NR 601 Week 4 Midterm: Valvular Disorders &
Principles of Primary Care for Older Adults – 80
Multiple-Choice Questions with Rationales-
Chamberlain
VALVULAR DISORDERS (~20 questions)
1. Which murmur is characteristic of aortic stenosis?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic decrescendo murmur at the left sternal border
C. Crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotids
D. Low-pitched diastolic rumble with opening snap at the apex
Answer: C
Rationale: Aortic stenosis produces a crescendo-decrescendo (diamond-shaped)
systolic murmur best heard at the right upper sternal border, radiating to the carotids.
2. Which symptom is a classic triad of severe aortic stenosis?
A. Dyspnea, cough, and hemoptysis
B. Angina, syncope, and exertional dyspnea
C. Palpitations, fatigue, and peripheral edema
D. Orthopnea, paroxysmal nocturnal dyspnea, and JVD
Answer: B
Rationale: The classic triad of severe aortic stenosis is angina, syncope, and exertional
dyspnea.
3. The most common cause of mitral stenosis is:
A. Infective endocarditis
B. Rheumatic heart disease
C. Myxomatous degeneration
D. Congenital bicuspid valve
Answer: B
Rationale: Rheumatic heart disease is the primary cause of mitral stenosis, leading to
valve thickening and scarring.
,4. Which auscultatory finding is characteristic of mitral stenosis?
A. Holosystolic murmur at the apex
B. Diastolic decrescendo murmur at the left sternal border
C. Low-pitched diastolic rumble with an opening snap at the apex
D. Crescendo-decrescendo systolic murmur at the right upper sternal border
Answer: C
Rationale: Mitral stenosis produces a low-pitched diastolic rumble with an opening
snap, best heard at the apex in the left lateral decubitus position.
5. Which medication is indicated for rate control in atrial fibrillation associated with
mitral stenosis?
A. Warfarin
B. Beta-blockers
C. Furosemide
D. ACE inhibitors
Answer: B
Rationale: Beta-blockers, calcium channel blockers, or digoxin are used for rate control
in atrial fibrillation. Warfarin is for anticoagulation.
6. A client with aortic stenosis should avoid which medication class due to risk of
hypotension?
A. Beta-blockers
B. Diuretics
C. Vasodilators (e.g., nitrates)
D. Calcium channel blockers
Answer: C
Rationale: Vasodilators can cause severe hypotension in aortic stenosis because
cardiac output is fixed. Diuretics must be used cautiously.
7. Which ECG finding is most consistent with chronic aortic stenosis?
A. Left ventricular hypertrophy with strain pattern
B. Right atrial enlargement
C. Atrial fibrillation
D. Right bundle branch block
Answer: A
, Rationale: Left ventricular hypertrophy with high voltage QRS and strain pattern (ST
depression, T wave inversion) is common due to pressure overload.
8. Which diagnostic test is the gold standard for confirming aortic stenosis
severity?
A. Chest X-ray
B. Echocardiography
C. Cardiac MRI
D. Electrocardiogram
Answer: B
Rationale: Echocardiography measures valve area, pressure gradients, and jet velocity,
confirming diagnosis and severity.
9. Which murmur is characteristic of aortic regurgitation?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic decrescendo murmur at the left sternal border
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Low-pitched diastolic rumble at the apex
Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic decrescendo
murmur at the left sternal border.
10. Which physical finding is classic for chronic severe aortic regurgitation?
A. Narrow pulse pressure
B. Bounding peripheral pulses and wide pulse pressure
C. Weak, thready pulses
D. Jugular venous distention
Answer: B
Rationale: Wide pulse pressure and bounding pulses (e.g., Corrigan's pulse) occur due
to increased stroke volume and rapid diastolic runoff.
11. Which murmur is characteristic of mitral regurgitation?
A. Diastolic decrescendo murmur at the left sternal border
B. Holosystolic murmur at the apex radiating to the axilla
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
Principles of Primary Care for Older Adults – 80
Multiple-Choice Questions with Rationales-
Chamberlain
VALVULAR DISORDERS (~20 questions)
1. Which murmur is characteristic of aortic stenosis?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic decrescendo murmur at the left sternal border
C. Crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotids
D. Low-pitched diastolic rumble with opening snap at the apex
Answer: C
Rationale: Aortic stenosis produces a crescendo-decrescendo (diamond-shaped)
systolic murmur best heard at the right upper sternal border, radiating to the carotids.
2. Which symptom is a classic triad of severe aortic stenosis?
A. Dyspnea, cough, and hemoptysis
B. Angina, syncope, and exertional dyspnea
C. Palpitations, fatigue, and peripheral edema
D. Orthopnea, paroxysmal nocturnal dyspnea, and JVD
Answer: B
Rationale: The classic triad of severe aortic stenosis is angina, syncope, and exertional
dyspnea.
3. The most common cause of mitral stenosis is:
A. Infective endocarditis
B. Rheumatic heart disease
C. Myxomatous degeneration
D. Congenital bicuspid valve
Answer: B
Rationale: Rheumatic heart disease is the primary cause of mitral stenosis, leading to
valve thickening and scarring.
,4. Which auscultatory finding is characteristic of mitral stenosis?
A. Holosystolic murmur at the apex
B. Diastolic decrescendo murmur at the left sternal border
C. Low-pitched diastolic rumble with an opening snap at the apex
D. Crescendo-decrescendo systolic murmur at the right upper sternal border
Answer: C
Rationale: Mitral stenosis produces a low-pitched diastolic rumble with an opening
snap, best heard at the apex in the left lateral decubitus position.
5. Which medication is indicated for rate control in atrial fibrillation associated with
mitral stenosis?
A. Warfarin
B. Beta-blockers
C. Furosemide
D. ACE inhibitors
Answer: B
Rationale: Beta-blockers, calcium channel blockers, or digoxin are used for rate control
in atrial fibrillation. Warfarin is for anticoagulation.
6. A client with aortic stenosis should avoid which medication class due to risk of
hypotension?
A. Beta-blockers
B. Diuretics
C. Vasodilators (e.g., nitrates)
D. Calcium channel blockers
Answer: C
Rationale: Vasodilators can cause severe hypotension in aortic stenosis because
cardiac output is fixed. Diuretics must be used cautiously.
7. Which ECG finding is most consistent with chronic aortic stenosis?
A. Left ventricular hypertrophy with strain pattern
B. Right atrial enlargement
C. Atrial fibrillation
D. Right bundle branch block
Answer: A
, Rationale: Left ventricular hypertrophy with high voltage QRS and strain pattern (ST
depression, T wave inversion) is common due to pressure overload.
8. Which diagnostic test is the gold standard for confirming aortic stenosis
severity?
A. Chest X-ray
B. Echocardiography
C. Cardiac MRI
D. Electrocardiogram
Answer: B
Rationale: Echocardiography measures valve area, pressure gradients, and jet velocity,
confirming diagnosis and severity.
9. Which murmur is characteristic of aortic regurgitation?
A. Holosystolic murmur at the apex radiating to the axilla
B. Diastolic decrescendo murmur at the left sternal border
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
D. Low-pitched diastolic rumble at the apex
Answer: B
Rationale: Aortic regurgitation produces a high-pitched, blowing diastolic decrescendo
murmur at the left sternal border.
10. Which physical finding is classic for chronic severe aortic regurgitation?
A. Narrow pulse pressure
B. Bounding peripheral pulses and wide pulse pressure
C. Weak, thready pulses
D. Jugular venous distention
Answer: B
Rationale: Wide pulse pressure and bounding pulses (e.g., Corrigan's pulse) occur due
to increased stroke volume and rapid diastolic runoff.
11. Which murmur is characteristic of mitral regurgitation?
A. Diastolic decrescendo murmur at the left sternal border
B. Holosystolic murmur at the apex radiating to the axilla
C. Crescendo-decrescendo systolic murmur at the right upper sternal border
