NR509 — Week 8 Final Exam
Exam Review · Questions & Answers
QUESTION 78
A 42-year-old female is at 39-weeks gestation. She reports no major issues except
swelling in her feet and shortness of breath which she assumed is normal for
pregnancy. On exam, the NP notes a diastolic murmur. Which of the following is true
about her presentation and the appropriate next step by the NP?
■ A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required
at this time.
● B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted.
■ C. A fetal echocardiogram would confirm a diagnosis of heart failure in this patient; the NP
should order an echocardiogram.
■ D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has been
taking iron supplementation.
■ E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this patient's
differentials list.
✓ CORRECT ANSWER
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted.
Systolic murmurs are common and generally benign in pregnancy due to increased cardiac output.
However, diastolic murmurs are always considered pathological and require thorough evaluation. Combined
with dyspnea and edema, this presentation raises concern for structural heart disease or peripartum
cardiomyopathy. An adult echocardiogram (not fetal) would be appropriate. Cardiomyopathy is a real risk in
peripartum women and must remain on the differential.
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,QUESTION 68
Primary prevention is defined as which of the following?
● A. Interventions designed to prevent disease.
■ B. Interventions designed to prevent complications.
■ C. Interventions to find asymptomatic conditions.
■ D. Interventions including screening tests.
■ E. Interventions to find disease processes at an early stage.
✓ CORRECT ANSWER
A. Interventions designed to prevent disease.
Primary prevention aims to prevent disease before it occurs — examples include vaccines, health
education, and lifestyle modification. Secondary prevention involves early detection of disease (screening,
e.g. mammograms). Tertiary prevention focuses on reducing complications and disability in those already
diagnosed. Options B–E describe secondary or tertiary prevention strategies.
Source image
,
Exam Review · Questions & Answers
QUESTION 78
A 42-year-old female is at 39-weeks gestation. She reports no major issues except
swelling in her feet and shortness of breath which she assumed is normal for
pregnancy. On exam, the NP notes a diastolic murmur. Which of the following is true
about her presentation and the appropriate next step by the NP?
■ A. A diastolic murmur during pregnancy is known as a venous hum; no intervention is required
at this time.
● B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted.
■ C. A fetal echocardiogram would confirm a diagnosis of heart failure in this patient; the NP
should order an echocardiogram.
■ D. Diastolic murmurs during pregnancy may be due to anemia; confirm that the patient has been
taking iron supplementation.
■ E. Cardiomyopathy is very rare during and after pregnancy due to the protective effects of
estrogen and progesterone; the NP does not need to consider this diagnosis on this patient's
differentials list.
✓ CORRECT ANSWER
B. A diastolic murmur during pregnancy is likely pathological; further investigation and
work-up is warranted.
Systolic murmurs are common and generally benign in pregnancy due to increased cardiac output.
However, diastolic murmurs are always considered pathological and require thorough evaluation. Combined
with dyspnea and edema, this presentation raises concern for structural heart disease or peripartum
cardiomyopathy. An adult echocardiogram (not fetal) would be appropriate. Cardiomyopathy is a real risk in
peripartum women and must remain on the differential.
Source image
,QUESTION 68
Primary prevention is defined as which of the following?
● A. Interventions designed to prevent disease.
■ B. Interventions designed to prevent complications.
■ C. Interventions to find asymptomatic conditions.
■ D. Interventions including screening tests.
■ E. Interventions to find disease processes at an early stage.
✓ CORRECT ANSWER
A. Interventions designed to prevent disease.
Primary prevention aims to prevent disease before it occurs — examples include vaccines, health
education, and lifestyle modification. Secondary prevention involves early detection of disease (screening,
e.g. mammograms). Tertiary prevention focuses on reducing complications and disability in those already
diagnosed. Options B–E describe secondary or tertiary prevention strategies.
Source image
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