AGNP BOARD EXAM QUESTIONS Cardiovascular Assessment (107 Questions with Answers and Explanations)
AGNP BOARD EXAM QUESTIONS Cardiovascular Assessment
... [Show More] (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, 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.
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.
Question:
A 68-year-old man with uncontrolled hypertension presents with sudden, intense left lower abdominal pain that radiates to the back. The pain is associated with a tearing sensation. These findings are MOST likely associated with:
cholecystitis.
an abdominal aortic aneurysm (AAA). Correct
perforated gastroesophageal (GI) ulcer.
nephrolithiasis.
Explanation:
Sudden, intense left lower abdominal pain that radiates to the back with a “tearing” sensation are symptoms of abdominal aortic aneurysm (AAA). For the diagnosis of a possible rupturing AAA, outpatient CT scan, abdominal ultrasound, and angiography testing are NOT recommended. The patient should be referred to the emergency department for acute assessment and treatment.
Question:
A condition that usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress may be associated with:
neurogenic claudication.
intermittent claudication.
atherosclerotic peripheral vascular disease.
Raynaud's disease. Correct
Explanation:
Raynaud's disease may present with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress. Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen in neurogenic claudication.
Question:
A twelve-month-old has a history of heart failure related to his congenital heart defect. He is receiving aldactone (Spironolactone), enalapril (Vasotec), furosemide (Lasix), and acetaminophen (Tylenol). The infant's potassium level is 3.1 meq/l. Which medication is most likely decreasing his potassium level?
Aldactone (Spironolactone)
Furosemide (Lasix) Correct
Enalapril (Vasotec)
Acetaminophen (Tylenol)
Explanation:
Loop diuretics can produce decreased potassium levels. Lasix is a loop diuretic. Potassium levels considered WNL by most labs range between 3.5 and 5.3 meq/l; so 3.1 meq/l is considered low and may need to be adjusted. The other medications are not known for excessive potassium losses.
Question:
The posterior auricular lymph node is located:
at the angle of the mandible.
in front of the ear.
at the base of the skull posteriorly.
superficial to the mastoid process. Correct
Explanation:
The posterior auricular nodes are superficial to the mastoid process. The preauricular lymph nodes are located in front of the ear. The tonsillar lymph nodes are at the angle of the mandible. The occipital lymph nodes are located at the base of the skull posteriorly.
Question:
A patient complains of a tight, bursting pain in the calf that increases with walking. Elevation of the leg sometimes relieves the pain. These symptoms may be consistent with:
intermittent claudication.
Raynaud's disease.
deep venous thrombosis. Correct
superficial thrombophlebitis.
Explanation:
Deep venous thrombosis (DVT) is a venous disorder. The patient often describes the pain as tight, and bursting around the affected area. The pain may be accompanied by swelling and tenderness. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds.
Question:
A patient complains of pain in the arch of the foot sometimes relieved by rest. Occasionally, he experiences intermittent pain in the toes, especially at rest. Exercise aggravates the pain in the arch. History reveals he smokes approximately a half pack of cigarettes per day. These symptoms may be consistent with:
intermittent claudication.
Raynaud's disease.
deep venous thrombosis.
thromboangiitis obliterans. Correct
Explanation:
Thromboangiitis obliterans or Buerger's disease, is defined as inflammatory and thrombotic occlusions of small arteries and also of veins, usually occurring in smokers. Symptoms include intermittent claudication especially in the arch of the foot and pain at rest in the toes or fingers. Other symptoms may include distal coldness or cyanosis. Episodic muscular ischemia induced by exercise, due to atherosclerosis of large or medium-sized arteries, is defined as intermittent claudication. The pain is usually associated with the calf muscles, but also may be in the buttock, hip, thigh, or foot, depending on the level of obstruction. Rest usually stops the pain within a few seconds. Reynaud's disease usually affects the distal portions of the fingers and causes pain especially with exposure to cold or stress. Deep venous thrombosis (DVT) is a venous disorder and the pain is tight, and bursting often in the calf. The pain may be accompanied by swelling and tenderness.
Question:
In older adults, the presence of heart sound S3 suggests:
hypertension.
heart failure. Correct
an aortic aneurysm.
aortic stenosis.
Explanation:
In older adults, an S3 suggest dilatation of the left ventricle from heart failure or cardiomyopathy. S3 is produced when blood strikes a compliant left ventricle. It commonly accompanies fluid overload. It may be normal in children or pregnant women.
Question:
The posterior chest wall and portions of the arms are drained by which group of lymph nodes?
Posterior mediastinal nodes
Subscapular nodes Correct
Parasternal nodes
Intercostal nodes
Explanation:
The subscapular lymph nodes drain lymphatic fluid from the posterior chest wall and a portion of the upper arms. The posterior mediastinal lymph nodes drain lymphatic fluid from the esophagus and posterior part of the pericardium. The lymph nodes of the chest wall include the parasternal, intercostal and the diaphragmatic areas. The parasternal lymph nodes drain the medial half of the breasts. The posterior-lateral aspect of the chest is drained by the intercostal lymph nodes. The diaphragmatic nodes drain the upper surface of the diaphragm.
Question:
In older adults, the presence of heart sound S4 suggests:
hypertension. Correct
heart failure.
an aortic aneurysm.
aortic stenosis.
Explanation:
An S4 heart sound occurs when the atria contract and force blood into a left ventricle that is non-compliant. This can be the result of diastolic heart failure, hypertension, infraction, or others. It is known as the "atrial gallop". This is always abnormal.
Question:
Deep cervical lymph nodes drain lymphatic fluid from the:
head and neck. Correct
breasts.
mouth, throat, and face.
posterior part of the temporoparietal region.
Explanation:
The deep cervical lymph nodes drain all of the lymphatic fluid from the head and neck. Axillary lymph nodes drain most of the lymphatic fluid of the breast. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region
Question:
Which of the following group of symptoms would be suggestive of an infant experiencing a congenital heart defect associated with a decreased pulmonary blood flow pattern?
Tissue perfusion greater than 3 seconds, bluish colored skin, and poor feeding Correct
Abnormal heart sounds, capillary refill less than 2 seconds, and oxygen saturation less than 95%
Capillary refill less than 2 seconds, tissue perfusion less than 3 seconds, and oxygen saturation greater than 95%
Poor feeding, audible heart murmur, and oxygen saturation greater than 95%
Explanation:
Infants with defects resulting from decreased pulmonary blood flow have cyanosis because of desaturated blood entering systemic circulation and/or because of the inability to get blood to the lungs. Tetralogy of Fallot (TOF), pulmonary atresia and tricuspid atresia all fall in this category and are considered cyanotic defects. Due to the ventricular septal defect in TOF, the absence of the tricuspid valve or pulmonary valve in tricuspid and pulmonary atresia, one should hear abnormal heart sounds either due to the murmur in TOF or single heart sounds of S1 or S2 in pulmonary atresia or tricuspid atresia. Usually these infants have activity intolerance and therefore, experience failure to thrive because of their inability to consume enough formula to gain weight appropriately. Capillary refill is usually prolonged due to poor oxygenation and poor perfusion secondary to the defect as well as the O2 sats being lower than normal, sometimes even in the 80% range.
Question:
The tonsillar, submandibular, and submental nodes drain the lymphatic fluid from portions of the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.
eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek.
mouth, throat, and face. Correct
posterior part of the temporoparietal region.
Explanation:
Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth , throat, and face. The preauricular nodes drain the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The facial lymph nodes (infraorbital or maxillary, buccinator, and supramandibular) drain the eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. The posterior auricular lymph nodes drain the posterior part of the temporoparietal region.
Question:
Symptoms of acrocyanosis in the newborn include:
bluish color of the tongue.
bluish color of the mucous membranes.
bluish color of the feet. Correct
bluish color of the abdomen.
Explanation:
Shortly after birth, cyanosis of the hands, feet, and perioral area are common findings and typically resolve in 24 - 48 hours. A blue color around the lips and philtrum is a relatively common finding shortly after birth. The skin in the infant is usually well perfused, and the tongue and mucous membranes in the mouth are pink, a finding that assures that central cyanosis is not present.
Question:
A widened pulse pressure greater than or equal to 60 in an older patient is a risk factor for cardiovascular disease, stroke, and:
emboli.
systolic hypertension.
renal disease. Correct
orthostatic hypertension.
Explanation:
A widened pulse pressure greater than or equal to 60 in the older patients is a risk factor for cardiovascular disease, stroke, and renal disease.
Question:
Widened pulse pressure (PP) is defined as systolic blood pressure (SBP):
dropping 20 mm Hg within 3 minutes of standing.
minus diastolic blood pressure. Correct
dropping 10 mm Hg within 5 minutes of sitting.
minus apical heart rate.
Explanation:
Widened pulse pressure (PP) is defined as SBP minus diastolic blood pressure (DBP). With aging, SBP and peripheral vascular resistance increase, whereas DBP decreases.
Question:
The infraorbital or maxillary, buccinator, and supramandibular lymph nodes drain lymphatic fluid from the:
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.
eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek. Correct
mouth, throat, and face.
posterior part of the temporoparietal region.
Explanation:
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. Tonsillar, submandibular, and submental nodes (anterior and superficial cervical lymph nodes) drain lymphatic fluid from portions of the mouth, throat, and face. The preauricular nodes drain lymphatic fluid from the palpebral conjunctiva as well as the skin adjacent to the ear within the temporal region. The posterior auricular lymph nodes drain lymphatic fluid from the posterior part of the temporoparietal region.
Question:
To auscultate the tricuspid valve heart sounds in an adult patient, place the stethoscope:
between the 2nd and 3rd intercostal spaces at the right upper sternal border.
near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line.
located between the 2nd and 3rd intercostal spaces at the left sternal border.
between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border. Correct
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 aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). The mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid clavicular line. The pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). The tricuspid region is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB).
Question:
A child presents with fever of 102.5 °F for the past five days. Kawasaki disease is suspected if which of the following groups of symptoms is present?
Strawberry tongue, pounding pulse, elevated blood pressure, and chronic hemolytic anemia
Cervical lymphadenopathy, bilateral non-purulent conjunctivitis, periungual desquamation, and polymorphous rash Correct
Retinopathy, petechiae, strawberry tongue, and jaundice
Recent Group A beta hemolytic streptococcus pharyngitis, erythema marginatum, non-purulent conjunctivitis, and joint pain
Explanation:
In Kawasaki disease there is persistent fever for 5 days. In order to be diagnosed with Kawasaki disease, a child must present with 4 of the following 5 symptoms. These include: cervical lymphadenopathy, bilateral conjunctivitis, macular rash, edema of the hand and/or feet, and strawberry tongue. Pounding pulse, elevated B/P, and chronic hemolytic anemia are not consistent with Kawasaki disease. Retinopathy and jaundice are more consistent with sickle cell disease. Group A beta hemolytic strep and erythema marginatum are common with rheumatic heart disease.
Question:
A patient presents with chest pain that radiates to the left side of the neck and down the left arm when he chops wood. This type of pain could be suggestive of:
an early onset myocardial infarction.
angina pectoris. Correct
costochondritis.
a dissecting aneurysm.
Explanation:
Assessing chest pain can be very difficult but a thorough patient history and physical exam can help the clinician determine a likely cause. 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 and tenderness associated with costochondritis worsens with coughing or taking deep breaths. A sudden sharp pain that radiates to the back or into the neck is usually associated with aortic dissection. Any pain in the chest is cardiac until proven otherwise.
Question:
When auscultating the heart of a 50-year-old patient, a soft murmur is audible in the left second and third intercostal spaces and radiates to the left shoulder and neck. Also noted is a crescendo-decrescendo pitch to the murmur. This finding could be consistent with:
pulmonic stenosis. Correct
tricuspid regurgitation.
mitral regurgitation.
aortic stenosis.
Explanation:
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 aortic stenosis, the murmur is audible loudest in the right second intercostal space and radiates to the carotids, 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. 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.
Question:
The external iliac lymph nodes drain lymphatic fluid from the following areas except the:
urinary bladder.
prostate.
uterus.
gluteal region. Correct
Explanation:
The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina. The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region.
An otherwise healthy two-year-old presents with a heart rate that varies with inspiration and expiration. Which statement is true?
The child has ingested too much caffeine.
A cardiology referral is prudent.
This is a normal exam. Correct
There is a need for an echocardiogram.
Explanation:
Sinus arrhythmia occurs when an irregular heart rate increases with inspiration and decreases with respiration and is considered normal in children. There is no need for an echo or referral to a cardiologist nor should the child be evaluated for caffeine intake.
Question:
When assessing a 3-year-old African American child, the most likely cause of black, dusky mucous membranes is related to:
jaundice.
pallor.
erythema.
cyanosis. Correct
Explanation:
In dark skinned children, black, dusky mucous membranes are significant for cyanosis. The mucous membranes are the best areas to identify cyanosis in African American children. Erythema is denoted as a dusky red or violet color over the body. The other choices are not characteristic of cyanosis.
Question:
Pain or cramping of the legs that occurs during exertion and is relieved by rest is termed:
neurogenic claudication.
intermittent claudication. Correct
atherosclerotic peripheral vascular disease.
Raynaud's disease.
Explanation:
Pain or cramping in the legs that occurs with exertion and is relieved by rest is termed intermittent claudication. Atherosclerotic peripheral artery disease presents with symptomatic limb ischemia with exertion. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, may be seen with neurogenic claudication. Raynaud's disease usually presents with numbness or tingling in the distal portions of one or more fingers aggravated by cold or emotional stress.
Question:
The patient has had an internal pacemaker in place for five years. Pacemaker failure is being considered because over the past few days, the patient has been experiencing episodes of:
hiccoughs. Correct
chest pain.
wheezing.
hypertension.
Explanation:
Pacemaker failure is uncommon. Most malfunctions are caused by electrode dislocation, electrode dislocation, poor contact or interference by other tissues. Symptoms include dizziness, lightheadedness, hiccoughs, sudden changes in heart rate, electric shock feeling in the chest. Chest pain is usually absent. Wheezing and hypertension are not specifically characteristic of pacemaker malfunction.
Question:
A heart rate of 100-180 beats per minute in an adult is considered:
normal sinus rhythm.
sinus tachycardia. Correct
supraventricular tachycardia.
ventricular tachycardia.
Explanation:
A normal heart rate in an adult is between 60 / 100 beats per minute. Tachycardia is over 100 beats / minute. Rates that exceed 180 beats / minute are usually supraventricular. Normal sinus rhythm is a measurement of the hearts electrical activity, not mechanical activity. Ventricular tachycardia is rapid and chaotic ventricular activity. [Show Less]