293 Exam 3 Practice Questions

The main symptom of coronary artery disease is: A. Angina B. Headache C. Breathlessness D. Cerebrovascular accident

A -Rationale: "Angina is a classic sign of coronary artery disease. Patients may report a crushing, squeezing or burning pain in the left side of the chest that radiates down the left arm and sometimes upwards into the neck and jaw - the same type of pain experienced in an MI. The pain is often accompanied by nausea, vomiting, fainting or sweating, although not all patients, especially females, report the classic pain symptoms of angina or MI. Symptoms usually occur after physical exertion or high emotions but can develop during rest or even sleep"

The most recent blood work of a patient with a diagnosis of heart failure indicates elevated levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the patient's physiology? A. Inhibition of the renin-angiotensin-aldosterone system (RAAS) B. Retention of water C. Increased tubular sodium reabsorption D. Stimulation of the sympathetic nervous system (SNS)

A -Rationale: Natriuretic peptides inhibit the SNS and RAAS in addition to decreasing tubular sodium and water reabsorption.

Match the following description to the associated valve disorder: Blood is backflowing from left ventricle (LV) into the left atrium (LA) resulting in backup of blood into the LA causes LA pressures to increase, which can eventually lead to pulmonary edema from the backup of blood from the LA into the pulmonary system. Additionally, end-diastolic volume in the LV is decreased resulting in decreased cardiac output. 1. Mitral valve regurgitation 2. Mitral valve stenosis 3. Tricuspid valve regurgitation 4. Aortic valve stenosis

1. Mitral valve regurgitation

Match the following description to the associated valve disorder: Decreased end-diastolic volume in the left ventricle (LV) from the left atrium (LA) due to decreased return of the blood from the pulmonary system, which leads to increased pressures in the LA decreased cardiac output from the LV 1. Mitral valve regurgitation 2. Mitral valve stenosis 3. Tricuspid valve regurgitation 4. Aortic valve stenosis

2. Mitral valve stenosis

Match the following description to the associated valve disorder: Blood is backflowing from the right ventricle (RV) to the right atrium (RA) resulting in backup of blood into the RA causes RA pressures to increase, which can eventually lead to backup of blood back into the venous system. Additionally, the end-diastolic volume in the RV that is ejected into the lungs is decreased resulting in decreased cardiac output. 1. Mitral valve regurgitation 2. Mitral valve stenosis 3. Tricuspid valve regurgitation 4. Aortic valve stenosis

3. Tricuspid valve regurgitation

Match the following description to the associated valve disorder: The left ventricle (LV) works harder to pump blood out leading to decreased cardiac output, which may lead to LV hypertrophy. LV hypertrophy leads to decreased end-diastolic volume and backup of blood flow through the left-side of the heart. 1. Mitral valve regurgitation 2. Mitral valve stenosis 3. Tricuspid valve regurgitation 4. Aortic valve stenosis

4. Aortic valve stenosis

True/False: If the heart valves become damaged, abnormal murmurs can be heard.

True -Rationale: "The heart valves can be damaged through injury, disease (such as endocarditis or rheumatic fever) although damage is more commonly due to congenital abnormalities. Additional murmurs can be heard as the blood flows forwards through narrowed valves or leaks backwards through incompetent valves. Symptoms associated with aortic valve damage may not present until the damage is quite advanced. They include angina (because the heart is working harder to pump blood away) and dyspnoea, dizziness and fainting (all associated with the obstruction of blood flow from the heart). Abnormal murmurs can usually be detected with a stethoscope and require referral for further investigation"

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -May progress to acute ischemia

Unstable angina

Match the description to the associated type of atherosclerotic plaque: Stable plaque vs. Unstable plaque -High shear stress

Unstable plaque

Match the description to the associated type of atherosclerotic plaque: Stable plaque vs. Unstable plaque -Large lipid core

Unstable plaque

Match the description to the associated type of atherosclerotic plaque: Stable plaque vs. Unstable plaque -Thin fibrous cap

Unstable plaque

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Onset unrelated to obvious causes of increased myocardial oxygen demand

Variant angina (Prinzmetal)

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Responds well to drugs that promote vasodilation for vasospastic vessels

Variant angina (Prinzmetal)

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Unpredictable attacks of anginal pain

Variant angina (Prinzmetal)

Coronary artery disease occurs when: A. The body's glucose supply exceeds demand B. The body's water demand exceeds supply C. The body's oxygen demand exceeds supply. D. The body's oxygen supply exceeds demand.

C -Rationale: "Coronary artery disease (CAD) reduces the supply of oxygen and nutrients to myocardial tissues due to poor coronary blood flow. The most common cause of CAD is atherosclerosis, when fatty, fibrous plaques (atheroma) accumulate. This narrows the inner lining of the walls of arteries supplying the heart, thus reducing the volume of blood that can flow through the vessels. Many of the risk factors associated with CAD are modifiable, so patients can help to reduce their risks of developing CAD or the associated MI, by making minor lifestyle adjustments, such as eating a diet low in saturated fat and taking regular moderate exercise"

A patient has been experiencing increasing fatigue in recent months. The provider orders an echocardiogram, which shows the patient's end-diastolic volume is insufficient. Which of the following parameters is directly decreased by an insufficient end-diastolic volume? A. Cardiac contractility (i.e., inotropy) B. Cardiac conduction C. Preload D. Afterload

C -Rationale: Preload is the volume of blood stretching the heart muscle at the end of diastole and is normally determined mainly by the venous return to the heart. Afterload represents the force that the contracting heart muscle must generate to eject blood from the blood-filled heart (end-systole). Cardiac contractility, or inotropy, is the contractile performance of the heart and not directly related to end-diastolic volume.

The nurse recognizes that smoking tobacco has which of the following effects? SELECT ALL THAT APPLY A. Increases high-density lipoprotein B. Decreases platelet aggregation C. Increases blood pressure and heart rate D. Elevates low-density lipoproteins, cholesterol, and triglycerides E. Injures endothelium

C, D, E -Rationale: Tobacco will increase blood pressure and heart rate, including elevating low-density lipoproteins, cholesterol, and triglycerides. Tobacco is also known to injure endothelium. Tobacco will decrease high-density lipoprotein and increase platelet aggregation.

BP formula

CO x SVR

Which of the following is not a predisposing risk factor for myocardial infarction? A. Diabetes mellitus B. Elevated serum lipid levels C. Hypertension D. Cerebrovascular accident (CVA)

D -Rationale: "A history of CVA is not associated with increased risk of MI. MI is caused by an occlusion (blockage) of a coronary artery, the occlusion can be due to a number of factors such as atherosclerosis, thrombosis, or platelet aggregation (clumping). Many of the predisposing factors for MI or ACS are lifestyle-related and include sedentary lifestyle, high salt diet, obesity, smoking, stress, use of recreational drugs. Non-lifestyle factors include increasing age and a family history of coronary artery disease (CAD)"

What are the differences between myocardial ischemia and myocardial infarction?

Myocardial ischemia is decreased oxygen and blood supply to an area of the myocardium, which is reversible. Myocardial infarction results from prolonged myocardial ischemia that leads to irreversible myocardial cell death (i.e., necrosis).

Increased heart rate

Positive chronotrophic effects

Increased rate of conduction through the AV node of the heart

Positive dromotrophic effects

Increased force of cardiac contraction

Positive inotropic effects

CO formula

SV x HR

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Elicited by similar stimuli

Stable angina

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Most common angina

Stable angina

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Onset is predictable

Stable angina

Match the description to the associated type of angina: Stable angina vs. Unstable angina vs. Variant angina (Prinzmetal) -Relieved by rest and nitroglycerin, a strong vasodilator for both arterial/venous systems

Stable angina

Match the description to the associated type of atherosclerotic plaque: Stable plaque vs. Unstable plaque -more collagen and fibrin

Stable plaque

Match the description to the associated type of atherosclerotic plaque: Stable plaque vs. Unstable plaque -stable cap

Stable plaque

What is stroke volume (SV)?

Stroke volume is the amount of blood pumped from the heart with one contraction.

What is systemic vascular resistance (SVR)?

Systemic vascular resistance is the resistance in the circulatory system that the heart must overcome to pump blood out to the body.

True/False: Cardiovascular disease describes disorders of the heart and its surrounding blood vessels.

True -"Cardiovascular diseases are diseases of the heart or blood vessels (vasculature). However, the term 'cardiovascular disease' is often used to describe diseases of the heart or blood vessels that are caused by atheroma (also known as atherosclerosis or hardening of the arteries). Patches of atheroma are small fatty lumps (or plaques) that develop on the inner, endothelial lining of arteries. Cardiovascular diseases that can be caused by atheroma include angina, MI, CVA and peripheral vascular disease"

True/False: Myocardial infarction (heart attack) is an acute coronary syndrome.

True -Rationale: "Acute coronary syndrome (ACS) is a term used to describe a range of thrombotic coronary artery diseases that cause acute ischaemia of the myocardial muscle tissue, namely unstable angina, ST-elevation MI (STEMI) and non-ST elevation MI (non-STEMI). All of these conditions are described as ACS because they reduce or impede blood flow through one of the coronary arteries causing ischaemia, injury and necrosis (infarction) to the tissue around the heart (see Figure 7.1). STEMI is the most serious ACS event because of the prolonged interruption of blood supply to the heart tissue, usually because the artery is completely occluded (blocked) (see Figure 7.2). A non-STEMI is less severe because the artery is only partly blocked, meaning blood supply is reduced but not completely impeded, therefore only part of the heart muscle being supplied by the affected artery is threatened. The different types of MI are diagnosed based on ECG observations (see Figure 7.3). Signs and symptoms of ACS are similar and are usually diagnosed from a detailed patient (and family) history, physical examination, electrocardiogram (ECG) and serum cardiac marker (enzyme) studies. ACS is a medical emergency and requires immediate hospital admission"

Which of the following can increase capillary hydrostatic pressure? SELECT ALL THAT APPLY A. Hypertension B. Heart failure C. Fluid volume overload D. Increase in serum albumin E. Decrease in serum albumin

A,B,C -Rationale: Hypertension, heart failure, and fluid volume overload all lead to increased capillary hydrostatic pressures in their respective effected capillary beds. For example, pulmonary hypertension increases capillary hydrostatic pressure, which may lead to pulmonary edema. Heart failure capillary hydrostatic pressure in the peripheral venous system as a result of poor heart function and backward flow of blood form the heart. Fluid volume overload increases capillary hydrostatic pressure by increasing the volume in a finite vascular space. Serum albumin, whether increased or decreased, affects oncotic/osmotic pressure.

How do diuretics work in terms of stroke volume? A. Increases stroke volume by decreasing fluid excretion B. Decreases stroke volume by increasing fluid excretion C. Increases stroke volume by increasing fluid excretion D. Decreases stroke volume by decreasing fluid excretion

B -Rationale: Diuretics work by decreasing fluid volume in the body by way of increasing fluid excretion, which will help decrease preload thereby decreasing stroke volume thereby decreasing work of the heart.

A 32-year-old female comes to the emergency department with complaints of a severe headache and photosensitivity (i.e., sensitivity to light) for the past 12 hours. While in the emergency department, she experiences an episode of vomiting. She has a history of cocaine abuse and has been recently diagnosed with hypertension. The nurse anticipates the following may be the cause: A. Hemorrhagic cerebrovascular accident B. Cerebral aneurysm C. Transient ischemic attack D. Ischemic cerebrovascular accident

B -Rationale: Severe headache and photosensitivity is indicative of a cerebral aneurysm, including recent diagnosis of hypertension and past cocaine abuse. Cerebrovascular accident and transient ischemic attack are excluded based on no evidence of other determinant stroke-related signs and symptoms, such as focal neurological deficits or changes in mental status.

Stable angina is caused by intermittent __________. A. decreased stroke volume B. myocardial ischemia C. decreased cardiac output D. atherosclerosis

B -Rationale: Stable angina is caused by intermittent myocardial ischemia, which results from decreased oxygen and blood supply to the heart by diseased coronary arteries that is often associated with atherosclerosis. Intermittent myocardial ischemia can also be caused by vasospasms of the coronary arteries. Stable angina is not caused by intermittent atherosclerosis as atherosclerosis is a chronic disease. Stable angina is also not caused by intermittent decreased stroke volume or cardiac output.

Which of the following would be observed in a patient with worsening mitral valve stenosis? A. Increased cardiac output B. Increased pressure in the left atrium C. Elevated left ventricular end-diastolic pressure D. Increased right ventricle stroke volume

B -Rationale: The increased left atrial pressure eventually is transmitted to the pulmonary venous system, causing pulmonary congestion. As the stenosis worsens, manifestations are related to the elevation in left atrial pressure and pulmonary congestion, such as dyspnea with exertion, decreased cardiac output owing to impaired left ventricular filling, and left atrial enlargement. Increases in left ventricular end-diastolic pressure and stroke volume in the left ventricle occur with aortic regurgitation.

Assessment of an older adult patient reveals the presence of bilateral 4+ pitting edema of the patient's feet and ankles. The patient's pedal pulses are difficult to palpate. Auscultation of the patient's lungs reveals clear air entry to bases. The patient's baseline oxygen saturation level is 93% on room air and vital signs are within reference ranges. What is this patient's most likely health problem? A. Pulmonary edema B. Hypotension C. Chronic venous insufficiency D. Heart failure

D -Rationale: A major effect of heart failure, particularly right-sided heart failure, is the development of significant peripheral edema. Peripheral edema coupled with lower-than-expected oxygen saturation level despite clear lung sounds also leads to a likely cause cardiovascular issue. Pulmonary edema is not inclusive to cardiovascular disease, which would not always result in peripheral edema. Hypotension is not indicated in this presentation.

A nurse is performing patient education with a 72-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis? A. "I'll be sure to take my antihypertensive medications whenever I feel short of breath." B. "I'm going to avoid as much physical activity as I can so that I preserve my strength." C. "I know it's good for me to drink a lot of water, so I'll be sure to do this from now on." D. "I'm trying to think of ways that I can cut down salt from my diet."

D -Rationale: Salt and fluid restrictions are indicated for most patients with heart failure. Antihypertensives will not address shortness of breath. Additionally, cardiac medications are not normally taken in response to an acute symptoms or issues. Patients should be encouraged to maintain, and increase, physical activity within the limits of their condition.

True/False: Stable angina is classified as an acute coronary syndrome.

False -Rationale: "Stable angina is not a symptom of acute coronary syndrome because it is not life-threatening. However, it is an important warning sign of an increased risk of more serious conditions, such as MI or CVA. Unstable angina is a symptom of acute coronary syndrome because symptoms develop rapidly, can persist even at rest, and can last up to 30 minutes. It is much more likely to develop into an MI than stable angina. It can sometimes be relieved by nitrates (such as glyceryl trinitrate (GTN)) which relax and dilate the blood vessels, increasing the blood supply to the heart. However, sometimes angina can be resistant to this treatment. Upon admission to hospital, patients are usually administered anticoagulant medication (such as heparin) to prevent MI. Other drugs can be used to control and reduce risk of acute coronary disease, including betaadrenoceptor blockers (beta-blockers) or angiotensin-converting enzyme (ACE) inhibitors as well as statins to control serum cholesterol levels"

True/False: When the atria distend in heart failure, there is a reflexive decrease in heart rate.

False -Rationale: "When the atria distend, there is a reflexive increase in the heart rate to pump the extra blood returning to the heart in venous return. Atrial distension can occur in heart failure or due to over-transfusion. When there is a sudden reduction in the pressure in the atria, the heartbeat slows. This is called the Bainbridge Reflex and is the cause of the significant bradycardia sometimes seen during spinal anaesthesia. It is best treated by elevating the legs to increase the venous return" (Rogers & Scott, 2011, p. 111).

True/False: All veins have corresponding arteries that run alongside each other.

False -Rationale: "Deep veins have corresponding arteries that are usually located alongside each other; more superficial veins do not have corresponding arteries. At any given time, the majority of blood in the body is being transported through deep veins. Although most veins take blood back to the heart, there is an exception - the hepatic portal vein. Damage to this vein can be dangerous. Blood clotting in the hepatic portal vein can cause portal hypertension which results in a decrease of blood flow to the liver"

True/False: Heart failure occurs as a result of impaired atrial function due to abnormality of the myocardial muscle.

False -Rationale: "Heart failure can occur when ventricular function (usually the left ventricle) is impaired due to cardiac muscle abnormalities. This abnormal muscle prevents the heart from pumping sufficient blood around the body to sustain oxygen and nutrient requirements of the tissues. The main symptom of heart failure is extreme tiredness due to the lack of oxygen getting to muscles and tissues. Other symptoms depend on the side of the heart affected. A left-sided failure will cause dyspnoea (breathlessness) while a right-sided failure can cause oedema in the ankles and legs due to accumulation of excess fluid. Fluid can also accumulate in the liver and stomach. Symptoms associated with failure on either (or both) sides of the heart include dizziness, loss of appetite, nausea and constipation"

How does afterload impact workload on the heart?

Increased afterload describes increased pressure/resistance in the systemic vasculature, which increases the workload on the heart due to forcing the heart to work harder to pump blood out against the increased afterload.

How does increased capillary hydrostatic pressure in the venous system cause edema?

Increased capillary hydrostatic pressure pushes fluid out of the vasculature and into the interstitial space, causing edema.

How does preload impact workload on the heart?

Increased preload leads to more volume returning to the heart, which translates to more volume at the end of diastole. More volume leads to increased pressure and more work for the heart to pump blood out and through the body.