Quiz #4: Chs 18, 19, 20

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? Select one: A. A cardiac glycoside B. A diuretic C. A β-adrenergic blocker D. An ACE inhibitor

A. A cardiac glycoside

A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? Select one: A. "I've starting going to the gym before work three times a week." B. "I'm resolving to eat organic foods from now on and to drink a lot more water." C. "I'm trying to cut back on the amount of salt that I cook with and add to my food." D. "I'm planning to lose 15 pounds before the end of this year."

B. "I'm resolving to eat organic foods from now on and to drink a lot more water."

The most common causes of left-sided heart failure include: Select one: A. Impaired renal blood flow B. Acute myocardial infarction C. Tricuspid valve regurgitation D. Chronic pulmonary disease

B. Acute myocardial infarction

Which of the following is a nonmodifiable risk factor for the development of primary hypertension? Select one: A. Male gender B. African American race C. Obesity D. High salt intake

B. African American race

A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client? Select one: A. Analgesics and use of a pneumatic compression device B. Anticoagulation therapy and elevation of the leg C. Massage followed by vascular surgery D. Frequent ambulation and the use of compression stockings

B. Anticoagulation therapy and elevation of the leg

Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: Select one: A. Varicosities B. Calf pain C. Strong pulse D. Edema

B. Calf pain

The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? Select one: A. A 87-year-old client admitted with uncontrolled dilated cardiomyopathy B. A 78-year-old client admitted with increasing fatigue related to aortic stenosis C. A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation D. A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade

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

A client 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 client's increased blood pressure? Select one: A. Activation of the renin-angiotensin-aldosterone mechanism B. Increased levels of adrenocortical hormones C. Increased sympathetic stimulation by the autonomic nervous system (ANS) D. Coarctation of the client's aorta

A. Activation of the renin-angiotensin-aldosterone mechanism

Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? Select one: A. C-reactive protein B. Homocysteine C. Leukocytosis D. Serum lipoprotein

A. C-reactive protein

Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: Select one: A. ECG changes B. Pulmonary disease C. Heart murmurs D. Pericardial effusion

A. ECG changes

Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? Select one: A. High-calorie diet B. Diabetes mellitus C. Bile-binding resin D. Cholesterol ingestion

A. High-calorie diet

In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis? Select one: A. Immune-mediated inflammation B. Tissue necrosis C. Necrotizing granulomatous D. Mononuclear cells

A. Immune-mediated inflammation

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: Select one: A. Pulmonary embolism due to development of deep vein thrombosis B. Hypovolemic shock due to acute intravascular volume loss C. Renal failure due to an overdose of medication D. Side effects from versed administration causing excessive vasoconstriction

B. Hypovolemic shock due to acute intravascular volume loss

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? Select one: A. Sympathetic nervous stimulation B. Inhibition of the renin-angiotensin-aldosterone system C. Increased tubular sodium reabsorption D. Water retention

B. Inhibition of the renin-angiotensin-aldosterone system

An elderly female client who reports increasing fatigue has been diagnosed with aortic stenosis, a disease that her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the woman's ejection fraction until recently? Select one: A. Increased blood pressure B. Left ventricular hypertrophy C. Aortic dilation D. Increased heart rate and stroke volume

B. Left ventricular hypertrophy

One of the principal mechanisms by which the heart compensates for increased workload is: Select one: A. Sodium and water retention B. Myocardial hypertrophy C. Ventricular wall tension increase D. Endothelin vasoconstrictors

B. Myocardial hypertrophy

Congenital heart defects can cause a right heart-to-left heart shunting of blood that results in increased: Select one: A. Right ventricle workload B. Unoxygenated blood flow C. Pulmonary blood volume D. Right atrial blood volume

B. Unoxygenated blood flow

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: Select one: A. Increased collateral circulation B. Excessive endothelial relaxing factors C. Fixed coronary obstruction D. Intermittent vessel vasospasms

C. Fixed coronary obstruction

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents: Select one: A. The amount of blood pumped out of the heart with each beat B. The volume of blood stretching the heart muscle at the end of diastole C. The amount of blood the heart pumps each minute D. Strength of the right ventricular pump to move blood

C. The amount of blood the heart pumps each minute

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by: Select one: A. Measuring all of the client's urine output daily to check for a decrease in output B. Take blood pressure daily and call doctor if it is decreased C. Weighing every day at the same time with same type of clothing D. Listening to the breath sound with a stethoscope every morning

C. Weighing every day at the same time with same type of clothing

A client 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 could the nurse best respond to this client's statement? Select one: A. "That's true, but it's an indicator that you're not taking very good care of yourself." B. "You're right, but it's still worthwhile to monitor it in case you do develop problems." C. "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." D. "You may not sense any problems, but it really increases your risk of heart disease and stroke."

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

Which of the following assessment findings would be suggestive of cardiac tamponade? Select one: A. Audible crackles on chest auscultation and presence of frothy sputum Incorrect B. Normal ECG combined with complaints of chest pain and shortness of breath C. Increasing PaCO2 and decreasing PaO2 D. A 20 mm Hg drop in systolic blood pressure during respiration

D. A 20 mm Hg drop in systolic blood pressure during respiration

For which of the following types of shock might intravenous antibiotic therapy be indicated? Select one: A. Obstructive shock B. Hypovolemic shock C. Cardiogenic shock D. Distributive shock

D. Distributive shock

Which of the following lab results strongly suggest an immunologic response in the client with possible rheumatic heart disease? Select one: A. Elevated erythrocyte sedimentation rate (ESR) B. High C-reactive protein levels C. Elevated white blood cell count D. Group A (β-hemolytic) streptococcal antibodies

D. Group A (β-hemolytic) streptococcal antibodies

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death? Select one: A. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) B. Takotsubo cardiomyopathy C. Dilated cardiomyopathy (DCM) D. Hypertrophic cardiomyopathy (HCM)

D. Hypertrophic cardiomyopathy (HCM)

Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: Select one: A. Vessel wall injury B. Red thrombus C. Calcified lesion D. Large lipid core

D. Large lipid core

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? Select one: A. Cor pulmonale B. Pericarditis C. Cardiogenic shock D. Right-sided heart failure

D. Right-sided heart failure

The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? Select one: A. Non-ST-segment elevation MI B. Unstable angina C. ST-segment elevation MI D. Stable angina

D. Stable angina

The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: Select one: A. Ulceration B. Fatty streaks C. Fibrous plaque D. Thrombosis

D. Thrombosis

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: Select one: A. Hyperinflated alveolar sacs B. Excessive surfactant C. Hyperventilation D. Ventilation-perfusion mismatch

D. Ventilation-perfusion mismatch