NURS 571 Midterm Q & A Latest update
2025
Aplastic Anemia --- correct answers ---Decreased prod of RBCs,
decreased retic count.
Cause: infection, more common in peds
- Pancytopenia, tx underlying cause: chemo, rad, drugs, toxins,
autoimmune
Hemolytic Anemia --- correct answers ---Intrinsic causes: sickle cell,
thalassemia, destruction from INSIDE RBC
Extrinsic: autoimmune, TTP, DIC, infections, burns, artificial heart
valves, ECMO, bypass
- Dx: Haptoglobin low, Retic count high, LDH high, bili high
- Tx: Tx underlying cause
Valvular disease --- correct answers ---Stenosis: narrowing, valves
don't open properly. Causes obstructed forward blood flow
- Stenotic murmurs: rough, harsh, rumbling, whooshing
,Regurgitation: insufficiency, backward flow from valve, blood goes
back in
- Regurgitation murmurs: soft, musical, tinkling
Murmur is heard during part of cardiac cycle when blood flows
abnormally through valves
Valve anatomy --- correct answers ---SYSTOLE: Aortic and pulmonic
valves open
DIASTOLE: Mitral and tricuspid valves open
R side heart: Tricuspid, pulmonic
L side heart: Mitral, aortic
- R side more challenging to hear murmurs (L side of heart is larger)
Levine scale of murmurs --- correct answers ---1. The murmur is only
audible after listening a long time.
2. The murmur is faint, but audible immediately after placing the
stethoscope on the chest.
3. A loud murmur is readily audible, but with no palpable thrill.
,4. A loud murmur with a palpable thrill.
5. A loud murmur with a palpable thrill. The murmur is so loud that it
is audible with only the rim of the stethoscope touching the chest.
6. A loud murmur with a palpable thrill. The murmur is so loud that it
is audible with the stethoscope not on the chest, but lifted just off it
Tricuspid Regurgitation --- correct answers ---TV: splits RA and RV.
Should be open during diastole
- Backflow of blood into RA
- Causes: abnormality of valve, prolapse, plaque, inflammation,
endocarditis (IVDU), RV pacemaker injury
- Systolic murmur may be present, S3 may be present
Dx: R side of heart (reflective of lungs), if louder on INspiration, then
it is tricuspid murmur
- TTE, TEE
Tx: diuretics, tx pulm HTN, reduce RV size
Tricuspid stenosis --- correct answers ---Heard during DIASTOLE, d/t
rheumatic disease.
, - S/S: R HF, congestion d/t increased blood in RA, hepatomegaly,
ascites, peripheral edema
- Dx: diastolic murmur, EKG- RA enlargement, tall peaked T waves
Pulmonic regurgitation --- correct answers ---Pulmonic valve, OPEN
during systole. If trouble closing, hear murmur during DIAstole
- Rare, congenital or acquired. Often caused by severe pulm HTN
- Graham Steel murmur, heard on L sternal border
Pulmonic stenosis --- correct answers ---Obstruction of flow from RV
to PA, usually dx in childhood
- d/t valve obstruction, congenital heart disease
Mitral stenosis --- correct answers ---Divides LA and LV. Should be
open during DIAstole. hear murmur during diastole. MV is biscuspid
- Cause: rheumatic endocarditis
- S/S: LA pressure increases, opening snap following A2. Best heard in
L lateral position (bring heart closer to chest wall). Fatigue, DOE,
pulmonary symptoms d/t backup of blood to pulm system. Check for
AFIB.
2025
Aplastic Anemia --- correct answers ---Decreased prod of RBCs,
decreased retic count.
Cause: infection, more common in peds
- Pancytopenia, tx underlying cause: chemo, rad, drugs, toxins,
autoimmune
Hemolytic Anemia --- correct answers ---Intrinsic causes: sickle cell,
thalassemia, destruction from INSIDE RBC
Extrinsic: autoimmune, TTP, DIC, infections, burns, artificial heart
valves, ECMO, bypass
- Dx: Haptoglobin low, Retic count high, LDH high, bili high
- Tx: Tx underlying cause
Valvular disease --- correct answers ---Stenosis: narrowing, valves
don't open properly. Causes obstructed forward blood flow
- Stenotic murmurs: rough, harsh, rumbling, whooshing
,Regurgitation: insufficiency, backward flow from valve, blood goes
back in
- Regurgitation murmurs: soft, musical, tinkling
Murmur is heard during part of cardiac cycle when blood flows
abnormally through valves
Valve anatomy --- correct answers ---SYSTOLE: Aortic and pulmonic
valves open
DIASTOLE: Mitral and tricuspid valves open
R side heart: Tricuspid, pulmonic
L side heart: Mitral, aortic
- R side more challenging to hear murmurs (L side of heart is larger)
Levine scale of murmurs --- correct answers ---1. The murmur is only
audible after listening a long time.
2. The murmur is faint, but audible immediately after placing the
stethoscope on the chest.
3. A loud murmur is readily audible, but with no palpable thrill.
,4. A loud murmur with a palpable thrill.
5. A loud murmur with a palpable thrill. The murmur is so loud that it
is audible with only the rim of the stethoscope touching the chest.
6. A loud murmur with a palpable thrill. The murmur is so loud that it
is audible with the stethoscope not on the chest, but lifted just off it
Tricuspid Regurgitation --- correct answers ---TV: splits RA and RV.
Should be open during diastole
- Backflow of blood into RA
- Causes: abnormality of valve, prolapse, plaque, inflammation,
endocarditis (IVDU), RV pacemaker injury
- Systolic murmur may be present, S3 may be present
Dx: R side of heart (reflective of lungs), if louder on INspiration, then
it is tricuspid murmur
- TTE, TEE
Tx: diuretics, tx pulm HTN, reduce RV size
Tricuspid stenosis --- correct answers ---Heard during DIASTOLE, d/t
rheumatic disease.
, - S/S: R HF, congestion d/t increased blood in RA, hepatomegaly,
ascites, peripheral edema
- Dx: diastolic murmur, EKG- RA enlargement, tall peaked T waves
Pulmonic regurgitation --- correct answers ---Pulmonic valve, OPEN
during systole. If trouble closing, hear murmur during DIAstole
- Rare, congenital or acquired. Often caused by severe pulm HTN
- Graham Steel murmur, heard on L sternal border
Pulmonic stenosis --- correct answers ---Obstruction of flow from RV
to PA, usually dx in childhood
- d/t valve obstruction, congenital heart disease
Mitral stenosis --- correct answers ---Divides LA and LV. Should be
open during DIAstole. hear murmur during diastole. MV is biscuspid
- Cause: rheumatic endocarditis
- S/S: LA pressure increases, opening snap following A2. Best heard in
L lateral position (bring heart closer to chest wall). Fatigue, DOE,
pulmonary symptoms d/t backup of blood to pulm system. Check for
AFIB.
