Cardio APEA
Cardio APEA
Question 1:
The lymphatic ducts drain into the:
arterial system.
venous system.  Correct
arteriovenous system.
capillary bed.  Incorrect
Explanation:
The lymphatic ducts drain into the venous system.
Question 2:
While auscultating the patient’s heart, a medium, soft murmur is audible. It is pansystolic and heard loudest at the apex with radiation to the left axilla. These findings are consistent with:
tricuspid regurgitation.mitral regurgitation.  Correcta ventricular septal defect.an innocent murmur.  Incorrect
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Explanation:
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. 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 murmur of an uncomplicated ventricular septal defect has a high pitch and is usually heard throughout systole. An innocent murmur is heard loudest at mid systole near the second to fourth intercostal spaces between the left sternal border and the apex. It usually decreases or disappears when sitting. Cardio APEA.
Question 3:
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. Cardio APEA. 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 4:
Right atrial pressure can be determined by:
palpating the carotid pulse.  Incorrect
identifying the pulsations of the right jugular vein.  Correct
analyzing the arterial blood gases.
assessing for dependent edema.
Explanation:
Jugular venous pressure reflects pressure in the right atrium and is best assessed from pulsations in the right internal jugular vein. This is an indicator of cardiac function and right heart hemodynamics. Palpating the carotid artery denotes arterial pressure; analyzing blood gases reflects the status of the arterial blood. Assessing for dependent edema is a reflection of heart failure and poor venous return and not atrial pressure. Cardio APEA.
Question 5:
When assessing the heart rate of a healthy 13-month-old child, which one of the following sites is the most appropriate for this child?
Apical pulse at the 5th intercostal space right midclavicular line
Apical pulse between the 3rd and 4th intercostal space in the left midclavicular line  Correct
Apical pulse to the right of the midclavicular line in the 3rd intercostal space
Apical pulse in the 5th intercostal space left midclavicular line  Incorrect
 
Explanation:
The apical pulse in a 13-month-old is auscultated for a full minute between the 3rd and 4th intercostal space to the left of the midclavicular line. The only time one would auscultate the right midclavicular line would be if the child had situs inversus or dextrocardia.
Question 6:
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.  Incorrect
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. Cardio APEA.
Question 7:
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.
Question 8:
The amplitude of the pulse in a patient in cardiogenic shock would most likely appear:
bounding.
thready.  Correct
normal.
as a bruit.
Explanation:
The amplitude of the pulse correlates with pulse pressure. Small, thready, or weak pulses occur in patients in cardiogenic shock. Bounding pulses are seen in patients in aortic insufficiency. A bruit is not typically associated with pulse amplitude. It is associated with stenosis or turbulent arterial blood flow. Usually the presence of a bruit requires further investigation and is not in itself diagnostic. Cardio APEA.
Question 9:
When auscultating the heart for aortic insufficiency, ask the patient to:
lie supine and inhale.
exhale while standing.
turn to the left side and breath deeply.
sit up, lean forward, and exhale.  Correct
Explanation:
To bring the left ventricular outflow tract closer to the chest wall to listen for aortic insufficiency, ask the patient to sit up, lean forward, and exhale. Cardio APEA.
Question 10:
The horizontal superficial inguinal lymph nodes are located in the anterior thigh below the inguinal ligament and drain lymphatic fluid from all of these areas except:
lower abdomen.
buttock.  Incorrect
testes.  Correct
lower vagina.
Explanation:
The horizontal superficial inguinal nodes lie in a chain high in the anterior thigh below the inguinal ligament. They drain the superficial portions of the lower abdomen and buttock, the external genitalia (but not the testes), the anal canal and perianal area, and the lower vagina.
Question 11:
When auscultating the point of maximal impulse (PMI), apex of the heart, in an adult, the stethoscope is placed at the:
third intercostal space to the left of the midclavicular line.
fifth intercostal space to the left of the midclavicular line.  Correct
fourth intercostal space to the right of the midclavicular line.
fifth intercostal space to the right of the midclavicular line.  Incorrect
Explanation:
To auscultate the apex of the heart in an adult, the proper placement of the stethoscope should be at the fifth intercostal space to the left of the midclavicular line.
Question 12:
Deep cervical lymph nodes drain lymphatic fluid from the:
head and neck.  Correct
breasts.
mouth, throat, and face.
posterior part of the temporoparietal region.  Incorrect
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 symptoms would necessitate the need for further evaluation in the newborn?
 
Blue hands and feet within an hour after birthBlood glucose level 45 mg/dl.Dusky cyanotic when crying  CorrectDeep sleep one hour after birth
 
Explanation:
An infant who is dusky and becomes cyanotic when crying is showing poor cardiovascular adaptation to extrauterine life and requires further evaluation. Acrocyanosis, blue feet and hands, is not central cyanosis and is an expected finding during the early neonatal life. Normal glucose levels for a newborn are 40-60 mg/dL. Infants enter the period of deep sleep or decreased activity when they are about one hour old.
Question:
Symptoms of acrocyanosis in the newborn include:
 
bluish color of the tongue.bluish color of the mucous membranes.bluish color of the feet.  Correctbluish 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. Cardio APEA.
Question:
A heart rate of 100-180 beats per minute in an adult is considered:
 
normal sinus rhythm.sinus tachycardia.  Correctsupraventricular 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.
Question:
Tissue ischemia is usually observed when assessing a patient with peripheral artery disease (PAD). What other symptom could be observed?
 
Peripheral edemaIntermittent claudication.  CorrectA brownish discoloration to the skin of the affected leg  IncorrectBounding pulses in the affected leg
 
Explanation:
With peripheral vascular disease, arterial peripheral blood flow is impeded resulting in inadequate tissue perfusion and oxygenation. This leads to intermittent claudication, ischemia muscle pain precipitated by a predictable amount of exercise and relieved by rest. Other symptoms include pale cool skin, cyanosis, audible bruits, diminished or absent pulses, and thickened and opaque nails. Usually by the time the symptoms appear, the artery is 75% narrowed. Peripheral edema and brownish discoloration of the skin would be consistent with venous disease. Bounding pulses may reflect hypertension. Cardio APEA.
Question:
When performing a cardiovascular assessment on a healthy 2-year-old child:
 
expect to hear a swooshing sound during diastole.place the stethoscope over the fifth intercostal space to the left of the mid-clavicular line.auscultate the heart sounds in all four cardiac areas.  Correctexpect to hear an S4 sound.
 
Explanation:
When performing cardiac assessment on the child, the heart sounds should be auscultated in all 4 cardiac areas: aortic, pulmonic, tricuspid, and mitral areas. In children younger than 7 years of age, the point of maximum impact (PMI) is auscultated at the third or fourth intercostal spaces, and one should not hear swooshing sounds as this would be indicative of a pathological heart murmur, especially if heard during diastole. S4 sound is produced by the atrium forcefully contracting against a stiffened ventricle. It is also a dull, low pitched sound. The presence of S4 usually indicates cardiac disease secondary to a decrease in ventricular compliance caused by either ventricular hypertrophy or myocardial ischemia. Cardio APEA.
Question:
A disparity between the brachial and femoral pulses in a 4-month-old could indicate:
 
an atrial septal defect (ASD).Tetralogy of Fallot.  Incorrectcoarctation of the aorta (COA).  Correcttricuspid atresia (TA).
 
Explanation:
In coarctation of the aorta (COA), there is a disparity of pulses between the upper and lower extremities due to the narrowing of the descending aorta resulting in decreased blood flow to the lower extremities. The other choices do not present with these findings.
Question:
The right lymph duct drains lymphatic fluid from all the following areas except the:
 
right side of the head.right upper thorax.right arm.right leg.  Correct
 
Explanation:
The right lymph duct drains lymphatic fluid from the body’s right upper quadrant and includes the right side of the head and neck, right side of the thorax, and right upper limb. The thoracic duct drains lymph from the remainder of the body including the legs. Cardio APEA.
Question:
When auscultating the apex of the heart in an 8-year-old, the bell of the stethoscope should be placed at the:
 
third intercostal space lateral to the midclavicular line.fifth intercostal space to the left of the midclavicular line.  Correctfourth intercostal space lateral of the midclavicular line.fifth intercostal space to the right of the midclavicular line.
 
Explanation:
In children older than 7 years, the apical pulse, or point of maximum impulse, is heard loudest at the fifth intercostal space and left of the midclavicular line. In children and infants less than seven years, it is heard at the third or fourth intercostal space and lateral to the midclavicular line. The apex would be located on the right side of the chest if dextrocardia was present. Cardio APEA.
Question:
In order to assess for varicosities in the lower extremities, position the patient:
 
lying supine.standing.  Correctsitting facing forward.squatting facing the examiner.  Incorrect
 
Explanation:
The standing posture allows any varicosities to fill with blood and makes them more easily visible.
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.  IncorrectRaynaud’s disease.deep venous thrombosis.  Correctsuperficial 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. Cardio APEA.
Question:
Symptoms of orthostatic hypotension include all of the following except:
 
syncope.unsteadiness.visual blurring.respiratory rate greater than 30.  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. Symptoms include lightheadedness, weakness, unsteadiness, visual blurring, and in 20% to 30% of patients, syncope.
Question:
A three-week-old infant presents with a generalized lacy, reticulated blue discoloration of the skin. This is suggestive of:
 
mongolian spots.  Incorrectharlequin color changes.acrocyanosis.cutis marmorata.  Correct
 
Explanation:
Cutis marmorata is a marbled or mottled look about the skin of a newborn caused by the uneven distribution of blood flow about the skin. The cause is due to both the immature vascular and neurologic systems in the newborn. Mongolian spots are blue-gray spots that are flat, “bruise-like” areas of skin. Usually confined to the back and buttocks. Acrocyanosis is a bluish discoloration of the hands, feet and lips. The phenomenon is considered normal to newborns because of immature circulation and underdeveloped capillaries.
Question:
The supraclavicular lymph nodes are located:
 
along the anterior edge of the trapezius.deep in the angle formed by the clavicle and the sternomastoid muscle.  Correctsuperficially to the sternomastoid muscle.  Incorrectmidway between the angle and the tip of the mandible.
 
Explanation:
The supraclavicular lymph nodes are located deep in the angle formed by the clavicle and the sternomastoid muscle. The posterior cervical lymph nodes are located along the anterior edge of the trapezius. Cardio APEA. The superficial cervical lymph nodes are located superficial to the sternomastoid muscle. Midway between the angle and the tip of the mandible are the submandibular lymph nodes.
Question:
In an adult patient, auscultate the sounds arising from the mitral valve by placing the stethoscope:
 
near the apex of the heard between the 5th and 6th intercostal spaces in the mid-clavicular line.  Correctbetween the 3rd, 4th, 5th, and 6th intercostal spaces at the left sternal border.between the 2nd and 3rd intercostal spaces at the left sternal border.  Incorrectbetween the 2nd and 3rd intercostal spaces at the right 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. Mitral listening point is near the apex of the heart between the 5th and 6th intercostal spaces in the mid-clavicular line. Aortic listening point is between the 2nd and 3rd intercostal spaces at the right upper sternal border (RUSB). Pulmonic listening point is located between the 2nd and 3rd intercostal spaces at the left sternal border (LUSB). Tricuspid listening point is between the 3rd, 4th, 5th, and 6th intercostal spaces at the left lower sternal border (LLSB). Cardio APEA.
Question:
The tonsillar lymph node is located:
 
at the angle of the mandible.  Correctin front of the ear.at the base of the skull posteriorly.superficial to the mastoid process.  Incorrect
 
Explanation:
The tonsillar lymph nodes are at the angle of the mandible. The preauricular lymph nodes are located in front of the ear. The occipital lymph nodes are located at the base of the skull posteriorly. The posterior auricular nodes are superficial to the mastoid process.
Question:
A bruit heard in the epigastric area with both systolic and diastolic components is suggestive of:
 
renal artery stenosis.  Correctaortic regurgitation.  Incorrectfemoral artery occlusion.an aortic aneurysm.
 
Explanation:
A bruit heard in the epigastric area, upper quadrants, or in the costovertebral region that has both systolic and diastolic components is suggestive of renal artery stenosis. Aortic regurgitation could be evidenced by the presence of S1, S2, and a diastolic murmur. Femoral artery occlusion would produce a cold, painful, discolored lower extremity. A pulsation visible or palpable in the epigastrium could be consistent with an aortic aneurysm.
Question:
Presence of a heart murmur in a child would be considered organic if the child:
 
is 18-months-old and was recently diagnosed with anemia.was a 3-year-old, afebrile and diagnosed with an upper respiratory infection.was a 10-month-old who presented with a temperature of 103 °F.was a 2-year-old with a congenital heart defect.   Correct Cardio APEA.
 
Explanation:
A heart murmur is classified an organic murmur if there is an anatomic cardiac defect with or without a physiologic abnormality. If a murmur was heard and the child presents with fever or anemia, the murmur is considered non organic or physiologic. The 3-year-old with the upper respiratory infection without fever would be an example of an innocent murmur since there is an absence of an anatomic or physiological condition.
Question:
A patient complaints of a sharp, knifelike pain that begins in the chest and radiates to the tip of the shoulder and to the neck. This type of chest pain is suggestive of:
 
pericarditis.  Correctan aortic dissection.angina pectoris.a myocardial infarction.  Incorrect
 
Explanation:
Assessing chest pain can be very difficult but thorough patient history and a physical exam can help the clinician determine the cause. Pain associated with pericarditis may radiate to the tip of the shoulder and to the neck and presents with a sharp, knifelike pain. A sharp pain that radiates to the back or into the neck can be associated with aortic dissection. Exertional pain is often angina pectoris.
Question:
In order to bring the ventricular apex closer to the chest wall when assessing the point of maximal impulse (PMI), ask the patient to:
 
lie supine.sit up.turn to the left side.  Correctlean forward.  Incorrect
 
Explanation:
To bring the ventricular apex closer to the chest wall to assess the PMI, ask the patient to turn to the left side, termed the left lateral decubitus position. The patient should lie supine during this part of the cardiac exam. To auscultate for aortic insufficiency, ask the patient to sit up, lean forward, and exhale.
Question:
The preauricular lymph node is located:
 
at the angle of the mandible.in front of the ear.  Correctat the base of the skull posteriorly.superficial to the mastoid process.
 
Explanation:
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. The posterior auricular nodes are superficial to the mastoid process.
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.  Correctbetween 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:
To assess aortic pulsations in patients with carotid obstruction, assess the pulse using the:
 
temporal artery.  Incorrectbrachial artery.  Correctfemoral artery.popliteal artery.
 
Explanation:
Aortic pulsation is most accurately assessed by palpating the carotid arteries. However, if the carotid arteries are obstructed, the brachial artery should be palpated to reflect aortic pulsation. The temporal, femoral, and popliteal are not the most accurate arteries for assessing aortic pulsations.
Question:
When screening a patient for peripheral arterial disease (PAD), one risk factor would include a history of:
 
smoking.  Correctan implantation of a temporary internal pacemaker.dysrhythmias.peripheral edema.
 
Explanation:
Nicotine in cigarettes promotes vasoconstriction which results in peripheral arterial disease. Cigarette smoking, hypertension, and hyperlipidemia are the three most common causes of peripheral arterial disease (PAD). Peripheral edema is consistent with venous disease. Dysrhythmias and a history of having a temporary internal pacemaker in place are not risk factors for PAD.
Question:
The preauricular nodes drain lymphatic fluid from the:
 
palpebral conjunctiva and the skin adjacent to the ear within the temporal region.  Correcteyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek.mouth, throat, and face.posterior part of the temporoparietal region. Cardio APEA.
 
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.
Question:
The ankle-brachial index is a screening test used to assess a person’s risk for:
 
deep venous thrombosis.peripheral artery disease.  Correctvenous insufficiency.thromboangiitis obliterans.
 
Explanation:
The ankle-brachial index test is a quick, noninvasive way to check a person’s risk for peripheral artery disease (PAD). It compares the blood pressure in the ankle and the arm and measures the difference. A low index is indicative of a narrowing or blockage in the arteries. Deep venous thrombosis, venous insufficiency, and thromboangiitis obliterans are related disorders of the venous system.
Question:
The internal iliac lymph nodes drain lymphatic fluid from the:
 
urinary bladder.prostate.uterus.gluteal region.  Correct
 
Explanation:
The internal iliac lymph nodes receive lymphatic fluid from all pelvic viscera, deep part of the perineum, and the gluteal region. The external iliac lymph nodes receive lymphatic fluid from the umbilicus, urinary bladder, prostate or uterus, and the upper vagina.
Question:
Causes of orthostatic hypotension in older adults may include all of the following except:
 
diabetes.  Incorrectcardiovascular 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:
A 5-year-old child presents with complaints of fever and headache. Examination reveals a heart rate of 157 beats/minute, respiratory rate of 40 breaths/minute, B/P 108/54, and a temperature of 102.6 °F. The increased heart rate is most likely related to:
 
an innocent heart murmur.the child’s age.a sinus arrhythmia.the child’s febrile state.  Correct
 
Explanation:
In the presence of fever, the heart rate increases by 10 beats/minute with each degree of fever and the respiratory rate increases by 4 breaths/minute with each degree of fever. Normal heart rate for this age group ranges from 70-120/minute. A murmur does not increase the heart rate. In sinus arrhythmia, the heart rate increases with inspiration and decreases with expiration.
Question:
The posterior chest wall and portions of the arms are drained by which group of lymph nodes?
 
Posterior mediastinal nodesSubscapular nodes  CorrectParasternal nodesIntercostal 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:
A patient states that the only way he can sleep at night is to use several pillows or to sleep upright in a recliner. This sleep pattern is most consistent with:
 
paroxysmal nocturnal dyspnea.  Incorrectobstructive lung disease.  Correctangina pectoris.decreased jugular venous pressure. Cardio APEA.
 
Explanation:
With obstructive lung disease, the patient experiences orthopnea, dyspnea that occurs when the patient lies down but improves with sitting. Therefore, the patient would use several pillows or sleep upright in a recliner. Orthopnea is seen in obstructive lung disease, mitral stenosis, and heart failure. Paroxysmal nocturnal dyspnea describe episodes of sudden dyspnea that cause the patient to awaken from sleep where the patient must sit up, walk, or stand for it to resolve. Coughing and wheezing may also occur. Angina pectoris commonly creates chest pain or shortness of breath. Jugular venous pressure reflects right atrial pressure and volume status. In cases of cardiac or pulmonary dysfunction, jugular venous pressures usually raise.
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.  Correctaortic stenosis.
 
Explanation:
A disease that may present as indigestion, but is precipitated by exertion and relieved by rest is most likely angina.
Question:
A patient suspected of having chronic venous insufficiency, may present with:
 
calf asymmetry.a brownish discoloration just above the malleolus.  Correctabsent right pedal pulse.decreased femoral pulse.
 
Explanation:
Brownish discoloration or ulcers just above the malleolus suggest chronic venous insufficiency. Calf asymmetry increases the likelihood of deep venous thrombosis (DVT). Decreased or absent pulses are reflective of arterial vascular disease.
Question:
The great saphenous vein enters the deep venous system by way of the:
 
inferior vena cava.  Incorrectiliac vein.popliteal vein.femoral vein.  Correct
 
Explanation:
The great saphenous vein, which originates on the dorsum of the foot, joins the femoral vein of the deep venous system below the inguinal ligament.
Question:
Warning signs of peripheral artery disease may include all of the following except:
 
aching or numbness that limits walking.non-healing lesions of the legs.abdominal pain after meals with weight loss.  Incorrectpersistent cough.  Correct
 
Explanation:
Patients with peripheral artery disease (PAD) may not experience any symptoms or may experience a variety of symptoms that indicate ischemia. Some warning signs of peripheral artery disease include: fatigue, aching, numbness, pain that limits walking, or poorly healing lesions on the legs. The nurse practitioner should conduct a thorough assessment and review of symptoms to detect early warning signs and differentiate nonatherosclerotic and nonvascular conditions. PAD is a treatable condition. When recognized early and appropriately managed, complications that can lead to limb loss can be minimized.
Question:
On assessment, which one of the following symptoms would be noted as a compensatory response to chronic hypoxia?
 
Pulmonary hypertensionDehydrationHematocrit (HCT) of 55%  CorrectHemoglobin (Hgb) of 8.5g/dl
 
Explanation:
With chronic hypoxia, the body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increasing the oxygen carrying capacity of the blood; this condition is termed polycythemia. Clubbing is a classic symptom of chronic hypoxia. Lab values denoting increased RBC such as HCT of 55-60% would be indicative of polycythemia. Pulmonary hypertension is a clinical consequence of increased pressure in the pulmonary arteries and is seen in children with congenital heart defects but it is not a direct result of hypoxia. Dehydration can occur rapidly in children with cyanotic heart defects; however, it is not a compensatory mechanism of chronic hypoxia. Anemia may develop as a result of poor tissue oxygenation secondary to decreased blood viscosity not increased as in polycythemia.
Question:
A patient complains of some pain in the distal portions of her fingers on both hands. She sta