On-Line Journal Club: Critical Appraisal Using CASP

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 

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 

a. pericardium. 

b. myocardium. 

c. endocardium. 

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

a. normal 

b. absent 

c. bounding 

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 

a. Claudication.

b. Sore muscles. 

c. Muscle cramps. 

d. Venous insufficiency.