Patho Exam 3: U5: 17 - 20 & U6: 21 - 23

The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following?

Tunica media

Which of the following blood vessel layers is composed primarily of smooth muscle cells?

Tunica media

Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?

Pulsus paradoxus

The heart is a four-chambered pump. What is the function of the right ventricle?

Pumps blood to the lungs

A client is brought to the emergency department and immediately diagnosed with a tension pneumothorax. The priority intervention would be:

Insertion of a large-bore needle or chest tube

When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?.

In the morning before arising from bed

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the patient about the anatomical location of the infection. The nurse evaluates the effectiveness of the teaching when the client correctly identifies which of the following as the location of the pericardium?

A membranous sac that encloses the heart

The heart and blood vessels receive both sympathetic and parasympathetic innervation from neural control. What controls the parasympathetic-mediated slowing of the heart rate?

The cardioinhibitory center

The parents of a child diagnosed with cystic fibrosis (CF) ask about the risk of any future children having the condition. How should the nurse respond?

You have a 25% chance that your next child will have CF.

There are three main atrial pressure waves that occur during the cardiac cycle. Which wave occurs during the last part of diastole and is caused by atrial contraction?

a

The client ask the nurse how influenza is spread from person-to-person. The nurse educates her client that influenza is transmitted by:

inhalation of droplet nuclei.

A client who has progressed to late-stage heart failure is experiencing sympathetic stimulation. The nurse would assess the client for: Select all that apply.

• Vasoconstriction • Arrhythmias • Increased oxygen demand

The nurse is performing a health history for a male client who is having a series of diagnostic test to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion?

"Do you have a history of smoking, and if so, how much?"

A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis?

"Do you work in construction and dig soil?"

A group of novice nursing students are learning how to manually measure a client's blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?

"If my client's arm is too big for the cuff, I'm going to get a BP reading that's artificially low."

A client with heart failure asks, "Why am I taking a 'water pill9 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?

"Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water."

A physician is teaching a group of medical students about the physiological basis for damage to the circulatory and neurological system that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician?

"Tension and vessel thickness increase proportionately."

As part of pre-surgical teaching for patients who are about to undergo a coronary artery bypass graft, a nurse is performing an education session with a group of surgical candidates. Which of the following teaching points best conveys an aspect of the human circulatory system?

"The blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation."

While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best?

"The earliest symptoms relate to a chronic cough and shortness of breath."

A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient?

"The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs."

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

"The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."

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:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her?

"This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens."

A pregnant client at 26 weeks of gestation states that she is "not really short of breath" but feels aware of the need to breathe. What is the nurse's best reply?

"This may be a normal response to pregnancy. What are you usually doing when you experience this feeling?"

A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia in her second trimester. What should her care provider teach her about this change in her health status?

"We don't really understand why some women get high blood pressure when they're pregnant."

A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. Which of the following is the best response?

"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated."

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?

"You have a heart valve that is diseased."

A client asks why he has not had major heart damage since his cardiac catheterization revealed he has 98% blockage of the right coronary artery. The nurse's best response is:

"You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked."

A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences?

"You'll find that in pediatric patients pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles."

A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session?

"Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk."

A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?

"Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."

The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:

20 mL/hour

During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

20 to 40 minutes

The neonatal ICU nurse is aware that Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation?

24-28 weeks.

A client has been placed on bed rest. Select the percentage of the blood volume that will be distributed to the client's pulmonary circulation.

25%

A client is lying in a recumbent position. In this patient approximately how much total blood volume is in the central circulation?

25% - 30%

A client has suffered chest injuries following a automobile accident. The chest injury has resulted in an increase in intrathoracic pressure. There can be a transient shift from the pulmonary to the systemic circulation of how much blood?

250 mL

A pregnant client has experienced episodes of premature labor and is concerned about her unborn child's lung development. The client asks the nurse when the fetus begins to produce sufficient surfactant. The best response would be:

27 weeks

The linear velocity of blood flow in the circulatory system varies widely. What is the linear velocity in the aorta?

30 to 35cm/second

The cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level. What is the normal young adult's percentage cardiac reserve?

300% - 400%

The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:

64 mm Hg

The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)?

A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation

In which of the following patients is the emergency department staff most likely to suspect a thoracic aortic aneurysm?

A 66-year-old client with facial edema, a cough, and neck vein distention

Which of the following patients is at greatest risk for orthostatic hypotension?

A 66-year-old post-surgery patient on bed rest

A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?

A 69-year-old woman who has entered ventricular fibrillation.

The intensive care nurse is evaluating a client with idiopathic cardiomyopathy and notes that the client's peripheral pulse is different than the apical pulse on the cardiac monitor, which reveals a normal sinus rhythm with the presence of frequent premature ventricular complexes. The nurse attributes the difference in rates to an inability of the heart to respond normally to the impulses initiated by the SA node and that premature ventricular complexes often do not initiate which of the following?

A normal mechanical response

Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?

A single-capillary network exists and the lungs are capable of respiration.

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in resulting in resting membrane potential.

What description is characteristic of the pathology of interstitial lung disease?

Airways become stiff and resist expansion, leading to hypoxemia.

What is the most common identifiable cause of secondary cardiomyopathy?

Alcohol abuse

Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?

An 80-year-old woman whose pain started at 6 a.m. shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose

Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

An 81 year-old male who has a productive cough and recurrent respiratory infections.

A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations leads the nurse to suspect a pneumothorax? Select all that apply.

Asymmetrical chest movements, esp. on inspiration. Diminished breath sounds over painful chest area. Respiratory rate 34.

The patient with airway obstruction may experience perfusion of the lungs without ventilation due to what disorder?

Atelectasis

The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD?

Atherosclerosis

A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below?

Atherosclerotic occlusive disease necessitating thrombolytic therapy

Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?

Atrial fibrillation

An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support?

Bronchopulmonary dysplasia

A client is brought into the ER with rapid, deep respirations at a rate of 25 breaths per minute and decreased level of consciousness. A stat MRI shows a lesion in the brain stem which may have infiltrated which of the following regulators of respiratory function responsible for detecting changes in carbon dioxide levels?

Central chemoreceptors

Bronchiectasis is considered a secondary COPD, and, with the advent of antibiotics, it is not a common disease entity. In the past, bronchiectasis often followed specific diseases. Which disease did it not follow?

Chickenpox

A 56-year-old male patient has been diagnosed with hypercholesterolemia. Which of the following are the lab results that support this diagnosis?

Cholesterol 250 mg/dL and HDL 32 mg/dL

Which condition places the client at risk for hypercapnia if given high-flow oxygen as treatment for a ventilation perfusion mismatch?

Chronic bronchitis from smoking

Chronic obstructive pulmonary disease (COPD) is a combination of disease processes. What disease processes have been identified as being part of COPD?

Chronic obstructive bronchitis and emphysema

A client has undergone pulmonary diagnostic studies. The health care provider reviews the results and notes a mismatching of ventilation and perfusion. The client most likely has developed:

Chronic obstructive pulmonary disease

For a client with which of the following is the use of oxygen at a rate above 2 L/minute inappropriate?

Chronic obstructive pulmonary disease (COPD), sitting in bed with cyanosis and pulse oximeter reading 57%

The distensibility of the blood vessel is the major factor in which of the vessel's characteristics?

Compliance

An elderly patient arrives to the healthcare provider's office complaining of a "sore" that won't heal on their lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is:

Compression therapy to help facilitate blood flow back to the vena cava.

The nurse obtains a blood pressure reading of 150/96 mm Hg from a patient at the clinic. What instructions for follow-up does the nurse anticipate giving to this patient?

Confirm within 2 months

A client with asbestosis-induced pulmonary fibrosis asks the nurse why breathing is so difficult at times. The nurse explains that the scar tissue in the client's lung tissues causes which of these?

Decreased compliance of the lung tissue

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrilate the patient

When explaining to a patient why they only had minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain this is primarily due to:

Development of collateral circulation that build channels between some of the smaller arteries usually when the flow is decreased gradually.

When blood pressure is measured, pressure rises during ventricular contraction, then falls during relaxation. As the pressure falls, there is a brief rise as the aortic valve closes. The nurse knows that this rise is which of the following?

Dicrotic notch

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. The best response would be: Select all that apply.

Dietary measures to reduce LDL levels Weight reduction if overweight Smoking cessation

A client with lung cancer is scheduled for the removal of the right lung. The nurse should anticipate that after surgery the client will experience a significant decrease in which of the following?

Diffusion capacity

Due to complications, a male postoperative patient has been unable to mobilize secretions for several days following surgery and develops atelectasis. Which of the following processes would his care team anticipate with relation to his health problem?

Directing blood flow away from the lung regions that are hypoxic

Select the statement that best describes Buerger disease.

Disease of young, heavy cigarette smokers occurring before the age of 35.

The parents of a premature infant ask how changing their baby's position can possibility help with the baby's ventilation. The nurse explains that changing the baby's position encourages which of these?

Distribution of ventilation

A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure?

Diuretic, ACE inhibitor, beta-blocker

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly matches which of the following drug categories to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?

Diuretics

A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which of the following clinical manifestations? Select all that apply.

Dyspnea Orthopnea Extreme fatigue with activity

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?

Dyspnea and crackles in bilateral lung bases.

A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?

Dyspnea, cough

A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics?

Echocardiogram, blood cultures, temperature

Our ability to oxygenate the tissues and organs of our bodies depends on our ability to ventilate, or exchange, gases in our respiratory system. The resultant distribution of ventilation or the areas of the body open to the exchange of gases in our respiratory system depends on what?

Effects of gravity and body position

When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression?

Elevate the head of the bed.

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?

Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation.

A patient with mitral valve regurgitation and left heart failure reports shortness of breath and fatigue with activities of daily living. Which of the following instructions by the nurse will be ineffective in reducing these symptoms?

Elevating legs for 20 minutes daily

A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?

Elevation of triglycerides

Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?

Emotional stress

A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing:

Epiglottitis

Which diagnosis places a child at the greatest risk for airway obstruction?

Epiglottitis

All of the following interventions are ordered stat for a patient stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first?

Epinephrine (Adrenalin).

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?

Fibrous atheromatous plaque

A nurse is assessing a client's apical pulse. The nurse is palpating the point of maximum impulse between which ribs?

Fifth and sixth

Raynaud disease or phenonemon is a functional disorder caused by intense vasospasm of the arteries and arterioles in which of the following?

Fingers

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?

HDL cholesterol is often characterized as being beneficial to health.

A client who has just recently completed his second series of radiation therapy for lung cancer was admitted yesterday to an acute care facility with ascites. He begins to have jugular vein distention, pedal edema, and dyspnea upon exertion as well as fatigue. What should the nurse suspect?

He has developed constrictive pericarditis.

A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms?

Headache and confusion

A patient comes to the clinic complaining of anorexia, weight loss, fever, fatigue along with paresthesias, pain, and weakness of the lower extremities. Assessment findings include reddish blue, mottled areas of discoloration to the skin of the lower extremities. Laboratory findings include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and abnormal liver function tests. A diagnosis of necrotizing vasculitis is confirmed through biopsy. The nurse anticipates treatment with which of the following medications?

High-dose corticosteroid therapy and cytotoxic immunosuppressant agents

A 21-year-old male client has suffered a head injury during a crash on his motorcycle, and a deficit that assessments have revealed is an impaired swallowing mechanism. He has also developed aspiration pneumonia. Which of the following statements most accurately captures an aspect of his condition?

His vocal folds are likely not performing their normal function.

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Select the factor that has a powerful vasodilator effect on arterioles and increases capillary permeability

Histamine

Which of the following enzymes has a powerful vasodilator effect on arterioles and increases capillary permeability?

Histamine

The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:

Hypertension

Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?

Hypertrophy

While rock climbing, a 22 year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition?

Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock?

Hypovolemic

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

Hypovolemic shock due to acute intravascular volume loss

A patient diagnosed with congestive heart failure has an arterial blood oxygen level (PaO2) of 89%. Which of the following terms should the nurse use to document a reduced oxygenation of arterial blood?

Hypoxemia

The nurse is caring for a client diagnosed with pneumonia. The client's arterial blood gas results identify decreased level oxygen in the arterial blood and a decreased in the partial pressure of oxygen. The nurse would interpret this as:

Hypoxemia

The nursing student has learned in his class that coronary artery disease (CAD) is heart disease caused by which of the following?

Impaired coronary blood flow

What is the underlying cause of respiratory failure in a child with bronchiolitis?

Impaired gas exchange

A client has suffered damage to his pericardium following a motor vehicle accident. Which consequence could be a possible complication of damaged pericardium that his care providers should assess for?

Impaired regulation of myocardial contraction

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

Improving quality of life by relieving symptoms

The nurse knows that which of the following statements regarding heart failure is correct?

In compensated failure, an increase in preload causes an increase in ventricular contractility.

Which of the following statements regarding heart failure is true?

In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.

As a result of dehydration, a client's epithelial cells are producing insufficient amounts of mucus. Consequently, the client's mucociliary blanket is compromised. Which of the following changes would the care provider anticipate as a direct result of this change?

Increased amounts of bacteria in the lungs

Which alteration in acid-base balance could be expected as a compensatory response for a client with severe chronic respiratory impairment?

Increased arterial blood bicarbonate

A client presents to his physician complaining of severe fatigue and intermittent shortness of breath. The physician is concerned that the client has developed anemia, a decreased oxygen carrying capacity of the blood, and has ordered blood work. A deficiency in which of the following would support the diagnosis of anemia secondary to a decrease in oxygen's ability to bind with hemoglobin?

Iron

A client with a history of asthma comes to the clinic complaining of wheezing and difficulty in breathing when harvesting the field. The assessment findings include use of accessory neck muscles, prolonged expiration, intercostal retractions, decreased breath sounds, and expiratory wheezes. Based on these finding the nurse determines which of the following anatomical receptors in the lungs have been stimulated?

Irritant receptors

A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy life style choices. The nurse explains that stimulation of certain lung receptors with things such as smoke, cigarette smoke, inhaled dust, or cold air can lead to constriction of the conducting airways resulting in rapid, shallow breathing. How does the nurse identify these receptors?

Irritant receptors

Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?

It documents only current cardiac function.

Which one of the following is characteristic of a thrombus?

It forms on the wall of a vessel.

A patient is diagnosed with systolic hypertension. The nurse knows that this patient is at risk for which of the following?

Left ventricular hypertrophy

A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?

Low blood pressure

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

Mitral valve stenosis

Antibodies directed against the M protein of certain strains of streptococcal bacteria seem to cross-react with glycoprotein antigens in the heart, joint, and other tissues to produce an autoimmune response resulting in rheumatic fever and rheumatic heart disease. This occurs through what phenomenon?

Molecular mimicry

A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?

Monitor the patient and document the findings.

The pericardium is a tri-layer sac. Which layer prevents acute dilation of the heart chambers and exerts a restraining effect on the left ventricle?

Outer fibrous layer

Question: Put these steps in order to describe the process of oxygen transport from the alveolar to the cellular level.

Oxygen moves from inspired air in the alveoli to the pulmonary capillaries through the process of diffusion. Oxygen moves quickly to the red blood cells where it binds reversibly to hemoglobin. Oxygen is released from the hemoglobin in the tissues capillaries. Oxygen separates from the hemoglobin and moves into the tissues where the PO2 level is lower.

Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?

P Wave

The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?

P wave above the baseline

A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis?

Peripheral edema weight gain

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?

Peripheral vascular resistance

A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority?

Place the child upright in bed and begin preparing for a tracheostomy placement.

A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her?

Platelet count; serum creatinine; liver enzymes

The nurse is hearing diminished breath sounds and a "grating" sound during respirations. This is consistent with excess collection of fluid in the pleural cavity. The medical term for this is:

Pleural effusion.

A diagnosis of exudative pleural effusion would be based on which of the following?

Pleural fluid protein/serum protein ratio >0.5

The respiratory neurons that turn off inspiration and assist with regulation of the respiratory rate are located where?

Pneumotaxic center

Resistance to flow is determined by the diameter of the blood vessels and the blood vessel itself. An equation has been developed for understanding the relationship between the diameter of the blood vessel, the viscosity of the blood, and resistance. What is the equation called?

Poiseuille law

An unconscious client has been admitted to the ICU with severe head injuries following a motorcycle accident. The client's respirations are very irregular with long inspiratory gasps interrupted by expiratory effort. The nurse explains to the family that the reason is injury to which of the following?

Posterior area of the brain

A nurse is caring for a patient who has been ordered complete bed rest. The nurse determines the area of this client's lungs that experience the most ventilation as which of the following?

Posterior portions of the lungs

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infections

A client has been admitted with bacterial pneumonia and is complaining of difficulty breathing. The nurse would explain the most likely reason for the dyspnea is that pneumonia interferes with lung compliance due to which of the following?

Pulmonary congestion

The client's ultrasound shows a thrombus in the venous sinus in the soleus muscle. The nurse explains that early treatment is important to prevent which of the following?

Pulmonary embolism

Three days following surgical repair of a hip fracture a client becomes anxious and complains of sudden shortness of breath. What disorder is the client most likely experiencing?

Pulmonary embolism

A female client tells the health care provider that she has recently been experiencing episodes of changes occuring in the color of her fingertips especially when she experiences cold temperatures. She further states that the tips become pale, turn a bluish color, and then become reddened. The client is most likely experiencing:

Raynaud phenomenon

A patient presents to the emergency department with complaints of bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color. Which of the following is a potential diagnosis for this patient?

Raynaud's disease

A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days?

Rebound symptoms

The nurse is reviewing the anatomy and physiology of the heart. What is the function of the right atrium?

Receives blood returning to the heart from the systemic circulation

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.

Reduce dietary sodium intake. Consume a diet rich in fruits, vegetables, and low-fat dairy products. Limit alcohol consumption. Stop smoking.

The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include:

Reduced chamber size

A client who has just received angioplasty for a blocked coronary artery following a myocardial infarction has an order for 12-lead ECGs every morning for three days. On the second day the nurse reads the ECG and notices a distinct difference in the QRS morphology from the previous ECG. Which of the following would be the best action to take?

Repeat ECG with proper lead placement.

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?

Repolarization of the ventricles

The pathogenesis of multiorgan dysfunction syndrome (MODS) is not clearly understood at this time. Supportive management is currently the focus of treatment in this disorder. What is not a major risk factor in MODS?

Respiratory dysfunction

A nurse is assessing a 1-year-old child diagnosed with croup. Which of the following manifestations would most likely be present?

Respiratory stridor and barking cough

A client has had an acute myocardial infarction. The brother of the client has a history of angina. The client asks how they will know if the brother's pain is angina or if the brother is actually having an MI. Which statement is correct?

Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.

A teenager is seen in the emergency room with complaints of a sore throat, headache, fever, abdominal pain, and swollen glands. His mother tells the nurse that he was seen three weeks before in the clinic and treated with antibiotics for a strep throat. He was better for a few days but now he seems to have gotten worse in the last two days. What should the nurse suspect is wrong with this client?

Rheumatic fever

Which of the following is the correct sequence for blood flow through the heart?

Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta

A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins?

Right sided heart failure

Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem?

Right-sided heart failure

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?

Staphylococcus aureus

A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?

Statins

A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete?

Streptococcus pneumoniae

When a person rises from a lying to a standing position, heart rate increases. What description would the nurse use to explain the physiological basis for this response?

Stretch on baroreceptors in the heart and blood vessels

The nurse is assessing a patient's respiratory status for lung expansion and airway resistance. The nurse is aware that changes in the pressure occurring in the walls of the airways will be adjusted by which of the following?

Stretch receptors

The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?

Sympathetic

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?

Sympathetic nervous system

Which of the following is a criterion for diagnosing moderately persistent asthma?

Symptoms occur daily.

Non-small cell lung cancers (NSCLCs) mimic small cell lung cancers (SCLCs) through their abilities to do what?

Synthesize bioactive products and produce paraneoplastic syndromes

Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response?

Systemic corticosteroids

An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication?

Systemic emboli, especially to brain.

The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply.

The arterial system distributes oxygenated blood to the tissues. The venous system collects deoxygenated blood from the tissues .

When thinking in terms of airway radius with regard to resistance, the lung structure responsible for the most airway resistance to airflow would be:

The bronchioles near the trachea

Select the client who may be at risk for developing an increase in resistance to blood flow.

The client admitted to the intensive care unit for extreme dehydration

A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation?

The client complains of sharp pain exacerbated by deep inspiration.

A client has been diagnosed with pneumococcal infection. The nurse shares with the client which statement about the spread of the disease?

The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals.

With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to:

The stiffening of the lung, making it more difficult to inflate

The parents of a child with cystic fibrosis ask the nurse to explain the sweat test performed on their newborn. How should the nurse respond?

The sweat test measures the concentration of salt in the infant's sweat.

Hypoxia is said to have a negative inotropic effect on the heart, which means:

There will be interference in the generation of ATP, which is needed for muscle contraction.

In infective endocarditis, vegetative lesions grow on the valves of the heart. These vegetative lesions consist of a collection of infectious organisms and cellular debris enmeshed in the fibrin strands of clotted blood. What are the possible systemic effects of these vegetative lesions?

They can fragment and cause cerebral emboli.

Bronchial blood vessels have several functions. They warm and humidify incoming air as well as distribute blood to the conducting airways and the supporting structures of the lung. What is it that makes bronchial blood vessels unique in the body?

They can undergo angiogenesis.

Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?

They have the same compensatory mechanisms.

A college student is training for a marathon in the mountains. One day, she experiences a sharp pain and suddenly becomes short of breath. At the emergency room, chest x-ray reveals a spontaneous pneumothorax. The client asks the nurse to explain why this happened. The nurse states, "For unknown reasons, you lose intrapleural negative pressure.

This means your lungs collapsed and expelled its air when you lose negative pressure."

Which of the following situations is most likely to result in an increased binding affinity of hemoglobin for oxygen?

Three of four binding sites on a client's hemoglobin molecule are occupied by oxygen.

A 28-year-old client, who is a heavy smoker, tells the practitioner that he has been experiencing pain in his feet and lower legs for several months. The practitioner notes that pulses in the feet are diminished and believes the client may have which of the following?

Thromboangiitis obliterans

The troponin complex is one of a number of important proteins that regulate actin-myosin binding. Troponin works in striated muscle to help regulate calcium-mediated contraction of the muscle. Which of the troponin complexes are diagnostic of a myocardial infarction?

Troponin T and troponin I

A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?

Troponin assay

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?

Troponin level

Which of the following blood vessel cells form the predominant cellular layer in the tunica media and produce vasoconstriction and/or dilation of blood vessels?

Vascular smooth muscle cells (SMCs)

An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A client has a blood pressure of 68/38 and fainted after donating a unit of blood. The client is experiencing low preload from loss of blood volume. What is preload?

Venous return to the heart

The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis?

Viral infections

A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following?

Weight gain

A client comes to an urgent care center. The nurse notes that the client has a fever of 103.2 F (39.5 C), pleuritic pain with each breath, and enlarged lymph nodes in the neck and axilla area. The client also has a productive cough. The nurse should consider tuberculosis if the client's history includes:

intravenous drug abuse and living on the streets.

A distressed, confused client is admitted to the hospital ER with a penetrating right chest stab wound. The nurse assesses the patient and notes a lack of breath sounds in the right lung due. The nurse knows this is likely the result of:

loss of intrapleural pressure.

An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

many people live with atrial fibrillation without even knowing they have it.

Which of the following clients are likely experiencing a shift to the right in the dissociation curve? Select all that apply.

• A client with respiratory influenza with a temperature of 102.6°F • A COPD client with pneumonia with blood gas pH level of 7.31 • A renal failure client with admitting hemoglobin level of 8.0 mg/dL

Which of the following statements regarding alcohol consumption and hypertension are correct? Select all that apply.

• A decrease in heavy alcohol consumption may help to lower blood pressure. • Moderate alcohol consumption may decrease risk for cardiovascular disease. • Chronic excessive alcohol consumption can induce hypertension.

A client with a right-sided chest tube in place to remove air describes an increase in his respiratory effort over the past day. The nurse would suspect an increase in the size of the pneumothorax and would anticipate that the pulmonary function tests would show which of the following? Select all that apply.

• A decrease in inspiratory capacity • An increase in dead space • A decrease in total lung capacity

The nurse is assessing a client said to be in sinus rhythm. What does the nurse expect to find when evaluating the electrocardiogram? Select all that apply.

• A p before every QRS wave • A rate between 60 and 100 beats per minute • Constant R to R intervals

Which of the following clients are more than likely experiencing impairment of the mucociliary blank with cilia dysfunction? Select all that apply.

• A smoker who smokes 2 packs of cigarettes/day and currently hospitalized with pneumonia • A mountain skier who spends all day outside teaching ski lessons • A nursing home client diagnosed with H1N1 influenza with fever of 102°F

Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply.

• A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation • A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food • A school-aged child with severe asthma controlled by steroids admitted for an exacerbation

The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply.

• Accumulation of fluid in the alveoli and airways • Lung stiffness • Impaired gas exchange

The nursing student when studying cardiomyopathies learns that the primary ones are classified into which of the following groups? Select all that apply.

• Acquired • Genetic • Mixed

Which of the following is/are a lower airway disease? (Select all that apply.)

• Acute bronchiolitis • Asthma

The nursing student, when studying about coronary artery disease, learns that it is commonly divided into different types of disorders which include which of the following? Select all that apply.

• Acute coronary syndrome • Chronic ischemic heart disease

A client comes to the emergency room with complaints of chest pain. When the nurse reads his ECG she sees changes which include T-wave inversion, ST-segment elevation, and an abnormal Q wave. What should she suspect?

• Acute myocardial infarction

Which factors influence diffusion of gases in the lungs? Select all that apply.

• Administration of high concentrations of oxygen • Difference in the partial pressures of the gas on either side of the membrane • Diffusion characteristics of the gas • Surface area available for diffusion • Thickness of the alveolar-capillary membrane

The nurse knows that the renin-angiotensin-aldosterone system (RAAS) is an important mechanism in blood pressure control. Which of the following events will activate this system? Select all that apply.

• Adrenergic (sympathetic) stimulation • Decreased blood sodium • Fall in blood pressure • Decreased blood volume

The nurse knows that which of the following statements regarding blood pressure in African-American persons are correct? Select all that apply.

• African Americans often experience greater renal damage from hypertension. • Hypertension is more severe among African Americans compared to other ethnic groups. • Hypertension in African Americans is often treated less aggressively.

Regarding heart failure, the nurse knows that which of the following statements are correct? Select all that apply.

• Aortic stenosis can cause left-sided failure. • Cardiomyopathy is a common cause of heart failure. • Compensated heart failure may be clinically asymptomatic.

After donating a pint of blood, a person suddenly feels light-headed and dizzy. Blood pressure has fallen to 68/38. The nurse knows that which responses will immediately attempt to regulate blood pressure? Select all that apply.

• Arterial vasoconstriction • Increased heart rate • Epinephrine release

A nurse is evaluating patients at risk for developing dyspnea. Which diagnoses would place a patient at risk? Select all that apply.

• Asthma • Heart disease • Emphysema • Pneumonia

A client who has just been diagnosed with atrial stenosis asks his nurse what can cause a problem with heart valves. Which of the following does the nurse tell this patient can cause a dysfunction of the heart valves? Select all that apply.

• Congenital defects • Rheumatic heart disease • Trauma • Ischemic heart disease • Inflammation • Degenerative changes

A patient diagnosed with diastolic heart failure asks the nurse to explain why this has developed. The nurse knows that which of the following are often associated with diastolic failure? Select all that apply.

• Constrictive pericarditis • Myocardial hypertrophy • Ischemic heart disease

A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply.

• Copious amounts of foul-smelling purulent sputum • Blood-tinged sputum • Wheezing throughout the lung fields

A patient has developed secondary hypertension. The nurse knows that causes of secondary hypertension include which of the following? Select all that apply.

• Cushing's syndrome • Oral contraceptives • Aortic coarctation • Pheochromocytoma

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The healthcare provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply.

• Decrease in exercise tolerance. • Exertional dyspnea. • Syncope.

A 71-year-old woman is dependent on oxygen therapy and bronchodilators due to her diagnosis of emphysema. Which of the following pathological processes occur as a result of her emphysema? Select all that apply.

• Decreased elastic recoil due to alveolar damage. • Increased anatomical dead space due to reduced tidal volume. • Increased alveolar dead space due to incorrect intrapleural pressure.

There can be many reasons for a client to present with hypoxemia. For a client's PO2 to fall, a respiratory disease is usually involved. Often, clients have involvement from more than one mechanism. Which of the following will result in hypoxemia? (Select all that apply.)

• Decreased oxygen in air • Disease in respiratory system • Dysfunction of neurologic system

The diagnosis is septic shock. The nurse knows that administration of insulin to this patient will provide which of the following beneficial effects? Select all that apply.

• Decreased risk of infection • Better wound healing

Which of the following consequences of cardiogenic shock will the nurse monitor? Select all that apply.

• Decreased stroke volume • Increased afterloading • Decreased cardiac output

Following coronary bypass graft (CABG) surgery for a massive myocardial infarction (MI) located on their left ventricle, the ICU nurses are assessing for clinical manifestations of cardiogenic shock. Which of the following assessment findings would confirm the client may be in the early stages of cardiogenic shock? Select all that apply.

• Decreasing mean arterial pressure (MAP). • Low BP reading of 86/60. • Urine output 15 mL last hour. • Periods of confusion.

The nurse is educating a patient diagnosed with pre-hypertension about reducing modifiable risk factors. Which risk factors will the nurse address? Select all that apply.

• Decreasing salt intake • Decreasing alcohol consumption. • Increasing dietary potassium

Which of the following children may be considered high risk for developing hypertension? Select all that apply.

• Diagnosed with coarctation of the aorta as an infant • Recent scan showing a pheochromocytoma • Takes cyclosporine daily since a kidney transplant

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

• Elongating the cardiac muscle cells • Decreasing the ventricular wall thickness

The nurse assesses a 65-year-old female client who reported to the emergency department with exacerbation of asthma during her daughter's wedding reception. Select all of the triggers that may have precipitated the attack.

• Emotional stress • Dancing • Aspirin

Aspiration pneumonia is a serious and sometimes life threatening inflammation in the lungs caused by inhaling food, fluids, stomach contents, or other foreign substances. Identify the structures that protect the lungs from aspiration. Select all that apply.

• Epiglottis • Glottis

A nurse is evaluating hypertension risk factors with an African American male who works as a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. He paternal grandfather had a stroke. He drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are modifiable risk factors associated with this diagnosis? Select all that apply.

• Excessive alcohol consumption • Obesity

An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply.

• Exertional dyspnea • Orthopnea • Paroxysmal nocturnal dyspnea • Palpitations

The nurse will monitor which of the following respiratory manifestations of heart failure? Select all that apply.

• Exertional dyspnea • Orthopnea • Cheyne-Stokes respiration • Chronic dry cough

Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse will monitor for which of the following signs and symptoms of heart failure? Select all that apply.

• Fatigue • Exercise intolerance • Cyanosis • Malnutrition

A nurse is assessing a client who has just been admitted to the unit with a diagnosis of acute pericarditis. The client would most likely manifest: Select all that apply.

• Fever • Chest pain • Pericardial friction rub • Pleuritic pain

A person newly diagnosed with Kawasaki disease in the acute phase will likely have which of the following clinical manifestations? Select all that apply.

• Fever • Edematous hands and feet • Bilateral conjunctivitis

Respiration has both automatic and voluntary components that are sent to the respiratory center of the brain from a number of sources. What physiologic forces can exert their influence on respiration through the lower brain centers? (Select all that apply.)

• Fever • Pain • Emotion

The nursing instructor when teaching about disorders of cardiac function informs the students that all people presenting with ST-segment elevation myocardial infarction (STEMI) should be assessed for reperfusion therapy as quickly as possible. Reperfusion therapy includes which of the following? Select all that apply.

• Fibrinolytic therapy • Percutaneous coronary intervention (PCI) • Coronary artery bypass grafting (CABG)

A client who has been admitted to the emergency room with symptoms of a STEMI is given nitroglycerine. The nurse explains to the client's wife that this medication is given for which of the following reasons? Select all that apply.

• For its vasodilatation effect • To relieve coronary pain

Acute pulmonary edema often occurs with heart failure. Which of the following signs of acute pulmonary edema should be monitored? Select all that apply.

• Frothy blood-tinged sputum • Respiratory crackles • Confusion • Rapid pulse

Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has: Select all that apply.

• Generalized lymph node enlargement • An enlarged liver via palpation • Copious bleeding at the site where the lab technician drew some blood

Which assessment findings concern the presence of respiratory distress in an infant? Select all that apply.

• Grunting • Respiratory rate of 95 breaths/minute • Sternal retraction • Central cyanosis

The community health nurse is developing a program to decrease the amount of pulmonary tuberculosis that has recently risen in her area. Which populations at risk will the nurse target? Select all that apply.

• HIV-infected people • Foreign-born people from countries with a high incidence of tuberculosis • Residents of high-risk congregate settings

A patient with hypertension is suspected to have a pheochromocytoma. The nurse knows that symptoms of this condition include which of the following? Select all that apply.

• Headache • Palpitations • Tremor • Fatigue

A patient has systolic hypertension. The nurse knows that systolic pressure is influenced by which of the following factors? Select all that apply.

• Heart rate • Compliance of arteries • Stroke volume • Contractile force

Which of the following clients are displaying known risk factors for the development of pulmonary emboli? A client who is: (Select all that apply)

• Immobilized following orthopedic surgery • A smoker and who takes oral contraceptives

The nurse must achieve which of the following objectives for a patient in cardiogenic shock? Select all that apply.

• Improve cardiac output • Regulate blood volume • Increase coronary perfusion • Correct pulmonary edema

Which of the following statements regarding heart failure are true? Select all that apply

• In uncompensated left heart failure, there is pulmonary congestion and edema. • In compensated heart failure, cardiac output is normal. • In uncompensated right heart failure, there is peripheral venous congestion and edema.

A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply.

• Increase in chest pain with deep inspiration • Loss of appetite for past few days • Purulent sputum with bloody patches

A client with cystic fibrosis reports recent weight loss without fever or cough. What interventions will the nurse implement to promote health for the client? Select all that apply.

• Increase protein intake • Increase pancreatic enzymes

As a consequence of long-standing lung disease, a client is in a chronic state of hypoxia. Which of the following phenomena would the client's care team be most justified in anticipating? Select all that apply:

• Increased erythropoietin production • Hyperventilation • Personality changes

Natriuretic peptides (NP) are part of the compensatory response to heart failure. Which of the following are actions of NP? Select all that apply.

• Increased glomerular filtration • Decreased renal reabsorption of sodium and water • Inhibition of endothelin action

In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply.

• Increased heart rate • Vasoconstriction • Activation of the renin angiotensin system (RAAS)

A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply.

• Increased respiratory rate to 44 breaths/minute • Substernal retractions becoming more pronounced • New-onset expiratory grunting

A 65-year-old male patient is diagnosed with systolic hypertension. Stating that he always had normal blood pressure, he does not understand this new diagnosis. The nurse will explain that as the aging process occurs, stiffening of the large arteries occurs resulting in which of the following? Select all that apply.

• Increased systolic pressure • Decreased diastolic pressure • Widened pulse pressure

The nurse knows that which of the following would put a patient at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply.

• Intravascular fluid retention • Elevated renin levels • Systemic vasoconstriction

A 78 year old male patient has undergone a total knee replacement. He just doesn't feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and lightheadedness. These symptoms are primarily caused by which of the following pathophysiological principles? Select all that apply. The patient:

• Is experiencing a reduction in plasma volume. • Peripheral vasoconstriction mechanism has failed.

Which of the following statements are true concerning atherosclerosis? Select all that apply.

• It is a leading cause of death in the United States. • Symptoms appear when the condition is in its advanced stage. • A family history of the disorder is generally present. • Age is considered a risk factor.

Which symptoms accompanying shortness of breath indicate a client has cor pulmonale? Select all that apply.

• Jugular vein distention • 2+ pitting edema in feet • Warm moist skin

Which of the following are interventions when the treatment objectives for venous thrombosis is preventing further thrombi from forming? Select all that apply

• Keeping the legs at a 15- to 20-degree elevation • Applying heat to the leg(s) • Applying elastic support hose

Vascular smooth muscle cells produce vasoconstriction or dilation of blood vessels. Smooth muscle contraction and relaxation can occur in response to local tissue factors. Which are examples of local tissue factors? Select all that apply.

• Lack of oxygen • Increased hydrogen ion concentrations

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.

• Large amount of pink, frothy sputum and new onset of murmur. • Tachypnea with respiratory distress. • Frequent ventricular arrhythmia unrelieved with Amiodarone drip. • Complaints of facial numbness and tingling.

A client has arrived in the emergency department in cardiogenic shock. Which of the following assessment findings confirm this diagnosis? Select all that apply.

• Less than 5 mL dark, concentrated urine in the past hour • BP reading of 80/65 • Difficult to arouse with changes in level of consciousness

The nurse teaches a client with a new diagnosis of asthma about measures to prevent asthma attacks. What should the nurse include? Select all that apply.

• Limit exposure to dust. • Schedule the influenza vaccine. • Use an inhaled corticosteroid.

The client with emphysema should be educated about changes in lung tissue that may include which of the following changes? Select all that apply.

• Loss of elastic recoil • Difficulty exhaling due to inability to recoil • Increased lung compliance

Which of the following diagnostic/assessment findings would been seen in a client with worsening mitral valve stenosis? Select all that apply.

• Low-pitched diastolic murmur that is increasing in duration • Sharp elevation in left atrial pressure • Decreased cardiac output

When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? (Select all that apply.)

• Maldistribution of blood flow • Hypovolemia • Obstruction of blood flow

A client diagnosed with rhinosinusitis asks the nurse what type of nonpharmacologic measures can be used to reduce the nasal stuffiness that occurs with the disorder. What suggestion can the nurse give to the client? Select all that apply.

• Mist humidification • Nasal irrigation • Saline nasal spray

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply.

• Muffled heart tones. • Narrowed pulse pressure. • Low BP—84/60.

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings is associated with this heart defect? Select all that apply.

• Murmur heard at the 2nd intercostals space, during both systole and diastole. • BP 84/30 classified as a wide pulse pressure.

Which of the following statements regarding causes of systolic and diastolic dysfunction are correct? Select all that apply.

• Myocardial hypertrophy causes diastolic dysfunction. • Ischemic heart disease causes systolic dysfunction. • Valvular insufficiency causes systolic dysfunction.

When the electrocardiogram (ECG) of a patient in the emergency department indicates an ST elevation myocardial infarction (STEMI) in progress, the physician orders a beta adrenergic blocker. Which of the following factors in the patient's history will cause the nurse to withhold medication? Select all that apply.

• Myocardial infarction caused by cocaine use • Third-degree heart block • Shock

A child with asthma is walking outside and develops a bronchospasm. The school nurse knows this bronchospasm has what effects on bronchioles with airflow? Select all that apply.

• Narrowing of bronchioles • Impairs airflow

In distributive shock, there are abnormalities in vascular resistance. Which of the following types of shock display the same distributive pattern? Select all that apply.

• Neurogenic • Septic • Anaphylactic

Which manifestations are most common in clients with COPD that is predominantly chronic bronchitis? Select all that apply.

• Peripheral edema • Increased mucus secretion • Cyanosis

A client who previously has suffered a myocardial infarction comes to clinic for a routine checkup. He tells the nurse that he has started to experience more episodes of angina pectoris than he had before. The nurse should tell this client that which of the following can precipitate his angina pectoris? Select all that apply.

• Physical exertion • Exposure to cold • Emotional stress

The nurse knows that factors that affect stroke volume include which of the following? Select all that apply

• Preload • Afterload • Myocardial contractility

The nurse is monitoring a patient's arterial blood pressure. Which of the following statements regarding arterial pressure are correct? Select all that apply.

• Pressure rises with left ventricular contraction. • Pressure falls with left ventricular relaxation.

The nurse is performing an assessment for a client who is suspected of having chronic histoplasmosis. What clinical manifestations reported by the client are consistent with this diagnosis? Select all that apply.

• Productive cough • Night sweats • Weight loss

A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply.

• Race • Family history

Unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI) is a clinical syndrome that ranges in severity between stable angina and MI. It is classified according to its risk of causing an acute MI and is diagnosed based on what? (Select all that apply.)

• Serum biomarkers • ECG pattern

The lungs are the working structures of the respiratory system, and they have several functions. What are the functions of the lungs? (Select all that apply.)

• Serve as reservoir for blood storage • Convert angiotensin I to angiotensin II

The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply.

• Severe accessory muscle retractions. • Nasal flaring. • Grunting on expiration.

A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which of the following clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply.

• Severe bronchospasm • Wheezing sound on inspiration • Hives over entire body • Swelling around the lips and eyes

Which of the following would be considered a clinical manifestation of acute pericarditis? Select all that apply.

• Sharp, abrupt onset of chest pain that radiates to the neck • Pericardial friction rub • Abnormal ECG results

A patient with pulmonary hypertension may display which of the following clinical manifestations? Select all that apply.

• Shortness of breath. • Decreased exercise tolerance. • Swell [edema] in their legs and feet.

Which breathing-related actions are affected by voluntary respiratory control? Select all that apply.

• Singing • Speaking • Blowing

Unstable plaque, a condition of atherosclerotic heart disease, occurs in unstable angina and myocardial infarction. Unstable plaque can rupture, causing platelet aggregation and thrombus formation. What are the major determinants of the vulnerability of plaque to rupture? (Select all that apply.)

• Size of lipid-rich core • Presence of inflammation • Thickness of fibrous cap

A client is preparing to attend a large conference for a week and informs the nurse that she has a major concern about contracting Legionnaire disease after hearing about the conference in 1976 in Philadelphia. The nurse can inform the client that who are the people most at risk for this disease? Select all that apply.

• Smokers • Persons with chronic diseases • Persons with impaired cell-mediated immunity

A nurse preparing education on managing the risk factors for coronary artery disease (CAD) will stress which information? Select all that apply.

• Smoking cessation techniques • Identification of high cholesterol foods • Importance of exercise on managing hypertension • Signs and symptoms of type 2 diabetes mellitus

A nurse working on a gerontology unit notes that the majority of the clients on the unit are prescribed antihypertensive medications. When it comes to the aging process, which of the following phenomena is primarily a contributing factor to hypertension in the elderly population? Select all that apply.

• Stiffening of large arteries like the aorta • Decreased baroreceptor sensitivity and renal blood flow • Increased peripheral vascular resistance

What mechanism has been proposed to explain the sensation of dyspnea? Select all that apply.

• Stimulation of lung receptors • Stimulation of muscle fibers in the intercostals and diaphragm • Decreased breathing reserve • Increased CNS sensitivity to changes in ventilation

Proper perfusion of vital organs requires which of the following conditions? Select all that apply.

• Sufficient blood volume to fill the vascular compartment • Efficient cardiac pumping ability • Intact vascular system • Ability of organs to extract oxygen and nutrients from blood

A patient with sepsis secondary to pneumonia develops acute respiratory distress syndrome (ARDS) and a low ventilation-perfusion ratio. Which of the following alterations in the lungs occurs as the disease progresses? Select all that apply.

• Surfactant inactivation • Intrapulmonary shunting • lung stiffens • Alveolar collapse

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.

• Surgery to remove tumor • Radiation therapy • Chemotherapy

Which statements regarding childhood respiratory tract infection are true? Select all that apply.

• The size of the child has an impact on the seriousness of the symptoms. • Impaired airflow and obstructions are common outcomes of these infections. • Each exposure to a new pathogen results in an infection. • An immature immune system is the usual trigger for such infections.

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.

• The sympathetic nervous system responds rapidly to a fall in cardiac output. • The sympathetic nervous system increase in heart rate and force of contraction support cardiac output. • The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure.

The nurse knows that systolic hypertension carries risk for which of the following cardiovascular events? Select all that apply.

• Thrombosis • Damage to elastic elements of blood vessel walls • Atherosclerosis • Risk for aneurysm

Pulmonary function studies are an essential tool in the diagnosis of pulmonary disorders. A spirometer is used in these studies and through direct measurement provides valuable information on which of the following? Select all that apply.

• Tidal volume • Inspiratory reserve volume • Expiratory reserve volume

Local control of blood flow is regulated by mechanisms that match blood flow to the metabolic needs of the tissue. Over the short term autoregulation controls flow through the synthesis of vasodilators and vasoconstrictors. Which components of the vascular system are involved in the short term control of blood flow? Select all that apply.

• Tissue • Smooth muscle • Endothelial cells

A client seen in the emergency department after a motor vehicle accident complains of increasing shortness of breath. A left tension pneumothorax is suspected. What manifestations support the diagnosis? Select all that apply.

• Tracheal deviation to the right • Hyperresonance on the left • Diminished breath sounds on the left • Subcutaneous emphysema

A nurse has been exposed to a client who has been diagnosed with pulmonary tuberculosis. What frequently used screening method does the nurse prepare for? Select all that apply.

• Tuberculin skin test • Chest x-ray

The nurse is performing a physical assessment for a client who is suspected to have sinusitis. What assessment findings does the nurse recognize may indicate this infection? Select all that apply.

• Turbinate edema • Nasal crusts • Purulence of the nasal cavity

Hypovolemic shock is characterized by a loss of blood volume or extracellular fluid. Administering which of the following would manage a patient with hypovolemic shock? Select all that apply.

• Whole blood • Packed red cells • Plasma volume expanders • Crystalloids

Which manifestations are most common in clients with COPD that is predominantly emphysema? Select all that apply.

• hyperresonance • increased A-P diameter

The nurse is monitoring trends in the patient's arterial blood gases and recognizes that changes in ventilation will result from which of the following? Select all that apply.

• pH • Oxygen • Carbon dioxide

A patient who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the patient is diagnosed with hypercapnia. The nurse will note the ABG results that confirm this diagnosis include: Select all that apply.

• pH 7.31 (Normal 7.35-7.45) • PCO2-58 mm Hg (Normal 38-42) • Serum HCO3-33 mEq/L (Normal 22-28)

An 82-year-old man with chronic obstructive pulmonary disease (COPD) is at the clinic for a regular checkup. Because of his diagnosis, the nurse would expect his respiratory rate under normal circumstances to be what?

≥18 to 20 breaths/minute

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

A health educator is performing a health-promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment?

"Actually, people who have the latent form of the disease won't be sick and can't spread it either."

The nurse determines that teaching has been effective when a client diagnosed with chronic stable angina states:

"Angina may result from exertional activity or emotional stress and be relieved within minutes by rest or by nitroglycerin."

A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus?

"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."

The dietitian is teaching a client about cholesterol reduction strategies. Which comment, by the client, indicates that he understands the teaching?

"I should avoid fats that are manufactured from vegetable oils and used to extend the shelf life of fast foods."

A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease?

"I should have my LDL monitored."

The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?

"I should report episodes of dizziness or fainting."

A client with advanced chronic obstructive pulmonary disease (COPD) has been taught methods to maintain maximum functioning. What client statement indicates accurate understanding of the instructions?

"I will skip church during flu season and wear a scarf when out in the cold."

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?

"I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising."

An elderly patient who was recently diagnosed with emphysema asks the nurse what caused the disease. Which of the following statements is the best response?

"One of the causes of emphysema is a history of cigarette smoking that causes damage to the lungs. Have you ever smoked?"

On a routine physical exam visit, the physician mentions that they hear a new murmur. The patient gets worried and asks, "What does this mean?" The physician responds:

"One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problems."

A client who has been diagnosed with mitral valve prolapse asks the nurse if there are any dietary modifications that should be incorporated into her lifestyle. The best response would be:

"Refraining from caffeine, alcohol, and cigarettes may be sufficient to control symptoms."

The mother of a 7 year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable?

"Research has shown that viruses may actually be a factor in many children's asthma."

While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be:

"Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction."

A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles?

"The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen."

A 71-year-old man is slated for pacemaker insertion for treatment of a third-degree AV block. The man's nurse has been educating him around his diagnosis and treatment and answering the numerous questions he has about his health problem. Which of the following teaching points should the nurse include in this patient teaching?

"The root problem is that the top chambers of your heart and the bottom chambers of your heart aren't coordinating to pump blood efficiently."

The cardiologist just informed a patient that they have a reentry circuit in the electrical conduction system in their heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to them. Which of the following statements most accurately describes what is happening?

"There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast."

The nurse teaches a patient scheduled for surgery about pulmonary function testing (PFT). Which statement, if made by the patient, indicates teaching was effective?

"These tests results will be used to assess any risk I could have due to the anesthesia."

A client tells the nurse he was diagnosed with a sinus infection about 7 days ago. He is now experiencing facial swelling and has also had periods of confusion. His family told him he is not remembering things. The best response by the nurse would be:

"This can be a complication of the infection; we need to let the health care provider know."

A client, newly diagnosed with lung cancer, asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best?

"This diagnostic procedure will let the doctor know if you have any mestastatic lesions in your body."

When a 55 year old patients routine blood work returns, the nurse notes that their C-reactive protein (CRP) is elevated. The patient asks what that means. The nurse responds:

"This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease."

A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client:

"This means your heart is not pumping as much blood out of the heart with each beat."

When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize:

"To destroy this bacterium, you must strictly adhere to a long-term drug regimen."

A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate?

"Too much alcohol, too little exercise and too much body fat all contribute to high blood pressure."

An elderly client newly diagnosed with systolic hypertension asks her health care provider why this happens. The most accurate response would be:

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

A patient with persistent primary hypertension remains apathetic about his high blood pressure, stating, "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How would the nurse best respond to this patient's statement?

"You may not sense any problems, but it really increases your risk of heart disease and stroke."

A 51 year-old female client who is two days post-operative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate?

"You should breath deeply and cough to help your lungs expand as much as possible while you're in bed."

A client with a history of hypertension and diabetes mellitus has developed a cold and tells the nurse he purchased an OTC (over-the-counter) nasal decongestant. The most important information for the nurse to provide would be:

"You should not take this medication; it can cause problems."

The venous system is a low pressure system that returns blood to the heart. What is the normal right atrial pressure?

0mm Hg

A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset?

1 hour

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Select the most appropriate treatment for the client.

1 to 2 L/min via nasal cannula

The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher.

140

The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following?

140/90

A client has had a myocardial infarction (MI) that damaged the right atrium, which has interfered with the SA node. The compensatory mechanism, the AV node, becomes the pacemaker of the heart and beats how many times/minute?

45 to 50 beats/minute

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply.

48-year-old client with uncontrolled hypertension A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

What is the normal tidal volume for a person at rest?

500 mL

A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography?

55% - 75%

The semilunar valves of the heart open at the onset of the ejection period. Approximately what percentage of the stroke volume is ejected during the first quarter of systole?

60%

The nurse knows that mean arterial pressure is determined as which of the following?

60% of diastolic pressure and 40% of systolic pressure

The stroke volume is the amount of blood ejected with every contraction of the ventricle. It is broken down into quarters. What is the approximate amount of the stroke volume per quarter?

60%, 20%, 20%, and little blood

At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which of the following clients is unable to receive the vaccine?

A 20-year-old healthy female reporting an allergy to eggs

The nurse knows that which of the following persons is at greatest risk for malignant hypertension?

A 25-year-old African-American man

Which of the following neurological patient's is most likely to have abnormalities in breathing regulation?

A 34-year-old male with damage to his upper and lower pons following a blow to the back of the head.

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

A 51-year-old male who has been diagnosed with glomerulonephritis

Which of the following individuals is most likely to be experiencing vasodilation?

A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician be most likely to rule out hypertension as a contributing factor?

A 61-year-old man who has a heart valve infection and recurrent fever

The nurse is caring for four clients. Select the client at risk for the development of a pulmonary embolism.

A 62-year-old male postop repair of a fractured femur

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

The nurse is assigned to care for four clients on a medical floor. Which client is most at risk for viral pneumonia after influenza?

A 76-year-old client with cardiopulmonary disease

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 cardiac glycoside

Which of the following is true regarding pulmonary circulation?

It is a low-pressure system that allows for improved gas exchange.

In which of the following situations would blood be most likely to be rapidly relocated from central circulation to the lower extremities?

A client is helped out of bed and stands up.

Select the clinical situation that would result in increased diffusion of gases from the arterial blood into the alveoli.

A client who is receiving 100% oxygen via oxygen mask

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:

A corticosteroid.

A client tells the nurse that he is concerned he may be developing chronic bronchitis and asks how the diagnosis is made. The most appropriate information for the nurse to provide would be:

A diagnosis of chronic bronchitis requires a history of a chronic productive cough that has persisted for at least 3 consecutive months in at least 2 consecutive years.

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

Which of the following clients is at risk for developing acute respiratory failure?

A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation

Which of the following situations would be most deserving of a pediatrician's attention?

A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

A nurse on an acute medical unit is providing care for a number of patients with a variety of diagnoses. Which of the following patients most likely exhibits risk factors for impaired coughing? A patient with:

A nasogastric (NG) tube attached to suction

Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility?

A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking"

The client tells the provider he has lower back pain. Although most abdominal aneurysms are asymptomatic, the provider examines the client for which of the following initial signs of this condition?

A pulsating mass in the abdomen

The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in:

A reading that is too high

A client recovered from influenza two days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for?

A secondary bacterial pneumonia

Dyspnea can best be described by which of the following?

A subjective sensation felt when experiencing difficulty breathing

It is known that over 100 distinct myocardial diseases can demonstrate clinical features associated with dilated cardiomyopathy (DCM). What is the most common identifiable cause of DCM in the United States?

Alcoholic cardiomyopathy

Which of the following is the most common cause of hypercapnia?

Alterations in respiratory rate

A client is admitted to the hospital with severe bradycardia, heart rate in low to upper 40s, after contracting Lyme disease. She asks the nurse why the heart rate is so slow. The most accurate response would be a possible disassociation between the atria and ventricles due which of the following?

AV nodal block

Valves in the veins prevent retrograde flow. In which veins are there no valves? Select all that apply.

Abdominal Thoracic

Which of the following types of aortic aneurysms is the most common?

Abdominal aortic

Cardiac reserve refers to which of the following events?

Ability to increase cardiac output during physical exercise

Tuberculosis is an infectious respiratory disease caused by the insoluble Myobacterium tuberculosis (M. tuberculosis). The nurse explains to the client, who has tested positive for the presence of M. tuberculosis but has a normal chest x-ray, that he does not have the active disease because his alveolar macrophages have:

Accumulated and encased the M. tuberculosis.

Which of the following neurotransmitters is associated with the parasympathetic nervous system?

Acetylcholine

ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart.

When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate?

Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels.

A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism

A 41 year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest X-ray indicates diffuse bilateral infiltrates of his lung tissue and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?

Acute lung injury

An adult comes to the urgent care clinic reporting facial pain, headache, and copious amounts of thick purulent nasal discharge. Based on these symptoms, the nurse practitioner suspects the client is experiencing which condition?

Acute viral rhinosinusitis

A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercule scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis?

Adenocarcinoma

Nursing students in an anatomy class are observing lung tissue under the microscope in order to identify regions of the lung. The slide shows a basement membrane, capillary lumen, macrophages, and brush cells. This tissue is identified as which of the following regions of the lung?

Alveoli

The nurse is caring for a client who is now 2 days post near-drowning. The focused assessment would involve which of the following areas of the lung involved in gas exchange?

Alveoli

The physician mentions the patient has developed alveolar dead space. The nurse recognizes that this means:

Alveoli are ventilated but not perfused.

Many pharmaceutical agents may cause pulmonary damage. The nurse knows the following cardiac medication has been associated with toxic effects in the lungs:

Amiodarone

The nurse knows that there are many different groups of antihypertensive drugs having varied mechanisms of action. Which one of the following drugs decreases the exit of adrenergic (sympathetic) stimulation from the central nervous system?

An alpha-2 adrenergic agonist

The nursing instructor teaches the students that when a client is suffering from pericarditis he/she will have a friction rub. The student asks the instructor what a friction rub is. What would be her best response?

An audible medical sign that is high-pitched and results from the rubbing and friction between the inflamed pericardial surfaces.

When reviewing diagnostic test results and physical assessment data for a client with a history of stage II hypertension, which of the following would be of most concern to the nurse?

An ejection fraction of 40%

Which of the following patients should most likely be assessed for orthostatic hypotension?

An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom.

A client is rushed to the emergency department with symptoms of urticaria, wheezing, chest tightness, and difficulty in breathing. The client is most likely experiencing which type of shock?

Anaphylactic

A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client.

Anaphylactic shock

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:

Antipyretic medications and rest

A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to:

Apply a Vaseline gauze (airtight) dressing over the insertion site

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be:

Apply sequential pneumatic compression devices to lower extremities

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?

Arterioles

A client has sudden severe dyspnea, fear, asymmetrical chest movement and decreased lung sounds on the right side. Which intervention is most appropriate?

Assist to high-Fowler's position and prepare for chest tube insertion.

In the early morning, an African-American woman brings her 5-year-old son to the emergency room. The boy is wheezing, short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 a.m. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has:

Asthma

The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?

At the apex of the heart

A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which of the following assessments should the nurse complete?

Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves

Atelectasis is the term used to designate an incomplete expansion of a portion of the lung. Depending on the size of the collapsed area and the type of atelectasis occurring, the nurse may see a shift of the mediastinum and trachea. Which way does the mediastinum and trachea shift in compression atelectasis?

Away from the affected lung

A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of bloodwork?

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology.

Hypertension in the elderly is a common finding. This is because of the age-related rise in systolic blood pressure. Among the aging processes, what is a contributor to hypertension?

Baroreceptor sensitivity

The nurse is counseling a client regarding a high cholesterol level. The nurse teaches the client that which of the following lipoproteins is the main carrier of cholesterol?

LDL

A 77 year old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of, "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could:

Be a result of catecholamines released from SNS which could increase the myocardial oxygen demand.

A client has been diagnosed with sinusitis. The nurses anticipate that the client may present with head pain that increases with:

Bending forward, coughing, or sneezing

The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:

Berry aneurysm

A client who was diagnosed with hypertension is now taking a medication that decreases heart rate and cardiac output. The nurse determines that the medication is a:

Beta adrenergic blocker

The nurse is reviewing a client's medications and lab results. The client has a high LDL level. Which medication can raise this level?

Beta blockers

A client is admitted to the intensive care unit suspected of having infective endocarditis. Which of the following tests is the most definitive diagnostic procedure that is done and used to guide treatment for this type of client?

Blood culture

A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?

Blood filling approximately one third of the pleural space

A nurse who works on a pediatric cardiology unit of a hospital is providing for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?

Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

The role of inflammation in the etiology of atherosclerosis has emerged over the last few years. Which lab test is a marker for systemic inflammation?

C-reactive protein

The emergency department is awaiting the arrival of a spinal cord injured patient. Knowing the innervation of the diaphragm, a patient with which type of injury may be in need of immediate mechanical ventilation? Injury to the:

C4 area.

Which of the following statements about calcium channel-blocking (CCB) drugs is accurate?

CCB drugs work on β-adrenergic receptors to close the channels, so vasodilation occurs.

The efficiency of the heart as a pump often is measured in the amount of blood the heart pumps per minute. Which is the correct formula to figure out the cardiac output?

CO = SV x HR

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is:

Call for emergency assistance utilizing hospital protocol.

In which period of fetal lung development does type II alveolar cells begin to produce surfactant?

Canalicular

Which of the following blood vessels function without the benefit of having walls comprised of three muscular layers?

Capillaries

Select the correct sequence of blood return to the heart.

Capillaries, venules, veins, right atrium

For which client condition will a pulse oximeter reading be inaccurate?

Carbon monoxide poisoning

While discussing carbon dioxide transport within the body, the instructor asks, "What enzyme helps carbon dioxide with water to form bicarbonate?" Which student response is correct?

Carbonic anhydrase

A nurse is planning a community education program on hypertension. Which of the following parameters should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistance

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac tamponade

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which of the following most likely had the greatest impact on development of the lung cancer?

Cigarette smoke

A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect?

Coarctation of the aorta

Which of the following statements regarding heart failure is true?

Compensated congestive heart failure may be clinically asymptomatic.

The heart valves control the direction of blood flow. What is the function of the pulmonic valve?

Controls the direction of blood flow from the right side of the heart to the lungs

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

Conversion from aerobic to anaerobic metabolism

A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include:

Cool, humidified air to relieve airway spasms

A client with primary lung disease has developed right heart failure. The health care provider would document this as:

Cor pulmonale

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids

A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications?

Crackles in bilateral lung bases caused by left-sided heart failure

A patient with chronic obstructive pulmonary disease presents to the emergency department with difficulty breathing. Physical examination reveals bluish skin, nail beds, and mucous membranes. Which of the following terms correctly describes this condition?

Cyanosis

A client arrives in the emergency department suffering a traumatic brain injury as a result of a car accident. While assessing this client, the nurse notices the client has an irregular breathing pattern consisting of prolonged inspiratory gasps interrupted by expiratory efforts. The underlying physiological principle for these signs would include:

Damage has occurred at the connection between the pneumotaxic and apneustic centers.

During the admission interview the client, who is admitted with bacterial pneumonia, reveals a 20 pack per year smoking history. The nurse relates the possible cause of this pneumonia to the decreased defense of the pulmonary system caused by cigarette smoking. Smoking affects the pulmonary defense system by which of these?

Damage or destruction of cilia

Which classification of medications used to self treat the common cold should be avoided by those with a history of hypertension?

Decongestants

A nurse is monitoring a patient with a consistent and regular heart rate of 128 beats/min. Which of the following physiologic alterations would be consistent with this finding?

Decrease in ventricular filling time and blood pressure

A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure?

Decrease vascular volume

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Decreased cardiac output

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

Decreased cardiac output

While intubated for surgery, a patient has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?

Decreased heart rate as a result of parasympathetic innervation of the heart

A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication?

Decreased level of consciousness

Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?

Decreased tidal volume

The nurse caring for a client with bilateral rib fractures explains to the client that the pain causes him to take more shallow respirations which will contribute to feeling SOB due to a

Decreased tidal volume.

A client is admitted to the emergency department after experiencing a motor vehicle accident and sustaining multiple injuries with significant blood loss. The nurse predicts that the client will display which of the following?

Decreased urinary output

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia. The nurse will likely assess for signs/symptoms of:

Decreasing cardiac output due to less ventricular filling time.

The nurse is explaining to the parents of a 23-week premature infant the reason their baby needs to be on mechanical ventilation. The education is successful when the parents state that they understand their baby was born before the type II alveolar cells could mature which has caused a

Deficiency in surfactant

When there is a mismatching of ventilation and perfusion within the lung itself, insufficient ventilation occurs. There is a lack of enough oxygen to adequately oxygenate the blood flowing through the alveolar capillaries, creating a physiologic shunt. What causes a physiologic right-to-left shunting of blood in the respiratory system?

Destructive lung disease or heart failure

A diagnosis of tension pneumothorax would be suspected in which of the following physical assessment findings?

Deviated trachea

For which of the following types of shock might intravenous antibiotic therapy be indicated?

Distributive shock

Which of the following diagnoses will present the highest risk for hypercapnic/hypoxemic respiratory failure?

Drug overdose

A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display?

Dry and warm skin

Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?

During feeding

A patient is reporting difficulty breathing when walking to the bathroom. The nurse documents this as:

Dyspnea

The school nurse is providing education to parents of school-age children during flu season. What should the nurse teach about the importance of early diagnosis of influenza?

Early diagnosis can reduce the inappropriate use of antibiotics.

What is the primary physiologic result of obstructive shock?

Elevated right heart pressure

A client is preparing for a hip replacement surgery and his physician orders pulmonary function tests (PFTs) to be done pre-surgical. Upon arrival to the lab for the PFTs, the client is anxious and asks the nurse why his physician would order these tests since he does not have any pulmonary diseases. The nurse responds that although the client should speak with his physician, the most likely reason is which of the following?

Evaluate anesthetic risk

The school nurse is doing a health class on the functional organization of the circulatory system. What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients and wastes

A client has been admitted to the hospital for new-onset dyspnea and is undergoing testing for obstructive lung disease. In reviewing the results of the pulmonary function studies, the nurse would expect to note a decrease in which of the following values with obstructive lung disease?

FEV1

All veins have internal valves to aid in the unidirectional flow of blood toward the heart.

False

A 35-year-old man presents to the emergency department complaining of chest pain for the last 2 hours. He describes the pain as crushing, like a huge weight is on his chest. He also states that the pain goes up into his neck and down his left arm. An acute myocardial infarction (MI) is diagnosed. When taking his history, the following things are noted: ● Hyperlipoproteinemia for past 7 years ● Family history of early MI ● Cholesterol deposits along the tendons (diagnosed 1 year ago) ● Atherosclerosis (diagnosed 6 months ago) ● Diabetes mellitus (type 1) diagnosed at age 16 The nurse suspects which of the following diagnoses will be made?

Familial hypercholesterolemia (type 2A)

Which one of the following is an example of hyperemia?

Finger redness in Raynaud phenomenon

A patient diagnosed with asthma is scheduled for a pulmonary function test. During the test, the technician instructs the patient to forcefully exhale air for 1 second to evaluate:

Forced expiratory volume

When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis?

Forced expiratory volume (FEV) is decreased.

A fully saturated hemoglobin molecule can hold how many oxygen molecules?

Four (4)

The nursing instructor is teaching about cardiomyopathies in class. Which type does she tell the students is the most common cause occurring in young athletes?

Genetic

A client who has just been diagnosed with dilated cardiomyopathy asks the nurse what caused the condition. The most appropriate response would be:

Genetic abnormalities

A client's chest x-ray and pathology report identify a granulomatous lesion that contains the tubercle bacilli. The health care provider would interpret this as:

Ghon focus

The client has symptoms of a focal inflammatory condition of medium-sized and large arteries which includes diplopia. Which condition does the client have?

Giant cell temporal arteritis

The nurse is teaching a class on reduction of cardiovascular disease. Which of the following demonstrates an intervention that is cognizant of the modifiable risk factors for hyperlipidemia?

Going for a brisk walk with a friend and talking to him about continuing to exercise regularly

Which of the following lab results strongly suggest an immunologic response in the client with possible rheumatic heart disease?

Group A (β-hemolytic) streptococcal antibodies

A nurse is assessing a 2-week-old infant with pulmonary edema. Which of the following symptoms indicates the infant is experiencing respiratory distress?

Grunting during expiration

Which of the following facilitates the clearance of cholesterol from the periphery (including atheromatous plaques) and transports it to the liver where it may be excreted?

HDL

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?

Have the client sit up and lean forward.

A 72 year old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, "What caused this [aortic stenosis] to happen now?" The clinic nurse responds:

Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.

The nursing instructor, while teaching the physiology of the heart, informs the students that there are 3 major determinants of myocardial oxygen demand, which include the heart rate, left ventricular contractility, and systolic pressure. Which does she tell them is the most important factor in myocardial oxygen demand?

Heart rate

What is the most important factor in myocardial oxygen demand?

Heart rate

Neurogenic shock, or spinal shock, is a phenomenon caused by the inability of the vasomotor center in the brain stem to control blood vessel tone through the sympathetic outflow to the blood vessels. In neurogenic shock, what happens to the heart rate and the skin?

Heart rate slower than normal; skin warm and dry

The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that the most likely cause of the varicosities is:

Heavy lifting

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?

Hemodynamic monitoring

A 31-year-old African-American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?

Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.

Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?

Histamine release causes massive vasodilation.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:

Hoarseness and difficulty swallowing

A pneumonia that occurs 48 hours or more after admission to the hospital is considered:

Hospital-acquired pneumonia.

Atherosclerosis begins in an insidious manner with symptoms becoming apparent as long as 20 to 40 years after the onset of the disease. Although an exact etiology of the disease has not been identified, epidemiologic studies have shown that there are predisposing risk factors to this disease. What is the major risk factor for developing atherosclerosis?

Hypercholesterolemia

A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?

Hypertension

During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the client, who is unfamiliar with aneurysms. Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides?

Hypertension is a frequent modifiable contributor to aneurysms.

The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?

Immediate defibrillation

In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis?

Immune-mediated inflammation

A patient is brought into the emergency department with severe crushing injuries to the chest wall and signs of respiratory failure following a motor vehicle accident. Which of the following laboratory values would be expected?

Increase in PCO2

A grandmother, a cook at a nearby school, was recently hospitalized when she lost an extensive amount of blood in a work-related accident. The grandmother tells the nurse that she heard that she would keep feeling faint until the brain made more blood. The nurse knows that when the blood pressure dropped, the pressure in the carotid arteries decreased. This was detected by baroreceptors in the carotid arteries. What did the baroreceptors do?

Increase sympathetic stimulation of the heart and blood vessels

A nurse is caring for a client following surgery. The central venous pressure (CVP) monitor indicates low pressures. Which action is a priority for the nurse to take?

Increase the IV fluid infusion per protocol.

Ventilation is driven by which alteration in arterial blood?

Increased PCO2

Which of the following phenomena would be most likely to accompany increased myocardial oxygen demand (MVO2)?

Increased aortic pressure

Acute respiratory failure is commonly signaled by varying degrees of hypoxemia and hypercapnia. Respiratory acidosis develops, manifested by:

Increased cerebral blood flow

Acute respiratory failure is commonly signalled by varying degrees of hypoxemia and hypercapnia. Respiratory acidosis develops, manifested by:

Increased cerebral blood flow

A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following?

Increased heart rate and increased contractility

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:

Increased turbulence of air moving through the obstructed airways

An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

Increased vascular stiffness

The nurse is caring for a client who is 2 days postop following a total hip replacement. The client is refusing to participate in physical therapy, complaining of extreme fatigue and severe pain with any movement. The nurse administers pain medication and then encourages the client to sit up to more effectively cough and deep breathe to increase ventilation by:

Increasing the spread of surfactant

A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process?

Infective endocarditis

Select the option that best describes the mediation of the systemic inflammatory responses that occurs in disseminated intravascular clotting (DIC).

Inflammatory mediators and cytokines

The nurse is assessing a client who states he felt fine all day and then within five minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?

Influenza

A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client?

Influenza transmission occurs by inhalation of droplet nuclei.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man?

Infusion of normal saline or Ringer's lactate to maintain the vascular space.

A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor?

Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction

The nurse is reviewing a client's history and recognizes that the client smokes cigarettes. The nurse is concerned because smoking does which of the following?

Injures the endothelial cells lining the blood vessels, thereby promoting thrombus development

People with emphysema often have a difficult time with air trapping, which is air left in the lungs following expiration, often due to the destruction of the alveoli. Pulmonary rehabilitation educates people who suffer from this disease to use which of the following to help air leave the lungs more effectively?

Intercostal and abdominal muscles

Talc lung can occur from injected or inhaled talc powder that has been mixed with heroin, methamphetamine, or codeine as a filler. What are people with talc lung very susceptible to?

Interstitial lung disease

A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine?

Intravenous

The client reports a sudden onset of excruciating pain in the anterior chest and describes it as "tearing or ripping." The physician is unable to palpate a pulse in the client's right arm. Based on the client's history and physical examination, which treatment would be implemented?

Intravenous sodium nitroprusside

While working in the newborn ICU, the nurses receive a call that an infant, gestational age of 23, is being air-flighted to their level three trauma nursery. The priority intervention for this infant would be:

Intubation and mechanical ventilation.

A nursing instructor is explaining arterial circulation to a group of nursing students. Which of the following is the most appropriate information for the nurse to provide?

It contains one sixth of the total blood volume.

While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?

It is an inflammatory process.

The student attends a health fair and has his serum cholestrol checked. He has a high lipoprotein level (LDL). He understands which of the following about LDL cholesterol?

It is believed to play an active role in the pathogenesis of the atherosclerotic lesion.

The nurse knows that advanced age is a risk factor for heart failure. Which statements regarding heart failure in older adults are true? Select all that apply.

It is more difficult to diagnose because of underlying chronic diseases. Sensitivity of beta adrenergic receptors decreases resulting in decreased ventricular contractility. Causes of heart failure in older adults include coronary heart disease and mitral valve dysfunction.

A client who was admitted to the cardiac intensive care unit with a diagnosis of myocarditis asks the nurse what caused his disease. What would be the nurse's best response?

It is usually caused by a viral infection.

The lymph system correlates with the vascular system without actually being a part of the vascular system. Among other things, the lymph system is the main route for the absorption of fats from the gastrointestinal system. The lymph system empties into the right and left thoracic ducts, which are the points of juncture with the vascular system. What are these points of juncture?

Junctions of the subclavian and internal jugular veins

The nurse practitioner's examination of a client reveals xanthomas along the client's tendons. Which of the following tests will the practitioner order?

LDL level

Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?

Laminar

A male, lifetime smoker has died as a result of chronic obstructive pulmonary disease. Which of the following phenomena regarding his alveoli would his care team expect in the weeks prior to his death?

Large numbers of alveolar macrophages in septal connective tissue

Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis?

Laryngeal edema

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:

Left side of the heart to the right side of the heart

A 66-year-old male presents the emergency room accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level at 126 mEq/L (normal 135-145 mEq/L). Based on this assessment, the nurse suspects the patient has:

Legionella pneumonia

The nurse is assessing a client with arteriosclerosis obliterans. Which of the following signs would she expect to see?

Limb color blanches with elevation of the leg

The nurse administers nitroglycerin to a patient with acute coronary syndrome. Which of the following is the best explanation of the expected outcome?

Limiting the size of the infarction

Several steps characterize the development of atherosclerosis. Which is the correct order in which atheromas develop?

Lipoprotein oxidation, foam cells produced, fibrous plaques develop, a thrombus forms

The diagnosis is right-sided heart failure. The nurse knows that which organ is primarily affected in this type of heart failure?

Liver

A nurse is assessing a female client and notes that her left arm is swollen from the shoulder down to the fingers, with non-pitting edema. The right arm is normal. The client had a left-sided mastectomy one year ago. Which of the following does the nurse suspect is the problem?

Lymphedema

A nursing student is studying the respiratory airways in the lungs, in particular the alveoli. A fellow student asks which of the following cells is most instrumental in the destruction of foreign substances that may enter the alveoli with inspired air. The most accurate response would be alveolar which of the following?

Macrophages

Around three weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the following processes is most likely taking place?

Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.

Elderly people are very susceptible to pneumonia in all its varieties. The symptoms the elderly exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are elderly people with pneumonia less likely to experience than people with pneumonia in other age groups?

Marked elevation in temperature

The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?

Morphine

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent.

A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.

Mucous membranes

Dyspnea is defined as an uncomfortable sensation or difficulty in breathing that is subjectively defined by the client. Which of the following disease states is not characterized by dyspnea?

Multiple sclerosis

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on?

Mycobacterium tuberculosis

Which of the following health problems can contribute to diastolic dysfunction heart failure?

Myocardial hypertrophy

A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?

Myocardial infarction

A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?

Myocardial infarction

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention

The nursing instructor is explaining pressure changes that occur during inspiration to a group of students. Which would be the most appropriate information to include? During inspiration, intrapleural pressure is:

Negative in relation to alveolar pressure

Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?

Negative intrapleural pressure holds the lungs against the chest wall

A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that which of the following is the most likely cause of this infection?

Nosocomial hospital-acquired infection

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis.

Nosocomial pneumonia

A client is admitted to the hospital following smoke inhalation. The nurse would anticipate the need for cellular metabolism and that the client would need supplemental:

O2

A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.

Obesity Inactive lifestyle High salt consumption

Which of the following patients with cardiomyopathy does the nurse identify as having the greatest risk for a complication?

One with an ejection fraction of 25% and atrial fibrillation

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has severe persistent asthma?

PEF 350 ml in AM, 200 ml at noon, symptoms occur continuously

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has mild intermittent asthma?

PEF 400 ml in AM, 390 ml at noon, symptoms occur twice a week

A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has moderate persistent asthma?

PEF 450 ml in AM, 300 ml at noon, symptoms occur daily

COPD clients live with persistently elevated PCO2 levels. Therefore, which assessment finding would likely initiate a stimulus for ventilation in this client population?

PO2 level of 50 mm Hg

A nurse is monitoring the electrocardiogram (ECG) of a patient with a recent right ventricular infarction. The ECG reveals a first-degree arterioventricular (AV) block, which is characterized by which of the following?

PR interval >0.20 seconds

A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF?

Pancreatic

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments are most likely to be related and effective, respectively?

Parainfluenza virus, treated with a mist tent and oxygen therapy.

When a client with a history of asthma takes a walk outside on a windy day with high pollen counts, she may experience an asthma attack, resulting in an increase in respiration rate and wheezing. The body's response is likely related to which pathophysiological principle?

Parasympathetic nervous system stimulation resulting in airway constriction

A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo:

Percutaneous transluminal angioplasty and stent placement

Following surgery, a client had a chest x-ray that reported some opacities in the lung bases likely due to atelectasis. Which of the following pathophysiologic processes will result from this condition?

Perfusion without ventilation

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?

Pericardial effusion

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:

Pericardial effusion

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

Pericardial effusion

A pulmonary embolism occurs when there is an obstruction in the pulmonary artery blood flow. Classic signs and symptoms of a pulmonary embolism include dyspnea, chest pain, and increased respiratory rate. What is a classic sign of pulmonary infarction?

Pleuritic pain

A young adult is brought to the urgent care by a parent. The client states that he just does not feel good. Upon further assessment, the health care provider notes the following: • Unilateral chest pain when the client is asked to cough or move • Rapid respiratory rate • Splinting of the chest • Decreased tidal volume The provider would interpret these manifestations as:

Pleuritis

A short, nonsmoking 44 year old male presents to the emergency room with left-sided chest pain and a cough. He states the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, no cyanosis. Which condition is most likely causing his symptoms?

Pleuritis related to infection

Select the group of respiratory neuron that turns off inspiration and assists in the control of the respiratory rate.

Pneumotaxic center

A 40-year-old male presents to the emergency department reporting chest pain and shortness of breath. The health care provider suspects a pulmonary embolism and orders several diagnostic tests. Select the test that would require further follow-up.

Positive D-dimer

Which of the following occurs during repolarization?

Positively charged K+ moves outward across the cell membrane

Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs?

Potassium-sparing diuretics

A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure?

Prehypertension

A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patient's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this?

Preload

Which of the following factors represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?

Preload

Which of the following factors affect cardiac performance? Select all that apply.

Preload Afterload Myocardial contractility

The nurse is teaching a client diagnosed with heart failure about preload. Which of the following would be the most appropriate information to provide?

Preload represents the volume work of the heart.

The nurse is caring for a client who has a positive tuberculin test and a negative chest x-ray. The most appropriate treatment for the client would be:

Prophylactic treatment with isoniazid

A newly admitted critical head injury client presents to the neuro-ICU. The client is unresponsive to painful stimuli but able to breathe on his own. As the shift progresses, the nurses note a decrease in the client's respiratory effort. The client cannot maintain his O2 saturation above 70%. The nurses should anticipate assisting in beginning what type of pulmonary support?

Prepare for mechanical ventilation.

The nurse caring for a patient 12 hours post coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which of the following should the nurse do next?

Prepare for pericardiocentesis

Which of the following best describes the pressure that drives breathing?

Pressure in the pleural cavity

A nurse is caring for a patient with a new diagnosis of rheumatic fever. Which of the following is the highest priority goal of treatment during the acute phase?

Prevent cardiac complications

The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?

Propranolol, a β-Adrenergic blocker.

A 75-year-old man presents at the clinic for a routine physical checkup. He is found to be hypertensive. While taking his blood pressure in the sitting, standing, lying positions, the nurse notes that the brachial artery is pulseless at a high cuff pressure, but she can still feel it. What condition would the nurse suspect?

Pseudohypertension

The heart consists of four valves. Which are the semilunar values? Select all that apply.

Pulmonary Aortic

The nurse is educating a client suffering from advanced emphysema on how to improve expiratory flow rates. Which of the following breathing techniques would the nurse describe as most effective?

Pursed-lip breathing

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Raising the head of the bed to a high Fowler's position

Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD?

Rapid and shallow breathing and chest retractions

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?

Rapid onset of profound malaise

An intensive care unit nurse is caring for a 50-year-old client who was admitted 8 hours before, following an anterior wall myocardial infarction (MI). The nurse notes frequent premature ventricular complexes on the client's ECG monitor and is concerned that the client could develop a lethal arrhythmia if one of the premature ventricular complexes fires just after which of the following?

Relative refractory period ends

A client is experiencing circulatory shock. The nurse is aware that compensation will occur with stimulation of the beta-2 (β2) receptors. The nurse anticipates the client will experience:

Relaxation of the bronchioles

Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis?

Release nitric oxide

A patient is admitted to the outpatient diagnostic unit for further testing to identity the cause of the uncontrolled secondary hypertension. In preparation, the nurse should anticipate that which of the following diagnostic procedures will provide the most definitive diagnosis?

Renal arteriography.

A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?

Renal artery stenosis

Which of the following diagnoses puts a patient at risk for developing an immunologic form of interstitial lung disease?

Rheumatoid arthritis

Which type of lung receptor monitors for lung inflation?

Stretch

Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node - AV node - bundle of His - bundle branches - Purkinje fibers

A 16 year old adolescent who received a kidney transplant at the age of 10, has recently developed a trend of increasing BP readings. Of the following list of medications, which may be the primary cause for the development of hypertension?

Sandimmune (Cyclosporine).

Which conditions increase client risk for developing pulmonary arterial hypertension (PAH)? Select all that apply.

Scleroderma HIV infection Family history

A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions?

Sclerotherapy or surgery

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?

See the doctor for evaluation immediately.

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock?

Septic

The diagnosis of chronic stable angina is based on a detailed pain history, the presence of risk factors, invasive and noninvasive studies, and laboratory studies. What test is not used in the diagnosis of angina?

Serum biochemical markers

A child is brought to the emergency department struggling to breathe with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following is the most likely diagnosis?

Severe asthma attack

Patients with chronic diseases such as chronic obstructive pulmonary disease (COPD), when given oxygen at a level that increases PO2 above 60 mmHg would experience which of the following?

Severely depressed ventilation

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?

Severity and duration of shock

Clients who have been bed-ridden for a long time likely will experience:

Shallow, quiet breathing, which impairs the spreading of surfactant

A client who presented with shortness of breath and difficulty climbing stairs has been diagnosed with pulmonary fibrosis, a disease characterized by scarring of the alveoli. Upon assessment of the lungs, what clinical manifestations should the nurse expect?

Short, shallow breaths.

A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which of the following drugs will the nurse anticipate administering first?

Short-acting beta 2-adrenergic agonists such as albuterol (SABA)

If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern?

Slowing of heart rate to below 60 beats/minute

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which of the following possible diagnoses?

Small cell lung cancer due to smoking history

Which of the following is the site of chylomicron synthesis?

Small intestine

Which one of the following organs are the two primary sites of lipoprotein synthesis?

Small intestine and liver

When trying to explain to a new dialysis patient the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:

Small openings that allow large amounts of smaller molecular substances to filter through the gomeruli.

Which would be the most appropriate measurement tool to determine lung volume and lung capacity of a patient?

Spirometer

A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.

Staphylococcus aureus

The health care provider is concerned that a client has developed a decrease in cardiac output. Cardiac output may be calculated as:

Stroke volume × heart rate

A client reports chest pain to the nurse. Which characteristics of the pain indicate pleuritis?

Sudden sharp pain in one side made worse by deep breathing

Which description of the onset of symptoms is most characteristic of epiglottitis?

Suddenly onset

The nurse develops a plan to prevent atelectasis in a postsurgical client. Which intervention will be effective?

Supervision of hourly deep breathing exercises

Select the primary function of bronchial circulation.

Supplies the blood supply for the conducting airways and supporting structures

A neonate delivered at 36 weeks gestation is in respiratory distress and requires ventilation. Tests reveal prematurity of the lungs and an underdevelopment of Type II alveolar cells. Based on these results the nurse will anticipate the administration of which of the following to improve respiratory function?

Surfactant

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?

Sustained systolic pressure equal to or greater that 160 mm Hg

A nurse is evaluating a client to determine the effectiveness of medications given to reduce left ventricular afterload. Which hemodynamic parameter is most appropriate for the nurse to monitor?

Systemic vascular resistance (SVR)

A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure?

Systemic vasoconstriction maintained the diastolic pressure.

A client says that when the hospital checked his blood pressure after he lost a lot of blood in a work-related accident, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. Why is this?

Systemic vasoconstriction maintained the diastolic pressure.

The nurse is assessing the ECG of a client who is experiencing unstable angina. The nurse observes:

T-wave changes

After an acute myocardial infarction, the client undergoes a cardiac catheterization which demonstrates severe atherosclerosis. The practitioner reviews the labs and finds the client has no HDL. Which of the following conditions does the client exhibit?

Tangier disease

A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:

Tearing or ripping-type pain in the chest or back

A patient's oxygen-hemoglobin dissociation curve is represented by a shift to the right. The nurse recognizes this as:

The affinity of hemoglobin for oxygen is decreased.

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which of the following characteristics of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?

The cells have a poorly defined sarcoplasmic reticulum.

An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG?

The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.

During an assessment of a client with ankle swelling, the nurse observes jugular venous pulsations 5 cm above the sternal angle when the head of his bed is elevated 45 degrees. Which of the following is the correct interpretation of this finding?

The client has increased pressure related to right heart failure.

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relate to these health problems?

The client is 89 years old and takes a diuretic medication for his congestive heart failure.

The client has been diagnosed with Raynaud disease. Which treatment measure will the nurse teach the client?

The client must protect the entire body from cold, not just the extremities.

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring?

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

The nursing instructor is teaching the students about rheumatic fever. She tells the students that it is an important cause of heart disease and is very serious mainly for which reason?

The disabling effects that result from involvement of heart valves

The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?

The kidneys

A client presents to the physician's office with a chronic cough, shortness of breath, and wheezing that has gotten progressively worse, with recent episodes of hemoptysis. Diagnostic tests reveal a lung mass. Based on these symptoms, the nurse is anticipates which of the following has occurred?

The lesion has eroded blood vessels in the lungs.

Where in the body is lipoprotein synthesized? (Select all that apply.)

The liver The small intestine

A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response?

The most common cause is a staph infection.

A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter?

The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

A 76-year-old male client is admitted to the emergency department after a fall. His assessment reveals a bruised left hip, shortness of breath, and shallow respirations with a respiratory rate of 30. What additional physical assessment finding would lead to a possible diagnosis of tension pneumothorax?

The presence of a deviated trachea

Analysis has shown that a client's right atrial pressure is 30 mmHG. What is the most likely conclusion that the client's care team will draw from this piece of data?

The pressure is excessive given that the right atrium should be at atmospheric pressure.

Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease?

The pulse decreases rather than increases in amplitude.

The nurse is teaching a group of nursing students about exudative pleural effusion. The nurse determines that teaching was effective when the students' state:

The specific gravity of the pleural exudate is greater than 1.020.

Select the statement that best describes pneumococcal infection.

The spread of some strains of pneumococci is through healthy colonized individuals.

A client arrives in the clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?

The use of antibiotics

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

A client asks the nurse what anatomic airway dead space is. Which of the following would be the nurse's best response?

The volume of air contained in the nose, pharynx, trachea, and bronchi

A patient has developed disseminated intravascular coagulation (DIC). The nurse knows that which statements regarding DIC are true? Select all that apply.

Thrombotic occlusion occurs in small and midsized blood vessels. Bleeding may accompany coagulation. Generation of thrombin increases. Endogenous anticoagulation mechanisms are suppressed.

The nurse is calculating the minute volume of a patient. Select the correct categories of measurement.

Tidal volume × respiratory rate

Following a winter power outage, a client who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning?

To increase the amount of oxygen carried in the dissolved state

A nurse experiences a person having seizure activity in the grocery store. Once the seizure activity has subsided the nurse places the person in a side lying position to avoid occlusion of the airway, which could cause cessation of ventilation due to which of the following?

Tongue falling back and blocking the airway

Clients with chronic obstructive lung disease (COPD) may experience airway closure at the end of normal instead of low lung volumes, which result in:

Trapping of large amounts of air that cannot participate in gas exchange

Which serum biomarker is highly specific for myocardial tissue?

Troponin

A patient has sustained a lung injury while hospitalized for the treatment of acute pancreatitis. The nurse anticipates that proliferation of cells will result from which of the following?

Type II alveolar cells

The nurse is caring for a patient with adult respiratory distress syndrome. The nurse knows that the pathophysiology of this disorder is related to what type of pulmonary alveolar cells?

Type II alveolar cells

The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following?

Unknown

A nurse is caring for a child with an airway obstruction. It is most important for the nurse to avoid:

Using a tongue depressor to assess the child's tonsils

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?

Vasoconstrictive drugs

An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by:

Vegetative emboli traveling in the blood stream to the lungs

During an automobile accident where the patient is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need?

Veins

A nurse is conducting a class on healthy living with COPD and presents potential complications with the disease. Many clients with COPD have bronchospasms, airway inflammation, and excess mucus production which contribute to obstruction to the alveoli. Which of the following physiologic conditions could result from the obstruction?

Ventilation perfusion mismatch

A 44-year-old woman has developed calf pain during a transatlantic flight. She is extremely short of breath upon arrival at her destination. She was subsequently diagnosed with a pulmonary embolism (PE) which resolved with anticoagulant therapy. Which of these statements best characterizes the underlying problem of her PE?

Ventilation was occurring but perfusion was inadequate causing shortness of breath.

The cardiac cycle describes the pumping action of the heart. Which statement is correct about systole?

Ventricles contract and blood is ejected from the heart.

A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis?

Ventricular dilation and wall tension are significantly lower than normal.

A 60-year-old male hospital patient with a diagnosis of chronic obstructive pulmonary disease (COPD) is undergoing lung function tests to gauge the progression of his disease. Which of the following aspects of the lung volumes will the respiratory therapist be most justified in using to guide interpretation of the test results?

Vital capacity will equal the patient's combined inspiratory reserve, expiratory reserve, and tidal volume.

Which of the following is a function of the bronchial circulation?

Warms and humidifies incoming air

The nurse is educating a group of school-age students about the prevention of cold viruses and staying healthy during the school year. What should the nurse inform the students is one of the most important ways for them to avoid spreading a cold?

Wash your hands after touching surfaces prior to touching your nose or eyes.

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by:

Weighing every day at the same time with same type of clothing

A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have?

Will prevent the conversion of angiotensin I to angiotensin II

Which of the following statements most accurately captures a principle of blood flow?

With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow.

A patient is admitted with pneumoconiosis. His history most likely reveals which of the following?

Work in a coal mine for 20 years

A client with chronic asthma is experiencing a severe asthma attack and is becoming increasingly agitated. The nurse supports the client's ability to move more air in and out of the lungs by instructing the client to stabilize his accessory muscles. The nurse understands that by stabilizing the accessory muscles the:

accessory muscles can assist in ventilation.

A group of nursing students is discussing ventricular arrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:

decreased ventricular filling time.

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms

A nursing student is studying the properties of cardiac rhythm to better understand what causes arrhythmias to occur. The student begins to understand that there is a programmed ability for certain cells to conduct impulses. Interruption in this ability can result in abnormalities of cardiac rate and rhythm; this property would be:

conductivity.

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that:

cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant.

The nurse is caring for an infant with a large ventricular septal defect, also called a hole in the heart, which is a congenital heart defect causing a right to left shunt. The nurse illustrates for the parents how this compromises their child's ability to deliver oxygenated blood to the tissues causing

cyanosis secondary to an anatomic shunt.

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the patient's following statements indicates a need for further health-promotion teaching? Select all that apply

• "I'm resolving to eat organic foods from now on." • "I will drink at least eight glasses of water every day."

The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:

decreased afterload.

A client reports chest pain to the nurse. Which characteristics of the pain indicate bronchial irritation?

dull pain in mid-chest that is worse when coughing

A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client:

has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.

The nurse is caring for a client admitted with carbon monoxide (CO) poisoning. The client is extremely agitated, dyspneic, and confused. The nurse understands that the treatment of choice would be a hyperbaric chamber with 100% oxygen administration which will:

increase the amount of oxygen in the dissolved state.

A client admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) asks the nurse what can be done to decrease the dyspnea. The nurse instructs the client to use pursed-lip breathing (PLB) to help keep airways open by:

increasing intrapulmonary pressures.

Which client will the nurse see first? The client with

refractory asthma, PEF 210 ml out of best PEF 450 ml, diminished wheezing.

Which client is showing signs of chronic hypoxemia? A client who is

restless, has clubbed fingers, and frequently drops items.

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

septic shock

The nurse is caring for a client with end stage chronic obstructive pulmonary disease (COPD). The client is extremely agitated and dyspneic, demanding that the oxygen be turned all the way up. The nurse states that this situation must be very frustrating for the client and then explains that the consequence of increasing the oxygen could cause:

serious depression of respirations.

Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)? The client who is

sitting in bed resting elbows on overbed table, expiratory wheezes noted.

A young child is brought to the ER with CPR in progress. The parent found the child lying on the kitchen floor without respirations, although a heartbeat was initially detected. The triage nurse anticipates the most likely cause of the situation is an obstruction of the conducting airways which caused an interruption in

ventilation

Mitral valve prolapse occurs frequently in the population at large. Its treatment is aimed at relieving the symptoms and preventing complications of the disorder. Which drug is used in the treatment of mitral valve prolapse to relieve symptoms and aid in preventing complications?

Β-Adrenergic-blocking drugs

A 10-year-old male is experiencing an acute exacerbation of his asthma. The most appropriate treatment for this client would be:

β-adrenergic agonist

While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply.

• "Antiprotease production and release is not adequate to neutralize the excess protease production." • "There is α1-antitrypsin deficiency, so this enzyme can't protect the lung from damage."

A 75-year-old patient is being evaluated for heart failure. Which questions will the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply.

• "Do you easily get tired?" • "Do you have swelling in your ankles?" • "Are you feeling depressed?" • "Do you get up often during the night to urinate?"

A client arrives at the clinic stating he is having "terrible headaches." What questions would be appropriate for the nurse to ask that may indicate the headaches are related to sinusitis? Select all that apply.

• "Does bending forward exaggerate the headache?" • "When you sneeze, does it make the headache worse?" • "Does your neck feel stiff along with the headache?"

Which of the following instructions should the nurse give to a patient with a new prosthetic mitral valve? Select all that apply.

• "Expect to take prophylactic antibiotics for dental work." • "Lifelong anticoagulants are necessary to prevent blood clots."

A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply.

• "I seem to have some difficulty swallowing food... this is new for me." • "Can you feel how large my lymph nodes are on my neck and armpits (axillae)?"

Upon admission to the ICU, a patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure? Select all that apply.

• +4 pitting edema in lower extremities. • Jugular vein distension. • Altered level of consciousness.

Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply.

• A 47-year-old waitress who works 12-hour shifts three or four times/week • A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week

Which of the following clients are at risk for venous thrombosis? Select all that apply.

• A client on bed rest after an acute myocardial infarction • A client taking oral contraceptives • A client who has had total hip replacement surgery

Which assessment findings may indicate that the acute rhinosinusitis is experiencing a complication? Select all that apply.

• Abnormal extraocular movements • Changes in mental status

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following events in the etiology of CF in ascending chronological order. Use all the options.

• Airway obstruction • Recurrent pulmonary infections • Impaired Cl- transport • Decreased water content of mucociliary blanket • Increased Na+ absorption

When CO2 levels in the blood rise, a state of hypercapnia occurs in the body. What factors contribute to hypercapnia? (Select all that apply.)

• Alteration in carbon dioxide production • Abnormalities in respiratory function • Disturbance in gas exchange function • Changes in neural control of respiration

When a client suffers from a pericardial effusion which of the following are considered to be factors that will influence what effects it will have on cardiac function? Select all that apply.

• Amount of fluid • Rapidity with which it accumulates • The elasticity of the pericardium

The nurse knows that which of the following drugs can cause secondary hypertension? Select all that apply.

• Amphetamines • Decongestants • Oral contraceptives • Cocaine

The nurse caring for a premature infant explains to the parents that the lack of type II alveolar cells in their baby's lungs will contribute to which of the following? Select all that apply.

• An interference in alveolar ventilation • An interference in pulmonary ventilation • An increase in alveolar collapse

A client diagnosed with influenza asks the nurse what treatment he can do to feel better. The nurses' response should include: Select all that apply.

• Analgesics • Cough medicine • Antiviral medication • Rest

What can trigger myocardial ischemia even when there is adequate coronary blood flow? Select all that apply.

• Anemia • Carbon monoxide poisoning • Hypoxia

A client with cystic fibrosis reports sinus congestion and coughing up thick greenish mucus. What interventions will the nurse implement? Select all that apply.

• Antibiotic therapy • Chest physiotherapy

A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply.

• Antihypertensives • Psychotropics • Diuretics

The circulatory system can be divided into two parts. What does the systemic circulation include? Select all that apply.

• Aorta • Capillaries

A client with a history of chronic obstructive pulmonary disease (COPD) has developed influenza. Which statements about possible treatments is accurate for this client. Select all that apply.

• At the onset of influenza-like symptoms, the client is eligible to begin antiviral medications within the first 36 hours. • The antiviral drug of choice is oral oseltamivir.

A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply.

• Audible wheezing • Respiratory rate—44 with prolonged exhalation • Sitting upright, leaning forward, and using accessory muscles to breathe

Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.

• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors

The nurse has just completed a respiratory assessment on a postoperative patient who has undergone repair of a large abdominal aneurysm. Which conditions may impair the patient's cough reflex? Select all that apply.

• Bed rest • Muscle weakness • Surgery • Paralysis

Two weeks after receiving a prosthetic mitral valve, a patient presents to the emergency department with fever, anorexia, and splinter hemorrhages of the nails. Which of the following interventions will the nurse implement? Select all that apply.

• Blood cultures • Antibiotics • Monitoring for emboli

A patient is diagnosed with gestational hypertension. The nurse recognizes which of the following as characteristic of this condition? Select all that apply.

• Blood pressure greater than 140/90 • Development after 20th week of pregnancy • Blood pressure back to normal by 12 weeks postpartum

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply.

• Bluish discoloration of the skin and mucous membranes (central cyanosis) • Substernal retractions with each breathe • Expiratory grunting

Which clients are at greatest risk of developing an occupational lung disease? Select all that apply.

• Bricklayer • Coal miner • Farmer • Flour miller

A patient who is taking a diuretic asks the nurse to explain how a drug which makes her urinate more frequently can help her hypertension. The nurse will explain that diuretics exert their antihypertensive action in which ways? Select all that apply.

• By decreasing vascular volume by increasing sodium and water excretion • By reducing peripheral vascular resistance

As the needs of the body change, the heart's ability to increase output needs to change too. This ability in the heart depends on what factors? (Select all that apply.)

• Cardiac contractility • Heart rate • Preload • Afterload

What etiologic determinants are important in the development of the pneumoconioses? (Select all that apply.)

• Chemical nature of the dust particle • Size of dust particle • Ability of particle to incite lung destruction

The nursing student correctly identifies which of the following as major risk factors for coronary artery disease? Select all that apply.

• Cigarette smoking • Elevated LDL • Diabetes • Abdominal obesity

Which of the following conditions reflect failure of the circulatory system? Select all that apply.

• Circulatory shock • Heart failure

While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the flu shot? Select all that apply.

• Client with allergy to eggs • Client with Guillain-Barre syndrome

A client has developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia? Select all that apply.

• Coexisting health problems • Age • Severity of illness

Some nursing students are studying normal respiratory physiology in relation to stimulation of the sympathetic nervous system. As they reflect on the fight or flight syndrome, they determine that which of the following would happen? Select all that apply.

• Dilation of the bronchioles • Blood vessel constriction

A patient is diagnosed with heart failure. Which of the following types of drugs is to be used to manage this disorder? Select all that apply.

• Diuretics • Digitalis • Beta-adrenergic blockers • Angiotensin-converting enzyme inhibitors (ACEI)

A client presents with atypical pneumonia signs/symptoms and is diagnosed with Mycoplasma pneumoniae. For which characteristics of the cough should the nurse assess this client? Select all that apply.

• Dry • Nonproductive • Hacking

A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? Select all that apply.

• Dyspnea • Peripheral cyanosis • Syncope

What manifestations would the nurse expect to find when assessing a client with a right pleural effusion? Select all that apply.

• Dyspnea on exertion • Diminished right breath sounds • Hypoxemia

The client has been diagnosed with venous insufficiency after having a deep vein thrombosis (DVT). Which signs and symptoms would the nurse expect to see? Select all that apply.

• Edema • Brown pigmentation of the skin • Status dermatitis

A patient exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which of the following tests are suggested to support a diagnosis of heart failure? Select all that apply.

• Electrocardiogram (EKG) • Cardiac computed tomography (CCT) • Echocardiography • Chest x-ray

Which of the following changes associated with aging contributes to heart failure development in older adults? Select all that apply

• Elevated diastolic BP. • Increased vascular stiffness.

A client admitted to the hospital with aspiration pneumonia subsequent to having a recent stroke is requesting an antitussive medication to stop her productive cough. The nurse explains to the client that the purpose of her cough is which of the following? Select all that apply.

• Expel excess secretions • Protect the lungs • Remove foreign aspirate

A client admitted to the hospital with symptoms of Digoxin toxicity is told that a cardiac monitor will be necessary during the admission because the client may develop which of the following? Select all that apply.

• Failure of the SA node • Incessant atrial tachycardia • Atrial fibrillation

A nurse teaching a patient about atherosclerosis identifies which of the following as major risk factors that can be affected by a change in health care behaviors? Select all that apply.

• High blood cholesterol levels • Cigarette smoking • Obesity • Hypertension

Which factors increase the risk that a client will develop chronic obstructive pulmonary disease (COPD)? Select all that apply.

• History of asthma • History of tobacco use

The diagnosis is left-sided heart failure. The nurse knows that the most common causes of left-sided failure include which of the following? Select all that apply.

• Hypertension • Acute myocardial infarction

All of the following clients are exhibiting manifestations of a common cold. At the pharmacy, the pharmacist should advise which clients to avoid decongestant drugs from over-the-counter? Client with a history of: Select all that apply.

• Hypertension • Cardiac disease

Which of the following statements regarding hypertension are correct? Select all that apply.

• Hypertension is one of the most common health problems for adults. • Hypertension is more frequent among younger men than in younger women. • Hypertension is a major risk factor for cardiovascular disease.

Cardiomyopathies are classified as either primary or secondary. The primary cardiomyopathies are further classified as genetic, mixed, or acquired. Which of the following are genetically based? (Select all that apply.)

• Hypertrophic cardiomyopathy • Left ventricular noncompaction

Which of the following statements are true regarding the parasympathetic nervous system and its effect on the cardiac system? Select all that apply.

• It innervates the heart. • Its effects are facilitated by the vagus nerve. • Bradycardia is a result of this system.

A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response?

• It is a defect of the mitral valve which causes obstruction of blood flow.

The nurse is evaluating a client who is in her last month of pregnancy and at risk for peripartum cardiomyopathy. Select the most appropriate information for the nurse to consider. Select all that apply.

• It is a dilated cardiomyopathy. • It is a disorder that can occur in the last month of pregnancy. • The incidence is greater in women with twin fetuses.

An acutely ill patient is developing multiple organ dysfunction syndrome (MODS). The nurse knows that which statements regarding multiple organ dysfunction syndrome are true? Select all that apply.

• Organs affected include kidneys, lungs, liver, brain, and heart. • Homeostasis is disrupted. • Risk factors for development of MODS include severe trauma, hepatic dysfunction, and prolonged hypotension. • Treatment is primarily supportive of the affected organs.

A client is brought to the emergency department presenting with symptoms of ACS (acute coronary syndrome). Select the most important interventions that should be implemented. Select all that apply.

• Oxygen • Morphine • Nitrates • ECG monitoring • β-adrenergic blocking agents

A 70-year-old client with a past medical history of diabetes type II and myocardial infarction (MI) is admitted to the hospital with sudden shortness of breath and palpitations. As the nurse is doing the admission assessment she notices that the apical pulse is very irregular with no pattern, vital signs include a heart rate of 130 and blood pressure of 100/60. The nurse suspects atrial fibrillation (AF) for which of the following reasons? Select all that apply.

• Palpitations • Irregular-irregular rhythm • Tachycardia

Community-acquired pneumonia can be categorized according to several indexes. What are these indexes? (Select all that apply.)

• Radiologic findings • Age • Presence of coexisting disease

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is distinguishable between the two by the extent of hypoxemia involved. What is the clinical presentation of ARDS? (Select all that apply.)

• Rapid onset • Increase in respiratory rate • Hypoxemia refractory to treatment

The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply.

• Rapid, shallow breathing • Chest retractions with accessory muscle use • Clubbing of the fingers

A 45-year-old woman with a diagnosis of multiple sclerosis comes to the clinic complaining of coldness and pain in her fingers. She says that her fingers turn blue, and then her fingers get red, and they throb and tingle. The nurse would expect what diagnosis and treatment for this client? (Select all that apply.)

• Raynaud disease; protecting the digits from cold • Raynaud phenomenon; stop smoking

A nurse is providing care for a client who has been admitted to a medical unit with a diagnosis of bronchiectasis. Which of the following signs and symptoms should the nurse expect to find during physical assessment of the client and the review of the client's history? Select all that apply:

• Recurrent chest infections • Production of purulent sputum • Low hemoglobin levels

The nurse is caring for a client who is in the hospital with adult respiratory distress syndrome (ARDS) caused by a near drowning and the client wants to know why he is having such difficulty breathing. The most accurate explanation would be that the dyspnea is caused by a lack of alveolar surfactant which is essential to:

• Reduce surface tension in the alveoli. • Increase lung compliance. • Prevent end-expiratory alveolar collapse. • Regulate the immune system in the lungs.

A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply.

• Renal failure • Coronary artery disease • Dementia • Loss of vision

Aortic aneurysms take varied forms and can occur anywhere along the aorta. What are the types of aneurysm termed abdominal aortic aneurysms? (Select all that apply.)

• Saccular aneurysms • Fusiform aneurysms

A COPD patient asks the nurse which of the following medications is prescribed to help their breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help their COPD in the long-term. Select all that apply.

• Salmeterol (Serevent), a bronchodilator. • Tiotropium (Spiriva), anticholinergic.

After a long bout with vomiting and diarrhea, a patient is suspected to be in hypovolemic shock. Which of the following signs and symptoms will the nurse evaluate to substantiate this diagnosis? Select all that apply.

• Tachycardia • Acidosis • Apprehension

A client is admitted to hospital to rule out Legionnaire disease following a canoe trip where he was sprayed in the face with a lot of "creek" water. Which of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

• Temperature of 103.5°, pulse 80 • "Talking but not making a lot of sense" (confusion) • Chest x-ray that reveals areas of consolidation suggestive of pneumonia

While studying the physiology of the heart, the nursing students have learned that which of the following influence the blood flow in the coronary vessels that supply the myocardium? Select all that apply.

• The aortic pressure • Autoregulatory mechanisms • Compression of the intramyocardial vessels

The nurse knows that which of the following statements regarding the arterial chemoreceptors are correct? Select all that apply.

• The chemoreceptors can induce widespread vasodilation. • The main function of the chemoreceptors is in regulation of ventilation. • The chemoreceptors trigger increased blood pressure in persons with sleep apnea. • The chemoreceptors induce systemic hypertension in persons with chronic obstructive pulmonary disease (COPD).

A child is having symptoms of spasmodic croup again after a previous admission to the hospital for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education received by the nurse at the hospital? Select all that apply.

• The parent brings the child into the bathroom where a warm shower is running to provide humidification. • The parent takes a child outside in the cool air. • The parent turns on the cold water room humidifier in the child's room.

The nurse is caring for an adult client diagnosed with acute rhinosinusitis. The nurse anticipates that the client will more than likely receive prescriptions for which medications? Select all that apply.

• Topical alpha-adrenergic decongestant • Guaifenesin • Intranasal corticosteroid

When a physician suspects a patient has suffered an acute myocardial infarction, which serum biomarkers should he order? Select all that apply.

• Troponin 1 • Creatine kinase • Troponin T

The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?

Reduced ventricular efficiency

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:

"Aspirin will help prevent blood clotting."

A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction?

"Because smoking causes a permanent increase in your risk of heart disease, it's best not to start."

Knowing the high incidence and prevalence of heart failure among the elderly, the manager of a long term care home has organized a workshop on the identification of early signs and symptoms of heart failure. Which of the following teaching points is most accurate?

"Displays of aggression, confusion and restlessness when the resident has no history of such behavior can be a sign of heart failure."

During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this?

"Essentially, experts don't really know why so many pregnant women develop high blood pressure."

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

A patient arrived at the emergency department two days after the development of "chest pressure" and "tightness" that the patient treated with antacids thinking it was indigestion. Their enzymes show a massive myocardial infarction (MI). Following angioplasty, the patient asks why so much muscle was damaged if only one vessel was blocked, the left circumflex. The nurse responds:

"If a major artery like the circumflex is occluded, the smaller vessels supplied by that vessel cannot restore the blood flow."

A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, "I've always been healthy and I can't believe I have a disease now." What would be her physician's most appropriate response?

"If you make sure to keep yourself warm, it will have a fairly minimal effect; I'll also give you pills to enhance your circulation."

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?

"Once you have varicose veins, there's little that can be done to reverse them."

When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements?

"One consequence of this type of block is a very slow heart rate that limits circulation to the brain."

A nurse educator is teaching a group of nurses at a long term care facility about atrial fibrillation in light of its prevalence in older adults. Which of the following statements by the nurses would the educator most want to correct?

"The contraction of the ventricles and the atria can range from 400-600 beats per minute."

As part of their orientation to a cardiac care unit, a group of recent nursing graduates is receiving a refresher in cardiac physiology from the unit educator. Which of the following teaching points best captures a component of cardiac function?

"The diastolic phase is characterized by relaxation of ventricles and their filling with blood."

As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Recognizing that the common cold is a frequent source of ailment, the nurse is addressing this health problem. Which of the following teaching points about the common cold is most accurate?

"Use caution when choosing over the counter drugs for your cold; most people do best with rest and anti-fever medications."

Nitroglycerin is the drug of choice in treating angina. What does nitroglycerin release into the vascular smooth muscle of the target tissues?

Nitric oxide

A local athlete is getting prepared for the upcoming national track and field championships. Since this athlete is performing extreme exercise, what would be the most probable cardiac output?

16 to 36 L/minute

The heart is a four-chambered muscular pump. In one day, how many gallons of blood are pumped throughout the body?

1800

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion?

20 mL/ hour

What is the normal range for an arterial blood gas pH?

7.35 - 7.45

Blood flow in the circulatory system depends on a blood volume that is sufficient to fill the blood vessels and a pressure difference across the system that provides the force to move blood forward. What is the total blood volume in an adult?

70 to 75 mL/kg

The nurse is assessing the blood pressure of a client who is experiencing cardiogenic shock. Which of the following blood pressure readings is most likely?

90/75

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?

A 51-yearold male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first?

Administer epinephrine (adrenaline).

Select the priority of care for the medical management of a client with a dissecting aortic aneurysm.

Administration of sodium nitroprusside and β-adrenergic blocking medications

Which client with a diagnosis of asthma is at greatest risk for developing an asthma attack?

Adult with a respiratory virus and reflux

Of the following factors, which one represents the contractile force used by the muscle in order to move blood into the aorta?

Afterload

A prison inmate contracted tuberculosis during a recent outbreak. The nurse caring for these inmates correctly identifies which of the following as the mode of transmit for this disease?

Airborne droplets

What description is characteristic of the pathology of chronic bronchitis?

Airways are obstructed by mucus, causing hypoxemia.

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?

As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture.

The nurse is assessing a client for early signs of constrictive pericarditis. The most likely manifestation would be:

Ascites

A client is suffering from severe gastroesophageal reflux disease (GERD) and has been admitted to the hospital with a diagnosis of pneumonia. Which of the following would be the most likely cause for the development of pneumonia?

Aspiration

An elderly client recently had a cerebrovascular accident that resulted in dysphagia. Which of the following is the nurse's greatest concern while feeding this client?

Aspiration

The parents of an infant bring the child to the emergency room three hours after they put the child to bed in apparent good health. The child is restless, the pulse is 140 beats/ minute, and lung sounds are diminished in all lung fields with intercostal retractions. What is the most likely cause of these symptoms?

Asthma

A patient with a 25-year history of smoking is diagnosed with emphysema. Physical assessment reveals an increased anterior-posterior chest diameter. Which of the following terms should the nurse use to document this finding?

Barrel chest

A client's echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:

Bicuspid valve

An 81-year-old female client of a long term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition?

Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

In pregnancy, which of the following data are diagnostic for pre-eclampsia and eclampsia?

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition?

Blood pressure in arms 20 mm Hg higher than in the legs

The nurse is caring for a client suffering from multiple pulmonary embolisms who is concerned that her lungs will be permanently destroyed. The nurse reassures the client that collateral circulation is formed to protect the lung tissue until the embolisms resolve by means of:

Bronchial blood vessels.

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?

Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract.

An infant born 10 weeks premature was placed on mechanical ventilation. Eight weeks later a nursing assessment reveals a barrel chest, tachycardia, rapid and shallow breathing, hypoxemia, hypercapnia, and poor weight gain. Based on this assessment which of the following is the most likely diagnosis?

Bronchopulmonary dysplasia

There are three main atrial pressure waves that occur during the cardiac cycle. What are the three main atrial pressure waves? Select all that apply.

C A V

The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock?

Cardiogenic

Tuberculosis is a highly destructive disease because the tubercle bacillus activates a tissue hypersensitivity to the tubercular antigens. What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person?

Caseating necrosis and cavitation

A nurse is assessing a client and becomes concerned that the client may be experiencing heart failure. Which of the following would be the best indicator to determine pressure being exerted on the right side of the heart?

Central venous pressure

The nurse determines that the client has clubbing of the fingertips. Which is the best intervention?

Check the patient's O2 saturation level.

Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?

Chemical mediators are released from pre-sensitized mast cells.

A patient is diagnosed with pulmonary embolism. Which of the following symptoms would most likely be present?

Chest pain and dyspnea

A client with hypercapnia needs to increase calorie intake without increasing work of breathing. What menu selection is the best choice?

Chicken salad, refried beans, and guacamole

A client has developed chronic hypoxia and has developed pulmonary hypertension (HTN). The nurse recognizes that the most likely cause of pulmonary hypertension would be:

Constriction of the pulmonary vessels in response to hypoxemia

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

Constrictive pericarditis

A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be:

Continuous measurement of urine output

If a virus has caused inflammation resulting in endothelial dysfunction, an excessive amount of endothelins in the blood can result in:

Contraction of the underlying smooth muscles within the vessels.

The heart controls the direction of blood flow. What is the role of the aortic valve?

Controls the direction of blood flow from the left side of the heart to the systemic circulation

Following a hypertensive crisis, a client's family asks, "Why are the client's eyes so bloodshot?" The nurse responds that high arterial pressure:

Damages more fragile blood vessels like those in the eyes to the point of rupture

The nurse is discussing hypertension with a group of patients. The nurse knows that which of the following statements regarding hypertension are true? Select all that apply.

Diabetes can lead to secondary hypertension. Family history of hypertension is a risk factor for hypertension.

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.

Diastolic dysfunction

A patient has developed pericarditis. The nurse knows that this condition will increase the risk for development of which condition?

Diastolic dysfunction

The nurse knows that persons with atrial fibrillation are at risk of developing which of the following?

Diastolic dysfunction

The nurse practitioner working in an overnight sleep lab assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient's blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

During apneic periods the patient experiences hypoxemia which stimulates chemoreceptors to induce vasoconstriction.

A client is preparing to travel for business and has developed the common cold. The client informs the nurse that she will be flying and does not want to give it to anyone else. When should the nurse inform the client is the most highly contagious period?

During the first 3 days after the onset of symptoms

A client who has no previous history of respiratory disease describes a sensation of shortness of breath and the feeling of not being able to pass enough air during exercise that has just developed over the past month. The client would be documented as having which of these?

Dyspnea

The pulmonary rehabilitation specialist is educating medical students on a respiratory disease process that causes a severe compromise in exhalation due to air trapping. Air trapping is caused by the loss of elastic recoil, especially in the alveoli, which occurs after overstretching in which of the following diseases?

Emphysema

A client who was hospitalized with bacterial pneumonia has now developed an infection in the pleural cavity. The nurse would recognize this as:

Empyema

Hypertension is a risk factor for atherosclerosis. The nurse knows that which of the following is the initial lesion in the pathogenesis of atherosclerosis?

Endothelial damage

A 3 year old child with right-sided heart failure has been admitted for worsening of their condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler?

Enlargement of liver.

A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections?

Epiglottitis

The health care provider suspects a newly admitted client may have a hemothorax. The client most likely experienced:

Fractured or dislocated ribs

The client's ultrasound shows a true aneurysm that involves the entire circumference of the vessel and has a gradual and progressive dilation of the vessel. The provider tells the client the aneurysm is which of the following forms?

Fusiform

A community health nurse is conducting a seminar at a local church group on health and wellness. Which of the following does she tell the group is the leading cause of death in the United States?

Heart disease

A female patient is requiring supplementary oxygen by face mask due to her reduced lung compliance. Which of the following pathophysiological processes is most likely to be a contributor to her low lung compliance?

Her thoracic cage is less flexible than when she was healthy.

A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?

High afterload because of backpressure against the left ventricle.

A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress. Which of the following is the most likely contributor to the infant's present health problem?

High inspired oxygen concentration and injury from positive-pressure ventilation

A young college football player was bought to the emergency room after collapsing on the football field during practice. When arriving he was unconscious and his ECG was abnormal. Subsequently he died after arresting in the emergency room. What does the physician suspect is the likely cause of this?

Hypertrophic cardiomyopathy

An asthmatic patient comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. Which of the following is the most likely cause?

Hyperventilation

A 60-year-old woman is hospitalized after losing an extensive amount of blood in a work-related accident. She tells the nurse that she heard the doctor say that she would keep feeling faint until her brain made more blood. The nurse recognizes that when the woman's blood pressure dropped, the pressure in her carotid arteries decreased. This was detected by baroreceptors in the carotid arteries, with which subsequent effect?

Increased sympathetic stimulation of the heart and blood vessels

The rennin-angiotensin-aldosterone system is a negative feedback system that plays a central role in blood pressure regulation. How does the end result of this feedback loop regulate blood pressure in the body?

Increases salt and water retention by the kidney

The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology?

Inhibition of the renin-angiotensin-aldosterone system

Influenza A subtype H5N1 (avian flu) has been documented in poultry in both East and Southeast Asian Countries. This form of avian flu is highly contagious from bird to bird but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate?

Initiation of a pandemic

The sensation of chest tightness due to an impending asthmatic attack appears to be related to which of the following physiological causes?

Input from lung receptors that monitor bronchial constriction.

A parent brings his child to the emergency department stating that the child became sick very quickly. The nurse observes the child having to sit upright with the mouth open, drooling, lethargic, with inspiratory and expiratory stridor. What action should the nurse perform at this time?

Keep the child calm and decrease anxiety.

The scar tissue that occurs between the layers of the pericardium becomes rigid and constrictive from scar tissue in constrictive pericarditis. What is a physiologic sign of constrictive pericarditis?

Kussmaul sign

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?

Left ventricle

When the semilunar valves open it signals the onset of the ejection period. The aortic pressure reflects changes in the ejection of blood from which part of the heart?

Left ventricle

A nurse is assessing a client for cyanosis. The most appropriate areas for the nurse to assess would be: Select all that apply.

Lips Nails Ears Cheeks

The nurse determines that the capillary pore exchange of a client's gases, nutrients, and/or waste products would be best facilitated by which of the following?

Liver

Which of the following organs has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?

Liver

The physician states that a client has adequate collateral circulation. The nurse interprets this as:

Long-term compensatory regulation of blood flow

The home care nurse is caring for a client who has sustained phrenic nerve damage from a skiing accident. The nurse understands that the client must be on a ventilator for which of the following reasons?

Loss of diaphragmatic function

Increased secretion of renin in heart failure is caused by which of the following events?

Low cardiac output

The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?

Measure his blood pressure and show him how much higher it is when he is smoking.

A nurse educator on a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice?

Measurement of urine output and mental status assessment

The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply.

Mitral Tricuspid

Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone?

Norepinephrine

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?

Obstructive shock

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

Onset of STEMI

A nurse is assessing a client diagnosed with severe mitral valve stenosis. The nurse anticipates the assessment will include:

Orthopnea

A client with heart failure tells the nurse that he is frustrated and is unable to get "a good night's rest." The client relates that he falls asleep and is suddenly awakened and feels as though he is having a hard time breathing and is suffocating. The nurse recognizes this assessment as:

Paroxysmal nocturnal dyspnea

Five hours after presenting to the emergency department with substernal chest pain, a patient's laboratory results demonstrate that troponin I is elevated and the creatine kinase-myoglobin (CK-MB) levels are within normal range. Which of the following is the nurse's interpretation of these results?

Patient is currently experiencing an MI.

The nurse is reviewing the lipid results of four clients. Select the client at greatest risk for cardiovascular disease.

Patient with LDL cholesterol 205 mg/dL, HDL 40 mg/dL, and triglyceride level 150 mg/dL

The nurse working on the cardiac floor identifies which of the following to be the initial treatment of choice for small pericardial effusions and mild cardiac tamponade?

Pericardiocentesis

A 37-year-old woman is admitted to the unit with a differential diagnosis of rule out pheochromocytoma. What are the most common symptoms the nurse would expect this client to exhibit?

Periodic severe headache and marked variability in blood pressure

A patient admitted to the hospital with heart failure tells the nurse he has developed a condition that interferes with movement of blood through sections of the lungs. The nurse recognizes this as which of the following?

Physiologic shunting

A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.

A nurse is using a stethoscope and blood pressure cuff to manually measuring a client's blood pressure. The nurse knows that which of the following facts related to blood flow underlies the ability to hear blood pressure by auscultation (listening)?

Pressure pulsation that exceeds the velocity of blood flow is audible and coincides with systolic BP.

A patient recently had surgery for a hip fracture. Which of the following nursing interventions would be most effective for preventing pulmonary emboli in this patient?

Prevention of the development of a deep vein thrombosis

A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?

Prompt diagnosis of streptococcal infections with a throat culture

Cystic fibrosis (CF) is an autosomal recessive disorder involving the secretion of fluids in specific exocrine glands. The genetic defect in CF inclines a person to chronic respiratory infections from a small group of organisms. Which organisms create chronic infection in a child with cystic fibrosis?

Pseudomonas aeruginosa and Staphylococcus aureus

A nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?

Pulmonary arterial pressure (PAP)

Reviewing pathology for an exam on pulmonary vasculature, the nursing student states that blood enters the right side of the heart via vena cava's, then to the right atrium, right ventricle, and then which vessel carries the deoxygenated blood into the pulmonary system?

Pulmonary artery.

A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:

Pulmonary embolism

The circulatory system is divided into two parts. What does the pulmonary circulation include? Select all that apply.

Pulmonary veins Right Heart Pulmonary Artery

Pulmonary hypertension is usually caused by long-term exposure to hypoxemia. When pulmonary vessels are exposed to hypoxemia, what is their response?

Pulmonary vessels constrict

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement techniques would be:

Pulse oximetry

The management of cor pulmonale is directed at the underlying lung disease and heart failure. Why is low-flow oxygen therapy a part of the management of cor pulmonale?

Reduces pulmonary hypertension and polycythemia associated with chronic lung disease

The nurse is educating the client with a cold about the use of over-the-counter decongestants. What expected outcome does the nurse anticipate with the use of this medication?

Reduction of nasal swelling

In infants and children, secondary hypertension is the most common form of hypertension. What is the most common cause of hypertension in an infant?

Renal artery thrombosis

Which description of symptoms would the nurse expect to obtain from a client with exacerbation of sarcoidosis?

Shortness of breath, non-productive cough, and chest pain

Which of the following is called the pacemaker of the heart?

Sinoatrial (SA) node

A nurse is explaining the conduction system of the heart to a client who is experiencing an arrhythmia. Which would be the most appropriate explanation?

Sinoatrial node (SA), internodal pathways, AV node, AV bundle, Purkinje fibers

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis?

Sputum or bronchial cultures

Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include which of the following?

Stasis of blood, hypercoagulability, vessel wall injury

Which of the following patients is at the greatest risk of developing rheumatic heart disease?

Teenager with untreated strep throat

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the:

Temporal

A group of vascular disorders called vasculitides cause inflammatory injury and necrosis of the blood vessel wall (i.e., vasculitis). These disorders are common pathways for tissue and organ involvement in many different disease conditions. What is the most common of the vasculitides?

Temporal arteritis

A 74-year-old man is being assessed by a nurse as part of a weekly basic health assessment at the long term care facility where he resides. His blood pressure at the time is 148/97 mmHg, with a consequent pulse pressure of 51 mmHg. The nurse would recognize that which of the following is the most significant determinant of the resident's pulse pressure?

The amount of blood that his heart ejects from the left ventricle during each beat

A 23-year-old woman goes to the drugstore to buy a medication to ease the symptoms of her cold. Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breathe. The woman talks with the pharmacist, who has known her many years. The pharmacist recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?

The client has a history of hyperthyroidism.

The nurse is caring for the following clients. Select the client at highest risk for the development of atelectasis.

The client who is postop total knee replacement and receiving client-controlled analgesia

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What medication education will the nurse provide to the client?

The client will need education about the administration of INH and the importance of taking it as prescribed.

Which client will the nurse assess first?

The client with premature ventricular contractions

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.

The incidence increases with age. It is the most common cardiovascular disorder. The systolic pressure is greater than or equal to 140 mm Hg.

An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate?

The infant is using nasal flaring to take in more air.

The circulatory system is a closed system that is divided into two parts. Which statement is correct about the closed system?

The low pressure pulmonary circulation links circulation and gas exchange in the lungs.

A physician is explaining to a group of medical students the concept of Virchow's triad as it applies to venous thrombosis. Which of the following clinical observations of a 50-year-old male client is most likely unrelated to a component of Virchow's triad?

The man has decreased cardiac output and an ejection fraction of 30%.

Which of the following assessment findings of a newly admitted 30-year-old male client would be most likely to cause his physician to suspect polyarteritis nodosa?

The man's blood pressure is 178/102 and he has abnormal liver function tests.

Emergency Medical Technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which of the following phenomena is most likely taking place?

The man's α and β adrenergic receptors have been activated resulting in vasoconstriction and increased heart rate.

The nurse is reviewing the near-drowning client's pulmonary function tests and is concerned that the forced vital capacity (FVC) is decreased. Which of the following accurately describes FVC?

The volume of air exhaled vigorously and quickly after maximum inspiration

The nurse is interviewing a client who has come in for the first round of radiation treatment of a large, right upper lobe lung tumor. The client asks how the tumor could get so large without causing any pain. The most accurate explanation would be which of these?

There are no pain receptors in the lung tissue.

A teenager comes to the emergency room with a history of strep throat and symptoms that lead the staff to suspect rheumatic fever. Which of the following tests can best establish a diagnosis of rheumatic fever?

There is no definitive test for diagnosing RF.

A client is admitted to the hospital suspected to have Legionnaire disease after a cruise. What type of specimen should the nurse collect that is a rapid test to detect the antigens of L. pneumophila?

Urine specimen

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?

Valvular defects usually are detected through cardiac auscultation.

A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following?

Valvular regurgitation

Which of the following statements about vascular compliance is accurate?

Veins can act as a reservoir for storing large quantities of blood.

Blood transports both oxygen and carbon dioxide in a physically dissolved form to the tissues and organs of the body. It is the measurements of the components of the gases in the blood that are used as indicators of the body's status by health care workers. Why is common to measure the blood in the arteries rather than the blood in the veins?

Venous blood measures the metabolic demands of the tissues rather than the gas exchange function of the lungs.

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Venous return to the heart

Which of the following is associated with stasis of blood, increased blood coagulability and vessel wall injury?

Venous thrombosis

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

Ventricular fibrillation

A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?

Ventricular repolarization

Which client is exhibiting manifestations of drug-induced interstitial lung disease? A client taking

amiodarone for dysrhythmias who develops a dry cough.

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 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. • 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.

What are the signs and symptoms of heart failure? (Select all that apply.)

• Fluid retention • Fatigue

A client has many residual health problems related to compromised circulation following recovery from septic shock. The nurse knows that which of the following complications listed below is a result of being diagnosed with septic shock and therefore should be assessed frequently? Select all that apply.

• Profound dyspnea due to acute respiratory distress syndrome. • Atelectasis resulting in injury to endothelial lining of pulmonary vessels which allows fluid/plasma to build up in alveolar spaces. • Acute renal failure due to decreased/impaired renal perfusion as a result of low BP.

Heart failure can have which of the following consequences? Select all that apply.

• Pulmonary congestion • Systemic congestion • Low cardiac output

Circulatory shock is characterized by an inability of the circulatory system to provide adequate oxygen to body tissues. Which of the following damaging effects at the cellular level can cause hypoxia? Select all that apply.

• Pyruvate converted to lactic acid • Cellular edema • Deranged sodium/potassium balance • Impaired cellular production of adenosine triphosphate (ATP)

A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply.

• Respiratory rate—32; pulse rate—122 beats/minute. • "Having a hard time catching my breath." • Using accessory muscles to help him breathe.

Heart failure may be systolic or diastolic dysfunction. Which of the following statements regarding systolic and diastolic dysfunction are correct? Select all that apply.

• Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. • In systolic dysfunction, the ejection fraction is decreased. • In systolic dysfunction, preload increases.

The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply.

• Severe burns • Fifteen percent blood volume loss • Severe dehydration

The nurse knows that which of the following statements regarding sodium and hypertension are correct? Select all that apply.

• Sodium may increase the responsiveness of the cardiovascular system to adrenergic (sympathetic) stimulation. • Reduction in sodium intake often produces a reduction in blood pressure. • In the INTERSALT study, urinary sodium excretion and systolic blood pressure are closely correlated.

In circulatory shock, the adrenergic (or sympathetic) nervous system is activated. The nurse knows that stimulation of beta-2 adrenergic receptors will result in which responses? Select all that apply.

• Vasodilation of the skeletal muscle vascular bed • Dilation of the bronchioles

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.

• Ventricular tachycardia with left bundle branch block pattern. • T-wave inversion in the right precordial leads.

Cardiac output is which of the following per minute? Select all that apply.

• Volume of blood pumped • Heart rate X stroke volume

A parent brings a child into the urgent care clinic. The practitioner suspects the child has a "cold" based on which clinical manifestations? Select all that apply.

• Watery, clear nasal secretions • Coughing • Mild fever

A client was involved in a motor vehicle accident and suffered a severe head injury and blunt abdominal trauma requiring immediate surgery. During the recovery period the client developed pneumonia due to an impaired cough reflex. Which of the following can interfere with the cough reflex? Select all that apply.

• Weak abdominal muscles following abdominal surgery • Prolonged bed rest • Presence of a nasogastric tube • Increase in intracranial pressure on the medulla

Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply.

• Who is 65 years old with chronic asthma • With a smoking history