NR 509 Midterm Exam Compilation with
250+ Questions with Correct Answers|
Guaranteed Pass
A 68-year-old retired waiter comes to your clinic for evaluation of fatigue. You perform a
cardiac examination and find that his pulse rate is less than 60. Which of the following
conditions could be responsible for this heart rate?
A) Second-degree A-V block
B) Atrial flutter
C) Sinus arrhythmia
D) Atrial fibrillation
A) Second-degree A-V block
Atrial flutter
and atrial fibrillation do not cause bradycardia unless there is a significant accompanying block.
Sinus arrhythmia does not cause bradycardia and represents respiratory variation of the heart
rate.
Where is the point of maximal impulse (PMI) normally located?
A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum
B) In the left 5th intercostal space, 10 to 12 cm lateral to the sternum
C) In the left 5th intercostal space, in the anterior axillary line
D) In the left 5th intercostal space, in the midaxillary line
A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum
Which of the following events occurs at the start of diastole?
A) Closure of the tricuspid valve
B) Opening of the pulmonic valve
C) Closure of the aortic valve
D) Production of the first heart sound (S1)
C) Closure of the aortic valve
It is thought that the closure of the aortic valve produces the second heart sound (S2). Closure of
the mitral valve is thought to produce the first heart sound (S1).
,Which is true of a third heart sound (S3)?
A) It marks atrial contraction.
B) It reflects normal compliance of the left ventricle.
C) It is caused by rapid deceleration of blood against the ventricular wall.
D) It is not heard in atrial fibrillation.
It is caused by rapid deceleration of blood against the ventricular wall.
Which is true of splitting of the second heart sound?
A) It is best heard over the pulmonic area with the bell of the stethoscope.
B) It normally increases with exhalation.
C) It is best heard over the apex.
D) It does not vary with respiration.
A) It is best heard over the pulmonic area with the bell of the stethoscope.
Which of the following is true of jugular venous pressure (JVP) measurement?
A) It is measured with the patient at a 45-degree angle.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
C) A JVP below 9 cm is abnormal.
D) It is measured above the sternal notch.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
How much does cardiovascular risk increase for each increment of 20 mm Hg systolic and
10 mm Hg diastolic in blood pressure?
A) 25%
B) 50%
C) 75%
D) 100%
D) 100%
Each increase of BP by 20 systolic and 10 diastolic doubles the risk of cardiovascular disease.
In healthy adults over 20, how often should blood pressure, body mass index, waist
circumference, and pulse be assessed, according to American Heart Association guidelines?
A) Every 6 months
B) Every year
C) Every 2 years
D) Every 5 years
,C) Every 2 years
Which of the following is a clinical identifier of metabolic syndrome?
A) Waist circumference of 38 inches for a male
B) Waist circumference of 34 inches for a female
C) BP of 134/88 for a male
D) BP of 128/84 for a female
C) BP of 134/88 for a male
The physical examination criteria for identifying metabolic syndrome include a waist of 40
inches or greater for a male, a waist of 35 inches or greater for a female, and a blood pressure of
130/85 or greater. Other criteria include triglycerides greater than or equal to 150 mg/dL, fasting
glucose greater than or equal to 110 mg/dL, and HDL less than 40 for men or less than 50 for
women.
Mrs. Adams would like to begin an exercise program and was told to exercise as intensely as
necessary to obtain a heart rate 60% or greater of her maximum heart rate. She is 52. What heart
rate should she achieve?
A) 80
B) 100
C) 120
D) 140
B) 100
Maximum heart rate is calculated by subtracting the patient's age from 220. For Mrs. Adams,
60% of this number is about 100. She must also be instructed in how to measure
her own pulse or have a device to do so.
In measuring the jugular venous pressure (JVP), which of the following is important?
A) Keep the patient's torso at a 45-degree angle.
B) Measure the highest visible pressure, usually at end expiration.
C) Add the vertical height over the sternal notch to a 5-cm constant.
D) Realize that a total value of over 12 cm is abnormal.
B) Measure the highest visible pressure, usually at end expiration.
You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you
search out?
A) Mitral valve prolapse
B) Pulmonic stenosis
, C) Tricuspid insufficiency
D) Aortic insufficiency
D) Aortic insufficiency
To hear a soft murmur or bruit, which of the following may be necessary?
A) Asking the patient to hold her breath
B) Asking the patient in the next bed to turn down the TV
C) Checking your stethoscope for air leaks
D) All of the above
D) All of the above
Which of the following may be missed unless the patient is placed in the left lateral
decubitus position and auscultated with the bell?
A) Mitral stenosis murmur
B) Opening snap of the mitral valve
C) S3 and S4 gallops
D) All of the above
D) All of the above
How should you determine whether a murmur is systolic or diastolic?
A) Palpate the carotid pulse.
B) Palpate the radial pulse.
C) Judge the relative length of systole and diastole by auscultation.
D) Correlate the murmur with a bedside heart monitor.
A) Palpate the carotid pulse.
Which of the following correlates with a sustained, high-amplitude PMI?
A) Hyperthyroidism
B) Anemia
C) Fever
D) Hypertension
D) Hypertension
You are examining a patient with emphysema in exacerbation and are having difficulty hearing
his heart sounds. What should you do to obtain a good examination?
A) Listen in the epigastrium.
B) Listen to the patient in the left lateral decubitus position.
250+ Questions with Correct Answers|
Guaranteed Pass
A 68-year-old retired waiter comes to your clinic for evaluation of fatigue. You perform a
cardiac examination and find that his pulse rate is less than 60. Which of the following
conditions could be responsible for this heart rate?
A) Second-degree A-V block
B) Atrial flutter
C) Sinus arrhythmia
D) Atrial fibrillation
A) Second-degree A-V block
Atrial flutter
and atrial fibrillation do not cause bradycardia unless there is a significant accompanying block.
Sinus arrhythmia does not cause bradycardia and represents respiratory variation of the heart
rate.
Where is the point of maximal impulse (PMI) normally located?
A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum
B) In the left 5th intercostal space, 10 to 12 cm lateral to the sternum
C) In the left 5th intercostal space, in the anterior axillary line
D) In the left 5th intercostal space, in the midaxillary line
A) In the left 5th intercostal space, 7 to 9 cm lateral to the sternum
Which of the following events occurs at the start of diastole?
A) Closure of the tricuspid valve
B) Opening of the pulmonic valve
C) Closure of the aortic valve
D) Production of the first heart sound (S1)
C) Closure of the aortic valve
It is thought that the closure of the aortic valve produces the second heart sound (S2). Closure of
the mitral valve is thought to produce the first heart sound (S1).
,Which is true of a third heart sound (S3)?
A) It marks atrial contraction.
B) It reflects normal compliance of the left ventricle.
C) It is caused by rapid deceleration of blood against the ventricular wall.
D) It is not heard in atrial fibrillation.
It is caused by rapid deceleration of blood against the ventricular wall.
Which is true of splitting of the second heart sound?
A) It is best heard over the pulmonic area with the bell of the stethoscope.
B) It normally increases with exhalation.
C) It is best heard over the apex.
D) It does not vary with respiration.
A) It is best heard over the pulmonic area with the bell of the stethoscope.
Which of the following is true of jugular venous pressure (JVP) measurement?
A) It is measured with the patient at a 45-degree angle.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
C) A JVP below 9 cm is abnormal.
D) It is measured above the sternal notch.
B) The vertical height of the blood column in centimeters, plus 5 cm, is the JVP.
How much does cardiovascular risk increase for each increment of 20 mm Hg systolic and
10 mm Hg diastolic in blood pressure?
A) 25%
B) 50%
C) 75%
D) 100%
D) 100%
Each increase of BP by 20 systolic and 10 diastolic doubles the risk of cardiovascular disease.
In healthy adults over 20, how often should blood pressure, body mass index, waist
circumference, and pulse be assessed, according to American Heart Association guidelines?
A) Every 6 months
B) Every year
C) Every 2 years
D) Every 5 years
,C) Every 2 years
Which of the following is a clinical identifier of metabolic syndrome?
A) Waist circumference of 38 inches for a male
B) Waist circumference of 34 inches for a female
C) BP of 134/88 for a male
D) BP of 128/84 for a female
C) BP of 134/88 for a male
The physical examination criteria for identifying metabolic syndrome include a waist of 40
inches or greater for a male, a waist of 35 inches or greater for a female, and a blood pressure of
130/85 or greater. Other criteria include triglycerides greater than or equal to 150 mg/dL, fasting
glucose greater than or equal to 110 mg/dL, and HDL less than 40 for men or less than 50 for
women.
Mrs. Adams would like to begin an exercise program and was told to exercise as intensely as
necessary to obtain a heart rate 60% or greater of her maximum heart rate. She is 52. What heart
rate should she achieve?
A) 80
B) 100
C) 120
D) 140
B) 100
Maximum heart rate is calculated by subtracting the patient's age from 220. For Mrs. Adams,
60% of this number is about 100. She must also be instructed in how to measure
her own pulse or have a device to do so.
In measuring the jugular venous pressure (JVP), which of the following is important?
A) Keep the patient's torso at a 45-degree angle.
B) Measure the highest visible pressure, usually at end expiration.
C) Add the vertical height over the sternal notch to a 5-cm constant.
D) Realize that a total value of over 12 cm is abnormal.
B) Measure the highest visible pressure, usually at end expiration.
You find a bounding carotid pulse on a 62-year-old patient. Which murmur should you
search out?
A) Mitral valve prolapse
B) Pulmonic stenosis
, C) Tricuspid insufficiency
D) Aortic insufficiency
D) Aortic insufficiency
To hear a soft murmur or bruit, which of the following may be necessary?
A) Asking the patient to hold her breath
B) Asking the patient in the next bed to turn down the TV
C) Checking your stethoscope for air leaks
D) All of the above
D) All of the above
Which of the following may be missed unless the patient is placed in the left lateral
decubitus position and auscultated with the bell?
A) Mitral stenosis murmur
B) Opening snap of the mitral valve
C) S3 and S4 gallops
D) All of the above
D) All of the above
How should you determine whether a murmur is systolic or diastolic?
A) Palpate the carotid pulse.
B) Palpate the radial pulse.
C) Judge the relative length of systole and diastole by auscultation.
D) Correlate the murmur with a bedside heart monitor.
A) Palpate the carotid pulse.
Which of the following correlates with a sustained, high-amplitude PMI?
A) Hyperthyroidism
B) Anemia
C) Fever
D) Hypertension
D) Hypertension
You are examining a patient with emphysema in exacerbation and are having difficulty hearing
his heart sounds. What should you do to obtain a good examination?
A) Listen in the epigastrium.
B) Listen to the patient in the left lateral decubitus position.
