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NUR 521 Exam 4 Blueprint Practice 20262027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A patient with a history of chronic heart failure is admitted with
dyspnea and orthopnea. Which hemodynamic parameter would the
nurse expect to be elevated, directly reflecting increased left
ventricular preload?
A) Systemic vascular resistance (SVR)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Central venous pressure (CVP)
Answer: B) Pulmonary artery wedge pressure (PAWP)
Explanation: PAWP is measured by inflating a balloon-tipped catheter in
a branch of the pulmonary artery, which temporarily blocks flow and
reflects the pressure downstream in the left atrium and left ventricle
during diastole. This directly indicates left ventricular preload. In left-
sided heart failure, the left ventricle fails to effectively eject blood,
causing blood to back up into the left atrium and pulmonary
vasculature, thus elevating PAWP. SVR reflects afterload, CVP reflects
right ventricular preload, and CO is often decreased in heart failure.
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2. Which assessment finding most strongly indicates a patient's
compensatory mechanism for decreased cardiac output is mediated by
the renin-angiotensin-aldosterone system (RAAS)?
A) Cool, clammy skin
B) Jugular venous distention
C) Peripheral edema and weight gain
D) Sinus tachycardia on the ECG monitor
Answer: C) Peripheral edema and weight gain
Explanation: RAAS activation, triggered by decreased renal perfusion,
leads to the release of aldosterone, causing sodium and water
retention by the kidneys. This fluid retention manifests as peripheral
edema and rapid weight gain, increasing preload in an attempt to
improve cardiac output. Cool, clammy skin is due to sympathetic
nervous system-mediated vasoconstriction. Jugular venous distention
reflects increased right-sided heart pressures. Sinus tachycardia is a
direct result of sympathetic nervous system stimulation of the sinoatrial
node.
3. A nurse is administering intravenous metoprolol to a patient with an
acute myocardial infarction. Which therapeutic effect of this
medication directly reduces myocardial oxygen demand?
A) Vasodilation of coronary arteries
B) Reduction of heart rate and contractility
C) Inhibition of platelet aggregation
D) Increase in serum potassium levels
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Answer: B) Reduction of heart rate and contractility
Explanation: Metoprolol is a beta-1 adrenergic blocker that selectively
blocks the effects of catecholamines on the heart. This results in a
negative chronotropic (decreased heart rate) and negative inotropic
(decreased contractility) effect. By reducing heart rate and the force of
contraction, the workload of the heart and its demand for oxygen are
diminished. This is distinct from vasodilation, which is an antiplatelet or
potassium-related effect.
4. While caring for a patient with severe mitral valve regurgitation, the
nurse auscultates a holosystolic murmur. What pathophysiological
event creates this specific sound?
A) Turbulent forward flow through a stenotic aortic valve
B) Retrograde blood flow from the left ventricle to the left atrium
throughout systole
C) High-pressure flow from the left ventricle during early diastole
D) Retrograde blood flow from the aorta to the left ventricle during
diastole
Answer: B) Retrograde blood flow from the left ventricle to the left
atrium throughout systole
Explanation: In mitral regurgitation, the valve leaflets fail to close
completely during ventricular systole. As the left ventricle contracts to
eject blood into the aorta, a portion of the blood flows backward
through the incompetent mitral valve into the left atrium. This
retrograde flow throughout the entire systolic phase creates a
holosystolic (pansystolic) murmur, heard best at the apex. A stenotic
aortic valve produces a systolic ejection murmur. Flow from the aorta
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back into the left ventricle is aortic regurgitation, which causes a
diastolic murmur.
5. A patient’s electrocardiogram shows a prolonged QT interval. The
nurse recognizes this finding poses the greatest risk for progressing into
which lethal dysrhythmia?
A) Atrial fibrillation
B) First-degree atrioventricular block
C) Torsades de pointes
D) Premature atrial contractions
Answer: C) Torsades de pointes
Explanation: A prolonged QT interval signifies an extended ventricular
repolarization time, creating a vulnerable period where an early
afterdepolarization can trigger a polymorphic ventricular tachycardia
known as torsades de pointes. This dysrhythmia is distinctive for its QRS
complexes appearing to twist around the isoelectric line and can rapidly
deteriorate into ventricular fibrillation. The other options are
supraventricular dysrhythmias not directly linked to the QT interval
prolongation.
6. A patient is diagnosed with peripheral arterial disease (PAD). Which
symptom, related to the physiological mechanism of ischemia, would
the nurse expect the patient to describe?
A) Burning pain in the legs when sitting
B) Intermittent claudication relieved by rest
NUR 521 Exam 4 Blueprint Practice 20262027 BANK QUESTIONS
WITH DETAILED VERIFIED ANSWERS EXAM QUESTIONS
WILL COME FROM HERE (100% CORRECT ANSWERS A+
GRADED
1. A patient with a history of chronic heart failure is admitted with
dyspnea and orthopnea. Which hemodynamic parameter would the
nurse expect to be elevated, directly reflecting increased left
ventricular preload?
A) Systemic vascular resistance (SVR)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Central venous pressure (CVP)
Answer: B) Pulmonary artery wedge pressure (PAWP)
Explanation: PAWP is measured by inflating a balloon-tipped catheter in
a branch of the pulmonary artery, which temporarily blocks flow and
reflects the pressure downstream in the left atrium and left ventricle
during diastole. This directly indicates left ventricular preload. In left-
sided heart failure, the left ventricle fails to effectively eject blood,
causing blood to back up into the left atrium and pulmonary
vasculature, thus elevating PAWP. SVR reflects afterload, CVP reflects
right ventricular preload, and CO is often decreased in heart failure.
,2|Page
2. Which assessment finding most strongly indicates a patient's
compensatory mechanism for decreased cardiac output is mediated by
the renin-angiotensin-aldosterone system (RAAS)?
A) Cool, clammy skin
B) Jugular venous distention
C) Peripheral edema and weight gain
D) Sinus tachycardia on the ECG monitor
Answer: C) Peripheral edema and weight gain
Explanation: RAAS activation, triggered by decreased renal perfusion,
leads to the release of aldosterone, causing sodium and water
retention by the kidneys. This fluid retention manifests as peripheral
edema and rapid weight gain, increasing preload in an attempt to
improve cardiac output. Cool, clammy skin is due to sympathetic
nervous system-mediated vasoconstriction. Jugular venous distention
reflects increased right-sided heart pressures. Sinus tachycardia is a
direct result of sympathetic nervous system stimulation of the sinoatrial
node.
3. A nurse is administering intravenous metoprolol to a patient with an
acute myocardial infarction. Which therapeutic effect of this
medication directly reduces myocardial oxygen demand?
A) Vasodilation of coronary arteries
B) Reduction of heart rate and contractility
C) Inhibition of platelet aggregation
D) Increase in serum potassium levels
,3|Page
Answer: B) Reduction of heart rate and contractility
Explanation: Metoprolol is a beta-1 adrenergic blocker that selectively
blocks the effects of catecholamines on the heart. This results in a
negative chronotropic (decreased heart rate) and negative inotropic
(decreased contractility) effect. By reducing heart rate and the force of
contraction, the workload of the heart and its demand for oxygen are
diminished. This is distinct from vasodilation, which is an antiplatelet or
potassium-related effect.
4. While caring for a patient with severe mitral valve regurgitation, the
nurse auscultates a holosystolic murmur. What pathophysiological
event creates this specific sound?
A) Turbulent forward flow through a stenotic aortic valve
B) Retrograde blood flow from the left ventricle to the left atrium
throughout systole
C) High-pressure flow from the left ventricle during early diastole
D) Retrograde blood flow from the aorta to the left ventricle during
diastole
Answer: B) Retrograde blood flow from the left ventricle to the left
atrium throughout systole
Explanation: In mitral regurgitation, the valve leaflets fail to close
completely during ventricular systole. As the left ventricle contracts to
eject blood into the aorta, a portion of the blood flows backward
through the incompetent mitral valve into the left atrium. This
retrograde flow throughout the entire systolic phase creates a
holosystolic (pansystolic) murmur, heard best at the apex. A stenotic
aortic valve produces a systolic ejection murmur. Flow from the aorta
, 4|Page
back into the left ventricle is aortic regurgitation, which causes a
diastolic murmur.
5. A patient’s electrocardiogram shows a prolonged QT interval. The
nurse recognizes this finding poses the greatest risk for progressing into
which lethal dysrhythmia?
A) Atrial fibrillation
B) First-degree atrioventricular block
C) Torsades de pointes
D) Premature atrial contractions
Answer: C) Torsades de pointes
Explanation: A prolonged QT interval signifies an extended ventricular
repolarization time, creating a vulnerable period where an early
afterdepolarization can trigger a polymorphic ventricular tachycardia
known as torsades de pointes. This dysrhythmia is distinctive for its QRS
complexes appearing to twist around the isoelectric line and can rapidly
deteriorate into ventricular fibrillation. The other options are
supraventricular dysrhythmias not directly linked to the QT interval
prolongation.
6. A patient is diagnosed with peripheral arterial disease (PAD). Which
symptom, related to the physiological mechanism of ischemia, would
the nurse expect the patient to describe?
A) Burning pain in the legs when sitting
B) Intermittent claudication relieved by rest
