Question 

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?

Hard and fixed cervical nodes
Enlarged and tender inguinal nodes
Bilateral enlargement of the popliteal nodes
“Pellet-like” nodes in the supraclavicular region

2. The direction of blood flow through the heart is best described by which of these?

Vena cava right atrium right ventricle lungs pulmonary artery left atrium left ventricle
Right atrium right ventricle pulmonary artery lungs pulmonary vein left atrium left ventricle
Aorta right atrium right ventricle lungs pulmonary vein left atrium left ventricle vena cava
Right atrium right ventricle pulmonary vein lungs pulmonary artery left atrium left ventricle

3. In assessing the carotid artery’s of an older patient with cardiovascular disease, the FNP would

Palpate the artery in the upper one third of the neck.
Listen with the bell of the stethoscope to assess for bruits.
Simultaneously palpate both arteries to compare amplitude.
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

Answer Preview

A 35-year-old man presents to the clinic with an infection in his left foot. During the assessment, the FNP should expect to see enlarged and tender inguinal nodes, as these nodes are located in the groin region and are often involved in infections of the lower extremities. It is unlikely that the FNP will observe hard and fixed cervical nodes, “pellet-like” nodes in the supraclavicular region, or bilateral enlargement of the popliteal nodes, as these findings are not typically associated with an infection in the foot.

The direction of blood flow through the heart can be described by the path of oxygenated and deoxygenated blood. Oxygenated blood, which has been enriched with oxygen from the lungs, flows from the left atrium to the left ventricle and is then pumped out to the rest of the body through the aorta. Deoxygenated blood, which has given up its oxygen to the body’s tissues, flows from the body’s veins into the right atrium and is then pumped into the right ventricle and sent to the lungs for oxygenation through the pulmonary artery. This flow can be summarized as: vena cava (deoxygenated blood) right atrium right ventricle (pumped to lungs) pulmonary artery (to lungs) left atrium left ventricle (pumped to body) aorta (oxygenated blood to body).

In assessing the carotid arteries of an older patient with cardiovascular disease, the FNP should palpate the arteries in the upper one third of the neck and listen with the bell of the stethoscope to assess for bruits, which are abnormal sounds that may indicate the presence of a blockage or narrowing in the artery. The FNP should also simultaneously palpate both arteries to compare the amplitude of the pulse, as differences in pulse strength between the two sides may be indicative of a problem. It is not necessary to instruct the patient to take slow deep breaths during auscultation, as this technique is typically used to assess the lungs rather than the carotid arteries.

When listening to heart sounds, the FNP should be aware that the valve closures that can be heard best at the base of the heart are the aortic and pulmonary valves. The aortic valve closure, or aortic component of the second heart sound, can be heard best at the right second intercostal space in the right sternal border, while the pulmonary valve closure, or pulmonic component of the second heart sound, can be heard best at the left second intercostal space in the left sternal border.

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