Description
kindly see the attached below.
Unformatted Attachment Preview
NURS 756 The Cardiovascular & Peripheral Vascular System Homework Packet
1. This condition arises from _____ and is often described as having intermittent
claudication. The extremity is pale on elevation with dependent rubor. The skin is
typically thin, shiny, and without hair. The ulcers are characterized by a “punched-out,”
well-defined, wound margins and are often found between or on the tips of the toes, on
the heels, on the outer ankle, or where there is pressure from walking or footwear.
2. This murmur is best heard at the apex, often radiating to the left axilla, and has a
“blowing” quality?
3. A 42-year-old HIV+ male presents to your office complaining of sharp knifelike pain on
the left side of his chest for the last two days. Breathing and lying down makes the pain
worse, while sitting forward helps alleviate the pain. Tylenol and ibuprofen have not
helped. The pain does not radiate to any other area. He is leaning over and holding his
left arm and hand to the chest’s left side on presentation. Vital signs include BP 130/70,
HR 90 bpm, and RR 12 breaths per minute. On auscultation, his lung fields have normal
breath sounds with no rhonchi, wheezes, or crackles. Percussion and palpation are
unremarkable. He has a regular rhythm and rate. S1S2. No murmur. The APRN notes a
scratching noise at the lower left sternal border with auscultation. What is the APRN’s
top differential diagnosis for this patient?
a. Pleurisy
b. Thoracic aortic dissection
c. Angina pectoris
d. Pericarditis
4. Name the atrioventricular valves:
5. What does the t-wave on a 12-lead ECG represent?
6. The _____sound marks the beginning of systole.
7. The S3 is best heard in what patient position?
8. You are performing a thorough cardiac examination. Which of the following chambers of
the heart can you assess by palpation?
a. Right ventricle
b. Left atrium
c. Right atrium
d. Left ventricle
9. What is responsible for the inspiratory splitting of S2?
a. Closure of the aortic valve then the pulmonic valve
1
b. Closure of the mitral valve then the pulmonic valve
c. Closure of the aortic valve then the tricuspid valve
d. Closure of the mitral valve then the tricuspid valve
10. A patient complaining of tearing chest pain going through to the back has a widened
mediastinum on the chest x-ray. What is this finding indicative of?
11. You are reevaluating a patient in your office for the third time for elevated blood
pressures. He is a 45-year-old male. He is asymptomatic. The previous two BPs are
documented as 144/80 and 149/88. Today’s BP is 144/94. According to the JNC-8
guidelines, how would you categorize these blood pressure readings for males in this agegroup?
a. Stage I Hypertension
b. Stage 2 Hypertension
c. Normal
d. Prehypertension
12. The _____sound marks the end of systole/beginning of diastole.
13. A patient comes to your office for the first time, and you note a blood pressure of 159/95.
The patient has no history of hypertension. The patient is asymptomatic of this elevated
blood pressure. What is your management of this patient?
a. Recheck the blood pressure in a few minutes, and if it’s still elevated, then begin
antihypertensive medication
b. Recheck the blood pressure in a few minutes and document the next recording.
Ask the patient to return in a week or so for a blood pressure recheck
c. Call 911 and send to the emergency department for further workup
d. Ask the patient to drive to the emergency department for further workup
14. The APRN is performing a cardiac examination on a patient with shortness of breath and
palpitations. You listen to the heart with the patient sitting upright and then again in the
supine position. Finally, you ask him to turn onto his left side in the left lateral decubitus
position. Which of the following valvular defects is best heard in this position?
a. Mitral valve
b. Tricuspid valve
c. Aortic valve
d. Pulmonic valve
15. A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs.
He has smoked two packs per day since the age of 16, but he is otherwise healthy. You
2
are concerned that he may have peripheral vascular disease. Which of the following is
part of common or concerning symptoms for the peripheral vascular system?
a. Shortness of breath
b. Intermittent claudication
c. Knee pain
d. Chest pressure with exertion
16. Name the semilunar valves:
17. You note a painful ulcerative lesion near the medial malleolus with accompanying
hyperpigmentation. Which of the following etiologies is most likely?
a. Arterial insufficiency
b. Neuropathic ulcer
c. Venous insufficiency
d. Trauma
18. Where is the point of maximal impulse (PMI) normally located?
a. In the left 5th ICS in the midaxillary line
b. In the left 5th ICS just lateral to the left sternal border
c. In the left ICS in the midclavicular line
d. In the right 5th ICS in the midclavicular line
19. What type of heart disease is currently the most common type?
20. You are a student in the vascular surgery clinic. You are asked to perform a physical
examination on a patient with known peripheral vascular disease in the legs. Which of the
following aspects is important to note when performing this examination?
a. Size, symmetry, and skin color
b. Lower extremity strength
c. Muscle bulk and tone
d. Nodules in the joints
21. Alternating loud and soft heart tones are almost always indicative of:
a. Severe left ventricular dysfunction
b. Cardiac tamponade
c. 3rd-degree heart block
d. Hypotension
22. When auscultating the heart, the S1 sound is located at the apex of the heart and signifies:
a. Increased resistance to ventricular filling
b. Closure of the mitral and tricuspid valves
c. Closure of the pulmonic and aortic valves
d. Closure of the pulmonic and tricuspid valves
3
23. Can you auscultate an S4 during atrial fibrillation?
24. Which of the following statements is true concerning auscultation of the typical murmur
associated with aortic stenosis?
a. It is a harsh, crescendo-decrescendo ejection type that often radiates to the carotid
artery
a. It is best heard at the apex of the heart
b. The loudness of the murmur reflects the severity of the lesion
c. It is a diastolic murmur
25. The chances of rupture and mortality increase dramatically when an abdominal aortic
aneurysm diameter exceeds _____ cm.
26. List the cluster of risk factors associated with metabolic syndrome:
27. What are the criteria for diagnosing someone with metabolic syndrome?
28. A patient comes in with shortness of breath, crackles in the bases, and has jugular venous
pressure of 5 cm. What condition do you suspect?
29. This type of murmur increases with inspiration and is heard best at the left lower sternal
border?
30. This type of murmur is heard best at the heart’s apex and is often associated with a
“click?”
31. This type of murmur is heard best at the right upper sternal border and is often confused
with a carotid bruit?
32. What does the p-wave on a 12-lead ECG represent?
33. This condition can be seen in peripheral vascular disease, where one extremity is cooler
than the other extremity.
34. Name the screening tool currently being used when recommending anticoagulation for a
patient who comes to your office with a new onset of atrial fibrillation?
35. This type of shallow wound arises from _____ and is often described as painful,
appearing over the malleolus with irregular borders. In its advanced stages, the lower
extremity often appears thickened with hyperpigmented brown discoloration.
36. When and why should the HEART score risk-stratification tool be used?
37. This condition often presents with normal radial pulses with episodes of sharply
demarcated pallor of the fingers caused by spasms of the distal arteries.
4
38. Name the electrical abnormality commonly associated with low magnesium levels with a
“ribbon” appearance on the 12-lead ECG?
39. Name two conditions in which enlarged epitrochlear lymph nodes can be palpated.
40. Name two differential diagnoses that you would consider in a patient presenting with
pain in the popliteal fossa of one knee with calf swelling.
41. What does the QRS complex on a 12-lead ECG represent?
42. What does this picture suggest?
Questions 43 – 46. Matching. Identify each murmur as being either systolic or diastolic.
_____ Aortic insufficiency
_____ Mitral regurgitation
a. Systolic murmur
b. Diastolic murmur
_____ Aortic stenosis
_____ Mitral stenosis
5
Questions 47 – 51. Match the following auscultatory areas on the chest wall with the proper
valve/area site.
_____2nd intercostal space (ICS), right sternal border
_____2nd intercostal space (ICS), left sternal border
_____3rd intercostal space (ICS), left sternal border
_____4th intercostal space (ICS), left sternal border
a.
b.
c.
d.
e.
Pulmonic valve/area
Mitral valve/area
Erb’s point
Aortic valve/area
Tricuspid valve/area
_____5th intercostal space (ICS), midclavicular line
Questions 52 – 57. Match the following descriptions to the heart sounds.
_____Can be a normal variant in pregnancy
a. S3
b. S4
_____Severe left ventricular hypertrophy
_____Conditioned athletes
_____Systolic heart failure
_____Diastolic heart failure
_____Can be a normal finding in children
6
Questions 58 – 63. Fill in the empty boxes for grading heart murmurs.
Grade 4
Very loud murmur audible with the stethoscope placed lightly on the chest
Grade 3
Grade 2
The faintest sound that can be detected
Extremely loud murmur audible with the stethoscope off of the chest
7
Calculate the Ankle Brachial Index (ABI) for the below patient and interpret the results.
Be sure you follow the rules for calculating the ABI correctly.
Right Arm Systolic Pressure
120 mmHg
Left Arm Systolic Pressure
100 mmHg
Left Ankle Systolic Pressure
Posterior tibial 136 mmHg
Dorsalis pedis 132 mmHg
Right Ankle Systolic Pressure
Posterior tibial 68 mmHg
Dorsalis pedis 64 mmHg
64. Right ABI =
65. Left ABI =
66. What is this patient’s overall ankle-brachial index?
67. What category of peripheral artery disease would you place this patient based on the
above patient’s overall ABI index?
8
9
Purchase answer to see full
attachment
