NSG 6020 Cardiovascular Exam Questions
with Answers and Rationales | Complete
Nursing Review
Question 1
A sixty-year-old male presents to the outpatient clinic reporting progressive
shortness of breath on exertion, orthopnea, and paroxysmal nocturnal dyspnea.
During the cardiovascular examination, the nurse practitioner auscultates a low-
frequency diastolic rumbling murmur with an opening snap heard best at the
apex in the left lateral decubitus position. This physical finding is most
characteristic of:
Option A. Aortic valve stenosis
Option B. Mitral valve stenosis
Option C. Tricuspid valve regurgitation
Option D. Aortic valve regurgitation
Answer: Option B
Rationale: Mitral stenosis typically results from rheumatic heart disease,
producing a characteristic low-pitched diastolic rumble with an opening
snap heard best at the cardiac apex using the bell of the stethoscope.
Question 2
An advanced practice registered nurse is evaluating a seventy-year-old female
with long-standing hypertension who presents with complaints of exertional chest
pressure and dyspnea. Auscultation reveals a loud, harsh systolic ejection murmur
at the right second intercostal space that radiates aggressively into both carotid
arteries. This murmur is most indicative of:
Option A. Mitral valve prolapse
Option B. Aortic valve stenosis
, Option C. Pulmonic valve stenosis
Option D. Tricuspid valve stenosis
Answer: Option B
Rationale: Aortic stenosis creates a harsh systolic crescendo-decrescendo
murmur audible at the right upper sternal border with prominent radiation
to the carotid arteries due to restricted forward flow across a calcified
valve.
Question 3
A fifty-five-year-old male is evaluated for sudden onset of severe, tearing chest
pain radiating directly through to the interscapular region of the back. His medical
history includes poorly controlled hypertension. Physical examination
demonstrates a notable blood pressure differential of twenty-five millimeters of
mercury between the right and left upper extremities. The nurse practitioner
should immediately suspect:
Option A. Acute ST-elevation myocardial infarction
Option B. Acute aortic dissection
Option C. Acute pulmonary thromboembolism
Option D. Acute pericardial tamponade
Answer: Option B
Rationale: Tearing chest pain radiating to the back combined with an inter-
arm blood pressure differential is the classic clinical presentation of acute
aortic dissection, which requires emergent diagnostic imaging and surgical
consultation.
Question 4
A nurse practitioner is assessing a patient with acute heart failure exacerbation.
Auscultation of the precordium reveals an extra heart sound occurring early in
diastole, just after the second heart sound, creating a gallop cadence often
described as Kentucky. This extra heart sound is designated as:
Option A. First heart sound
, Option B. Second heart sound
Option C. Third heart sound
Option D. Fourth heart sound
Answer: Option C
Rationale: An S3 gallop represents passive early diastolic filling into a
dilated or volume-overloaded ventricle, frequently heard in patients with
systolic heart failure.
Question 5
During an annual wellness evaluation, a forty-eight-year-old male has blood
pressure readings of one hundred thirty-four over eighty-four millimeters of
mercury on two separate clinic visits. According to current American College of
Cardiology and American Heart Association guidelines, how should this blood
pressure be classified?
Option A. Normal blood pressure
Option B. Elevated blood pressure
Option C. Stage one hypertension
Option D. Stage two hypertension
Answer: Option C
Rationale: Stage one hypertension is defined as a systolic blood pressure
ranging from one hundred thirty to one hundred thirty-nine millimeters of
mercury or a diastolic reading ranging from eighty to eighty-nine
millimeters of mercury.
Question 6
A sixty-five-year-old female presents with fatigue, peripheral edema, and
elevated jugular venous pressure. Echocardiography demonstrates a left
ventricular ejection fraction of fifty-five percent, normal left ventricular
dimensions, and signs of left ventricular hypertrophy and diastolic dysfunction.
This clinical profile is diagnostic of:
, Option A. Heart failure with reduced ejection fraction
Option B. Heart failure with preserved ejection fraction
Option C. Acute cor pulmonale
Option D. Primary pulmonary arterial hypertension
Answer: Option B
Rationale: Heart failure with preserved ejection fraction is characterized by
clinical signs of heart failure in the presence of a normal ejection fraction,
driven primarily by impaired ventricular relaxation and diastolic filling
abnormalities.
Question 7
A sixty-year-old male with a history of heavy smoking and hyperlipidemia
presents with severe cramping pain in his right calf that consistently occurs after
walking two blocks and resolves completely with five minutes of rest. Which of
the following diagnostic tests is the initial non-invasive modality of choice?
Option A. Lower extremity venography
Option B. Ankle-brachial index measurement
Option C. Magnetic resonance angiography of the brain
Option D. Diagnostic right heart catheterization
Answer: Option B
Rationale: Intermittent claudication suggests peripheral artery disease.
Measuring the ankle-brachial index is the primary, cost-effective non-
invasive diagnostic test to evaluate arterial perfusion in the lower
extremities.
Question 8
A nurse practitioner is evaluating a patient with acute chest pain. The twelve-lead
electrocardiogram demonstrates ST-segment elevations in leads II, III, and aVF.
These electrocardiographic findings indicate acute myocardial injury localized to
which wall of the left ventricle?
with Answers and Rationales | Complete
Nursing Review
Question 1
A sixty-year-old male presents to the outpatient clinic reporting progressive
shortness of breath on exertion, orthopnea, and paroxysmal nocturnal dyspnea.
During the cardiovascular examination, the nurse practitioner auscultates a low-
frequency diastolic rumbling murmur with an opening snap heard best at the
apex in the left lateral decubitus position. This physical finding is most
characteristic of:
Option A. Aortic valve stenosis
Option B. Mitral valve stenosis
Option C. Tricuspid valve regurgitation
Option D. Aortic valve regurgitation
Answer: Option B
Rationale: Mitral stenosis typically results from rheumatic heart disease,
producing a characteristic low-pitched diastolic rumble with an opening
snap heard best at the cardiac apex using the bell of the stethoscope.
Question 2
An advanced practice registered nurse is evaluating a seventy-year-old female
with long-standing hypertension who presents with complaints of exertional chest
pressure and dyspnea. Auscultation reveals a loud, harsh systolic ejection murmur
at the right second intercostal space that radiates aggressively into both carotid
arteries. This murmur is most indicative of:
Option A. Mitral valve prolapse
Option B. Aortic valve stenosis
, Option C. Pulmonic valve stenosis
Option D. Tricuspid valve stenosis
Answer: Option B
Rationale: Aortic stenosis creates a harsh systolic crescendo-decrescendo
murmur audible at the right upper sternal border with prominent radiation
to the carotid arteries due to restricted forward flow across a calcified
valve.
Question 3
A fifty-five-year-old male is evaluated for sudden onset of severe, tearing chest
pain radiating directly through to the interscapular region of the back. His medical
history includes poorly controlled hypertension. Physical examination
demonstrates a notable blood pressure differential of twenty-five millimeters of
mercury between the right and left upper extremities. The nurse practitioner
should immediately suspect:
Option A. Acute ST-elevation myocardial infarction
Option B. Acute aortic dissection
Option C. Acute pulmonary thromboembolism
Option D. Acute pericardial tamponade
Answer: Option B
Rationale: Tearing chest pain radiating to the back combined with an inter-
arm blood pressure differential is the classic clinical presentation of acute
aortic dissection, which requires emergent diagnostic imaging and surgical
consultation.
Question 4
A nurse practitioner is assessing a patient with acute heart failure exacerbation.
Auscultation of the precordium reveals an extra heart sound occurring early in
diastole, just after the second heart sound, creating a gallop cadence often
described as Kentucky. This extra heart sound is designated as:
Option A. First heart sound
, Option B. Second heart sound
Option C. Third heart sound
Option D. Fourth heart sound
Answer: Option C
Rationale: An S3 gallop represents passive early diastolic filling into a
dilated or volume-overloaded ventricle, frequently heard in patients with
systolic heart failure.
Question 5
During an annual wellness evaluation, a forty-eight-year-old male has blood
pressure readings of one hundred thirty-four over eighty-four millimeters of
mercury on two separate clinic visits. According to current American College of
Cardiology and American Heart Association guidelines, how should this blood
pressure be classified?
Option A. Normal blood pressure
Option B. Elevated blood pressure
Option C. Stage one hypertension
Option D. Stage two hypertension
Answer: Option C
Rationale: Stage one hypertension is defined as a systolic blood pressure
ranging from one hundred thirty to one hundred thirty-nine millimeters of
mercury or a diastolic reading ranging from eighty to eighty-nine
millimeters of mercury.
Question 6
A sixty-five-year-old female presents with fatigue, peripheral edema, and
elevated jugular venous pressure. Echocardiography demonstrates a left
ventricular ejection fraction of fifty-five percent, normal left ventricular
dimensions, and signs of left ventricular hypertrophy and diastolic dysfunction.
This clinical profile is diagnostic of:
, Option A. Heart failure with reduced ejection fraction
Option B. Heart failure with preserved ejection fraction
Option C. Acute cor pulmonale
Option D. Primary pulmonary arterial hypertension
Answer: Option B
Rationale: Heart failure with preserved ejection fraction is characterized by
clinical signs of heart failure in the presence of a normal ejection fraction,
driven primarily by impaired ventricular relaxation and diastolic filling
abnormalities.
Question 7
A sixty-year-old male with a history of heavy smoking and hyperlipidemia
presents with severe cramping pain in his right calf that consistently occurs after
walking two blocks and resolves completely with five minutes of rest. Which of
the following diagnostic tests is the initial non-invasive modality of choice?
Option A. Lower extremity venography
Option B. Ankle-brachial index measurement
Option C. Magnetic resonance angiography of the brain
Option D. Diagnostic right heart catheterization
Answer: Option B
Rationale: Intermittent claudication suggests peripheral artery disease.
Measuring the ankle-brachial index is the primary, cost-effective non-
invasive diagnostic test to evaluate arterial perfusion in the lower
extremities.
Question 8
A nurse practitioner is evaluating a patient with acute chest pain. The twelve-lead
electrocardiogram demonstrates ST-segment elevations in leads II, III, and aVF.
These electrocardiographic findings indicate acute myocardial injury localized to
which wall of the left ventricle?
