NUR 631 LEARNING WORKBOOK 2026 PATIENT
ASSESSMENT AND DIAGNOSTIC REASONING
SKILLS
◉ Which of the following statements best describes Raynaud
disease?
a. An inflammatory disorder of small and medium-size arteries in
the feet and sometimes in the hands
b. A neoplastic disorder of the lining of the arteries and veins of the
upper extremities
c. A vasospastic disorder of the small arteries and arterioles of the
fingers, and less commonly, the toes
d. An autoimmune disorder of the large arteries and veins of the
upper and lower extremities.
Answer: c. A vasospastic disorder of the small arteries and arterioles
of the fingers, and less commonly, the toes
◉ A patient is diagnosed with pulmonary disease and elevated
pulmonary vascular resistance. Which of the following heart failures
may result from this condition?
a. Right heart failure
b. Left heart failure
,c. Low-output failure
d. High-output failure.
Answer: a. Right heart failure
Exp: Right heart failure is defined as the inability of the right
ventricle to provide adequate blood flow into the pulmonary
circulation at a normal central venous pressure. It most often results
from the left heart failure when the increase in left ventricular filling
pressure that is reflected back into the pulmonary circulation is
severe enough. As pressure in the pulmonary circulation rises, the
resistance to right ventricular emptying increases.
◉ What physical sign is the result of turbulent blood flow through a
vessel?
a. Increased blood pressure during periods of stress
b. Bounding pulse felt on palpation
c. Cyanosis observed on excretion
d. Murmur heard on auscultation.
Answer: d. Murmur heard on auscultation
Exp: Where flow is obstructed the vessel turns or blood flows over
rough surfaces. The flow becomes turbulent with whorls or eddy
currents that produce noise causing a murmur to be heard on
auscultation such as occurs during blood pressure measurement
with a sphygomanometer. This selection is the only option that
accurately identifies the physical sign of turbulent vascular blood
flow. pg 1113
,◉ Which congenital heart defects occur in trisomy 13, trisomy 18
and down syndrome?
a. Coarctation of the aorta and pulmonary stenosis
b. Tetralogy of Fallot and persistent truncus arteriosus
c. Atrial septal defect and dextrocardia
d. Ventricular septal defect and patent ductus arteriosus.
Answer: d. Ventricular septal defect and patent ductus arteriosus
Exp: Congenital heart defects that are related to dysfunction of
trisomy 13, trisomy 18 and down syndrome include VSD and PDA
see Table 33-2 The other defects are not associated with dysfunction
of trisomy 13 or 17 and down syndrome. pg 1200
◉ An infant has a continuous machine/type murmur best heard at
the left upper sternal border throughout systole and diastole as well
as a bounding pulse and a thrill on palpation. These clinical findings
are consistent with which congenital heart defect?
a. Atrial septal defect
b. Ventricular septal defect
c. Patent ductus arteriosus
d. Atrioventricular canal defect.
Answer: c. Patent ductus arteriosus
Exp: If pulmonary vascular resistance has fallen then infants with
will characteristically have a continuous machine/type murmur best
, heard at the left upper sternal border throughout systole and
diastole. If the PDA is significant then the infant also will have
bounding pulses an active precordium, a thrill on palpation and
signs and symptoms of pulmonary over circulation. The
presentations of the other congenital heart defects are not
consistent with the described the symptoms pages 1203-1204
◉ Which compensatory mechanism is spontaneously used by
children diagnosed with tetralogy of Fallot to relieve hypoxic spells?
a. Lying on their left side
b. Performing the valsalva maneuver
c. Squatting
d. hyperventilating.
Answer: c. Squatting
Exp: squatting is a spontaneous compensatory mechanism used by
older children to alleviate hypoxic spells. Squatting and its variants
increase systemic resistance while decreasing venous return to the
heart from the inferior vena cava. The other options would not
result in these changes. pg 1209
◉ An infant diagnosed with a small patent ductus arteriosus would
likely exhibit which symptom?
a. Intermittent murmur
b. Lack of symptoms
c. Need for surgical repair
ASSESSMENT AND DIAGNOSTIC REASONING
SKILLS
◉ Which of the following statements best describes Raynaud
disease?
a. An inflammatory disorder of small and medium-size arteries in
the feet and sometimes in the hands
b. A neoplastic disorder of the lining of the arteries and veins of the
upper extremities
c. A vasospastic disorder of the small arteries and arterioles of the
fingers, and less commonly, the toes
d. An autoimmune disorder of the large arteries and veins of the
upper and lower extremities.
Answer: c. A vasospastic disorder of the small arteries and arterioles
of the fingers, and less commonly, the toes
◉ A patient is diagnosed with pulmonary disease and elevated
pulmonary vascular resistance. Which of the following heart failures
may result from this condition?
a. Right heart failure
b. Left heart failure
,c. Low-output failure
d. High-output failure.
Answer: a. Right heart failure
Exp: Right heart failure is defined as the inability of the right
ventricle to provide adequate blood flow into the pulmonary
circulation at a normal central venous pressure. It most often results
from the left heart failure when the increase in left ventricular filling
pressure that is reflected back into the pulmonary circulation is
severe enough. As pressure in the pulmonary circulation rises, the
resistance to right ventricular emptying increases.
◉ What physical sign is the result of turbulent blood flow through a
vessel?
a. Increased blood pressure during periods of stress
b. Bounding pulse felt on palpation
c. Cyanosis observed on excretion
d. Murmur heard on auscultation.
Answer: d. Murmur heard on auscultation
Exp: Where flow is obstructed the vessel turns or blood flows over
rough surfaces. The flow becomes turbulent with whorls or eddy
currents that produce noise causing a murmur to be heard on
auscultation such as occurs during blood pressure measurement
with a sphygomanometer. This selection is the only option that
accurately identifies the physical sign of turbulent vascular blood
flow. pg 1113
,◉ Which congenital heart defects occur in trisomy 13, trisomy 18
and down syndrome?
a. Coarctation of the aorta and pulmonary stenosis
b. Tetralogy of Fallot and persistent truncus arteriosus
c. Atrial septal defect and dextrocardia
d. Ventricular septal defect and patent ductus arteriosus.
Answer: d. Ventricular septal defect and patent ductus arteriosus
Exp: Congenital heart defects that are related to dysfunction of
trisomy 13, trisomy 18 and down syndrome include VSD and PDA
see Table 33-2 The other defects are not associated with dysfunction
of trisomy 13 or 17 and down syndrome. pg 1200
◉ An infant has a continuous machine/type murmur best heard at
the left upper sternal border throughout systole and diastole as well
as a bounding pulse and a thrill on palpation. These clinical findings
are consistent with which congenital heart defect?
a. Atrial septal defect
b. Ventricular septal defect
c. Patent ductus arteriosus
d. Atrioventricular canal defect.
Answer: c. Patent ductus arteriosus
Exp: If pulmonary vascular resistance has fallen then infants with
will characteristically have a continuous machine/type murmur best
, heard at the left upper sternal border throughout systole and
diastole. If the PDA is significant then the infant also will have
bounding pulses an active precordium, a thrill on palpation and
signs and symptoms of pulmonary over circulation. The
presentations of the other congenital heart defects are not
consistent with the described the symptoms pages 1203-1204
◉ Which compensatory mechanism is spontaneously used by
children diagnosed with tetralogy of Fallot to relieve hypoxic spells?
a. Lying on their left side
b. Performing the valsalva maneuver
c. Squatting
d. hyperventilating.
Answer: c. Squatting
Exp: squatting is a spontaneous compensatory mechanism used by
older children to alleviate hypoxic spells. Squatting and its variants
increase systemic resistance while decreasing venous return to the
heart from the inferior vena cava. The other options would not
result in these changes. pg 1209
◉ An infant diagnosed with a small patent ductus arteriosus would
likely exhibit which symptom?
a. Intermittent murmur
b. Lack of symptoms
c. Need for surgical repair
