NURS 620 Exam 2 – Cardiovascular And Respiratory Review
MVU NURS 620 Adult 1 Exam 2 Prep Test A |
600 Practice Questions With Correct Answers And Detailed Rationales
1. Charles has chronic ischemic heart disease and is taking a beta-blocker, which results in:
A. An increase in high-density lipoprotein cholesterol.
B. A reduced heart rate.
C. A decreased diastolic filling time.
D. An increase in oxygen demand.
Correct Answer: B. A reduced heart rate.
Rationale: Beta-blockers competitively block beta-adrenergic receptors, reducing the
effects of catecholamines on the heart. This leads to decreased heart rate, reduced
myocardial contractility, and lowered blood pressure. The net effect is decreased
myocardial oxygen demand, not increased. Beta-blockers do not consistently raise HDL;
some may slightly lower HDL. Diastolic filling time is prolonged, not decreased, because of
the slower heart rate.
2. Which of the following statements is true concerning auscultation of the typical murmur
associated with aortic stenosis?
A. It is a harsh, crescendo-decrescendo ejection type that often radiates to the carotid
arteries.
[1]
,B. It is a diastolic murmur.
C. It is best heard at the apex of the heart.
D. The loudness of the murmur reflects the severity of the lesion.
Correct Answer: A. It is a harsh, crescendo-decrescendo ejection type that often radiates to
the carotid arteries.
Rationale: Aortic stenosis produces a systolic ejection murmur that is harsh, crescendo-
decrescendo (diamond-shaped), and best heard at the right upper sternal border. It
radiates to the carotid arteries. It is a systolic, not diastolic, murmur. The loudness (grade)
does not correlate reliably with severity; a soft murmur may still indicate critical stenosis,
and a loud murmur may occur with mild stenosis. The apex is the best location for mitral
valve murmurs, not aortic stenosis.
3. You are managing a client with CHF. The client is presently on Carvedilol 12.5 mg PO BID,
Lisinopril 2.5 mg PO daily, Lasix 80 mg PO daily, and spironolactone (Aldactone) 25 mg PO
daily. He is in to see you for a 2-week follow-up and shares he has gained 7 lb. in the past
week. He shares he has been faithful to his fluid and dietary restrictions and that his
urinary output is somewhat less than it has been. What medication could you add to
optimize the response to the loop diuretic?
A. Bumex
B. Metolazone
C. Demadex
D. Diamox
Correct Answer: B. Metolazone.
Rationale: Metolazone is a thiazide-type diuretic that acts synergistically with loop
diuretics like furosemide (Lasix) to produce a potent diuretic effect, often referred to as
sequential nephron blockade. It works on the distal convoluted tubule, while loop diuretics
[2]
,act on the ascending loop of Henle. Bumex and Demadex are also loop diuretics and would
not add a different mechanism. Diamox (acetazolamide) is a carbonic anhydrase inhibitor
used mainly for glaucoma or metabolic alkalosis, not for diuresis in CHF.
4. Sandra says she wants to know more about the Pooled Cohort Equation to determine her
10-year risk of ASCVD. You tell her that the variables include which of the following?
A. Total and HDL cholesterol levels.
B. Systolic BP.
C. Diabetes.
D. Current smoking status.
E. All of the above.
Correct Answer: E. All of the above.
Rationale: The Pooled Cohort Equation (PCE) estimates 10-year risk for atherosclerotic
cardiovascular disease (ASCVD) in adults aged 40-79. The variables include age, sex, race,
total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension,
diabetes, and current smoking status. All options listed (A-D) are components of the
equation.
5. Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue
over the past 6 months. She has been trying to lose weight, has been on a walking exercise
program for over a year, and had taken the fenfluramine-phentermine (Fen-Phen)
combination many years ago but stopped when its adverse effects were reported. Your
examination reveals a grade II/VI systolic murmur along the apex. What do you do?
A. Obtain pulmonary function tests.
B. Instruct the client about other exercise activities that may not produce her symptoms.
[3]
, C. Refer the client to a cardiologist for an echocardiogram and cardiovascular work-up.
D. Start endocarditis prophylaxis.
Correct Answer: C. Refer the client to a cardiologist for an echocardiogram and
cardiovascular work-up.
Rationale: Martha's history of Fen-Phen use is significant because this combination was
associated with valvular heart disease, particularly mitral and aortic valve abnormalities.
Her symptoms (dyspnea, fatigue) and a systolic murmur at the apex raise concern for
mitral valve disease. An echocardiogram is essential to evaluate valve structure and
function. Endocarditis prophylaxis is not indicated without a definitive valve lesion that
meets current guidelines. PFTs and exercise counseling would delay necessary cardiac
evaluation.
6. Which statement about mitral valve prolapse (MVP) is true?
A. MVP occurs in about 10% of the population.
B. MVP is usually detected in older adults.
C. The incidence is equal in men and women younger than age 20.
D. The incidence is more common in women younger than age 20.
Correct Answer: D. The incidence is more common in women younger than age 20.
Rationale: Mitral valve prolapse is more common in young women, with a female-to-male
ratio of approximately 2:1 in the younger age groups. The prevalence is about 2-3% in the
general population, not 10%. It is typically detected in young to middle-aged adults, not
older adults. The gender disparity is most pronounced in younger individuals.
7. Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you
begin your examination, you know that it:
[4]
MVU NURS 620 Adult 1 Exam 2 Prep Test A |
600 Practice Questions With Correct Answers And Detailed Rationales
1. Charles has chronic ischemic heart disease and is taking a beta-blocker, which results in:
A. An increase in high-density lipoprotein cholesterol.
B. A reduced heart rate.
C. A decreased diastolic filling time.
D. An increase in oxygen demand.
Correct Answer: B. A reduced heart rate.
Rationale: Beta-blockers competitively block beta-adrenergic receptors, reducing the
effects of catecholamines on the heart. This leads to decreased heart rate, reduced
myocardial contractility, and lowered blood pressure. The net effect is decreased
myocardial oxygen demand, not increased. Beta-blockers do not consistently raise HDL;
some may slightly lower HDL. Diastolic filling time is prolonged, not decreased, because of
the slower heart rate.
2. Which of the following statements is true concerning auscultation of the typical murmur
associated with aortic stenosis?
A. It is a harsh, crescendo-decrescendo ejection type that often radiates to the carotid
arteries.
[1]
,B. It is a diastolic murmur.
C. It is best heard at the apex of the heart.
D. The loudness of the murmur reflects the severity of the lesion.
Correct Answer: A. It is a harsh, crescendo-decrescendo ejection type that often radiates to
the carotid arteries.
Rationale: Aortic stenosis produces a systolic ejection murmur that is harsh, crescendo-
decrescendo (diamond-shaped), and best heard at the right upper sternal border. It
radiates to the carotid arteries. It is a systolic, not diastolic, murmur. The loudness (grade)
does not correlate reliably with severity; a soft murmur may still indicate critical stenosis,
and a loud murmur may occur with mild stenosis. The apex is the best location for mitral
valve murmurs, not aortic stenosis.
3. You are managing a client with CHF. The client is presently on Carvedilol 12.5 mg PO BID,
Lisinopril 2.5 mg PO daily, Lasix 80 mg PO daily, and spironolactone (Aldactone) 25 mg PO
daily. He is in to see you for a 2-week follow-up and shares he has gained 7 lb. in the past
week. He shares he has been faithful to his fluid and dietary restrictions and that his
urinary output is somewhat less than it has been. What medication could you add to
optimize the response to the loop diuretic?
A. Bumex
B. Metolazone
C. Demadex
D. Diamox
Correct Answer: B. Metolazone.
Rationale: Metolazone is a thiazide-type diuretic that acts synergistically with loop
diuretics like furosemide (Lasix) to produce a potent diuretic effect, often referred to as
sequential nephron blockade. It works on the distal convoluted tubule, while loop diuretics
[2]
,act on the ascending loop of Henle. Bumex and Demadex are also loop diuretics and would
not add a different mechanism. Diamox (acetazolamide) is a carbonic anhydrase inhibitor
used mainly for glaucoma or metabolic alkalosis, not for diuresis in CHF.
4. Sandra says she wants to know more about the Pooled Cohort Equation to determine her
10-year risk of ASCVD. You tell her that the variables include which of the following?
A. Total and HDL cholesterol levels.
B. Systolic BP.
C. Diabetes.
D. Current smoking status.
E. All of the above.
Correct Answer: E. All of the above.
Rationale: The Pooled Cohort Equation (PCE) estimates 10-year risk for atherosclerotic
cardiovascular disease (ASCVD) in adults aged 40-79. The variables include age, sex, race,
total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension,
diabetes, and current smoking status. All options listed (A-D) are components of the
equation.
5. Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue
over the past 6 months. She has been trying to lose weight, has been on a walking exercise
program for over a year, and had taken the fenfluramine-phentermine (Fen-Phen)
combination many years ago but stopped when its adverse effects were reported. Your
examination reveals a grade II/VI systolic murmur along the apex. What do you do?
A. Obtain pulmonary function tests.
B. Instruct the client about other exercise activities that may not produce her symptoms.
[3]
, C. Refer the client to a cardiologist for an echocardiogram and cardiovascular work-up.
D. Start endocarditis prophylaxis.
Correct Answer: C. Refer the client to a cardiologist for an echocardiogram and
cardiovascular work-up.
Rationale: Martha's history of Fen-Phen use is significant because this combination was
associated with valvular heart disease, particularly mitral and aortic valve abnormalities.
Her symptoms (dyspnea, fatigue) and a systolic murmur at the apex raise concern for
mitral valve disease. An echocardiogram is essential to evaluate valve structure and
function. Endocarditis prophylaxis is not indicated without a definitive valve lesion that
meets current guidelines. PFTs and exercise counseling would delay necessary cardiac
evaluation.
6. Which statement about mitral valve prolapse (MVP) is true?
A. MVP occurs in about 10% of the population.
B. MVP is usually detected in older adults.
C. The incidence is equal in men and women younger than age 20.
D. The incidence is more common in women younger than age 20.
Correct Answer: D. The incidence is more common in women younger than age 20.
Rationale: Mitral valve prolapse is more common in young women, with a female-to-male
ratio of approximately 2:1 in the younger age groups. The prevalence is about 2-3% in the
general population, not 10%. It is typically detected in young to middle-aged adults, not
older adults. The gender disparity is most pronounced in younger individuals.
7. Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you
begin your examination, you know that it:
[4]
