NU 518 Exam Alabama Cardiac & Vascular Assessment
Questions and Correct Answers
| University of South
Question 1: During cardiac inspection in an adult patient, the nurse practitioner
notes the point of maximal impulse (PMI) displaced laterally. What does this
finding most likely indicate?
A. Normal variant in thin individuals
B. Left ventricular hypertrophy or dilation
C. Right ventricular enlargement
D. Pericardial effusion
CORRECT ANSWER: B. Left ventricular hypertrophy or dilation
Rationale: Lateral displacement of the PMI beyond the midclavicular line in the
5th intercostal space typically reflects left ventricular enlargement due to
conditions such as hypertension, heart failure, or valvular disease, altering the
heart's position and size.
Question 2: When auscultating heart sounds, the nurse practitioner hears a
low-pitched sound immediately after S2 at the apex in a patient with
suspected heart failure. What is this extra sound?
A. Opening snap
B. S3 gallop
C. S4 gallop
D. Pericardial knock
CORRECT ANSWER: B. S3 gallop
Rationale: An S3 gallop is a low-pitched early diastolic sound caused by rapid
ventricular filling, commonly associated with volume overload in heart failure,
best heard at the apex with the bell of the stethoscope.
Question 3: A patient reports intermittent claudication in the calves during
walking that resolves with rest. Which peripheral vascular condition is most
consistent with this history?
A. Chronic venous insufficiency
B. Peripheral arterial disease
C. Deep vein thrombosis
D. Raynaud's phenomenon
CORRECT ANSWER: B. Peripheral arterial disease
Rationale: Intermittent claudication is a classic symptom of peripheral arterial
disease (PAD) due to atherosclerotic narrowing reducing blood flow to the lower
extremities during increased demand.
Question 4: During jugular venous pressure assessment, the nurse
practitioner observes the highest point of pulsation at 4 cm above the
sternal angle with the patient at 45 degrees. What does this indicate?
A. Normal JVP
Page 1 of 43
,B. Elevated JVP suggestive of right-sided heart failure
C. Hypovolemia
D. Superior vena cava obstruction
CORRECT ANSWER: B. Elevated JVP suggestive of right-sided heart failure
Rationale: Normal JVP is less than 3-4 cm above the sternal angle at 45 degrees;
elevation indicates increased central venous pressure often from right heart
failure, fluid overload, or pulmonary hypertension.
Question 5: Which auscultatory area is best for listening to the pulmonic
valve sounds?
A. 2nd intercostal space, right sternal border
B. 2nd intercostal space, left sternal border
C. 5th intercostal space, midclavicular line
D. 4th intercostal space, left sternal border
CORRECT ANSWER: B. 2nd intercostal space, left sternal border
Rationale: The pulmonic area is located at the 2nd intercostal space to the left of
the sternum, where closure of the pulmonic valve contributing to S2 is best
assessed.
Question 6: A bounding carotid pulse with a rapid upstroke and collapse is
noted. This is characteristic of which valvular condition?
A. Mitral stenosis
B. Aortic regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation
CORRECT ANSWER: B. Aortic regurgitation
Rationale: Aortic regurgitation causes a wide pulse pressure leading to a
bounding (Corrigan's or water-hammer) pulse due to rapid diastolic runoff back
into the left ventricle.
Question 7: In peripheral vascular examination, what does a +1 grading of
pedal pulses indicate?
A. Normal
B. Diminished but palpable
C. Absent
D. Bounding
CORRECT ANSWER: B. Diminished but palpable
Rationale: The standard 0-4+ scale rates +1 as a diminished, weak pulse that is
palpable but reduced, often seen in mild arterial insufficiency.
Question 8: During auscultation, a high-pitched, blowing murmur is heard
throughout systole at the apex radiating to the axilla. What is the most
likely cause?
A. Aortic stenosis
Page 2 of 43
,B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonic regurgitation
CORRECT ANSWER: B. Mitral regurgitation
Rationale: Mitral regurgitation produces a holosystolic, high-pitched blowing
murmur at the apex radiating to the left axilla due to backward flow into the
left atrium.
Question 9: What is the primary purpose of assessing capillary refill time in
the extremities?
A. Evaluate venous return
B. Assess peripheral arterial perfusion
C. Measure skin turgor
D. Detect deep vein thrombosis
CORRECT ANSWER: B. Assess peripheral arterial perfusion
Rationale: Capillary refill time greater than 2-3 seconds indicates impaired
arterial blood flow and tissue perfusion, useful in detecting PAD or shock.
Question 10: An S4 heart sound is most commonly associated with which
condition?
A. Volume overload
B. Decreased ventricular compliance (e.g., hypertension)
C. Atrial fibrillation
D. Normal in young adults
CORRECT ANSWER: B. Decreased ventricular compliance (e.g., hypertension)
Rationale: S4 is a late diastolic sound from atrial contraction into a stiff
ventricle, seen in conditions causing ventricular hypertrophy or reduced
compliance.
Question 11: A patient with suspected abdominal aortic aneurysm should
have which finding on palpation?
A. Bruit over the femoral arteries
B. Pulsatile mass in the epigastrium
C. Absent femoral pulses
D. Bilateral lower extremity edema
CORRECT ANSWER: B. Pulsatile mass in the epigastrium
Rationale: An abdominal aortic aneurysm often presents as a pulsatile midline
mass on deep palpation in the upper abdomen.
Question 12: Which maneuver best enhances auscultation of a mitral stenosis
murmur?
A. Patient leaning forward
B. Left lateral decubitus position
Page 3 of 43
, C. Sitting upright
D. Valsalva maneuver
CORRECT ANSWER: B. Left lateral decubitus position
Rationale: The left lateral position brings the apex closer to the chest wall,
improving detection of the low-pitched diastolic rumble of mitral stenosis with
the bell.
Question 13: Unilateral leg swelling, warmth, and positive Homan's sign
suggest:
A. Peripheral arterial disease
B. Deep vein thrombosis
C. Cellulitis only
D. Chronic venous insufficiency
CORRECT ANSWER: B. Deep vein thrombosis
Rationale: These signs indicate possible acute DVT, requiring prompt evaluation
to prevent pulmonary embolism.
Question 14: The splitting of S2 that widens on inspiration is considered:
A. Pathologic fixed splitting
B. Normal physiologic splitting
C. Paradoxical splitting
D. Absent splitting
CORRECT ANSWER: B. Normal physiologic splitting
Rationale: Physiologic splitting of S2 occurs due to delayed pulmonic valve
closure during inspiration from increased venous return to the right heart.
Question 15: In a patient with chronic venous insufficiency, skin changes
typically include:
A. Cool, shiny skin with hair loss
B. Hyperpigmentation, stasis dermatitis, and ulcers around the ankles
C. Pallor on elevation
D. Clubbing of toes
CORRECT ANSWER: B. Hyperpigmentation, stasis dermatitis, and ulcers
around the ankles
Rationale: Venous stasis leads to hemosiderin deposition (brown pigmentation),
eczema-like dermatitis, and venous ulcers usually above the medial malleolus.
Question 16: A thrill palpated at the 2nd right intercostal space suggests:
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic regurgitation
Page 4 of 43
Questions and Correct Answers
| University of South
Question 1: During cardiac inspection in an adult patient, the nurse practitioner
notes the point of maximal impulse (PMI) displaced laterally. What does this
finding most likely indicate?
A. Normal variant in thin individuals
B. Left ventricular hypertrophy or dilation
C. Right ventricular enlargement
D. Pericardial effusion
CORRECT ANSWER: B. Left ventricular hypertrophy or dilation
Rationale: Lateral displacement of the PMI beyond the midclavicular line in the
5th intercostal space typically reflects left ventricular enlargement due to
conditions such as hypertension, heart failure, or valvular disease, altering the
heart's position and size.
Question 2: When auscultating heart sounds, the nurse practitioner hears a
low-pitched sound immediately after S2 at the apex in a patient with
suspected heart failure. What is this extra sound?
A. Opening snap
B. S3 gallop
C. S4 gallop
D. Pericardial knock
CORRECT ANSWER: B. S3 gallop
Rationale: An S3 gallop is a low-pitched early diastolic sound caused by rapid
ventricular filling, commonly associated with volume overload in heart failure,
best heard at the apex with the bell of the stethoscope.
Question 3: A patient reports intermittent claudication in the calves during
walking that resolves with rest. Which peripheral vascular condition is most
consistent with this history?
A. Chronic venous insufficiency
B. Peripheral arterial disease
C. Deep vein thrombosis
D. Raynaud's phenomenon
CORRECT ANSWER: B. Peripheral arterial disease
Rationale: Intermittent claudication is a classic symptom of peripheral arterial
disease (PAD) due to atherosclerotic narrowing reducing blood flow to the lower
extremities during increased demand.
Question 4: During jugular venous pressure assessment, the nurse
practitioner observes the highest point of pulsation at 4 cm above the
sternal angle with the patient at 45 degrees. What does this indicate?
A. Normal JVP
Page 1 of 43
,B. Elevated JVP suggestive of right-sided heart failure
C. Hypovolemia
D. Superior vena cava obstruction
CORRECT ANSWER: B. Elevated JVP suggestive of right-sided heart failure
Rationale: Normal JVP is less than 3-4 cm above the sternal angle at 45 degrees;
elevation indicates increased central venous pressure often from right heart
failure, fluid overload, or pulmonary hypertension.
Question 5: Which auscultatory area is best for listening to the pulmonic
valve sounds?
A. 2nd intercostal space, right sternal border
B. 2nd intercostal space, left sternal border
C. 5th intercostal space, midclavicular line
D. 4th intercostal space, left sternal border
CORRECT ANSWER: B. 2nd intercostal space, left sternal border
Rationale: The pulmonic area is located at the 2nd intercostal space to the left of
the sternum, where closure of the pulmonic valve contributing to S2 is best
assessed.
Question 6: A bounding carotid pulse with a rapid upstroke and collapse is
noted. This is characteristic of which valvular condition?
A. Mitral stenosis
B. Aortic regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation
CORRECT ANSWER: B. Aortic regurgitation
Rationale: Aortic regurgitation causes a wide pulse pressure leading to a
bounding (Corrigan's or water-hammer) pulse due to rapid diastolic runoff back
into the left ventricle.
Question 7: In peripheral vascular examination, what does a +1 grading of
pedal pulses indicate?
A. Normal
B. Diminished but palpable
C. Absent
D. Bounding
CORRECT ANSWER: B. Diminished but palpable
Rationale: The standard 0-4+ scale rates +1 as a diminished, weak pulse that is
palpable but reduced, often seen in mild arterial insufficiency.
Question 8: During auscultation, a high-pitched, blowing murmur is heard
throughout systole at the apex radiating to the axilla. What is the most
likely cause?
A. Aortic stenosis
Page 2 of 43
,B. Mitral regurgitation
C. Tricuspid stenosis
D. Pulmonic regurgitation
CORRECT ANSWER: B. Mitral regurgitation
Rationale: Mitral regurgitation produces a holosystolic, high-pitched blowing
murmur at the apex radiating to the left axilla due to backward flow into the
left atrium.
Question 9: What is the primary purpose of assessing capillary refill time in
the extremities?
A. Evaluate venous return
B. Assess peripheral arterial perfusion
C. Measure skin turgor
D. Detect deep vein thrombosis
CORRECT ANSWER: B. Assess peripheral arterial perfusion
Rationale: Capillary refill time greater than 2-3 seconds indicates impaired
arterial blood flow and tissue perfusion, useful in detecting PAD or shock.
Question 10: An S4 heart sound is most commonly associated with which
condition?
A. Volume overload
B. Decreased ventricular compliance (e.g., hypertension)
C. Atrial fibrillation
D. Normal in young adults
CORRECT ANSWER: B. Decreased ventricular compliance (e.g., hypertension)
Rationale: S4 is a late diastolic sound from atrial contraction into a stiff
ventricle, seen in conditions causing ventricular hypertrophy or reduced
compliance.
Question 11: A patient with suspected abdominal aortic aneurysm should
have which finding on palpation?
A. Bruit over the femoral arteries
B. Pulsatile mass in the epigastrium
C. Absent femoral pulses
D. Bilateral lower extremity edema
CORRECT ANSWER: B. Pulsatile mass in the epigastrium
Rationale: An abdominal aortic aneurysm often presents as a pulsatile midline
mass on deep palpation in the upper abdomen.
Question 12: Which maneuver best enhances auscultation of a mitral stenosis
murmur?
A. Patient leaning forward
B. Left lateral decubitus position
Page 3 of 43
, C. Sitting upright
D. Valsalva maneuver
CORRECT ANSWER: B. Left lateral decubitus position
Rationale: The left lateral position brings the apex closer to the chest wall,
improving detection of the low-pitched diastolic rumble of mitral stenosis with
the bell.
Question 13: Unilateral leg swelling, warmth, and positive Homan's sign
suggest:
A. Peripheral arterial disease
B. Deep vein thrombosis
C. Cellulitis only
D. Chronic venous insufficiency
CORRECT ANSWER: B. Deep vein thrombosis
Rationale: These signs indicate possible acute DVT, requiring prompt evaluation
to prevent pulmonary embolism.
Question 14: The splitting of S2 that widens on inspiration is considered:
A. Pathologic fixed splitting
B. Normal physiologic splitting
C. Paradoxical splitting
D. Absent splitting
CORRECT ANSWER: B. Normal physiologic splitting
Rationale: Physiologic splitting of S2 occurs due to delayed pulmonic valve
closure during inspiration from increased venous return to the right heart.
Question 15: In a patient with chronic venous insufficiency, skin changes
typically include:
A. Cool, shiny skin with hair loss
B. Hyperpigmentation, stasis dermatitis, and ulcers around the ankles
C. Pallor on elevation
D. Clubbing of toes
CORRECT ANSWER: B. Hyperpigmentation, stasis dermatitis, and ulcers
around the ankles
Rationale: Venous stasis leads to hemosiderin deposition (brown pigmentation),
eczema-like dermatitis, and venous ulcers usually above the medial malleolus.
Question 16: A thrill palpated at the 2nd right intercostal space suggests:
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic regurgitation
Page 4 of 43
