UTICA COLLEGE NUR 621 Final Exam
Study Guide (2026/2027): Cardiovascular
Assessment
Table of Contents
1. Course Topic Overview
2. Multiple-Choice Questions (1–30)
3. Answer Key
4. Detailed Rationales
5. High-Yield Review Sheet
Course Topic Overview
Advanced Practice Nursing in cardiovascular assessment requires mastery of advanced
physical examination techniques, hemodynamic interpretation, electrophysiology, and structural
heart evaluation across the lifespan. Advanced Practice Nurses (APNs) must integrate historical
data, advanced imaging, and diagnostic biomarkers to differentiate complex cardiovascular
pathologies and guide evidence-based therapeutic interventions.
Definitions
● Heart Failure with Preserved Ejection Fraction (HFpEF): Heart failure syndrome
characterized by normal left ventricular ejection fraction (≥50%) accompanied by
diastolic dysfunction and elevated left ventricular filling pressures.
● Acute Coronary Syndrome (ACS): A spectrum of clinical conditions ranging from
unstable angina to non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation
myocardial infarction (STEMI) caused by acute myocardial ischemia.
● Infective Endocarditis (IE): Microbial infection of the endothelial surface of the heart,
most commonly affecting heart valves, resulting in vegetation formation and systemic
embolization.
Pathophysiology
● Atherosclerosis: Chronic inflammatory fibrofatty lesion development in medium and
large arteries driven by endothelial injury, low-density lipoprotein (LDL) accumulation,
and macrophage foam cell infiltration.
, ● Valvular Stenosis vs. Regurgitation: Stenosis creates fixed pressure overload through
narrowed orifice obstruction, whereas regurgitation induces volume overload via
incompetent valve closure.
● Diastolic Dysfunction: Impaired myocardial relaxation and increased ventricular
stiffness, preventing adequate ventricular filling during diastole despite preserved
systolic contraction.
Risk Factors
● Hypertension, dyslipidemia, diabetes mellitus, tobacco use, advanced age, family history
of premature coronary artery disease (CAD), obesity, and sedentary lifestyle.
● Rheumatic fever history, congenital heart disease, intravenous drug use, and prosthetic
heart valves (for endocarditis).
Clinical Manifestations
● Chest discomfort (pressure, tightness, radiation to jaw/left arm), dyspnea on exertion,
orthopnea, paroxysmal nocturnal dyspnea, palpitations, syncope, peripheral edema, and
fatigue.
● Systemic signs: Fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions,
Roth spots (in endocarditis).
Assessment Findings
● Elevated jugular venous pressure (JVP), hepatojugular reflux, displaced apical impulse
(cardiomegaly), paradoxical splitting of S2, pathological S3 (ventricular gallop) and S4
(atrial gallop) sounds, murmurs graded by intensity and timing, and peripheral pulses.
Differential Diagnoses
● Aortic dissection vs. Pulmonary embolism vs. Acute coronary syndrome vs. Esophageal
spasm.
● Heart failure vs. Chronic obstructive pulmonary disease (COPD) exacerbation vs.
Nephrotic syndrome.
● Hypertensive urgency vs. Hypertensive emergency.
Diagnostic Testing
● 12-lead electrocardiogram (ECG) and continuous ambulatory telemetry.
● Transthoracic echocardiogram (TTE) and Transesophageal echocardiogram (TEE).
● High-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP) or
NT-proBNP assays.
● Coronary angiography and cardiac magnetic resonance imaging (CMR).
, Evidence-Based Management
● Guideline-directed medical therapy (GDMT) for heart failure and ischemic heart disease.
● Modified Duke criteria utilization for infective endocarditis diagnosis.
● Primary and secondary cardiovascular risk reduction strategies utilizing risk calculators
(e.g., PCE/PREVENT equations).
Pharmacological Interventions
● Heart Failure (HFrEF): ARNI/ACEi/ARB, beta-blockers, mineralocorticoid receptor
antagonists (MRAs), and SGLT2 inhibitors (the "four pillars").
● ACS / Ischemia: Dual antiplatelet therapy (DAPT), high-intensity statins, anticoagulants,
beta-blockers, and nitrates.
● Hypertension: Thiazide diuretics, CCBs, ACEi/ARBs, and beta-blockers tailored to
compelling indications.
Non-Pharmacological Interventions
● Cardiac rehabilitation and structured aerobic exercise regimens.
● Dietary modifications (DASH diet, strict sodium restriction for heart failure).
● Surgical valve repair/replacement, percutaneous coronary intervention (PCI), and
coronary artery bypass graft (CABG) surgery.
Patient Education
● Daily weight monitoring and self-adjustment protocols for fluid overload signs.
● Recognition of atypical and typical ischemic equivalent symptoms.
● Medication adherence counseling and side effect management.
Follow-Up Care
● Serial echocardiographic surveillance of valvular gradients and ventricular remodeling.
● Post-ACS and post-PCI longitudinal risk factor optimization and lipid target management.
● Multidisciplinary heart failure clinic enrollment to prevent hospital readmissions.
Multiple-Choice Questions
1. A 62-year-old male presents with dyspnea on exertion and lower extremity edema.
Echocardiography demonstrates a left ventricular ejection fraction (LVEF) of 55%, a left
ventricular mass index elevated at 145 g/m², and an E/e' ratio of 16, indicating elevated
left ventricular filling pressures. Which diagnosis is most consistent with these findings?
A. Heart failure with reduced ejection fraction (HFrEF) B. Heart failure with preserved
ejection fraction (HFpEF) C. Acute decompensated cor pulmonale D. Non-obstructive
hypertrophic cardiomyopathy without diastolic dysfunction
Study Guide (2026/2027): Cardiovascular
Assessment
Table of Contents
1. Course Topic Overview
2. Multiple-Choice Questions (1–30)
3. Answer Key
4. Detailed Rationales
5. High-Yield Review Sheet
Course Topic Overview
Advanced Practice Nursing in cardiovascular assessment requires mastery of advanced
physical examination techniques, hemodynamic interpretation, electrophysiology, and structural
heart evaluation across the lifespan. Advanced Practice Nurses (APNs) must integrate historical
data, advanced imaging, and diagnostic biomarkers to differentiate complex cardiovascular
pathologies and guide evidence-based therapeutic interventions.
Definitions
● Heart Failure with Preserved Ejection Fraction (HFpEF): Heart failure syndrome
characterized by normal left ventricular ejection fraction (≥50%) accompanied by
diastolic dysfunction and elevated left ventricular filling pressures.
● Acute Coronary Syndrome (ACS): A spectrum of clinical conditions ranging from
unstable angina to non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation
myocardial infarction (STEMI) caused by acute myocardial ischemia.
● Infective Endocarditis (IE): Microbial infection of the endothelial surface of the heart,
most commonly affecting heart valves, resulting in vegetation formation and systemic
embolization.
Pathophysiology
● Atherosclerosis: Chronic inflammatory fibrofatty lesion development in medium and
large arteries driven by endothelial injury, low-density lipoprotein (LDL) accumulation,
and macrophage foam cell infiltration.
, ● Valvular Stenosis vs. Regurgitation: Stenosis creates fixed pressure overload through
narrowed orifice obstruction, whereas regurgitation induces volume overload via
incompetent valve closure.
● Diastolic Dysfunction: Impaired myocardial relaxation and increased ventricular
stiffness, preventing adequate ventricular filling during diastole despite preserved
systolic contraction.
Risk Factors
● Hypertension, dyslipidemia, diabetes mellitus, tobacco use, advanced age, family history
of premature coronary artery disease (CAD), obesity, and sedentary lifestyle.
● Rheumatic fever history, congenital heart disease, intravenous drug use, and prosthetic
heart valves (for endocarditis).
Clinical Manifestations
● Chest discomfort (pressure, tightness, radiation to jaw/left arm), dyspnea on exertion,
orthopnea, paroxysmal nocturnal dyspnea, palpitations, syncope, peripheral edema, and
fatigue.
● Systemic signs: Fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions,
Roth spots (in endocarditis).
Assessment Findings
● Elevated jugular venous pressure (JVP), hepatojugular reflux, displaced apical impulse
(cardiomegaly), paradoxical splitting of S2, pathological S3 (ventricular gallop) and S4
(atrial gallop) sounds, murmurs graded by intensity and timing, and peripheral pulses.
Differential Diagnoses
● Aortic dissection vs. Pulmonary embolism vs. Acute coronary syndrome vs. Esophageal
spasm.
● Heart failure vs. Chronic obstructive pulmonary disease (COPD) exacerbation vs.
Nephrotic syndrome.
● Hypertensive urgency vs. Hypertensive emergency.
Diagnostic Testing
● 12-lead electrocardiogram (ECG) and continuous ambulatory telemetry.
● Transthoracic echocardiogram (TTE) and Transesophageal echocardiogram (TEE).
● High-sensitivity cardiac troponin (hs-cTn) and B-type natriuretic peptide (BNP) or
NT-proBNP assays.
● Coronary angiography and cardiac magnetic resonance imaging (CMR).
, Evidence-Based Management
● Guideline-directed medical therapy (GDMT) for heart failure and ischemic heart disease.
● Modified Duke criteria utilization for infective endocarditis diagnosis.
● Primary and secondary cardiovascular risk reduction strategies utilizing risk calculators
(e.g., PCE/PREVENT equations).
Pharmacological Interventions
● Heart Failure (HFrEF): ARNI/ACEi/ARB, beta-blockers, mineralocorticoid receptor
antagonists (MRAs), and SGLT2 inhibitors (the "four pillars").
● ACS / Ischemia: Dual antiplatelet therapy (DAPT), high-intensity statins, anticoagulants,
beta-blockers, and nitrates.
● Hypertension: Thiazide diuretics, CCBs, ACEi/ARBs, and beta-blockers tailored to
compelling indications.
Non-Pharmacological Interventions
● Cardiac rehabilitation and structured aerobic exercise regimens.
● Dietary modifications (DASH diet, strict sodium restriction for heart failure).
● Surgical valve repair/replacement, percutaneous coronary intervention (PCI), and
coronary artery bypass graft (CABG) surgery.
Patient Education
● Daily weight monitoring and self-adjustment protocols for fluid overload signs.
● Recognition of atypical and typical ischemic equivalent symptoms.
● Medication adherence counseling and side effect management.
Follow-Up Care
● Serial echocardiographic surveillance of valvular gradients and ventricular remodeling.
● Post-ACS and post-PCI longitudinal risk factor optimization and lipid target management.
● Multidisciplinary heart failure clinic enrollment to prevent hospital readmissions.
Multiple-Choice Questions
1. A 62-year-old male presents with dyspnea on exertion and lower extremity edema.
Echocardiography demonstrates a left ventricular ejection fraction (LVEF) of 55%, a left
ventricular mass index elevated at 145 g/m², and an E/e' ratio of 16, indicating elevated
left ventricular filling pressures. Which diagnosis is most consistent with these findings?
A. Heart failure with reduced ejection fraction (HFrEF) B. Heart failure with preserved
ejection fraction (HFpEF) C. Acute decompensated cor pulmonale D. Non-obstructive
hypertrophic cardiomyopathy without diastolic dysfunction
