patho4

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply. A) Atrial flutter B) Ventricular tachycardia with left bundle branch block pattern C) T-wave inversion in the right precordial leads D) Sinus arrhythmia with a first-degree AV block E) Development of a "U" wave following a normal T wave

B, C Feedback: The electrical (ECG) changes associated with ARVC/D include ventricular tachycardia with LBBB, T-wave inversion in the right precordial leads, and epsilon waves. Right ventricular BBB may also be present. Atrial flutter and sinus arrhythmia with a first-degree AV block are not characteristic of this form of cardiomyopathy.

A nurse is providing care for a client who has a history of severe atherosclerosis. Which of the following clinical manifestations of the client's illness should the nurse anticipate and assess in the client? A) Motor deficits in muscles distal to plaque formation B) Peripheral vasodilation to compensate for ischemia C) Cognitive deficits due to ischemia or thrombosis D) Aneurysm formation due to weakening of blood vessel walls E) Necrosis of the vessel wall

D Feedback: Aneurysm can be a manifestation of atherosclerosis as a consequence of weakened vessel walls. Motor and cognitive deficits as well as vasodilation are not common manifestations of atherosclerosis. Necrosis of the vessel wall is associated with vasculitis.

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? A) Echocardiogram, PET scan, ECG B) Ambulatory ECG, cardiac MRI, echocardiogram C) Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy D) Cardiac catheterization, cardiac CT, exercise stress testing

A Feedback: An echocardiogram would provide an image of the client's heart, while a PET scan reveals metabolic activity and an ECG the electrical activity. Answer B would lack data on the client's myocardial metabolism; answer C would lack electrical and physical measurement information; answer D would lack electrical measurement of his heart.

Which of the following individuals is most likely to be experiencing vasodilation? A) A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system B) A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting C) A 30-year-old woman who takes antihistamines to treat her seasonal allergies D) A 32-year-old man who takes a selective serotonin reuptake inhibitor for the treatment of depression

A Feedback: Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a vasodilator, so antihistamine medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels are apt to promote vasoconstriction.

A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was "so fast I couldn't even count it." The child was determined to be in atrial flutter, and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? A) The child is experiencing a reentry rhythm in his right atrium. B) The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions. C) The child is likely to have a normal ECG apart from the rapid heart rate. D) The boy's atria are experiencing abnormal sympathetic stimulation.

A Feedback: Atrial flutter is caused by a reentry rhythm that is located in the right atrium. It is normally responsive to pacing. His ECG will appear highly irregular, and the problem does not originate from sympathetic stimulation.

A female older adult client has presented with a new onset of shortness of breath, and her physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of blood work? A) BNP is released as a compensatory mechanism during heart failure, and measuring it can help differentiate the client's dyspnea from a respiratory pathology. B) BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. C) BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. D) BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

A Feedback: BNP is released to compensate for heart failure, and elevated levels help confirm the diagnosis of heart failure as opposed to respiratory etiologies. It does not measure the effectiveness of the RAA system, the risk of cognitive deficits, or the specific severity of pulmonary symptoms of heart failure.

A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive â-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? A) They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. B) They inhibit the potassium current and repolarization, extending the action potential and refractoriness. C) They counteract arrhythmias and tachycardias by increasing vagal stimulation. D) They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.

A Feedback: Beta-blockers are often used in the treatment of supraventricular arrhythmias, and they decrease automaticity by depressing phase 4 of the action potential. They do not inhibit the potassium current and repolarization, nor do they cause vagal stimulation or block the release of intracellular calcium.

A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? A) Measurement of urine output and mental status assessment B) Pupil response and counting the patient's apical heart rate C) Palpation of pedal (foot) pulses and pain assessment D) Activity tolerance and integumentary inspection

A Feedback: Both increased and decreased urine output can be markers of heart failure, as can changes in mental status not attributable to other factors. While heart auscultation, pedal pulses, and activity tolerance are relevant parameters, integumentary inspection, pupil response, and pain assessment are less likely to be relevant assessment components.

A patient, who is experiencing some angina associated with atrial tachycardia, has been placed on verapamil (Calan), a calcium channel blocker. Knowing that this medication blocks the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 action potential, the nurse should assess this patient for which of the following adverse reactions? A)Bradycardia B)Ventricular tachycardia C)Sudden cardiac death D)Increased cardiac output

A Feedback: Calcium channel blockers (CCB) are used to slow the SA node pacemaker and inhibit conduction in the AV node, slowing the ventricular response in atrial tachycardias. Therefore, the nurse should be aware that it may cause bradycardia. CCB are not known to cause VT or sudden death. These medications reduce the force of myocardial contractility, thereby decreasing myocardial O2 demand. They do not increase cardiac output.

A physician is explaining to a group of medical students the concept of Virchow triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow triad? A) The man has decreased cardiac output and an ejection fraction of 30%. B) The man's prothrombin time and international normalized ratio (INR) are both low. C) The man has a previous history of a dissecting aneurysm. D) There is bilateral, brown pigmentation of his lower legs.

A Feedback: Cardiac output is not a component of Virchow triad. However, decreased INR and prothrombin time indicate hypercoagulability; a dissecting aneurysm is an example of vessel wall injury; and pigmentation in the lower legs indicates stasis of blood.

A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction? A) "Because smoking causes a permanent increase in your risk of heart disease, it's best not to start." B) "All things being equal, men have a higher risk of coronary heart disease than perimenopausal women." C) "High blood pressure often accompanies, or even causes, clogging of the arteries." D) "Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease."

A Feedback: Cessation of smoking is associated with a decrease in the risk of CHD. Males have an increased risk of atherosclerosis. Atherosclerosis is often associated with hypertension. Lowering cholesterol levels brings a commensurate reduction in risk of CHD.

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long-term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate? A) "Displays of aggression, confusion, and restlessness when the resident has no history of such behavior can be a sign of heart failure." B) "Heart failure will often first show up with persistent coughing and lung crackles." C) "Residents in early heart failure will often be flushed and have warm skin and a fever." D) "Complaints of chest pain are actually more often related to heart failure than to myocardial infarction."

A Feedback: Cognitive changes can often accompany heart failure in the elderly. Pulmonary edema is a later sign, and they are less likely to display coughing, chest pain of flushed skin, and fever.

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential? A) A 51-year-old male who has been diagnosed with glomerulonephritis B) An African American man who leads a sedentary lifestyle C) A 69-year-old woman with a diagnosis of cardiometabolic syndrome D) A 40-year-old smoker who eats excessive amounts of salt and saturated fats

A Feedback: Damage to the organs that control and mediate the control of blood pressure, most notably the kidneys, is associated with secondary hypertension. Race, lifestyle, sodium intake, and associated cardiac and metabolic sequelae are associated with essential hypertension.

Which of the following statements most accurately captures a principle of blood flow? A) With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. B) Blood flow is primarily determined by blood viscosity and temperature. C) Blood flows most quickly in the small diameter peripheral capillaries. D) Smaller cross-sectional vessel area is associated with lower flow velocity.

A Feedback: Doubling the radius of a vessel is associated with a fourth-power increase in flow, provided pressure remains constant. Blood flow is primarily a function of blood pressure, resistance, and viscosity. The small size of capillaries is associated with quite slow velocity, given their large total combined cross-sectional area. Smaller cross-sectional area is associated with greater velocity.

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node? A) A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential. B) The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached. C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity. D) Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.

A Feedback: During phase 4 in the cells of the SA node, a slow leakage of current through the slow channels of the cellular membrane leads to spontaneous depolarization; this slow response enables pacemaker function. Answer B describes the relative refractory period of the action potential curve, which occurs at the end of phase 3 in cardiac cells, and answer C describes phase 1 of the action potential, which signals the end of depolarization. The sodium-potassium pump transports sodium out of the cell and a smaller amount of potassium into it, contributing to the negative intracellular charge of the resting membrane potential in phase 4.

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds, A) "Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur." B) "Aortic stenosis is commonly seen in elderly patients. Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow." C) "This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends." D) "Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening."

A Feedback: Heart murmur results from turbulent flow through a diseased heart valve that may be too narrow, too stiff, or too floppy. This turbulent flow causes a vibration called a murmur.

During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found? A) Noted hemorrhages and microaneurysms during evaluation of the internal eye B) Unable to feel vibrations when a tuning fork is placed on the skull C) Inability to locate the kidneys with deep palpation to the abdomen D) Slight increase in the number of varicose veins noted bilaterally

A Feedback: Hypertension affects the eye in sometimes devastating ways. If there are acute increases in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations relate to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not associated with hypertension.

A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy? A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes. B) Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem. C) Mortality exceeds 50%, and very few surviving women regain normal heart function. D) Symptomatology mimics that of stable angina and is diagnosed and treated similarly.

A Feedback: Immune responses, diet, and infections are all potential etiologies of peripartum cardiomyopathy. Treatment is complicated, but not impossible, in antepartum women due to possible teratogenic drug effects. About half of women suffer long-term effects on cardiac function, while signs and symptoms are similar to those of early heart failure.

All of the following interventions are ordered stat. for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? A)Epinephrine (Adrenalin) B)Normal saline infusion C)Dexamethasone (Decadron) D)Diphenhydramine (Benadryl)

A Feedback: Treatment includes immediate discontinuation of the inciting agent; close monitoring of CV and respiratory function; and maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles.

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles? A) During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction. B) When the patient starts to snore, his epiglottis is closed over the trachea. C) When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate. D) When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

A Feedback: People with sleep apnea also may experience an increase in BP because of the hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are located in carotid bodies and aortic bodies of the aorta. Retention of fluid is not the cause of increased BP during sleep apnea episodes.

An IV drug abuser walks into the ED telling the nurse that, "he is sick." He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? A) Systemic emboli, especially to the brain B) Petechial hemorrhages under the skin and nail beds C) GI upset from the massive amount of antibiotics required to kill the bacteria D) Pancreas enlargement due to increased need for insulin secretion

A Feedback: Systemic emboli develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. Answer choice B refers that petechial hemorrhages are signs and symptoms of IE. GI upset is common following antibiotic therapy but is not usually life threatening. Stress can increase insulin needs but not associated with pancreas enlargement.

A 68-year-old male complains to his family physician that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also had occasionally light-headedness and a recent syncopal episode. What is this client's most likely diagnosis and the phenomenon underlying it? A) Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias B) Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation C) Torsade de pointes as a result of disease of the bundle of His D) Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process

A Feedback: The client's alternating bradycardic and tachycardic episodes are indicative of sick sinus syndrome. This pattern is not characteristic of ventricular arrhythmia, premature atrial contractions, or torsade de pointes.

A patient arrives at the ED complaining of numbness in the left lower leg. Upon assessment, the nurse finds the lower left leg to be cold to touch, pedal and posterior tibial pulses nonpalpable, and a sharp line of paralysis/paresthesia. The nurse's next action is based on the fact that A) acute arterial occlusion is a medical emergency requiring immediate intervention to restore blood flow. B) submersion in a whirlpool with warm water will improve the venous blood flow and restore pulses. C) the immediate infusion of tissue plasminogen activator (tPA) will not correct the problem and should only be used for CVAs. D) administration of an aspirin and sublingual nitroglycerin will vasodilate the artery to restore perfusion.

A Feedback: The presentation of acute arterial embolism is often described as that of the seven "P's": pistol shot, pallor, polar, pulselessness, pain, paresthesia, and paralysis. Treatment is aimed at restoring blood flow. Embolectomy, thrombolytic therapy, and anticoagulant therapy (heparin) are usually given. Application of cold should be avoided.

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? A) "You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles." B) "Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients." C) "Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate." D) "Fever is a sign of heart failure in children that you are unlikely to see in older adults."

A Feedback: The pulmonary edema that accompanies heart failure is more often interstitial rather than alveolar in children. Jugular venous distention is difficult to gauge in children, and low blood pressure and fever are not noted signs of heart failure in children.

Which of the following medications will likely be prescribed for a patient with elevated LDL and triglyceride levels? A) Zocor (simvastatin), an HMG-CoA reductase inhibitor or "statin" B) Cholestyramine (Questran), a bile acid sequestrant C) Nicotinic acid (Niacin), a B vitamin D) Fenofibrate (Tricor), a fibric acid

A Feedback: The statins can reduce or block the hepatic synthesis of cholesterol and are the cornerstone of LDL-reducing therapy. Statins also reduce triglyceride levels and increase HDL levels.

As part of presurgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system? A) "The blood pressure varies widely between arteries and veins and between pulmonary and systemic circulation." B) "Only around one quarter of your blood is in your heart at any given time." C) "Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system." D) "Left-sided and right-sided pumping action on each beat of the heart must equal each other to ensure adequate blood distribution."

A Feedback: There is a large variation between the higher pressure in the systemic circulatory system and arteries and the lower pressure in the pulmonary system and veins. Approximately 8% of the blood supply is in the heart at any given time. Blood pressure and blood volume are inversely proportionate. The body is able to accommodate short-term differences in left-sided and right-sided output.

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman? A) "Once you have varicose veins, there's little that can be done to reverse them." B) "Your varicose veins are likely a consequence of an existing cardiac problem." C) "If you're able to stay off your feet and wear tight stockings, normal vein tone can be reestablished." D) "The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins."

A Feedback: Treatment of varicose veins focuses on prevention and slowing of the progression of the problem; it is not normally possible to reverse existing varicose veins. Staying off one's feet and wearing antiembolic stockings may prevent, but not reverse, the condition. While cardiac problems may coexist with varicose veins, this does not necessarily account for the woman's condition. Blood thinners will not resolve her varicose veins.

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likely rule out hypertension as a contributing factor? A) A 61-year-old man who has a heart valve infection and recurrent fever B) An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness C) A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week D) A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

A Feedback: While cardiac complications are common sequelae of hypertension, a heart valve infection would be less likely to be so. Stroke, kidney failure, and angina are all identified as consequences of hypertension.

Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place? A) The man's á- and â-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate. B) Hemolysis and blood pooling are taking place in the man's peripheral circulation. C) Bronchoconstriction and hyperventilation are initiated as a compensatory mechanism. D) Intracellular potassium and extracellular sodium levels are rising as a result of sodium-potassium pump failure.

A Feedback: á- and â-adrenergic receptor activation is a central response to all types of shock. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriction, often results from adrenergic stimulation, and sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium.

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this heart defect? Select all that apply. A) Murmur heard at the second intercostal space, during both systole and diastole B) BP 84/30 classified as a wide pulse pressure C) Shortness of breath with activity such as kicking D) Stridor with inspiratory wheezes E) Bulging jugular neck veins

A, B Feedback: Persistent patency of the ductus arteriosus is defined as a duct that remains open for greater than 3 months. A murmur is detected within days of birth. It is loudest at the second left intercostal space and is continuous through systole and diastole. A wide pulse pressure is common (BP 84/30). Most newborns have an elevated respiratory rate with exertional activity. Stridor is usually associated with bronchial infections or narrowing of the airways. Bulging jugular neck veins are associated with right-sided heart failure.

A 78-year-old male patient has undergone a total knee replacement. He just does not feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and light-headedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient('s) A) is experiencing a reduction in plasma volume. B) peripheral vasoconstriction mechanism has failed. C) is so stressed that he is releasing too many endorphins. D) is still bleeding from the surgical procedure. E) has lost all of his muscle tone.

A, B Feedback: Prolonged bed rest promotes a reduction in plasma volume, a decrease in venous tone, failure of peripheral vasoconstriction, and weakness of the skeletal muscles that support the veins and assist in returning blood to the heart. Endorphins make one feel better in mood. Three days post-op, there should be no further bleeding from the surgical site. If there is, then this is a complication that must be addressed immediately. Loss of vascular and skeletal muscle tone is less predictable but probably becomes maximal after 2 weeks.

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply. A)Muffled heart tones B)Narrowed pulse pressure C)Low BP—84/60 D)Heart rate 78 E)Bounding femoral pulse

A, B, C Feedback: Cardiac tamponade results in increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and decreased stroke volume and cardiac output. This accumulation of fluid results in tachycardia, elevated CVP, jugular vein distention, fall in systolic BP, narrowed pulse pressure, and signs of shock. Heart sounds may be muffled. A pulse rate of 78 is normal (not tachycardic). With pulsus paradoxus, the arterial pulse as palpated at the carotid or femoral artery becomes weakened (not bulging) or absent with inspiration.

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply. A) Large amount of pink, frothy sputum and new onset of murmur B) Tachypnea with respiratory distress C) Frequent ventricular arrhythmia unrelieved with amiodarone drip D) Complaints of facial numbness and tingling E) Enhanced renal perfusion as seen as an increase in urine output

A, B, C, D Feedback: Following MI, many complications can occur: Answer choice A relates to pulmonary edema or papillary muscle rupture; answer choice B refers that acute respiratory distress could result from heart failure; answer choice C relates to life-threatening arrhythmias; answer choice D relates to acute stroke.

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on his left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm that the client may be in the early stages of cardiogenic shock? Select all that apply. A) Decreasing mean arterial pressure (MAP) B) Low BP reading of 86/60 C) Urine output of 15 mL last hour D) Low pulmonary capillary wedge pressure (PCWP) E) Periods of confusion

A, B, C, E Feedback: Signs and symptoms of cardiogenic shock include indications of hypoperfusion with hypotension (BP 96/60), decrease in mean arterial pressure (MAP) due to poor stroke volume, and a narrow pulse pressure. Urine output decreases because of lower renal perfusion pressures. PCWP is usually elevated due to increased preload. Periods of confusion or altered cognition/consciousness may occur because of low cardiac output.

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below are a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply. A) Profound dyspnea due to acute respiratory distress syndrome B) Atelectasis resulting in injury to endothelial lining of pulmonary vessels, which allows fluid/plasma to build up in alveolar spaces C) Formation of plaque within vessels supplying blood to the heart causing muscle damage and chest pain D) Acute renal failure due to decreased/impaired renal perfusion as a result of low BP E) Flushed skin and pounding headache that coincides with each heart beat

A, B, D Feedback: ARDS, atelectasis, and acute renal failure are all noted consequences of shock that might be, respectively, treated by dialysis, an ostomy, or platelet transfusion. Plaque formation to heart vessels is not directly related to any of the identified consequences of shock. Pounding headache that coincides with each heart beat may occur with migraine headaches.

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply. A) Decrease in exercise tolerance B) Exertional dyspnea C) Palpitations D) Syncope E) Heartburn

A, B, D Feedback: Because of the slow onset of aortic valve stenosis, the heart is able to compensate by hypertrophying and may still maintain a normal chamber volume and ejection fraction. As the stenosis progresses, the patient will experience classic symptoms of angina, syncope, heart failure, and decrease in exercise tolerance or exertional dyspnea. Palpitations and heartburn are not usually noted with aortic stenosis.

A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena are primarily the contributing factors to hypertension in the elderly population? Select all that apply. A) Stiffening of large arteries like the aorta B) Increased sensitivity of the renin-angiotensin-aldosterone system C) Decreased baroreceptor sensitivity and renal blood flow D) Increased peripheral vascular resistance E) Increase in renal perfusion

A, C, D Feedback: Increased sensitivity of the renin-angiotensin-aldosterone system is not a noted phenomenon among older adults. Stiffening of large arteries, increased peripheral vascular resistance, and decreased baroreceptor sensitivity and renal blood flow are all accompaniments of aging.

An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG? A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity. B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane. C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle. D) A total of 12 chest leads are necessary to attain the most accurate ECG.

B Feedback: A complete ECG is obtained by combining data from chest leads, which measure activity on the horizontal plane, and limb leads, corresponding to the vertical or frontal plane. The electrical potential recorded by a lead on an extremity should not vary significantly depending on where the lead is placed on the extremity, and limb leads do not measure electrical activity by way of skeletal muscle activity. A total of 12 leads, only six of which are on the chest, are necessary for a complete ECG.

A patient with a new automatic implantable cardioverter-defibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing that the AICD will A) periodically fire just to test for lead placement and battery life. B) respond to ventricular tachyarrhythmia by delivering a shock within 10 to 20 seconds of its onset. C) use radiofrequency energy to deliver an electrical shock through the site where the lethal rhythm originates. D) remove scar tissue and aneurysm during placement of electrodes and then will shock if paradoxical ventricular movement is located.

B Feedback: AICD successfully treats individuals with life-threatening ventricular tachyarrhythmias by use of intrathoracic electrical countershock. It senses and detects ventricular dysrhythmias. It responds by delivering an electrical shock between intrathoracic electrodes within 10 to 20 seconds of its onset. It does not periodically fire to test lead placement. It does not utilize radiofrequency energy (this is used in ablations). The procedure does not remove scar tissue or aneurysms. This is a ventriculotomy.

Which of the following patients should the nurse be assessing for long QT syndrome? A) A 95-year-old patient with Alzheimer's who is having periods of apnea B) A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse C) A 56-year-old female admitted for total hysterectomy due to excessive bleeding and clotting D) A 68-year-old male who was in a car accident with sternal bruising and fractured femur

B Feedback: Acquired LQTS has been linked to a variety of conditions, including cocaine use, exposure to organophosphorous compounds, electrolyte imbalances, marked bradycardia, MI, SAH, HIV, and protein-sparing fasting.

When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate? A) The end result of oxidation is rupture of the plaque resulting in hemorrhage. B) Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. C) Oxidized free radicals produce toxic metabolic waste that can kill liver cells. D) Activated cells roam in the vascular system looking for inflammatory cells to engulf.

B Feedback: Activated macrophages release free radicals that oxidize LDL. Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? A) Chest pain and intermittent ventricular tachycardia B) Dyspnea and crackles in bilateral lung bases C) Petechia and spontaneous bleeding D) Muscle cramping and cyanosis in the feet

B Feedback: Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion.

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? A) CT of the heart, chest x-ray, and ECG B) Echocardiogram, blood cultures, and temperature C) ECG, blood pressure, and stress test D) Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count

B Feedback: An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation, and temperature would gauge the presence of infection. A chest x-ray, blood pressure measurement, and cardiac catheterization would be less likely to indicate infective endocarditis.

A patient is admitted to the outpatient diagnostic unit for further testing to identify the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis? A)Routine ultrasound of kidney B)Renal arteriography C)Echocardiography D)Serum creatinine level

B Feedback: With the dominant role that the kidney assumes in blood pressure regulation, it is not surprising that the largest single cause of secondary hypertension is renal disease. Renal arteriography remains the definitive test for identifying renal artery disease. Ultrasound, CT, and MRA are other tests that can be used to screen for renovascular hypertension.

A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could A) decrease renal perfusion and result in the development of ascites. B) be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C) desensitize the á-adrenergic receptors leading to increase in norepinephrine levels. D) prolong the electrical firing from the SA node resulting in the development of a heart block.

B Feedback: An increase in sympathetic activity by stimulation of the â-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and arrhythmias. Acutely, tachycardia significantly increases the workload of the heart, thus increasing myocardial O2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decreased renal perfusion would activate the RAA system, increasing heart rate and BP further. Ventricular arrhythmias are primarily seen at this stage of HF.

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate? A) Immediate cardioversion followed by surgery to correct the atrial defect B) Anticoagulants and beta-blockers to control rate C) Antihypertensives and constant cardiac monitoring in a high acuity unit D) Diuretics, total bed rest, and cardioversion if necessary

B Feedback: Atrial fibrillation is most often treated with anticoagulants to prevent embolic events as well as beta-blockers and digoxin. Cardioversion would not be a first-line intervention, and antihypertensives and diuretics would be unlikely treatments of choice.

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient? A) Hyperlipidemia is a consequence of diet and lifestyle rather than genetics. B) HDL cholesterol is often characterized as being beneficial to health. C) Cholesterol is a metabolic waste product that the liver is responsible for clearing. D) The goal of medical treatment is to eliminate cholesterol from the vascular system.

B Feedback: Because it transports cholesterol back to the liver from the periphery, HDL is associated with increased health and lowered risk of atherosclerosis. Genetics play a role in hyperlipidemia, and it is inaccurate to characterize cholesterol as a waste product. Cholesterol is necessary for several physiological processes, and complete elimination is neither realistic nor desirable.

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? A) Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. B) Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. C) Peripheral dilation is associated with decreased stroke volume and ejection fraction. D) Heart valves are not capable of preventing backflow in cases of atrial congestion.

B Feedback: Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins, which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation.

When explaining to a patient why he only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to A) the possibility that the person has elevated INR levels that prevent blood from backlogging in the vessel. B) development of collateral circulation that builds channels between some of the smaller arteries usually when the flow is decreased gradually. C) good genetic makeup that allows occluded arteries to keep vasodilating to meet metabolic needs. D) the release of substances formed by special glands that transport the blood cell-by-cell through smaller spaces.

B Feedback: Collateral circulation is a mechanism for the long-term regulation of local blood flow. Anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When the artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel.

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? A) Antihypertensive, diuretic, antiplatelet aggregator B) Diuretic, ACE inhibitor, beta-blocker C) Anticoagulant, antihypertensive, calcium supplement D) Beta-blocker, potassium supplement, anticoagulant

B Feedback: Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Antiplatelet aggregators, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure.

Following electrophysiological testing that included ablation therapy, the nurse should be assessing the patient for which complication that may occur postprocedure? A) Complaints of nausea and spitting up bile-looking secretions along with stomach cramps B) Sudden onset of dysonea, tachypnea, and chest pain of a "pleuritic" nature (worsened by breathing) C) Bleeding from the nose that requires packing, excessive swallowing of mucus, and coughing D) Complaints of heart palpitations, frequent PVCs noted on monitor, and substernal chest pain

B Feedback: Following EPS that included an ablation, the procedure increases the risk of complications, which include venous thrombosis and pulmonary emboli. Answer choice B refers to s/s of pulmonary emboli. Answer choice A refers to GI symptoms, which are not associated with EPS. Answer choice C refers that this procedure does not place a tube down the nose/throat. Answer choice D refers that EPS usually does not involve the left side of the heart; therefore, the risk of MI is minimal.

A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. His parents, who believe in "natural remedies," have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for A)myocarditis. B)mitral valve stenosis. C)infective endocarditis. D)vasculitis.

B Feedback: Group A streptococcal infection can be adequately treated with antibiotics, but this infection may have been present long enough to trigger an immune response—rheumatic fever—that will damage his heart valves, ultimately causing mitral valve stenosis. Group A streptococcal infection is not known to predispose to myocarditis, endocarditis, or vasculitis and aneurysm of coronary arteries.

A patient arrived at the emergency department 2 days after the development of "chest pressure" and "tightness" was treated with antacids thinking it was indigestion. His enzymes show a massive myocardial infarction (MI). Following angioplasty, the patient asks why so much muscle was damaged if only one vessel was blocked, the left circumflex. The nurse responds, A) "With any blockage in the heart, muscle damage always occurs." B) "If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow." C) "Since the circumflex artery supplies oxygenated blood flow to the posterior surface of the left ventricle, any amount of blockage will result in vital muscle tissue being lost." D) "When it comes to arteries in the heart, all vessels are equal, and any blockage causes a massive amount of damage that will not be restored."

B Feedback: Hyperemia cannot occur when the arteries that supply the capillary beds are narrowed. For example, if a major coronary artery becomes occluded, the opening of channels supplied by that vessel cannot restore blood flow.

During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? A) Aneurysms are commonly a result of poorly controlled diabetes mellitus. B) Hypertension is a frequent modifiable contributor to aneurysms. C) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. D) Aneurysms can normally be resolved with lifestyle and diet modifications.

B Feedback: Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? A) Increased preload due to vascular resistance B) High afterload because of backpressure against the left ventricle C) Impaired contractility due to aortic resistance D) Systolic impairment because of arterial stenosis

B Feedback: Increased pressure in the aorta and other arteries constitutes a greater amount of afterload work. This situation is not indicative of increased preload or impaired contractility. Systolic impairment is not a recognized characterization of inadequate cardiac performance.

A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? A)Hypovolemic shock B)Septic shock C)Neurogenic shock D)Obstructive shock

B Feedback: Low blood pressure accompanied by warm, flushed skin and cognitive changes is indicative of septic shock, as is vessel dilatation and decreased vascular resistance.

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client? A) "The normal tissue that makes up the valve between the right sides of your heart has stiffened." B) "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation." C) "Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs." D) "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through."

B Feedback: Mitral valve stenosis represents the incomplete opening of the mitral valve during diastole with left atrial distention and impaired filling of the left ventricle. It does not exist in the right side of the heart, and the problem is associated primarily with improper ventricular filling and with pulmonary backflow only secondarily. Although it is often caused by infection, it is not an infectious process of the valve per se.

Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa? A) The man's blood work indicates polycythemia (elevated red cell levels) and leukocytosis (elevated white cells). B) The man's blood pressure is 178/102, and he has abnormal liver function tests. C) The man is acutely short of breath, and his oxygen saturation is 87%. D) The man's temperature is 101.9°F, and he is diaphoretic (heavily sweating).

B Feedback: Polyarteritis nodosa is associated with abnormal liver function and acute hypertension. Anemia, not elevated red cells, is a manifestation, while respiratory symptoms, diaphoresis, and fever are not noted to be accompaniments.

In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems? A) A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized B) A 77-year-old with diminished S3 and S4 heart tones, irregular heart rate, and a history of atrial fibrillation C) A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge D) A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

B Feedback: S3 and S4 irregularities and irregular heart rate are not noted symptoms of pericarditis. Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels are all indicators of pericarditis.

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health? A) "People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times." B) "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel." C) "Infections of any sort are often a signal that plaque disruption is in danger of occurring." D) "The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption."

B Feedback: Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation. Plaque disruption is noted to correlate with sympathetic events and is not seemingly random; infections and respiratory problems are not noted to be associated with obstruction of blood flow, however.

When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have A) no capillary openings since this would lead to extensive hemorrhage. B) small openings that allow large amounts of smaller molecular substances to filter through the glomeruli. C) large pores so that substances can pass easily through the capillary wall. D) endothelial cells that are joined by tight junctions that form a barrier to medication filtration.

B Feedback: The glomerular capillaries in the kidneys have small openings called fenestrations that pass directly through the middle of the endothelial cells. These allow large amounts of small molecular and ionic substances to filter through the glomeruli without having to pass through the clefts between the endothelial cells.

A 16-year-old adolescent who received a kidney transplant at the age of 10 has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension? A)Furosemide (Lasix) B)Cyclosporine (Sandimmune) C)Isotretinoin (Accutane) D)Hydrochlorothiazide (Hydrodiuril)

B Feedback: The nephrotoxicity of the drug cyclosporine, an immunosuppressant used in transplant therapy, may cause hypertension in children after bone marrow, heart, kidney, or liver transplantation.

A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart? A) Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation. B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells. C) The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions. D) The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.

B Feedback: The selective permeability of cell membranes to potassium, and its near-impermeability to sodium ions, produces the resting membrane potential of cardiac cells. Potassium does not catalyze the metabolism of ATP, and sodium and potassium ions do not move across the cell membrane in a 1:1 ratio.

An elderly patient arrives to the health care provider's office complaining of a "sore" that would not heal on his lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is A) hydrotherapy to facilitate improvement in circulation. B) compression therapy to help facilitate blood flow back to the vena cava. C) initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm. D) long-term antibiotic therapy to facilitate healing of the wound.

B Feedback: Treatment of venous ulcers includes compression therapy with dressings and inelastic or elastic bandages. Medications that help include aspirin and pentoxifylline. Occasionally skin grafting may be required. Hydrotherapy, Coumadin therapy, and long-term antibiotic therapy are usually not required for venous ulcers.

A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct? A) "I'll inflate the cuff around 30 mm Hg above the point at which I can't palpate the client's pulse." B) "If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low." C) "The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope." D) "With practice, my measurement of clients' blood pressures with this method will be more accurate than with automated machines."

B Feedback: Undercuffing yields a blood pressure reading that is overestimated. The cuff should indeed be inflated to 30 mm Hg above palpated systolic pressure and is both dependent on clear auscultation of the Korotkoff sounds. The properly performed manual method is more accurate than automated measurement.

A number of patients in an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? A) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia B) A 69-year-old woman who has entered ventricular fibrillation C) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation D) A 60-year-old woman who has just been diagnosed with a first-degree AV block

B Feedback: Ventricular fibrillation, or ventricular flutter, is a life-threatening emergency that would necessitate immediate intervention. Ventricular tachycardia is also a serious condition but less so than ventricular fibrillation. PVCs and a first-degree AV block would not normally require emergency intervention.

When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share? A) "All you need to do is stop drinking sodas and sugary drinks." B) "A 10 lb loss of weight can produce a decrease in blood pressure." C) "An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines." D) "If your leptin (hormone) level is too low, you are at increased risk for developing high BP."

B Feedback: Weight reduction of as little as 4.5 kg (10 lb) can produce a decrease in BP in a large proportion of overweight people with hypertension. There are no data to suggest this patient has a history of high intake of sodas. An increased waist-to-hip ratio is associated with hypertension. Leptin acts on the hypothalamus to increase BP by activating the SNS.

A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him about his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching? A) "This is almost certainly a condition that you were actually born with, but that is just now becoming a serious problem." B) "Because the normal electrical communication in lacking, the bottom parts of your heart are beating especially fast to compensate for inefficiency." C) "The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently." D) "If left untreated, this would have put you at great risk of stroke or heart attack."

C Feedback: A third-degree AV block is characterized by independent, and thus uncoordinated, pacemaker action for the atria and for the ventricles. It can be either congenital or acquired, and ventricular contraction tends to be slow, not fast. Manifestations tend to be those associated with decreased cardiac output, and a third-degree AV block is not necessarily associated with a large increase in stroke or MI risk.

A nurse is providing care for a number of older clients on a restorative care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which of the following assessments would the nurse be most justified in eliminating during a busy morning on the unit? A) Checking the recent potassium levels of a client receiving an ACE inhibitor B) Measuring the heart rate of a client who takes a â-adrenergic blocker C) Measuring the pulse of a client taking an ACE inhibitor D) Noting the sodium and potassium levels of a client who is receiving a diuretic

C Feedback: ACE inhibitors act on the renin-angiotensin-aldosterone system and thus do not significantly influence heart rate. They can, however, induce hyperkalemia, and it would be prudent for the nurse to check potassium levels. â-adrenergic blockers affect a client's heart rate, and diuretics can affect electrolyte levels.

Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)? A) Inadequate ventricular end-diastolic pressure B) Use of calcium channel blocker medications C) Increased aortic pressure D) Ventricular atrophy

C Feedback: An increase in aortic pressure results in a rise in afterload, wall tension, and, ultimately, MVO2. Increased, not inadequate, ventricular end-diastolic pressure would cause an increase in MVO2, and medications such as calcium channel blockers would decrease MVO2. Hypertrophy of ventricles would occur in response to prolonged wall stress and consequent oxygen demand.

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? A) "I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community." B) "With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this." C) "I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising." D) "There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible."

C Feedback: Aspirin, exercise, and weight loss are all identified treatments for angina. Angina does not normally necessitate blood work, heparin administration, or avoidance of activity.

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle? A) The cell samples lack intercalated disks. B) The muscle cells have small and a few mitochondria. C) The cells have a poorly defined sarcoplasmic reticulum. D) The muscles are striated and composed of sarcomeres.

C Feedback: Cardiac cells have a less clearly defined sarcoplasmic reticulum than do skeletal muscles. They also have intercalated disks and large, numerous mitochondria. Both types of muscles are striated and composed of sarcomeres.

During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need? A)Liver and pancreas B)Kidneys C)Veins D)Aorta

C Feedback: Compliance refers to the total quantity of blood that can be stored in a given portion of the circulation for each mm Hg rise in pressure. The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure. This allows the veins to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. The liver, pancreas, and kidneys are not vascular components.

A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems? A) Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution. B) Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces. C) Insufficient albumin is causing insufficient absorption of fluid into the capillaries. D) Low albumin contributing to an inability to counter gravitational effects.

C Feedback: Deficits of plasma proteins like albumin result in insufficient amounts of fluid being absorbed into the capillary circulation by osmotic pressure. It is not a result of hydrostatic pressure, hypertension, or the effects of gravity.

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function? A) "Efficient heart function requires that the ventricles do not retain any blood at the end of the cardiac cycle." B) "Recall that the heart sounds that we listen to as part of our assessments are the sounds of the myocardium contracting." C) "The diastolic phase is characterized by relaxation of ventricles and their filling with blood." D) "Aortic pressure will exceed ventricular pressure during systole."

C Feedback: Diastole is associated with ventricular filling and relaxation. Cardiac output is not 100% or near to it with each cardiac cycle, and heart sounds are associated with valve closing. Ventricular pressure exceeds that of the aorta during systole.

Assuming that they have not responded to drug therapy, which of the following clients is likely to be the best candidate for surgical cardiac ablation? A) A 62-year-old woman with peripheral vascular disease who has experienced multiple episodes of torsade des pointes B) A 75-year-old man with diabetes but no previous heart disease that suddenly develops syncope due to sick sinus syndrome C) A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long QT syndrome and episodes of frequent ventricular arrhythmias D) A 22-year-old woman with an atrial septal defect who has recurrent paroxysmal atrial flutter with rapid ventricular rate associated with her caffeine intake.

C Feedback: Due to his history of MI, the 46-year-old man probably has several areas of necrotic tissue that are interfering with conduction and ventricular function and would probably benefit from having them removed. The 62-year-old woman may have little or no myocardial tissue damage, so a less invasive procedure to improve her cardiac circulation would be a better choice for her. The 75-year-old man may not have any areas of infarction and is a risky surgical candidate because of his age and diabetes. The 22-year-old woman's tachycardia is likely to be nonischemic in origin.

In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities? A) A client undergoes a stress test on a treadmill. B) A client does isotonic exercises in a wheelchair. C) A client is helped out of bed and stands up. D) A client reclines from a sitting to supine position.

C Feedback: During a change in body position, blood is rapidly relocated from the central circulation (when the patient is recumbent) to the lower extremities (when the patient stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body.

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in A) arterial wall weakening resulting in aneurysm formation. B) release of excess fatty plaque causing numerous pulmonary emboli. C) contraction of the underlying smooth muscles within the vessels. D) overproduction of growth factors resulting in new vessel production.

C Feedback: Endothelial dysfunction describes several types of potentially reversible changes in endothelial function that occur in response to environmental stimuli. Inducers of endothelial dysfunction include cytokines, bacterial, viral, and parasitic products that cause inflammation. They also influence the reactivity of underlying smooth muscle cells through production of both relaxing factors (nitric oxide) and contracting factors (e.g., endothelins).

In which of the following patients is the emergency department staff most likely to suspect an abdominal aortic aneurysm? A) A 60-year-old client with diminished oxygen saturation, low red blood cell levels, and pallor B) A 70-year-old woman with jugular venous distention, shortness of breath, and pulmonary edema C) A 66-year-old client with facial edema, cough, and neck vein distention D) An 81-year-old man with acute cognitive changes as well as difficulty in speaking and swallowing

C Feedback: Facial edema, cough, and neck vein distention are associated with abdominal aortic aneurysms. Low red cells, pulmonary edema, and cognitive changes are not associated with abdominal aortic aneurysms.

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels? A) A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy B) A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism C) A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness D) A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

C Feedback: Hemorrhagic stroke is not a pathology noted to be associated with secondary hypercholesterolemia. Diabetes, thyroid medications, estrogen therapy, obesity, and beta-blocker medications are all correlated with hypercholesterolemia.

A 30-year-old woman presents at a hospital after fainting at a memorial service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? A)Faster than normal heart rate B)Pain C)Dry and warm skin D)Increased thirst

C Feedback: In contrast to hypovolemic shock, in which the heart rate is faster than normal and the skin is cold and clammy, a person in neurogenic shock is likely to have a slower than normal heart rate and dry, warm skin. Fainting due to emotional causes is a transient form of neurogenic shock, while increased thirst is an early sign of hypovolemic shock.

A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? A) A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity. B) The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. C) Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording. D) Holter monitors are normally set to record electrical activity of the heart at least once per hour.

C Feedback: It is imperative that activity level be correlated with Holter monitor results in order to draw accurate diagnostic conclusions. It is the long-term gathering of data, rather than sensitivity or accuracy that gives Holter monitoring an advantage over standard ECG measurement. The goal is to diagnose arrhythmias, not cardiomyopathies. The hallmark of Holter monitoring is its continuous, rather than intermittent, measurement.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? A) Resolution of compensatory pulmonary edema and heart arrhythmias B) Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility C) Infusion of normal saline or Ringer lactate to maintain the vascular space D) Administration of oxygen and epinephrine to promote perfusion

C Feedback: Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock and can be achieved in the short term through intravenous administration of saline or Ringer lactate. Resolution of pulmonary edema and heart arrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? A) Increased serum creatinine and troponin I as a result of enzyme release from damaged cells B) Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium-potassium pump C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation D) Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

C Feedback: Myocardial necrosis releases creatine kinase and troponins that normally exist intracellularly. Serum creatinine and potassium are not core markers of heart damage, and myoglobin and creatine kinase levels rise, not fall, with cardiac events.

Analysis has shown that a client's right atrial pressure is 30 mm Hg. What is the most likely conclusion that the client's care team will draw from this piece of data? A) The result is likely normal and gravity dependent given the lack of valves in thoracic and central veins. B) The pressure is insufficient to provide adequate stroke volume and cardiac output. C) The pressure is excessive given that the right atrium should be at atmospheric pressure. D) Pressure pulsations are likely to be undetectable given the low atrial pressure.

C Feedback: Normal right atrial pressure is around 0 mm Hg, or atmospheric pressure. Right atrial pressure does not have a direct influence on stroke volume or pulse pressure.

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate? A) "It's important to minimize the amount of potassium and, especially, sodium in your diet." B) "High blood pressure is largely controllable, except for those with a significant family history or African Americans." C) "Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure." D) "Hypertension puts you at a significant risk of developing type 2 diabetes later in life."

C Feedback: Obesity, excess alcohol consumption, and a sedentary lifestyle are all linked with hypertension. Inadequate, rather than excessive, potassium intake is thought to be causative, and while race and family influence an individual's predisposition to hypertension, it does not render the condition untreatable or uncontrollable. Diabetes is thought to be a contributor to hypertension, not vice versa.

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of A) development of hypertension with BP 190/98. B) oxygen deprivation with O2 saturation decreasing to approximately 90%. C) decreasing cardiac output due to less ventricular filling time. D) increasing cardiac index by correlating the volume of blood pumped by the heart with an individual's body surface area.

C Feedback: One of the dangers of ventricular tachycardia is a reduction in cardiac output because the heart does not have time to fill adequately.

A 74-year-old man is being assessed by a nurse as part of a weekly, basic health assessment at the long-term care facility where he resides. His blood pressure at the time is 148/97 mm Hg, with a consequent pulse pressure of 51 mm Hg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure? A) Blood volume, resistance, and flow B) The cardiac reserve or possible increase in cardiac output over normal resting level C) The amount of blood that his heart ejects from the left ventricle during each beat D) The relationship between total blood volume and resting heart rate

C Feedback: Pulse pressure is a reflection of the amount of blood that the heart ejects from the left ventricle during each beat combined with the distensibility of the atrial tree. Other factors such as blood flow characteristics, cardiac reserve, heart rate, and blood volume are less directly associated with pulse pressure.

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client A) has a distended bladder, facial edema, and nighttime difficulty breathing. B) complains of dyspnea and has adventitious breath sounds on auscultation (listening). C) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. D) has cyanotic lips and extremities, low urine output, and low blood pressure.

C Feedback: Right-sided failure is associated with peripheral edema, fatigue, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-sided failure when the liver becomes engorge. Facial edema, pulmonary edema, peripheral cyanosis, low urine output, and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs and symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.

On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds, A) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit." B) "This could be caused by an infection. Have you been feeling well the past few weeks?" C) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem." D) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed."

C Feedback: Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. Blood flow through a normal valve can increase by five to seven times the resting volume. Valvular disease is not caused by stress. The murmur can be caused not only by infection but also by stenosis or regurgitation of a valve leaflet. The valve problem is very severe if it is causing signs of decreased cardiac output.

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate? A) There is a break in the normal wall between the right and left atria that results in compromised oxygenation. B) The aortic valve is stenotic, resulting in increased afterload. C) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis. D) The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

C Feedback: Tetralogy of Fallot is marked by obstruction or narrowing of the pulmonary outflow channel, including pulmonic valve stenosis, a decrease in the size of the pulmonary trunk, or both. The characteristic septal defect is ventricular, not atrial. Aortic valve stenosis and right ventricular atrophy are not associated with the diagnosis.

Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction? A) A 33-year-old male whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable. B) A 67-year-old female whose pain started at 2 AM while she was asleep and responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable. C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose. D) A 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened.

C Feedback: The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other patients have angina of varying severity.

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable, and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plans listed below? A) Acute arterial occlusion that will be treated with angioplasty B) Raynaud disease that will require antiplatelet medications C) Atherosclerotic occlusive disease necessitating thrombolytic therapy D) Giant cell temporal arteritis that will be treated with corticosteroids

C Feedback: The client's symptoms of calf pain with intermittent claudication and diminished pulses are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are not as closely associated with acute arterial occlusion or giant cell temporal arteritis and are not related to Raynaud disease.

A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider most likely suspect? A) Pheochromocytoma B) Essential hypertension C) Coarctation of the aorta D) An adrenocortical disorder

C Feedback: The differences in blood pressure between the upper and lower extremities combined with weak femoral pulses and unilateral brachial pulse weakness are associated most strongly with coarctation of the aorta.

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client's mean arterial pressure is at the low end of the normal range; at 6 AM, the client's MAP has fallen definitively below normal. The client is at risk for A) pulmonary hypertension. B) left ventricular hypertrophy. C) organ damage and hypovolemic shock. D) orthostatic hypotension.

C Feedback: The mean arterial pressure, which represents the average blood pressure in the systemic circulation, is a good indicator of tissue perfusion. Hospitalization and bed rest predispose to dehydration and low blood volume. Blood pressure normally follows a diurnal pattern in which pressures are highest in the morning. The fact that this client's MAP is falling at a time when it should be at its daily peak is the cause for grave concern; blood volume is likely low, and vital organs, which depend on adequate perfusion, are at risk.

During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this? A) "A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy." B) "By avoiding salt, staying active, and minimizing weight gain, you can prevent this during your pregnancy." C) "Essentially, experts don't really know why so many pregnant women develop high blood pressure." D) "I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you."

C Feedback: The root causes of pregnancy-induced hypertension are not known. It is pathological rather than normal, however, and it cannot necessarily be avoided by lifestyle modifications. It can be pernicious to both the mother and the fetus.

The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening? A) "This means that the SA node (which is the beginning of your heart's electrical system) has been damaged and is no longer functioning normal." B) "You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart." C) "There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast." D) "For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better."

C Feedback: There are several forms of reentry. The first is anatomic reentry. It involves an anatomic obstacle around which the circulating current must pass and results in an excitation wave that travels in a set pathway. Arrhythmias that arise as a result of anatomic reentry are paroxysmal supraventricular tachycardias, as seen in WPW syndrome, atrial fibrillation, atrial flutter, etc. Answer choice A relates to sinus node arrhythmias and SSS. Answer choice B relates to arrhythmias caused by MI. Answer choice D relates to third-degree block or ventricular standstill, for example.

Which of the following patients will likely experience difficulty in maintaining lipoprotein synthesis resulting in elevated LDL levels? A) A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD) B) A 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis C) A 35-year-old patient with a history of hepatitis C and B with end-stage liver disease D) A 27-year-old patient with pancreatitis related to alcohol abuse

C Feedback: There are two sites of lipoprotein synthesis—the small intestine and the liver. The liver synthesizes and releases VLDL and HDL. IDL are taken to the liver and recycled to form VLDL or converted to LDL in the vascular compartment. Liver disease will result in this mechanism not working as expected. COPD, cervical cancer, and pancreatitis are not involved in elevated LDL levels.

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg, and she has proteinuria. What other lab tests should be ordered for her? A) Plasma angiotensin I and II and renin B) Urinary sodium and potassium C) Platelet count, serum creatinine, and liver enzymes D) Urinary catecholamines and metabolites

C Feedback: This woman shows signs and symptoms of preeclampsia. A low platelet count with elevated serum creatinine and liver enzymes would reinforce this diagnosis. The other tests might indicate kidney problems or the presence of a pheochromocytoma, but her symptoms do not indicate a need for these tests.

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe? A) Decreased vascular perfusion due to parasympathetic stimulation B) Decreased heart rate, contractility, and afterload C) Decreased heart rate as a result of parasympathetic innervation of the heart D) Decreased heart rate as a result of impaired acetylcholine reuptake

C Feedback: Vagal stimulation results in lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility, and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced.

A patient in the emergency department is experiencing a massive stroke with extremely low blood flow to the brain exhibited by a BP less than 60 mm Hg. The nurse suddenly notes there is a sharp rise in the BP to 250 mm Hg. This high BP lasts about 5 minutes, and then the BP drops sharply again. The pathophysiologic principle behind this is likely due to the A) activation of the autonomic nervous system. B) release of mineralocorticoids. C) CNS ischemic response. D) protective homeostatic mechanism.

C Feedback: When blood flow to the brain has been sufficiently interrupted to cause ischemia of the vasomotor center, these vasomotor neurons become strongly excited. This causes massive vasoconstriction as a means of raising the blood pressure to levels as high as the heart can pump against. This response is called the CNS ischemic response and can raise BP to levels as high as 270 mm Hg for as long as 10 minutes.

A nurse educator is teaching a group of nurses at a long-term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct? A) "The electrical impulses go in chaotic directions, and so the atria can't contract properly." B) "An ECG of someone in atrial fibrillation would be almost random in appearance." C) "The contraction of the ventricles and the atria can range from 400 to 600 beats/minute." D) "It can be hard to measure at the bedside because not all ventricular beats make a palpable pulse."

C Feedback: While atrial contraction can range from 400 to 600 beats/minute, ventricular contraction is normally in the range of 80 to 180 beats/ minute during atrial fibrillation. The electrical impulses do go in chaotic, inappropriate directions, and the ECG can appear random. Measurement can be challenging because of the lack of pulses corresponding to all ventricular contractions.

A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler? A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output

C Feedback: With RV function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion often is one of the first signs on systemic venous congestion in infants and children.

The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications? A)Lisinopril, an ACE inhibitor B)Lasix, a diuretic C)Propranolol, a â-adrenergic blocker D)Lanoxin, an inotropic

C Feedback: â-Adrenergic blockers are generally the initial choice for persons with symptomatic HCM. Calcium channel blockers can also be used. ACE inhibitors, diuretics, or positive inotropics are not the first-line medications.

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply. A) Increased incidence of mitral stenosis B) Sludge buildup in the kidneys C) Elevated diastolic BP D) Increased vascular stiffness E) Inflammation in the joints due to arthritis

C, D Feedback: Changes with aging contribute to the development of HF in older adults. First is reduced responsiveness to â-adrenergic stimulation. Second is increased vascular stiffness that contributes to ventricular hypertrophy. Third, the heart itself becomes less compliant with age. Fourth relates to altered myocardial metabolism at the level of the mitochondria. Older adults usually develop aortic stenosis and mitral regurgitation. Kidney stones do not contribute to HF. Increase in diastolic pressure compromises LV filling leading to increases in pressures predisposing to HF. Arthritis is not associated with heart failure.

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring? A) The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. B) Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system. C) Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction. D) The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

D Feedback: Angiotensin conversion in the lungs is a component of the renin-angiotensin-aldosterone system that ultimately increases blood pressure and sodium reabsorption. Juxtaglomerular cells release renin, and epinephrine (vasopressin) is responsible for neither initiating the renin-angiotensin-aldosterone system nor directly influencing chemoreceptors and baroreceptors.

A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically? A) His AV node will be performing the primary pacemaker role due to inadequacy of the SA node. B) His ECG will show a flattened P wave as a result of impaired atrial depolarization. C) Conduction from the Purkinje fibers to the bundle branches is compromised by inadequate conduction. D) His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue.

D Feedback: Because impulses must pass through muscle tissue rather than specialized conduction tissue, the client's QRS complex will be wide. His SA node is unlikely to be defective, and the client's P wave is not likely to be abnormal on an ECG. Conduction takes place from the bundle branches to the Purkinje fibers rather than vice versa.

A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? A) Signal-averaged ECG B) Exercise stress testing C) Electrophysiologic study D) Holter monitoring

D Feedback: Because sick sinus syndrome frequently involves intermittent or alternating types of arrhythmias, Holter monitoring, which can record changes in rhythm that occur over a period of up to 48 hours, is likely to provide the best picture of the spectrum of cardiac changes in any particular client. Signal-averaged ECG is most useful for identifying specific arrhythmias that may not be clear on traditional surface ECG. Exercise stress testing measures changes in rhythm specifically in response to exercise. Electrophysiologic studies are used diagnostically to determine a person's potential for arrhythmia formation.

When a 55-year-old patient's routine blood work returns, the nurse notes that his C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds, A) "You must eat a lot of red meat since this means you have a lot of fat floating in your vessels." B) "You are consuming high levels of folate, which works with the B vitamins and riboflavin to metabolize animal protein." C) "This means you have high levels of HDL to balance the LDL found in animal proteins." D) "This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

D Feedback: CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B6, vitamin B12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for the development of premature coronary heart disease.

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught stating, "I've always been healthy, and I can't believe I have a disease now." What would be her physician's most appropriate response? A) "This likely won't have a huge effect on your quality of life, and I'll prescribe anticlotting drugs to prevent attacks." B) "I'll teach you some strategies to minimize its effect on your life, and minor surgery to open up your blood vessels will help too." C) "You need to make sure you never start smoking, and most of the symptoms can be alleviated by regular physical activity." D) "If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

D Feedback: Ensuring total body warmth and the use of vasodilators are the normal treatment modalities for Raynaud disease.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to A) have medical supply department bring up suction equipment. B) apply oxygen via nasal cannula at 3 lpm. C) page the respiratory therapist to come give him a breathing treatment. D) call for emergency assistance utilizing hospital protocol.

D Feedback: Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, the skin is moist, and the lips/nail beds are cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The patient needs the emergency responder team (including ICU nurses, physicians, respiratory therapist, etc.) to intervene. Applying O2 by mask will not increase his oxygen level fast enough, and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course respiratory therapist will arrive with the emergency assistance team.

A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer thus resulting in decreased vessel lumen radius? A)Nitric oxide B)Adrenal glands C)Fibroblast growth factor D)Norepinephrine

D Feedback: Nerve cells and circulating hormones are responsible for vasoconstriction of the vessel walls. Because they do not enter the tunica media of the blood vessel, the nerves do not synapse directly on the smooth muscle cells. Instead, they release the neurotransmitter, norepinephrine, which diffuses into the media and acts on the nearby smooth muscle cells, resulting in contraction of the entire muscle cell layer and thus reducing the radius of the vessel lumen. This increases the systemic circulation.

An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist's report is most suggestive of a possible history of poorly controlled blood pressure? A) "Scarring of the urethra suggestive of recurrent urinary tract infections is evident." B) "Bilateral renal hypertrophy is noted." C) "Vessel wall changes suggestive of venous stasis are evident." D) "Arterial sclerosis of subcortical brain regions is noted."

D Feedback: Neurological consequences of hypertension include narrowing and sclerosis of subcortical regions. Urethral scarring and impaired venous return would be less likely to derive from hypertension, and while nephrosclerosis and glomerular damage are associated with hypertension, hypertrophy of the kidneys themselves is not noted as an indicator.

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems? A) The patient is male and has a history of hypertension. B) The patient's cardiac ejection fraction was 40% during his last echocardiogram. C) The patient has a history of acute and chronic renal failure. D) The client is 89 years old and takes a diuretic medication for his congestive heart failure.

D Feedback: Old age and diuretic use are strongly associated with orthostatic hypotension, which is normally marked by falls and syncope. Gender, hypertension, stroke volume, and kidney disease are less likely to be causative factors.

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? A) Pressure in pulmonary circulation and the right side of the infant's heart fall markedly. B) Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries. C) Systemic vascular resistance and left ventricular pressure are both increasing. D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

D Feedback: One of the hallmarks of the transition from placental circulation is a rapid and then steady decrease in pulmonary vascular resistance. Answers A, B, and C relate normal physiological processes.

An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms are least likely to decrease the symptoms of his heart failure? A) An increase in preload via the Frank-Starling mechanism B) Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine C) Activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) D) AV node pacemaking activity and vagal nerve suppression

D Feedback: Reassignment of cardiac pacemaking activities and suppression of the vagal nerve are not noted compensatory actions related to heart failure. Increased preload and sympathetic stimulation, increased levels of epinephrine and norepinephrine, and activation of the renin-angiotensin-aldosterone system and secretion of brain natriuretic peptide (BNP) are all noted compensatory mechanisms.

A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for? A) Impaired physical restraint of the left ventricle B) Increased friction during the contraction/relaxation cycle C) Reduced protection from infectious organisms D) Impaired regulation of myocardial contraction

D Feedback: Regulation of myocardial contraction is not a role of the fibrous covering around the heart. The pericardium does restrain the left ventricle, reduce friction by way of fluid in the pericardial cavity, and provide a physical barrier to infection.

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)? A) A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort B) A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin C) A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

D Feedback: STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms, and radiating substernal pain are all associated with STEMI.

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? A) His resting blood pressure is normally in the range of 150/90, and an echocardiogram indicates his ejection fraction is 30%. B) His end-diastolic volume is higher than normal, and his resting heart rate is regular and 82 beats/minute. C) He is presently volume overloaded following several days of intravenous fluid replacement. D) Ventricular dilation and wall tension are significantly lower than normal.

D Feedback: Systolic dysfunction is associated with increased ventricular dilation and wall tension. Hypertension, low ejection fraction, high preload, and volume overload are all commonly associated with systolic dysfunction.

A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician? A) "As vessel wall thickness increases, tension decreases." B) "Smaller blood vessels require more pressure to overcome wall tension." C) "The smaller the vessel radius, the greater the pressure needed to keep it open." D) "Tension and vessel thickness increase proportionately."

D Feedback: Tension and vessel wall thickness are inversely proportionate, in that thinner blood vessels have greater tension and vice versa. Answer choices A, B, and C all express the correct inverse relationship between tension and wall thickness.

A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? A) Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. B) Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. C) Defibrillation must be coincided with the R wave of the ECG in order to be successful. D) The goal is to depolarize the entire heart during the passage of current.

D Feedback: The benefits of defibrillation are achieved by depolarizing the heart during the passage of current, allowing the SA node to regain control. It is not achieved by the use of a pacemaker, and cardioversion, not defibrillation, is coincided with the R wave.

A nurse is using a stethoscope and blood pressure cuff to manually measure a client's blood pressure. The nurse knows that which of the following facts related to blood flow underlies the ability to hear blood pressure by auscultation (listening)? A) The force of blood with each cardiac contraction produces friction on vessel walls that can be heard and felt. B) The movement of smooth muscle surrounding vessels produces noise that is audible by a stethoscope. C) Turbulent flow of blood during systole produces sound while laminar flow during diastole is silent. D) Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.

D Feedback: The pressure pulsations that accompany intermittent blood ejection from the ventricles cause sounds that are audible when measuring blood pressure and palpable at pulse sites. Friction, muscle movement, and turbulent blood flow do not account for the pressure pulsations.

A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? A) "Remember the 'H' in HDL and the 'L' in LDL correspond to high danger and low danger to your health." B) "Having high cholesterol increases your risk of developing diabetes and irregular heart rate." C) "Smoking and being overweight increases your risk of primary hypercholesterolemia." D) "Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."

D Feedback: There is a genetic basis to high cholesterol, but lifestyle modification can compensate for many of the increased risks. LDL is more deleterious to health than HDL, and diabetes contributes to high cholesterol but not necessarily vice versa. Hypercholesterolemia resulting from other factors is secondary rather than primary.