Ch. 26 - Alterations of Cardiovascular Function EAQ

An individual who is diagnosed with infective endocarditis says "I was told that these strange lines in my fingernails are splinter hemorrhages. How could a heart infection cause me to get splinters? I haven't been working with wood." Which response is appropriate? a. "Owing to the infection in your heart, little pieces of fibrin and bacteria can break off and circulate in the blood. If they land in the nail beds, they can look like splinters." b. "Sometimes an infection elsewhere in your body can move to the heart and create infective endocarditis. Splinter hemorrhages are a sign of fingernail infection." c. "Because you have infective endocarditis, your immune system has been activated and can attack your nail beds inappropriately. That makes them look like you have splinters." d. "Having a heart infection can cause people to be restless from lack of oxygen. Maybe you have been rubbing your fingers on the underside of the table without realizing it."

a. "Owing to the infection in your heart, little pieces of fibrin and bacteria can break off and circulate in the blood. If they land in the nail beds, they can look like splinters." Rationale Splinter hemorrhages with infective endocarditis are caused by embolism of vegetations from the heart (little pieces of fibrin and bacteria that break off and circulate in the blood). Splinter hemorrhages do not indicate fingernail infection. Splinter hemorrhages with infective endocarditis are not caused by the immune system attacking the nail beds. Splinter hemorrhages are not due to real splinters.

Which blood pressure reading from an adult would be reported as normal? a. 110/70 mm Hg b. 120/80 mm Hg c. 130/90 mm Hg d. 140/100 mm Hg

a. 110/70 mm Hg Rationale Normal blood pressure is considered to be systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. Systolic pressure of 120 to 139 or diastolic pressure of 80 to 89 is considered hypertensive. Systolic pressure of 140 to 159 or diastolic pressure of 90 to 99 is stage 1 hypertension. Systolic pressure of 160 or greater or diastolic pressure of 100 or greater is stage 2 hypertension.

Which action should follow the administration of oxygen in the management of acute myocardial infarction? a. Administer aspirin. b. Offer caffeinated fluid. c. Insert a urinary catheter. d. Provide intermittent cardiac monitoring.

a. Administer aspirin. Rationale The individual should be placed on supplemental oxygen and given an aspirin immediately (or ticlopidine if allergic to aspirin). Caffeine is discouraged. A urinary catheter may be needed, but it is not as crucial as the aspirin. Continuous monitoring is needed because the first 24 hours after onset of symptoms is the time of highest risk for sudden death.

Which conditions predispose to embolism or already have an embolus? Select all that apply. a. An infected blood vessel b. A foreign object in the bloodstream c. Dislodged fat after long-bone surgery d. An air bolus from intravenous therapy e. A chronic blood disorder such as anemia

a. An infected blood vessel b. A foreign object in the bloodstream c. Dislodged fat after long-bone surgery d. An air bolus from intravenous therapy RationaleAn infection present in a vessel can trigger an embolus. Any foreign body in the circulatory system (bloodstream) can be the cause of an embolus. Fat emboli can occur after long-bone surgery or trauma. Air introduced into the circulatory system by intravenous therapy can result in an air embolus. Chronic blood disorders such as anemia are not generally triggers for emboli

Which information from young adults indicates that teaching about the harmful effects of cigarette smoking was effective? a. Clotting is increased because of smoking. b. Epinephrine decreases in people who smoke cigarettes. c. Smoking will reduce low-density lipoprotein (LDL) levels. d. Cigarettes cause an increase in high-density lipoprotein (HDL) levels.

a. Clotting is increased because of smoking. Rationale Cigarette smoking produces an increased thrombotic (clotting) and inflammatory state, decreased HDL, and increased LDL. Nicotine stimulates the release of catecholamines (epinephrine and norepinephrine), which increase heart rate and peripheral vascular constriction.

Which action is appropriate in an individual with these findings (see chart) and atherosclerosis? a. Control of diabetes b. Smoking cessation c. Hypertension management d. Medication for total cholesterol

a. Control of diabetes Rationale Control of the patient's diabetes is the priority. There is no information here that indicates that the patient has hypertension; the vital signs are stable; and smoking cessation is not needed because the patient is a nonsmoker. Although the LDL cholesterol level is high, total cholesterol medication is not needed because the total cholesterol is below 200 mg/dL.

Which information should be included when teaching an adult class at a wellness clinic about risk factors for atherosclerosis? Select all that apply. a. Diabetes b. Nonsmoker c. Hypertension d. Active lifestyle e. Periodontal disease

a. Diabetes c. Hypertension e. Periodontal disease Rationale Diabetes, hypertension, and periodontal disease are three risk factors for atherosclerosis. Being a nonsmoker and having an active lifestyle are not risk factors for atherosclerosis; smoking can actually increase risk.

Which statement describes the role of diabetes mellitus in the development of coronary artery disease? a. Diabetes causes endothelial damage. b. Diabetes causes thinning of vessel walls. c. Diabetes causes hyperhomocysteinemia. d. Diabetes causes decreased inflammation.

a. Diabetes causes endothelial damage. Rationale Insulin resistance and diabetes have multiple effects on the cardiovascular system, including endothelial damage, thickening of the vessel wall, and increased inflammation. Hyperhomocysteinemia occurs because of a genetic lack of the enzyme that metabolizes homocysteine (an amino acid) or because of a nutritional deficiency of folate, cobalamin (vitamin B 12), or pyridoxine (vitamin B 6).

Which cardiomyopathy is associated with alcohol abuse? a. Dilated cardiomyopathy b. Restrictive cardiomyopathy c. Obstructive cardiomyopathy d. Hypertrophic cardiomyopathy

a. Dilated cardiomyopathy Rationale Dilated cardiomyopathy typically occurs from alcohol abuse. Restrictive, obstructive, and hypertrophic cardiomyopathy typically have other causes.

Which class of medication will reduce preload in left-sided heart failure? a. Diuretics b. Beta-blockers c. Corticosteroids d. Calcium channel blockers

a. Diuretics Rationale Diuretics reduce preload. Beta-blockers slow the heart rate and reduce the force with which the heart muscle contracts, thereby lowering blood pressure. Corticosteroids are not used for affecting cardiac preload but rather are antiinflammatory agents. Calcium channel blockers are not commonly used to decrease cardiac preload.

Which term describes an occlusion of a blood vessel from a bolus of circulating matter in the bloodstream? a. Embolus b. Foam cell c. Thrombus d. Thrombophlebitis

a. Embolus RationaleAn embolus detaches from the wall of a vessel, and this bolus of matter circulates within the vascular system until it reaches a vessel small enough for it to occlude. Foam cells are lipid-laden cells that contribute to fatty streaks. A thrombus is a blood clot that remains attached to the vessel wall. Thrombophlebitis is the inflammation caused by a thrombus.

Which information indicates teaching was successful about the known causes of infective endocarditis? Select all that apply. a. Fungi b. Parasites c. Rickettsia d. Autoimmunity e. Myocardial f. ischemia

a. Fungi b. Parasites c. Rickettsia Rationale Infective endocarditis can be caused by fungi, rickettsia, parasites, and viruses, although they are not the most frequent causes. Bacteria are the most common cause. Infective endocarditis is caused by infection with microorganisms, not by autoimmunity or by myocardial ischemia.

Which arteries are affected in coronary artery disease? a. Heart arteries b. Cerebral arteries c. Capillary arteries d. Peripheral arteries

a. Heart arteries Rationale The word coronary comes from a root meaning "crown" and indicates that one object encircles another as a crown encircles a head; the coronary arteries, which supply blood to the heart muscle, were named thus because they encircle the heart. Cerebral arteries carry blood to the brain. Capillaries are not arteries; they are the single-cell- layer vessels where nutrients and oxygen are diffused into the tissues. Peripheral arteries carry blood to the extremities.

Which pathophysiologic event is associated with left ventricular failure when the renin-angiotensin-aldosterone system (RAAS) is activated? a. Increased plasma volume b. Decreased cardiac oxygen demand c. Decreased systemic vascular resistance d. Increased pulmonary capillary permeability

a. Increased plasma volume Rationale As cardiac output falls, renal perfusion diminishes with activation of the RAAS, which acts to increase plasma volume by causing sodium and water retention, thus further increasing afterload and preload. The end results of activation of the RAAS increase myocardial oxygen demand. Activation of the RAAS causes systemic vasoconstriction through the formation of angiotensin II, which increases systemic vascular resistance. Activation of the RAAS does not affect pulmonary capillary permeability.

Which measures should be implemented to obtain an accurate blood pressure reading? Select all that apply. a. Individual must be seated. b. Readings must be 2 minutes apart. c. Arm must be raised above heart level. d. Individual must have been at rest for at least 5 minutes. e. Individual must not have smoked in the previous 30 minutes.

a. Individual must be seated. b. Readings must be 2 minutes apart. d. Individual must have been at rest for at least 5 minutes. e. Individual must not have smoked in the previous 30 minutes. Rationale Diagnosis requires the measurement of blood pressure on at least two separate occasions, averaging two readings at least 2 minutes apart, with the following conditions: the person must be seated, the arm must be supported at heart level, the person must be at rest for at least 5 minutes, and the person must not have smoked or ingested any caffeine in the previous 30 minutes.

Which heart chamber would have increased pressure (demonstrated by cardiac catheterization) in mitral stenosis? a. Left atrium b. Right atrium c. Left ventricle d. Right ventricle

a. Left atrium Rationale Impedance to blood flow results in incomplete emptying of the left atrium and elevated atrial pressure as the chamber tries to force blood through the stenotic valve. Continued increases in left atrial volume and pressure cause atrial dilation and hypertrophy. Mitral valve stenosis is not characterized by increased pressure in the right atrium, left ventricle, or right ventricle.

Which heart valves are the most commonly affected in adults with valvular dysfunction? Select all that apply. a. Mitral b. Aortic c. Pulmonic d. Tricuspid e. Myocardium

a. Mitral b. Aortic Rationale Although all four heart valves may be affected, in adults those of the left heart (mitral and aortic valves) are far more commonly affected than those of the right heart (tricuspid and pulmonic valves). Myocardium is the heart muscle and is not a valve.

Which condition causes the left atrium to work harder during systole? a. Mitral stenosis b. Aortic stenosis c. Tricuspid stenosis d. Pulmonary stenosis

a. Mitral stenosis Rationale Mitral stenosis impairs the flow of blood from the left atrium to the left ventricle. Blood from the left atrium is pumped through the mitral valve into the left ventricle. Mitral stenosis causes the left atrium to work harder during systole, pumping through the narrowed opening. The left atrium does not pump blood directly through the aortic, tricuspid, or pulmonary valves.

Which term describes acute inflammation of the pericardium? a. Pericarditis b. Cardiomyopathy c. Pericardial effusion d. Myocardial infarction

a. Pericarditis Rationale Acute pericarditis is acute inflammation of the pericardium. The cardiomyopathies are a diverse group of diseases that primarily affect the myocardium, not the pericardium, itself. Pericardial effusion is the accumulation of fluid in the pericardial cavity. When coronary blood flow is interrupted for an extended period of time, myocyte necrosis occurs. This results in myocardial infarction.

Which statement describes how blood flow is affected in aortic stenosis? a. Resistance to blood flow from the left ventricle into the aorta b. Resistance to blood flow from the right ventricle into the lungs c. Resistance to blood flow from the left atrium to the left ventricle d. Resistance to blood flow from the right atrium to the right ventricle

a. Resistance to blood flow from the left ventricle into the aorta RationaleIn aortic stenosis, the orifice of the aortic valve narrows, causing resistance to blood flow from the left ventricle into the aorta. Pulmonic valve dysfunction can lead to problems from the right ventricle to the lungs. Mitral stenosis impairs the flow of blood from the left atrium to the left ventricle. Tricuspid stenosis impairs the flow of blood from the right atrium to the right ventricle.

An individual calls the clinic reporting that painful indigestion cannot be alleviated and asks what to do. Before answering, which information should be considered? a. The individual may be having a myocardial infarction. b. The individual activated the parasympathetic nervous system. c. The individual probably became dehydrated from gastric distress. d. The individual needs to deep breathe to get oxygen to the tissues.

a. The individual may be having a myocardial infarction. Rationale Infarction often simulates a sensation of unrelenting indigestion. The sympathetic nervous system would be activated. Although dehydration can result from gastric distress, the fact that the individual cannot get rid of the feeling of painful indigestion is common with a heart attack. The individual needs more than deep breathing to get oxygen to the tissues; the individual needs to seek medical help.

Which piece of equipment is used to monitor for early signs of impending renal dysfunction in complicated hypertension? a. Urine test kit b. Stethoscope c. Pulse oximeter d. Blood pressure cuff

a. Urine test kit RationaleMicroalbuminuria (small amounts of protein in the urine) is now recognized as an early sign of impending renal dysfunction. A urine test kit can detect it. A blood pressure cuff and stethoscope are good for measuring blood pressure, but they do not indicate the damage to the kidneys. A pulse oximeter will determine oxygen saturation but not the damage to the kidneys.

Which lifestyle modifications should be taught to an individual with high blood pressure? Select all that apply. a. Weight loss b. Exercise program c. Medication therapy d. Dietary modifications e. Increased sodium intake

a. Weight loss b. Exercise program d. Dietary modifications Rationale Important lifestyle modifications include following an exercise program, making dietary modifications, stopping smoking, and losing weight. Medication therapy is not considered a lifestyle modification but rather is considered pharmacologic treatment of hypertension. A low-sodium diet, not an increase in sodium intake, decreases sodium retention and blood volume, altering stroke volume and cardiac output, which results in a lower blood pressure.

Which information indicates an accurate understanding of a dissecting aneurysm? a. A tear that is discovered during an autopsy b. A tear that causes blood to enter the artery wall c. An aneurysm that is an extravascular hematoma d. An aneurysm that balloons out on one side of the artery

b. A tear that causes blood to enter the artery wall Rationale A dissecting aneurysm occurs when there is a tear in the intima and blood enters the wall of the artery. A dissecting aneurysm may be discovered in a living client. A false aneurysm is an extravascular hematoma that communicates with the intravascular space. An aneurysm that balloons out on one side of the artery is a saccular aneurysm.

Which advice is given to an elderly individual with normal extracellular fluid (ECF) volume who almost fainted when getting out of bed in the morning? a. Restrict sodium in the diet. b. Arise slowly from the bed or chair. c. Stop smoking and reduce fat in the diet. d. Replace body fluid losses with salt and water.

b. Arise slowly from the bed or chair. RationaleThe most important advice for this client to know immediately is to stand up slowly from the bed or chair to give the body time to adjust to the postural change. Restricting dietary sodium could decrease ECF volume and make orthostatic hypotension worse. Stopping smoking and reducing dietary fat will reduce risk factors for atherosclerosis, but that is not the cause of orthostatic hypotension. Replacing body fluid losses with salt and water is important to prevent orthostatic hypotension associated with ECF volume deficit, but the client does not have ECF volume deficit at this time.

Which modifiable factors increase the risk of coronary artery disease? Select all that apply. a. Advanced age b. Atherogenic diet c. Cigarette smoking d. Lack of physical activity e. Family history of hypertension

b. Atherogenic diet c. Cigarette smoking d. Lack of physical activity Rationale Atherogenic diet, cigarette smoking, and lack of physical activity are modifiable risk factors for coronary artery disease. Advanced age and family history are not modifiable.

Which complication is associated with chronic orthostatic hypotension? a. Heart failure b. Bone fractures c. Hyperglycemia d. Atherosclerosis

b. Bone fractures RationaleOrthostatic hypotension often is accompanied by dizziness and fainting, which can lead to head injuries or bone fractures from falls. Hypertension, rather than hypotension, is a risk factor for heart failure because of high left ventricular afterload. Clients with diabetes mellitus (and thus frequent hyperglycemia) may develop orthostatic hypotension, but orthostatic hypotension does not cause hyperglycemia. Hypertension, rather than hypotension, is a risk factor for atherosclerosis because high pressure and turbulent blood flow can cause endothelial dysfunction.

Which conditions should be avoided by an individual with Raynaud disease to prevent vasospastic attacks? Select all that apply. a. Tropical areas b. Cold exposure c. Wearing gloves d. Emotional stress e. Warm water immersion

b. Cold exposure d. Emotional stress Rationale Clients with Raynaud disease experience vasospasm in the small arteries of the fingers during cold exposure or emotional stress. Tropical areas, wearing gloves, and warm water do not trigger vasospasms in Raynaud disease; in fact, gloves and warm water can help manage the symptoms.

Which laboratory result is associated with an increased risk for development of fatty streaks in atherosclerosis? a. Decreased levels of highly sensitive C-reactive proteins b. Increased levels of low-density lipoproteins (LDLs) c. Increased levels of high-density lipoproteins (HDLs) d. Decreased levels of serum fibrinogen levels

b. Increased levels of low-density lipoproteins (LDLs) Rationale High plasma LDL is a risk factor for atherosclerosis. Elevated levels, not decreased levels, of highly sensitive C-reactive proteins and serum fibrinogen are risk factors for atherosclerosis. High plasma HDL levels protect against the development of atherosclerosis.

Which term describes myocardial cells temporarily deprived of blood supply? a. Infarction b. Ischemia c. Dyslipidemia d. Peripheral artery disease

b. Ischemia Rationale Ischemia refers to the local state in which myocardial cells are temporarily deprived of blood supply. They remain alive but cannot function normally. Infarction is caused by persistent ischemia and is irreversible cell damage. Dyslipidemia is the abnormal concentrations of serum lipoproteins. Peripheral artery disease is a disease of the arteries that perfuse the limbs.

Which information about the cause of Prinzmetal angina is correct? a. It is from a deep vein clot. b. It is from a spasm of a heart artery. c. It is from a blood clot in a lung artery. d. It is from low oxygen due to respiratory disease.

b. It is from a spasm of a heart artery. Rationale Prinzmetal angina is a special type of chest pain that occurs transiently at rest, most likely owing to vasospasm of coronary arteries (that is, in simpler terms that the patient used, a spasm of a heart artery). Deep vein thrombosis occurs in the limbs and does not affect coronary artery blood flow. Blood clots in a lung artery cause pulmonary embolism rather than Prinzmetal angina. Respiratory disease does not cause Prinzmetal angina.

What is the primary pathophysiologic response in neurogenic shock? a. Decreased volume b. Massive vasodilation c. Sympathetic overstimulation d. Increased systemic vascular resistance

b. Massive vasodilation Rationale Neurogenic shock (sometimes called vasogenic shock) is the result of widespread and massive vasodilation that results from parasympathetic overstimulation and sympathetic understimulation, not overstimulation. Decreased (not increased) systemic vascular resistance occurs, resulting in "relative hypovolemia." The amount of blood has not changed (so there is not decreased volume), but the space that carries blood has increased.

Which term describes inflammation of the myocardium? a. Carditis b. Myocarditis c. Pericarditis d. Endocarditis

b. Myocarditis Rationale The myocardium is inflamed in myocarditis. Carditis is inflammation of the heart. Pericarditis is inflammation of the pericardium. Endocarditis is inflammation of the endocardium.

Which part of the heart is damaged in cardiomyopathy? a. Pericardium b. Myocardium c. Endocardium d. Interstitium

b. Myocardium Rationale The cardiomyopathies are a diverse group of diseases that primarily affect the myocardium itself. Pericarditis affects the pericardium. Endocarditis affects the endocardium. Interstitium is the area between cells.

Which action is appropriate in the management of hypovolemic shock? a. Prepare to administer antibiotics. b. Prepare to administer blood products. c. Prepare to administer antihypertensives. d. Prepare to administer cholesterol-lowering agents.

b. Prepare to administer blood products. Rationale Management begins with rapid fluid replacement with crystalloids and blood products. Antibiotics can be given in septic shock. Antihypertensives are given for hypertension, not for shock. Cholesterol-lowering agents are given for high cholesterol levels.

Which clinical manifestation is associated with diastolic heart failure? a. Bloody stools b. Pulmonary edema c. Frequent infections d. Elevated ejection fraction

b. Pulmonary edema Rationale Individuals with diastolic dysfunction present with dyspnea on exertion, fatigue, and evidence of pulmonary edema (inspiratory crackles on auscultation, pleural effusions). The ejection fraction is normal in diastolic heart failure. Frequent infections and bloody stools are not associated with diastolic heart failure.

Which goal is important in the management of elevated levels of adipokines? a. Reduce pain b. Reduce weight c. Increase blood pressure d. Increase blood viscosity

b. Reduce weight Rationale Weight loss, exercise, and healthy diet improve adipokine levels. Elevated adipokines increase the risk for coronary artery disease. In coronary artery disease, decreasing blood pressure and blood viscosity (thickness) is helpful. Adipokines are not associated with pain.

Which findings are associated with chronic arterial insufficiency of the lower extremities from thromboangiitis obliterans? a. Swollen, red, and warm leg b. Shiny skin, thick nails, and pain during activity c. Thickened skin, high blood pressure, and no pain d. Normal findings except for dilated, tortuous veins and aching

b. Shiny skin, thick nails, and pain during activity Rationale With chronic arterial insufficiency in an extremity, the limb will be shiny with thick nails, and it will be painful during activity. Extremities that are swollen, reddish, and warm are more likely indications of venous problems. Thickened skin occurs in venous problems; thin skin occurs with arterial problems, as does high blood pressure. Tortuous veins are varicose veins, which can cause aches but are not symptoms of arterial insufficiency.

Which condition causes blood to pool and produces distended, tortuous, and palpable vessels? a. Thrombus b. Varicose veins c. Venous stasis ulcers d. Deep vein thrombosis

b. Varicose veins Rationale A varicose vein is a vein in which blood has pooled, producing distended, tortuous, and palpable vessels. Thrombus is a blood clot that remains attached to a vessel wall. Venous stasis ulcers are caused by cell death and necrosis secondary to trauma or pressure-induced oxygen deficiency. Deep vein thrombosis is a thrombus formation occurring mainly in the lower extremities.

Which statement describes a silent myocardial infarction? a. A heart attack that causes rapid death b. A heart attack that occurs at the same time as a stroke c. A heart attack that occurs without the person experiencing pain d. A heart attack that occurs before the person is able to call for help

c. A heart attack that occurs without the person experiencing pain Rationale A silent myocardial infarction occurs without the person experiencing pain. A silent myocardial infarction is not defined as causing rapid death or stroke. A person with silent myocardial infarction is not aware that he or she needs help because he or she does not experience pain.

Which treatment is effective in the management of chronic venous insufficiency? a. Avoid exercising. b. Keep legs dependent. c. Apply compression stockings. d. Ambulate with tight-fitting shoes.

c. Apply compression stockings. Rationale Treatment of varicose veins and chronic venous insufficiency begins conservatively, and excellent wound healing results have followed noninvasive treatments such as elevating the legs, wearing compression stockings, and performing physical exercise. Any trauma or pressure can lower the oxygen supply and cause cell death and necrosis.

Which intervention can decrease the risk of deep vein thrombosis? a. Place individual on bed rest. b. Monitor individual's blood pressure. c. Apply pneumatic devices. d. Allow individual to sit with legs crossed.

c. Apply pneumatic devices. Rationale Because deep vein thrombosis is usually asymptomatic and difficult to detect clinically, prevention is important in at-risk individuals and includes early ambulation (not bed rest), pneumatic devices, and prophylactic anticoagulation. Monitoring blood pressure will not prevent deep vein thrombosis. Sitting with legs crossed will increase the risk for deep vein thrombosis.

Which statement after a teaching session about arteriosclerosis indicates teaching was effective? a. The plaque is caused by neutrophils. b. Fatty streaks and foam cells are identical. c. Arteriosclerosis involves thickening and hardening of the vessel wall. d. Arteriosclerosis results from an acute process of heart muscle degeneration.

c. Arteriosclerosis involves thickening and hardening of the vessel wall. RationaleArteriosclerosis is characterized by thickening and hardening of the vessel wall. It is caused by the accumulation of lipid-laden macrophages, not neutrophils, within the arterial wall, which leads to the formation of a lesion called plaque. Foam cells are lipid- laden cells that contribute to fatty streaks; but a fatty streak is a macroscopic structure comprising many cells (not only foam cells but also some thrombocytes and lymphocytes). Arteriosclerosis is a chronic degeneration of blood vessel walls and is not an acute process of heart muscle degeneration.

Which infection commonly causes infective endocarditis? a. Viral infection b. Fungal infection c. Bacterial infection d. Autoimmune infection

c. Bacterial infection Rationale Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, and enterococci. Although fungi and viruses can cause infective endocarditis, they are not the most frequent cause. Infective endocarditis is caused by infection with microorganisms, not an autoimmune response.

Which assessment findings are expected in an individual who is being transferred from another medical facility with a diagnosis of acute myocardial infarction (AMI)? Select all that apply. a. Cough b. High fever c. Cool, clammy skin d. Crushing chest pain e. Nausea and vomiting

c. Cool, clammy skin d. Crushing chest pain e. Nausea and vomiting Rationale Acute myocardial infarction may be associated with cool and clammy skin, crushing chest pain, nausea, and vomiting. Cough and high fever are not considered signs of an AMI but occur with infections.

Which statement describes third-degree block? a. Disorder of impulse formation b. Disorder of bacterial infection c. Disorder of impulse conduction d. Disorder of bacterial overgrowth

c. Disorder of impulse conduction Rationale Third-degree block is classified as abnormal conduction within the heart. Disorders of impulse formation include sinus bradycardia, atrial flutter, and ventricular fibrillation. Third-degree block is not classified as a bacterial infection or overgrowth.

Which telemetry finding is seen in atrial fibrillation? a. QRS complex is greater than 300 ms, with an absent P wave. b. The P wave precedes each QRS complex at a rate of 100 to 150 beats/min. c. Disorganized and irregular atrial waves are accompanied by an irregular QRS rhythm. d. P wave is absent or independent of the QRS complex, with a rate of 40 beats/min or lower.

c. Disorganized and irregular atrial waves are accompanied by an irregular QRS rhythm. Rationale Atrial fibrillation is described as disorganized and irregular atrial waves accompanied by an irregular QRS rhythm. Ventricular fibrillation occurs when the QRS complex is greater than 300 ms and the P wave is absent. Rates of 100 to 150 beats/min with QRS for each P is called simple sinus tachycardia. A P wave that is absent or independent of the QRS complex with a rate of 40 beats/min or lower is called junctional bradycardia.

Based on the risk for lower extremity problems, what sign or symptom should be monitored in a cashier at a local grocery store who stands for 8 hours at a time? a. Muscle wasting b. Pale, fragile skin c. Distended, twisted veins d. Postural color changes of the calf

c. Distended, twisted veins RationaleDistended, twisted veins are varicose veins; standing for long periods is a risk factor for varicose veins. Muscle wasting, skin that is pale and fragile, and postural color changes can occur in peripheral artery disease or other arterial problems.

Which piece of equipment is used to detect the primary cause of sudden cardiac death in an individual with hypertrophic obstructive cardiomyopathy? a. Reflex hammer b. Oral thermometer c. Electrocardiogram d. Blood pressure cuff

c. Electrocardiogram Rationale An electrocardiogram can detect ventricular dysrhythmias. This type of hypertrophic cardiomyopathy is a significant risk factor for serious ventricular dysrhythmias and sudden death, and it has been implicated in more than 33% of sudden deaths in young athletes. A reflex hammer detects neurologic problems. An oral thermometer detects hypothermia or hyperthermia. A blood pressure cuff monitors for hypertension or hypotension.

Which term describes inflammation of the internal lining of the cardiac chambers and valves? a. Myocarditis b. Epicarditis c. Endocarditis d. Pericarditis

c. Endocarditis Rationale The internal lining of the cardiac chambers and valves is the endocardium, and its inflammation is called endocarditis. The myocardium is the heart muscle, and its inflammation is called myocarditis. The epicardium is the outer layer of epithelial cells that is part of the pericardium, and its inflammation is called epicarditis. The pericardium is the protective covering around the heart, with inflammation called pericarditis.

Which laboratory result is associated with increased risk of atherosclerosis and coronary artery disease? a. Triglyceride level of 150 mg/dL b. Total cholesterol level of 180 mg/dL c. High-density lipoprotein (HDL) level of 30 mg/dL d. Low-density lipoprotein (LDL) level of 100 mg/dL

c. High-density lipoprotein (HDL) level of 30 mg/dL Rationale Low levels of HDL cholesterol (<40 mg/dL), and high levels of triglycerides (>200 mg/dL) increase the risk of coronary artery disease. LDL, total cholesterol, and triglycerides have low levels in this instance, which would decrease the risk for coronary artery disease.

Which term describes pain with ambulation associated with peripheral artery disease? a. Emboli in leg vessels b. Raynaud phenomenon c. Intermittent claudication d. Traumatic injury

c. Intermittent claudication Rationale In most individuals, gradually increasing obstruction to arterial blood flow to the legs caused by atherosclerosis in the iliofemoral vessels results in pain with ambulation called intermittent claudication. An embolus is a traveling clot (a thrombus that has moved through the circulation). Raynaud phenomenon is attacks of vasospasms in the fingers from a systemic disease. Peripheral artery disease is not a traumatic injury.

Which chamber of the heart should be monitored closely with aortic stenosis? a. Left atrium b. Right atrium c. Left ventricle d. Right ventricle

c. Left ventricle Rationale The orifice of the aortic valve narrows, causing resistance to blood flow from the left ventricle into the aorta. Aortic stenosis can cause incomplete emptying of the left ventricle. Blood does not pump directly from the left atrium, right atrium, or right ventricle through the aortic valve.

Which valvular abnormality is associated with a loud holosystolic murmur that radiates to the back and axilla? a. Mitral stenosis b. Aortic stenosis c. Mitral regurgitation d. Aortic regurgitation

c. Mitral regurgitation Rationale Mitral regurgitation permits backflow of blood from the left ventricle into the left atrium during ventricular systole, producing a holosystolic (throughout systole) murmur heard best at the apex, which radiates into the back and axilla. Mitral stenosis has a rumbling-decrescendo diastolic murmur. Aortic stenosis has a crescendo- decrescendo systolic murmur. Aortic regurgitation is associated with a Corrigan pulse with a decrescendo diastolic murmur.

Which statement indicates understanding of cardiac tamponade? a. This is when the venous return is too low to fill the heart. b. This is when pericardial isoenzymes cause pericardial pain and hypotension. c. This is when the heart is compressed externally and is unable to fill adequately. d. This is when a myocardial infarction causes death of most of the left ventricle wall.

c. This is when the heart is compressed externally and is unable to fill adequately. RationaleCardiac tamponade occurs when the heart is compressed externally to the extent that it is unable to fill adequately. Cardiac tamponade does not occur from a low venous return or from pericardial isoenzymes. Cardiac tamponade does not involve death of most of the left ventricle wall.

Which statement describes the pathophysiologic effect of ventricular fibrillation? a. This rhythm causes premature contractions. b. This rhythm creates a heart block of the atria. c. This rhythm results in no cardiac output from the heart. d. This rhythm is a serious problem but is not life threatening.

c. This rhythm results in no cardiac output from the heart. Rationale In ventricular fibrillation, there is no cardiac output. It does not involve premature contractions. Ventricular fibrillation is not a heart block. Ventricular fibrillation is life threatening.

Which information should be included when teaching about a percutaneous coronary intervention (PCI)? a. A laser will be used to fix a heart vessel. b. A vein from the leg will be placed in the heart. c. A medication will be injected into the heart chamber. d. A narrow coronary vessel will be opened up with a catheter.

d. A narrow coronary vessel will be opened up with a catheter. Rationale PCI is a procedure in which stenotic (narrowed) coronary vessels are dilated with a catheter. No laser or injection of medication into the heart chambers is used in PCI. Severe coronary artery disease can be surgically treated by a coronary artery bypass graft, usually using the saphenous vein from the lower leg.

Which condition may be associated with a 6-year-old who presents with polyarthritis and murmur with the parents reporting no medical history except for a sore throat 4 weeks ago? a. Lyme disease b. Reiter syndrome c. Rheumatoid arthritis d. Acute rheumatic fever

d. Acute rheumatic fever Rationale This child most likely has acute rheumatic fever. It most commonly affects those 5 to 15 years old. It is an inflammatory disease that follows group A beta-hemolytic streptococcal pharyngeal infection. The incubation period is 1 to 5 weeks. Arthritis with Lyme disease from a tick bite can occur, but generally it affects the knee and a large effusion is present. Reiter syndrome is generally found after an infection of the gastrointestinal tract. Rheumatoid arthritis commonly affects women, with a peak incidence in the fourth to sixth decade of life

Which individual is at greatest risk for a pulmonary embolism? a. A woman with varicose veins b. A man with atherosclerosis c. A young adult with Raynaud disease d. An elderly client with deep vein thrombosis

d. An elderly client with deep vein thrombosis Rationale Emboli that arise from a thrombus in the deep veins of the lower extremities are most likely to lodge in the pulmonary circulation (pulmonary embolism). Varicose veins are a disorder of superficial veins, and a thrombus in these veins is not likely to embolize to the pulmonary circulation. Atherosclerosis is an arterial disease, and emboli that arise in arteries may lodge in peripheral capillary beds, coronary arteries, or cerebral vasculature rather than in the lungs. Raynaud disease is vasospastic attacks of small arteries and arterioles of the fingers.

Which type of shock may develop after eating peanuts? a. Septic b. Neurogenic c. Cardiogenic d. Anaphylactic

d. Anaphylactic Rationale Anaphylactic shock begins with exposure of a sensitized individual to an allergen. Common allergens known to cause these reactions are insect venoms, shellfish, peanuts, latex, and medications such as penicillin. Septic shock begins with an infection that progresses to bacteremia; it is not from eating peanuts. Trauma to the spinal cord or medulla and conditions that interrupt the supply of oxygen or glucose to the medulla can cause neurogenic shock by interrupting sympathetic activity. Cardiogenic shock is defined as decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume.

Which laboratory result indicates the severity of the disease in left heart failure? a. Bleeding time b. Platelet count c. White blood cell count d. Brain natriuretic peptide

d. Brain natriuretic peptide Rationale The level of serum brain natriuretic peptide can help make the diagnosis of heart failure and give some insight into its severity. Bleeding time and platelet count help with clotting problems, not with left heart failure. White blood cell count helps with infections, not with left heart failure.

Which information from an individual about hypertension indicates effective teaching? a. Low weight contributes to high blood pressure. b. Diagnosis can be made with one elevated reading. c. Hypertension is defined as systolic pressure greater than 160 mm Hg. d. Hypertension is the most common primary diagnosis in the United States.

d. Hypertension is the most common primary diagnosis in the United States. RationaleHypertension is the most common primary diagnosis in the United States. Obesity (not low weight), elevated sodium intake, age, ethnicity, and family history are all correlated with high blood pressure. The diagnosis of hypertension requires the recording on two separate occasions of these elevations. The definition of high blood pressure is a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg, or both.

Which type of shock is associated with uncontrolled massive bleeding? a. Septic b. Neurogenic c. Cardiogenic d. Hypovolemic

d. Hypovolemic Rationale Hypovolemic (low-volume) shock occurs in the presence of massive blood loss when the amount of blood available for circulation decreases. Septic shock commonly is associated with gram-negative infections. Causes of neurogenic shock include brain trauma that results in depression of the vasomotor center, spinal cord injury, high spinal anesthesia, and drug overdose. Cardiogenic shock is usually a result of severe ventricular dysfunction associated with myocardial infarction or heart failure.

Which type of shock is associated with a decrease in blood volume due to hemorrhage from a wound? a. Septic b. Vasogenic c. Anaphylactic d. Hypovolemic

d. Hypovolemic Rationale Hypovolemic shock results from a decrease in blood volume due to hemorrhage. Septic shock is due to infection. Vasogenic shock results from an increase in parasympathetic nervous stimulation and a decrease in sympathetic nervous stimulation, usually from spinal cord or medulla trauma. Anaphylactic shock is a hypersensitivity usually caused by penicillin, latex, and food allergies.

Which condition is associated with endocardial inflammation caused by Staphylococcus aureus? a. Cardiomyopathy b. Pericardial effusion c. Chronic pericarditis d. Infective endocarditis

d. Infective endocarditis Rationale Infective endocarditis is caused by an infection of Staphylococcus aureus that causes inflammation of the endocardium, especially the cardiac valves. Cardiomyopathy is a disease of the myocardium. Pericardial effusion is an accumulation of fluid in the pericardium. Chronic pericarditis is most commonly caused by radioactive exposure, rheumatoid arthritis, or uremia.

Which area is likely to be involved in chronic venous insufficiency? a. Head b. Trunk c. Nervous system d. Lower extremities

d. Lower extremities RationaleThe lower extremities are likely involved in chronic venous insufficiency. Symptoms of chronic venous insufficiency include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. The nervous system may be involved in stroke. The head and trunk are not as affected as the lower extremities.

Which term describes severe shock with failure of the urinary, cardiac, and respiratory systems? a. Hypertension b. Acute pericarditis c. Aortic regurgitation d. Multiple organ dysfunction syndrome

d. Multiple organ dysfunction syndrome RationaleThe term multiple organ dysfunction syndrome (MODS) describes the failure of two or more organ systems after severe illness and injury and is a frequent complication of severe shock. Hypertension is consistent elevation of systemic arterial blood pressure; shock produces hypotension. Acute pericarditis is acute inflammation of the pericardium. Aortic regurgitation results from an inability of the aortic valve leaflets to close properly during diastole because of abnormalities of the leaflets, the aortic root and annulus, or both.

Which manifestation describes the erythema marginatum associated with rheumatic fever? a. Sudden, aimless, irregular, involuntary movements b. Migratory polyarthritis, especially in the large joints c. Palpable subcutaneous nodules over bony prominences d. Nonpruritic, pink macules on the trunk but not on the face or hands

d. Nonpruritic, pink macules on the trunk but not on the face or hands Rationale Erythema marginatum is nonpruritic, pink, erythematous macules on the trunk that do not occur on the face or hands. Chorea is the sudden, aimless, irregular, involuntary movements that can occur in rheumatic fever. Migratory polyarthritis, especially of the large joints, can occur in rheumatic fever. Subcutaneous nodules that are palpable over bony prominences can occur with rheumatic fever.

Which clinical manifestation is associated with deep vein thrombosis (DVT) in the lower leg? a. Muscle paralysis b. Reduced pulses in the foot c. Skin pallor near the thrombus d. Pain and edema in the affected limb

d. Pain and edema in the affected limb Rationale Pain and edema from blocked venous return and inflammation are the hallmark signs of DVT. A DVT does not affect neuromuscular function (paralysis), although pain may make the limb difficult to move. A DVT will reduce venous return; pulses are felt in arteries, so pulses are not reduced. Pallor is associated with arterial disease.

Which infection is associated with acute rheumatic fever? a. Fungal lung infection b. Staphylococcus skin infection c. Intestinal enterococci infection d. Pharyngeal group A beta-hemolytic streptococcus infection

d. Pharyngeal group A beta-hemolytic streptococcus infection Rationale Acute rheumatic fever can develop as a sequel to pharyngeal infection by group A beta- hemolytic streptococci. Bacteria are the most common cause of infective endocarditis, especially streptococci, staphylococci, and enterococci. A fungus can lead to infective endocarditis but not to acute rheumatic fever.

Which condition is associated with chest pain that occurs at rest and abnormal vasospasm of the coronary arteries? a. Stable angina b. Silent ischemia c. Angina pectoris d. Prinzmetal angina

d. Prinzmetal angina Rationale Prinzmetal angina is an abnormal vasospasm of the coronary vessels. It typically produces pain at rest. Stable angina occurs with activity and is often limited and resolves with rest. Silent ischemia is occlusion of the coronary arteries without pain. Angina pectoris is chest pain, usually substernal chest discomfort, and includes stable and unstable angina variants.

Which condition is associated with the development of valvular stenosis or valvular regurgitation of the mitral or aortic valves? a. Heart failure b. Syphilis infection c. Myocardial infarction d. Rheumatic heart disease

d. Rheumatic heart disease Rationale Inflammatory damage from rheumatic heart disease can cause either valvular stenosis, through scarring, or valvular regurgitation, through leaflet stretching. Heart failure is a consequence, not a cause, of valvular disease. Syphilis infection is associated primarily with aortic regurgitation. Myocardial infarction does not lead to valvular stenosis or regurgitation.

Which type of hypertension is caused by renal disease? a. Primary b. Idiopathic c. Orthostatic d. Secondary

d. Secondary Rationale Secondary hypertension is caused by an underlying disorder such as renal disease. Primary hypertension, also called idiopathic hypertension, does not have a specific detectable cause. Orthostatic hypotension (not hypertension) is a condition in which blood pressure drops noticeably when one rises to a standing position.

Which values for total cholesterol level, high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level are elevated? a. Total cholesterol level of 40 mg/dL, HDL of 200 mg/dL, and LDL of 160 mg/dL b. Total cholesterol level of 90 mg/dL, HDL of 160 mg/dL, and LDL of 200 mg/dL c. Total cholesterol level of 200 mg/dL, HDL of 160 mg/dL, and LDL of 40 mg/dL d. Total cholesterol level of 250 mg/dL, HDL of 65 mg/dL, and LDL of 165 mg/dL

d. Total cholesterol level of 250 mg/dL, HDL of 65 mg/dL, and LDL of 165 mg/dL RationaleHigh values for cholesterol levels are as follows: total cholesterol level over 240 mg/dL, HDL level over 60 mg/dL, and LDL level over 160 mg/dL. The other values are either too high or too low. In addition, the options in which the sum of the HDL and LDL values far exceeds the total cholesterol value are not realistic because the total includes both HDL and LDL (as well as very low-density lipoproteins).

Which result is a sign of systemic inflammatory response syndrome (SIRS)? a. Temperature, 37° C b. Respiratory rate, 16 breaths/min c. Heart rate less than 70 beats/min d. White blood cell count greater than 12,000 cells/mm 3

d. White blood cell count greater than 12,000 cells/mm 3 Rationale Criteria for SIRS include the following: white blood cell count greater than 12,000 cells/mm 3, less than 4000 cells/mm 3, or containing less than 10% immature forms (bands); temperature greater than 38° C (not 37° C); respiratory rate greater than 20 breaths/min (not 16 breaths/min); heart rate greater than 90 beats/min (not less than 70 beats/min); or arterial blood carbon dioxide level less than 32 mm Hg.