APEA FNP CARDIO EXAM
QUESTIONS WITH CORRECT AND VERIFIED
ANSWERS WITH RATIONALE| RATED A+
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system. Correct
arteriovenous system.
capillary bed. Incorrect
Explanation:
The lymphatic ducts drain into the venous system.
Question 2:
While auscultating the patient's heart, a medium, soft murmur is audible. It is pansystolic and heard
loudest at the apex with radiation to the left axilla. These findings are consistent with:
tricuspid regurgitation.mitral regurgitation Correct. a ventricular septal defect.an innocent
murmur. Incorrect
Explanation:
Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation
toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud.
With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to
the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is
pansystolic. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually
heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth
intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when
sitting.
Question 3:
Which of the following group of symptoms would be suggestive of an infant experiencing a congenital
heart defect associated with a decreased pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95%
,Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater
than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than 95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of
desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs.
Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are
considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid
valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds
either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid
atresia. Usually these infants have activity intolerance and therefore, experience failure to thrive because
of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually
prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats
being lower than normal, sometimes even in the 80% range.
Question 4:
Right atrial pressure can be determined by:
palpating the carotid pulse. Incorrect
identifying the pulsations of the right jugular vein. Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best assessed from pulsations in the
right internal jugular vein. This is an indicator of cardiac function and right heart hemodynamics.
Palpating the carotid artery denotes arterial pressure; analyzing blood gases reflects the status of the
arterial blood. Assessing for dependent edema is a reflection of heart failure and poor venous return and
not atrial pressure.
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the
most appropriate for this child?
Apical pulse at the 5th intercostal space right midclavicular line
Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line Correct
Apical pulse to the right of the midclavicular line in the 3rd intercostal space
,Apical pulse in the 5th intercostal space left midclavicular line Incorrect
Explanation:
The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal
space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line
would be if the child had situs inversus or dextrocardia.
Question 6:
The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from
the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.
eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Correct
mouth, throat, and face. Incorrect
posterior part of the temporoparietal region.
Explanation:
The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid
from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. Tonsillar,
submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic
fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the
palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior
auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region.
Question 7:
The external iliac lymph nodes drain lymphatic fluid from the following areas except the:
urinary bladder.
prostate.
uterus.
gluteal region. Correct
Explanation:
The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or
uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic
viscera, deep part of the perineum, and the gluteal region.
, Question 8:
The amplitude of the pulse in a patient in cardiogenic shock would most likely appear:
bounding.
thready. Correct
normal.
as a bruit.
Explanation:
The amplitude of the pulse correlates with pulse pressure. Small, thready, or weak pulses occur in
patients in cardiogenic shock. Bounding pulses are seen in patients in aortic insufficiency. A bruit is not
typically associated with pulse amplitude. It is associated with stenosis or turbulent arterial blood flow.
Usually the presence of a bruit requires further investigation and is not in itself diagnostic.
Question 9:
When auscultating the heart for aortic insufficiency, ask the patient to:
lie supine and inhale.
exhale while standing.
turn to the left side and breath deeply.
sit up, lean forward, and exhale. Correct
Explanation:
To bring the left ventricular outflow tract closer to the chest wall to listen for aortic insufficiency, ask the
patient to sit up, lean forward, and exhale.
Question 10:
The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal
ligament and drain lymphatic fluid from all of these areas except:
lower abdomen.
buttock. Incorrect
testes. Correct
lower vagina.
Explanation:
The horizontal superficial inguinal nodes lie in a chain high in the anterior thigh below the inguinal
QUESTIONS WITH CORRECT AND VERIFIED
ANSWERS WITH RATIONALE| RATED A+
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system. Correct
arteriovenous system.
capillary bed. Incorrect
Explanation:
The lymphatic ducts drain into the venous system.
Question 2:
While auscultating the patient's heart, a medium, soft murmur is audible. It is pansystolic and heard
loudest at the apex with radiation to the left axilla. These findings are consistent with:
tricuspid regurgitation.mitral regurgitation Correct. a ventricular septal defect.an innocent
murmur. Incorrect
Explanation:
Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation
toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud.
With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to
the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is
pansystolic. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually
heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth
intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when
sitting.
Question 3:
Which of the following group of symptoms would be suggestive of an infant experiencing a congenital
heart defect associated with a decreased pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95%
,Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater
than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than 95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of
desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs.
Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are
considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid
valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds
either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid
atresia. Usually these infants have activity intolerance and therefore, experience failure to thrive because
of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually
prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats
being lower than normal, sometimes even in the 80% range.
Question 4:
Right atrial pressure can be determined by:
palpating the carotid pulse. Incorrect
identifying the pulsations of the right jugular vein. Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best assessed from pulsations in the
right internal jugular vein. This is an indicator of cardiac function and right heart hemodynamics.
Palpating the carotid artery denotes arterial pressure; analyzing blood gases reflects the status of the
arterial blood. Assessing for dependent edema is a reflection of heart failure and poor venous return and
not atrial pressure.
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the
most appropriate for this child?
Apical pulse at the 5th intercostal space right midclavicular line
Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line Correct
Apical pulse to the right of the midclavicular line in the 3rd intercostal space
,Apical pulse in the 5th intercostal space left midclavicular line Incorrect
Explanation:
The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal
space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line
would be if the child had situs inversus or dextrocardia.
Question 6:
The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from
the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.
eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Correct
mouth, throat, and face. Incorrect
posterior part of the temporoparietal region.
Explanation:
The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid
from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. Tonsillar,
submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic
fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the
palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior
auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region.
Question 7:
The external iliac lymph nodes drain lymphatic fluid from the following areas except the:
urinary bladder.
prostate.
uterus.
gluteal region. Correct
Explanation:
The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or
uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic
viscera, deep part of the perineum, and the gluteal region.
, Question 8:
The amplitude of the pulse in a patient in cardiogenic shock would most likely appear:
bounding.
thready. Correct
normal.
as a bruit.
Explanation:
The amplitude of the pulse correlates with pulse pressure. Small, thready, or weak pulses occur in
patients in cardiogenic shock. Bounding pulses are seen in patients in aortic insufficiency. A bruit is not
typically associated with pulse amplitude. It is associated with stenosis or turbulent arterial blood flow.
Usually the presence of a bruit requires further investigation and is not in itself diagnostic.
Question 9:
When auscultating the heart for aortic insufficiency, ask the patient to:
lie supine and inhale.
exhale while standing.
turn to the left side and breath deeply.
sit up, lean forward, and exhale. Correct
Explanation:
To bring the left ventricular outflow tract closer to the chest wall to listen for aortic insufficiency, ask the
patient to sit up, lean forward, and exhale.
Question 10:
The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal
ligament and drain lymphatic fluid from all of these areas except:
lower abdomen.
buttock. Incorrect
testes. Correct
lower vagina.
Explanation:
The horizontal superficial inguinal nodes lie in a chain high in the anterior thigh below the inguinal
