NUR 6550 Final Exam NUR 6550 Final Exam

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?

Not selected symbolNephrotic syndrome

Not selected symbolDecompensated congestive heart failure

Not selected symbolCirrhosis

Not selected symbolRenal failure

Not selected symbolDeep venous thrombosis

Not selected symbolLate-stage pregnancy

Correct symbolG. 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

Hypokalemia

Metabolic acidosis

6. Which of the following are primary cardiomyopathy categories, as described by the World Health Organization (WHO) in 1995?

Dilated cardiomyopathy

Not selected symbolHypertrophic cardiomyopathy (HCM)

Not selected symbolRestrictive cardiomyopathy

Not selected symbolArrhythmogenic right ventricular dysplasia

Not selected symbolUnclassified

Correct symbolAll of the above

7. What is the most common cause of sudden cardiac death in young people?

What is the most common cause of sudden cardiac death in young people?

Incorrect symbolMyocardial infarction

Correct answer-Hypertrophic cardiomyopathy

Not selected symbolSupraventricular tachycardia

Not selected symbolArrhythmogenic right ventricular dysplasia; aka arrhythmogenic right ventricular cardiomyopathy (ARVC)

8. Which of the following are treatment options for a patient who presents with peripartum cardiomyopathy while still carrying the fetus? (Select all that apply.)

Not selected symbolACE inhibitors

Correct symbolInduction if stable

Correct symbolEmergent cesarean section if unstable

Correct symbolDigoxin

Correct symbolNitroglycerin

9. What are the 3 major clinical complications related to cardiomyopathies?

Arrhythmias; including ventricular tachycardia and ventricular fibrillation

Thromboembolic complications; including DVT, PE, and ventricular thrombi

Acute pulmonary edema

10. Some patients with primary cardiomyopathies remain asymptomatic throughout their lifetime.

-TRUE

11. Evaluation of all 12 leads is required for which of the following when reading a 12-lead electrocardiogram? 

12.

Joseph Martinez VE – Walden (Basic)- Student Testing Mode

Show Patient
Record

Evaluated

Select test to show results and interpretations.

Results

Please be sure to read interpretation.

Next Step: Make Diagnosis

Basic Science & Clinical Questions – Student Testing Mode

3 of 3

Supplemental exercise #3

Which of the following is the appropriate term for atrial fibrillation that recurs after several cardioversions and the decision is made to not attempt to reestablish normal sinus rhythm?

Persistent atrial fibrillation

Recurrent paroxysmal atrial fibrillation

Newly discovered atrial fibrillation

Permanent atrial fibrillation

13. A person in atrial fibrillation can have an S4 on physical exam.

-FALSE

14. A patient in atrial fibrillation can have an S3 on physical exam.

-TRUE

15. Which of the following is one of the most serious complications of atrial fibrillation?

a. CAD

b. CVA

c. Hypertension

d. Thyrotoxicosis

16. Which of the following agents would not be effective in reducing the ventricular rate in a patient with atrial fibrillation?

17. Fred Colby is a 49-year-old male on warfarin (Coumadin) for ongoing prophylaxis of thromboembolic complications associated with atrial fibrillation who comes to the clinic for his regularly scheduled INR:

INR 5.2

PT 35

Question: What is the best approach to these laboratory findings?

Reevaluate the INR in 3 days

Encourage consumption of food rich in vitamin K

Administer vitamin K 10 mEq SQ

Lower the warfarin dose

18. When counseling patients regarding general cardiovascular health and the prevention of coronary artery disease, you should advise them that dyslipidemia, cigarette smoking, and hypertension may contribute to which of the following conditions in addition to coronary artery disease?

-Mitral valve stenosis