ANCC CV-BCFree Cardiac-Vascular Nurse practice test

Correct answer: C. Buerger's disease

Buerger's disease (thromboangiitis obliterans) is strongly linked to tobacco use and characteristically presents in young adults with segmental thrombotic inflammation of small and medium vessels in the distal limbs. Preserved proximal pulses combined with distal rest pain and toe gangrene are hallmark features. Cold-induced tissue injury relates to environmental exposure and does not account for segmental arterial involvement with intact upstream pulses in a chronic tobacco user. Takayasu arteritis targets large vessels, typically in younger women, producing symptoms from occlusion or aneurysm formation rather than distal ischemia confined to the toes. Deep vein thrombosis affects the venous system and typically presents with swelling and erythema rather than ischemic rest pain or gangrene with preserved arterial pulses.

Correct answer: A. Cyanosis of the digits

Cyanosis of the digits indicates worsening vascular compromise and inadequate perfusion, reflecting advancing occlusive disease in small and medium-sized arteries. Without adequate intervention this stage may progress to ulceration and frank gangrene. Excessive hand sweating can result from sympathetic activation but is not a reliable marker of arterial occlusion progression in Buerger's disease. Proteinuria signals kidney involvement and is unrelated to this predominantly distal limb vascular condition. Resting hypotension is a systemic finding not characteristic of Buerger's disease progression, which is gauged by local perfusion changes such as cyanosis or tissue breakdown rather than global blood pressure values.

Correct answer: A. Aortic dissection

Aortic dissection is defined by an abrupt, severe tearing chest pain that radiates to the back. An intimal tear allows blood to track between the aortic wall layers, creating a false lumen. This classic presentation represents a life-threatening vascular emergency. Pulmonary embolism typically features dyspnea and pleuritic chest pain rather than a tearing quality radiating posteriorly. Acute coronary syndrome more commonly produces a pressure-like or squeezing sensation rather than a sharp, tearing pain radiating to the back. Tension pneumothorax causes acute chest pain and respiratory compromise but lacks the tearing quality and posterior radiation characteristic of aortic dissection.

Correct answer: C. Newly detected diastolic aortic murmur

A newly detected diastolic aortic murmur is the most specific physical finding because it indicates acute aortic regurgitation, which occurs when the dissection extends to involve the aortic root and disrupts valve coaptation. A pericardial friction rub is the hallmark of pericarditis rather than aortic dissection, although it can appear as a rare dissection complication. Pulsus alternans reflects severe left ventricular dysfunction and is not a distinguishing feature of aortic dissection. Bradycardia may arise from various conditions including conduction disturbances or vagal responses and is not specific to or commonly associated with aortic dissection.

Correct answer: B. Increase consumption of monounsaturated fats such as olive oil and nuts

Replacing saturated fats with monounsaturated fats found in sources like olive oil and nuts raises HDL cholesterol and can simultaneously lower LDL and triglycerides, making it the most impactful single dietary change for improving HDL. Aggressively reducing all dietary fat may inadvertently lower HDL along with LDL, which does not serve the primary goal of raising protective cholesterol. Eliminating added sugar primarily reduces triglycerides and has only modest effects on HDL; it is a beneficial change but not the most direct lever for raising HDL. A high-protein, low-fiber approach neglects the value of dietary fiber and healthy unsaturated fats and is unlikely to meaningfully improve the HDL level.

Correct answer: D. Intermittent claudication

Intermittent claudication describes exertional muscle pain caused by inadequate arterial perfusion during activity, which resolves when demand drops at rest. Although it is most often a manifestation of peripheral arterial disease, claudication is the term that best names this specific symptom complex. Deep vein thrombosis can produce unilateral leg pain and swelling but is not characteristically triggered by walking and relieved by rest. Varicose veins may cause aching or heaviness, but this discomfort is not reliably activity-dependent and does not follow the classic exertion-relief pattern. Peripheral arterial disease is the underlying pathology driving claudication; however, intermittent claudication is the more precise answer for this symptom description.

Correct answer: B. Aortic dissection

Aortic dissection best explains this constellation: abrupt tearing posterior chest pain, diaphoresis, and a significant inter-arm blood pressure differential arising when the dissection occludes branch vessels and diminishes perfusion to one extremity. Acute myocardial infarction typically produces crushing or pressure-type chest pain with diaphoresis but does not produce sustained blood pressure differences between the upper extremities. Cardiac tamponade presents with Beck's triad of hypotension, muffled heart sounds, and jugular venous distension rather than inter-arm pressure discrepancy or posterior radiating pain. Pulmonary embolism may cause acute chest pain and diaphoresis but is typically pleuritic or associated with dyspnea and does not create arm-to-arm blood pressure asymmetry.

Correct answer: A. "Do you sleep with more than one pillow?"

Asking whether the patient sleeps with more than one pillow screens for orthopnea, a characteristic feature of heart failure in which lying flat causes dyspnea due to redistributed fluid increasing pulmonary venous pressure. Patients instinctively elevate the head to ease breathing. An asthma history is relevant to nocturnal dyspnea but is less specific to cardiac causes such as paroxysmal nocturnal dyspnea associated with heart failure. Nighttime dreams are unlikely to explain the described symptom and would not guide a cardiac assessment. Mattress firmness has no bearing on the differential diagnosis for nocturnal breathing difficulty.

Correct answer: D. Elevated LDL

Markedly elevated LDL is the dominant lipid risk factor for coronary artery disease because LDL directly drives atherogenesis by depositing cholesterol in the arterial intima, and it remains the primary therapeutic target in clinical lipid management. While reduced HDL independently elevates risk, its contribution is considered secondary to LDL in driving atherogenic plaque formation, and guidelines prioritize LDL-lowering therapy first. Elevated triglycerides add to cardiovascular risk but are generally addressed after LDL goals are met unless levels exceed 500 mg/dL, at which point pancreatitis risk becomes the primary concern. Total cholesterol aggregates all lipoprotein fractions and lacks the specificity of LDL as a direct atherogenic marker, making it less actionable as an isolated target.

Correct answer: C. Whether the sensation is accompanied by dizziness or lightheadedness

Inquiring about dizziness or lightheadedness is the most clinically relevant follow-up because these symptoms together with palpitations may indicate an arrhythmia such as atrial fibrillation, which can reduce cardiac output sufficiently to impair cerebral perfusion. Lower back pain has no established link to cardiac palpitations or arrhythmia evaluation. Although family history of myocardial infarction informs overall cardiac risk, it does not help characterize an acute palpitation episode. Vision changes are more relevant in conditions such as hypertensive emergency or stroke and are not directly associated with the fluttering sensation described.