1. What are the main functions of the cardiovascular system?

A. Delivering oxygen and nutrients, removing waste, and maintaining perfusion

B. Producing hormones and regulating metabolism
C. Filtering blood and producing white blood cells
D. Controlling muscle movement and digestion

2. Where is the heart located within the body?

A. In the abdominal cavity near the liver
B. In the pericardial cavity within the mediastinum
C. Behind the spinal cord near the kidneys
D. Below the diaphragm next to the stomach
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3. What is the precordium?
A. The sac surrounding the heart
B. The major artery supplying blood to the heart
C. The area of the chest overlying the heart and great vessels
D. The right ventricle of the heart

4. Which chamber of the heart occupies most of the anterior cardiac surface?
A. Right ventricle
B. Left atrium
C. Right atrium
D. Left ventricle

5. The base of the heart is located at which anatomical landmark?

A. 5th and 6th intercostal spaces
B. Xiphoid process
C. Right and left 2nd intercostal spaces
D. Umbilical region

6. What structure lies at the junction of the sternum and the xiphoid process?
A. Right ventricle’s inferior border
B. Aortic arch
C. Left atrium
D. Pulmonary veins

7. Which of the following best describes the normal location of the point of maximal
impulse (PMI)?
A. 2nd intercostal space, right midclavicular line
B. 3rd intercostal space, midsternal line
C. 5th intercostal space, 7–9 cm lateral to the midsternal line
D. 6th intercostal space, left axillary line

8. Which of the following findings is most suggestive of left ventricular hypertrophy (LVH)?
A. PMI located at the 4th intercostal space
B. PMI measuring 1 cm in diameter
C. PMI displaced 10 cm lateral to the midsternal line
D. PMI located at the midline of the sternum

9. Dr. Wane palpates a patient’s precordium and finds a PMI with a diameter of 3 cm.
What is the most likely diagnosis?
A. Normal heart size
B. Right ventricular hypertrophy
C. Pericarditis
D. Left ventricular hypertrophy

10. A patient presents with a heart murmur that is best heard at the 2nd right intercostal
space and radiates toward the neck. Based on the auscultation site, which valve is most
likely involved?
A. Aortic valve
B. Tricuspid valve
C. Mitral valve
D. Pulmonic valve

11. Why is it necessary to correlate auscultatory findings with other cardiac examination
findings when identifying heart murmurs?
A. Because all murmurs are heard best at the same location
B. Because sounds from different valves may overlap in certain areas of the chest
C. Because auscultation is the only reliable method for diagnosing heart disease
D. Because murmurs never change in intensity or location

12. What does preload refer to in cardiac physiology?

A. The resistance the heart must overcome to eject blood
B. The volume of blood in the right ventricle at the end of diastole
C. The contraction strength of the myocardium
D. The difference between systolic and diastolic blood pressure

13. Which of the following increases myocardial contractility?

A. Decreased oxygen delivery to the myocardium
B. Lower blood volume
C. Increased afterload
D. Sympathetic nervous system stimulation

14. What is afterload?

A. The resistance to ventricular contraction
B. The amount of blood returning to the heart
C. The contraction strength of the cardiac muscle
D. The total blood volume in circulation
15. Which of the following describes pulse pressure?
A. The average pressure in the arterial system
B. The peak pressure in the aorta during systole
C. The difference between systolic and diastolic pressure
D. The pressure within the veins returning blood to the heart

16. Which vein is most commonly used to estimate jugular venous pressure (JVP)?
A. Left external jugular vein
B. Right internal jugular vein
C. Subclavian vein
D. Brachiocephalic vein

17. A patient presents with an increased JVP. What could this indicate about their
cardiovascular status?
A. Decreased right atrial pressure
B. Increased central venous pressure
C. Decreased preload
D. Increased myocardial contractility

18. A patient with high blood pressure is found to have increased afterload. How does this
affect the heart?
A. Increases the workload on the left ventricle
B. Increases venous return to the right atrium
C. Decreases myocardial oxygen demand
D. Reduces preload

19. Dr. Sue measures a patient’s blood pressure and finds an extremely wide pulse pressure.
Which condition could be responsible for this finding?
A. Aortic stenosis
B. Aortic regurgitation
C. Dehydration
D. Myocardial infarction

20. A patient with heart failure is given a medication to reduce preload. Which of the
following actions best explains how the medication helps?
A. It increases myocardial contractility
B. It reduces the volume of blood returning to the heart
C. It strengthens the left ventricular contraction
D. It increases arterial resistance

21. During a physical examination, a patient’s internal jugular vein pulsations show two
rapid peaks and two troughs. What does this pattern suggest about heart function?
A. Normal atrial and ventricular function
B. Abnormal ventricular filling
C. Increased myocardial contractility
D. Decreased arterial blood pressure

22. Why is the carotid artery pulse an important assessment in cardiac evaluation?
A. It helps determine venous insufficiency
B. It provides valuable information about cardiac function and aortic valve disorders
C. It measures blood pressure directly
D. It assesses lung function

23. Why should both carotid arteries never be pressed at the same time?
A. It may cause an irregular heart rhythm
B. It can increase blood pressure suddenly
C. It may decrease blood flow to the brain and induce syncope
D. It may overstimulate the vagus nerve and cause a headache

24. What is a potential cause of decreased carotid pulsations?

A. Increased heart rate
B. Atherosclerotic narrowing or occlusion
C. High blood volume
D. Increased stroke volume

25. A patient presents with a bounding carotid pulse. Which of the following conditions is most
commonly associated with this finding?
A. Aortic insufficiency
B. Cardiogenic shock
C. Carotid artery stenosis
D. Myocardial infarction

26. A patient in cardiogenic shock presents with a weak and thready pulse. What is the most
likely physiological explanation for this pulse characteristic?
A. Increased stroke volume leading to higher pulse pressure
B. Decreased cardiac output resulting in low pulse amplitude
C. Increased peripheral resistance causing a bounding pulse
D. Rapid upstroke of the carotid artery pulse wave

27. During the hepatojugular reflux maneuver, how long should pressure be applied to the right
upper quadrant of the abdomen?
A. 10 seconds
B. 20 seconds
C. 30 seconds
D. 1 minute

28. In assessing the carotid pulse wave, which of the following findings would indicate a normal
physiological response?
A. A slow and prolonged upstroke that follows S2
B. A brisk and rapid upstroke that follows S1
C. A sharp upstroke with a delayed peak during diastole
D. A rapid downstroke followed by a steep upstroke before S1

29. A physician auscultates a murmur-like sound over the carotid artery using the bell of a
stethoscope. What is the clinical significance of this finding?
A. It confirms the presence of a heart murmur originating from the left ventricle
B. It suggests a vascular abnormality such as carotid artery stenosis
C. It indicates a normal physiological variation in pulse contour
D. It is a harmless sound produced by turbulent blood flow in the aorta

30. When performing a cardiac examination, what is the recommended angle for elevating the
head of the bed?
A) 10°
B) 20°
C) 30°
D) 45°

31. How does the timing of the carotid upstroke assist in differentiating heart sounds during
tachycardia?
A. It follows S2 and occurs just before the next S1, helping to identify diastole
B. It follows S1 and precedes S2, helping to confirm systole
C. It occurs simultaneously with S2, distinguishing systole from diastole
D. It occurs after S2, marking the transition between diastole and systole

32. Which of the following best describes the purpose of the hepatojugular reflux maneuver?
A. To evaluate liver function
B. To check for jugular vein distention in suspected heart failure
C. To assess for abdominal tenderness
D. To measure pulmonary artery pressure

33. Which heart sound is typically louder at the apex of the heart?
A. S1
B. S2
C. S3
D. S4

34. Why is the patient asked to turn to the left side during a cardiac examination?
A. To better assess right ventricular function
B. To enhance detection of the point of maximal impulse (PMI)
C. To increase heart rate for better auscultation
D. To measure the hepatojugular reflux
35. Dr. Ambot is examining a patient and is unable to palpate the apical impulse in the supine
position. What is the best next step to enhance detection?
A. Ask the patient to exhale fully and stop breathing for a few seconds
B. Instruct the patient to sit and lean forward
C. Press firmly on the chest wall over the suspected location
D. Use percussion to estimate the size of the heart

36. A patient has situs inversus. Which of the following findings would be expected upon
examination?
A. Apical impulse on the right, liver on the left, and stomach on the right
B. Apical impulse on the right, liver on the right, and stomach on the left
C. Apical impulse on the left, liver on the right, and stomach on the left
D. Apical impulse on the right, liver on the left, and stomach on the left

37. Nurse Yarn palpates a prominent pulsation in the right 2nd intercostal space. What is the
most likely cause of this finding?
A. Right ventricular hypertrophy
B. Pulmonary hypertension
C. Aortic aneurysm or increased flow through the aortic outflow tract
D. Mitral stenosis

38. A patient presents with an enlarged right ventricle. Which of the following physical exam
findings would most likely be present?
A. A displaced PMI at the left midclavicular line
B. A prominent pulsation at the lower left sternal border and subxiphoid area
C. A palpable diastolic murmur at the aortic area
D. An increased S2 intensity at the right 2nd intercostal space

39. A medical student is learning cardiac auscultation. Which of the following is the correct way
to use the bell of the stethoscope?
A. Press firmly against the chest wall to detect high-pitched sounds
B. Use light pressure to detect low-pitched sounds like S3 and S4
C. Apply firm pressure while listening to mitral regurgitation murmurs
D. Use the bell for pericardial friction rubs and aortic murmurs

40. Which type of murmur starts immediately after S2 without a gap and fades before the next
S1?
A. Midsystolic murmur
B. Early diastolic murmur
C. Late systolic murmur
D. Pansystolic murmur

41. A murmur that starts with S1 and continues until S2 without a gap is called:
A. Midsystolic murmur
B. Middiastolic murmur
C. Pansystolic murmur
D. Late diastolic murmur

42. Which murmur begins after S1 and stops before S2, with audible gaps between heart
sounds?
A. Late systolic murmur
B. Midsystolic murmur
C. Late diastolic murmur
D . Early diastolic murmur

43. Which of the following statements best explains the relationship between metabolic
syndrome and cardiovascular risk?
A. Metabolic syndrome has no significant impact on cardiovascular health since it mainly
affects blood sugar levels.
B. The presence of three or more risk factors associated with metabolic syndrome significantly
increases the risk of cardiovascular disease due to factors like high blood pressure, elevated
triglycerides, and abdominal obesity.
C. Metabolic syndrome only affects people with high triglyceride levels, and it does not
influence blood pressure or cholesterol.
D. Metabolic syndrome is unrelated to smoking, as it primarily involves high blood sugar levels.

44. Nurse Mikasa is assessing the patient radial pulse. Upon placing her fingers, she has noted
that the patient has a bounding pulse. The nurse should grade this pulse on her chart as
A. 3+
B. 2+
C. 1+
D. 0

45. If you cannot feel the dorsalis pedis pulse, where should you try palpating next?
A. Lateral side of the popliteal fossa
B. Behind and below the medial malleolus
C. More laterally on the dorsum of the foot
D. In the midline behind the knee

46. Where should the femoral pulse be palpated?

A. Below the knee, on the medial side
B. Below the inguinal ligament, midway between the anterior superior iliac spine and the
symphysis pubis
C. Just lateral to the extensor tendon of the great toe
D. Behind and slightly below the medial malleolus

47. When the patient has a pulsus alternans, the nurse must suspect for which of the following
in the patient?
A. Aortic stenosis
B. Hyperthyroidism
C. Pericardial tamponade
D. Left ventricular failure

48. Which of the following is true about palpating the popliteal pulse?
A. It is easily palpable in the midline behind the knee when the patient’s knee is straight.
B. The popliteal pulse is typically difficult to find and may require deep pressure in the popliteal
fossa, especially with the patient prone.
C. The popliteal pulse is located just lateral to the extensor tendon of the great toe.
D. The popliteal pulse is located behind the medial malleolus.

49. Edema, varicose veins, and aching in the legs are symptoms of
A. Arterial stasis
B. Venous stasis
C. Arterial pooling
D. Atherosclerosis

50. kind of abdominal pain occurs when hollow abdominal organ such as intestine or biliary tree
contract unusually forcefully or distended or stretched?
A. Visceral pain C. Referred pain
B. Parietal pain D. Unusual