CARDIOVASCULAR ASSESSMENT AGNP BOARD EXAM
(107 Questions with Answers and Explanations)
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, buccinators,
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.
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.
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).
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.
(107 Questions with Answers and Explanations)
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, buccinators,
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.
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.
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).
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.
