NURS 6550 FINAL EXAM (2 VERSIONS)
, NURS 6550 FINAL EXAM: LATEST (VERSION 1)
1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase
the sound of a cardiac murmur associated with which of these conditions?
a. Hypertrophic cardiomyopathy
2. Which of the following conditions may result in lower extremity edema?
Nephrotic syndrome
Decompensated congestive heart failure
Cirrhosis
Renal failure
Deep venous thrombosis
Late-stage pregnancy
All of the above
3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial
infarction. He has now developed significant dyspnea at rest and, per physical
exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You
suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-
valve regurgitation.
Question: Which of the following physical findings would support this diagnostic
hypothesis?
, A palpable diastolic murmur maximal in the second intercostal space (ICS) at
the left sternal border
A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the
left sternal border
A holosystolic systolic murmur heard maximally in the fifth ICS at the
midclavicular line
4. emodynamics and the Frank-Starling law
Cardiac output (CO) is the total volume of blood pumped by the ventricle per
minute.
Stroke volume (SV) is the amount of blood pumped from the left ventricle per
single contraction (systole). This is also referred to as the ejection fraction on an
echocardiogram.
Therefore, CO = SV x HR (heart rate).
Example: An average healthy adult having a SV of 70 mL and a HR of 80 bpm
would have CO of 5.6 L/min. This means that almost the entire blood volume is
circulated every minute.
Although in general an increase of heart rate increases cardiac output, when the
heart rate increases significantly (>160 bpm), there is less time for the ventricles to
fill with blood (decreased diastolic filling time). This results in decreased stroke
volume and, therefore, decreased cardiac output.
Stroke volume is affected by preload and afterload.
Preload is the amount of blood in the ventricles just prior to ventricular
contraction (i.e., end-diastolic volume) and correlates with the degree to which the
cardiac muscle (i.e., the sarcomere, the contractile unit of the myocardium) is
stretched. Increasing preload increases stroke volume in a healthy heart, but only
up to a maximum stretch.
, Afterload is the net of the hemodynamic forces that prevent blood from being
ejected during ventricular contraction (systole); i.e., afterload is the amount
of peripheral resistance. An increase in peripheral vascular resistance (e.g.,
uncontrolled hypertension) would increase afterload and thereby decrease stroke
volume, unless the heart rate increases.
The Frank-Starling law states that stroke volume increases in response to an
increase in preload (but only up to a point, as will be discussed). That is, increased
preload results in increased stretch of the sarcomere which triggers a more forceful
contraction.
In heart failure, the hemodynamic properties of the Frank-Starling curve are
exceeded and increased preload now results in decreased cardiac output. If stroke
volume cannot be increased, heart rate must increase in order to maintain an
appropriate cardiac output to perfuse the body.
4. The most common ECG finding in a patient with a cardiomyopathy is an ST-
elevation MI.
-false
5. Nina Martinez is a 70-year-old female who experienced an episode of acute
pulmonary edema following an endovascular aneurysm repair. She was discharged
on furosemide 60 mg daily and instructed to follow up with cardiology. She is now
seen in the office at 2 weeks post discharge. Her metabolic panel includes the
following lab values:
Na 126 mEq/L
K 4.0 mEq/L
Cl 93 mEq/L
CO2 28 mEq/L
BUN 40 mg/dL
Cr 1.3 mg/dL
Question: This patient has which of the following abnormalities as a likely
consequence of diuretic overuse?
Hyponatremia
, NURS 6550 FINAL EXAM: LATEST (VERSION 1)
1. The Valsalva maneuver and the squat-to-stand maneuver are likely to increase
the sound of a cardiac murmur associated with which of these conditions?
a. Hypertrophic cardiomyopathy
2. Which of the following conditions may result in lower extremity edema?
Nephrotic syndrome
Decompensated congestive heart failure
Cirrhosis
Renal failure
Deep venous thrombosis
Late-stage pregnancy
All of the above
3. Art Bakke is a 46-year-old male who is being treated for an acute myocardial
infarction. He has now developed significant dyspnea at rest and, per physical
exam, has coarse rales involving the lower 2/3 of the lung fields bilaterally. You
suspect acute pulmonary edema due to papillary-muscle rupture and acute mitral-
valve regurgitation.
Question: Which of the following physical findings would support this diagnostic
hypothesis?
, A palpable diastolic murmur maximal in the second intercostal space (ICS) at
the left sternal border
A harsh, rumbling, diastolic murmur heard maximally in the fourth ICS at the
left sternal border
A holosystolic systolic murmur heard maximally in the fifth ICS at the
midclavicular line
4. emodynamics and the Frank-Starling law
Cardiac output (CO) is the total volume of blood pumped by the ventricle per
minute.
Stroke volume (SV) is the amount of blood pumped from the left ventricle per
single contraction (systole). This is also referred to as the ejection fraction on an
echocardiogram.
Therefore, CO = SV x HR (heart rate).
Example: An average healthy adult having a SV of 70 mL and a HR of 80 bpm
would have CO of 5.6 L/min. This means that almost the entire blood volume is
circulated every minute.
Although in general an increase of heart rate increases cardiac output, when the
heart rate increases significantly (>160 bpm), there is less time for the ventricles to
fill with blood (decreased diastolic filling time). This results in decreased stroke
volume and, therefore, decreased cardiac output.
Stroke volume is affected by preload and afterload.
Preload is the amount of blood in the ventricles just prior to ventricular
contraction (i.e., end-diastolic volume) and correlates with the degree to which the
cardiac muscle (i.e., the sarcomere, the contractile unit of the myocardium) is
stretched. Increasing preload increases stroke volume in a healthy heart, but only
up to a maximum stretch.
, Afterload is the net of the hemodynamic forces that prevent blood from being
ejected during ventricular contraction (systole); i.e., afterload is the amount
of peripheral resistance. An increase in peripheral vascular resistance (e.g.,
uncontrolled hypertension) would increase afterload and thereby decrease stroke
volume, unless the heart rate increases.
The Frank-Starling law states that stroke volume increases in response to an
increase in preload (but only up to a point, as will be discussed). That is, increased
preload results in increased stretch of the sarcomere which triggers a more forceful
contraction.
In heart failure, the hemodynamic properties of the Frank-Starling curve are
exceeded and increased preload now results in decreased cardiac output. If stroke
volume cannot be increased, heart rate must increase in order to maintain an
appropriate cardiac output to perfuse the body.
4. The most common ECG finding in a patient with a cardiomyopathy is an ST-
elevation MI.
-false
5. Nina Martinez is a 70-year-old female who experienced an episode of acute
pulmonary edema following an endovascular aneurysm repair. She was discharged
on furosemide 60 mg daily and instructed to follow up with cardiology. She is now
seen in the office at 2 weeks post discharge. Her metabolic panel includes the
following lab values:
Na 126 mEq/L
K 4.0 mEq/L
Cl 93 mEq/L
CO2 28 mEq/L
BUN 40 mg/dL
Cr 1.3 mg/dL
Question: This patient has which of the following abnormalities as a likely
consequence of diuretic overuse?
Hyponatremia
