AGNP Board Exam – Cardiovascular Assessment
Exam
1.Question:
The preauricular nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal
region. Correct
eyelids, the conjunctiva, and the skin and mucous membrane of the nose
and cheek.
mouth, throat, and face.
posterior part of the temporoparietal region.
Explanation:
The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva
as well as the skin adjacent to the ear within the temporal region. Tonsillar,
submandibular, and submental nodes (anterior and superficial cervical lymph
nodes) drain lymphatic fluid from portions of the mouth , throat, and face.
The facial lymph nodes (infraorbital or maxillary, buccinator, and
supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and
the skin and mucous membranes of the nose and cheek. The posterior
auricular lymph nodes drain lymphatic fluid from the posterior part of the
temporoparietal region.
2.Question:
When auscultating the heart, the displacement of the point of maximal
impulse (PMI) is greater than 10 cm lateral to the midsternal line. This finding
is consistent with:
right ventricular hypertrophy.
left ventricular hypertrophy. Correct
pulmonary stenosis.
a normal PMI location.
,Explanation:
Displacement of the PMI lateral to the midclavicular line or greater than 10
cm lateral to the midsternal line suggests left ventricular hypertrophy (LVH).
3.Question:
When auscultating the heart of a 55-year-old patient, a loud murmur with a
thrill is audible in the right second intercostal space that radiates to the
carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the
apex. The murmur is heard best with the patient sitting and leaning forward.
This finding is consistent with:
pulmonic stenosis.
tricuspid regurgitation.
mitral regurgitation.
aortic stenosis. Correct
Explanation:
With aortic stenosis, the murmur is audible loudest in the right second
intercostal space and radiates to the carotid arteries, down the left sternal
border, or the apex. There is a crescendo-decrescendo pitch audible at the
apex. The murmur is heard best with the patient sitting and leaning forward.
The murmur audible with pulmonic stenosis produces a soft intensity with a
crescendo-decrescendo pitch. It is loudest at the second or third intercostal
spaces and radiates to the left shoulder and neck. With tricuspid
regurgitation, the murmur is audible loudest at the left sternal border with
radiation to the right sternal border, xiphoid area, or to the left midclavicular
line. It produces a blowing sound and is pansystolic. The intensity may
increase with inspiration. Mitral regurgitation produces a pansystolic, harsh
murmur heard loudest at the apex with radiation toward the left axilla. The
intensity of the murmur can be soft, or if there is an atrial thrill, it can be
loud.
4. Question:
,A disease that may present as indigestion, but is precipitated by exertion
and relieved by rest is most likely:
gastroesophageal reflux.
inflammatory bowel disease.
angina. Correct
aortic stenosis.
Explanation:
A disease that may present as indigestion, but is precipitated by exertion
and relieved by rest is most likely angina.
5. Question:
Causes of orthostatic hypotension in older adults may include all of the
following except:
diabetes.
cardiovascular disorders.
medications.
impaired visual acuity. Correct
Explanation:
Orthostatic hypotension occurs in 20% of older adults and in up to 50% of
frail nursing home residents, especially when they first arise in the morning.
Causes include medications, autonomic disorders, diabetes, prolonged bed
rest, volume depletion, amyloidosis, and cardiovascular disorders. Impaired
visual acuity is not a cause of orthostatic hypotension but can be a resulting
symptom.
6. Question:
To auscultate the heart sounds arising from the pulmonic valve in an adult
patient, place the stethoscope:
near the apex of the heart between the 5th and 6th intercostal spaces in
the mid-clavicular line.
between the 2nd and 3rd intercostal spaces at the right upper sternal
border.
, between the 2nd and 3rd intercostal spaces at the left sternal
border. Correct
between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower
sternal border.
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the
anterior chest, beginning with the patient in the supine position and using
the diaphragm of the stethoscope. The mitral listening point is near the apex
of the heart between the 5th and 6th intercostal spaces in the mid-clavicular
line. The aortic listening point is between the 2nd and 3rd intercostal spaces
at the right upper sternal border (RUSB). The pulmonic listening point is
located between the 2nd and 3rd intercostal spaces at the left sternal border
(LUSB). The tricuspid listening point is between the 3rd, 4th, 5th, and 6th
intercostal spaces at the left lower sternal border (LLSB).
7. Question:
A sudden, tearing, sharp pain that begins in the chest and radiates to the
back or into the neck is usually associated with:
angina pectoris.
a myocardial infarction.
an aortic dissection. Correct
pericarditis.
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and
physical exam can help the clinician determine a likely cause. A sudden
sharp pain that radiates to the back or into the neck is usually associated
with aortic dissection. Exertional pain can be angina pectoris. Symptoms
most often seen with myocardial infarction include a retrosternal type pain
that often radiates up to the neck, shoulder, and jaw and down to the ulnar
aspect of the left arm. Pain associated with pericarditis may radiate to the tip
of the shoulder and to the neck and presents with a sharp knifelike pain. Any
pain in the chest is cardiac until proven otherwise.
Exam
1.Question:
The preauricular nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal
region. Correct
eyelids, the conjunctiva, and the skin and mucous membrane of the nose
and cheek.
mouth, throat, and face.
posterior part of the temporoparietal region.
Explanation:
The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva
as well as the skin adjacent to the ear within the temporal region. Tonsillar,
submandibular, and submental nodes (anterior and superficial cervical lymph
nodes) drain lymphatic fluid from portions of the mouth , throat, and face.
The facial lymph nodes (infraorbital or maxillary, buccinator, and
supramandibular) drain lymphatic fluid from the eyelids, the conjunctiva, and
the skin and mucous membranes of the nose and cheek. The posterior
auricular lymph nodes drain lymphatic fluid from the posterior part of the
temporoparietal region.
2.Question:
When auscultating the heart, the displacement of the point of maximal
impulse (PMI) is greater than 10 cm lateral to the midsternal line. This finding
is consistent with:
right ventricular hypertrophy.
left ventricular hypertrophy. Correct
pulmonary stenosis.
a normal PMI location.
,Explanation:
Displacement of the PMI lateral to the midclavicular line or greater than 10
cm lateral to the midsternal line suggests left ventricular hypertrophy (LVH).
3.Question:
When auscultating the heart of a 55-year-old patient, a loud murmur with a
thrill is audible in the right second intercostal space that radiates to the
carotid arteries. Also noted is a crescendo-decrescendo pitch audible at the
apex. The murmur is heard best with the patient sitting and leaning forward.
This finding is consistent with:
pulmonic stenosis.
tricuspid regurgitation.
mitral regurgitation.
aortic stenosis. Correct
Explanation:
With aortic stenosis, the murmur is audible loudest in the right second
intercostal space and radiates to the carotid arteries, down the left sternal
border, or the apex. There is a crescendo-decrescendo pitch audible at the
apex. The murmur is heard best with the patient sitting and leaning forward.
The murmur audible with pulmonic stenosis produces a soft intensity with a
crescendo-decrescendo pitch. It is loudest at the second or third intercostal
spaces and radiates to the left shoulder and neck. With tricuspid
regurgitation, the murmur is audible loudest at the left sternal border with
radiation to the right sternal border, xiphoid area, or to the left midclavicular
line. It produces a blowing sound and is pansystolic. The intensity may
increase with inspiration. Mitral regurgitation produces a pansystolic, harsh
murmur heard loudest at the apex with radiation toward the left axilla. The
intensity of the murmur can be soft, or if there is an atrial thrill, it can be
loud.
4. Question:
,A disease that may present as indigestion, but is precipitated by exertion
and relieved by rest is most likely:
gastroesophageal reflux.
inflammatory bowel disease.
angina. Correct
aortic stenosis.
Explanation:
A disease that may present as indigestion, but is precipitated by exertion
and relieved by rest is most likely angina.
5. Question:
Causes of orthostatic hypotension in older adults may include all of the
following except:
diabetes.
cardiovascular disorders.
medications.
impaired visual acuity. Correct
Explanation:
Orthostatic hypotension occurs in 20% of older adults and in up to 50% of
frail nursing home residents, especially when they first arise in the morning.
Causes include medications, autonomic disorders, diabetes, prolonged bed
rest, volume depletion, amyloidosis, and cardiovascular disorders. Impaired
visual acuity is not a cause of orthostatic hypotension but can be a resulting
symptom.
6. Question:
To auscultate the heart sounds arising from the pulmonic valve in an adult
patient, place the stethoscope:
near the apex of the heart between the 5th and 6th intercostal spaces in
the mid-clavicular line.
between the 2nd and 3rd intercostal spaces at the right upper sternal
border.
, between the 2nd and 3rd intercostal spaces at the left sternal
border. Correct
between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower
sternal border.
Explanation:
Auscultation should proceed in a logical manner over 4 general areas on the
anterior chest, beginning with the patient in the supine position and using
the diaphragm of the stethoscope. The mitral listening point is near the apex
of the heart between the 5th and 6th intercostal spaces in the mid-clavicular
line. The aortic listening point is between the 2nd and 3rd intercostal spaces
at the right upper sternal border (RUSB). The pulmonic listening point is
located between the 2nd and 3rd intercostal spaces at the left sternal border
(LUSB). The tricuspid listening point is between the 3rd, 4th, 5th, and 6th
intercostal spaces at the left lower sternal border (LLSB).
7. Question:
A sudden, tearing, sharp pain that begins in the chest and radiates to the
back or into the neck is usually associated with:
angina pectoris.
a myocardial infarction.
an aortic dissection. Correct
pericarditis.
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and
physical exam can help the clinician determine a likely cause. A sudden
sharp pain that radiates to the back or into the neck is usually associated
with aortic dissection. Exertional pain can be angina pectoris. Symptoms
most often seen with myocardial infarction include a retrosternal type pain
that often radiates up to the neck, shoulder, and jaw and down to the ulnar
aspect of the left arm. Pain associated with pericarditis may radiate to the tip
of the shoulder and to the neck and presents with a sharp knifelike pain. Any
pain in the chest is cardiac until proven otherwise.
