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NU 518 EXAM 2 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED SOLUTIONS) LATEST
UPDATED VERSION |ALREADY GRADED A+
1. A 70-year-old patient presents with bilateral ankle edema. During cardiovascular
assessment, the nurse practitioner observes jugular venous pulsations
approximately 5 cm above the sternal angle while the patient is positioned at a 45-
degree angle. Which interpretation is most appropriate?
A. The finding indicates decreased intravascular volume.
B. The finding is consistent with increased cardiac output.
C. The finding suggests obstruction of the carotid arteries.
D. The finding indicates elevated right-sided cardiac filling pressure.
Answer: D. The finding indicates elevated right-sided cardiac filling pressure.
Rationale: Elevated jugular venous pressure reflects increased right atrial pressure
and may occur with right-sided heart failure, volume overload, or other conditions
that increase systemic venous pressure. A markedly elevated JVP is not a finding
of dehydration.
2. During auscultation of the heart, the examiner identifies the first heart sound, S1.
Which physiological event most directly produces S1?
A. Closure of the aortic and pulmonic valves
B. Closure of the mitral and tricuspid valves
C. Rapid ventricular filling during early diastole
D. Opening of the semilunar valves
Answer: B. Closure of the mitral and tricuspid valves
Rationale: S1 is generated primarily by closure of the atrioventricular valves at the
beginning of ventricular systole. S2 is associated with closure of the aortic and
pulmonic valves.
3. A patient has a blowing holosystolic murmur best heard at the cardiac apex with
radiation toward the left axilla. Which valvular abnormality should the clinician
suspect first?
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A. Aortic stenosis
B. Pulmonic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
Answer: C. Mitral regurgitation
Rationale: Mitral regurgitation classically produces a high-pitched, blowing,
holosystolic murmur best heard at the apex and commonly radiating toward the left
axilla.
4. A patient with a history of hypertension reports exertional chest pressure and
syncope. Examination reveals a harsh crescendo-decrescendo systolic murmur that
is loudest at the right second intercostal space and radiates to the carotids. Which
diagnosis is most likely?
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a harsh systolic ejection murmur, typically
best heard at the right upper sternal border with radiation to the carotids. Exertional
angina, syncope, and dyspnea are classic associated symptoms.
5. While assessing a patient with suspected heart failure, the clinician asks the
patient to recline to approximately 45 degrees and evaluates the internal jugular
vein. Which observation most strongly supports elevated central venous pressure?
A. Jugular venous pulsation visible only at the base of the neck
B. Jugular venous pulsation extending several centimeters above the sternal angle
C. Absence of visible venous pulsation
D. A carotid pulsation that disappears with inspiration
Answer: B. Jugular venous pulsation extending several centimeters above the
sternal angle
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Rationale: Elevated JVP is an important bedside indicator of increased right atrial
pressure. Proper positioning and identification of venous rather than arterial
pulsation are essential.
6. During a peripheral vascular examination, a patient reports calf discomfort that
begins after walking several blocks and consistently resolves after stopping to rest.
Which condition is most strongly suggested?
A. Deep venous thrombosis
B. Intermittent claudication from peripheral arterial disease
C. Chronic venous insufficiency
D. Acute arterial embolism
Answer: B. Intermittent claudication from peripheral arterial disease
Rationale: Intermittent claudication is reproducible exertional muscle pain caused
by inadequate arterial blood flow and typically resolves with rest.
7. Which peripheral vascular finding would be most concerning for acute arterial
occlusion?
A. Warm skin with mild dependent edema
B. Bilateral brown pigmentation around the ankles
C. Sudden pain, pallor, pulselessness, paresthesia, and coolness of an extremity
D. Mild varicosities without pain
Answer: C. Sudden pain, pallor, pulselessness, paresthesia, and coolness of an
extremity
Rationale: Acute limb ischemia classically presents with the “6 Ps”: pain, pallor,
pulselessness, paresthesia, paralysis, and poikilothermia. This is a vascular
emergency requiring urgent evaluation.
8. A patient has bilateral lower-extremity edema that worsens throughout the day
and improves after elevation. The skin around the ankles is hyperpigmented and
thickened. Which diagnosis is most likely?
A. Chronic venous insufficiency
B. Acute arterial occlusion
C. Lymphedema caused by malignancy
D. Deep venous thrombosis
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Answer: A. Chronic venous insufficiency
Rationale: Chronic venous disease commonly causes dependent edema,
improvement with elevation, venous stasis pigmentation, skin thickening, and
sometimes venous ulcers.
9. During assessment of the carotid arteries, which technique is safest?
A. Palpate both carotid arteries simultaneously.
B. Compress the carotid artery firmly for several seconds.
C. Palpate one carotid artery at a time.
D. Ask the patient to perform a Valsalva maneuver while palpating.
Answer: C. Palpate one carotid artery at a time.
Rationale: Bilateral carotid compression can compromise cerebral blood flow and
potentially provoke syncope. The carotids should be assessed individually.
10. A clinician hears a low-pitched, rumbling diastolic murmur at the cardiac apex.
Which condition should be considered?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Pulmonic regurgitation
Answer: A. Mitral stenosis
Rationale: Mitral stenosis classically produces a low-frequency diastolic rumble
best heard at the apex, often with an opening snap.
11. A patient with a history of intravenous drug use presents with fever and a new
murmur. Which valve is particularly associated with infective endocarditis in
patients who inject drugs?
A. Mitral
B. Aortic
C. Tricuspid
D. Pulmonic
Answer: C. Tricuspid
NU 518 EXAM 2 COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED SOLUTIONS) LATEST
UPDATED VERSION |ALREADY GRADED A+
1. A 70-year-old patient presents with bilateral ankle edema. During cardiovascular
assessment, the nurse practitioner observes jugular venous pulsations
approximately 5 cm above the sternal angle while the patient is positioned at a 45-
degree angle. Which interpretation is most appropriate?
A. The finding indicates decreased intravascular volume.
B. The finding is consistent with increased cardiac output.
C. The finding suggests obstruction of the carotid arteries.
D. The finding indicates elevated right-sided cardiac filling pressure.
Answer: D. The finding indicates elevated right-sided cardiac filling pressure.
Rationale: Elevated jugular venous pressure reflects increased right atrial pressure
and may occur with right-sided heart failure, volume overload, or other conditions
that increase systemic venous pressure. A markedly elevated JVP is not a finding
of dehydration.
2. During auscultation of the heart, the examiner identifies the first heart sound, S1.
Which physiological event most directly produces S1?
A. Closure of the aortic and pulmonic valves
B. Closure of the mitral and tricuspid valves
C. Rapid ventricular filling during early diastole
D. Opening of the semilunar valves
Answer: B. Closure of the mitral and tricuspid valves
Rationale: S1 is generated primarily by closure of the atrioventricular valves at the
beginning of ventricular systole. S2 is associated with closure of the aortic and
pulmonic valves.
3. A patient has a blowing holosystolic murmur best heard at the cardiac apex with
radiation toward the left axilla. Which valvular abnormality should the clinician
suspect first?
,2|Page
A. Aortic stenosis
B. Pulmonic stenosis
C. Mitral regurgitation
D. Aortic regurgitation
Answer: C. Mitral regurgitation
Rationale: Mitral regurgitation classically produces a high-pitched, blowing,
holosystolic murmur best heard at the apex and commonly radiating toward the left
axilla.
4. A patient with a history of hypertension reports exertional chest pressure and
syncope. Examination reveals a harsh crescendo-decrescendo systolic murmur that
is loudest at the right second intercostal space and radiates to the carotids. Which
diagnosis is most likely?
A. Mitral stenosis
B. Aortic stenosis
C. Mitral regurgitation
D. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: Aortic stenosis produces a harsh systolic ejection murmur, typically
best heard at the right upper sternal border with radiation to the carotids. Exertional
angina, syncope, and dyspnea are classic associated symptoms.
5. While assessing a patient with suspected heart failure, the clinician asks the
patient to recline to approximately 45 degrees and evaluates the internal jugular
vein. Which observation most strongly supports elevated central venous pressure?
A. Jugular venous pulsation visible only at the base of the neck
B. Jugular venous pulsation extending several centimeters above the sternal angle
C. Absence of visible venous pulsation
D. A carotid pulsation that disappears with inspiration
Answer: B. Jugular venous pulsation extending several centimeters above the
sternal angle
,3|Page
Rationale: Elevated JVP is an important bedside indicator of increased right atrial
pressure. Proper positioning and identification of venous rather than arterial
pulsation are essential.
6. During a peripheral vascular examination, a patient reports calf discomfort that
begins after walking several blocks and consistently resolves after stopping to rest.
Which condition is most strongly suggested?
A. Deep venous thrombosis
B. Intermittent claudication from peripheral arterial disease
C. Chronic venous insufficiency
D. Acute arterial embolism
Answer: B. Intermittent claudication from peripheral arterial disease
Rationale: Intermittent claudication is reproducible exertional muscle pain caused
by inadequate arterial blood flow and typically resolves with rest.
7. Which peripheral vascular finding would be most concerning for acute arterial
occlusion?
A. Warm skin with mild dependent edema
B. Bilateral brown pigmentation around the ankles
C. Sudden pain, pallor, pulselessness, paresthesia, and coolness of an extremity
D. Mild varicosities without pain
Answer: C. Sudden pain, pallor, pulselessness, paresthesia, and coolness of an
extremity
Rationale: Acute limb ischemia classically presents with the “6 Ps”: pain, pallor,
pulselessness, paresthesia, paralysis, and poikilothermia. This is a vascular
emergency requiring urgent evaluation.
8. A patient has bilateral lower-extremity edema that worsens throughout the day
and improves after elevation. The skin around the ankles is hyperpigmented and
thickened. Which diagnosis is most likely?
A. Chronic venous insufficiency
B. Acute arterial occlusion
C. Lymphedema caused by malignancy
D. Deep venous thrombosis
, 4|Page
Answer: A. Chronic venous insufficiency
Rationale: Chronic venous disease commonly causes dependent edema,
improvement with elevation, venous stasis pigmentation, skin thickening, and
sometimes venous ulcers.
9. During assessment of the carotid arteries, which technique is safest?
A. Palpate both carotid arteries simultaneously.
B. Compress the carotid artery firmly for several seconds.
C. Palpate one carotid artery at a time.
D. Ask the patient to perform a Valsalva maneuver while palpating.
Answer: C. Palpate one carotid artery at a time.
Rationale: Bilateral carotid compression can compromise cerebral blood flow and
potentially provoke syncope. The carotids should be assessed individually.
10. A clinician hears a low-pitched, rumbling diastolic murmur at the cardiac apex.
Which condition should be considered?
A. Mitral stenosis
B. Aortic stenosis
C. Aortic regurgitation
D. Pulmonic regurgitation
Answer: A. Mitral stenosis
Rationale: Mitral stenosis classically produces a low-frequency diastolic rumble
best heard at the apex, often with an opening snap.
11. A patient with a history of intravenous drug use presents with fever and a new
murmur. Which valve is particularly associated with infective endocarditis in
patients who inject drugs?
A. Mitral
B. Aortic
C. Tricuspid
D. Pulmonic
Answer: C. Tricuspid
