NR 667 Cardiac and Respiratory
Assessments | Full Questions and Answers |
2026/2027 Updated | 100% Correct -
Chamberlain College of Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates graduate-level advanced practice assessment of the cardiac and respiratory systems,
emphasizing evidence-based interpretation of physical findings, diagnostics, and hemodynamic data. Items
span inspection, palpation, percussion, auscultation, imaging, ECG, pulmonary function, and vascular
assessment using current clinical standards.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 80%.
HIGHP - Page 1 of 47
,1. A patient's ECG shows an irregularly irregular rhythm with absent P waves and a
ventricular rate of 150 bpm. Which assessment finding is most consistent with this
rhythm?
[ ] A. Bounding peripheral pulses with widened pulse pressure
[ ] B. Pulse deficit between apical and radial rates
[ ] C. Fixed splitting of the second heart sound
[ ] D. Pulsus paradoxus greater than 10 mm Hg
CORRECT: B. Pulse deficit between apical and radial rates
The rhythm described is atrial fibrillation, which commonly produces a pulse deficit because not all ventricular
contractions generate a palpable peripheral pulse. Bounding pulses with widened pulse pressure suggest
hyperdynamic states, fixed S2 splitting indicates ASD, and pulsus paradoxus is associated with tamponade
or severe asthma.
2. Which spirometry pattern best characterizes a patient with a history of smoking,
chronic productive cough, and a post-bronchodilator FEV1/FVC ratio of 0.62?
[ ] A. Restrictive pattern with reduced total lung capacity
[ ] B. Obstructive pattern with air trapping
[ ] C. Normal spirometry with isolated diffusion defect
[ ] D. Mixed pattern with normal residual volume
CORRECT: B. Obstructive pattern with air trapping
A post-bronchodilator FEV1/FVC below 0.70 confirms persistent airflow obstruction consistent with COPD.
Restrictive disease preserves or raises the ratio, isolated diffusion defects do not reduce the ratio, and a
mixed pattern requires coexisting restriction not supported here.
3. During auscultation, a harsh holosystolic murmur is heard best at the apex and radiates
to the axilla. Which maneuver would most likely intensify this murmur?
[ ] A. Valsalva strain phase
[ ] B. Isometric handgrip
[ ] C. Standing abruptly from squatting
[ ] D. Inspiration during held expiration
CORRECT: B. Isometric handgrip
The murmur described is mitral regurgitation, which is intensified by increased afterload such as isometric
handgrip. Valsalva strain and standing reduce preload and diminish most murmurs, and inspiration increases
right-sided murmurs rather than mitral regurgitation.
HIGHP - Page 2 of 47
,4. A patient with suspected pulmonary embolism has a Wells score of 6. Which diagnostic
approach is most appropriate according to current guidelines?
[ ] A. D-dimer alone to rule out embolism
[ ] B. Immediate CT pulmonary angiography
[ ] C. Serial troponin monitoring
[ ] D. Observation with repeat assessment in 24 hours
CORRECT: B. Immediate CT pulmonary angiography
A Wells score above 4 indicates high pretest probability, so guidelines recommend proceeding directly to CT
pulmonary angiography rather than D-dimer, which has poor negative predictive value in high-probability
patients. Troponin and observation do not confirm or exclude PE.
5. Which jugular venous waveform finding is most consistent with complete heart block?
[ ] A. Prominent v wave
[ ] B. Cannon a waves
[ ] C. Absent x descent
[ ] D. Elevated mean JVP with Kussmaul sign
CORRECT: B. Cannon a waves
Cannon a waves occur when the right atrium contracts against a closed tricuspid valve, as seen in complete
heart block with atrioventricular dissociation. A prominent v wave suggests tricuspid regurgitation, absent x
descent occurs in AF, and Kussmaul sign relates to constrictive pericarditis.
6. A patient's chest radiograph shows tracheal deviation toward the affected side with
increased opacity and volume loss. This pattern most suggests:
[ ] A. Tension pneumothorax
[ ] B. Large pleural effusion
[ ] C. Atelectasis with lobar collapse
[ ] D. Massive pulmonary embolism
CORRECT: C. Atelectasis with lobar collapse
Tracheal deviation toward the opacified side with volume loss indicates atelectasis. Tension pneumothorax
and large effusion push the trachea away from the lesion, and pulmonary embolism typically produces no
such focal volume loss.
7. Which auscultatory finding is most characteristic of severe aortic stenosis?
[ ] A. Mid-diastolic rumble at the apex
[ ] B. Crescendo-decrescendo systolic murmur radiating to the carotids
[ ] C. Holosystolic murmur at the left lower sternal border
[ ] D. Early diastolic decrescendo murmur at the left upper sternal border
HIGHP - Page 3 of 47
, CORRECT: B. Crescendo-decrescendo systolic murmur radiating to the carotids
Aortic stenosis produces a crescendo-decrescendo systolic murmur that radiates to the carotids.
Mid-diastolic apical rumble indicates mitral stenosis, holosystolic LLSB murmur suggests tricuspid
regurgitation or VSD, and early diastolic decrescendo murmur indicates aortic regurgitation.
8. Which arterial blood gas finding is most consistent with acute respiratory distress
syndrome (ARDS)?
[ ] A. PaO2/FiO2 ratio of 250 with bilateral infiltrates
[ ] B. PaO2/FiO2 ratio of 450 with clear lungs
[ ] C. Respiratory alkalosis with normal chest imaging
[ ] D. Elevated PaCO2 with unilateral consolidation
CORRECT: A. PaO2/FiO2 ratio of 250 with bilateral infiltrates
ARDS is defined by acute onset, bilateral infiltrates, and a PaO2/FiO2 ratio below 300. A ratio above 400 with
clear lungs is normal, normal imaging excludes ARDS, and unilateral consolidation suggests pneumonia or
atelectasis rather than diffuse ARDS.
9. Which physical examination finding is most specific for right ventricular failure?
[ ] A. S3 gallop at the apex
[ ] B. Elevated jugular venous pressure with hepatojugular reflux
[ ] C. Bibasilar crackles
[ ] D. Displaced apical impulse
CORRECT: B. Elevated jugular venous pressure with hepatojugular reflux
Elevated JVP with hepatojugular reflux reflects increased right atrial pressure and is specific for right
ventricular failure. S3 gallop and displaced apical impulse indicate left ventricular dysfunction, and bibasilar
crackles suggest left-sided failure or pulmonary congestion.
10. A patient with a history of asthma reports nocturnal wheezing and cough. Which
assessment finding best supports poor asthma control?
[ ] A. FEV1 greater than 80% predicted
[ ] B. Peak expiratory flow variability greater than 20%
[ ] C. Normal oxygen saturation at rest
[ ] D. Absence of wheezing on auscultation
CORRECT: B. Peak expiratory flow variability greater than 20%
Increased peak expiratory flow variability indicates unstable airway obstruction and poor asthma control. A
normal FEV1, normal oxygen saturation, and absent wheezing do not exclude poor control, as symptoms
may be intermittent or silent.
HIGHP - Page 4 of 47
Assessments | Full Questions and Answers |
2026/2027 Updated | 100% Correct -
Chamberlain College of Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
148 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This exam evaluates graduate-level advanced practice assessment of the cardiac and respiratory systems,
emphasizing evidence-based interpretation of physical findings, diagnostics, and hemodynamic data. Items
span inspection, palpation, percussion, auscultation, imaging, ECG, pulmonary function, and vascular
assessment using current clinical standards.
STUDY GUIDE
Recommended duration: 2.5 hours. Passing target: 80%.
HIGHP - Page 1 of 47
,1. A patient's ECG shows an irregularly irregular rhythm with absent P waves and a
ventricular rate of 150 bpm. Which assessment finding is most consistent with this
rhythm?
[ ] A. Bounding peripheral pulses with widened pulse pressure
[ ] B. Pulse deficit between apical and radial rates
[ ] C. Fixed splitting of the second heart sound
[ ] D. Pulsus paradoxus greater than 10 mm Hg
CORRECT: B. Pulse deficit between apical and radial rates
The rhythm described is atrial fibrillation, which commonly produces a pulse deficit because not all ventricular
contractions generate a palpable peripheral pulse. Bounding pulses with widened pulse pressure suggest
hyperdynamic states, fixed S2 splitting indicates ASD, and pulsus paradoxus is associated with tamponade
or severe asthma.
2. Which spirometry pattern best characterizes a patient with a history of smoking,
chronic productive cough, and a post-bronchodilator FEV1/FVC ratio of 0.62?
[ ] A. Restrictive pattern with reduced total lung capacity
[ ] B. Obstructive pattern with air trapping
[ ] C. Normal spirometry with isolated diffusion defect
[ ] D. Mixed pattern with normal residual volume
CORRECT: B. Obstructive pattern with air trapping
A post-bronchodilator FEV1/FVC below 0.70 confirms persistent airflow obstruction consistent with COPD.
Restrictive disease preserves or raises the ratio, isolated diffusion defects do not reduce the ratio, and a
mixed pattern requires coexisting restriction not supported here.
3. During auscultation, a harsh holosystolic murmur is heard best at the apex and radiates
to the axilla. Which maneuver would most likely intensify this murmur?
[ ] A. Valsalva strain phase
[ ] B. Isometric handgrip
[ ] C. Standing abruptly from squatting
[ ] D. Inspiration during held expiration
CORRECT: B. Isometric handgrip
The murmur described is mitral regurgitation, which is intensified by increased afterload such as isometric
handgrip. Valsalva strain and standing reduce preload and diminish most murmurs, and inspiration increases
right-sided murmurs rather than mitral regurgitation.
HIGHP - Page 2 of 47
,4. A patient with suspected pulmonary embolism has a Wells score of 6. Which diagnostic
approach is most appropriate according to current guidelines?
[ ] A. D-dimer alone to rule out embolism
[ ] B. Immediate CT pulmonary angiography
[ ] C. Serial troponin monitoring
[ ] D. Observation with repeat assessment in 24 hours
CORRECT: B. Immediate CT pulmonary angiography
A Wells score above 4 indicates high pretest probability, so guidelines recommend proceeding directly to CT
pulmonary angiography rather than D-dimer, which has poor negative predictive value in high-probability
patients. Troponin and observation do not confirm or exclude PE.
5. Which jugular venous waveform finding is most consistent with complete heart block?
[ ] A. Prominent v wave
[ ] B. Cannon a waves
[ ] C. Absent x descent
[ ] D. Elevated mean JVP with Kussmaul sign
CORRECT: B. Cannon a waves
Cannon a waves occur when the right atrium contracts against a closed tricuspid valve, as seen in complete
heart block with atrioventricular dissociation. A prominent v wave suggests tricuspid regurgitation, absent x
descent occurs in AF, and Kussmaul sign relates to constrictive pericarditis.
6. A patient's chest radiograph shows tracheal deviation toward the affected side with
increased opacity and volume loss. This pattern most suggests:
[ ] A. Tension pneumothorax
[ ] B. Large pleural effusion
[ ] C. Atelectasis with lobar collapse
[ ] D. Massive pulmonary embolism
CORRECT: C. Atelectasis with lobar collapse
Tracheal deviation toward the opacified side with volume loss indicates atelectasis. Tension pneumothorax
and large effusion push the trachea away from the lesion, and pulmonary embolism typically produces no
such focal volume loss.
7. Which auscultatory finding is most characteristic of severe aortic stenosis?
[ ] A. Mid-diastolic rumble at the apex
[ ] B. Crescendo-decrescendo systolic murmur radiating to the carotids
[ ] C. Holosystolic murmur at the left lower sternal border
[ ] D. Early diastolic decrescendo murmur at the left upper sternal border
HIGHP - Page 3 of 47
, CORRECT: B. Crescendo-decrescendo systolic murmur radiating to the carotids
Aortic stenosis produces a crescendo-decrescendo systolic murmur that radiates to the carotids.
Mid-diastolic apical rumble indicates mitral stenosis, holosystolic LLSB murmur suggests tricuspid
regurgitation or VSD, and early diastolic decrescendo murmur indicates aortic regurgitation.
8. Which arterial blood gas finding is most consistent with acute respiratory distress
syndrome (ARDS)?
[ ] A. PaO2/FiO2 ratio of 250 with bilateral infiltrates
[ ] B. PaO2/FiO2 ratio of 450 with clear lungs
[ ] C. Respiratory alkalosis with normal chest imaging
[ ] D. Elevated PaCO2 with unilateral consolidation
CORRECT: A. PaO2/FiO2 ratio of 250 with bilateral infiltrates
ARDS is defined by acute onset, bilateral infiltrates, and a PaO2/FiO2 ratio below 300. A ratio above 400 with
clear lungs is normal, normal imaging excludes ARDS, and unilateral consolidation suggests pneumonia or
atelectasis rather than diffuse ARDS.
9. Which physical examination finding is most specific for right ventricular failure?
[ ] A. S3 gallop at the apex
[ ] B. Elevated jugular venous pressure with hepatojugular reflux
[ ] C. Bibasilar crackles
[ ] D. Displaced apical impulse
CORRECT: B. Elevated jugular venous pressure with hepatojugular reflux
Elevated JVP with hepatojugular reflux reflects increased right atrial pressure and is specific for right
ventricular failure. S3 gallop and displaced apical impulse indicate left ventricular dysfunction, and bibasilar
crackles suggest left-sided failure or pulmonary congestion.
10. A patient with a history of asthma reports nocturnal wheezing and cough. Which
assessment finding best supports poor asthma control?
[ ] A. FEV1 greater than 80% predicted
[ ] B. Peak expiratory flow variability greater than 20%
[ ] C. Normal oxygen saturation at rest
[ ] D. Absence of wheezing on auscultation
CORRECT: B. Peak expiratory flow variability greater than 20%
Increased peak expiratory flow variability indicates unstable airway obstruction and poor asthma control. A
normal FEV1, normal oxygen saturation, and absent wheezing do not exclude poor control, as symptoms
may be intermittent or silent.
HIGHP - Page 4 of 47
