Quiz 6
The most common causes of left-sided heart failure include: A- Acute myocardial infarction B- Chronic pulmonary disease C- Impaired renal blood flow D- Tricuspid valve regurgitation
A- Acute myocardial infarction
A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? A- A β-adrenergic blocker B- A diuretic C- A cardiac glycoside D- An ACE inhibitor
C- A cardiac glycoside
Because of its location, the presence of an abdominal aortic aneurysm may first be manifested as: A- Constipation B- Indigestion C- A pulsating mass D- Midabdominal pain
C- A pulsating mass
Heart muscle differs from skeletal muscle tissue by being able to generate: A- Contractions B- Calcium influx C- Action potentials D- Sarcomere binding
C- Action potentials
Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? A- Leukocytosis B- Homocysteine C- Serum lipoprotein D- C-reactive protein
D- C-reactive protein
From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. A- A 48-year-old client with uncontrolled hypertension B- A marathon runner with history of chronic bradycardia whose pulse rate is 46 C- A 57-year-old client with history of ischemic heart disease D- A 70-year-old with enlarged left ventricle due to myocardial hypertrophy
A- A 48-year-old client with uncontrolled hypertension D- A 70-year-old with enlarged left ventricle due to myocardial hypertrophy
The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? A- A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation B- A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade C- A 87-year-old client admitted with uncontrolled dilated cardiomyopathy D- A 78-year-old client admitted with increasing fatigue related to aortic stenosis
A- A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation
The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply. A- Accumulation of fluid in the alveoli and airways B- Lung stiffness C- Worsening renal failure D- Myocardial muscle necrosis E- Impaired gas exchange
A- Accumulation of fluid in the alveoli and airways B- Lung stiffness E- Impaired gas exchange
A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? A- Blood pressure is no longer able to overcome vessel wall tension. B- Decreasing vessel radii has caused a decrease in blood pressure. C- Wall thickness of small vessels has decreased due to hypotension. D- Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.
A- Blood pressure is no longer able to overcome vessel wall tension.
Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A- Fixed coronary obstruction B- Increased collateral circulation C- Intermittent vessel vasospasms D- Excessive endothelial relaxing factors
A- Fixed coronary obstruction
Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? A- High-calorie diet B- Diabetes mellitus C- Bile-binding resin D- Cholesterol ingestion
A- High-calorie diet
One of the principal mechanisms by which the heart compensates for increased workload is: A- Myocardial hypertrophy B- Sodium and water retention C- Endothelin vasoconstrictors D-Ventricular wall tension increase
A- Myocardial hypertrophy
While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A- Peripheral vascular resistance B- Electrical impulses in the heart C= Release of stress hormones D- Rigidity of the ventricular walls
A- Peripheral vascular resistance
The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A- Stable angina B- Non-ST-segment elevation MI C- ST-segment elevation MI D- Unstable angina
A- Stable angina
When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements? A- "This means that your atria are not contracting normally, they are quivering." B- "One consequence of this type of block is a very slow heart rate that limits circulation to the brain." C- "This type of arrhythmia requires defibrillation, which will occur in the cardiac catheter lab later today." D- "It's pretty common for everyone to experience this arrhythmia, especially during times of stress in their lives.
B- "One consequence of this type of block is a very slow heart rate that limits circulation to the brain."
A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which of the following explanations is most appropriate to share? A- "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." B- "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." C- "Your heart muscle is overstretched, so it's not able to pump all the blood out. The prescribed 'water pills' help by decreasing your weight." D- "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out."
B- "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."
Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles? A- "You have been exposed to an infection that went into your blood stream." B- "You have a heart valve that is diseased." C- "You heart has been pumping your blood so hard, that the pressure has damaged your valves." D- "Your heart has enlarged, so naturally your valves had to enlarge as well.
B- "You have a heart valve that is diseased."
A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein? A- "Your neighbor probably has higher amounts of good cholesterol (HDL) as well." B- "You more than likely have small, dense type of 'bad cholesterol' (LDL)." C- "Your neighbor has larger 'bad cholesterol' particles that can move into blood vessels but park in joints/tendons." D- "You must have a genetic predisposition to having clogged arteries."
B- "You more than likely have small, dense type of 'bad cholesterol' (LDL)."
Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A- A client whose most recent ECG indicates that silent myocardial ischemia has occurred B- A client who occasionally experiences persistent and severe chest pain when at rest C- A client who sometimes experiences chest pain when climbing stairs D- A client who has recently been diagnosed with variant (vasospastic) angina
B- A client who occasionally experiences persistent and severe chest pain when at rest
Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: A- Edema B- Calf pain C- Varicosities D- Strong pulse
B- Calf pain
Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A- Red thrombus B- Large lipid core C- Calcified lesion D- Vessel wall injury
B- Large lipid core
The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A- Ulceration B- Thrombosis C- Fatty streaks D- Fibrous plaque
B- Thrombosis
When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply. A- The AV node offers a two-way conduction area between the atria and the ventricles. B- The velocity of conduction through the AV junctional fibers is very fast, which greatly increases impulse transmission. C- A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. D- When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular.
C- A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. D- When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular.
A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced: A- Acute myocarditis." B- High troponin levels." C- Acute ventricular arrhythmia." D- Hypertrophic cardiomyopathy."
C- Acute ventricular arrhythmia."
A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? A- Small diameter of this vessel will cause it to rupture more readily. B- The larger the aneurysm, the less tension placed on the vessel. C- As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. D- The primary cause for rupture relates to increase in abdominal pressure such as straining to have a bowel movement.
C- As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.
A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond: A- "Pull your blood from the right side of the heart and run it through a machine to oxygenate it better, and then return it to your body." B- "Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." C- "Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." D- "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
D- "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A- Backup of blood from the right atrium into the superior vena cava B- Backflow from the right ventricle to the right atrium during systole C- Inhibition of the SA node's normal action potential D- Backflow from the left ventricle to the left atrium
D- Backflow from the left ventricle to the left atrium
While in the ICU, a client's status changes. The health care providers suspect heart failure. Which of the following diagnostic procedures would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions? A- Echocardiography B- Radionuclide ventriculography C- Cardiac magnetic resonance imaging D- Hemodynamic monitoring
D- Hemodynamic monitoring
If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A- Heart rate 150 beats/minute, labeled as supraventricular tachycardia B- Disorganized ventricular fibrillation C- Complete cardiac standstill D- Slowing of heart rate to below 60 beats/minute
D- Slowing of heart rate to below 60 beats/minute
Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A- Chronic atrial fibrillation B- Myocardial inflammation C- Left ventricle hypertrophy D- Vegetative valve destruction
D- Vegetative valve destruction