Chapter 11-Cardiovascular Problems
Ted, age 18, is to have a cardiac screening examination to determine if he can play college basketball. The diagnostic test of choice for detecting hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy is a(n): A. Echocardiogram. B. Electrocardiogram. C. Arteriogram. D. Stress test.
A
The cardinal sign of right-sided heart failure in infants and children is A. hepatomegaly. B. edema of the lower extremities. C. tachypnea. D. cyanosis.
A
The classic 12-lead EKG change that indicates an acute coronary syndrome is A. ST-segment elevation B. T-wave inversion C. flipped P waves with a prolonged PR interval D. deep Q waves
A
A client presents with substernal chest pain that is provoked by exertion and relieved by rest and nitroglycerin. What do you suspect? A. stable angina B. unstable angina C. acute coronary syndrome (ACS) D. simple overexertion
A
Deep vein thrombosis (DVT) may result in A. generalized edema of the involved extremity B. atrophy of leg muscles C. loss of sensation in the affected extremity D. the release of fat emboli
A
Discriminating between symptoms of occlusive arterial disease and other disorders (such as musculoskeletal or neurological disorders) requires a careful history. Which symptom is noted with occlusive arterial disease? A. pain occurring in the calves or thighs when walking, with relief obtained when standing still B. pain when standing that is not relieved by sitting or lying down C. severe pain at rest that requires the client to raise the legs in the air to obtain relief D. redness and pronounced superficial veins
A
Greg, age 68, has just been given a diagnosis of CHF. Which of his medications should be discontinued? A. Nifedipine (Procardia XL) for long-term management of his chronic stable angina B. HCTZ for his HTN C. Enalapril (Vasotec) for his HTN D. Butalbital (Esgic) for his headaches
A
Jeremiah has been on lipid-lowering therapy (statins) for 2 years. He is new to your practice. He says, "I haven't had my liver function tests (LFTs) in a while to check if my cholesterol medication is causing a problem." What do you tell him? A. "You've been tolerating the medication well. We no longer need to monitor this." B. "Oh yes, we check liver function tests every 6 months when you're on statins." C. "We'll order LFTs prior to your next visit." D. "We better stop your medication until we get the results."
A
Jessica is pregnant and is being seen for the first time. She states that her BP has been high for a long time, but she never wanted to take medication for it. Today her BP is 172/98, lungs are clear, and she has no pedal or ankle edema. What medication would you most likely order? A. Methyldopa B. Atenolol C. Nifedipine D. Clonidine
A
Larry, age 66, is a smoker with hypertension and hyperlipidemia. He is 6 months post MI. To prevent reinfarction, the most important behavior change that he can make is to A. quit smoking. B. maintain aggressive hypertension therapy. C. stick to a low-fat, low-sodium diet. D. continue with his exercise program.
A
MVP is characterized by A. elongation of the chordae tendineae and enlarged valve leaflets B. ballooning (prolapse) of the cusps into the ventricle during diastole C. an early diastolic murmur D. an early systolic murmur
A
Pharmacological therapy for mitral valve disease in adults includes A. treatment of dyspnea with diuretics to relieve congestion B. reduction of fast ventricular rates with beta blockers or calcium channel blockers C. preload reduction with antihypertensive agents to decrease regurgitant flow D. daily antibiotic use to ward off bacterial infections
A
Sarah, who is postmenopausal, has controlled asthma, hypertension being effectively treated with medication, and smokes cigarettes. She has a low-density lipoprotein (LDL) cholesterol level of 170 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 40 mg/dL. To reduce Sarah ' s risk of a coronary event, the treatment plan would focus on A. lowering her LDL cholesterol level. B. lowering her HDL cholesterol level. C. aggressively treating and controlling her hypertension and asthma. D. getting Sarah to stop smoking.
A
Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you begin your exam, you know that it A. may present with only complaints of coldness or paresthesia of the extremity B. may present as the only disease C. always occurs in the lower extremities D. will result in an extremity that appears "blue"
A
Sexual activity is a major concern for clients with chronic ischemic heart disease. Which statement is true? A. the sexual partner should be included in the education process B. the physical stress of sexual intercourse is equivalent to running a half mile C. antianginal medication taken just after sexual activity can help prevent symptoms D. sexual activity should be attempted only in the morning when the client is well rested
A
Shirley, age 58, has been a diabetic for 7 years. Her BP is normal. Other than her diabetes meds, what would you prescribe today during her routine office visit? A. ACEI B. CCB C. BB D. no HTN med
A
Which of the following findings is suggestive of renovascular hypertension? A. bilateral flank pain on percussion B. renal arterial bruits in the abdomen, flanks, or back C. a palpable mass in the right lower quadrant D. decreased urine output
B
To determine the presence of target organ damage (TOD) and other risk factors in the client with HTN, basic diagnostic tests that should be ordered include A. CXR, EKG, UA, CBC, Chem, lipids, and TSH B. renal arteriogram C. plasma renin activity and 24-hour urine sodium D. echocardiogram
A
What is a common funduscopic change associated with HTN? A. optic disc swelling B. gray lesions C. deep intraretinal hemorrhages D. a cup-disc ratio greater than 1 to 2
A
When a client is getting ready for a cardiac catheterization, which question is essential to ask? A. "Are you allergic to shellfish?" B. "Have you ever had a catheterization before?" C. "Have you completed an advanced directive?" D. "What current medications are you on?"
A
When performing a cardiac assessment, where is the most essential site for assessing edema? A. dependent areas B. periorbital areas C. upper extremities D. cerebral edema
A
Which classification of antihypertensive drugs is the most effective for treating HTN in African American clients and older adults? A. diuretics B. ACEIs C. BBs D. alpha-adrenergic blockers
A
Which is the most common symptom of digitalis toxicity? A. nausea and vomiting B. tingling of the extremities C. rash D. headache
A
Which of the following conditions would warrant bacterial endocarditis prophylaxis? A. prosthetic heart valves B. surgical repair of atrial septal defect C. MVP without significant mitral regurgitation D. cardiac pacemakers
A
Which of the following drugs should be considered as first-line therapy for a client with HTN and HF? A. Enalapril B. Diltiazem C. Atenolol D. Metoprolol
A
Which of the following statements is true about HTN during pregnancy? A. Methyldopa (Aldomet) is the drug of first choice for control of mild to mod HTN in pregnancy B. BBs are safe during pregnancy C. ACEIs (I and II) are safe during all trimesters D. BBs are safe only in the first trimester of pregnancy
A
Which of the following statements is true concerning auscultation of the typical murmur associated with aortic stenosis? A. it is a harsh, crescendo-decrescendo ejection type that often radiates to the carotid arteries B. it is a diastolic murmur C. it is best heard at the apex of the heart D. the loudness of the murmur reflects the severity of the lesion
A
Which of the following statements is true of auscultation of the aortic valve? A. it is best performed using the diaphragm of the stethoscope B. it is best heard at the second left intercostal space C. auscultation need only be done at one site D. it is best performed using the bell of the stethoscope
A
Which of the following statements is true of mitral regurgitation? A. it may be noted as a holosystolic mumur B. it is caused by stiff, noncompliant leaflets that limit flow from the left atrium to the left ventricle C. it occurs only as the result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps D. it results in a prolonged PR interval on EKG
A
Which resuscitation recommendation was made by the American Heart Association to improve survival rates in clients with a return of spontaneous circulation (ROSC) following a cardiac arrest? A. Hypothermia B. Hyperthermia C. Initiation of intravenous lidocaine D. A rebreathing mask
A
You are starting Jill, age 61, on a statin as she had a stroke recently as well as having PVD. Which is your drug of choice? A. Atorvastatin B. Pravastatin C. Lovastatin D. Simvastatin
A
Which of the following is usually the earliest sign or symptom of chronic occlusive arterial disease in the extremities? A. loss of hair over the lower extremity B. intermittent claudication C. painful ulcerations of the toes of the affected extremity D. muscle atrophy
B
Which of the following usually indicates hyperlipidemia in an adult? A. Lipoma B. Xanthelasma C. Jaundiced skin D. Multiple actinic keratoses
B
While much teaching is needed for your client with congestive heart failure, the most beneficial thing you can tell him that might prevent rehospitalization may be: A. "Be sure to use two pillows at night." B. "Weigh yourself every day, and if your weight increases by 3 pounds in 24 hrs or 5 pounds in one week, call me." C. "Take your pulse daily; if it increases by six beats, call me." D. "Let me know if you're sleeping more than 10 hours a day and feel depressed."
B
Characteristics of ischemic arterial ulcers include A. an irregularly shaped border with crusting or scaling at the edges B. severe pain C. a location anywhere on the leg D. a moist ulcer base with ill-defined borders
B
Charles has chronic ischemic heart disease and is taking a beta blocker, which results in A. an increase in high-density lipoprotein cholesterol. B. a reduced heart rate. C. a decreased diastolic filling time. D. an increase in oxygen demand.
B
Clinical findings associated with aortic regurgitation include A. pulsus paradoxus B. waterhammer pulses C. pulsus alternans D. weak, thready pulses
B
During pregnancy, many women develop which cardiovascular change? A. diastolic murmur B. HTN C. bradycardia D. systolic murmur
B
Headache, flushing, tachycardia, and peripheral edema are adverse effects associated with which class of antihypertensive agents? A. BBs B. CCBs C. ACEIs D. diuretics
B
Impaired blood flow to the extremities is caused by which of the following common disorders? A. Raynaud's disease B. Peripheral vascular disease C. Polycythemia D. Buerger's disease
B
Janice, age 64, arrives at the office this morning without an appt. She appears quite anxious and pale and is complaining of an intermittent aching across her sternum and into her jaw and left arm that started about an hour ago and woke her out of a sound sleep. She took an antacid and acetaminophen, but they did not seem to help. Her BP is 160/90, and heart rate is 98. An EKG shows normal sinus rhythm with 2-mm ST segment elevations in leads II, III, and AVF. What do you suspect? A. An acute anterior wall MI B. An acute inferior wall MI C. severe gastrointestinal reflux D. an anxiety attack
B
Martin, age 56, has HTN and has been taking anti-HTN medication for about 10 years. He has been very stable. You have not seen him in about 6 months. His exam today should specifically A. include only a BP measurement with the client seated comfortably B. include a funduscopic exam C. be a focused exam limited to the respiratory and cardio systems D. include a discussion of weaning him off his medication
B
Marvin, age 56, is a smoker with diabetes mellitus. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? A. Angiotensin-converting enzyme (ACE) inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics
B
Mary, age 50, has cardiovascular disease but has an LDL cholesterol level of less than 100. She is slightly overweight. What is crucial to do for her today? A. stress the need for her to begin therapeutic lifestyle changes B. begin her a on a statin C. do an angiogram to see if there is any further cardiovascular damage D. do a stress test to determine if she can begin an exercise program
B
Nathan, age 63, comes for his annual physical. He has a history of mild hypertension and hyperlipidemia that he has not been successful in treating by diet and weight loss. His only complaint is a problem with impotence. On physical examination, you note a palpable, pulsatile abdominal mass in the umbilical region; a bruit above the umbilical region; and diminished femoral pulses. You suspect: A. Renal artery stenosis. B. An abdominal aortic aneurysm. C. A cardiac tumor. D. A thoracic aortic aneurysm.
B
Sam, age 70, originally had symptoms of syncope and then symptomatic ventricular tachycardia with aborted sudden death. He is now treated pharmacologically. He asks you when he can resume driving. How do you respond? A. "You may drive again in 1 month" B. "You should not drive again for 6 months" C. "As this may recur, let's wait until you're free of any symptoms for 1 year" D. "You probably shouldn't drive anymore"
B
Signs of right-sided heart failure include A. a low cardiac output B. indications of fluid retention C. dyspnea D. elevated pulmonary venous pressure
B
The leading cause of death in women in the United States is A. trauma B. cardiovascular disease C. diabetes D. cancer
B
What is the most important question to ask when a client presents with chest pain? A. "What were you doing at the time of onset of chest pain?" B. "What was the time of the onset of pain?" C. "Are you a smoker?" D. "When was the last time you had blood work done?"
B
What is the recommendation when treating high triglycerides over 190? A. aggressively treat with fenofibrates B. treatment should be with a statin C. focus on lifestyle changes as initial therapy D. use a bile acid sequestrant
B
When auscultating an adult client's heart, you note a short, high-frequency click (opening snap) after S2 during the beginning of diastole. What could this indicate? A. aortic regurgitation B. mitral stenosis C. mitral regurgitation D. nothing, this is normal
B
Which of the following causes coronary valve leaflets to billow into the atrium during ventricular systole and runs in families? A. mitral regurgitation B. MVP C. aortic regurgitation D. aortic stenosis
B
Which of the following conditions is more common in women, and therefore aggressive teaching needs to be done at every visit? A. MI B. angina pectoris C. myocardial ischemia D. TIAs
B
Which of the following conditions or medications can increase triglycerides? A. biliary obstruction B. glucocorticoids C. pregnancy D. diuretics
B
You are managing a client with CHF. The client is presently on Carvedilol 12.5 mg PO bid, Lisinopril 2.5 mg PO daily, Lasix 80 mg PO daily, and spironolactone (Aldactone) 25 mg PO daily. He is in to see you for a 2 week follow-up and shares he has gained 7 lb in the last week. He shares he has been faithful to his fluid and dietary restrictions and that his urinary output is somewhat less than it has been. What medication could you add to optimize the response to the loop diuretic? A. Bumex B. Metolazone C. Demadex D. Diamox
B
A newly discharged outpatient surgery client, age 65, presents with insidious onset of edema and dusky blue discoloration of the head and upper extremities. You know it is a medical emergency and suspect which of the following? A. evolving cerebral infarction B. impending MI C. superior vena cava syndrome D. temporal arteritis
C
An active 68-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes in, you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to: A. defer any further dental work until his valve replacement is completed. B. instruct the client to have dental extraction done cautiously, having no more than two teeth per visit removed. C. suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis. D. coordinate with his cardiac and oral surgeons to have the tooth extraction and valve replacement done at the same time to reduce the risk of anesthetic complications.
C
Bob is being seen in the office, and you suspect an acute ischemic syndrome and an acute MI. Which would be the last step that you would consider? A. Prompt admission to a monitored bed with cardiology consultation B. Initiation of ASA, IV heparin, and anti-ischemic therapy with nitrates or BBs C. Measurement of serum lipid levels to determine risk factors of hyperlipidemia D. Evaluation for possible angiography with rescue percutaneous transluminal coronary angioplasty or thrombolytic therapy
C
Clients with Prinzmetal's angina frequently have a history of Raynaud's disease and which other disorder? A. syncope B. insomnia C. migraine headaches D. leg cramps
C
Cough, loss of taste, and rash are adverse effects associated with which class of antihypertensive agents? A. Diuretics B. Beta blockers C. ACE inhibitors D. Calcium channel blockers
C
Dana has ischemic arterial ulcers. What is your first priority when counseling her? A. Tell her that increasing coffee intake will stimulate heart rate and circulation. B. Tell her to decrease water intake slightly to improve blood viscosity. C. Tell her to reduce risk factors to improve tissue perfusion. D. Tell her to begin an intense aerobic program.
C
During a cardiovascular assessment, why is it important to note funduscopic changes? A. You may pick up beginning cataracts in this age group B. You should note any glaucoma because some medications will be contraindicated C. Changes may suggest the possibility of target organ involvement D. You may be able to pick up arcus senilis
C
For the routine management of HF, which one of the following medication classes would NOT be recommended? A. ACEI B. BB C. CCB D. diuretic
C
George, a 59-year-old African American man, has just been diagnosed with HTN. Which of the following classifications of medications would you start him on? A. ACEI with a thiazide-type diuretic B. ARB with a thiazide C. CCB with a thiazide D. BB with a thiazide
C
Individuals with clinical evidence of chronic ischemic heart disease (abnormal EKG, chest pain syndrome, unusual dyspnea, or fatigue) should have a full eval done to evaluate their risk for MI or sudden death. When initially collecting data for this risk stratification, which would be the last step to be considered, if at all? A. careful history and physical exam B. exercise stress testing with or without nuclide imaging C. cardiac cath D. CXR
C
Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Her EKG shows some changes. Your next action would be to A. start ASA therapy and schedule an exercise stress test at the client's convenience B. initiate lipid-lowering agents C. hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate D. prescribe a Holter monitor and start her on a beta blocker
C
Jim, age 72, has a history of DM II that has been controlled by diet. He has come for a routine exam and reports feeling more tired than usual. On his EKG, you notice Q waves in leads II and III, and he is in Afib that was not present on his EKGs. What do you do? A. Immediately hospitalize Jim, order a cardiology consultation, start IV administration of an anticoagulant and nitrates, and run serial cardiac enzyme tests B. Do nothing because you know the normal progression of DM II in older adults includes changes in their EKG as a result of neuropathy involving the transmission of electrical impulses C. Initiate ASA therapy and refer Jim to a cardiologist for eval of occult ischemic heart disease and left ventricular function ASAP D. Initiate lipid-lowering therapy because Jim may have had an acute MI
C
Management of the client with HTN with an AAA would include A. CT scan without contrast B. changing the client's BP meds C. referral to a cardiologist D. immediate cardiac cath
C
Margie, age 45, comes into your office as a new patient and says that she has been on nicotinic acid to treat her serum hyperlipidemia for years. What do you tell her? A. "There has been no evidence to show that this works. Let's change you to a statin." B. "Boy, your old provider is antiquated." C. "If you've been on it for years, and it's working, let's just keep monitoring your levels." D. "Let's eliminate the nicotinic acid for a few months to determine your baseline cholesterol levels."
C
Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue over the past 6 months. She has been trying to lose weight, has been on a walking exercise program for over a year, and had taken the fenfluramine-phentermine (Fen-Phen) combination many years ago but stopped when its adverse effects were reported. Your exam reveals a grade II/VI systolic murmur along the apex. What do you do? A. Obtain pulmonary function tests B. Instruct the client about other exercise activities that may not produce her symptoms C. Refer the client to a cardiologist for an echocardiogram and cardiovascular workup D. Start endocarditis prophylaxis
C
Mort is hypertensive, and you need to add a second HTN agent to his medication regimen. Which of the following factors influence your choice of using an alpha blocker as the second antihypertensive medication? A. Mort is African American B. he also has CHF C. he has BPH D. he has frequent migraine headaches
C
Mr. Michaels has a long-standing cardiac problem. His electrocardiogram rhythm strip is shown below. Which medication should he be taking to prevent a pulmonary or cerebral problem? (AFIB RHYTHM) A. An ACE inhibitor such as enalapril (Vasotec) B. An antiarrhythmic agent such as procainamide (Procan-SR) C. An anticoagulant such as warfarin, dabigatran, apixaban, or rivaroxaban D. An anticonvulsant such as phenytoin (Dilantin)
C
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S 3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. What do you suspect? A. Asthma B. Nocturnal allergies C. Heart failure D. Valvular disease
C
Terry, a 42 year old black man who just moved into the area, comes into the clinic for a new client visit. He brings his medical records from his previous healthcare provider; the records show a BP of 140/104 mm Hg on two separate occasions. Recent lab tests (CBC, Chem, UA, and TSH) are normal. A recent EKG shows normal sinus rhythm with left ventricular hypertrophy. He denies any medical problems and tells you he has never been diagnosed with HTN. He is not taking any medications, does not smoke, and drinks about 2 beers per day. He is currently unemployed. His BP today is 150/110 mm Hg. Your next step would be to A. obtain plasma and urine catecholamine measurements B. have him keep a food diary for 1 week and then return for a repeat blood pressure reading C. begin drug therapy with chlorthalidone 25 mg D. start him on metoprolol 100 mg twice a day
C
To reduce the incidence of coronary events in an individual without coronary artery disease who has two or more risk factors, the goal serum low-density lipoprotein cholesterol level should be A. 170 to 190 B. 150 to 170 C. 130 to 150 D. less than 130
C
When indicated, which procedures need endocarditis prophylaxis? A. vaginal or cesarean deliveries B. insertion or removal of IUDs C. dental procedures or extractions D. body piercings
C
When teaching a client with hypertension about restricting dietary sodium, you would include which of the following instructions? A. Sodium restriction can cause serious adverse effects B. Diets with markedly reduced intake of sodium may be associated with other beneficial effects beyond blood pressure control C. 75% of sodium intake is derived from processed food D. A goal of 3g of Na or 1.2g of sodium per day is easily achievable
C
When teaching your client with a new diagnosis of aortic stenosis, which of the following statements made by him leads you to believe he needs more teaching? A. "I no longer need antibiotic prophylaxis to prevent endocarditis prior to dental work." B. "You told me I still need aggressive treatment of my HTN." C. "I'll continue the use of diuretics and nitrates that my previous doctor gave me." D. "I'll have a yearly Doppler echocardiography to evaluate the progression of the valve lesion."
C
Which drug may be used to convert a fib to sinus rhythm? A. digitalis B. lidocaine C. amiodarone (Cordarone) D. adenosine (Adenocard)
C
Which drugs are used to lower BP in a client with coexisting BPH? A. BBs B. ACEIs C. alpha-adrenergic blockers D. CCBs
C
Which of the following cardiac tests is used to identify intermittent ectopy and match symptoms with underlying rhythms and should be used if the interval between symptom occurrence is greater than 48 hours? A. a 12-lead EKG B. holter monitor C. event monitor D. echo
C
Which of the following is the most important preventable cause of premature death in women? A. HTN B. obesity C. cigarette smoking D. alcoholism
C
Which of the following statements about hypertension is true? A. It is frequently caused by pheochromocytoma B. It is usually the result of an underlying, correctable problem C. The cause is unknown in approximately 95% of cases D. It has a higher incidence among adult white men than any other group
C
Which resuscitation recommendation made by the American Heart Association has the highest priority? A. timed delivery of an epi bolus B. rapid provision of advanced airway mgmt C. high quality, uninterrupted chest compressions D. early electrical therapy
C
An anterior wall MI most likely occurs from occlusion of the A. left circumflex artery B. left main artery C. right coronary artery D. left anterior descending artery
D
Before counseling partners about sexual activity following a myocardial infarction, the provider should consider what factor(s)? A. Most clients do not want to know how their condition affects their sex life. B. Spouses are knowledgeable about their partner's condition; therefore, they do not need counseling. C. Most clients return to the same frequency of sexual intercourse after they have regained their physical strength. D. Depression, loss of interest, spousal reluctance, and anxiety may interfere with a client's resumption of sexual activities.
D
Harry has been on HTN therapy with a single agent for 1 month. His readings are still too high. What do you tell him? A. "Let's give it a 3-month trial. If your BP is still too high after that, we'll make some changes." B. "You must continue to follow the DASH diet, which will make a difference." C. "You must exercise for at least 30 minutes on most days of the week." D. "We must increase the dosage of that drug now or add a second drug."
D
Harry, age 54, comes to your office with waxing and waning ischemic symptoms over a period of days and weeks, an increase in angina while at rest, and transient ST changes on his EKG. This presentation leads you to believe that he is experiencing A. a brain attack (stroke, CVA) B. a myocardial infarction C. stable angina D. unstable angina
D
In the JNC 8 guidelines, in healthy patients ages 60 or older, what is the goal BP level? A. less than 120/80 B. less than 130/80 C. less than 140/90 D. less than 150/90
D
JNC 8 recommends four classifications of HTN drugs to be used for initial therapy of adult HTN. Which one of the following classifications is NOT recommended to begin therapy with? A. Thiazide-type diuretic B. CCB C. Angiotensin-converting enzyme inhibitor D. Beta blocker
D
Josie is 78. She has no existing problems and is wondering what her systolic BP should be. You tell her that it should be A. less than 120 B. less than 130 C. less than 140 D. less than 150
D
Many clients with MVP exhibit A. a slow heart rate B. somnolence C. a lengthened PR interval on EKG D. fatigue
D
Murmurs are graded according to their intensity (loudness). A murmur that is audible with the stethoscope off the chest is a A. grade III murmur. B. grade IV murmur. C. grade V murmur. D. grade VI murmur.
D
Pathological U waves on the electrocardiogram are most commonly associated with which disorder? A. Hypercalcemia B. Hypocalcemia C. Hyperkalemia D. Hypokalemia
D
Rick, age 35, is modifying his diet to try to lose weight, but after 3 months, he has not lost any weight even though he has complied with his diet plan. A follow up lipid profile reveals the following: total cholesterol 238, triglycerides 100, HDL 28, LDL 190. What would you recommend? A. continuing the diet plan for another month B. starting an exercise program with a goal of uninterrupted aerobic exercise for 30 minutes per day and aiming for 5 days per week C. stopping his current diet plan and trying another D. starting statin drug therapy
D
Rona, age 69, has HTN, drinks one glass of white wine per day, and is slightly overweight. She asks you if making changes in her life at this age will make any difference. You tell her that lifestyle mods for the control of HTN A. are not as effective in older adults because HTN is an inevitable consequence of aging B. require a marked reduction in weight and a very limited choice of foods to achieve any benefit C. should include at least three glasses of red wine every day because it improves HDL levels, a known cardiovascular risk factor, which may be worsened with HTN D. may prevent HTN, lower elevated BP, and reduce the number and dosage of anti-HTN meds needed to manage a condition
D
Sandra says she wants to know more about the Pooled Cohort Equation to determine her 10-year risk of ASCVD. You tell her that the variables include which of the following? A. Total and HDL cholesterol levels B. Systolic BP C. Current smoking status D. All of the above
D
Some older adults develop postural hypotension with hypertensive drug therapy. What is included in your teaching with these individuals? A. Drug therapy will be d/c'ed as soon as their blood pressure stabilizes to prevent this problem from recurring B. Slight dehydration will prevent postural hypotension from occurring C. Clients should sleep in a high Fowler's position to prevent this from happening D. Clients should be taught to sit on the edge of the bed before standing
D
The most common cause of elevated total and low-density lipoprotein cholesterol levels in the United States is A. heredity B. hypothyroidism C. diabetes D. a diet high in saturated fat
D
There are four classifications of HF that often are interwoven; they include systolic, diastolic, acute, and/or chronic. Clients who present with JVD, dyspnea on exertion, peripheral edema, and abdominal fullness would most likely be experiencing chronic right-sided HF. A routine diagnostic workup would include all of the following except A. BNP B. BMP C. echocardiogram D. CTA
D
What is a causative factor in the formation of blood clots causing DVT? A. blood flow turbulence B. intact vessels C. thin blood D. hypercoagulability
D
What value on the ABI diagnoses PAD? A. Less than 0.25 B. Less than 0.50 C. Less than 0.9 D. 1 or greater
D
Which of following conditions is the least frequent cause of HF? A. HTN B. aortic stenosis C. ischemic cardiomyopathy D. valvular heart disease (mitral and tricuspid)
D
Which of the following antihypertensive agents would most likely produce a rebound hypertensive crisis following its abrupt withdrawal? A. Doxazosin (Cardura) B. Lisinopril (Prinivil) C. Losartan (Cozaar) D. Clonidine (Catapres)
D
Which of the following is usually indicative of an abdominal aortic aneurysm? A. RUQ tenderness B. venous hum in abdomen C. ascites D. positive bruit or wide, diffuse pulsation in epigastric area
D
Which of the following statements about aortic stenosis (AS) is true? A. The disease is typically manifested during midlife B. once symptoms appear, life expectancy without surgery is about 10 years C. right from the early course of the disease, symptoms are bothersome D. the cardinal symptoms include dyspnea, angina, and syncope
D
Which statement about mitral valve prolapse (MVP) is true? A. MVP occurs in about 10% of the population B. MVP is usually detected in older adults C. The incidence is equal in men and women younger than 20 D. The incidence is more common in women younger than 20
D
Which statement regarding rheumatic fever in children is true? A. the peak period of risk is ages 1-5 B. the disease is more common in boys C. the disease is more common in Caucasians D. Group A beta-hemolytic streptococcal infections of the upper respiratory track remain the primary environment trigger of rheumatic fever in children
D
Which would be the LAST step you would consider in a client with long-term chronic ischemic heart disease? A. Use of aspirin B. Use of beta blockers, CCBs, and nitrates C. Risk factor and lifestyle modifications D. A coronary angiogram
D
Your post-MI client is allergic to ASA. Which drug should he be on indefinitely? A. Coumadin B. Heparin C. Pentoxifylline (Trental) D. Clopidogrel (Plavix)
D
