NR509 APEA Prep Exam 2024| 104 Cardio Questions with Verified Answers and Explanations (100% Correct)

NR509 APEA Prep Exam 2024| 104 Cardio Questions with Verified Answers and Explanations (100% Correct) Q 1: The lymphatic ducts drain into the: a. Arterial system. b. Venous system. c. Arteriovenous system. d. Capillary bed. Detailed Rationale>>> The lymphatic ducts drain into the venous system. Q 2: While auscultating the patient's heart, a medium, soft murmur is audible. It is pansystolic and heard loudest at the apex with radiation to the left axilla. These findings are consistent with: a. Tricuspid regurgitation. b. Mitral regurgitation. c. ventricular septal defect d. An innocent murmur. Detailed Rationale>>> Mitral regurgitation produces a pansystolic, harsh murmur heard loudest at the apex with radiation toward the left axilla. The intensity of the murmur can be soft or if there is an atrial thrill, it can be loud. With tricuspid regurgitation, the murmur is audible loudest at the left sternal border with radiation to the right sternal border, xiphoid area, or to the left midclavicular line. It produces a blowing sound and is pansystolic. The murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when sitting. Q 3: Which of the following group of symptoms would be suggestive of an infant experiencing a congenital heart defect associated with a decreased pulmonary blood flow pattern? a. Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding b. Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95% c. Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater than 95% d. Poor feeding, audible heart murmur, and oxygen saturation greater than 95% Detailed Rationale>>> Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs. Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid atresia. Usually these infants have activity intolerance and therefore, experience failure to thrive because of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats being lower than normal, sometimes even in the 80% range. Q 4: Right atrial pressure can be determined by: a. Palpating the carotid pulse. Incorrect b. Identifying the pulsations of the right jugular vein. c. Analyzing the arterial blood gases. d. Assessing for dependent edema. Detailed Rationale>>> Jugular venous pressure reflects pressure in the right atrium and is best assessed from pulsations in the right internal jugular vein. This is an indicator of cardiac function and right heart hemodynamics. Palpating the carotid artery denotes arterial pressure; analyzing blood gases reflects the status of the arterial blood. Assessing for dependent edema is a reflection of heart failure and poor venous return and not atrial pressure. Q 5: When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the most appropriate for this child? a. Apical pulse at the 5th intercostal space right midclavicular line b. Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line c. Apical pulse to the right of the midclavicular line in the 3rd intercostal space d. Apical pulse in the 5th intercostal space left midclavicular line Incorrect Detailed Rationale>>> The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line would be if the child had situs inversus or dextrocardia. Q 6: The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from the: a. Palpebral conjunctiva and the skin adjacent to the ear within the temporal region. b. Eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. c. Mouth, throat, and face. Incorrect d. Posterior part of the temporoparietal region. Detailed Rationale>>> The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and the skin and mucous membranes of the nose and cheek. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Q 7: The external iliac lymph nodes drain lymphatic fluid from the following areas except the: a. Urinary bladder. b. Prostate. c. Uterus. d. Gluteal region. Detailed Rationale>>> The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region. Q 8: The amplitude of the pulse in a patient in cardiogenic shock would most likely appear: a. Bounding. b. thread. c. Normal. d. As a bruit. Detailed Rationale>>> The amplitude of the pulse correlates with pulse pressure. Small, thready, or weak pulses occur in patients in cardiogenic shock. Bounding pulses are seen in patients in aortic insufficiency. A bruit is not typically associated with pulse amplitude. It is associated with stenosis or turbulent arterial blood flow. Usually the presence of a bruit requires further investigation and is not in itself diagnostic. Q 9: When auscultating the heart for aortic insufficiency, ask the patient to: a. Lie supine and inhale. b. Exhale while standing. c. Turn to the left side and breathe deeply. d. Sit up, lean forward, and exhale. Detailed Rationale>>> To bring the left ventricular outflow tract closer to the chest wall to listen for aortic insufficiency, ask the patient to sit up, lean forward, and exhale. Q 10: The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal ligament and drain lymphatic fluid from all of these areas except: a. Lower abdomen. b. buttock. c. testes. d. Lower vagina. Detailed Rationale>>> The horizontal superficial inguinal nodes lie in a chain high in the anterior thigh below the inguinal ligament. They drain the superficial portions of the lower abdomen and buttock, the external genitalia (but not the testes), the anal canal and perianal area, and the lower vagina. Q 11: When auscultating the point of maximal impulse (PMI), apex of the heart, in an adult, the stethoscope is placed at the: a. Third intercostal space to the left of the midclavicular line. b. Fifth intercostal space to the left of the midclavicular line. c. Fourth intercostal space to the right of the midclavicular line. d. Fifth intercostal space to the right of the midclavicular line. Detailed Rationale>>> To auscultate the apex of the heart in an adult, the proper placement of the stethoscope should be at the fifth intercostal space to the left of the midclavicular line. Q 12: Deep cervical lymph nodes drain lymphatic fluid from the: a. Head and neck. b. Breasts. c. Mouth, throat, and face. d. Posterior part of the temporoparietal region. Detailed Rationale>>> The deep cervical lymph nodes drain all of the lymphatic fluid from the head and neck. Axillary lymph nodes drain most of the lymphatic fluid of the breast. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region. Q 13: Which of the following symptoms would necessitate the need for further evaluation in the newborn? a. Blue hands and feet within an hour after birth b. Blood glucose level 45 mg/dl. c. Dusky cyanotic when crying d. Deep sleep one hour after birth Detailed Rationale>>> An infant who is dusky and becomes cyanotic when crying is showing poor cardiovascular adaptation to extrauterine life and requires further evaluation. Acrocyanosis, blue feet and hands, is not central cyanosis and is an expected finding during the early neonatal life. Normal glucose levels for a newborn are 40-60 mg/dL. Infants enter the period of deep sleep or decreased activity when they are about one hour old. Q 14: Symptoms of acrocyanosis in the newborn include: a. Bluish color of the tongue. b. Bluish color of the mucous membranes. c. Bluish color of the feet. d. Bluish color of the abdomen. Detailed Rationale>>> Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present. Q 15: A heart rate of 100-180 beats per minute in an adult is considered: a. normal sinus rhythm. b. sinus tachycardia. c. supraventricular tachycardia. d. ventricular tachycardia. Detailed Rationale>>> A normal heart rate in an adult is between 60 / 100 beats per minute. Tachycardia is over 100 beats / minute. Rates that exceed 180 beats / minute are usually supraventricular. Normal sinus rhythm is a measurement of the hearts electrical activity, not mechanical activity. Ventricular tachycardia is rapid and chaotic ventricular activity. Q 16 Tissue ischemia is usually observed when assessing a patient with peripheral artery disease (PAD). What other symptom could be observed? a. Peripheral edema b. Intermittent claudication. c. A brownish discoloration to the skin of the affected leg d. Bounding pulses in the affected leg Detailed Rationale>>> With peripheral vascular disease, arterial peripheral blood flow is impeded resulting in inadequate tissue perfusion and oxygenation. This leads to intermittent claudication, ischemia muscle pain precipitated by a predictable amount of exercise and relieved by rest. Other symptoms include pale cool skin, cyanosis, audible bruits, diminished or absent pulses, and thickened and opaque nails. Usually by the time the symptoms appear, the artery is 75% narrowed. Peripheral edema and brownish discoloration of the skin would be consistent with venous disease. Bounding pulses may reflect hypertension. Q 17: When performing a cardiovascular assessment on a healthy 2-year-old child: a. Expect to hear a swooshing sound during diastole. b. Place the stethoscope over the fifth intercostal space to the left of the mid- clavicular line. c. Auscultate the heart sounds in all four cardiac areas. d. Expect to hear an S4 sound. Detailed Rationale>>> When performing cardiac assessment on the child, the heart sounds should be auscultated in all 4 cardiac areas: aortic, pulmonic, tricuspid, and mitral areas. In children younger than 7 years of age, the point of maximum impact (PMI) is auscultated at the third or fourth intercostal spaces, and one should not hear swooshing sounds as this would be indicative of a pathological heart murmur, especially if heard during diastole. S4 sound is produced by the atrium forcefully contracting against a stiffened ventricle. It is also a dull, low pitched sound. The presence of S4 usually indicates cardiac disease secondary to a decrease in ventricular compliance caused by either ventricular hypertrophy or myocardial ischemia. Q 18: A disparity between the brachial and femoral pulses in a 4-month-old could indicate: a. An atrial septal defect (ASD). b. Tetralogy of Fallot. c. coarctation of the aorta (COA). d. Tricuspid atresia (TA). Detailed Rationale>>> In coarctation of the aorta (COA), there is a disparity of pulses between the upper and lower extremities due to the narrowing of the descending aorta resulting in decreased blood flow to the lower extremities. The other choices do not present with these findings. Q 19: The right lymph duct drains lymphatic fluid from all the following areas except the: a. right side of the head. b. right upper thorax. c. right arm. d. right leg. Detailed Rationale>>> The right lymph duct drains lymphatic fluid from the body's right upper quadrant and includes the right side of the head and neck, right side of the thorax, and right upper limb. The thoracic duct drains lymph from the remainder of the body including the legs. Q 20: When auscultating the apex of the heart in an 8-year-old, the bell of the stethoscope should be placed at the: a. third intercostal space lateral to the midclavicular line. b. fifth intercostal space to the left of the midclavicular line. c. fourth intercostal space lateral of the midclavicular line. d. fifth intercostal space to the right of the midclavicular line. Detailed Rationale>>> In children older than 7 years, the apical pulse, or point of maximum impulse, is heard loudest at the fifth intercostal space and left of the midclavicular line. In children and infants less than seven years, it is heard at the third or fourth intercostal space and lateral to the midclavicular line. The apex would be located on the right side of the chest if dextrocardia was present. Q 21 In order to assess for varicosities in the lower extremities, position the patient: a. lying supine. b. standing. c. sitting facing forward. d. squatting facing the examiner. Detailed Rationale>>> The standing posture allows any varicosities to fill with blood and makes them more easily visible. Q 22: A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with: a. intermittent claudication. b. Raynaud's disease. c. deep venous thrombosis. d. superficial thrombophlebitis. Detailed Rationale>>> Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as tight, and bursting around the affected area. The pain may be accompanied by swelling and tenderness. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Q 23: Symptoms of orthostatic hypotension include all of the following except: syncope. unsteadiness. visual blurring. respiratory rate greater than 30. Detailed Rationale>>> Orthostatic hypotension occurs in 20% of older adults and in up to 50% of frail nursing home residents, especially when they first arise in the morning. Symptoms include lightheadedness, weakness, unsteadiness, visual blurring, and in 20% to 30% of patients, syncope. Q 24: A three-week-old infant presents with a generalized lacy, reticulated blue discoloration of the skin. This is suggestive of: a. mongolian spots. b. harlequin color changes. c. acrocyanosis. d. cutis marmorata. Detailed Rationale>>> Cutis marmorata is a marbled or mottled look about the skin of a newborn caused by the uneven distribution of blood flow about the skin. The cause is due to both the immature vascular and neurologic systems in the newborn. Mongolian spots are blue-gray spots that are flat, "bruise-like" areas of skin. Usually confined to the back and buttocks. Acrocyanosis is a bluish discoloration of the hands, feet and lips. The phenomenon is considered normal to newborns because of immature circulation and underdeveloped capillaries. Q 25: The supraclavicular lymph nodes are located: a. along the anterior edge of the trapezius. b. deep in the angle formed by the clavicle and the sternomastoid muscle. c. superficially to the sternomastoid muscle. d. midway between the angle and the tip of the mandible. Detailed Rationale>>> The supraclavicular lymph nodes are located deep in the angle formed by the clavicle and the sternomastoid muscle. The posterior cervical lymph nodes are located along the anterior edge of the trapezius. The superficial cervical lymph nodes are located superficial to the sternomastoid muscle. Midway between the angle and the tip of the mandible are the submandibular lymph nodes. Q 26: In an adult patient, auscultate the sounds arising from the mitral valve by placing the stethoscope: a. near the apex of the heard between the 5th and 6th intercostal spaces in the mid- clavicular line. b. between the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border. c. between the 2nd and 3rd intercostal spaces at the left sternal border. d. between the 2nd and 3rd intercostal spaces at the right sternal border. Detailed Rationale>>> Auscultation should proceed in a logical manner over 4 general areas on the anterior chest, beginning with the patient in the supine position and using the diaphragm of the stethoscope. Mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. Aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). Pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). Tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Q 27: The tonsillar lymph node is located: a. at the angle of the mandible. b. in front of the ear. c. at the base of the skull posteriorly. d. superficial to the mastoid process. Detailed Rationale>>> The tonsillar lymph nodes are at the angle of the mandible. The preauricular lymph nodes are located in front of the ear. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process. Q 28 A bruit heard in the epigastric area with both systolic and diastolic components is suggestive of: a. Renal artery stenosis. b. Aortic regurgitation. c. Femoral artery occlusion. d. An aortic aneurysm. Detailed Rationale>>>