Cardiovascular - Chronic
Ted, age 18, is to have a cardiac screening examination to determine if he can play college basketball. The diagnostic test of choice for detecting hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy is a(n) A. echocardiogram. B. electrocardiogram. C. arteriogram. D. stress test.
Answer A In athletes younger than age 30, the three most common causes of sudden death are hypertrophic cardiomyopathy, idiopathic left ventricular hypertrophy, and coronary artery anomalies.
For clients with known coronary artery disease, it is recommended that the low-density lipoprotein cholesterol be A. 200 mg/dL or more. B. 100 mg/dL or less. C. 101 - 130 mg/dL. D. 131 - 200 mg/dL.
Answer B According to the National Cholesterol Education Program guidelines, for clients with known coronary artery disease (CAD), it is recommended that the low-density lipoprotein (LDL) cholesterol level be 100 mg/dL or less.
To reduce the progression of atherosclerotic lesions and occlusions in postcoronary artery bypass graft clients, it is recommended that the low-density lipoprotein cholesterol level be aggressively reduced to A. 70 mg/dL. B. 80 - 100 mg/dL. C. 101 - 120 mg/dL. D. 121 - 140 mg/dL.
Answer A A study by the Post Coronary Artery Bypass Graft Trial investigators found that aggressively lowering the low-density lipoprotein (LDL) cholesterol level to 70 mg/dL in clients who had previously undergone bypass surgery was more effective in reducing the progression of atherosclerotic lesions and occlusions than any other moderate treatment.
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit? A. An ACE inhibitor B. A calcium channel blocker C. A beta blocker D. No hypertension medication
Answer A ACE inhibitors have been found to postpone progression of microalbuminuria and ultimately nephropathy in clients with diabetes
Which of the following drugs should be considered as first-line therapy for a client with hypertension and heart failure? A. Enalapril (Vasotec) B. Diltiazem (Cardizem) C. Atenolol (Tenormin) D. Metoprolol (Lopressor)
Answer A ACE inhibitors such as enalapril (Vasotec) should be considered as first-line therapy for a client with hypertension (HTN) and heart failure
Sarah, who is postmenopausal, has controlled asthma, hypertension being effectively treated with medication, and smokes cigarettes. She has a low-density lipoprotein (LDL) cholesterol level of 170 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 40 mg/dL. To reduce Sarah ' s risk of a coronary event, the treatment plan would focus on A. lowering her LDL cholesterol level. B. lowering her HDL cholesterol level. C. aggressively treating and controlling her hypertension and asthma. D. getting Sarah to stop smoking.
Answer A According to the National Cholesterol Education Program (NCEP) expert panel, Sarah ' s treatment should focus on lowering her low-density lipoprotein (LDL) cholesterol to less than 100 mg/dL because she has several risk factors for coronary artery disease.
Which of the following statements is true concerning auscultation of the typical murmur associated with aortic stenosis? A. It is a harsh, crescendo-decrescendo ejection type that often radiates to the carotid arteries. B. It is a diastolic murmur. C. It is best heard at the apex of the heart. D. The loudness of the murmur reflects the severity of the lesion.
Answer A Auscultation of the typical murmur associated with aortic stenosis usually reveals that it is a systolic murmur of a harsh, crescendo-decrescendo ejection type, best heard at the base of the heart
Liver function tests should be monitored routinely every 4 months in the client on maintenance therapy with all hypolipidemic drugs except A. bile acid sequestrants (Questran, Colestid). B. hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins). C. nicotinic acid (niacin). D. fibric acid derivatives (gemfibrozil).
Answer A Bile acid sequestrants (Questran, Colestid) are not absorbed from the gastrointestinal tract and lack systemic toxicity; therefore, liver function tests do not need to be monitored in clients taking these drugs.
Which classification of antihypertensive drugs is the most effective for treating hypertension in African American clients and older adults? A. Diuretics B. ACE inhibitors C. Beta blockers D. Alpha-adrenergic blockers
Answer A Diuretics are effective in lowering blood pressure in all clients, especially African Americans and older adults.
Which of the following statements is true about hypertension (HTN) during pregnancy? A. Methyldopa (Aldomet) is the drug of first choice for control of mild to moderate HTN in pregnancy. B. Beta blockers are safe during the pregnancy. C. ACE inhibitors (I and II) are safe during all trimesters. D. Beta blockers are safe only in the first trimester of pregnancy.
Answer A Evidence-based guidelines from the American Association of Clinical Endocrinologists single out methyldopa and nifedipine as preferable antihypertensive medications in pregnancy, with magnesium sulfate for women with pre-eclampsia who are at high risk for seizures.
What is a common funduscopic change associated with hypertension? A. Optic disk swelling B. Gray lesions C. Deep intraretinal hemorrhages D. A cup-disk ratio greater than 1:2
Answer A Funduscopic changes associated with hypertension include optic disk swelling, AV nicking, hard exudates, creamy yellow lesions, and soft exudates such as cotton wool (also seen with subacute bacterial endocarditis).
The cardinal sign of right-sided heart failure in infants and children is A. hepatomegaly. B. edema of the lower extremities. C. tachypnea. D. cyanosis.
Answer A Hepatomegaly is the cardinal sign of right-sided heart failure in infants and children. Edema of the lower extremities is indicative of right ventricular heart failure in older children and adults
Jessica is pregnant and is being seen for the first time. She states that she was told that her blood pressure (BP) has been high for a long time, but she never wanted to take medication for it. Today her BP is 172/98, her lungs are clear, and she has no pedal or ankle edema. What medication would you most likely order? A. Methyldopa (Aldomet) B. Atenolol (Tenormin) C. Nifedipine (Adalat, Procardia) D. Clonidine (Catapres)
Answer A Methyldopa, an alpha-adrenergic inhibitor, is used to treat chronic hypertension during pregnancy. At low doses, it can be used as monotherapy
Which of the following statements is true of mitral regurgitation? A. It may be noted as a holosystolic murmur. B. It is caused by stiff, noncompliant leaflets that limit flow from the left atrium to the left ventricle. C. It occurs only as the result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps. D. It results in a prolonged PR interval on electrocardiogram.
Answer A Mitral regurgitation may be noted as a holosystolic murmur. Because ventricular pressure exceeds atrial pressure at the beginning of systole, regurgitant backflow begins with the first heart sound (S 1 ).
Mitral valve prolapse is characterized by A. elongation of the chordae tendineae and enlarged valve leaflets. B. ballooning (prolapse) of the cusps into the ventricle during diastole. C. an early diastolic murmur. D. an early systolic murmur
Answer A Mitral valve prolapse (MVP) is a congenital syndrome characterized by elongation of the chordae tendineae and enlarged valve leaflets
Nicotinic acid is an inexpensive drug used to treat serum hyperlipidemia. Which of the following statements is true about nicotinic acid? A. Nicotinic acid lowers low-density lipoprotein cholesterol levels, raises high-density lipoprotein cholesterol levels, and decreases triglyceride levels. B. Nicotinic acid is the drug of choice for individuals with diabetes. C. Nicotinic acid may decrease the effect of some antihypertensive agents. D. Rare adverse reactions of nicotinic acid include flushing, pruritus, and gastrointestinal upset
Answer A Nicotinic acid lowers low-density lipoprotein cholesterol levels, and is effective in the management of the highly atherogenic lipoprotein.
Greg has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued? A. Nifedipine (Procardia XL) for long-term management of his chronic stable angina B. Hydrochlorothiazide (HydroDIURIL) for his hypertension C. Enalapril (Vasotec) for his hypertension D. Butalbital (Esgic) for his headaches
Answer A Nifedipine (Procardia XL), a calcium channel blocker, should be discontinued, along with most antiarrhythmic agents, when a client develops congestive heart failure (CHF) because both of these classes of medications are important causes of worsening heart failure.
Pharmacological therapy for mitral valve disease includes A. treatment of dyspnea with diuretics to relieve congestion. B. reduction of fast ventricular rates with digoxin, beta blockers, or calcium channel blockers. C. preload reduction with antihypertensive agents to decrease regurgitant flow. D. daily antibiotic use to ward off bacterial infections
Answer A Pharmacological therapy for mitral valve disease includes treatment of dyspnea with diuretics to relieve congestion. It also consists of afterload (not preload) reduction with antihypertensive agents to decrease regurgitant flow
Discriminating between symptoms of occlusive arterial disease and other disorders (such as musculoskeletal or neurological disorders) requires a careful history. Which symptom is noted with occlusive arterial disease? A. Pain occurring in the calves or thighs when walking, with relief obtained when standing still B. Pain when standing that is not relieved by sitting or lying down C. Severe pain at rest that requires the client to raise the legs in the air to obtain relief D. Redness and pronounced superficial veins
Answer A Symptoms of occlusive arterial disease include pain occurring in the calves or thighs when walking, with relief obtained when standing still, and severe pain at rest that requires the client to hang the leg over the side of the bed to obtain relief
To determine the presence of target organ damage and other risk factors in the client with hypertension, basic diagnostic tests that should be ordered include A. chest x-ray, electrocardiogram, urinalysis, complete blood count, chemistry profile, lipid profile, and thyroid-stimulating hormone (TSH) level. B. renal arteriogram. C. plasma renin activity and 24-hour urinary sodium. D. echocardiogram.
Answer A To determine the presence of target organ damage and other risk factors in the client with hypertension, basic diagnostic tests that should be ordered include a chest x-ray, electrocardiogram, urinalysis, complete blood count, chemistry profile, lipid profile, and thyroid-stimulating hormone level.
Your client has documented hypertension (blood pressure of 140/92 mm Hg confirmed on multiple visits) and no other medical history. What would you consider low down on the list of priorities? A. Immediate initiation of antihypertensive drug therapy to prevent any complications B. Identification of known causes of hypertension C. Assessment of the presence or absence of target organ damage and the extent of the disease D. Identification of clinical cardiovascular disease (CVD) and risk factors, as well as other concomitant disorders that may guide prognosis and treatment
Answer A Treatment of hypertension is dependent on risk stratification.
Sexual activity is a major concern for clients with chronic ischemic heart disease. Which statement is true? A. The sexual partner should be included in the education process. B. The physical stress of sexual intercourse is equivalent to running a half mile. C. Antianginal medication taken just after sexual activity can help prevent symptoms. D. Sexual activity should be attempted only in the morning when the client is well rested.
Answer A True statements concerning sexual activity for clients with chronic ischemic heart disease include that the sexual partner should be included in the education process, that antianginal medication taken before sexual activity can help prevent symptoms, and that sexual activity should be attempted when the client is well rested, although morning hours may not always be best.
When performing a cardiac assessment, where is the most essential site for assessing edema? A. Dependent areas B. Periorbital areas C. Upper extremities D. Cerebral edema
Answer A When assessing for edema, check the client ' s most dependent areas such as the legs, sacrum, and scrotum.
Which classification of antihypertensive drugs is the first-choice therapy for treating hypertension and angina in clients with known coronary artery disease? A. Diuretics B. Beta blockers C. Calcium channel blockers D. ACE inhibitors
Answer B Beta blockers are the first-choice therapy for treating hypertension and angina in clients with known coronary artery disease because they control angina by decreasing myocardial demand through reduction of heart rate, systolic blood pressure, and contractility.
Charles has chronic ischemic heart disease and is taking a beta blocker, which results in A. an increase in high-density lipoprotein cholesterol. B. a reduced heart rate. C. a decreased diastolic filling time. D. An increase in oxygen demand.
Answer B Beta blockers reduce the heart rate, which results in a decrease in oxygen demand and an increase in coronary blood flow from the increased diastolic filling time
Marvin, age 56, is a smoker with diabetes mellitus. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? A. Angiotensin-converting enzyme (ACE) inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics
Answer B Beta blockers should not be ordered for Marvin for two reasons: He smokes and he is a diabetic. The adverse effects of all beta blockers include the potential for developing bronchial asthma and for inhibiting gluconeogenesis, and therefore they may prolong hypoglycemic episodes
Characteristics of ischemic arterial ulcers include A. an irregularly shaped border with crusting or scaling at the edges. B. severe pain. C. a location anywhere on the leg. D. a moist ulcer base with ill-defined borders
Answer B Characteristics of ischemic arterial ulcers include severe pain and a discrete border (which may have a " punched-out " appearance) with a pale, dry ulcer base and a slightly inflamed " halo " around the border if infected
While much teaching is needed for your client with congestive heart failure (CHF), the most beneficial thing you can tell him that might prevent rehospitalization may be A. " Be sure to use two pillows at night. " B. " Weigh yourself every day and if your weight increases by 3 lb in 24 hrs or 5 lb in one week, call me. " C. " Take your pulse daily; if it increases by six beats, call me. " D. " Let me know if you ' re sleeping more than 10 hours a day and feel depressed. "
Answer B Despite the technological advances of recent years, including cardiac resynchronization, implantable defibrillators, left ventricular assist devices, and totally implantable artificial hearts, it should be remembered that many clients with chronic heart failure are elderly and have multiple comorbidities
Martin, age 56, has hypertension and has been taking antihypertensive medication for about 10 years. He has been very stable. You have not seen him in about 6 months. His examination today should specifically A. include only a blood pressure measurement with the client seated comfortably. B. include a funduscopic examination. C. be a focused examination limited to the respiratory and cardiovascular systems. D. include a discussion of weaning him off his medication.
Answer B Funduscopic examination for hypertensive retinopathy (arteriovenous nicking, arteriole narrowing, hemorrhages, exudates, and disk edema) should be included in the physical examination of a client with hypertension (HTN).
Impaired blood flow to the extremities is caused by which of the following common disorders? A. Raynaud ' s disease B. Peripheral vascular disease C. Polycythemia D. Buerger ' s disease
Answer B Impaired blood flow to the extremities results in leg aches and is most often caused by peripheral vascular disorders. Peripheral vascular disease (PVD) affects the arteries and veins
At least 75% of clients need two or more antihypertensive agents to reach their blood pressure goal. In choosing combination therapy for a client with stage 2 hypertension (HTN) (SBP greater than 160 and or DBP greater than 100) in a 59-year-old male with a PMH relevant for uncontrolled essential HTN, DM, SOB, DOE, stage 1 diastolic heart failure, with an EF of 55% and a serum creatinine of 0.4, the best initial combination treatment would include A. Lasix and a beta blocker. B. thiazide diuretic and an ACE inhibitor. C. nitrate and a beta blocker. D. thiazide and a calcium channel blocker.
Answer B In a client with uncontrolled essential hypertension, the risk of the development of Diastolic heart failure is a concern as the increased workload on the heart has the propensity to cause left ventricular hypertrophy (LVH) and subsequent dysfunction.
Which of the following causes coronary valve leaflets to billow into the atrium during ventricular systole and runs in families? A. Mitral regurgitation B. Mitral valve prolapse C. Aortic regurgitation D. Aortic stenosis
Answer B Mitral valve prolapse causes one or both leaflets to billow into the atrium during ventricular systole and runs in families
Signs of right-sided heart failure include A. a low cardiac output. B. signs of fluid retention. C. dyspnea. D. elevated pulmonary venous pressure.
Answer B Signs of right-sided heart failure focus on fluid retention with edema and hepatic congestion, and depending on the extent of the disease, ascites will be evident. Signs of left-sided heart failure focus on a low cardiac output and an elevated pulmonary venous pressure, with dyspnea being the cardinal feature
Which of the following statements regarding the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure category about prehypertension is true? A. Clients with prehypertension usually remain in that category forever. B. Clients with a blood pressure (BP) in the range of 130/80 to 139/89 mm Hg are twice as likely to develop hypertension as those with lower values. C. All clients in this category should be started on diuretics immediately to avoid future end-organ disease. D. Diastolic BP control should be the focus of treatment.
Answer B The JNC includes a category designated as prehypertension. The range for the systolic pressure is 120 - 139 and for diastolic pressure is 80 - 89
You are managing a client with CHF. The client is presently on Carvedilol 12.5 mg bid, Lisinopril 2.5 mg PO daily, Lasix 80 mg PO daily, and Spironolactone 25 mg PO daily. He is in to see you for a 2-week follow-up and shares he has gained 7 lbs in the last week. He shares he has been faithful to his fluid and dietary restrictions and that his urinary output is somewhat less than it has been. What medication could you add to optimize the response to the loop diuretic? A. Bumex B. Metolazone C. Demadex D. Diamox
Answer B The addition of metolazone is the appropriate next intervention in the management of congestive heart failure that presents with a decreased sensitivity to loop diuretics and Aldactone combination
Which of the following is usually the earliest sign or symptom of chronic occlusive arterial disease in the extremities? A. Loss of hair over the lower extremity B. Intermittent claudication C. Painful ulcerations of the toes of the affected extremity D. Muscle atrophy
Answer B The clinical symptoms of chronic occlusive arterial disease occur slowly over a period of years and result primarily from tissue underperfusion and ischemia
Clinical findings associated with aortic regurgitation include A. pulsus paradoxus. B. waterhammer pulses. C. pulsus alternans. D. weak, thready pulses.
Answer B Waterhammer pulses (Corrigan ' s pulses) are present in a client with aortic regurgitation or aortic insufficiency.
When auscultating a client ' s heart, you note a short, high-frequency click (opening snap) after S 2 during the beginning of diastole. What could this indicate? A. Aortic regurgitation B. Mitral stenosis C. Mitral regurgitation D. Nothing; this is normal
Answer B When auscultating the heart, if you note a short, high-frequency click (opening snap) after S 2 during the beginning of diastole, suspect mitral stenosis
Which of the following usually indicates hyperlipidemia? A. Lipoma B. Xanthelasma C. Jaundiced skin D. Multiple actinic keratoses
Answer B Xanthelasmas (small, yellow, raised plaques on the eyelids) are lipid deposits that may indicate hyperlipidemia
Cough, loss of taste, and rash are adverse effects associated with which class of antihypertensive agents? A. Diuretics B. Beta blockers C. ACE inhibitors D. Calcium channel blockers
Answer C A cough, loss of taste, and a rash are all adverse effects of ACE inhibitors
Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication? A. Mort is black. B. Mort also has congestive heart failure. C. Mort has benign prostatic hyperplasia (BPH). D. Mort has frequent migraine headaches.
Answer C An alpha blocker is the antihypertensive agent of choice because Mort has benign prostatic hyperplasia (BPH).
What are the recommendations when treating high triglycerides? A. Aggressively treat with fenofibrates. B. Treatment should be with combination therapy with a statin and fenofibrate. C. Focus on lifestyle changes as initial therapy. D. Use a bile acid sequestrant.
Answer C Based on an algorithm for screening and managing clients with elevated triglycerides, experts have established an optimal level of triglycerides of less than 100 mg/dL and recommend intensive diet and lifestyle changes for clients with borderline elevated triglycerides
During a cardiovascular assessment, why is it important to note funduscopic changes? A. You may pick up beginning cataracts in this age group. B. You should note any glaucoma because some medications will be contraindicated. C. Changes may suggest the possibility of target organ involvement. D. You may be able to pick up arcus senilis.
Answer C Because hypertension and diabetes are risk factors for coronary artery disease, it is important to note any funduscopic changes early in the progression of the disease
For the routine management of heart failure, which one of the following medication classes would not be recommended? A. ACE inhibitor B. Beta blocker C. Calcium channel blocker D. Diuretic
Answer C Calcium channel blockers, with the exception of amlodipine and felodipine, should not be ordered for the routine management of heart failure
Individuals with clinical evidence of chronic ischemic heart disease (abnormal electrocardiogram, chest pain syndrome, unusual dyspnea, or fatigue) should have a full evaluation done to evaluate their risk for myocardial infarction or sudden death. When initially collecting data for this risk stratification, which would be the last step to be considered if at all? A. Careful history and physical examination B. Exercise stress testing with or without nuclide imaging C. Cardiac catheterization D. Chest x-ray
Answer C Cardiac catheterization is not generally performed during initial data collection
Which of the following is the most important preventable cause of premature death in women? A. Hypertension B. Obesity C. Cigarette smoking D. Alcoholism
Answer C Cigarette smoking is the most important preventable cause of premature death in women. Cigarette smoking increases cerebrovascular disease (CVD) incidence and mortality
When teaching your client with a new diagnosis of aortic stenosis, which of the following statements made by him leads you to believe he needs more teaching? A. " I will need antibiotic prophylaxis to prevent endocarditis. " B. " You told me I still need aggressive treatment of my hypertension. " C. " I ' ll continue the use of diuretics and nitrates that my previous doctor gave me. " D. " I ' ll have a yearly Doppler echocardiography to evaluate the progression of the valve lesion. "
Answer C Clients with aortic stenosis should avoid overuse of diuretics and nitrates because they can reduce preload and result in orthostatic hypotension and syncope. They should also avoid beta blockers and calcium channel blockers because they may further depress left ventricular function and precipitate failure.
Which statement is true of hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins)? A. They are the first drugs of choice for men younger than age 45. B. They should be given in the morning after breakfast. C. They may cause myopathies, especially at higher dosages or in combination with certain drugs. D. They are contraindicated in clients taking Coumadin.
Answer C Hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) may cause — albeit rarely — myopathies, especially at higher dosages or in combination with certain drugs, such as gemfibrozil (Lopid), nicotinic acid (Nicobid), or erythromycin (E-Mycin).
A blood pressure of 160/100 mm Hg is classified as A. prehypertension. B. stage 1 hypertension. C. stage 2 hypertension. D. stage 3 hypertension.
Answer C In the JNC guidelines, hypertension stages 2 and 3 have been combined. A blood pressure of 160 or greater systolic and 100 or greater diastolic is considered to be stage 2 hypertension.
Management of a client with hypertension with an abdominal aortic aneurysm would include A. computed tomography scan without contrast. B. changing the client ' s BP medications. C. referral to a cardiologist. D. immediate cardiac catheterization.
Answer C Management of a client with hypertension who also has an abdominal aortic aneurysm would include an abdominal aortic ultrasound or computed tomography (CT) scan with contrast, aggressive management of the client ' s hypertension, and referral to a cardiologist
Which of the following statements about hypertension is true? A. It is frequently caused by pheochromocytoma. B. It is usually the result of an underlying, correctable problem. C. The cause is unknown in approximately 95% of cases. D. It has a higher incidence among adult white men than any other group.
Answer C The cause of hypertension is unknown (idiopathic) in approximately 95% of cases. This form of hypertension is known as primary or essential hypertension
An active 68-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes in, you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to A. defer any further dental work until his valve replacement is completed. B. instruct the client to have dental extraction done cautiously, having no more than two teeth per visit removed. C. suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis. D. coordinate with his cardiac and oral surgeons to have the tooth extraction and valve replacement done at the same time to reduce the risk of anesthetic complications.
Answer C The client ' s poor dental status is a probable source of endocarditis. Proper management of his dental work is essential before valve replacement because it will lower the risk for endocarditis
Dana has ischemic arterial ulcers. What is your first priority when counseling her? A. Tell her that increasing coffee intake will stimulate heart rate and circulation. B. Tell her to decrease water intake slightly to improve blood viscosity. C. Tell her to reduce risk factors to improve tissue perfusion. D. Tell her to begin an intense aerobic program
Answer C The first priority for managing ischemic arterial ulcers is to improve tissue perfusion. When counseling clients, tell them to decrease their risk of further damage by reducing risk factors
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S 3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. What do you suspect? A. Asthma B. Nocturnal allergies C. Heart failure D. Valvular disease
Answer C The greater the number of symptoms in a client, the more reliable is the diagnosis of heart failure. One of the classic symptoms of heart failure that Sheila has is a nocturnal cough that wakes her up
When teaching a client with hypertension about restricting dietary sodium, you would include which of the following instructions? A. Sodium restriction can cause serious adverse effects. B. Diets with markedly reduced intake of sodium may be associated with other beneficial effects beyond blood pressure control. C. Seventy-five percent of sodium intake is derived from processed food. D. A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable.
Answer C When teaching a client with hypertension about restricting dietary sodium, it is important to stress that 75% of sodium intake is derived from processed food.
Which of the following is usually indicative of an abdominal aortic aneurysm? A. RUQ tenderness B. Venous hum in abdomen C. Ascites D. Positive bruit or wide, diffuse pulsation in epigastric area
Answer D A positive bruit or wide, diffuse pulsation in the epigastric area is indicative of an abdominal aortic aneurysm. Right upper quadrant tenderness, a venous hum, and ascites are indicative of right-sided congestive heart failure
Which of the following antihypertensive agents would most likely produce a rebound hypertensive crisis following its abrupt withdrawal? A. Doxazosin (Cardura) B. Lisinopril (Prinivil) C. Losartan (Cozaar) D. Clonidine (Catapres)
Answer D Abrupt withdrawal of clonidine (Catapres), a central acting alpha agonist, will most likely produce a rebound hypertensive crisis.
The most common cause of elevated total and low-density lipoprotein cholesterol levels in the United States is A. heredity. B. hypothyroidism. C. diabetes. D. a diet high in saturated fat.
Answer D Although heredity, hypothyroidism, and diabetes contribute to abnormal serum lipid levels, a diet high in saturated fat is the most common cause of elevated total and low-density lipoprotein cholesterol in the United States.
Many clients with mitral valve prolapse exhibit A. a slow heart rate. B. somnolence. C. a lengthened PR interval on electrocardiogram. D. fatigue.
Answer D Although many clients with mitral valve prolapse (MVP) are asymptomatic, clients may appear with a variety of symptoms, including what some have described as " MVP syndrome " : a characteristic click, fatigue, palpitations, postural hypotension, chest pain, atrial and ventricular arrhythmias, anxiety, and symptoms of autonomic dysfunction (excessive secretion of catecholamines causing vasoconstriction and orthostatic tachycardia).
Which of the following statements about aortic stenosis (AS) is true? A. The disease is typically manifested during midlife. B. Once symptoms appear, life expectancy without surgery is about 10 years. C. Right from the early course of the disease, symptoms are bothersome. D. The cardinal symptoms include dyspnea, angina, and syncope.
Answer D Aortic stenosis (AS) has a classic triad of chest pain, dyspnea on exertion progressing to dyspnea at rest, heart failure, and syncope.
Rick is modifying his diet to try to lose weight, but after 3 months, he has not lost any weight, even though he has complied with his diet plan. A follow-up lipid profile reveals the following: total cholesterol, 238 mg/dL; triglycerides, 100 mg/dL; high-density lipoprotein cholesterol, 28 mg/dL; and low-density lipoprotein cholesterol, 190 mg/dL. What would you recommend? A. Continuing the diet plan for another month B. Starting an exercise program with a goal of uninterrupted aerobic exercise for 30 minutes 2 days a week C. Stopping his current diet plan and trying another D. Starting hypolipidemic drug therapy
Answer D Because dietary therapy has not resulted in any significant reduction of Rick ' s low-density lipoprotein (LDL) cholesterol level, starting him on hypolipidemic drug therapy is strongly recommended to help him achieve an LDL cholesterol goal of less than 130 mg/dL.
Many older adults develop postural hypotension with hypertensive drug therapy. What is included in your teaching with these individuals? A. Drug therapy will be discontinued as soon as their blood pressure stabilizes to prevent this problem from recurring. B. Slight dehydration will prevent postural hypotension from occurring. C. Clients should sleep in a high Fowler ' s position to prevent this from happening. D. Clients should be taught to sit on the edge of the bed before standing.
Answer D Because some older adults develop postural hypotension with hypertensive drug therapy, the clinician must insist that these clients change position slowly while on HTN medication and that they sit on the edge of the bed for several minutes before standing
There are four classifications of heart failure that often are interwoven; they include systolic, diastolic, acute, and/or chronic. Clients who present with JVD, dyspnea with exertion, peripheral edema and abdominal fullness would most likely be experiencing chronic right sided heart failure. A routine diagnostic work up would include all of the following except A. BNP. B. BMP. C. echocardiogram. D. CTA.
Answer D Diagnostics would include a serum pro-BNP to assess degree of cardiac dysfunction. BNP is a hormone released from the ventricle in response to increased heart workload
Rona, age 69, has hypertension (HTN), drinks one glass of white wine per day, and is slightly overweight. She asks you if making changes in her life at this age will make any difference. You tell her that lifestyle modifications for the control of HTN A. are not as effective in older adults because HTN is an inevitable consequence of aging. B. require a marked reduction in weight and a very limited choice of foods to achieve any benefit. C. should include at least three glasses of red wine every day because it improves high-density lipoprotein cholesterol levels, a known cardiovascular risk factor, which may be worsened by HTN. D. may prevent HTN, lower elevated blood pressure, and reduce the number and dosage of antihypertensive medications needed to manage a condition.
Answer D Lifestyle modifications are essential for the control of hypertension (HTN). Weight reduction of as little as 4.5 kg (10 lb) reduces blood pressure in a large proportion of overweight persons with HTN.
Which would be the LAST step you would consider in a client with long-term chronic ischemic heart disease? A. Use of aspirin B. Use of beta blockers, calcium channel blockers, and nitrates C. Risk factor and lifestyle modification D. A coronary angiogram
Answer D Long-term secondary prevention for chronic ischemic heart disease includes the use of aspirin, beta blockers, nitrates, and risk factor and lifestyle modification. Further pharmaceutical management may include diuretics, ACE inhibitors and/or angiotensin receptor blockers, spironolactone, and digoxin
Which statement about mitral valve prolapse (MVP) is true? A. MVP occurs in about 10% of the population. B. MVP is usually detected in older adults. C. The incidence is equal in men and women younger than age 20. D. The incidence is more common in women younger than age 20.
Answer D Mitral valve prolapse is more common in women younger than age 20 than in other populations. MVP occurs in about 2% - 4% of the population and is usually detected in young adulthood.
To reduce the incidence of coronary events in an individual without coronary artery disease who has two or more risk factors, the goal serum low-density lipoprotein cholesterol level should be A. 170 - 190 mg/dL. B. 150 - 170 mg/dL. C. 130 - 150 mg/dL. D. less than 130 mg/dL.
Answer D The National Cholesterol Education Program (NCEP) guidelines recommend a goal serum lowdensity lipoprotein cholesterol level of less than 130 mg/dL for individuals without coronary artery disease but with two or more risk factors
Murmurs are graded according to their intensity (loudness). A murmur that is audible with the stethoscope off the chest is a A. grade III murmur. B. grade IV murmur. C. grade V murmur. D. grade VI murmur.
Answer D The intensity of a murmur is determined by the quantity and velocity of blood flow across the sound-producing area, its distance from the stethoscope, and the type of tissue between the murmur and the stethoscope
Which of the following conditions is the least frequent cause of heart failure? A. Hypertension B. Aortic stenosis C. Ischemic cardiomyopathy D. Valvular heart disease (mitral and tricuspid)
Answer D Valvular heart disease (mitral and tricuspid) has become the least common cause of heart failure of the conditions listed because of the declining incidence and severity of rheumatic fever.
