudden onset of clinical symptoms of congestive heart failure? a. Bacterial endocarditis b. Infarction c. Myocarditis d. Cardiac tamponade -------- Correct Answer ---------- a. Bacterial endocarditis The examiner suspects that a patient has pulmonary hypertension. What examination findings are consistent with this? a. Decreased intensity of S1 heart sounds; increased intensity of S2 heart sounds b. A thrill palpated in the area of apex c. Paradoxic splitting of S1 and S2 heart sounds d. Pericardial friction rub -------- Correct Answer ---------- a. Decreased intensity of S heart sounds; increased intensity of S2 heart sounds Which of the following cardiac changes occurs at birth in the normal child?

a. The foramen ovale opens b. Pressure in the right atrium rises c. The ductus arteriosus closes d. The relative mass of the left ventricle decreases -------- Correct Answer ---------- c. The ductus arteriosus closes In most adults, the apical impulse should be visible at the a. Midaxillary line in the fifth right intercostal space b. Sternal notch c. Midclavicular line in the fifth left intercostal space d. Costovertebral angle -------- Correct Answer ---------- c. Midclavicular line in the fifth left intercostal space While palpating the precordium, a heave is identified, with lateral displacement of the apical pulse. Such a finding may indicate a. Mitral regurgitation b. Aortic stenosis c. Left ventricular hypertrophy d. Pericarditis -------- Correct Answer ---------- c. Left ventricular hypertrophy A thrill generally indicates which of the following? a. A disturbance in the electrical conductivity of the heart b. A fine, rushing vibration related to disruption of blood flow in the heart c. The presence of significant infection of the myocardium d. Forceful apical impulse felt below the left sternal border -------- Correct Answer ---------

• b. A fine, rushing vibration related to disruption of blood flow in the heart Because percussion has a limited value in determining heart size, left ventricular size is more accurately determined by a. Auscultating the heart sounds b. Locating the apical pulse or PMI c. Palpating the left sternal border d. Palpating the heart base -------- Correct Answer ---------- c. Palpating the left sternal border Which of the following may be easily mistaken for cardiac-generated sounds? a. Bowel sounds b. Pulmonary insufficiency c. Pericardial friction rub d. Tracheal shifting -------- Correct Answer ---------- c. Pericardial friction rub Cardiac tamponade is a. Caused by myocardial infarct and requires immediate intervention b. Indicated by jugular venous distention, hypertension, and exaggerated heart sounds c. The result of excessive accumulation of fluid between the pericardium and the myocardium

d. Characterized by excessive cardiac relaxation, increased blood pressure, and bounding pulse -------- Correct Answer ---------- c. The result of excessive accumulation of fluid between the pericardium and the myocardium During cardiac auscultation, the examiner notes a mid-systolic murmur with a medium pitch; a coarse thrill is palpated as well. These findings are consistent with which condition? a. Aortic stenosis b. Aortic regurgitation c. Pulmonic stenosis d. Mitral stenosis -------- Correct Answer ---------- a. Aortic stenosis Which physical finding is most suggestive of right-sided heart failure? a. Cardiomegaly b. Hypotension c. Jugular venous distention d. Shortness of breath -------- Correct Answer ---------- c. Jugular venous distention Which of the following cardiovascular findings would be considered normal for a woman who is 8 months pregnant? a. The apical impulse has shifted upward and laterally b. Splitting of S1 and S2 is less audible c. A grade III diastolic ejection murmur is heard d. A fourth heart sound can be auscultated -------- Correct Answer ---------- a. The apical impulse has shifted upward and laterally Which principle helps the examiner determine where heart sounds are best heard? a. The doppler effect diminishes the sound over time b. Sound is transmitted in the direction of blood flow c. Accumulation of fluid magnifies the intensity of sound d. Duration of sound varies directly with frequency -------- Correct Answer ---------- b. Sound is transmitted in the direction of blood flow S2 is a. The result of opening of the atrioventricular valves b. The beginning of systole c. Best heard in the mitral area d. Of higher pitch and shorter duration than S1 -------- Correct Answer ---------- d. Of higher pitch and shorter duration than S Splitting of heart sounds is a. an unexpected event that should be further evaluated b. the result of opening of the valves during exhalation c. often most distinct at the peak of inspiration d. caused by synchronization of valve closure -------- Correct Answer ---------- c. often most distinct at the peak of inspiration

To distinguish a heart murmur from respiratory sounds in an infant, the examiner could correctly do which of the following? a. Time the sound with the carotid pulsation b. Distract the child with a moving toy c. Ask the child to hold his or her breath d. Use the flat side of the stethoscope to auscultate the child's chest -------- Correct Answer ---------- a. Time the sound with the carotid pulsation In a young child, the examiner notes a systolic ejection murmur that is loud, harsh, and high in pitch heard over the second intercostal space along the left sternal border. What problem should the examiner suspect? a. Mitral valve prolapse b. Mitral valve stenosis c. Coarctation of the aorta d. Atrial septal defect -------- Correct Answer ---------- d. Atrial septal defect To hear low-pitched filling sounds of the heart, the examiner should place the patient in a a. Supine position and listen with the bell of the stethoscope b. Sitting position and listen with the diaphragm of the stethoscope c. Sitting position and listen with the bell of the stethoscope d. Left lateral recumbent position and listen with the bell of the stethoscope -------- Correct Answer ---------- d. Left lateral recumbent position and listen with the bell of the stethoscope The carotid artery is considered the most suitable artery for evaluation of cardiac function because it a. Is the largest artery in the peripheral vascular system b. Is the most pliable artery in the peripheral vascular system c. Is the most accessible artery close to the heart d. Has the thickest layer of smooth muscle within the vessel walls -------- Correct Answer ---------- c. Is the most accessible artery close to the heart The purpose of the great vessels is to a. Provide a reservoir for blood volume to be used in times of stress b. Circulate the blood to and from the body and the lungs c. Quickly and efficiently move blood in and out of the heart d. Send blood to the lungs for large-scale reoxygenation -------- Correct Answer ---------- b. Circulate the blood to and from the body and the lungs Pregnant women may experience palmar erythema and spider telangiectasis as a result of a. Peripheral vasodilation with decreased vascular resistance b. Peripheral vasoconstriction c. Increased peripheral resistance

d. Diminished cardiac output and peripheral vascular resistance -------- Correct Answer - --------- a. Peripheral vasodilation with decreased vascular resistance Why would an examiner perform an Allen test on a patient? a. To evaluate risk of thrombophlebitis b. To detect cyclic differences in the pulse wave c. To check patency of the ulnar artery d. To monitor for development of a bruit -------- Correct Answer ---------- c. To check patency of the ulnar artery A bounding pulse would be expected in an infant with what condition? a. Coarctation of the aorta b. Patent ductus arteriosus c. Venous hum d. Right-sided heart failure -------- Correct Answer ---------- b. Patent ductus arteriosus Which word best describes a 3+ amplitude pulse? a. Diminished b. Normal c. Full d. Bounding -------- Correct Answer ---------- c. Full Claudication a. Indicates tissue necrosis caused by venous insufficiency b. Is pain that results from muscle ischemia c. Progresses from a sharp, tingling pain to a dull, burning ache d. Occurs after exercise and during sleep -------- Correct Answer ---------- b. Is pain that results from muscle ischemia Which action will diminish the intensity of a venous hum? a. Tilting the head slightly upward b. Turning the head away from the area of auscultation c. Performing the Valsalva maneuver d. Taking a deep breath -------- Correct Answer ---------- c. Performing the Valsalva maneuver Which characteristic of the pulse is being described when a pulse is referred to as bounding? a. Regularity b. Amplitude c. Contour d. Waveform -------- Correct Answer ---------- b. Amplitude How does rotating the patient's head to the side being examined facilitated palpation of the carotid pulse? a. It "fixes" the artery in place

b. It increases the pulse amplitude c. It brings the artery closer to the skin surface d. It relaxes the sternocleidomastoid muscle -------- Correct Answer ---------- d. It relaxes the sternocleidomastoid muscle Hepatojugular reflux can be sued to evaluate a. Right-sided heart failure b. Degree of aortic stenosis c. Incompetence of venous valves d. Arterial insufficiency -------- Correct Answer ---------- a. Right-sided heart failure In determining the jugular venous pressure, the examiner would correctly do which of the following? a. Apply manual pressure on the carotid artery while the patient forcefully exhales b. Examine neck veins while occluding the brachial artery with the blood pressure cuff c. Use light to supply tangential illumination across the neck d. Have the patient lean forward from the waist and take a deep breath -------- Correct Answer ---------- c. Use light to supply tangential illumination across the neck Varicose veins are characterized by a. Dilation and tortuosity when the extremities are dependent b. Increased rate of blood flow to the extremities c. Decreased intravenous pressure d. Edema resulting from obstruction to a distal vein -------- Correct Answer ---------- a. Dilation and tortuosity when the extremities are dependent A condition that results in progressive ischemia caused by insufficient perfusion is a. Raynaud phenomenon b. Peripheral atherosclerotic disease c. Venous thrombosis d. Arterial aneurysm -------- Correct Answer ---------- b. Peripheral atherosclerotic disease Which problem should be suspected when an examiner documents that a patient has "2+ pitting edema of the right lower extremity"? a. Lymphedema b. Arterial insufficiency c. Occlusion of a major vein d. Congestive heart failure -------- Correct Answer ---------- c. Occlusion of a major vein Which is a characteristic of the jugular pulse that can aid the examiner in differentiating it from the carotid pulse? a. The jugular pulse can be visualized but not palpated b. Respiration has no effect on the jugular pulse c. Pressure on the left upper quadrant of the abdomen will obliterate the jugular pulse

d. Exaggeration of the jugular pulse occurs in response to pressure just above the clavicle -------- Correct Answer ---------- a. The jugular pulse can be visualized but not palpated The most common cause of venous thrombosis in children is a. Congenital venous incompetence b. Atherosclerosis of deep veins c. Arteriovenous malformation d. Placement of venous access devices -------- Correct Answer ---------- d. Placement of venous access devices Which fact is critical for an examiner to consider when evaluating a patient with a possible deep vein thrombosis (DVT)? a. A defining characteristic of DVT is venous distention after 5 deep knee bends b. DVT cannot be confirmed based solely on physical examination c. A negative human sign rules out the diagnosis of DVT d. It is impossible to distinguish Achilles tendon pain from DVT on clinical examination -- ------ Correct Answer ---------- b. DVT cannot be confirmed based solely on physical examination Which of the following distinguishes musculoskeletal pain from the pain of vascular insufficiency? a. Onset during activity b. Increases with intensity and duration of activity c. May occur several hours after activity d. Quickly relieved by rest -------- Correct Answer ---------- c. May occur several hours after activity When examining a 10-month-old infant, the examiner should suspect dehydration or hypovolemic shock when capillary refill time is longer than __ second(s). a. 1 b. 2 c. 3 d. 4 -------- Correct Answer ---------- b. 2 Chest pain subjective data -------- Correct Answer ---------- *substernal pain or intense pressure radiating to the neck, jaw, and arms (particularly the left) *often accompanied by SOB, fatigue, diaphoresis, faintness, and syncope Objective questions about chest pain to ask patients -------- Correct Answer ---------- 1. are you currently having chest pain?

2. what medicines are you currently taking?
3. do you have any comorbidities?
4. is this your 1st time having CP or is it recurrent?
5. how long has the chest pain been occuring?
6. is it constant or intermittent?

7. does the pain radiate anywhere?
8. how long does the CP last?
9. what does the pain feel like?
10. what would you rate the pain?
11. do you have any other symptoms?
12. what makes the CP worse?
13. what makes the CP better?
14. have you had an injury to your chest recently? What is a split S1 and possible causes? -------- Correct Answer ---------- *S1 is usually heard as 1 sound even though there is asynchrony between the closure of the mitral and tricuspid valve. Split S1 is when you can hear the asynchrony & is best heard in the tricuspid area *may occur in RBBB and with PVCs What conditions cause an increase of the intensity of S2? -------- Correct Answer ---------

• *systemic hypertension, syphilis of the aortic valve, exercise, or excitement *pulmonary hypertension, mitral stenosis, CHF *diseased valves but still mobile What conditions cause a decrease in the intensity of S2? -------- Correct Answer ---------- *shock-like state with arterial hypotension *valves are immobile, thickened, or calcified *aortic stenosis, pulmonic stenosis *overlying tissue, fat, or fluid What conditions cause an increase in the intensity of S1? -------- Correct Answer ---------
• *complete heart block *rhythm disruption (fibrillation) What conditions cause a decrease in the intensity of S1? -------- Correct Answer ---------- *systemic or pulmonary hypertension *fibrosis and calcification of a diseased mitral valve (rheumatic heart disease) Wide Splitting: S1 and S2 -------- Correct Answer ---------- *split becomes wider when delayed activation of contraction or right ventricle emptying slows pulmonic closure *S1 - caused by RBBB *S2 - caused by RBBB, pulmonic stenosis, pulmonary hypertension, or mitral regurgitation Fixed splitting of S2 -------- Correct Answer ---------- *unaffected by respiration *Occurs with large atrial septal defects, ventricular septal defects with L to R shunting, or right ventricular failure Paradoxical (Reversed) Splitting of S2 -------- Correct Answer ---------- *only heard during expiration

*associated with delayed closure of aortic valve (LBBB) Ventricular Gallop (S3) -------- Correct Answer ---------- *Ken-TUCK-y; best heart in left lateral recumbent *low pitch; best heard in apex with bell during inspiration *Physiological - children, young adults, pregnancy = rapid early ventricular filling *Pathological - adults with decreased myocardial contractility, HF, volume overload Atrial Gallop (S4) -------- Correct Answer ---------- *TEN-nes-see; supine or left semi- lateral *Loud S4 always suggests pathology! *low pitch; best heard in apex with bell on inspiration - just before S1 *most commonly heard in elderly; may be heard at any age when there is increased resistance to filling because the ventricular walls have lost compliance (HTN/CAD) or with increased stroke volume of high-output states (profound anemia, pregnancy, thyrotoxicosis) Opening snap heart sound -------- Correct Answer ---------- *abrupt recoil of stenotic mitral or tricuspid valve *high pitch; heard in any position in apex with diaphragm *may be confused with S3 Ejection sounds -------- Correct Answer ---------- *best heard sitting or supine in 2nd RICS or 2nd LICS or apex *high pitch; use diaphragm *sounds are increased on expiration with pulmonary stenosis *due to opening of deformed semi-lunar valves *Aortic ejection sound same as S1 & S2; pulmonary ejection sound increased on expiration Systolic Click -------- Correct Answer ---------- *best heard in sitting or supine in apex with diaphragm *high pitch; increased on inspiration *due to prolapse of mitral valve leaflet *occurs later in systole with increased venous return Pericardial friction rub -------- Correct Answer ---------- *easily mistaken for cardiac- generated sounds *rubbing machine-like sound due to inflammation of the pericardial sac *usually heard widely, but more distinct toward apex *may have 3 components *if only 1 or 2 components, it will be less intense and may sound like a murmur Heart Murmurs -------- Correct Answer ---------- *prolonged extra sounds heard during systole or diastole; some a benign and some are pathologic *caused by disruption of blood flow

Murmur Intensity -------- Correct Answer ---------- I - barely audible in quiet room II - quiet but clearly audible III - moderately loud IV - loud, associated with a thrill V - very loud, thrill easily palpable VI - very loud, audible with stethoscope not in contact with chest, thrill palpable and visible 10 types of heart murmurs -------- Correct Answer ---------- 1. mitral stenosis

2. aortic stenosis
3. subaortic stenosis
4. pulmonic stenosis
5. tricuspid stenosis
6. mitral regurgitation
7. mitral valve prolapse
8. aortic regurgitation
9. pulmonic regurgitation
10. tricuspid regurgitation Mitral Stenosis -------- Correct Answer ---------- *heard with bell at apex in LLR position *narrowed valve restricts forward flow; forceful ejection into ventricle *often occurs with mitral regurgitation *caused by rheumatic fever or cardiac infection Mitral Stenosis Findings -------- Correct Answer ---------- *low-frequency diastolic rumble, more intense in early & late diastole, does not radiate *systole usually quiet *palpable thrill at apex in late diastole; S1 increased and often palpable at LSB; S2 split often with accented P2; opening snap follows P2 closely *visible lift in R parasternal area if RV hypertrophied *Arterial pulse amplitude decreased Aortic Stenosis -------- Correct Answer ---------- *heard over aortic area; ejection sound at 2nd RICB *calcification of valve cusps restricts forward flow; forceful ejection from ventricle into systemic circulation

• caused by congenital bicuspid (rather than usual tricuspid) valve, rheumatic heart disease, atherosclerosis *may be the cause of sudden death, particularly in children & adolescents, either at rest or during exercise *risk apparently related to the degree of stenosis Aortic Stenosis findings -------- Correct Answer ---------- *Mid-systolic (ejection) murmur, medium pitch, coarse, diamond-shaped, crescendo-decrescendo *radiates along the LSB (sometimes to the apex) and to carotid with palpable thrill

*S1 often heard best at apex, disappearing when stenosis is severe, often followed by ejection click *S2 soft or absent and may not be split *S4 palpable *Ejection sound muted in calcified valves *The more severe the stenosis, the later the peak of the murmur in systole *Apical thrust shifts down and left and is prolonged if left ventricular hypertrophy is also present Subaortic Stenosis -------- Correct Answer ---------- *heard at apex and along left border

• Fibrous ring, usually 1-4 mm below aortic valve *Most pronounced on ventricular septal side
• May become progressively severe with time
• Difficult to distinguish from aortic stenosis on clinical grounds alone Subaortic stenosis findings -------- Correct Answer ---------- *Murmur fills systole, diamond-shaped, medium pitch coarse *Thrill often palpable during systole at apex and right sternal border *Multiple waves in apical impulses *S2 usually split *S4 often present *Arterial pulse brisk, double wave in carotid common *Jugular venous pulse prominent Pulmonic stenosis -------- Correct Answer ---------- *heard over pulmonic area radiating to left and into the neck; thrill in second and third left intercostal spaces *Valve restricts forward flow
• Forceful ejection from ventricle into pulmonary *Cause is almost always congenital Pulmonic stenosis findings -------- Correct Answer ---------- *Systolic (ejection) murmur, diamond-shaped, medium pitch, coarse *Usually with thrill *S1 often followed quickly by ejection click *S2 often diminished, usually wide split *P2 soft or absent *S4 common in right ventricular hypertrophy *Murmur may be prolonged and confused with that of a ventricular septal defect Tricuspid stenosis -------- Correct Answer ---------- *heard with bell over tricuspid area *Calcification of valve cusps restricts forward flow; forceful ejection into ventricles *Usually seen with mitral stenosis, rarely occurs alone
• Caused by rheumatic heart disease, congenital defect, endocardial fibroelastosis, right atrial myxoma

Tricuspid stenosis findings -------- Correct Answer ---------- * Diastolic rumble accentuated early and late in diastole, resembling mitral stenosis but louder on inspiration

• Diastolic thrill palpable over right ventricle *S2 may be split during inspiration *Arterial pulse amplitude decreased *Jugular venous pulse prominent, especially a wave *Slow fall of V wave Mitral regurgitation -------- Correct Answer ---------- *heard best at apex; loudest there, transmitted into left axilla
• Valve incompetence allows backflow from ventricle to atrium *Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae Mitral regurgitation findings -------- Correct Answer ---------- *Holosystolic, plateau- shaped intensity, high pitch, harsh blowing quality, often quite loud and may obliterate S2 *Radiates from the apex to base or to left axilla *Thrill may be palpable at apex during systole
• S1 intensity diminished *S2 more intense with P2 often accented *S3 often present *S3-S4 gallop common in late disease
• If mild, late systolic murmur crescendos
• If severe, early systolic intensity crescendos
• Apical thrust more to left and down in ventricular hypertrophy Mitral valve prolapse -------- Correct Answer ---------- *heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright
• Valve is competent early in systole but prolapses into atrium later in systole *May become progressively severe, resulting in a holosystolic murmur *Often concurrent with pectus excavatum Mitral valve prolapse findings -------- Correct Answer ---------- *Typically late systolic murmur preceded by midsystolic clicks, but both murmur and clicks highly variable in intensity and timing Aortic regurgitation -------- Correct Answer ---------- *heard with diaphragm patient sitting and leaning forward; Austin-Flint murmur heard with bell; ejection click heard in second intercostal space
• Valve incompetence allows backflow from aorta to ventricle *Caused by rheumatic heart disease, endocarditis, aortic diseases (like marfan syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma Aortic regurgitation findings -------- Correct Answer ---------- *Early diastolic, high pitch blowing, often with diamond-shaped mid-systolic murmur, sounds often not prominent

*duration varies with blood pressure *Low-pitched, rumbling murmur at apex common (Austin-Flint) *Early ejection click is sometimes present *S1 soft

• S2 split may have drum-like quality *Mitral (M1) and A2 often intensified, S3-4 gallop common
• In left ventricular hypertrophy, prominent prolonged apical impulse down and to left *Pulse pressure wide *Water-hammer or Corrigan pulse common in carotid, brachial, and femoral arteries Pulmonic regurgitation -------- Correct Answer ---------- Description: *Valve incompetence allows backflow pulmonary artery to ventricle
• Secondary to pulmonary hypertension or bacterial endocarditis Findings of Exam: *Difficult to distinguish from aortic regurgitation on physical examination Tricuspid regurgitation -------- Correct Answer ---------- *heard at left lower sternum, occasionally radiating a few cm to left *Valve incompetence allows backflow from ventricle to atrium *Caused by congenital defects, bacterial endocarditis (esp. In IV drug abusers), pulmonary HTN, cardiac trauma Tricuspid regurgitation findings -------- Correct Answer ---------- *Holosystolic murmur over right ventricle, blowing, increased on inspiration *S3 and thrill over tricuspid area common *In pulmonary HTN, pulmonary impulse palpable over second left intercostal space and P2 accented *In right ventricle hypertrophy, visible lift to right of sternum
• Jugular venous pulse has large V waves Steps to palpation of the cardiac system -------- Correct Answer ---------- *patient supine; palpate the precordium using the proximal halves of the four fingers held gently together *Touch lightly; let the cardiac movements rise to your hand s/t sensation decreasing as you increase pressure *Begin at the apex, move to the inferior left sternal border, then move up the sternum to the base and down the right sternal border and into the epigastrium or axillae
• Feel for apical impulse and identify its location by the intercostal space and the distance from the midsternal line *PMI: What is the diameter of the area? (Usually no more than 1 cm) Impulse is usually gentle & brief not lasting as long as systole *If obese or thick chest you may not be able to feel the apical pulse *Feel for a thrill which is a fine, palpable, rushing vibration, a palpable murmur, over the base of the heart in the area of the right or left 2nd intercostal space *While palpating the precordium, use your other hand to palpate the carotid artery