10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
NURS 6512 Final Exam Review (Week 7-11)
Heart, Lungs, and Peripheral Vascular
Examination techniques of the Heart, Lungs, and PV systems
Examination findings of arterial blood flow in infants
o pH 7.35 - 7.45
o PaCO2 5 - 45 mm Hg
o PaO250 - 70 mm Hg (term infant)
o 45 - 65 mm Hg (preterm infant)
o HCO3 22 - 26 mEq/liter
o Base Excess -2 - + 2 mEq/liter
o O2 saturation 92 - 94 %
Examination findings of the heart and lungs in a patient with illegal
drug use
o Cocaine and meth: 30-35% increase in aortic stiffening, 8mm
Hg higher systolic blood pressure, 18% greater thickeness of
heart’s left ventricle wall. Increased risk of cardiomyopathy,
aortic dissection, endocarditis, and MI.
o Cocaine: increased risk of focal air space disease, atelectasis,
pneumothorax, pneumomediastinum, pulmonary edema,
“pocket shot” (IV drug users who develop abscesses in major
neck veins of jugular, subclavian, or brachiocephalic veins by
injecting in supraclavicular fossa after having superficial arm
and leg veins getting thrombosed due to frequent IV drug use)
o Interstitial pneumonitides, noncardiac pulmonary edema,
pulmonary infiltrates, eosinophilic pneumonia, cryptogenic
organizing pneumonia, diffuse alveolar damage, pulmonary
hemorrhage, granulomatous pneumonitis, pulmonary fibrosis,
pulmonary nodules), pleural effusion, drug-induced lupus,
pleural thickening, pneumothorax, ovarian hyperstimulation
syndrome, bronchospasm, asthma, cough, hoarseness,
calcification of cartilaginous rings, pulm htn, hemoptysis, central
respiratory depression
Description of types of shortness of breath (orthopnea, platypnea.
Tachypnea, bradypnea)
© 2019 Walden University Page 1 of 32
o Orthopnea: unable to breathe well laying flat, patients need to
sit or stand
o Platypnea: shortness of breath worse by standing or sitting,
improves when flat.
o Tachyapnea: more than 20 RR/min
o Bradypnea: less than 12 RR/min
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,10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 1 of 32
o Orthopnea: unable to breathe well laying flat, patients need to
sit or stand
o Platypnea: shortness of breath worse by standing or sitting,
improves when flat.
o Tachyapnea: more than 20 RR/min
o Bradypnea: less than 12 RR/min
Symptoms associated with intrathoracic infection
o Tenderness, swelling, difficulty taking a deep breath, pain in
shoulders or back, headaches, joint pain, dry cough, fever
Percussion techniques when examining the lungs
Examination findings when percussing the lungs
o resonant, normal; dull over solid organ OR pleural effusion,
presence of hepatic tissue, pleural thickening, hyperresonant in
pneumothorax or COPD, hyperinflated lung tissue, air in pleural
space
Cardiac examination findings for a patient with rheumatic fever
o Inflammation of heart, rapid heart rate, fatigue, shortness of
breath, exercise intolerance, fever in 90% of patients, arthritis in
75% of patients, partial AV block, chorea (jerky uncontrolled
body movements), symptoms of CHF, valvular damage (usually
mitral, sometimes combined with aortic valve)
Grading of heart murmurs
o Grade 1: very faint, not heart in all positions, no thrill
o Grade 2: soft, heart in all positions, no thrill
o Grade 3: moderately loud, no thrill
o Grade 4: loud and associated with a palpable thrill
o Grade 5: very loud with thrill, heart with stethoscope partly off
the chest
o Grade 6: loudest, with thrill, heart with stethoscope off chest
entirely
Evaluation of ECG tracings
o P-wave: atrial depolarization
© 2019 Walden University Page 2 of 32
o QRS: ventricular depolarization
o T-wave: ventricular repolarization
o Lateral wall, leads I, AVL, V5, V6 (st elevation)
o Inferior wall leads, II, III, AVF (twave inversion, ST elevation)-
RCA and posterior descending branch
o Posterior wall, V1-V4, tall R waves, ST depression, upright T
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,10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 2 of 32
o QRS: ventricular depolarization
o T-wave: ventricular repolarization
o Lateral wall, leads I, AVL, V5, V6 (st elevation)
o Inferior wall leads, II, III, AVF (twave inversion, ST elevation)-
RCA and posterior descending branch
o Posterior wall, V1-V4, tall R waves, ST depression, upright T
waves – LCA, LCX, RCA, posterior descending branch
o Septal wall, leads V1 and V2, r wave disappears, ST elevation,
T wave inversion
o Anterior wall, V2-V4, poor R-wave progression, ST segment
elevation, t wave inversion – LAD and DX
Examination technique for the apical pulse
ABI: right ABI higher right-ankle pressure over higher arm pressure,
left ABI higher left-ankle pressure over higher arm pressure, greater
than 1.4 calcification and vessel hardening, 1.0-1.4 normal, 0.9-1.0
borderline, 0.8-0.9 some arterial disease, 0.5-0.8 moderate arterial
disease, less than 0.5 severe arterial disease.
Examining technique for different cardiac sounds and their names
o Normal diameter of aorta less than 3 cm
o AORTIC (right 2nd ICS), PULMONIC (left 2nd ICS), ERB (left 3rd
ICS), TRICUSPID (lower left sternal border), MITRAL (left 5 th
ICS)
o S3 linked with blood flow into ventricles, S4 linked with atrial
contraction
o Mitral murmur best heard at apex and radiate to axilla with
patient in left lateral position
o Mitral regurg pansystolic murmur even in sound through systole
o Mitral insufficiency: loudest at apex, 5th ICS, high pitched
blowing sound
o Mitral stenosis, diastolic murmur (presystolic) heard
immediately before S1
o Mitral valve prolapse is a click mid-systolic
© 2019 Walden University Page 3 of 32
o Austin Flint’s murmur for aortic regurg- soft rumbling low-
pitched late-diastolic murmur best heard at apex
o Tricuspid stenosis/murmurs: best heard left lower sternal edge,
heard in RVH
o Tricuspid insufficiency: backflow of blood, diaphragm at 5th ics
at sternal border, radiates to left anterior sternal line
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, 10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 3 of 32
o Austin Flint’s murmur for aortic regurg- soft rumbling low-
pitched late-diastolic murmur best heard at apex
o Tricuspid stenosis/murmurs: best heard left lower sternal edge,
heard in RVH
o Tricuspid insufficiency: backflow of blood, diaphragm at 5th ics
at sternal border, radiates to left anterior sternal line
o Pulmonary stenosis gets louder then softer (crescendo-
decrescendo) during systole, pulmonary ejection sounds
diminish or disappear in inspiration, while aortic ones do not. In
AORTIC stenosis same sound only it transmits to the carotids.
o Aortic stenosis A2 is soft. Aortic sclerosis A2 is loud or normal.
Pressure/gradient thru smaller valve, increased pumping
pressure of left ventricle
o Pulmonary regurgitation and aortic regurg have early diastolic
murmur
o Atrial septal defect: pulmonary flow murmur
o Ventricular septal defect: harsh systolic murmur best heard on
left sternal edge. (ex. Fallot’s tetraology)
o Aortic aneurysm (ex marfan) flow murmurs
o Patent ductus arteriosus: late systolic murmur into diastolic,
best heard on the back (ex. Continuous machinery murmur/to-
and-fro murmur in both systolic and diastole, louder in systole).
o Pericarditis: sounds like boots tramping through snow, heard
best left sternal edge
o Prosthetic valves loud sound heard across quiet room.
o Murmurs in kids grade 3 or less common, typically resolve with
age
Varicosity findings in pregnant women
o Heavy feelings in legs, itching in veins, leg cramps, pain aching
or tenderness in lower legs, swelling in legs and feet
Examination of peripheral arteries
Epigastric and renal bruits heard with diaphragm of steth
© 2019 Walden University Page 4 of 32
Aortic, iliac, and femoral bruits heard with bell of steth
Grading of pulses
o 0-nonpalpable, 1-barely detectable, 2-slightly diminished, 3-
normal pulse and palpable, 4-bounding.
Examination findings of a child with Kawasaki disease
o Fever, rash, swelling of hands and feet, irritation and redness of
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NURS 6512 Final Exam Review (Week 7-11)
Heart, Lungs, and Peripheral Vascular
Examination techniques of the Heart, Lungs, and PV systems
Examination findings of arterial blood flow in infants
o pH 7.35 - 7.45
o PaCO2 5 - 45 mm Hg
o PaO250 - 70 mm Hg (term infant)
o 45 - 65 mm Hg (preterm infant)
o HCO3 22 - 26 mEq/liter
o Base Excess -2 - + 2 mEq/liter
o O2 saturation 92 - 94 %
Examination findings of the heart and lungs in a patient with illegal
drug use
o Cocaine and meth: 30-35% increase in aortic stiffening, 8mm
Hg higher systolic blood pressure, 18% greater thickeness of
heart’s left ventricle wall. Increased risk of cardiomyopathy,
aortic dissection, endocarditis, and MI.
o Cocaine: increased risk of focal air space disease, atelectasis,
pneumothorax, pneumomediastinum, pulmonary edema,
“pocket shot” (IV drug users who develop abscesses in major
neck veins of jugular, subclavian, or brachiocephalic veins by
injecting in supraclavicular fossa after having superficial arm
and leg veins getting thrombosed due to frequent IV drug use)
o Interstitial pneumonitides, noncardiac pulmonary edema,
pulmonary infiltrates, eosinophilic pneumonia, cryptogenic
organizing pneumonia, diffuse alveolar damage, pulmonary
hemorrhage, granulomatous pneumonitis, pulmonary fibrosis,
pulmonary nodules), pleural effusion, drug-induced lupus,
pleural thickening, pneumothorax, ovarian hyperstimulation
syndrome, bronchospasm, asthma, cough, hoarseness,
calcification of cartilaginous rings, pulm htn, hemoptysis, central
respiratory depression
Description of types of shortness of breath (orthopnea, platypnea.
Tachypnea, bradypnea)
© 2019 Walden University Page 1 of 32
o Orthopnea: unable to breathe well laying flat, patients need to
sit or stand
o Platypnea: shortness of breath worse by standing or sitting,
improves when flat.
o Tachyapnea: more than 20 RR/min
o Bradypnea: less than 12 RR/min
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,10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 1 of 32
o Orthopnea: unable to breathe well laying flat, patients need to
sit or stand
o Platypnea: shortness of breath worse by standing or sitting,
improves when flat.
o Tachyapnea: more than 20 RR/min
o Bradypnea: less than 12 RR/min
Symptoms associated with intrathoracic infection
o Tenderness, swelling, difficulty taking a deep breath, pain in
shoulders or back, headaches, joint pain, dry cough, fever
Percussion techniques when examining the lungs
Examination findings when percussing the lungs
o resonant, normal; dull over solid organ OR pleural effusion,
presence of hepatic tissue, pleural thickening, hyperresonant in
pneumothorax or COPD, hyperinflated lung tissue, air in pleural
space
Cardiac examination findings for a patient with rheumatic fever
o Inflammation of heart, rapid heart rate, fatigue, shortness of
breath, exercise intolerance, fever in 90% of patients, arthritis in
75% of patients, partial AV block, chorea (jerky uncontrolled
body movements), symptoms of CHF, valvular damage (usually
mitral, sometimes combined with aortic valve)
Grading of heart murmurs
o Grade 1: very faint, not heart in all positions, no thrill
o Grade 2: soft, heart in all positions, no thrill
o Grade 3: moderately loud, no thrill
o Grade 4: loud and associated with a palpable thrill
o Grade 5: very loud with thrill, heart with stethoscope partly off
the chest
o Grade 6: loudest, with thrill, heart with stethoscope off chest
entirely
Evaluation of ECG tracings
o P-wave: atrial depolarization
© 2019 Walden University Page 2 of 32
o QRS: ventricular depolarization
o T-wave: ventricular repolarization
o Lateral wall, leads I, AVL, V5, V6 (st elevation)
o Inferior wall leads, II, III, AVF (twave inversion, ST elevation)-
RCA and posterior descending branch
o Posterior wall, V1-V4, tall R waves, ST depression, upright T
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,10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 2 of 32
o QRS: ventricular depolarization
o T-wave: ventricular repolarization
o Lateral wall, leads I, AVL, V5, V6 (st elevation)
o Inferior wall leads, II, III, AVF (twave inversion, ST elevation)-
RCA and posterior descending branch
o Posterior wall, V1-V4, tall R waves, ST depression, upright T
waves – LCA, LCX, RCA, posterior descending branch
o Septal wall, leads V1 and V2, r wave disappears, ST elevation,
T wave inversion
o Anterior wall, V2-V4, poor R-wave progression, ST segment
elevation, t wave inversion – LAD and DX
Examination technique for the apical pulse
ABI: right ABI higher right-ankle pressure over higher arm pressure,
left ABI higher left-ankle pressure over higher arm pressure, greater
than 1.4 calcification and vessel hardening, 1.0-1.4 normal, 0.9-1.0
borderline, 0.8-0.9 some arterial disease, 0.5-0.8 moderate arterial
disease, less than 0.5 severe arterial disease.
Examining technique for different cardiac sounds and their names
o Normal diameter of aorta less than 3 cm
o AORTIC (right 2nd ICS), PULMONIC (left 2nd ICS), ERB (left 3rd
ICS), TRICUSPID (lower left sternal border), MITRAL (left 5 th
ICS)
o S3 linked with blood flow into ventricles, S4 linked with atrial
contraction
o Mitral murmur best heard at apex and radiate to axilla with
patient in left lateral position
o Mitral regurg pansystolic murmur even in sound through systole
o Mitral insufficiency: loudest at apex, 5th ICS, high pitched
blowing sound
o Mitral stenosis, diastolic murmur (presystolic) heard
immediately before S1
o Mitral valve prolapse is a click mid-systolic
© 2019 Walden University Page 3 of 32
o Austin Flint’s murmur for aortic regurg- soft rumbling low-
pitched late-diastolic murmur best heard at apex
o Tricuspid stenosis/murmurs: best heard left lower sternal edge,
heard in RVH
o Tricuspid insufficiency: backflow of blood, diaphragm at 5th ics
at sternal border, radiates to left anterior sternal line
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, 10/11/23, 7:30 PM USW1 NURS 6512 Final Exam Review
© 2019 Walden University Page 3 of 32
o Austin Flint’s murmur for aortic regurg- soft rumbling low-
pitched late-diastolic murmur best heard at apex
o Tricuspid stenosis/murmurs: best heard left lower sternal edge,
heard in RVH
o Tricuspid insufficiency: backflow of blood, diaphragm at 5th ics
at sternal border, radiates to left anterior sternal line
o Pulmonary stenosis gets louder then softer (crescendo-
decrescendo) during systole, pulmonary ejection sounds
diminish or disappear in inspiration, while aortic ones do not. In
AORTIC stenosis same sound only it transmits to the carotids.
o Aortic stenosis A2 is soft. Aortic sclerosis A2 is loud or normal.
Pressure/gradient thru smaller valve, increased pumping
pressure of left ventricle
o Pulmonary regurgitation and aortic regurg have early diastolic
murmur
o Atrial septal defect: pulmonary flow murmur
o Ventricular septal defect: harsh systolic murmur best heard on
left sternal edge. (ex. Fallot’s tetraology)
o Aortic aneurysm (ex marfan) flow murmurs
o Patent ductus arteriosus: late systolic murmur into diastolic,
best heard on the back (ex. Continuous machinery murmur/to-
and-fro murmur in both systolic and diastole, louder in systole).
o Pericarditis: sounds like boots tramping through snow, heard
best left sternal edge
o Prosthetic valves loud sound heard across quiet room.
o Murmurs in kids grade 3 or less common, typically resolve with
age
Varicosity findings in pregnant women
o Heavy feelings in legs, itching in veins, leg cramps, pain aching
or tenderness in lower legs, swelling in legs and feet
Examination of peripheral arteries
Epigastric and renal bruits heard with diaphragm of steth
© 2019 Walden University Page 4 of 32
Aortic, iliac, and femoral bruits heard with bell of steth
Grading of pulses
o 0-nonpalpable, 1-barely detectable, 2-slightly diminished, 3-
normal pulse and palpable, 4-bounding.
Examination findings of a child with Kawasaki disease
o Fever, rash, swelling of hands and feet, irritation and redness of
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