NR509 Exam Questions with 100% Correct
Answers
A 65-year-old man is admitted to the Cardiac Intensive Care Unit with decompensated
heart failure. On physical examination, the patient is cool to touch, heart sounds are
regular in rate and rhythm, the neck veins are elevated 8 cm above the sternal angle,
diffuse crackles are heard in the lungs, and there is 2+ pitting edema to the knee. What
would you expect with palpation of the peripheral pulses?
The answer is small, weak pulses. This patient is presenting with decompensated heart failure
and has increased peripheral resistance as evidenced by being cool to touch. Small, weak
pulses are often indicative of increased peripheral resistance in severe heart failure.
A first-year medical student is examining a standardized patient. The patient has a
murmur that coincides with the carotid upstroke. What is the most likely cause of this
murmur?
The answer is aortic stenosis.. Palpation of the carotid artery is helpful to differentiate S1
from S2. As the carotid upstroke always occurs in systole immediately after S1, sounds or
murmurs coinciding with the upstroke are systolic and sounds or murmurs occurring after
completion of the upstroke are diastolic. In this case, the murmur occurs with the carotid
upstroke and is therefore systolic.
diastolic murmurs
Aortic insufficiency, mitral stenosis, tricuspid stenosis, and pulmonic regurgitation
A first-year medical student recently received his stethoscope and is utilizing only the
diaphragm for cardiac auscultation. Which of the following sounds is this student most
likely to miss?
, The answer is mitral stenosis. The bell of the stethoscope is more sensitive in auscultating
low-pitched sounds such as mitral stenosis
The diaphragm is better at discerning
high-pitched sounds such as S1, aortic regurgitation, and mitral regurgitation, and pericardial
friction rubs.
A 42-year-old woman with an enlarged ascending aorta is undergoing a preoperative
physical examination. On examination, blood pressure is 130/40 mmHg and there is a
blowing, decrescendo diastolic murmur heard best at the left second interspace. Which
of the following would be the expected finding with the carotid pulse?
The answer is large, bounding. Patients with an enlarged ascending aorta often also have
aortic insufficiency. This patient has physical examination findings associated with aortic
insufficiency including a widened pulse pressure and cardiac murmur. Given the widened
pulse pressure, the carotid pulse is described as large and bounding.
A small, weak pulse
may be found in heart failure, hypovolemia, or aortic stenosis
Pulsus alternans is often seen in
left ventricular failure.
bigeminal pulse is the result of
a rhythm disturbance with a normal beat alternating with a premature contraction.
Paradoxical pulses may be found
in pericardial tamponade, asthma, and chronic obstructive pulmonary disease exacerbations,
or constrictive pericarditis.
Answers
A 65-year-old man is admitted to the Cardiac Intensive Care Unit with decompensated
heart failure. On physical examination, the patient is cool to touch, heart sounds are
regular in rate and rhythm, the neck veins are elevated 8 cm above the sternal angle,
diffuse crackles are heard in the lungs, and there is 2+ pitting edema to the knee. What
would you expect with palpation of the peripheral pulses?
The answer is small, weak pulses. This patient is presenting with decompensated heart failure
and has increased peripheral resistance as evidenced by being cool to touch. Small, weak
pulses are often indicative of increased peripheral resistance in severe heart failure.
A first-year medical student is examining a standardized patient. The patient has a
murmur that coincides with the carotid upstroke. What is the most likely cause of this
murmur?
The answer is aortic stenosis.. Palpation of the carotid artery is helpful to differentiate S1
from S2. As the carotid upstroke always occurs in systole immediately after S1, sounds or
murmurs coinciding with the upstroke are systolic and sounds or murmurs occurring after
completion of the upstroke are diastolic. In this case, the murmur occurs with the carotid
upstroke and is therefore systolic.
diastolic murmurs
Aortic insufficiency, mitral stenosis, tricuspid stenosis, and pulmonic regurgitation
A first-year medical student recently received his stethoscope and is utilizing only the
diaphragm for cardiac auscultation. Which of the following sounds is this student most
likely to miss?
, The answer is mitral stenosis. The bell of the stethoscope is more sensitive in auscultating
low-pitched sounds such as mitral stenosis
The diaphragm is better at discerning
high-pitched sounds such as S1, aortic regurgitation, and mitral regurgitation, and pericardial
friction rubs.
A 42-year-old woman with an enlarged ascending aorta is undergoing a preoperative
physical examination. On examination, blood pressure is 130/40 mmHg and there is a
blowing, decrescendo diastolic murmur heard best at the left second interspace. Which
of the following would be the expected finding with the carotid pulse?
The answer is large, bounding. Patients with an enlarged ascending aorta often also have
aortic insufficiency. This patient has physical examination findings associated with aortic
insufficiency including a widened pulse pressure and cardiac murmur. Given the widened
pulse pressure, the carotid pulse is described as large and bounding.
A small, weak pulse
may be found in heart failure, hypovolemia, or aortic stenosis
Pulsus alternans is often seen in
left ventricular failure.
bigeminal pulse is the result of
a rhythm disturbance with a normal beat alternating with a premature contraction.
Paradoxical pulses may be found
in pericardial tamponade, asthma, and chronic obstructive pulmonary disease exacerbations,
or constrictive pericarditis.
