NRNP 6560 Week 10 Quiz
Cardiovascular and Hemodynamic Disorders
1. A 59-year-old female with known aortic regurgitation presents with activity
intolerance and weight gain after 16 months of no follow-up. Physical exam
reveals a grade IV/VI diastolic murmur and 2+ lower extremity edema. What is
the most appropriate management?
A) Serial echocardiography every 6 months
B) Begin a calcium channel antagonist
C) Begin an angiotensin-converting enzyme (ACE) inhibitor
D) Surgical consultation and intervention
Answer: C – ACE inhibitors lower blood pressure, which often worsens underlying
conditions causing heart murmurs. Surgery is indicated only when valves are
damaged or leaky. The patient's symptoms suggest worsening regurgitation
requiring afterload reduction .
2. An ascending thoracic aneurysm >5.5 cm is an indication for surgical repair.
Which of the following is NOT an additional indication for immediate operation
regardless of size?
A) Comorbid Marfan's syndrome
B) Enlargement of >1 cm since diagnosis
C) Crushing chest pain
D) History of giant cell arteritis
,Answer: C – Prophylactic surgery is recommended when the aorta reaches 5.5 cm,
in Marfan syndrome, when enlargement >0.5 cm, or with a history of giant cell
arteritis. Crushing chest pain is a symptom, not an independent indication .
3. A patient with a pulmonary embolus becomes increasingly lethargic over
several hours. Vital signs: BP 88/54, HR 110, RR 22, SaO2 93% on 50% mask,
SVR 1600 dynes·sec/cm⁵, CI 1.3 L/min, PCWP 8 mmHg. This is most
consistent with which shock state?
A) Hypovolemic
B) Cardiogenic
C) Distributive
D) Obstructive
Answer: C – Distributive shock is characterized by hypotension, tachycardia,
tachypnea, and low systemic vascular resistance. The cardiac index is low with
normal PCWP, suggesting vasodilation rather than pump failure .
4. What is one of the earliest findings in hypovolemic shock?
A) Drop in SBP <10 mmHg when sitting up
B) Change in mental status
C) SaO2 <88%
D) Hemoglobin <9 g/dL and hematocrit <27%
Answer: D – As blood is lost, hemoglobin and hematocrit decrease. The body
preferentially shunts blood to the brain and heart, so mental status changes occur
,later. Orthostatic hypotension is another early sign, but the question asks for the
earliest finding .
5. Mr. Mettenberger is discharged after his second spontaneous pneumothorax
this year. He has stopped smoking. What is his current risk for another
pneumothorax?
A) <10%
B) 25-50%
C) 50-75%
D) >90%
Answer: B – Having one pneumothorax increases the chance for a second and
third. Without surgical intervention, the recurrence risk after a second
pneumothorax is 25-50% .
6. Which lab result best suggests acute kidney injury (AKI)?
A) Rising creatinine with stable urine output
B) Normal creatinine
C) Low BUN
D) Decreasing potassium
Answer: A – A rising creatinine level indicates acute kidney injury in the appropriate
clinical context. Even with stable urine output, creatinine elevation reflects
decreased GFR .
, 7. In acute chest pain evaluation, what is the first step?
A) Order an MRI
B) Obtain ECG and troponin
C) Schedule a stress test
D) Start antibiotics
Answer: B – Immediate rule-out of myocardial ischemia is essential. ECG and
troponin are the initial diagnostic tests for acute coronary syndrome .
8. Which BNP level pattern is most consistent with heart failure?
A) Normal or low BNP
B) Markedly elevated BNP
C) BNP not useful in this context
D) Decreased troponin
Answer: B – Elevated BNP supports the diagnosis of heart failure. BNP is released
from ventricular myocytes in response to increased wall stress .
9. All of the following are risk factors for spontaneous pneumothorax EXCEPT:
A) Connective tissue disease
B) Scuba diving
C) Chronic obstructive pulmonary disease (COPD)
D) Central line insertion
Cardiovascular and Hemodynamic Disorders
1. A 59-year-old female with known aortic regurgitation presents with activity
intolerance and weight gain after 16 months of no follow-up. Physical exam
reveals a grade IV/VI diastolic murmur and 2+ lower extremity edema. What is
the most appropriate management?
A) Serial echocardiography every 6 months
B) Begin a calcium channel antagonist
C) Begin an angiotensin-converting enzyme (ACE) inhibitor
D) Surgical consultation and intervention
Answer: C – ACE inhibitors lower blood pressure, which often worsens underlying
conditions causing heart murmurs. Surgery is indicated only when valves are
damaged or leaky. The patient's symptoms suggest worsening regurgitation
requiring afterload reduction .
2. An ascending thoracic aneurysm >5.5 cm is an indication for surgical repair.
Which of the following is NOT an additional indication for immediate operation
regardless of size?
A) Comorbid Marfan's syndrome
B) Enlargement of >1 cm since diagnosis
C) Crushing chest pain
D) History of giant cell arteritis
,Answer: C – Prophylactic surgery is recommended when the aorta reaches 5.5 cm,
in Marfan syndrome, when enlargement >0.5 cm, or with a history of giant cell
arteritis. Crushing chest pain is a symptom, not an independent indication .
3. A patient with a pulmonary embolus becomes increasingly lethargic over
several hours. Vital signs: BP 88/54, HR 110, RR 22, SaO2 93% on 50% mask,
SVR 1600 dynes·sec/cm⁵, CI 1.3 L/min, PCWP 8 mmHg. This is most
consistent with which shock state?
A) Hypovolemic
B) Cardiogenic
C) Distributive
D) Obstructive
Answer: C – Distributive shock is characterized by hypotension, tachycardia,
tachypnea, and low systemic vascular resistance. The cardiac index is low with
normal PCWP, suggesting vasodilation rather than pump failure .
4. What is one of the earliest findings in hypovolemic shock?
A) Drop in SBP <10 mmHg when sitting up
B) Change in mental status
C) SaO2 <88%
D) Hemoglobin <9 g/dL and hematocrit <27%
Answer: D – As blood is lost, hemoglobin and hematocrit decrease. The body
preferentially shunts blood to the brain and heart, so mental status changes occur
,later. Orthostatic hypotension is another early sign, but the question asks for the
earliest finding .
5. Mr. Mettenberger is discharged after his second spontaneous pneumothorax
this year. He has stopped smoking. What is his current risk for another
pneumothorax?
A) <10%
B) 25-50%
C) 50-75%
D) >90%
Answer: B – Having one pneumothorax increases the chance for a second and
third. Without surgical intervention, the recurrence risk after a second
pneumothorax is 25-50% .
6. Which lab result best suggests acute kidney injury (AKI)?
A) Rising creatinine with stable urine output
B) Normal creatinine
C) Low BUN
D) Decreasing potassium
Answer: A – A rising creatinine level indicates acute kidney injury in the appropriate
clinical context. Even with stable urine output, creatinine elevation reflects
decreased GFR .
, 7. In acute chest pain evaluation, what is the first step?
A) Order an MRI
B) Obtain ECG and troponin
C) Schedule a stress test
D) Start antibiotics
Answer: B – Immediate rule-out of myocardial ischemia is essential. ECG and
troponin are the initial diagnostic tests for acute coronary syndrome .
8. Which BNP level pattern is most consistent with heart failure?
A) Normal or low BNP
B) Markedly elevated BNP
C) BNP not useful in this context
D) Decreased troponin
Answer: B – Elevated BNP supports the diagnosis of heart failure. BNP is released
from ventricular myocytes in response to increased wall stress .
9. All of the following are risk factors for spontaneous pneumothorax EXCEPT:
A) Connective tissue disease
B) Scuba diving
C) Chronic obstructive pulmonary disease (COPD)
D) Central line insertion
