NUR 445 COMPREHENSIVE EXAM 2026 QUESTIONS AND
ANSWERS GRADED A+
✔✔What can caused elevated PAWP? - ✔✔fluid overload, LVHF, myocardial ischemia,
mitral stenosis, cardiac tampanode
✔✔What are some interventions to reduce elevated PAWP? - ✔✔diuretics, vasodilators,
nitrates, fluid and Na+ restrictions, ACE inhibitors, digoxin, dobutamine, amrinone, intra-
aortic balloon pump, carefully give meds, thorough assessments, strict I&Os, daily
weight
✔✔What is systemic vascular resistance (SVR)? - ✔✔left ventricular afterload that
represents an average of the resistance of all vascular beds
✔✔What are the normal ranges of SVR? - ✔✔800-1200 dynes/sec/cm^-5
✔✔What can cause an increased SVR? - ✔✔hypothermia, hypovolemia, hypotension
(think compensatory mech)
✔✔How can increased SVR be treated? - ✔✔diuretics, nitrates, nitro, ACE inhibitor,
milrinone
reduce preload and afterload
✔✔What can cause decreased SVR? - ✔✔vasodilation
(drugs/shock/sepsis/anaphylaxis)
✔✔How can decreased SVR be treated? - ✔✔dopamine, phenylephrine,
norepinephrine, change dose of drugs, fluid resuscitation
✔✔What is peripheral vascular resistance (PVR)? - ✔✔right ventricular afterload that
represents an average of the resistance of pulmonary vascular beds
✔✔Why is high PVR concerning? - ✔✔It reduces right ventricular stroke volume and
cardiac output, causing the right ventricle to work harder and require more oxygen
✔✔If the patient's HR increases, will that affect stroke volume? - ✔✔Yes; high HR will
lower SV
✔✔What is atrial systole? - ✔✔AV open, semilunar close
✔✔What is atrial diastole? - ✔✔All valve close and atria relax and refill
✔✔What is ventricular systole? - ✔✔AV close, semilunar open as pressure increases
,✔✔What is ventricular diastole? - ✔✔AV open, semilunar close
✔✔What happens to CO if HR is high and SV is low? - ✔✔Compensated; remains the
same
✔✔What happens to CO if HR is low and SV is high? - ✔✔Compensated; remains the
same
✔✔What happens to CO if HR is high and SV is the same? - ✔✔Increased CO
✔✔What happens to CO if HR is low and SV is the same? - ✔✔Decreased CO
✔✔What happens to CO if HR is extremely high and SV is decreased? - ✔✔Decreased
CO
✔✔What raises HR? - ✔✔SNS stimulation, rapid cardiac conduction
✔✔What lowers HR? - ✔✔Parasympathetic NS stimulation, impaired/slow cardiac
conduction
✔✔What increases preload? - ✔✔increased blood volume
✔✔What decreases preload? - ✔✔decreased blood volume and a rapid HR
✔✔What increases contractility? - ✔✔SNS stimulation, drug effects
✔✔What decreases contractility? - ✔✔parasympathetic NS stimulation, hypoxia,
ischemia, myocardial disease, drug effects
✔✔What increases afterload? - ✔✔vasoconstriction or semilunar valve failure
✔✔What decreases afterload? - ✔✔arteriole vasodilation
✔✔What might you find on assessment of increased right ventricular preload? -
✔✔JVD, ascites, hepatic engorgement (tenderness), peripheral edema
✔✔What might you find on assessment of decreased right ventricular preload? - ✔✔flat
jugular veins, dry mucous membranes, orthostatic hypotension, poor skin turgor
✔✔What might you find on assessment of increased left ventricular preload? -
✔✔dyspnea, cough, S3/S4 sounds
, ✔✔What might you find on assessment of decreased left ventricular preload? -
✔✔muffled S1/S2 sounds, flat jugular veins, dry mucous membranes, orthostatic
hypotension, poor skin turgor
✔✔What might you find on assessment of increased contractility? - ✔✔bounding and
vigorous radial pulse and increased pulse pressure
✔✔What might you find on assessment of decreased contractility? - ✔✔weak and
thready radial pulse, splitting S2 heart sounds, decreased pulse pressure
✔✔What is the apical-radial pulse deficit? - ✔✔A deficit between the apical and radial
rate, caused by irregular rhythms that result in varying SV, causing some beats being
too weak to palpate at radial artery
✔✔What is pulse pressure? - ✔✔The difference between systolic and diastolic
pressure; reflects how much the heart is able to raise pressure in arterial system with
each beat
✔✔Junctional rhythms originate at which node? - ✔✔AV node
✔✔What is the intrinsic rate of the AV node? - ✔✔40-60 bpm
✔✔If an impulse is fired from the AV node, what happens to the P wave? (on lead II)
What defines a junctional rhythm? - ✔✔may be inverted or absent
✔✔What is considered a typical heart rate for a junctional rhythm? - ✔✔40-60 bpm
✔✔At what heart rate is it considered an accelerated junctional rhythm? - ✔✔60-100
bpm
✔✔At what heart rate is it considered junctional tachycardia? - ✔✔100+ bpm
✔✔How is a junctional rhythm treated if symptomatic? - ✔✔atropine, pacemaker
insertion
✔✔How is junctional tachycardia treated if symptomatic? - ✔✔insert pacemaker,
withheld digitalis if associated with toxicity
✔✔Junctional Rhythm - ✔✔
✔✔Accelerated Junctional Rhythm - ✔✔
✔✔Junctional Tachycardia - ✔✔
ANSWERS GRADED A+
✔✔What can caused elevated PAWP? - ✔✔fluid overload, LVHF, myocardial ischemia,
mitral stenosis, cardiac tampanode
✔✔What are some interventions to reduce elevated PAWP? - ✔✔diuretics, vasodilators,
nitrates, fluid and Na+ restrictions, ACE inhibitors, digoxin, dobutamine, amrinone, intra-
aortic balloon pump, carefully give meds, thorough assessments, strict I&Os, daily
weight
✔✔What is systemic vascular resistance (SVR)? - ✔✔left ventricular afterload that
represents an average of the resistance of all vascular beds
✔✔What are the normal ranges of SVR? - ✔✔800-1200 dynes/sec/cm^-5
✔✔What can cause an increased SVR? - ✔✔hypothermia, hypovolemia, hypotension
(think compensatory mech)
✔✔How can increased SVR be treated? - ✔✔diuretics, nitrates, nitro, ACE inhibitor,
milrinone
reduce preload and afterload
✔✔What can cause decreased SVR? - ✔✔vasodilation
(drugs/shock/sepsis/anaphylaxis)
✔✔How can decreased SVR be treated? - ✔✔dopamine, phenylephrine,
norepinephrine, change dose of drugs, fluid resuscitation
✔✔What is peripheral vascular resistance (PVR)? - ✔✔right ventricular afterload that
represents an average of the resistance of pulmonary vascular beds
✔✔Why is high PVR concerning? - ✔✔It reduces right ventricular stroke volume and
cardiac output, causing the right ventricle to work harder and require more oxygen
✔✔If the patient's HR increases, will that affect stroke volume? - ✔✔Yes; high HR will
lower SV
✔✔What is atrial systole? - ✔✔AV open, semilunar close
✔✔What is atrial diastole? - ✔✔All valve close and atria relax and refill
✔✔What is ventricular systole? - ✔✔AV close, semilunar open as pressure increases
,✔✔What is ventricular diastole? - ✔✔AV open, semilunar close
✔✔What happens to CO if HR is high and SV is low? - ✔✔Compensated; remains the
same
✔✔What happens to CO if HR is low and SV is high? - ✔✔Compensated; remains the
same
✔✔What happens to CO if HR is high and SV is the same? - ✔✔Increased CO
✔✔What happens to CO if HR is low and SV is the same? - ✔✔Decreased CO
✔✔What happens to CO if HR is extremely high and SV is decreased? - ✔✔Decreased
CO
✔✔What raises HR? - ✔✔SNS stimulation, rapid cardiac conduction
✔✔What lowers HR? - ✔✔Parasympathetic NS stimulation, impaired/slow cardiac
conduction
✔✔What increases preload? - ✔✔increased blood volume
✔✔What decreases preload? - ✔✔decreased blood volume and a rapid HR
✔✔What increases contractility? - ✔✔SNS stimulation, drug effects
✔✔What decreases contractility? - ✔✔parasympathetic NS stimulation, hypoxia,
ischemia, myocardial disease, drug effects
✔✔What increases afterload? - ✔✔vasoconstriction or semilunar valve failure
✔✔What decreases afterload? - ✔✔arteriole vasodilation
✔✔What might you find on assessment of increased right ventricular preload? -
✔✔JVD, ascites, hepatic engorgement (tenderness), peripheral edema
✔✔What might you find on assessment of decreased right ventricular preload? - ✔✔flat
jugular veins, dry mucous membranes, orthostatic hypotension, poor skin turgor
✔✔What might you find on assessment of increased left ventricular preload? -
✔✔dyspnea, cough, S3/S4 sounds
, ✔✔What might you find on assessment of decreased left ventricular preload? -
✔✔muffled S1/S2 sounds, flat jugular veins, dry mucous membranes, orthostatic
hypotension, poor skin turgor
✔✔What might you find on assessment of increased contractility? - ✔✔bounding and
vigorous radial pulse and increased pulse pressure
✔✔What might you find on assessment of decreased contractility? - ✔✔weak and
thready radial pulse, splitting S2 heart sounds, decreased pulse pressure
✔✔What is the apical-radial pulse deficit? - ✔✔A deficit between the apical and radial
rate, caused by irregular rhythms that result in varying SV, causing some beats being
too weak to palpate at radial artery
✔✔What is pulse pressure? - ✔✔The difference between systolic and diastolic
pressure; reflects how much the heart is able to raise pressure in arterial system with
each beat
✔✔Junctional rhythms originate at which node? - ✔✔AV node
✔✔What is the intrinsic rate of the AV node? - ✔✔40-60 bpm
✔✔If an impulse is fired from the AV node, what happens to the P wave? (on lead II)
What defines a junctional rhythm? - ✔✔may be inverted or absent
✔✔What is considered a typical heart rate for a junctional rhythm? - ✔✔40-60 bpm
✔✔At what heart rate is it considered an accelerated junctional rhythm? - ✔✔60-100
bpm
✔✔At what heart rate is it considered junctional tachycardia? - ✔✔100+ bpm
✔✔How is a junctional rhythm treated if symptomatic? - ✔✔atropine, pacemaker
insertion
✔✔How is junctional tachycardia treated if symptomatic? - ✔✔insert pacemaker,
withheld digitalis if associated with toxicity
✔✔Junctional Rhythm - ✔✔
✔✔Accelerated Junctional Rhythm - ✔✔
✔✔Junctional Tachycardia - ✔✔
