MSN 610 Cardiac Assessment Midterm
Actual Review & Exam Preparation for
2026/2027 Academic Year
DOMAIN 1: CARDIAC ANATOMY, PHYSIOLOGY & HEMODYNAMICS (Q1-15)
1. During cardiac assessment, the nurse practitioner recalls that the point of maximal
impulse (PMI) is normally located at the 5th intercostal space, midclavicular line. This
corresponds to the anatomical location of the:
A. Right ventricular apex
B. Left atrial appendage
C. Left ventricular apex
D. Tricuspid valve area
Correct Answer: C
Rationale: C is correct. The point of maximal impulse (PMI) represents the left
ventricular apex where it contacts the chest wall during systole. Normal location is the
5th intercostal space at the midclavicular line. The right ventricle (A) lies beneath the
sternum. The left atrial appendage (B) is not normally palpable. The tricuspid valve (D)
is located at the 4th left intercostal space.
2. A patient's echocardiogram shows an ejection fraction of 40% with left ventricular
dilation. The nurse practitioner understands this represents impaired:
A. Diastolic function (ventricular filling)
B. Systolic function (ventricular contraction)
C. Atrial kick (late diastolic filling)
D. Preload optimization (venous return)
,Correct Answer: B
Rationale: B is correct. Ejection fraction measures the percentage of blood ejected from
the ventricle during systole, directly assessing systolic function. An EF <50% indicates
systolic dysfunction. Diastolic function (A) relates to ventricular filling and relaxation.
Atrial kick (C) contributes 20-30% of ventricular filling but doesn't primarily affect EF.
Preload (D) influences stroke volume but is not the direct measure provided by EF.
3. The nurse practitioner explains to a patient that the S1 heart sound corresponds to
closure of which valves, marking the beginning of:
A. Aortic and pulmonic valves; beginning of diastole (incorrect valves and phase)
B. Mitral and tricuspid valves; beginning of diastole (correct valves, wrong phase)
C. Mitral and tricuspid valves; beginning of systole (correct valves and phase)
D. Aortic and pulmonic valves; beginning of systole (incorrect valves)
Correct Answer: C
Rationale: C is correct. S1 (the "lub") represents closure of the mitral and tricuspid
valves (atrioventricular valves), marking the beginning of systole (ventricular
contraction). The mitral valve closes slightly before the tricuspid, creating the split S1
sound. Aortic and pulmonic valves (A, D) produce S2. Diastole (B) begins with S2, not
S1. Understanding the cardiac cycle phases is essential for interpreting heart sounds
and murmur timing.
4. During hemodynamic assessment, the nurse practitioner notes a pulmonary capillary
wedge pressure (PCWP) of 24 mmHg. Normal PCWP is 6-12 mmHg. This elevated
PCWP most accurately reflects:
A. Right ventricular preload (measured by CVP, not PCWP)
B. Left atrial pressure (PCWP is surrogate measure of left heart filling pressures)
C. Systemic vascular resistance (calculated from arterial pressure and cardiac output)
D. Pulmonary artery systolic pressure (measured directly by pulmonary artery catheter)
Correct Answer: B
Rationale: B is correct. Pulmonary capillary wedge pressure (PCWP) is a surrogate
measure of left atrial pressure and left ventricular end-diastolic pressure (preload),
obtained when the pulmonary artery catheter balloon is inflated to occlude flow. Normal
,is 6-12 mmHg; 24 mmHg indicates elevated left heart pressures (heart failure, volume
overload). Right ventricular preload (A) is measured by CVP. Systemic vascular
resistance (C) requires calculation. Pulmonary artery systolic pressure (D) is a separate
measurement.
5. A patient with severe aortic stenosis has delayed pulse upstroke (pulsus parvus et
tardus). The nurse practitioner understands this results from:
A. Increased stroke volume ejecting rapidly through stenotic valve
B. Decreased left ventricular contractility reducing pulse pressure
C. Obstruction to left ventricular outflow prolonging ejection time
D. Peripheral vasodilation reducing systemic vascular resistance
Correct Answer: C
Rationale: C is correct. Pulsus parvus et tardus (weak and delayed pulse) in aortic
stenosis results from obstruction to left ventricular outflow, which prolongs ejection
time and reduces the rate of pressure rise in the aorta. The stenotic valve creates a
pressure gradient that impedes rapid systolic ejection. Increased stroke volume (A)
would produce bounding pulses. Decreased contractility (B) reduces pulse strength but
doesn't specifically cause delayed upstroke. Peripheral vasodilation (D) would reduce
diastolic pressure but not delay systolic upstroke.
6. The nurse practitioner is explaining Frank-Starling mechanism to a patient with heart
failure. This physiological principle states that:
A. Increased heart rate always increases cardiac output proportionally
B. Increased afterload improves ventricular contraction strength
C. Increased ventricular preload (stretch) increases contractile force up to a
physiological limit
D. Decreased venous return improves cardiac efficiency
Correct Answer: C
Rationale: C is correct. The Frank-Starling law states that increased ventricular preload
(end-diastolic volume/pressure, which stretches cardiac muscle fibers) increases the
force of contraction (stroke volume) up to an optimal physiological limit. Beyond this
, limit (as in heart failure), further stretch reduces contractile efficiency. Heart rate (A)
affects output but is not the Frank-Starling mechanism. Afterload (B) opposes ejection.
Decreased venous return (D) reduces preload and output.
7. During assessment of cardiac output, the nurse practitioner recalls that the primary
determinants include all EXCEPT:
A. Heart rate
B. Stroke volume
C. Systemic vascular resistance
D. Preload, afterload, and contractility (which determine stroke volume)
Correct Answer: C
Rationale: C is correct. Cardiac output (CO) = Heart rate (HR) × Stroke volume (SV).
Stroke volume is determined by preload, afterload, and contractility. Systemic vascular
resistance (SVR) is not a direct determinant of cardiac output but rather the resistance
against which the heart must pump (afterload component). SVR affects blood pressure
(MAP = CO × SVR) and ventricular workload, but CO is calculated from HR and SV only.
8. A patient with hypertrophic cardiomyopathy has dynamic left ventricular outflow tract
obstruction. The nurse practitioner understands that this obstruction WORSENS with:
A. Increased preload (volume expansion moves septum away from wall)
B. Decreased afterload (reduced aortic pressure increases gradient)
C. Increased contractility (vigorous contraction narrows outflow tract)
D. Squatting (increases venous return and afterload, reduces obstruction)
Correct Answer: C
Rationale: C is correct. In hypertrophic cardiomyopathy (HCM), the dynamic obstruction
worsens with maneuvers that increase contractility (digitalis, beta-agonists, exercise) or
decrease preload/afterload (vasodilators, diuretics, standing). Increased contractility
brings the hypertrophied septum closer to the anterior mitral leaflet, narrowing the
outflow tract. Increased preload (A) improves filling and reduces obstruction. Decreased
afterload (B) worsens obstruction. Squatting (D) increases both preload and afterload,
reducing obstruction (relief of symptoms on squatting is characteristic).
Actual Review & Exam Preparation for
2026/2027 Academic Year
DOMAIN 1: CARDIAC ANATOMY, PHYSIOLOGY & HEMODYNAMICS (Q1-15)
1. During cardiac assessment, the nurse practitioner recalls that the point of maximal
impulse (PMI) is normally located at the 5th intercostal space, midclavicular line. This
corresponds to the anatomical location of the:
A. Right ventricular apex
B. Left atrial appendage
C. Left ventricular apex
D. Tricuspid valve area
Correct Answer: C
Rationale: C is correct. The point of maximal impulse (PMI) represents the left
ventricular apex where it contacts the chest wall during systole. Normal location is the
5th intercostal space at the midclavicular line. The right ventricle (A) lies beneath the
sternum. The left atrial appendage (B) is not normally palpable. The tricuspid valve (D)
is located at the 4th left intercostal space.
2. A patient's echocardiogram shows an ejection fraction of 40% with left ventricular
dilation. The nurse practitioner understands this represents impaired:
A. Diastolic function (ventricular filling)
B. Systolic function (ventricular contraction)
C. Atrial kick (late diastolic filling)
D. Preload optimization (venous return)
,Correct Answer: B
Rationale: B is correct. Ejection fraction measures the percentage of blood ejected from
the ventricle during systole, directly assessing systolic function. An EF <50% indicates
systolic dysfunction. Diastolic function (A) relates to ventricular filling and relaxation.
Atrial kick (C) contributes 20-30% of ventricular filling but doesn't primarily affect EF.
Preload (D) influences stroke volume but is not the direct measure provided by EF.
3. The nurse practitioner explains to a patient that the S1 heart sound corresponds to
closure of which valves, marking the beginning of:
A. Aortic and pulmonic valves; beginning of diastole (incorrect valves and phase)
B. Mitral and tricuspid valves; beginning of diastole (correct valves, wrong phase)
C. Mitral and tricuspid valves; beginning of systole (correct valves and phase)
D. Aortic and pulmonic valves; beginning of systole (incorrect valves)
Correct Answer: C
Rationale: C is correct. S1 (the "lub") represents closure of the mitral and tricuspid
valves (atrioventricular valves), marking the beginning of systole (ventricular
contraction). The mitral valve closes slightly before the tricuspid, creating the split S1
sound. Aortic and pulmonic valves (A, D) produce S2. Diastole (B) begins with S2, not
S1. Understanding the cardiac cycle phases is essential for interpreting heart sounds
and murmur timing.
4. During hemodynamic assessment, the nurse practitioner notes a pulmonary capillary
wedge pressure (PCWP) of 24 mmHg. Normal PCWP is 6-12 mmHg. This elevated
PCWP most accurately reflects:
A. Right ventricular preload (measured by CVP, not PCWP)
B. Left atrial pressure (PCWP is surrogate measure of left heart filling pressures)
C. Systemic vascular resistance (calculated from arterial pressure and cardiac output)
D. Pulmonary artery systolic pressure (measured directly by pulmonary artery catheter)
Correct Answer: B
Rationale: B is correct. Pulmonary capillary wedge pressure (PCWP) is a surrogate
measure of left atrial pressure and left ventricular end-diastolic pressure (preload),
obtained when the pulmonary artery catheter balloon is inflated to occlude flow. Normal
,is 6-12 mmHg; 24 mmHg indicates elevated left heart pressures (heart failure, volume
overload). Right ventricular preload (A) is measured by CVP. Systemic vascular
resistance (C) requires calculation. Pulmonary artery systolic pressure (D) is a separate
measurement.
5. A patient with severe aortic stenosis has delayed pulse upstroke (pulsus parvus et
tardus). The nurse practitioner understands this results from:
A. Increased stroke volume ejecting rapidly through stenotic valve
B. Decreased left ventricular contractility reducing pulse pressure
C. Obstruction to left ventricular outflow prolonging ejection time
D. Peripheral vasodilation reducing systemic vascular resistance
Correct Answer: C
Rationale: C is correct. Pulsus parvus et tardus (weak and delayed pulse) in aortic
stenosis results from obstruction to left ventricular outflow, which prolongs ejection
time and reduces the rate of pressure rise in the aorta. The stenotic valve creates a
pressure gradient that impedes rapid systolic ejection. Increased stroke volume (A)
would produce bounding pulses. Decreased contractility (B) reduces pulse strength but
doesn't specifically cause delayed upstroke. Peripheral vasodilation (D) would reduce
diastolic pressure but not delay systolic upstroke.
6. The nurse practitioner is explaining Frank-Starling mechanism to a patient with heart
failure. This physiological principle states that:
A. Increased heart rate always increases cardiac output proportionally
B. Increased afterload improves ventricular contraction strength
C. Increased ventricular preload (stretch) increases contractile force up to a
physiological limit
D. Decreased venous return improves cardiac efficiency
Correct Answer: C
Rationale: C is correct. The Frank-Starling law states that increased ventricular preload
(end-diastolic volume/pressure, which stretches cardiac muscle fibers) increases the
force of contraction (stroke volume) up to an optimal physiological limit. Beyond this
, limit (as in heart failure), further stretch reduces contractile efficiency. Heart rate (A)
affects output but is not the Frank-Starling mechanism. Afterload (B) opposes ejection.
Decreased venous return (D) reduces preload and output.
7. During assessment of cardiac output, the nurse practitioner recalls that the primary
determinants include all EXCEPT:
A. Heart rate
B. Stroke volume
C. Systemic vascular resistance
D. Preload, afterload, and contractility (which determine stroke volume)
Correct Answer: C
Rationale: C is correct. Cardiac output (CO) = Heart rate (HR) × Stroke volume (SV).
Stroke volume is determined by preload, afterload, and contractility. Systemic vascular
resistance (SVR) is not a direct determinant of cardiac output but rather the resistance
against which the heart must pump (afterload component). SVR affects blood pressure
(MAP = CO × SVR) and ventricular workload, but CO is calculated from HR and SV only.
8. A patient with hypertrophic cardiomyopathy has dynamic left ventricular outflow tract
obstruction. The nurse practitioner understands that this obstruction WORSENS with:
A. Increased preload (volume expansion moves septum away from wall)
B. Decreased afterload (reduced aortic pressure increases gradient)
C. Increased contractility (vigorous contraction narrows outflow tract)
D. Squatting (increases venous return and afterload, reduces obstruction)
Correct Answer: C
Rationale: C is correct. In hypertrophic cardiomyopathy (HCM), the dynamic obstruction
worsens with maneuvers that increase contractility (digitalis, beta-agonists, exercise) or
decrease preload/afterload (vasodilators, diuretics, standing). Increased contractility
brings the hypertrophied septum closer to the anterior mitral leaflet, narrowing the
outflow tract. Increased preload (A) improves filling and reduces obstruction. Decreased
afterload (B) worsens obstruction. Squatting (D) increases both preload and afterload,
reducing obstruction (relief of symptoms on squatting is characteristic).
