Assessing the carotid arteries of an older patient with cardiovascular disease
1. A 35-year-old man is seen in the clinic for an infection in his left foot. Which of these findings should the FNP expect to see during an assessment of this patient?
a. Hard and fixed cervical nodes
b. Enlarged and tender inguinal nodes
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c. Bilateral enlargement of the popliteal nodes
d. Pelletlike nodes in the supraclavicular region
2. The direction of blood flow through the heart is best described by which of these
a. Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle
b. Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
c. Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava
d. Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle
3. In assessing the carotid arteries of an older patient with cardiovascular disease, the FNP would
a. Palpate the artery in the upper one third of the neck.
b. Listen with the bell of the stethoscope to assess for bruits.
c. Simultaneously palpate both arteries to compare amplitude.
d. Instruct the patient to take slow deep breaths during auscultation.
4. When listening to heart sounds the FNP knows that the valve closures that can be heard best at the base of the heart are
a. mitral, tricuspid.
b. tricuspid, aortic.
c. aortic, pulmonic.
d. mitral, pulmonic.
5. The sack that surrounds and protects the heart is called the
d. pleural space.
6. When assessing a newborn infant who is five minutes old the FNP knows that which of these statements would be true?
a. The left ventricle is larger and weighs more than the right.
b. The circulation of a newborn is identical to that of an adult.
c. There is an opening in the atrial septum where blood can flow into the left side of the heart.
d. The foramen ovale closes just minutes before birth and the ductus arteriosus closes immediately after.
7. The FNP is performing an assessment on an adult. The adults vital signs are normal and capillary refill is five seconds. What should the FNP do next?
a. ask the parent if the child has had frostbite in the past.
b. suspect that the child has a venous insufficiency problem.
c. consider this a delayed capillary refill time and investigate further.
d. consider this a normal capillary refill time that requires no further assessment.
8. During an assessment of an older adult the FNP should expect to notice which finding as normal physiologic change associated with aging process?
a. Hormonal changes causing vasodilation and a resulting drop in blood pressure
b. Progressive atrophy of the intramuscular calf veins, causing venous insufficiency
c. Peripheral blood vessels growing more rigid with age, producing a rise in systolic blood pressure
d. Narrowing of the inferior vena cava, causing low blood flow and increases in venous pressure resulting in varicosities
9. The mother of a three month old infant states that her baby has not been gaining weight. With further questioning the FNP finds that the infant falls asleep after nursing and wakes up after a short amount of time hungry again. What other information with the FNP want to have?
a. The position that baby sleeps in
b. Sibling history of eating disorders
c. Amount of background noise when eating
d. Presence of dyspnea or diaphoresis when sucking
10. In assessing a patient’s major risk factors for heart disease which would the FNP want to include when taking a history?
a. Family history, hypertension, stress, age
b. Personality type, high cholesterol, diabetes, smoking
c. Smoking, hypertension, obesity, diabetes, high cholesterol
d. Alcohol consumption, obesity, diabetes, stress, high cholesterol
11. The FNP is assessing… the pulses of a patient who has been admitted for untreated hyperthyroidism. The FNP should expect to find a—— pulse
d. weak, thread
12. A patient complains of leg pain that wakes him at night. He states that he has been having problems with his legs. He has pain in his legs his legs when they are elevated, which disappears when he dangles them. He recently noticed a sore on the inner aspect of his right ankle. On the basis of this history information the FNP interprets that the patient is most likely experiencing
a. pain related to lymphatic abnormalities.
b. problems related to arterial insufficiency.
c. problems related to venous insufficiency.
d. pain related to musculoskeletal abnormalities.
13. During an assessment the FNP uses the profile sign to detect
a. Pitting edema.
b. Early clubbing.
c. Symmetry of the fingers.
d. Insufficient capillary refill.
14. Which of these statements describes the closure of the valves in a normal cardiac cycle?
a. The aortic valve closes slightly before the tricuspid valve.
b. The pulmonic valve closes slightly before the aortic valve.
c. The tricuspid valve closes slightly later than the mitral valve.
d. Both the tricuspid and pulmonic valves close at the same time.
15. When performing a peripheral vascular assessment on a patient the FNP is unable to palpate the ulnar pulses. The patient skin is warm and capillary refill is normal. The FNP should next
a. check for the presence of claudication.
b. refer the individual for further evaluation.
c. consider this a normal finding and proceed with the peripheral vascular evaluation.
d. ask the patient if he or she has experienced any unusual cramping or tingling in the arm.
16. A 67-year-old patient states that he “recently began have pain in his left calf when climbing the 10 stairs to his apartment”. This pain is relieved by sitting for about two minutes then he’s able to resume activities. The FNP interprets this patient is most likely experiencing
b. Sore muscles.
c. Muscle cramps.
d. Venous insufficiency.
17. In assessing a 70-year-old man the FNP finds the following blood pressure 140/100 mmHg, heart rate 104 and slightly irregular, split S2. Which of these findings can… by expected hemodynamic changes related to age?
a. Increase in resting heart rate
b. Increase in systolic blood pressure
c. Decrease in diastolic blood pressure
d. Increase in diastolic blood pressure
18. The FNP is examining the lymphatic system of a healthy three year old child. Which finding should the FNP expect?
a. Excessive swelling of the lymph nodes
b. The presence of palpable lymph nodes
c. No nodes palpable because of the immature immune system of a child
d. Fewer numbers and a decrease in size of lymph nodes compared with those of an adult
19. The FNP is preparing to perform modified Allen test. Which is an appropriate reason for this test?
a. To measure the rate of lymphatic drainage
b. To evaluate the adequacy of capillary patency before venous blood draws
c. To evaluate the adequacy of collateral circulation before cannulating the radial artery
d. To evaluate the venous refill rate that occurs after the ulnar and radial arteries are temporarily occluded
20. A 25-year-old woman is in her fifth month of pregnancy has a blood pressure of 100/70 mmHg. In reviewing her previous exam the FNP notes that her blood pressure in her second month was 124/80 mmHg. When evaluating this change what does the FNP know to be true?
a. This is the result of peripheral vasodilatation and is an expected change.
b. Because of increased cardiac output, the blood pressure should be higher this time.
c. This is not an expected finding because it would mean a decreased cardiac output.
d. This would mean a decrease in circulating blood volume, which is dangerous for the fetus
21. Findings from an assessment of a 70-year-old patient with swelling in his ankles include jugular venous pusations, 5 cm above the sternal angle when the head of his bed is eleveted 45°. The FNP knows that this finding indicate:
a. Decreased fluid volume.
b. Increased cardiac output.
c. Narrowing of jugular veins.
d. Elevated pressure related to heart failure.
22. The component of the conduction system referred to as the pacemaker of the heart is the
a. Atrioventricular (AV) node.
b. Sinoatrial (SA) node.
c. Bundle of His.
d. Bundle branches.
23. The FNP is reviewing anatomy and physiology of the heart. Which statement best describes by atrial kick?
a. The atria contract during systole and attempt to push against closed valves.
b. Contraction of the atria at the beginning of diastole can be felt as a palpitation.
c. Atrial kick is the pressure exerted against the atria as the ventricles contract during systole.
d. The atria contract toward the end of diastole and push the remaining blood into the ventricles.
24. A 45-year-old man is in the clinic for a routine physical. During history the patient states he has been having difficulty sleeping. I’ll be sleeping great and then I wake up and feel like I can’t catch my breath. The FNP‘s best response to this would be
a. “When was your last electrocardiogram?”
b. “It’s probably because it’s been so hot at night.”
c. “Do you have any history of problems with your heart?”
d. “Have you had a recent sinus infection or upper respiratory infection?”
25. When assessing a patient the FNP notes that the left femoral pulse as diminished 1 /4 . What should the FNP do next?
Auscultate the site for a bruit.