NURS 6565 Week 4 Quiz: Comprehensive
Assessment QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Cardiology & Vascular Disorders
1. A 72-year-old male presents with fatigue, shortness of breath when climbing
stairs, and bilateral ankle edema. On auscultation, you hear an S3 gallop.
What is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Infective endocarditis
• C) Congestive heart failure (CHF)
• D) Dissecting abdominal aortic aneurysm
Rationale: The triad of fatigue, dyspnea on exertion, and peripheral edema is
classic for CHF. An S3 gallop is a hallmark sign of ventricular volume overload
and reduced ejection fraction .
2. A 65-year-old woman with a history of smoking and hypertension presents
for a follow-up. Her mother died of a heart attack at age 40. Her LDL is 200
mg/dL. According to the latest guidelines, what is the best next step in
addition to therapeutic lifestyle changes?
• A) Bile acid sequestrant
• B) A statin drug
• C) A cholesterol absorption inhibitor
• D) Low-dose aspirin
,Rationale: Given her age, smoking history, hypertension, and very high LDL
(>190 mg/dL) along with a strong family history of premature CVD, she is at high
risk and requires high-intensity statin therapy for primary prevention .
3. On cardiac auscultation, you appreciate a murmur that is very loud,
palpable as a thrill, and audible with the stethoscope partially off the chest.
How would you grade this murmur?
• A) Grade III
• B) Grade IV
• C) Grade VI
• D) Grade V
Rationale: Murmur grading: Grade I is faint, Grade II is quiet, Grade III is
moderately loud, Grade IV is loud with a thrill, Grade V is very loud with a thrill
(audible with scope edge on chest), and Grade VI is audible with the scope off the
chest .
4. A patient presents with a blood pressure of 150/95 mmHg on three separate
occasions. She has no known cause. This is classified as:
• A) Secondary hypertension
• B) Essential hypertension
• C) Isolated systolic hypertension
• D) Hypertensive urgency
Rationale: Essential (or primary) hypertension is diagnosed when there is no
identifiable secondary cause, accounting for 95% of cases. Secondary hypertension
results from renal disease, endocrine disorders, or medication use .
5. A patient presents with chest pain and an ECG showing ST-segment
elevation in leads II, III, and aVF. Which area of the heart is likely affected?
• A) Anterior
• B) Septal
• C) Inferior
• D) Lateral
, Rationale: ECG leads correspond to specific myocardial territories. Leads II, III,
and aVF view the inferior wall of the left ventricle .
6. An elderly patient with atrial fibrillation has a CHADS₂ score of 3. What is
the appropriate management?
• A) Aspirin only
• B) Clopidogrel only
• C) Anticoagulation therapy (e.g., warfarin or DOAC)
• D) No treatment needed
Rationale: The CHADS₂ score predicts stroke risk in atrial fibrillation. A score ≥2
indicates a high risk of stroke, requiring systemic anticoagulation. Points are given
for CHF, HTN, Age ≥75, DM, and prior Stroke/TIA (2 points) .
7. A patient with a prosthetic heart valve presents with fever, chills, a new
heart murmur, splinter hemorrhages, and petechiae on the palate. What is the
presumptive diagnosis?
• A) Congestive heart failure
• B) Infective endocarditis
• C) Rheumatic heart disease
• D) Pericarditis
Rationale: The combination of a prosthetic valve (high-risk factor), fever, a new
murmur, and peripheral stigmata (splinter hemorrhages, petechiae) is highly
indicative of infective endocarditis until proven otherwise .
Section 2: Pulmonology & Respiratory Disorders
8. A 22-year-old male presents with a 5-day history of cough without sputum,
worse in the morning, with hoarseness and post-nasal drip. He has a low-
grade fever. What treatment is NOT indicated?
• A) Rest
• B) Mucolytics
• C) Antibiotics
Assessment QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Cardiology & Vascular Disorders
1. A 72-year-old male presents with fatigue, shortness of breath when climbing
stairs, and bilateral ankle edema. On auscultation, you hear an S3 gallop.
What is the most likely diagnosis?
• A) Acute myocardial infarction
• B) Infective endocarditis
• C) Congestive heart failure (CHF)
• D) Dissecting abdominal aortic aneurysm
Rationale: The triad of fatigue, dyspnea on exertion, and peripheral edema is
classic for CHF. An S3 gallop is a hallmark sign of ventricular volume overload
and reduced ejection fraction .
2. A 65-year-old woman with a history of smoking and hypertension presents
for a follow-up. Her mother died of a heart attack at age 40. Her LDL is 200
mg/dL. According to the latest guidelines, what is the best next step in
addition to therapeutic lifestyle changes?
• A) Bile acid sequestrant
• B) A statin drug
• C) A cholesterol absorption inhibitor
• D) Low-dose aspirin
,Rationale: Given her age, smoking history, hypertension, and very high LDL
(>190 mg/dL) along with a strong family history of premature CVD, she is at high
risk and requires high-intensity statin therapy for primary prevention .
3. On cardiac auscultation, you appreciate a murmur that is very loud,
palpable as a thrill, and audible with the stethoscope partially off the chest.
How would you grade this murmur?
• A) Grade III
• B) Grade IV
• C) Grade VI
• D) Grade V
Rationale: Murmur grading: Grade I is faint, Grade II is quiet, Grade III is
moderately loud, Grade IV is loud with a thrill, Grade V is very loud with a thrill
(audible with scope edge on chest), and Grade VI is audible with the scope off the
chest .
4. A patient presents with a blood pressure of 150/95 mmHg on three separate
occasions. She has no known cause. This is classified as:
• A) Secondary hypertension
• B) Essential hypertension
• C) Isolated systolic hypertension
• D) Hypertensive urgency
Rationale: Essential (or primary) hypertension is diagnosed when there is no
identifiable secondary cause, accounting for 95% of cases. Secondary hypertension
results from renal disease, endocrine disorders, or medication use .
5. A patient presents with chest pain and an ECG showing ST-segment
elevation in leads II, III, and aVF. Which area of the heart is likely affected?
• A) Anterior
• B) Septal
• C) Inferior
• D) Lateral
, Rationale: ECG leads correspond to specific myocardial territories. Leads II, III,
and aVF view the inferior wall of the left ventricle .
6. An elderly patient with atrial fibrillation has a CHADS₂ score of 3. What is
the appropriate management?
• A) Aspirin only
• B) Clopidogrel only
• C) Anticoagulation therapy (e.g., warfarin or DOAC)
• D) No treatment needed
Rationale: The CHADS₂ score predicts stroke risk in atrial fibrillation. A score ≥2
indicates a high risk of stroke, requiring systemic anticoagulation. Points are given
for CHF, HTN, Age ≥75, DM, and prior Stroke/TIA (2 points) .
7. A patient with a prosthetic heart valve presents with fever, chills, a new
heart murmur, splinter hemorrhages, and petechiae on the palate. What is the
presumptive diagnosis?
• A) Congestive heart failure
• B) Infective endocarditis
• C) Rheumatic heart disease
• D) Pericarditis
Rationale: The combination of a prosthetic valve (high-risk factor), fever, a new
murmur, and peripheral stigmata (splinter hemorrhages, petechiae) is highly
indicative of infective endocarditis until proven otherwise .
Section 2: Pulmonology & Respiratory Disorders
8. A 22-year-old male presents with a 5-day history of cough without sputum,
worse in the morning, with hoarseness and post-nasal drip. He has a low-
grade fever. What treatment is NOT indicated?
• A) Rest
• B) Mucolytics
• C) Antibiotics
